26. A 68-year-old, well-developed, well-nourished black man presents to the emergency department complaining of shortness of breatii. He denies chest pain. He has no significant past medical history and takes no medications. A chest x-ray film shows clear lung fields, mild cardiomegaly, and a widened thoracic aorta with linear calcifications. An MRI of the chest shows aortic dilatation in the thorax, extending proximally, with atrophy of the muscularis and wrinkling of the intimal surface. What is the most likely etiology of this condition?

(A) Atherosclerosis

(B) Hypertension

(C) Marfan syndrome

(D) Syphilis infection

(E) Takayasu arteritis

27. A 32-year-old woman is diagnosed with breast cancer. Her mother had cervical cancer at age 35, her grandfather had colon cancer at age 36, and her brother was recently diagnosed with lung cancer. If genetic analysis is performed, what would be the likely genotype of this individual at the p53 tumor suppressor gene locus?

(A) One deleted allele

(B) Two deleted alleles

(C) Two wild-type alleles

(D) Three wild-type alleles

(E) Fusion of one p53 allele with another gene

28. Bronchoalveolar lavage is performed in a patient with long-standing congestive heart failure exacerbated by periodic acute pulmonary edema. Which of die following findings would be consistent with this patient's history of cardiac failure?

(A) Anthracotic macrophages

(B) Charcot-Leyden crystals

(C) Curschmann spirals

(D) Fat-laden macrophages

(E) Ferruginous bodies

(F) Goblet cells

(G) Iron-laden macrophages

(H) Squamous pearls

29. A 23-year-old African American woman presents to die emergency department with severe abdominal pain and evidence of dehydration. Her past medical history is significant for numerous pulmonary infections and effusions of the knees. This patients erythrocytes would be expected to exhibit

(A) an absence of central pallor

(B) deletion of all four alpha Fib genes

(C) denaturation during deoxygenation

(D) Heinz bodies on RBC staining

30. A young man presents to his physician's office for a physical examination. He is concerned because his father died of a heart attack in his late 40s. The physician finds that the patient has elevated serum cholesterol and LDL levels, but his VLDL and triglyceride levels are normal. Further investigation reveals an LDL receptor deficiency. This patient has which of the following types of hyper) ipidemia?

31. A brief occlusion of the right femoral artery produces transient ischemia in the forebmb of a laboratory animal. The cellular edema seen in reversibly injured cells in a muscle biopsy taken from the animal is most closely related to an increase in which of the following?

(A) Intracellular Ca2+

(B) Intracellular K+

(C) Intracellular Mg2h

(D) Intracellular Na+

(E) Na'h/K+ ATPase pump activity

32. A 28-year-old woman presents to the physician complaining of syncopal episodes that last a few minutes. She is not taking any medications and has no previous medical history. EEG and EKG studies are performed and are unremarkable. An echocardiogram shows a single ball-shaped mass dangling in the left atrium near the mitral valve. Which of die following is the most likely diagnosis?











33. Biopsy of the lung from a patient with chronic lung disease demonstrates a honeycomb appearance on gross inspection and fibrosis with inflammation of the alveolar walls on microscopic examination. The patient's blood gas studies are within normal limits. If spirometry were performed on this patient, which of the following would most likely be seen?

(A) Decreased airway resistance

(B) Decreased compliance

(C) Increased functional residual capacity (FRC)

(D) Increased lung volume

(E) Increased tidal volume

34. An infant born at 33 weeks' gestation exhibits signs of respiratory distress at birth. Her mother had gestational diabetes. Which of the following would have indicated lung immaturity in the fetus prior to birth?

(B) Alpha-1 antitrypsin deficiency in amniodc fluid

(C) Amniotic lecithin sphingomyelin ratio less than 2:1

(D) Elevated maternal HbA]c

(E) Elevated maternal serum alpha-fetoprotein (AFP)

35. A patient is observed to have an abnormal breathing pattern characterized by cyclical changes in tidal volume. The tidal volume first increases and then decreases to the point of apnea. What term best describes diis breathing pattern?

(A) Apneustic

(C) Cheyne-Stokes

(D) Hysterical

(E) Kussmaul

36. A cyanotic infant is discovered to have a ventricular septal defect, an overriding aorta, right ventricular hypertrophy, and complete pulmonic stenosis. Which of the following accompanying congenital anomalies permits survival in this patient?

(A) Bicuspid aortic valve

(B) Ostium secundum defect

(C) Patent ductus arteriosus

(D) Patent foramen ovale

(E) Preductal coarctation of aorta

37. A 45-year-old man presents to the physician with muscle cramps, perioral numbness, and irritability over the past 3-4 months. Laboratory results reveal hypocalcemia, normal albumin level, mild hypomagnesemia, and hyperphosphatemia. Parathyroid hormone (PTH) level is decreased. Alkaline phosphatase level is normal. Which of the following is most likely causing this clinical scenario?

(A) Bone metastases

(B) Hashimoto thyroiditis

(C) Hypervitaminosis D

(D) Hypomagnesemia

(E) Previous subtotal thyroidectomy

38. A patient with systemic lupus erythematosus (SLE) very much wants to become pregnant What should her physician should tell her regarding pregnancy in lupus patients?

(A) There is no increased risk to the baby

(B) There is an increased risk of cardiovascular malformations

(C) There is an increased risk of nervous system malformations

(D) There is an increased risk of renal malformations

(E) There is an increased risk of spontaneous abortions and prematurity

39. Deficiency of which of the following factors usually predisposes to thrombosis rather than bleeding?

40. A 32-year-old woman with one child has tried unsuccessfully to conceive for the past 2 years. She tells her physician that she has had problems putting on weight and is often anxious and irritable. On physical examination, her thyroid is enlarged with no palpable nodules. Which of the following laboratory findings would be most suggestive of a diagnosis of secondary hyperthyroidism?

Research Physical Examination

43. A 32-year-old man with a history of chronic drug abuse presents to his primary care physician complaining of uncontrollable shaking in his hands. He moves very slowly and walks with a stooped posture and shuffling gait. Physical examination reveals cogwheel rigidity, a pill-rolling tremor, and masked fades. His condition deteriorates, and he eventually dies. Structures similar to which of the following would be expected on autopsy?

(A) Hirano bodies

(B) Lewy bodies

(C) Lipofuscin granules

(D) Negri bodies

(E) Neurofibrillary tangles

44. A 45-year-old woman complains of difficulty speaking, chewing, and swallowing. She experiences generalized weakness that increases with effort and as the day goes on. Symptoms are significandy improved after taking neostigmine. Autoantibodies responsible for causing the patient's condition are directed against which of the following?

(A) Acetylcholine receptors

(B) Double-stranded DNA

(C) Dystrophin

(D) Erythrocyte surface antigens

(E) Myelin

45. A patient has severe arthritis involving the lower back. Before making a diagnosis of ankylosing spondylitis, the patient should be questioned about which of the following diseases?

(A) Carcinoid syndrome

(B) Celiac disease

(C) Crohn disease

(D) Peptic ulcer

(E) Whipple disease

46. A 3-year-old child develops severe generalized edema following a viral infecdon. On the basis of clinical chemistry tests, a renal biopsy is performed, with normal light microscopic findings. Which of the following abnormal laboratory values might be expected in this individual?

(A) Decreased alpha2 globulin levels

(B) Decreased fibrinogen

(C) Increased serum calcium levels

(D) Low serum albumin levels

(E) Red blood cell casts in the urine

47. A patient with long-standing hypertension dies in a car accident. At autopsy, multiple, small, cavitary lesions are observed in the basal ganglia. This finding is most consistent with pathology of which of the following arteries?

(A) Anterior cerebral

(B) Lateral striate

(C) Posterior cerebral

(D) Superior cerebellar

(E) Vertebral

48. The osmotic fragility test would be most useful for the diagnosis of which of the following disorders?

(A) Alpha thalassemia minor

(B) Beta thalassemia major

(C) Hereditary spherocytosis

(D) Sickle cell anemia

(E) Sickle cell trait

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