Você está na página 1de 17

2/20/2015

https://cmumed.myexammaster.com/faculty_exams/53358/print?display_type=alpha

MD3QUIZ
PossibleRawScore:28
#1of28(QID:821216)1Points
Unknown|Unknown|Unknown

Question:
An8yearoldmalepatientisbroughttoaruralhospitalwithahistoryofrecurrentinfection.Thepatienthasa
characteristicfacieswithahigh,broadnasalbridge,longface,narrowpalpebralfissures,andanabnormallysmall
mandible.Thepatientalsohasacleftpalate.ThepatientisdiagnosedwithDiGeorgesyndrome,aninherited
immunodeficiencydiseaseduetoachromosome22q11.2deletion.Inthissyndrome,theproductionofwhichofthe
followingcellsisaffectedinthethymus.

A. Bcells
B. Endothelialcells
C. Macrophages
D. Neutrophils
E. Tcells

Explanation:
22q11.2deletionsyndrome,whichhasseveralpresentationsincludingDiGeorgesyndrome(DGS),DiGeorgeanomaly
velocardiofacialsyndrome,Shprintzensyndrome,conotruncalanomalyfacesyndrome,Strong
syndrome,congenitalthymicaplasia,andthymichypoplasia,isasyndromecausedbythedeletionofasmallpiece
ofchromosome22.Thedeletionoccursnearthemiddleofthechromosomeatalocationdesignated22q11.2signifying
itslocationonthelongarmofoneofthepairofchromosomes22,onregion1,band1,subband2.Theinheritance
patternisautosomaldominantandithasaprevalenceestimatedat1:4000
Tlymphocyteproductionmaybeimpaired,resultinginlowTlymphocytenumbersandfrequentinfections

#2of28(QID:822184)1Points
Unknown|Unknown|Unknown

Question:
Thesebelowdescriptionofalesionfoundundermicroscopy:

Reductioninthesizeand/ornumberofcells.Causesincludeincreased:
endogenoushormones(e.g.,postmenopausalovaries)
exogenoushormones(e.g.,factitiousthyrotoxicosis,steroiduse)
innervation(e.g.,motorneurondamage)
https://cmumed.myexammaster.com/faculty_exams/53358/print?display_type=alpha

1/17

2/20/2015

https://cmumed.myexammaster.com/faculty_exams/53358/print?display_type=alpha

bloodflow/nutrients
metabolicdemand(e.g.,prolongedhospitalization,paralysis)
pressure(e.g.,nephrolithiasis)
Occlusionofsecretoryducts(e.g.,cysticfibrosis)
Thisreferto:

A. Apoptosis
B. Necrosis
C. Hyperplasia
D. Dystrophy
E. Atrophy

#3of28(QID:822185)1Points
Unknown|Unknown|Unknown

Question:
A40yearoldmalepresentstotheemergencydepartmentwith2daysoflowvolumehemoptysis.Hereportsthat
he has been coughing up 25 tablespoons of blood each day. He reports mild chest pain, lowgrade fevers, and
weightloss.Inaddition,hehashadabout1yearofsevereupperrespiratorysymptomsincludingfrequentepistaxis
andpurulentdischargetreatedwithseveralcoursesofantibiotics.Asidefrommildhyperlipidemia,heisotherwise
healthy.Hisonlymedicationsaredailyaspirinandlovastatin.Onphysicalexaminationhehasnormalvitalsigns,
and the upper airway is notable for saddle nose deformity and clear lungs. A CT of the chest shows multiple
cavitatingnodules,andurinalysisshowsredbloodcells.
Whichofthefollowingtestsoffersthehighestdiagnosticyieldtomaketheappropriatediagnosis?

A. .Deepskinbiopsy
B. Percutaneouskidneybiopsy
C. Pulmonaryangiogram
D. Surgicallungbiopsy
E. .Upperairwaybiopsy

#4of28(QID:822186)1Points
https://cmumed.myexammaster.com/faculty_exams/53358/print?display_type=alpha

2/17

2/20/2015

https://cmumed.myexammaster.com/faculty_exams/53358/print?display_type=alpha

Unknown|Unknown|Unknown

Question:
/.A37yearoldmanhasrecentlybeendiagnosedwithsystemichypertension.HeisprescribedLisinoprilasinitial
monotherapy.Hetakesthismedicationasprescribedfor3daysandonthethirddaynotesthathisrighthandis
swollen,mildlyitchy,andtingling.Laterthateveninghislipsbecomeswollenandhehasdifficultybreathing.
Whichofthefollowingstatementsaccuratelydescribesthiscondition?

A. Hissymptomsareduetodirectactivationofmastcellsbylisinopril
B. Hissymptomsareduetoimpairedbradykinindegradationbylisinopril.
C. Hissymptomsareunlikelytorecurifheisswitchedtoenalapril.
D. PeripheralbloodanalysiswillshowdeficiencyofC1binhibitor.
E. PlasmaIgElevelsarelikelytobeelevated

#5of28(QID:822187)1Points
Unknown|Unknown|Unknown

Question:
A50yearoldHIVpositivemanpresentstohisprimarycarephysicianwitha1dayhistoryofnauseaandvomiting.
Healsohassevereepigastricpainradiatingtotheback.Reviewofthepatientsmedicalhistoryrevealsthatheis
takingthereversetranscriptaseinhibitordidanosine.Laboratorytestingrevealsanamylaselevelfivetimeshigher
thannormalandalipaselevelsixtimeshigherthannormal.
Whattypeofnecrosisyouwillseeinthepancreas?

A. Enzymaticnecrosis
B. Saponificationtypenecrosis
C. Coagulativenecrosis
D. Caseousnecrosis
E. AandBarethecorrectanswer.
F. Alloftheabove
G. Noneoftheabove
H. Nonecrosisarehappening

#6of28(QID:822188)1Points
Unknown|Unknown|Unknown

https://cmumed.myexammaster.com/faculty_exams/53358/print?display_type=alpha

3/17

2/20/2015

https://cmumed.myexammaster.com/faculty_exams/53358/print?display_type=alpha

Question:
An infant with a severe diaper rash with pustule formation is found to have a staphylococcal skin infection.
Phagocytosisofthebacteriabyneutrophilsisimportantintheinfantsdefenseagainsttheinfection.Whichofthe
followingclassesofadhesivemoleculesismostimportantinphagocytosis?

A. A.Beta1integrins
B. A.Beta2integrins
C. A.IgCAMs
D. A.Selectins
E. A.VLAmolecules

#7of28(QID:822189)1Points
Unknown|Unknown|Unknown

Question:
Apersondevelopsasmallabscessatthesiteofanembeddedsplinterinhisfoot.Thisabscessischaracterized
microscopicallybythepresenceoflargenumbersofneutrophilsinthetissue.Theneutrophilsareattractedtothe
tissueinpartbecauseofthereleaseofinterleukin8.
Whichofthefollowingcellsproducesinterleukin8?

A. Endothelialcells
B. Fibroblasts

C. Lymphocytes
D.

Macrophages

E. Neutrophils

https://cmumed.myexammaster.com/faculty_exams/53358/print?display_type=alpha

4/17

2/20/2015

https://cmumed.myexammaster.com/faculty_exams/53358/print?display_type=alpha

#8of28(QID:822190)1Points
Unknown|Unknown|Unknown

Question:

A33yearoldwomanundergoesahysterectomybecauseofchronicpelvicpainandabnormaluterine
bleeding.Whenthehysterectomyspecimenisexaminedinthepathologylaboratory,itisfoundthatthe
uteruscontainsmultipleleiomyomas,andchronicinflammatoryprocesses,buttheovariesappeargrossly.
Withintheovaries,numerousverylarge,palecellssurroundedbyasinglelayerofmuchsmallercolumnar
cellscanbeseen.Thelarge,palecellsaremostlikelyinwhichofthefollowingcellstages?
A. MetaphaseofmeiosisI
B. Metaphaseofmitosis
C. ProphaseofmeiosisI
D. ProphaseofmeiosisII
E.

TelophaseofmeiosisII

F. Telophaseofmitosis

#9of28(QID:822191)1Points
Unknown|Unknown|Unknown

Question:

A67yearoldmanhasdevelopeddifficultyininitiatingurinationandmaintainingastrongurinestream.
Thepatientconsultsaphysicianfortheseproblems,andrectalexaminationdemonstratesacoarse
nodularityoftheprostategland.SerumPSAlevelsaremildlyelevatedat15ng/mL.Thephysicianordersa
transrectalultrasoundwithbiopsyoftheprostate.Duringtheultrasoundprocedure,theultrasound
technicianidentifiesanarterythatsuppliesthehypertrophiedglandandusesitasalandmark.Thisartery
usuallyarisesasabranchofwhichofthefollowing?
A.A.
Cremastericartery
A.
B.
Inferiorvesicularartery

C. Internalpudendalartery

https://cmumed.myexammaster.com/faculty_exams/53358/print?display_type=alpha

5/17

2/20/2015

https://cmumed.myexammaster.com/faculty_exams/53358/print?display_type=alpha

A.D.
Testicularartery
A.E.
Superiorvesicularartery

#10of28(QID:822193)1Points
Unknown|Unknown|Unknown

Question:

Atype1diabetichasabloodglucosevalueof250mg/dL.Afterinjectinghimselfwithinsulin,thevalue
decreasedto150mg/dL.Whichofthefollowingchangesinlivermetabolismwouldmostlikelyaccompany
thisdecreaseinbloodglucose?
A.A.
Increasedactivityoffructose1,6bisphosphatase
A.
B.
Increasedlevelsoffructose2,6bisphosphate
A.C.
Increasedhexokinaseactivity
A.D.
Increasedphosphoenolpyruvatecarboxykinaseactivity
A.E.
Increasedrecruitmentofglucosetransporters

#11of28(QID:822194)1Points
Unknown|Unknown|Unknown

Question:

A6weekoldchildinaMennonitecommunityisbroughttotheemergencydepartmenthavingseizures.
Theexaminingphysiciannotesabnormalmuscletone.Laboratoryworkrevealsmetabolicacidosis
associatedwithketosis.Atestforurinaryhydroxybutyrateisnegative.Thelaboratorytechnicianreports
anunusualsweetodortotheurine.Thephysiciandiagnosesageneticdeficiencyassociatedwithamino
acidmetabolism.Whichofthefollowingaminoacidsshouldbesignificantlyrestrictedfromthedietofthis
child?
A.A.
Glutamate
A.
B.
Isoleucine
A.C.
Methionine
A.D.
Phenylalanine
https://cmumed.myexammaster.com/faculty_exams/53358/print?display_type=alpha

6/17

2/20/2015

https://cmumed.myexammaster.com/faculty_exams/53358/print?display_type=alpha

A.E.
Threonine

#12of28(QID:822195)1Points
Unknown|Unknown|Unknown

Question:

Electroretinographyperformedonapatientwithlossofvisualacuityrevealsanattenuatedelectrical
responsetolight.Thenormallightinducedmembranehyperpolarizationinrodcellsisduetowhichofthe
following?
A.
A.
DecreaseincGMP
A.B.
IncreaseincAMP
A.C.
IncreasedpermeabilitytoNa+
A.D.
Inhibitionofadenylatecyclase
A.E.
Repressionoftheguanylatecyclasegene

#13of28(QID:822196)1Points
Unknown|Unknown|Unknown

Question:
A55yearoldmalepresentstoyourofficewithnewsymptomsofexertionalfatigue.Heisotherwisewellwithno
significantpastmedicalhistory.Hishemoglobinisfoundtobelowat10.6g/dl,withanMCVof92.Hehasnormal
serumferritin,vitaminB12,andfolicacidlevels.Absoluteneutrophilcountis1.3x103/ulandplatelets117x109/uL.
Hehasacreatinineof0.9mg/dL,calciumof9.2mg/dL,andalbuminof3.8g/dL.Aserumproteinelectrophoresisis
performedthatdemonstratesamonoclonalIgAproteinof1.5g/dL.Askeletalsurveyshowsoccultlyticlesionsin
the skull and bilateral humeri, and a bone marrow biopsy shows 30 percent involvement by abnormal appearing
plasma cells, confirmed by CD138+ immunohistochemical stain. Diagnosis of symptomatic multiple myeloma IS
MADE.
Whattypeofcellinclusionwillbefoundonthebiopsy?

A. .Tauinclusions
B. Mallorybodies
C. Councilmanbodies
D. Russellbodies
E. Microcalcificationinclusion

https://cmumed.myexammaster.com/faculty_exams/53358/print?display_type=alpha

7/17

2/20/2015

https://cmumed.myexammaster.com/faculty_exams/53358/print?display_type=alpha

#14of28(QID:822199)1Points
Unknown|Unknown|Unknown

Question:
/ A 15yearold woman had acute onset of fever, myalgia, jaundice, and dyspnea that started five days before
admission to a hospital. She reported that rats were common in her neighborhood and that she was exposed to
floodwaters one week prior to symptoms. Past medical history was unremarkable.On physical examination, she
was alert, jaundiced, and lungs were clear to auscultation. Blood counts showed 9,500 leukocytes/mm3 (88%
neutrophils, 10% lymphocytes, and 2% monocytes). The hematocrit was 26% and the platelet count was 46,000
cells/mm3.Shehadthefollowinglaboratorytestvalues:bloodureanitrogen=108mg/dL(referencerange=1050
mg/dL), serum creatinine = 2.6 mg/dL (0.7.5 mg/dL), sodium = 133 mmol/L (135145 mmol/L), potassium = 3.0
mmol/L(n:3.55.0mmol/l),serummagnesium=1.5mg/dL(0.56mmol/L)(1.92.5mg/dL),totalbilirubin=11mg/dL
(0.21.2 mg/dL), and creatine kinase = 620 U/L (0190 U/L). Alanine aninotransferase and aspartate
aminotransferase levels were normal. Urinalysis showed a protein level of 30 mg/dL (reference range = 30140
mg/dL).Urineoutputwas3.3litersinthefirst24hours.Theresultsofbloodandurineculturesandserologictests
for hepatitis viruses and human immunodeficiency virus were negative. Diagnosis of leptospirosis was
demonstratedbyapositiveIgMenzymelinkedimmunosorbentassayresultonday15ofillness.Thisresultwas
confirmed by seroconversion between paired serum samples analyzed by the microscopic agglutination test
(highesttiteragainstserovarCopenhageni,titer=1:800).
Besidetheinfectiousdiagnosis,whatwouldbethecauseofhisseveresymptoms?

A. severehyponatremiaassociatedwithmyalgiaandlethargyintheacutephaseofleptospirosis
B. severehypokaliemiaassociatedwithmyalgiaandlethargyintheacutephaseofleptospirosis
C. severehypermagnesemiaassociatedwithmyalgiaandlethargyintheacutephaseofleptospirosis
D.
severehypermagnesemiaassociatedwithmyalgiaandlethargyintheacutephaseofleptospirosis
E. severehypomagnesemiaassociatedwithmyalgiaandlethargyintheacutephaseofleptospirosis

#15of28(QID:822303)1Points
Unknown|Unknown|Unknown

Question:
A 17yearold boy infected with hepatitis A experiences mild nausea for about 1 week anddevelops very mild
scleral icterus. On physical examination, he has minimal right upper quadrant tenderness. Laboratory findings
includeaserum
ASTof68U/L[840IU/L],ALTof75U/L[560U/L],andtotalbilirubinof5.1mg/dL[0.21.2mg/dL].
Theincreaseinthispatient'sserumenzymelevelsmostlikelyresultsfromwhichofthefollowingchangesinthe
hepatocytes?
https://cmumed.myexammaster.com/faculty_exams/53358/print?display_type=alpha

8/17

2/20/2015

https://cmumed.myexammaster.com/faculty_exams/53358/print?display_type=alpha

A.A.
Autophagybylysosomes
A.B.
Clumpingofnuclearchromatin
A.
C.
Defectsinthecellmembrane
A.
D.
Dispersionofribosomes
A.E.
Swellingofthemitochondria

#16of28(QID:822304)1Points
Unknown|Unknown|Unknown

Question:
A large volume of blood is transfused to a person whose baroreceptor blood pressure control system is not
functioningandarterialbloodpressurerisesfromthenormallevelof100to160mmHg.Ifthesamevolumeof
bloodisinfusedintothesamepersonwhenthebaroreceptorsystemisfunctioningandthistimethearterial
pressure increases from the normal level from 100 mm Hg up to 120 mm Hg, calculate the gain of the
baroreceptorsysteminthisperson.
Ifthepressurekeepdecreasingwithinthenextmonth,intherightlambarea,whatwillbetheconsequences

A.A.
Necrosismostlycoagulative
A.
B.
Atrophyofthemuscleswithchancesorrecovery
A.C.
Dystrophyofthemusclewithchancesofmetaplasia
A.D.
Hypertrophyofthemusclesreactionaltotheinjury
E. Nothingwillhappenbecauseshuntwillopenup

#17of28(QID:822305)1Points
Unknown|Unknown|Unknown

Question:
During DNA replication, which of the following enzymes produces a short strand of RNA complementary to the
https://cmumed.myexammaster.com/faculty_exams/53358/print?display_type=alpha

9/17

2/20/2015

https://cmumed.myexammaster.com/faculty_exams/53358/print?display_type=alpha

templateDNAwithafree3'OHend?

A. DNAligase
B. PolymeraseI
C. PolymeraseIII
D. Primase
E. Topoisomerase

#18of28(QID:822306)1Points
Unknown|Unknown|Unknown

Question:

Anelderlyfemalewithahistoryofalcoholicdiseasedevelopsjaundiceandmarkedanasarca.Whichofthe
followingisthemostlikelypathophysiologyofherpersistentedema?
A. Lymphaticobstruction
B. Reducedcentralvenouspressure
C. Reducedplasmaoncoticpressure
D. Sodiumretention
E. Venousthrombosis

#19of28(QID:822307)1Points
Unknown|Unknown|Unknown

Question:

A30yearoldAfricanAmericanwomanhasachestxraythatshowshilarlymphadenopathyanddiffuse
abnormalitiesofthelungparenchyma.Biopsyrevealsnoncaseatinggranulomas.Acidfast,silver,andPAS
stainsonthegranulomasarenegative.Whichofthefollowingisthemostlikelydiagnosis?
A. Coccidioidomycosis
B. Histoplasmosis
C. Leprosy
D. Sarcoidosis
E. Tuberculosis

#20of28(QID:822308)1Points
Unknown|Unknown|Unknown

Question:

Apatientpresentswithasevereformofatopicasthma.Whichofthefollowingchangeswouldmostlikely
befoundinthispatient'sblood?
https://cmumed.myexammaster.com/faculty_exams/53358/print?display_type=alpha

10/17

2/20/2015

https://cmumed.myexammaster.com/faculty_exams/53358/print?display_type=alpha

A. Basophilicleukocytosis
B. Eosinophilicleukocytosis
C. Lymphocytosis
D. Monocytosis
E. Neutrophilicleukocytosis

#21of28(QID:822309)1Points
Unknown|Unknown|Unknown

Question:
Ionizedcalciumamplifiestheadverseeffectsofhypoxiabyactivatingseveralenzymes
Whichoneisthebestanswer:

A. LyticATPase:DegradesATPandfurtherreducestheenergystores.
A.B.
Phospholipases:Theseenzymesremovephospholipidsfromtheplasmaormitochondrial
A.C.
Membranes,furtherimpairingtheirfunction.
A.D.
Proteases:Theseenzymesdegradecellmembraneorcytoskeletalproteins.
A.E.
Endonucleases:TheseenzymesactontheRNAandDNA.
F. Alloftheabove
A.G.
Noneoftheabove
A.H.
AandBarecorrect
A.
I. CandDarecorrect

#22of28(QID:822534)1Points
Unknown|Unknown|Unknown

Question:
A35yearoldmanpresentstothephysicianwitharthriticpaininbothkneesalongwithbackpain.Hestatesthatthe
painhasbeenpresentformonths.Inanefforttoobtainrelief,hehastakenonlyaspirin,butthishasbeenoflittle
benefit.Thepatientisafebrile,andhisslightlyswollenkneejointsareneitherhotnortendertopalpationhowever,
thepaindoesrestricthismotion.Thecartilageofhisearsappearsslightlydarkerthannormal.Notophiarepresent.
Aurinespecimenistakenforanalysisofuricacidcontentandturnsblackinthelaboratorywhilestanding.

https://cmumed.myexammaster.com/faculty_exams/53358/print?display_type=alpha

11/17

2/20/2015

https://cmumed.myexammaster.com/faculty_exams/53358/print?display_type=alpha

Adefectinwhichofthefollowingisthemostlikelyunderlyingcauseofthepatientscondition?

A.A.
Galactokinase
A.
B.
Homogentisicacidoxidase
A.C.
Phenylalaninehydroxylase
A.D.
Ketoaciddehydrogenase
A.E.
Orotatephosphoribosyltransferase

#23of28(QID:822544)1Points
Unknown|Unknown|Unknown

Question:
Aspartoftheroutinephysicalexamination,physicianstypicallyevaluatepalatalelevationbyaskingthepatientto
sayah.Themusclesusedtoperformpalatalelevationarederived
fromwhichofthefollowingembryologicstructures?

A.A.
Branchialarches1and2
A.
B.
Branchialarches3and4

C. Branchialclefts1and2
A.D.
Branchialarches4and6
A.E.
Branchialpouches3and4

#24of28(QID:822547)1Points
Unknown|Unknown|Unknown

Question:
https://cmumed.myexammaster.com/faculty_exams/53358/print?display_type=alpha

12/17

2/20/2015

https://cmumed.myexammaster.com/faculty_exams/53358/print?display_type=alpha

Wasstronglysuspectedclinicallyofhavingprimarysclerosingcholangitisbasedonclinicalexaminationsandlater
died of hepatic failure. The entire course of the disease lasted about 10 mo. The autopsy revealed extensive
fibrinoid necrosis in the liver, kidney, spleen, pancreas, lung, lymph nodes, and pleura. Particularly extensive
fibrinoidnecrosisintheportaltractsoftheliverinducedseverestenosesoftheintrahepaticbileducts,resultingin
cholestasis in association with prominent liver injury. There were no findings indicating primary sclerosing
cholangitis.Thehepaticlesionsinthiscasedidnotcoincidewithanyknowndiseaseincludingcollagendiseases.To
clarifythecauseofirregularstenosesoftheintrahepaticbiliarytreesoncholangiographicfindings,wepostulate
thatsomeformofimmunologicalderangementmightbeinvolvedinpathogenesisoffibrinoidnecrosis.However,
thetrueetiologyremainsunknown.
Whichofthefollowingpicturesisrelatedtothiscase?

A. A
B. B
C. C
D. D
Media

#25of28(QID:822551)1Points
Unknown|Unknown|Unknown

Question:
A40yearoldwomanfelldown9stairsandlandedonherleftside.Shedevelopedalargehematomaonherleft
buttockandsubsequentlyexperiencedpainthatstartedathermidbackandradiateddownherleftbuttocktothe
posterioraspectofherleftcalf.Thepainwassharp,constant,andsevereenoughtoawakenherfromsleep.Five
monthslater,shenoticedamassinherleftbuttock,wassentformagneticresonanceimaging(MRI)ofherpelvis,
andwasreferredtoanorthopediconcologist.Herhistorywasnotableforaspinefusion7yearsprior,butshehad
sincebeenpainfreeuntilherfall.Shewastakingacetaminophen/hydrocodone(750/7.5,3daily),fentanyl(50mcg,
onceevery3days),cyclobenzaprine(10mg,3daily),andtizanidine(48mgatbedtime)forpainwithoutrelief.No
masses were palpable on physical examination, but a horizontal indentation into the left buttock contour was
present.Therewasnooverlyingwarmth,erythema,oredemainherleftbuttockorposteriorleg.However,shewas
sensitive to light touch throughout the left buttock region and into the posterior thigh and calf. She had full,
unrestrictedrangeofmotionofherleftlowerextremitywithanonantalgic,heeltoeprogressivegaitpattern.
WHATMIGHTBEGOINGONINTHISPATIENT?

https://cmumed.myexammaster.com/faculty_exams/53358/print?display_type=alpha

13/17

2/20/2015

https://cmumed.myexammaster.com/faculty_exams/53358/print?display_type=alpha

A.
A.
Lipoatrophyoftheareaofinjurieswithafatscaring
A.B.
Cavitationcausedbythehematomaduringthefall
A.C.
Muscledystrophyfromoldcancer
A.D.
Sarcopenia,normaltrophyofthemusclewithoutunderlyingpathology
A.E.
Metaplasiaofherlegsmuscles
Media

#26of28(QID:822552)1Points
Unknown|Unknown|Unknown

Question:
Thisfemalefetuswastheproductofelectivedeliveryat23weeksofgestationalageafteraprenatalultrasound
disclosedbilateralmulticystickidneys.Afullautopsywasperformed.Anthropometricvalueswereadequateforthe
gestationalage.Onexternalexamination,nogrossmalformationswereidentifiedsignificantabdominaldistention
was noted. Internal examination revealed massively enlarged kidneys, with poor demarcation between the renal
cortexandmedullaandnumerouscyststhroughouttheparenchyma,rangingfrom0.1to0.7cmindiameter,some
ofthemfilledbyclearyellowfluid(Figure1).Nootherurinarysystemabnormalitieswereidentified,andbothureters
andtheurethrawerepatent.Theotherorgansweregrosslynormal.Microscopic evaluation of the liver revealed
diffusemicroandmacrovesicularsteatosis(seepicture).Therewerenoapparentabnormalitiesinthebiliarytree
or hepatic fibrosis. Extramedullary hematopoiesis was also present. The pancreatic acinar cells and uterus also
showedseverelipidaccumulation(seepic),andthethyroid,adrenalglandsandlungshowedvariabledegreesof
steatosis. There was also acute and chronic thymic involution, and the placenta showed immature villi for the
gestationalageandnonhydropicvillousedema.Metabolicstudieswereperformedinamnioticfluid(storedafteran
amniocentesis) and macerated liver obtained during autopsy, and showed marked elevation of organic acids,
includingglutaricacid,elevationofunsaturatedlongfattyacidsandmarkedlydecreasedcarnitine.
BesidehercongenitalmetabolicconditionleadingtoFattyacidoxidationdisorder,whatPotentialpathophysiologic
mechanismsforfattyliver?

A. Decreasedmitochondrialfattyacidbetaoxidation
A.B.
Increasedendogenousfattyacidsynthesisorenhanceddeliveryoffattyacidstotheliver
https://cmumed.myexammaster.com/faculty_exams/53358/print?display_type=alpha

14/17

2/20/2015

https://cmumed.myexammaster.com/faculty_exams/53358/print?display_type=alpha

C. Deficientincorporationorexportoftriglyceridesasverylowdensitylipoprotein(VLDL)
A.
D.
Alloftheabove
A.E.
NoneoftheabovebesideAiscorrect
A.F.
AandBarecorrect
Media

#27of28(QID:822690)1Points
Unknown|Unknown|Unknown

Question:
A48yearoldmanwasreferredtoPapanikolaouGeneralHospital(Thessaloniki,Greece)duetopleuralpain,which
startedthreedaysbeforereferral.Healsoreportedanepisodeofhemoptysistwodaysearlier.Thepatienthada
medical history of factor V Leiden thrombophilia (heterozygous), which had produced a myocardial infarction 15
years previously and an ischemic stroke one year previously. Acenocoumarol was used for the treatment of
thrombophilia.Hischestxrayshowedperfusionoftheleftupperlobewithpossiblecentralnecrosisclosetotheleft
portal. A laboratory test was positive for Ddimers (0.766 g/mL, normal range 0 g/mL to 0.500 g/mL). A
pulmonaryembolismwassuspectedbutwasexcludedbyacomputedtomography(CT)angiogram.Bronchoscopy
wasalsoperformedfordiagnosticpurposes.Forpreventionofhemorrhage,theacenocoumarolwasdiscontinued
two days before the examination and was replaced with low molecular weight heparin. After the procedure, the
patient showed signs of abdominal aortic embolism (low back pain, discolouration of the lower extremities,
paralysisandabsenceofpulse).Thepreoperativeangiogramshowednotonlyanembolusintheaortabutalso
occlusionoftheceliacartery.
whatorgan(s)arewesuspectingtobehemorrhagicnecrotic?

A. esophagealbranch,stomachbranch,Spleen,liver,pancreas
B. liver,pancreasonlytobecomeportalsystem
C. jejunum,stomach,liver
D. jejunum,ileum,spleenpancreasleftkidney
E. Alloftheabovearecorrect
Media
https://cmumed.myexammaster.com/faculty_exams/53358/print?display_type=alpha

15/17

2/20/2015

https://cmumed.myexammaster.com/faculty_exams/53358/print?display_type=alpha

#28of28(QID:822705)1Points
Unknown|Unknown|Unknown

Question:

WHICHOFTHESE3PICTURESREPRESENTADYSPLASIA:
A. A
B. B
C. C
Media

AnswerKey
1. E:Tcells
2. E:Atrophy
3. D:Surgicallungbiopsy
4. B:Hissymptomsareduetoimpairedbradykinindegradationbylisinopril.
5. E:AandBarethecorrectanswer.
6. D:A.Selectins
7. B:Fibroblasts
8. C:ProphaseofmeiosisI
9. B:A.Inferiorvesicularartery
10. B:A.Increasedlevelsoffructose2,6bisphosphate
11. B:A.Isoleucine
https://cmumed.myexammaster.com/faculty_exams/53358/print?display_type=alpha

16/17

2/20/2015

https://cmumed.myexammaster.com/faculty_exams/53358/print?display_type=alpha

12. A:A.DecreaseincGMP
13. D:Russellbodies
14. E:severehypomagnesemiaassociatedwithmyalgiaandlethargyintheacutephaseofleptospirosis
15. C:A.Defectsinthecellmembrane
16. B:A.Atrophyofthemuscleswithchancesorrecovery
17. D:Primase
18. C:Reducedplasmaoncoticpressure
19. D:Sarcoidosis
20. B:Eosinophilicleukocytosis
21. F:Alloftheabove
22. B:A.Homogentisicacidoxidase
23. B:A.Branchialarches3and4
24. B:B
25. A:A.Lipoatrophyoftheareaofinjurieswithafatscaring
26. D:A.Alloftheabove
27. A:esophagealbranch,stomachbranch,Spleen,liver,pancreas
28. B:B

QIDList:821216,822184,822185,822186,822187,822188,822189,822190,822191,822193,822194,822195
,822196,822199,822303,822304,822305,822306,822307,822308,822309,822534,822544,822547,822551
,822552,822690,822705

https://cmumed.myexammaster.com/faculty_exams/53358/print?display_type=alpha

17/17

Você também pode gostar