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A 58-year-old woman with a past medical history of congenital atrial septal defect is brought to the emergency department with complaints of bilateral lower extremity edema of 2 weeks duration. Cardiac examination is remarkable for a loud S1 with an opening snap, a wide, fixed-split pulmonary S2, and a III/VI mid-diastolic rumble with pre-systolic accentuation. Also, An ECG demonstrates a right bundle branch block with evidence of left atrial enlargement. What is the most likely diagnosis of this patient? +
The innate immune system includes a variety of cell types that act as a primary response to infection. One major player in the innate immune system harbors a key protective component known as major basic protein and is induced to proliferate in the presence of IL-5. Which of the following cellular functions also correlates with the cell described above? +
A 4-year-old boy is brought to the pediatrics outpatient clinic for a 4-week history of pallor and excessive sleepiness. His mother reports normal development and feeding habits. Physical examination is significant for splenomegaly and marked pallor. Work-up is remarkable for a hemoglobin level of 8.8 g/dL with hypochromia and microcytosis. Futher testing reveals a mutation in the ''ALAS2'' gene. What is the most appropriate strategy for the chronic management of this patient? +
A 36-year-old woman presents to the physician's office with complaints of chronic fatigue and decreased exercise tolerance. She explains that over the past 4 months, these symptoms have became increasingly intolerable. Upon physical examination, the physician notes a mild splenomegaly. The results from the ordered lab tests are illustrated below. The patient's diagnosis is then confirmed and chemotherapy is initiated. What is the mechanism of action of the drug most likely administered to this patient?
Hb = 9.0 g/dL<br>
Hct = 27.2 %<br>
MCV = 82 fL<br>
Plt = 120 x 10<sup>9</sup>/L<br>
WBCs = 56000 / mm<sup>3</sup><br>
%Neutrophils = 96 %<br>
%Lymphocytes = 2 %<br>
Vitamin B12 level: Elevated<br>
Leukocyte alkaline phosphatase: Low +
A 62-year-old man presents to the physician's office with worsening pruritus for the past 3 months. He reports that his pruritus becomes much worse following a hot shower. On review of systems, the patient also complains of recurrent headaches for the past few weeks. His temperature is 37.1 °C (98.8 °F), blood pressure is 165/92 mmHg, and heart rate is 88/min. Physical examination is remarkable for facial plethora, engorged conjunctival veins, and splenomegaly palpated 3 cm below costal margin. Further investigation reveals hemoglobin of 18.8 g/dL and undetectable serum erythropoietin levels. The physician suspects a genetic disorder and confirms the diagnosis with genetic testing. Which of the following receptor types is most likely involved in this patient's condition? +
A 4-year-old girl is brought to her pediatrician's office for right ear pain and chills for the past 2 days. Physical examination is remarkable for a fever of 38.7 °C (101.6 °F) and a bulging right tympanic membrane. She is diagnosed with acute otitis media and is prescribed a course of antibiotics. In addition, the patient is also prescribed acetaminophen to reduce her temperature. Which of the following inflammatory mediators is involved in the patient’s fever? +
A 7-year-old boy is brought to the emergency department for several hours of unremitting cough. The mother mentions that this is not the first occurrence, as he has been having severe coughing fits at night and following gym class for several weeks now. Physical examination reveals significant wheezing and decreased air entry bilaterally. Expression of which of the following mediators is likely to be elevated in this patient? +
A 33-year-old woman presents to the physician's office for complaints of chronic fatigue. She explains that she was highly active until a few months ago when she began to get excessively tired and sleepy. The patient reports that she is also sad that she has been gaining weight. Review of systems reveals chronic constipation and cold intolerance. Which of the following mechanisms is most likely involved in the patient’s condition? +
A 27-year-old newly graduated nurse is applying for a job at a hospital. As part of her pre-employment screening tests, she has to submit a copy of her vaccination history and undergo a PPD test to screen for tuberculosis. She is administered 0.1 mL of 5 tuberculin units intradermal injection and is asked to return 48 hours later. Upon re-evaluation, the physician notices a 12 mm induration at the site of injection. Which of the following mechanisms is most likely responsible for this finding? +
A 52-year-old woman presents to her primary care physician after noticing a firm lump in her right breast. She undergoes fine needle aspiration of the mass, which reveals a grade 3 invasive ductal carcinoma with overexpression of the HER2/Neu oncogene. Following surgical resection of the mass and axillary lymph node dissection, the patient undergoes breast reconstructive surgery. Two weeks after her surgery, she starts noticing a bony protrusion in her back everytime she lifts her right arm. Which of the following is the most likely origin of the injured nerve in this patient? +
A 45-year-old female scientist presents to her primary care physician because of pain and tingling in his right hand. Upon further questioning, the patient reports that the pain is worse at night. Over the past 3 months, the patient has hurried to submit two R01 applications and has been working often at his keyboard. When the skin overlying the patient’s right wrist is tapped lightly, the patient reports a feeling of “pins and needles” in his thumb and the index finger, middle finger, and lateral half of the ring finger on the dorsum of the right hand. The affected nerve courses between which two muscle groups in the forearm? +
An epidemiologist is studying the prevalence and mortality of cancer among American patients older than 40 years of age. After collecting his data, he adjusts his mortality estimates for gender and age at diagnosis. Assuming his sample is representative of the general population, which of the following cancers would be responsible for the most deaths per year? +
A pharmacologist is investigating the complex metabolism of several neuropsychiatric drugs. In one of his experiments, he administers a 20 mg intravenous (IV) bolus of phenytoin to 30 mice. He then measures the plasma concentrations of phenytoin at 5 minutes after administration, and at 2, 4, and 6 hours. Which of the following statements is true regarding the elimination of this drug? +
A 66-year-old man presents to the cardiology clinic with complaints of constipation, decreased libido and excessive hair loss. He has a three year history of atrial fibrillation that is well controlled on medical therapy. Physical examination demonstrates dry, coarse skin with a distinct bluish-grey discoloration of the nose, cheeks, and lips. Which of the following electrophysiological changes is characteristic of the drug most likely to be used in this case? +
A 7-year-old boy is brought to the pediatrics clinic for fever of 39 °C (102.2 °F), cough, and wheezing for the past week. Over the last 24 hours, the child has developed nausea, vomiting, and watery diarrhea. The child's past medical history is significant for neurofibromatosis, asthma, and seizure disorder. He is currently taking daily albuterol and valproic acid. His mother explains that she was diagnosed with insulin-dependent diabetes mellitus at his age and fears he may have developed it too. On physical examination, you note a lethargic and ill-appearing boy. His heart rate is 96/min, blood pressure is 124/84 mm Hg, temperature is 36.8°C (98.2°F), and respiratory rate is 28/min. You decide to admit the child for evaluation and monitoring. Over the next two days, the patient has recurrent episodes of hypoglycemia, with fingerstick glucose levels as low as 33 mg/dL. Both episodes occur at night, with the mother alerting the nurses each time. Further investigation reveals a serum insulin level of 2344 µU/mL (5–25 µU/mL) and a C-peptide level of 0.7 ng/mL (0.8–4.0 ng/mL). What is the most likely diagnosis in this patient? +
A 58-year-old woman presents to the dermatology clinic for vaginal irritation. She reports a long history of recurrent pruritus and vulvar tenderness. The patient explains that she has been to her gynecologist several times but the antifungal creams he has prescribed have not helped. She denies any vaginal bleeding or discharge. She reports having significant dyspareunia particularly in the past 2 months. Physical examination reveals a raised ivory-white plaque on the vulva with excoriations adjacent to and overlying the lesion. What is the most likely diagnosis in this patient? +
A 60-year-old man presents to the outpatient clinic with complaints of increased urinary frequency and difficulty initiating urination. He was diagnosed with hypertension 10 years ago, and is maintained on amlodipine. His heart rate is 67/min, blood pressure is 135/85 mmHg, and temperature is 37.0 °C (98.6 °F). His physical exam is unremarkable except for a hard nodule palpated on digital rectal examination. The physician orders a prostate-specific antigen (PSA) assay that reveals an elevated concentration at 22 ng/mL. Which of the following is true about the patient's most likely diagnosis? +
A 2-year-old girl is brought to the pediatrician because her mother is concerned that her teeth have turned a dark shade of gray since her last check-up. The mother explains that her daughter has been developing normally, but she recently started refusing formula. She also reports that approximately 2 months ago, the child had an episode of cough and sore throat for which she gave her some left-over antibiotics she had at home. Physical exam is unremarkable except for annular gray-brown stains apparent mostly across the front teeth. Which of the following was most likely mechanism of action of the drug used in this patient? +
A 31-year-old man presents to the dermatology clinic for hair loss. The patient reports progressive hairline regression and hair loss mainly localized above the temples and at the vertex. He also explains that he has a strong family history of androgenetic alopecia, and cannot stand the idea of going completely bald. The patient has tried many topical products intended for hair loss, which have not been very helpful. You consider using an agent that is also approved for the treatment of benign prostatic hyperplasia. Which of the following is the most likely mechanism of action of this drug? +
A pharmacist is planning a study with mice in order to determine the effects of a novel drug called “Compound A572”. He knows that the drug is supposed to work in the hypothalamus, to regulate the release of different pituitary hormones. He measures serum concentration of hypothalamic hormones and determines that the drug causes different changes in FSH and LH if dosed continuously or in a pulsatile fashion. Which of the following drugs has a similar mechanism of action as “Compound A572”? +