35
85.
A 42-year-old woman comes to the physician for a routine examination. She says that she has felt well except for occasional
episodes of constipation, abdominal discomfort, and mild fatigue. She was treated for a renal calculus 10 years ago and was
told she had a "lazy gallbladder." Her pulse is 82/min, and blood pressure is 150/80 mm Hg. Physical examination shows no
other abnormalities. Laboratory studies show:
Erythrocyte count
3 million/mm
3
Serum
K
+
4.5 mEq/L
Cl
–
107 mEq/L
Ca
2+
12 mg/dL
Phosphorus
2.2 mg/dL
Alkaline phosphatase
95 U/L
The most likely cause of this patient's condition is a small, well-defined nodule in which of the following locations?
(A) Adrenal gland
(B) Anterior pituitary gland
(C) Gallbladder
(D) Kidney
(E) Parathyroid gland
(F) Thymus
86.
A new severe respiratory illness caused by a newly identified virus is discovered. Which of the following properties of a
killed vaccine relative to a live vaccine is the most appropriate rationale for developing a killed vaccine for this illness?
(A) Avoids the concern for reversion to virulence
(B) Develops more rapid protective immunity
(C) Is less likely to require subsequent boosters for lifelong immunity
(D) Is most likely to generate mucosal immunity
(E) Requires little safety monitoring to ensure inactivation
87.
A 72-year-old woman comes to the physician because of a 3-day history of fever, shortness of breath, difficulty swallowing,
chest pain, and cough. She is frail. Physical examination shows tachypnea and equal pulses bilaterally. Percussion of the
chest shows dullness over the right lower lung field. Laboratory studies show arterial hypoxemia and decreased P
CO
2
. A chest
x-ray shows an area of opacification in the lower region of the right lung. Which of the following is the most likely cause of
this patient's condition?
(A) Alveolar proteinosis
(B) Aspiration
(C) Cigarette smoking
(D) Emphysema
(E) Vasculitis
88.
A 25-year-old woman comes to the office because of a 6-month history of increasingly severe low back pain and heavy
menses. Her temperature is 37.1°C (98.8°F), pulse is 75/min, respirations are 13/min, and blood pressure is 115/79 mm Hg.
Physical examination shows no abnormalities. An endometrial biopsy specimen shows regular tubular endometrial glands
with abundant mitotic figures in the endometrial glands and stroma. Which of the following proteins or enzymes regulate the
progression of cells into this phase of this patient's menstrual cycle?
(A) AMP-dependent kinases
(B) Cyclin-dependent kinases
(C) Hexokinases
(D) Lipid kinases
(E) Urokinases
36
89.
A 72-year-old woman is brought to the emergency department by her husband because of a 1-hour history of difficulty
walking and speaking. The husband says that she was well last night but when she awoke this morning, she had difficult y
getting out of bed and her speech was slurred. She has a 20-year history of type 2 diabetes mellitus well controlled with
medication and diet. She is alert and oriented and is able to follow commands and respond verbally, but she has impaired
speech. Her pulse is 80/min, respirations are 16/min, and blood pressure is 142/88 mm Hg. Physical examination shows left-
sided hemiparesis. The tongue deviates to the right when protruded. Sensation to pinprick and temperature is normal, and
proprioception and sensation to light touch are absent over the left upper and lower extremities. Which of the following
labeled sites in the photograph of a cross section of a normal brain stem is most likely damaged in this patient?
90.
A 4-year-old boy is brought to the physician because of slow growth during the past year. He has had recurrent urinary tract
infections since the age of 1 year. He is at the 10th percentile for height and 25th percentile for weight. Physical examination
shows pallor. Laboratory studies show a normochromic, normocytic anemia and increased serum concentrations of urea
nitrogen and creatinine. Urinalysis shows a low specific gravity. Which of the following sets of additional serum findings is
most likely in this patient?
Calcium
Inorganic Phosphorus
1,25-Dihydroxycholecalciferol
Erythropoietin
(A)
↑
↑
↑
↓
(B)
↑
↑
↓
↓
(C)
↑
↓
↓
↑
(D)
↓
↑
↑
↓
(E)
↓
↑
↓
↓
(F)
↓
↓
↑
↑