1. A 3-year-old girl is brought to the physician by her mother because of a 2-day history of cough and runny nose. She attends a day-care center. The mother says that the patient’s appetite and activity levels are only mildly decreased and that she sleeps through the night. Her temperature is 37.8C (100 F) pulse is 100/min, and respirations are 19/min. Physical examination shows mildly injected conjunctivae, clear nasal discharge, and mild pharyngitis. A throat culture grows viridans streptococci. A heterophile antibody titer is negative. Which of the following is most likely the diagnosis? A. Common Cold B. Infectious mononucleosis c. croup d. pertussis
1. A 3-year-old girl is brought to the physician by her mother because of a 2-day history of cough and runny nose. She attends a day-care center. The mother says that the patient’s appetite and activity levels are only mildly decreased and that she sleeps through the night. Her temperature is 37.8C (100 F) pulse is 100/min, and respirations are 19/min. Physical examination shows mildly injected conjunctivae, clear nasal discharge, and mild pharyngitis. A throat culture grows viridans streptococci. A heterophile antibody titer is negative. Which of the following is most likely the diagnosis?
A. Common Cold
B. Infectious mononucleosis
c. croup
d. pertussis
e. streptococcal pharyngitis
2. A 33-year-old woman comes to the physician’s office because of increasing fatigue and shortness of breath over the past 2 years. She has also noted chest pressure with exertion and recently almost fainted while walking. Examination shows increased jugular venous distention, a right ventricular heave, accentuation of the pulmonic component of S2, and peripheral edema. Mean pulmonary pressure is 50 mmHg at rest. Which of the following findings is the most likely underlying abnormality?
A. Atrophy of vascular smooth muscle cells
B. Decreased blood homocysteine concentration C. Defect in leukocyte function
D. Dysfunction of vascular endothelium
E. Factor 7 (proconvertin) deficiency
3. An 18-year-old man has had the insidious onset of shortness of breath over the past 2 years. Examination shows jugular venous distention and lateral displacement of the apical impulse. Echocardiography shows biventricular dilation; wall thickness is normal. Histologic examination of tissue obtained on an endomyocardial biopsy shows nonspecific changes. Two months later he has a stroke and dies. Which of the following cardiovascular findings at an autopsy is most likely to determine the cause of the stroke?
A. Carotid atherosclerosis
B. Deep venous thrombosis
C. Infectiveendocarditis
D. Nonbacterial thrombotic endocarditis
E. Ventricular mural thrombus
4. A 65-year-old man has been successfully treated for ventricular tachycardia develops progressive dyspnea and a nonproductive cough. X-ray of the chest shows a diffuse interstitial infiltrate. Which of the following is the most likely causal antiarrhythmic drug?
A. Amiodarone
B. Flecainide
C. Phenytoin
D. Propranolol
E. Verapamil
5. A 72-year-old man has mild congestive heart failure. An ECG shows normal findings. Before starting therapy, serum concentrations of electrolytes, magnesium, and calcium are within the reference ranges. After 1 week of furosemide therapy, he has palpitations. An ECG shows multifocal premature ventricular contractions. Which of the following is the most likely cause of the ECG finding?
A. Hyperammonemia B. Hyperphosphatemia C. Hypocalcemia D. Hypokalemia
E. Hypomagnesemia F. Hyponatremia G. Hypoxia
6. A 68-year-old woman with congested heart failure is brought to the emergency department because of a 5-day history of shortness of breath and swollen legs. Her respirations are 30/min and labored. Physical examination shows 2+ edema of the lower extremities. An increase of which of the following best explains the patient’s edema?
A. Interstitial colloid osmotic pressure B. Lymph flow
C. Plasma colloid osmotic pressure
D. Right atrial pressure
E. Stroke volume
7. Two days after undergoing an abdominal hysterectomy, a 40-year-old womman has shortness of breath while walking. She appears apprehensive and has a low-grade fever, tachycardia, and tachypnea. Lungs are clear on auscultation. An x-ray of the chest shows no abnormalities. Which of the following is the most likely diagnosis?
A. Aspiration pneumonia
B. Asthma
C. Atelectasis
D. Nosocomial pneumonia
E. Pulmonary emboli
8. In the influenza pandemic of 1957, a strain of influenza virus was isolated from numerous patients living in broad geographic area. These patients were found to have no protective immunity against this strain despite previous exposure to influenza virus. Which of the following genetic events most likely contributed to the spread of influenza in these patients?
A. Accumulation of point mutations involiving the hemagglutinin gene
B. Accumulation of point mutations involving mucleocapsid gene
C. Frame-shift mutation involving the hemagglutinin gene
D. Frame-shift mutation involving the nucleocapsid gene
9. The diagram shows the major determinants of blood pressure. Which of the following labeled factors is most responsibility for the antihypertensive effect of calcium channel inhibitors?
A. Blood volume
B. Heart rate
c. peripheral resistance
d. myocardial contractility
E. Capacitance vessel tone
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