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61.
A 54-year-old man comes to the physician for a follow-up examination 10 days after undergoing a stereotactic brain
operation to remove a small tumor. The operation was successful. During the procedure, he was under conscious sedation.
The patient recalls that at one point during the operation he experienced a sudden, intense feeling of overwhelming fear.
Which of the following areas of the brain was most likely stimulated at that time?
(A) Amygdala
(B) Hippocampus
(C) Mammillary body
(D) Prefrontal cortex
(E) Thalamus
62.
A placebo-controlled clinical trial is conducted to assess whether a new antihypertensive drug is more effective than standard
therapy. A total of 5000 patients with essential hypertension are enrolled and randomly assigned to one of two groups: 2500
patients receive the new drug and 2500 patients receive placebo. If the alpha is set at 0.01 instead of 0.05, which of the
following is the most likely result?
(A) Significant findings can be reported with greater confidence
(B) The study will have more power
(C) There is a decreased likelihood of a Type II error
(D) There is an increased likelihood of statistically significant findings
(E) There is an increased likelihood of a Type I error
63.
A male stillborn is delivered at 32 weeks' gestation to a 30-year-old woman. The pregnancy was complicated by
oligohydramnios. Examination of the stillborn shows the absence of a urethral opening. Which of the following additional
findings is most likely in this stillborn?
(A) Congenital diaphragmatic hernia
(B) Intralobar sequestration
(C) Pulmonary hypoplasia
(D) Situs inversus
(E) Tracheoesophageal fistula
64.
A 33-year-old man undergoes a radical thyroidectomy for thyroid cancer. During the operation, moderate hemorrhaging
requires ligation of several vessels in the left side of the neck. Postoperatively, serum studies show a calcium concentration of
7.5 mg/dL, albumin concentration of 4 g/dL, and parathyroid hormone concentration of 200 pg/mL. Damage to which of the
following vessels caused the findings in this patient?
(A) Branch of the costocervical trunk
(B) Branch of the external carotid artery
(C) Branch of the thyrocervical trunk
(D) Tributary of the internal jugular vein
(E) Tributary of the left brachiocephalic vein
(F) Tributary of the right brachiocephalic vein
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65.
A 42-year-old man comes to the physician for a follow-up examination 1 week after he passed a renal calculus. X-ray
crystallographic analysis of the calculus showed calcium as the primary cation. Physical examination today shows no
abnormalities. A 24-hour collection of urine shows increased calcium excretion. Which of the following is the most
appropriate pharmacotherapy?
(A) Carbonic anhydrase inhibitor
(B) Na
+
–Cl
−
symport inhibitor
(C) Na
+
–K
+
–2Cl
−
symport inhibitor
(D) Osmotic diuretic
(E) Renal epithelial sodium channel inhibitor
66.
A 55-year-old man comes to the physician because of a 2-week history of recurrent, widespread blister formation. Physical
examination shows lesions that are most numerous in the flexural areas including the axillae and groin. The blisters do not
break easily, and there are no oral lesions. These blisters are most likely the result of adhesion failure involving which of the
following?
(A) Basement membrane
(B) Dermal papillae
(C) Langerhans cells
(D) Melanocytes
(E) Merkel cells
67.
A 24-year-old man is brought to the emergency department 40 minutes after he was involved in a motor vehicle collision. He
was the unrestrained driver. He is conscious. Physical examination shows numerous lacerations and ecchymoses over the
face. His vision is normal. Ocular, facial, and lingual movements are intact. The gag reflex is present. Sensation to pinprick is
absent over the right side of the face anterior to the right ear, extending down along the full extent of the mandible to the
chin. Sensation also is absent over the right side of the tongue. X-rays of the skull show fractures of the orbit, zygomatic arch,
and infratemporal fossa. The most likely cause of these findings is a fracture affecting which of the following locations?
(A) Foramen lacerum
(B) Foramen ovale
(C) Foramen rotundum
(D) Foramen spinosum
(E) Jugular foramen
68.
A 55-year-old man who is a business executive is admitted to the hospital for evaluation of abdominal pain. He is polite to
the physician but berates the nurses and other staff. The patient's wife and two of his three adult children arrive for a visit.
The patient says with disgust that the missing child is and always has been worthless. Which of the following is the most
likely explanation for this patient's behavior?
(A) Countertransference
(B) Projection
(C) Projective identification
(D) Reaction formation
(E) Splitting