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100.
A 35-year-old woman comes to the office because of a 3-day history of severe right back pain. She has not had any fever,
chills, or weight loss. She has no history of major medical illness. Musculoskeletal and neurologic examinations show no
abnormalities. When told that her examination is normal, the patient becomes tearful and demands an MRI of her back
because her mother just died from breast cancer metastatic to bone and she fears that she may also have cancer. The patient
already contacted her insurance company, who told her that if she has neurologic abnormalities an MRI may be covered by
her plan. The patient asks the physician to order the MRI indicating that she has neurologic findings. Which of the following
is the most appropriate initial action by the physician?
(A) Advise the patient to change insurance companies as soon as she is able so that she can receive more comprehensive
medical care
(B) Explain that the patient does not need the MRI and that it is not appropriate to misrepresent her examination findings
(C) Immediately inform the patient's insurance company about what the patient has asked the physician to do
(D) Order the MRI as the patient requests
(E) Recommend that the patient pay for the MRI out-of-pocket in order to ease her worry
101.
A 6-day-old breast-fed boy is brought to the emergency department by his mother because of poor weight gain and irritability
since delivery, and a 2-hour history of vomiting. Physical examination shows jaundice and hepatomegaly. A reducing
substance test result of the urine is positive, and a glucose oxidase test result is negative. The concentration of which of the
following metabolites in liver is most likely increased in this patient?
(A) Fructose 1,6-bisphosphate
(B) Galactose 1-phosphate
(C) Glucose 1-phosphate
(D) Glucose 6-phosphate
102.
A 14-year-old boy is brought to the physician because of a 2-day history of a sore throat and fever that peaks in the late
afternoon. He also has a 1-week history of progressive fatigue. He recently began having unprotected sexual intercourse with
one partner. He appears ill. His temperature is 39°C (102.2°F). Physical examination shows cervical lymphadenopathy and
pharyngeal erythema with a creamy exudate. Which of the following is the most likely diagnosis?
(A) Candidiasis
(B) Herpangina
(C) Infectious mononucleosis
(D) Mumps
(E) Syphilis
103.
In a cohort study of elderly women, the relative risk ratio for hip fractures among those who exercise regularly is 1.2
(95% confidence interval of 1.1 to 1.8). Which of the following is the most appropriate conclusion about the effect of regular
exercise on the risk for hip fracture?
(A) Statistically nonsignificant increase in risk
(B) Statistically nonsignificant
overall decrease in risk
(C) Statistically significant overall decrease in risk
(D) Statistically significant overall increase in risk
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104.
A 12-year-old boy is brought to the physician by his mother because of a 1-month history of pain below the left knee. His
mother says, "He can usually walk around, but he hasn't been able to play in any of his soccer games since this all began."
Examination of the left knee shows warmth, swelling, and tenderness. An x-ray of the knee is shown. Which of the following
structures is attached to the abnormal anterior tibial area?
(A) Anterior cruciate ligament
(B) Gastrocnemius muscle
(C) Patellar ligament
(D) Popliteus muscle
(E) Posterior cruciate ligament
(F) Soleus muscle
105.
A 22-year-old woman comes to the office because of a 3-day history of cold symptoms and a 1-week history of progressive
fatigue. Six weeks ago, she received a kidney transplant from a living, related donor. Immediately after the operation, she
received monoclonal anti-CD3 therapy. Current medications are azathioprine, cyclosporine, and prednisone. Her temperature
is 39°C (102.2°F). Physical examination shows a well-healed surgical scar. Serum studies show that her urea nitrogen and
creatinine concentrations have tripled. A diagnosis of allograft rejection is suspected. In addition, this patient's clinical
presentation is best explained by an infection with which of the following agents?
(A) Adenovirus
(B) BK virus
(C) Epstein-Barr virus
(D) Herpes simplex virus
(E) Varicella-zoster virus
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106.
A new test to detect the presence of malarial antibodies by ELISA is evaluated in 100 patients with active untreated malaria
proven by demonstration of blood-borne parasites and in 100 patients with no history of infection. Results of testing are
shown:
Malaria
Present
Absent
ELISA Test Results
Positive
75
5
80
Negative
25
95
120
100
100
200
Which of the following is the specificity of this test?
(A) 65%
(B) 71%
(C) 75%
(D) 94%
(E) 95%
107.
A 30-year-old woman comes to the physician because of a 2-day history of abdominal pain. She has a history of recurrent
upper respiratory tract infections, sinusitis, and pancreatitis. She has thick nasal secretions. She says that her sweat is salty
and crystallizes on her skin. Her vital signs are within normal limits. Physical examination shows epigastric tenderness.
Genetic testing for the 36 most common mutations shows a detectable mutation (G551D) in one allele of the CFTR gene.
Which of the following best explains this patient's clinical phenotype?
(A) Loss of heterozygosity of the CFTR gene has occurred in the pancreas
(B) Only one G551D allele is needed in
CFTR
(C) The patient is a CFTR obligate carrier
(D) The patient's CFTR mutation is unrelated to her clinical phenotype
(E) The second CFTR mutation was not detected by the testing obtained
108.
A 52-year-old man is brought to the emergency department 30 minutes after he had an episode of chest pain radiating to his
jaw while shoveling snow. His pulse is 80/min, and blood pressure is 130/70 mm Hg. The lungs are clear to auscultation.
Cardiac examination shows an S
4
. While undergoing an ECG, the patient says that he feels the chest pain returning. The most
appropriate immediate treatment is a drug with which of the following mechanisms of action?
(A) Increases cAMP concentration
(B) Increases nitric oxide concentration
(C) Inhibits potassium flux
(D) Inhibits sodium flux
109.
A technician wants to determine whether cytomegalovirus (CMV) DNA is present in the blood of a bone marrow transplant
recipient. DNA purified from the leukocytes of the patient is reacted in a mixture containing oligonucleotides specific for
CMV DNA, thermostable DNA polymerase, and nucleotides. Repetitive cycles of heating and cooling are performed, and the
reaction product is detected by gel electrophoresis. The technician most likely used which of the following laboratory
procedures on this patient's blood?
(A) Northern blotting
(B) Polymerase chain reaction
(C) Reverse transcription
(D) Southern blotting
(E) Western blotting