MUMPS
The causative agent is a filterable virus. It is found in the saliva of patients, where it may be present for at least 24 hours before swelling of the salivary glands develops, and throughout the entire period of glandular enlargement. Spread is by droplet infections or direct contact with materials contaminated with infected saliva. Most cases occur in children between 5 and 15 years of age; the disease is unusual in children under 2 years. Infants up to 10 months ordinarily are immuned. However, the disease may occur at any age, and cases in the older age groups may be seen.
After an incubation period of 14 to 21 days onset is marked by chilly sensations, headache, anorexia and malaise. This is accompanied by a low to moderate fever which may last from 12 to 24 hours before any involvement of the salivary glands. In mild cases, these prodromal symptoms may be absent. Pain on chewing or swallowing is the earliest symptom of parotitis. There is marked sensitivity to pressure over the angle of the jaw. With development of parotitis, the temperature frequently rises to 103 or 104 F. Swelling of the gland reaches its maximum about the 2nd day and is associated with swelling, involving the cheek and area below the ear. In most cases, both parotid glands are involved. Occasionally the submaxillary and sublingual glands also may be swollen, or, more rarely, may be the only glands affected. In such cases, there is swelling of the neck beneath the jaw.
The diagnosis of typical cases during an epidemic is simple, but sporadic cases present a more difficult problem. Swelling of the parotid or other salivary glands due to the mumps virus must be distinguished from: (1) bacterial parotid involvement, occuring in streptococcal throat infections, diphtheria, or debilitated patients with poor oral hygiene, typhoid or typhus fever; (2) malignant tumors of the salivary glands; (3) postoperative parotitis.
In uncomplicated mumps, prognosis is extent. However, relapses may occur occasionally after about 2 weeks. In complicated cases, deafness or facial paralysis has been known to occur following involvement of the nervous system.
2022 - Англійська частина(АМПС) 1 день
2022 - Англійська частина(АМПС) 1 день
Питань: 90
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Питання 1 з 90
Текст
Питання 1
In some cases, mumps must be distinguished from diphtheria:
Питання 2
Mumps can be complicated with deafness:
Питання 3
The virus which causes mumps can be found in the urine of the patients:
Питання 4
Choose the correct statement. :
Питання 5
Choose the correct statement:
Питання 6
Usually, only one parotid gland is affected by the disease:
Питання 7
It is always easy to diagnose this disease:
Питання 8
Elder people are immune to mumps:
Питання 9
Only parotid salivary glands can be affected in the case of mumps:
Питання 10
The virus is spreading with the saliva of the people, who are sick:
Питання 11
A 50-year-old man presents to the office with the complaint of pain in his left great toe. The pain started 2 days ago and has been progressively getting worse to the point that it is difficult to walk even a few steps. He adds that his left big toe is swollen and hot to the touch. He normally drinks 2-3 glasses of
red wine each day. Physical examination is notable for an overweight gentleman (BMI of 35) in moderate pain, with an erythematous, swollen, and
exquisitely tender left great toe. A complete blood count shows: hemoglobin - 120 g/L, hematocrit - 0.45, platelets - 160*10^9/L, leukocytes 8.0 - 10^9/L,
neutrophils - 65%, lymphocytes - 25%, eosinophils - 3%, and monocytes - 7%. Synovial fluid analysis shows cell count of 15,000 cells/mm^3 (80% neutrophils), negatively birefringent crystals present. Elevated concentration of which of the following compounds is the most common laboratory finding in these patients?
Питання 12
A 43-year-old man seeks evaluation at an emergency department with complaints of fever with chills, malaise, diffuse abdominal pain for over a week, diarrhea and loss of appetite. He says that his symptoms are progressively getting worse He recalls that the fever began slowly and climbed its way up stepwise to the current 39.8°C. His blood pressure is 110/70 mm Hg. A physical exam reveals a coated tongue, enlarged spleen and rose spots on the abdomen. Serologic study shows the agglutinin O titre of 1:200 by the Widal test. Which of the following is the most likely causative organism for this
patient's condition?
Питання 13
A 16-year-old girl concerned about her sexual development comes to the physician. She mentions that she has still not had a menstrual period. However, she is otherwise a healthy girl with no significant medical problems since birth On physical examination, her vital signs are stable. She does not have pubic hair and her breast is slightly elevated with areola remaining, in contour with surrounding breast. Which of the following is the most likely cause of this abnormal physical development?
Питання 14
A 38-year-old woman presents for evaluation to a clinic with painful ulceration in her right breast for the last 2 months. She is worried because the ulcer is increasing in size. On further questioning, she says that she has a discharge from her right nipple as well. Her mother and aunt died of breast cancer at 60 and 54 years of age, respectively. On examination, the right breast is enlarged and firm, with thickened skin, diffuse erythema, edema, and an ulcer measuring 3x3 cm. Mammography is ordered that shows a mass with a large area of calcifications, parenchymal distortion, and extensive soft tissue
and trabecular thickening in the aflected breast. The patient subsequently undergoes core needle and full-thickness skin punch biopsies. The pathology report states a clear dermal lymphatic invasion by tumor cells. Which of the following is the most common site for metastatic disease in this pathology?
Питання 15
During local anesthetization the patient has gone into anaphylactic shock. What drug must be administered to the patient?
Питання 16
A 54-year-old woman has a total thyroidectomy for papillary thyroid carcinoma. 11 hours after operation she complains of tingling around her mouth. On physical examination, the Trousseau's Sign and Chvostek's sign are present. Her condition rapidly deteriorates with laryngospasm and focal seizures. The surgeon suggests surgical destruction of parathyroid glands. Which of the following is the most likely cause of this patient's neurologic abnormality?
Питання 17
A 65-year-old patient with a history of coronary artery disease presents to the doctor's office complaining of dizziness and sudden onset of a «bluish
discoloration» of his skin. Physical examination reveals cyanotic patient. His blood pressure is 100/50 mm Hg, heart rate - 110/min., respiratory rate - 14/min. Laboratory testing is significant for methemoglobinemia. Which of the following medications did this patient most likely misuse?
Питання 18
A 2-year-old boy is diagnosed with Down syndrome. What chromosomal changes may be the cause of this disease?
Питання 19
A 60-year old man with a history of hypertension, diabetes and hyperlipidemia had a sudden onset of right-sided weakness. By the time the ambulance arrived, he had difficulty speaking. Unfortunately, the patient died within the next 2 hours and an autopsy was performed immediately. The gross examination of the cerebral left hemisphere showed brain swelling, widened gyri and poorly demarcated gray-white junction. Which of the following is the most likely cause of this patient's death?
Питання 20
A 7-week-old infant is brought to the pediatrician due to feeding difficulty for the last 4 days. She has been drinking very little breast milk and stops feeding as if she is tired, only to start sucking again after a few minutes. On chest auscultation, bilateral wheezing is present. A cardiac murmur starts immediately after the onset of the first heart sound (S1), reaching its maximal intensity at the end of systole, and waning during late diastole. The murmur is best heard over the second intercostal space and radiates to the left clavicle. The first heart sound (S1) is normal, while the second heart sound (S2) is obscured by the murmur. The pediatrician suspects a patent ductus arteriosus. Communication between which of the following arteries is the most likely cause of hemodynamic instability?
Питання 21
A team of medical students is performing research on phases of cell cycle. During one of the mitotic phases the cell is nearly done dividing, the chromosomes decondense and two nuclei begin to form around them. Which of the following phases most likely takes place in the cell?
Питання 22
A 78-year-old woman presents to the emergency department for fever and generalized malaise. Her symptoms began several days ago, when she noticed
pain with urination and mild blood in her urine. Earlier this morning she experienced chills, flank pain and mild nausea. Her temperature is 38.7°C, blood pressure is 140/80 mm Hg, heart rate is 98/min. Later she dies of unknown cause. At autopsy, her kidney is swollen with punctate abscesses that outlined by a thin red margin (signs of marginal vascular dilation). Microscopic observation reveals a large number of neutrophils. Which of the following is the most likely diagnosis?
Питання 23
A patient suffers from acute cardiopulmonary failure with pulmonary edema. What diuretic should be prescribed in the given case?
Питання 24
A newborn delivered at 33 weeks of gestation has a respiratory rate of 70/min. and heart rate of 148/min. 2 hours after birth. He is grunting and has
intercostal and subcostal retractions. He has peripheral cyanosis as well. An immediate chest radiograph is taken which shows a fine reticular granulation
with ground glass opacity on both lungs. A neonatologist suggests respiratory distress syndrome due to surfactant deficiency. Which of the following is the most likely mechanism of these clinical and imaging findings?
Питання 25
A mother of a 4-month-old male infant brought him to pediatrician with complaints of food rejection and weight loss. He started having trouble latching onto his bottle. He has also become extremely lethargic. Examination reveals diminished muscle tone in all four limbs, and hepatosplenomegaly. An ophthalmoscopic exam reveals macular cherry red spots. During the next few weeks, hepatosplenomegaly progresses, the boy fails to thrive, and he
continues to reject food. Chest X-ray shows a reticulonodular pattern and rcalcified nodules. Biopsy of the liver shows foamy histiocytes. A Niemann-Pick
disease is suspected. Which of the following is the most likely deficient enzyme in this patient?
Питання 26
A 25-year-old male visits his family physician for a 5-day history of fever and fatigue. Upon further questioning, he says that he also had constant muscular pain and headaches. He adds additional information by giving a history of regular unprotected sexual relationship with multiple partners. He is a non-smoker and drinks alcohol occasionally. Vital signs: heart-98/min., respiratory rate-16/min., temperature-38°C and blood pressure - 120/80 mm Hg. On physical examination, he is icteric and hepatosplenomegaly is evident with abdominal tenderness particularly in the right upper quadrant. The serologic markers show the following pattern: IgM anti-HBc positive, HBsAg positive. Which of the following is the most likely diagnosis?
Питання 27
A 56-year-old man presents for a checkup. The patient says he has to urinate quite frequently, but denies any dysuria or pain on urination. Past medical history is significant for diabetes mellitus type 2 and hypertension, both managed medically. Current medications are metformin, aspirin, rosuvastatin, captopril and furosemide. Laboratory findings are significant for the following: Glycated Hemoglobin (Hb A1c)-8.0%, Fasting Blood Glucose-12 mmol/L. His doctor decides to add glibenclamide to the therapy. Which of the following is the most likely mechanism of this drug’s action?
Питання 28
A 64-year-old man presents with a tremor in his legs and arms. He says he has had the tremor for «many years», but it has worsened in the last year. The
tremor is more prominent at rest and nearly disappears on movement. His daughter mentions that his movements have become slower. The patient is
febrile and vital signs are within normal limits. On physical examination, the patient is hunched over and his face is expressionless throughout examination.
There is a «pill-rolling» resting tremor that is accentuated when the patient is asked to clench the contralateral hand and alleviated by finger-nose testing.
When asked to walk across the room, the patient has difficulty taking the first step, has a stooped posture and takes short rapid shuffling steps. A doctor
initiates pharmacotherapy and the drug of first line, levodopa, is prescribed. Which of the following is the most likely mechanism of action of this drug?
Питання 29
A 56-year-old woman is rushed to the emergency department with sudden onset of severe chest pain radiating to her left arm and jaw. She has a history of periodic chest pain for which she uses nitroglycerine sublingually, but today her medication did not relieve the pain. Her blood pressure is 140/100 mm Hg, pulse - 130/min., respiratory rate-18/min., temperature - 37°C. A bedside electrocardiogram shows ST-segment elevation in leads II, III, and aVF. Blood is
drawn and sent to the lab, which is positive for specific biomarker. A diagnosis of acute inferior myocardial infarction is made, and the patient is sent to the catheterization lab for angioplasty with stent placement. Which of the following is the most likely specific and sensitive biomarker of cardiac injury?
Питання 30
A 20-year-old female comes to the clinic after missing her last 2 periods. Her cycles are usually regular, occurring at 28-30 day interval with moderate
bleeding and some abdominal discomfort. She also complains of progressively diminishing peripheral vision. Her doctor reveals loss of vision in the lateral
halves of both eyes. Involvement of which of the following structures would you most likely expect to be the reason of bitemporal hemianopsia?
Питання 31
A group of researchers aimed to study cardiac physiology found that overstretching of atria in the heart leads to decreased sodium reabsorption in the distal convoluted tubule and increase in glomerular filtration rate. Which of the following is the most likely cause of physiologic effects discovered by researchers?
Питання 32
A 45-year-old woman comes to her physician with complaints of excessive fatigue and weakness. She says that these symptoms have been present for
the past month. On further questioning, she admits having lost 3 kilograms in the last 2 weeks. On physical examination, she is a tired-appearing thin woman. Hyperpigmentation is present over many areas of her body, most prominently over the face, neck and back of hands (areas exposed to light).
Increased production of which of the following hormones is the most likely cause of hyperpigmentation in this patient?
Питання 33
A 65-year-old woman presents to the emergency department because of shortness of breath and chest pain that started a few hours ago. She did not have a fever, expectoration, or any accompanying symptoms. She has a history of right leg deep vein thrombosis that occurred 5 years ago. Some time later, she dies of severe respiratory distress. A pulmonary autopsy specimen reveals red loose mass that is lodged in the bifurcation of the pulmonary trunk with extensions into both the left and right main pulmonary arteries. Which of the following is the most likely diagnosis?
Питання 34
An 18-year-old girl comes to her physician with concern about her health because she has not achieved menarche. She denies any significant weight loss, changes in mood, or changes in her appetite. She mentions that her mother told her about mild birth defects, but she cannot recall the specifics. Past medical history and family history are benign. On physical examination, the patient is short in stature, has a short and webbed neck and wide chest. Staining of buccal smear reveals absence of Barr bodies in the nucleus of epithelial cells. A urine pregnancy test is negative. Which of the following genetic disorders is the most likely cause of this patient's condition?
Питання 35
A 34-year-old man visits his dentist complaining of toothache. After a dental procedure that involved extraction of several teeth, he develops severe bleeding lasting more than 15 minutes. He has a history of chronic hepatitis C. Which of the following is the most likely cause of prolonged bleeding in this patient?
Питання 36
A 14-year old girl presents to the emergency department for evaluation of an «infected leg». She states there is no history of trauma but mentions she had a history of sickle cell disease. On physical examination, her upper part of right shin is very painful, red, swollen and hot. Her temperature is 39.2°C. An X-ray shows focal bony lysis and loss of trabecular architecture in the metaphysis of right tibia. Increased activity of which of the following cells is the most likely cause of bone reabsorption in this patient?
Питання 37
A 24-year-old man undergoes surgery and during the operation, an organ is excised and sent for histological evaluation. A light microscopic examination
reveals the organ encased by thin connective tissue capsule that enters the substance of the lobes to further subdivide the organ into irregular lobular units. Each lobule contains a cluster of follicles filled with colloid. Follicular epithelium consists of low columnar, cuboidal or squamous cells depending on the level of activity of the follicle. Which of the following organs does this tissue most likely belong to?
Питання 38
A male neonate born to a 24-year-old, who was pregnant for the fist time, had jaundice at 8 hours of life. The neonate's red blood cell type was A+, while
the mothers RBC type was O+. Laboratory studies revealed elevated titer of mother's anti-A antibody, normal erythrocyte glucose-6-phosphate and
negative sickle cell test. The infant's hemoglobin was 106 g/L. Which of the following is the most likely cause of infant's jaundice?
Питання 39
A 37-year-old man is admitted to hospital with mental confusion and disorientation. His wife reports he became more irritable and forgetful in the past year. In addition, she notes that he became a vegan a year ago, and currently, his diet consists of starchy foods like potatoes, corn, and leafy vegetables. GI symptoms include anorexia, diarrhea and vomiting. He has glossitis and skin lesions that appear as vesicles over the extremities. Eczema-like lesions around the mouth, as well as desquamation and roughened skin over the hands are also present. Neurologic examination reveals symmetrical hypesthesia for all types of sensation in both upper and lower extremities in a «gloves and socks» distribution. Deficiency in diet of which of the following amino acids is the most likely cause of this condition?
Питання 40
An unidentified surgical specimen is received for histopathologic analysis. A portion of the specimen is cut and stained with hematoxylin and eosin. Under
the microscope, you see an organ encapsulated by dense connective tissue that extends to the deeper areas by way of the trabecular extensions. The
organ can be subdivided into two regions: a cortex with lymphoid nodules and medulla with medullary cords populated by plasma cells, B-cells and T-cells.
Which of the following structures is most likely the origin of this surgical specimen?
Питання 41
During surgical intervention, an organ is removed from a 34-year-old patient and sent for histologic evaluation. The pathologist examines the slide. The organ is encased in a connective tissue capsule that extends septae into the organ's substance, which is portioned into cortex and medulla. It is richly vascularized and capsular blood vessels penetrate along with the septae. The medulla is fairly homogenous and consists of chromaffin cells, but in the cortex, three concentric zones can be distinguished. Which of the following is the most likely organ?
Питання 42
A 25-year-old man presents to his physician with a 1-week history of fever, sore throat, nausea, and fatigue. His vital signs include: temperature - 38.5°C,
pulse-72/min., blood pressure - 120/70 mm Hg, and respiratory rate - 17/min. On physical examination, he has bilateral posterior cervical lymphadenopathy,
exudates over the palatine tonsil walls with soft palate petechiae, an erythematous macular rash on the trunk and arms, and mild hepatosplenomegaly. This patient most likely has infectious mononucleosis. Which of the following would be the most appropriate diagnostic laboratory test?
Питання 43
After delivery of a child by pregnant woman, the midwife notices a defect in external genitalia of a newborn. The woman only had one prenatal ultrasound that reported a male fetus. On physical exam, the neonatologists notices a short, broad penis with an orifice in its dorsal aspect, both testicles are present in the scrotum. Which of the following is the most likely congenital abnormality?
Питання 44
A 35-year-old woman has come to her physician with chief complaint of elevated blood pressure up to 180/100 mm Hg. She currently does not take any medications. During the physical examination, her blood pressure is 140/80 mm Hg, heart rate is 65/min. and temperature is 36.8°C. She has a «moon face», hirsutism, centripetal obesity, and striae on the skin with atrophy over the abdomen and thighs. Which of the following is the most likely cause of this patient's condition?
Питання 45
A 37-year old female presents to the clinic complaining of severe pain in her left wrist and tingling sensation in her left thumb, index finger, and middle finger, and some part of her ring finger. The pain started as an occasional throb and she could ignore it or take ibuprofen but now the pain is much worse and wakes her up at night. She works as a typist and her pain mostly increases after typing all day. Her right wrist and fingers are fine. Nerve conduction studies reveal nerve compression. Which of the following nerves is most likely compressed in this patient?
Питання 46
A 37-year-old woman presents to the emergency department complaining of palpitations, dry cough, and shortness of breath. She is a nonsmoker. Her
blood pressure 100/65 mm Hg, pulse - 76/min., respiratory rate - 23/min. Her physical exam is significant for bibasilar lung crackles and a low-pitched, middiastolic rumbling murmur best heard at the apical region without radiation. She has jugular vein distention and bilateral pitting edema in her lower
extremities. Despite considerable efforts in the emergency department, she dies from sudden cardiac death at night. The family requests an autopsy to
determine her cause of death. The patient's heart shows a mitral stenosis. Histologic examination reveals increased connective tissue in the myocardium
and Ashoff-Talalaev's granulomas. Which of the following is the most likely diagnosis?
Питання 47
A 40-year-old woman dies of intracerebral hemorrhage after the hypertensive emergency. During an autopsy, the pathologist reveals severe obesity, excess of body hair and wide purplish stria on the abdomen. Microscopic examination of pituitary gland reveals hyperplastic acini. What was the most likely underlying disease?
Питання 48
A 38-year-old woman, who was diagnosed with systemic lupus erythematosus (SLE) 3 years ago, comes to her physician with a complaint of facial swelling and decreased urination that she first noticed 2 weeks ago. She currently takes azathioprine and corticosteroid. Her vital signs show blood pressure 150/90 mm Hg, pulse - 91/min., temperature - 36.8°C and respiratory rate - 15/min. On physical examination, the doctor notices erythematous rash on her face exhibiting a butterfly pattern. The laboratory studies reveal hypercholesterolemia, hypertriglyceridemia and proteinuria. Which of the following is the most likely mechanism of SLE's complication in this patient?
Питання 49
An 11-year-old girl is brought to the doctor's office by her mother who states her daughter has been weak with swollen face for 3 days. The mother states her daughter had always been healthy and active until the initiation of symptoms. Upon inquiry, the girl describes a foamy appearance of her urine but denies blood in urine, urinary frequency at night, or pain during urination. Physical examination reveals generalized swelling of the face and pitting edema on the lower limbs. Laboratory study shows proteinuria an microscopic hematuria. Which of the following is the most likely cause of findings in the laboratory study of urine?
Питання 50
A 39-year-old man comes to the doctor with complaints of chest pain and cough with occasionally blood-streaked sputum. He does not have increased temperature or night sweating and his history is insignificant for smoking or alcohol abuse. However, he mentions visiting a few weeks ago a relative who
owns a sheep farm. Radiographic examination shows a cyst in the left lower lobe with calcification. Casoni test is positive. Which of the following
organisms is the most likely cause of this patient's condition?
Питання 51
A 25-year-old man presents to his physician with a 1-week history of fever, sore throat, nausea, and fatigue. His vital signs include: temperature - 38.5°C,
pulse-72/min., blood pressure - 120/70 mm Hg, and respiratory rate - 17/min. On physical examination, he has bilateral posterior cervical lymphadenopathy,
exudates over the palatine tonsil walls with soft palate petechiae, an erythematous macular rash on the trunk and arms, and mild hepatosplenomegaly. This patient most likely has infectious mononucleosis. Which of the following would be the most appropriate diagnostic laboratory test?
Питання 52
A 24-year-old man undergoes surgery and during the operation, an organ is excised and sent for histological evaluation. A light microscopic examination
reveals the organ encased by thin connective tissue capsule that enters the substance of the lobes to further subdivide the organ into irregular lobular units. Each lobule contains a cluster of follicles filled with colloid. Follicular epithelium consists of low columnar, cuboidal or squamous cells depending on the level of activity of the follicle. Which of the following organs does this tissue most likely belong to?
Питання 53
A 40-year-old woman dies of intracerebral hemorrhage after the hypertensive emergency. During an autopsy, the pathologist reveals severe obesity, excess of body hair and wide purplish stria on the abdomen. Microscopic examination of pituitary gland reveals hyperplastic acini. What was the most likely underlying disease?
Питання 54
An 18-year-old girl comes to her physician with concern about her health because she has not achieved menarche. She denies any significant weight loss, changes in mood, or changes in her appetite. She mentions that her mother told her about mild birth defects, but she cannot recall the specifics. Past medical history and family history are benign. On physical examination, the patient is short in stature, has a short and webbed neck and wide chest. Staining of buccal smear reveals absence of Barr bodies in the nucleus of epithelial cells. A urine pregnancy test is negative. Which of the following genetic disorders is the most likely cause of this patient's condition?
Питання 55
A 14-year old girl presents to the emergency department for evaluation of an «infected leg». She states there is no history of trauma but mentions she had a history of sickle cell disease. On physical examination, her upper part of right shin is very painful, red, swollen and hot. Her temperature is 39.2°C. An X-ray shows focal bony lysis and loss of trabecular architecture in the metaphysis of right tibia. Increased activity of which of the following cells is the most likely cause of bone reabsorption in this patient?
Питання 56
An unidentified surgical specimen is received for histopathologic analysis. A portion of the specimen is cut and stained with hematoxylin and eosin. Under
the microscope, you see an organ encapsulated by dense connective tissue that extends to the deeper areas by way of the trabecular extensions. The
organ can be subdivided into two regions: a cortex with lymphoid nodules and medulla with medullary cords populated by plasma cells, B-cells and T-cells.
Which of the following structures is most likely the origin of this surgical specimen?
Питання 57
A 37-year old female presents to the clinic complaining of severe pain in her left wrist and tingling sensation in her left thumb, index finger, and middle finger, and some part of her ring finger. The pain started as an occasional throb and she could ignore it or take ibuprofen but now the pain is much worse and wakes her up at night. She works as a typist and her pain mostly increases after typing all day. Her right wrist and fingers are fine. Nerve conduction studies reveal nerve compression. Which of the following nerves is most likely compressed in this patient?
Питання 58
A 54-year-old woman has a total thyroidectomy for papillary thyroid carcinoma. 11 hours after operation she complains of tingling around her mouth. On physical examination, the Trousseau's Sign and Chvostek's sign are present. Her condition rapidly deteriorates with laryngospasm and focal seizures. The surgeon suggests surgical destruction of parathyroid glands. Which of the following is the most likely cause of this patient's neurologic abnormality?
Питання 59
A 39-year-old man comes to the doctor with complaints of chest pain and cough with occasionally blood-streaked sputum. He does not have increased temperature or night sweating and his history is insignificant for smoking or alcohol abuse. However, he mentions visiting a few weeks ago a relative who
owns a sheep farm. Radiographic examination shows a cyst in the left lower lobe with calcification. Casoni test is positive. Which of the following
organisms is the most likely cause of this patient's condition?
Питання 60
An 11-year-old girl is brought to the doctor's office by her mother who states her daughter has been weak with swollen face for 3 days. The mother states her daughter had always been healthy and active until the initiation of symptoms. Upon inquiry, the girl describes a foamy appearance of her urine but denies blood in urine, urinary frequency at night, or pain during urination. Physical examination reveals generalized swelling of the face and pitting edema on the lower limbs. Laboratory study shows proteinuria an microscopic hematuria. Which of the following is the most likely cause of findings in the laboratory study of urine?
Питання 61
A 16-year-old girl concerned about her sexual development comes to the physician. She mentions that she has still not had a menstrual period. However, she is otherwise a healthy girl with no significant medical problems since birth On physical examination, her vital signs are stable. She does not have pubic hair and her breast is slightly elevated with areola remaining, in contour with surrounding breast. Which of the following is the most likely cause of this abnormal physical development?
Питання 62
A 35-year-old woman has come to her physician with chief complaint of elevated blood pressure up to 180/100 mm Hg. She currently does not take any medications. During the physical examination, her blood pressure is 140/80 mm Hg, heart rate is 65/min. and temperature is 36.8°C. She has a «moon face», hirsutism, centripetal obesity, and striae on the skin with atrophy over the abdomen and thighs. Which of the following is the most likely cause of this patient's condition?
Питання 63
A 60-year old man with a history of hypertension, diabetes and hyperlipidemia had a sudden onset of right-sided weakness. By the time the ambulance arrived, he had difficulty speaking. Unfortunately, the patient died within the next 2 hours and an autopsy was performed immediately. The gross examination of the cerebral left hemisphere showed brain swelling, widened gyri and poorly demarcated gray-white junction. Which of the following is the most likely cause of this patient's death?
Питання 64
A 25-year-old male visits his family physician for a 5-day history of fever and fatigue. Upon further questioning, he says that he also had constant muscular pain and headaches. He adds additional information by giving a history of regular unprotected sexual relationship with multiple partners. He is a non-smoker and drinks alcohol occasionally. Vital signs: heart-98/min., respiratory rate-16/min., temperature-38°C and blood pressure - 120/80 mm Hg. On physical examination, he is icteric and hepatosplenomegaly is evident with abdominal tenderness particularly in the right upper quadrant. The serologic markers show the following pattern: IgM anti-HBc positive, HBsAg positive. Which of the following is the most likely diagnosis?
Питання 65
A 38-year-old woman presents for evaluation to a clinic with painful ulceration in her right breast for the last 2 months. She is worried because the ulcer is increasing in size. On further questioning, she says that she has a discharge from her right nipple as well. Her mother and aunt died of breast cancer at 60 and 54 years of age, respectively. On examination, the right breast is enlarged and firm, with thickened skin, diffuse erythema, edema, and an ulcer measuring 3x3 cm. Mammography is ordered that shows a mass with a large area of calcifications, parenchymal distortion, and extensive soft tissue
and trabecular thickening in the aflected breast. The patient subsequently undergoes core needle and full-thickness skin punch biopsies. The pathology report states a clear dermal lymphatic invasion by tumor cells. Which of the following is the most common site for metastatic disease in this pathology?
Питання 66
A 20-year-old female comes to the clinic after missing her last 2 periods. Her cycles are usually regular, occurring at 28-30 day interval with moderate
bleeding and some abdominal discomfort. She also complains of progressively diminishing peripheral vision. Her doctor reveals loss of vision in the lateral
halves of both eyes. Involvement of which of the following structures would you most likely expect to be the reason of bitemporal hemianopsia?
Питання 67
A group of researchers aimed to study cardiac physiology found that overstretching of atria in the heart leads to decreased sodium reabsorption in the distal convoluted tubule and increase in glomerular filtration rate. Which of the following is the most likely cause of physiologic effects discovered by researchers?
Питання 68
After delivery of a child by pregnant woman, the midwife notices a defect in external genitalia of a newborn. The woman only had one prenatal ultrasound that reported a male fetus. On physical exam, the neonatologists notices a short, broad penis with an orifice in its dorsal aspect, both testicles are present in the scrotum. Which of the following is the most likely congenital abnormality?
Питання 69
During surgical intervention, an organ is removed from a 34-year-old patient and sent for histologic evaluation. The pathologist examines the slide. The organ is encased in a connective tissue capsule that extends septae into the organ's substance, which is portioned into cortex and medulla. It is richly vascularized and capsular blood vessels penetrate along with the septae. The medulla is fairly homogenous and consists of chromaffin cells, but in the cortex, three concentric zones can be distinguished. Which of the following is the most likely organ?
Питання 70
A 56-year-old man presents for a checkup. The patient says he has to urinate quite frequently, but denies any dysuria or pain on urination. Past medical history is significant for diabetes mellitus type 2 and hypertension, both managed medically. Current medications are metformin, aspirin, rosuvastatin, captopril and furosemide. Laboratory findings are significant for the following: Glycated Hemoglobin (Hb A1c)-8.0%, Fasting Blood Glucose-12 mmol/L. His doctor decides to add glibenclamide to the therapy. Which of the following is the most likely mechanism of this drug’s action?
Питання 71
A 34-year-old man visits his dentist complaining of toothache. After a dental procedure that involved extraction of several teeth, he develops severe bleeding lasting more than 15 minutes. He has a history of chronic hepatitis C. Which of the following is the most likely cause of prolonged bleeding in this patient?
Питання 72
A 64-year-old man presents with a tremor in his legs and arms. He says he has had the tremor for «many years», but it has worsened in the last year. The
tremor is more prominent at rest and nearly disappears on movement. His daughter mentions that his movements have become slower. The patient is
febrile and vital signs are within normal limits. On physical examination, the patient is hunched over and his face is expressionless throughout examination.
There is a «pill-rolling» resting tremor that is accentuated when the patient is asked to clench the contralateral hand and alleviated by finger-nose testing.
When asked to walk across the room, the patient has difficulty taking the first step, has a stooped posture and takes short rapid shuffling steps. A doctor
initiates pharmacotherapy and the drug of first line, levodopa, is prescribed. Which of the following is the most likely mechanism of action of this drug?
Питання 73
A 43-year-old man seeks evaluation at an emergency department with complaints of fever with chills, malaise, diffuse abdominal pain for over a week, diarrhea and loss of appetite. He says that his symptoms are progressively getting worse He recalls that the fever began slowly and climbed its way up stepwise to the current 39.8°C. His blood pressure is 110/70 mm Hg. A physical exam reveals a coated tongue, enlarged spleen and rose spots on the abdomen. Serologic study shows the agglutinin O titre of 1:200 by the Widal test. Which of the following is the most likely causative organism for this
patient's condition?
Питання 74
A 37-year-old woman presents to the emergency department complaining of palpitations, dry cough, and shortness of breath. She is a nonsmoker. Her
blood pressure 100/65 mm Hg, pulse - 76/min., respiratory rate - 23/min. Her physical exam is significant for bibasilar lung crackles and a low-pitched, middiastolic rumbling murmur best heard at the apical region without radiation. She has jugular vein distention and bilateral pitting edema in her lower
extremities. Despite considerable efforts in the emergency department, she dies from sudden cardiac death at night. The family requests an autopsy to
determine her cause of death. The patient's heart shows a mitral stenosis. Histologic examination reveals increased connective tissue in the myocardium
and Ashoff-Talalaev's granulomas. Which of the following is the most likely diagnosis?
Питання 75
A 7-week-old infant is brought to the pediatrician due to feeding difficulty for the last 4 days. She has been drinking very little breast milk and stops feeding as if she is tired, only to start sucking again after a few minutes. On chest auscultation, bilateral wheezing is present. A cardiac murmur starts immediately after the onset of the first heart sound (S1), reaching its maximal intensity at the end of systole, and waning during late diastole. The murmur is best heard over the second intercostal space and radiates to the left clavicle. The first heart sound (S1) is normal, while the second heart sound (S2) is obscured by the murmur. The pediatrician suspects a patent ductus arteriosus. Communication between which of the following arteries is the most likely cause of hemodynamic instability?
Питання 76
A 45-year-old woman comes to her physician with complaints of excessive fatigue and weakness. She says that these symptoms have been present for
the past month. On further questioning, she admits having lost 3 kilograms in the last 2 weeks. On physical examination, she is a tired-appearing thin woman. Hyperpigmentation is present over many areas of her body, most prominently over the face, neck and back of hands (areas exposed to light).
Increased production of which of the following hormones is the most likely cause of hyperpigmentation in this patient?
Питання 77
A 65-year-old woman presents to the emergency department because of shortness of breath and chest pain that started a few hours ago. She did not have a fever, expectoration, or any accompanying symptoms. She has a history of right leg deep vein thrombosis that occurred 5 years ago. Some time later, she dies of severe respiratory distress. A pulmonary autopsy specimen reveals red loose mass that is lodged in the bifurcation of the pulmonary trunk with extensions into both the left and right main pulmonary arteries. Which of the following is the most likely diagnosis?
Питання 78
A 37-year-old man is admitted to hospital with mental confusion and disorientation. His wife reports he became more irritable and forgetful in the past year. In addition, she notes that he became a vegan a year ago, and currently, his diet consists of starchy foods like potatoes, corn, and leafy vegetables. GI symptoms include anorexia, diarrhea and vomiting. He has glossitis and skin lesions that appear as vesicles over the extremities. Eczema-like lesions around the mouth, as well as desquamation and roughened skin over the hands are also present. Neurologic examination reveals symmetrical hypesthesia for all types of sensation in both upper and lower extremities in a «gloves and socks» distribution. Deficiency in diet of which of the following amino acids is the most likely cause of this condition?
Питання 79
A mother of a 4-month-old male infant brought him to pediatrician with complaints of food rejection and weight loss. He started having trouble latching onto his bottle. He has also become extremely lethargic. Examination reveals diminished muscle tone in all four limbs, and hepatosplenomegaly. An ophthalmoscopic exam reveals macular cherry red spots. During the next few weeks, hepatosplenomegaly progresses, the boy fails to thrive, and he
continues to reject food. Chest X-ray shows a reticulonodular pattern and rcalcified nodules. Biopsy of the liver shows foamy histiocytes. A Niemann-Pick
disease is suspected. Which of the following is the most likely deficient enzyme in this patient?
Питання 80
A 2-year-old boy is diagnosed with Down syndrome. What chromosomal changes may be the cause of this disease?
Питання 81
A 38-year-old woman, who was diagnosed with systemic lupus erythematosus (SLE) 3 years ago, comes to her physician with a complaint of facial swelling and decreased urination that she first noticed 2 weeks ago. She currently takes azathioprine and corticosteroid. Her vital signs show blood pressure 150/90 mm Hg, pulse - 91/min., temperature - 36.8°C and respiratory rate - 15/min. On physical examination, the doctor notices erythematous rash on her face exhibiting a butterfly pattern. The laboratory studies reveal hypercholesterolemia, hypertriglyceridemia and proteinuria. Which of the following is the most likely mechanism of SLE's complication in this patient?
Питання 82
A male neonate born to a 24-year-old, who was pregnant for the fist time, had jaundice at 8 hours of life. The neonate's red blood cell type was A+, while
the mothers RBC type was O+. Laboratory studies revealed elevated titer of mother's anti-A antibody, normal erythrocyte glucose-6-phosphate and
negative sickle cell test. The infant's hemoglobin was 106 g/L. Which of the following is the most likely cause of infant's jaundice?
Питання 83
A team of medical students is performing research on phases of cell cycle. During one of the mitotic phases the cell is nearly done dividing, the chromosomes decondense and two nuclei begin to form around them. Which of the following phases most likely takes place in the cell?
Питання 84
During local anesthetization the patient has gone into anaphylactic shock. What drug must be administered to the patient?
Питання 85
A newborn delivered at 33 weeks of gestation has a respiratory rate of 70/min. and heart rate of 148/min. 2 hours after birth. He is grunting and has
intercostal and subcostal retractions. He has peripheral cyanosis as well. An immediate chest radiograph is taken which shows a fine reticular granulation
with ground glass opacity on both lungs. A neonatologist suggests respiratory distress syndrome due to surfactant deficiency. Which of the following is the most likely mechanism of these clinical and imaging findings?
Питання 86
A 50-year-old man presents to the office with the complaint of pain in his left great toe. The pain started 2 days ago and has been progressively getting worse to the point that it is difficult to walk even a few steps. He adds that his left big toe is swollen and hot to the touch. He normally drinks 2-3 glasses of
red wine each day. Physical examination is notable for an overweight gentleman (BMI of 35) in moderate pain, with an erythematous, swollen, and
exquisitely tender left great toe. A complete blood count shows: hemoglobin - 120 g/L, hematocrit - 0.45, platelets - 160*10^9/L, leukocytes 8.0 - 10^9/L,
neutrophils - 65%, lymphocytes - 25%, eosinophils - 3%, and monocytes - 7%. Synovial fluid analysis shows cell count of 15,000 cells/mm^3 (80% neutrophils), negatively birefringent crystals present. Elevated concentration of which of the following compounds is the most common laboratory finding in these patients?
Питання 87
A 78-year-old woman presents to the emergency department for fever and generalized malaise. Her symptoms began several days ago, when she noticed
pain with urination and mild blood in her urine. Earlier this morning she experienced chills, flank pain and mild nausea. Her temperature is 38.7°C, blood pressure is 140/80 mm Hg, heart rate is 98/min. Later she dies of unknown cause. At autopsy, her kidney is swollen with punctate abscesses that outlined by a thin red margin (signs of marginal vascular dilation). Microscopic observation reveals a large number of neutrophils. Which of the following is the most likely diagnosis?
Питання 88
A 56-year-old woman is rushed to the emergency department with sudden onset of severe chest pain radiating to her left arm and jaw. She has a history of periodic chest pain for which she uses nitroglycerine sublingually, but today her medication did not relieve the pain. Her blood pressure is 140/100 mm Hg, pulse - 130/min., respiratory rate-18/min., temperature - 37°C. A bedside electrocardiogram shows ST-segment elevation in leads II, III, and aVF. Blood is
drawn and sent to the lab, which is positive for specific biomarker. A diagnosis of acute inferior myocardial infarction is made, and the patient is sent to the catheterization lab for angioplasty with stent placement. Which of the following is the most likely specific and sensitive biomarker of cardiac injury?
Питання 89
A patient suffers from acute cardiopulmonary failure with pulmonary edema. What diuretic should be prescribed in the given case?
Питання 90
A 65-year-old patient with a history of coronary artery disease presents to the doctor's office complaining of dizziness and sudden onset of a «bluish
discoloration» of his skin. Physical examination reveals cyanotic patient. His blood pressure is 100/50 mm Hg, heart rate - 110/min., respiratory rate - 14/min. Laboratory testing is significant for methemoglobinemia. Which of the following medications did this patient most likely misuse?