1/10
A 46-year-old Caucasian female with severe upper abdominal pain, vomiting and fever is found to have an inflamed and partially necrotic gallbladder on laparotomy. Which of the following events most likely initiated this patient's condition?
- Bacterial invasion of the gallbladder wall
- Ischemic disruption of the mucosal layer
- Cystic artery thrombosis
- Gallbladder outflow obstruction
- Lecithin hydrolysis and mucosal damage
2/10
A 50-year-old Caucasian female presents to your office with periodic flatulence, abdominal pain and explosive diarrhea. After careful history taking, you suspect lactase deficiency as the cause of this patient's symptoms. If your diagnosis is correct, which of the following is most likely to decrease on lactose challenge in this patient?
- Stool osmotic gap
- Stool pH
- Breath hydrogen content
- D-xylose absorption
- Cobalamin absorption
3/10
A 50-year-old woman comes to the emergency department with severe upper abdominal pain. The pain started suddenly and is sharp and colicky. She has also vomited several times throughout the day, including once while in the emergency department. The patient describes several prior episodes of similar abdominal pain that resolved spontaneously without treatment. Her other medical problems include complicated appendicitis when she was 22 years old. Her temperature is 37.8 C (100 F) and pulse is 112/min. Abdominal examination shows cessation of inspiration with deep palpation of the right upper quadrant. Laboratory assessment shows a serum bilirubin of 0.8 mg/dL and a serum alkaline phosphatase of 100 U/L. Which of the following diagnostic test results would be most specific for acute cholecystitis?
- Distended duodenum on upper gastrointestinal series
- Echogenic structures inside the gallbladder on abdominal ltrasound
- Failed gallbladder visualization on radionuclide biliary scan
- Increased serum aspartate and alanine aminotransferase levels
- Opacities in the right subcostal area on abdominal x-ray
4/10
A 44-year-old woman comes to the clinic after several 'near collisions' over the past month while driving at night. She also has generalized pruritus. The patient has not seen a physician for several years and has missed several scheduled appointments. She takes no medications. On physical examination, her skin is diffusely coarse and dry. Which of the following processes is most likely responsible for these findings?
- Chronic renal failure
- Hemolytic anemia
- Inadequate sunlight exposure
- Prolonged biliary obstruction
- Rheumatoid arthritis
- Strict vegetarian diet
5/10
A 39-year-old Caucasian female presents with several episodes of severe upper abdominal pain after an uncomplicated pregnancy. The pain is exacerbated after consumption of fatty foods. Her temperature is 37.2 C (98.9 F), and blood pressure is 143/76 mm Hg. She weighs 95 kg (210 Ib) and is 173 cm (68 in) tall. Her medications include a calcium channel blocker for hypertension and a fibrate for dyslipidemia. She undergoes an elective cholecystectomy. The contents of her gallbladder are shown on the slide below.

Decreased activity of which of the following enzymes would most contribute to this patient's condition?

Decreased activity of which of the following enzymes would most contribute to this patient's condition?
- Aromatase
- HMG-CoA reductase
- 7α-hydroxylase
- β-glucuronidase
- Thiolase
6/10
A 30-year-old man with progressive exertional dyspnea is found to have elevated liver enzymes. A liver biopsy is performed and light microscopy of the tissue specimen after periodic acid-Schiff staining is shown in the image below.

Which of the following is the most likely cause of this patient's dyspnea?

Which of the following is the most likely cause of this patient's dyspnea?
- Intraalveolar substance accumulation
- Interalveolar septa destruction
- Interstitial infiltration
- Bronchial hyperreactivity
- Pulmonary congestion
- Pulmonary vascular obstruction
7/10
An 8-year-old boy with cystic fibrosis presents to the emergency room with weakness and confusion. His mother reports that he had been playing soccer in the yard when he suddenly collapsed. On physical examination, his blood pressure is 60/30 mmHg and his heart rate is 130/min. His oral mucosa is dry. Which of the following is most likely responsible for his current symptoms?
- Sodium loss with sweating
- Free water loss with sweating
- Chloride loss with urine
- Free water loss with urine
- Gastrointestinal potassium loss
8/10
A 55-year-old man comes to the physician complaining of progressive fatigue, dyspnea, and lower extremity edema. Several days ago, he had a slight fever, runny nose, and myalgias. He has no other past medical history and takes no medications. He has no family history of cardiomyopathy or sudden cardiac death. He drinks alcohol occasionally and does not use tobacco. Physical examination reveals jugular venous distention, crackles on lung auscultation, and 2+ pitting edema involving the lower extremities. After initial evaluation, the physician suspects dilated cardiomyopathy due to viral myocarditis. Which of the following hemodynamic findings would be most suggestive of an alternative diagnosis?
- Left ventricular dilatation with abnormal systolic flow to the left atrium
- Right ventricular dilatation with abnormal systolic flow to the right atrium
- High systolic pressure gradient between the left ventricle and tile aorta
- Increased end-systolic and end-diastolic left ventricular volumes
- No significant narrowing of coronary arteries
9/10
A 10-year-old boy with dyspnea undergoes a myocardial biopsy. Light microscopy of the tissue specimen is shown in the image below.


- Recent viral infection
- Recent bacterial Infection
- Recent drug exposure
- Recent travel to Latin America
- Vaccination non-compliance
10/10
A 56-year-old man is admitted to a tertiary care center after being involved in a high-speed motor vehicle accident. He was thrown from his vehicle and suffered severe head trauma along with multiple fractures involving his ribs and extremities. Despite aggressive treatment, he dies from massive cerebral edema and brain herniation the following day. Autopsy shows increased thickness of the left ventricular wall and decreased left ventricular cavity size. The structural changes observed in this patient's heart are most likely associated with which of the following conditions?
- Atrial septal defect
- Hemochromatosis
- Longstanding nvpertension
- Mitral insufficiency
- Normal aging
- Recent myocardial infarction
- Wolff-Parkinson-White syndrome
已结束!
请选择一个选项!