37
91.
A 42-year-old woman is brought to the emergency department because of double vision that began 20 minutes after she fell
from her horse and landed on the left side of her face. Examination of the face shows ecchymoses over the left zygomatic
arch. A CT scan of the head is shown. Which of the following arteries is at greatest risk for injury in this patient?
(A) Facial
(B) Frontal
(C) Infraorbital
(D) Lacrimal
(E) Ophthalmic
92.
A previously healthy 24-year-old woman who is a college student comes to the office because of a 6-month history of
abdominal bloating, upper abdominal discomfort, and constipation. The symptoms are more severe when she is preparing for
examinations but improve after bowel movements. She takes no medications. She does not smoke or use illicit drugs. She
drinks alcoholic beverages occasionally. She is 160 cm (5 ft 3 in) tall and weighs 57 kg (125 lb); BMI is 22 kg/m
2
. Her pulse
is 72/min, and blood pressure is 100/72 mm Hg. Physical examination, including digital rectal examination, shows no other
abnormalities. A complete blood count and serum electrolyte concentrations are within the reference ranges. A urease breath
test result is negative. Upper and lower endoscopies show no abnormalities. Which of the following is the most appropriate
pharmacotherapy for this patient?
(A) Azathioprine
(B) Infliximab
(C) Lubiprostone
(D) Mesalamine
(E) Sulfasalazine
93.
A 32-year-old man is brought to the emergency department 30 minutes after being struck by a car while driving his
motorcycle. He reports severe pelvic pain. On examination, there is bruising of the perineum and pain is elicited with motion
of his pelvis. Blood is noted at the urethral meatus. There is no other penile trauma. A plain x-ray shows a fracture of the
superior pubic ramus and retrograde urethrography is done to evaluate for a urethral disruption. Which of the following
portions of the urethra would be at greatest risk for injury in this patient?
(A) Intramural (pre-prostatic)
(B) Membranous
(C) Prostatic
(D) Spongy
38
94.
A 2-year-old boy is brought to the office by his mother because of a 1-day history of severe pain, swelling, and redness of his
left thumb. The mother does not recall any trauma to the area. She says he has been eating poorly during this period, but
otherwise he has been behaving normally. He has no history of major medical illness and receives no medications. He
appears tearful. He is at the 90th percentile for length and 80th percentile for weight. His temperature is 37.7°C (99.8°F),
pulse is 100/min, respirations are 20/min, and blood pressure is 100/50 mm Hg. Physical examination shows an oral vesicle,
cervical lymphadenopathy, and the findings in the photograph. Which of the following types of infectious agents is the most
likely cause of the findings in this patient’s finger?
(A) DNA virus
(B) Gram-negative bacterium
(C) Gram-positive bacterium
(D) RNA virus
(E) Yeast
95.
A 46-year-old woman with active ankylosing spondylitis comes to the office for a follow-up examination. The use of various
conventional nonsteroidal anti-inflammatory drugs has been ineffective. Sulfasalazine treatment also has not resulted in
improvement. The most appropriate next step in treatment is administration of a drug that inhibits which of the following?
(A) CD20
(B) Cyclooxygenase-2
(C) Cytotoxic T-lymphocyte antigen 4
(D) Epidermal growth factor
(E) Interleukin-1 (IL-1)
(F) Tumor necrosis factor α
96.
During a study of renal glomeruli, a healthy animal kidney is kept in a vascular bath preparation at a constant afferent arterial
pressure of 100 mm Hg. If the efferent arteriole is constricted with a vascular clamp, which of the following Starling forces is
most likely to change in the glomeruli?
(A) Decreased filtration coefficient (K
f
)
(B) Decreased hydrostatic pressure
(C) Decreased oncotic pressure
(D) Increased hydrostatic pressure
(E) Increased oncotic pressure
39
97.
A 67-year-old woman is brought to the emergency department 30 minutes after she had a generalized tonic-clonic seizure.
Her family says that she seemed mildly confused before her eyes rolled backward and she had the onset of uncontrollable
jerking movements of her arms and legs and loss of consciousness. During the seizure, she passed urine and bit her tongue.
At the scene, her vital signs were within normal limits. She has a 6-month history of a 7-kg (15-lb) weight loss despite no
changes in appetite. She received the diagnosis of small cell carcinoma of the lung last week and has not begun treatment.
She has hypertension well controlled with lisinopril. On arrival, she is awake but does not respond to verbal stimuli. She is
not in distress. Her temperature is 37°C (98.6°F), pulse is 70/min, and blood pressure is 130/88 mm Hg while supine.
Examination shows no abnormalities. Laboratory studies show:
Serum
Na
+
115 mEq/L
K
+
4 mEq/L
Cl
−
81 mEq/L
HCO
3
−
25 mEq/L
Urea nitrogen
9 mg/dL
Glucose
102 mg/dL
Creatinine
0.6 mg/dL
Urine
Sodium
60 mEq/L
Potassium
20 mEq/L
Osmolality
900 mOsmol/kg H
2
O
Which of the following is the most likely diagnosis?
(A) Adrenal insufficiency
(B) Diuretic abuse
(C) Heart failure
(D) Syndrome of inappropriate secretion of ADH (vasopressin)
(E) Water intoxication
98.
A 23-year-old woman comes to the physician for genetic counseling prior to conception. Her brother and maternal uncle had
Duchenne muscular dystrophy (DMD) and died at the ages of 28 and 17 years, respectively. Genetic analysis was not
performed on either relative prior to death. Serum studies show a muscle creatine kinase concentration of 120 U/L (N=22–
198). The patient's 50-year-old mother has a serum muscle creatine kinase concentration of 300 U/L. Which of the following
is the most appropriate assessment of this patient's carrier status for this disease?
(A) The patient has a 50% risk for developing DMD
(B) The patient has a 50% risk of having a child with DMD
(C) The patient is a carrier of the disease based on her family history of DMD
(D) The patient is not a carrier of the DMD based on her normal creatine kinase concentration
(E) The patient's DMD carrier status is uncertain because of random X inactivation
99.
A randomized controlled trial is conducted to assess the risk for development of gastrointestinal adverse effects using
azithromycin compared with erythromycin in the treatment of pertussis in children. Of the 100 children with pertussis
enrolled, 50 receive azithromycin, and 50 receive erythromycin. Results show vomiting among 5 patients in the azithromycin
group, compared with 15 patients in the erythromycin group. Which of the following best represents the absolute risk
reduction for vomiting among patients in the azithromycin group?
(A) 0.1
(B) 0.2
(C) 0.33
(D) 0.67
(E) 0.8