MCQ Book Questions

Q60242. A 45-year-old woman with longstanding Crohn disease and severe fat malabsorption experiences a fracture of the femoral neck after a minor contusion. This woman most likely has a defi ciency of which of the following vitamins?

Q60243. A 28-year-old pregnant woman weighs 86.4 kg (190 lb) and gives birth after 39 weeks of gestation to a small baby weigh- ing 2,300 g (5 lb, 1 oz). The baby has no congenital anoma- lies. Which of the following maternal factors in this case may be associated with the infant’s low birth weight?

Q60244. A 52-year-old man presents with sudden crushing chest pain and tachycardia. He admits to cigarette smoking, consump- tion of alcohol, and abuse of illicit drugs. An ECG is consistent with ischemic change in the anteroseptal region of the heart. Laboratory studies show elevated serum levels of CK-MB and troponin I. Serum cholesterol is 240 mg/dL. Which of the fol- lowing most likely contributed to this patient’s condition?

Q60245. A 52-year-old man presents with a chronic cough and shortness of breath. He admits to smoking two packs of cigarettes a day for 30 years. Pulmonary function tests reveal chronic obstruc- tive pulmonary disease. In counseling this patient, you advise him to stop smoking immediately. You also mention that, in addition to emphysema, which of the following organs carries a signifi cantly increased risk of smoking-related cancer?

Q60246. A homeless, poorly nourished man collapses on the street and cannot be revived by the emergency medical technicians. A social service agency notes that he had a long history of abus- ing many illicit drugs. An autopsy is performed and reveals a moderately enlarged heart, with patent coronary arteries and no valvular abnormalities. Microscopic examination shows patchy fi brosis of the myocardium. Which of the following substances most likely caused this cardiomyopathy?

Q60247. A starving, 4-year-old, African boy presents with apathy, gen- eralized edema, and an enlarged fatty liver. The physician notes that, despite generalized growth failure, subcutaneous fat is preserved. What is the appropriate diagnosis?

Q60248. Petechial hemorrhages were noticed on the upper and lower extremities of a 5-day-old infant. Hemorrhagic disease of the neonate was most likely caused by a defi ciency of which of the following vitamins?

Q60249. A 6-year-old girl is examined at a clinic in central Africa. Physical examination reveals wasting of muscle and fat, and a protuberant abdomen. Her pulse, blood pressure, and temper- ature are low. The face appears wrinkled. There is no evidence of generalized edema. What is the appropriate diagnosis?

Q60250. A 40-year-old, chronically ill man from a Vietnamese village presents with painful sores around his mouth. Physical exami- nation reveals prominent fi ssures at the angles of his mouth. Cheilosis in this patient is most likely caused by a defi ciency of which of the following vitamins?

Q60251. A 32-year-old woman is a vegan (i.e., a strict vegetarian who eats no animal products of any kind). She is weak and pale, and laboratory studies show a macrocytic, normochromic anemia (hemoglobin = 6.2 g/dL). This patient most likely has which of the following vitamin defi ciencies?

Q60252. A 23-year-old man presents with a 6-day history of fever, sore throat, swollen lymph nodes, weight loss, and fatigue. Physi- cal examination shows generalized lymphadenopathy, most prominent in the cervical lymph nodes, and mild hepatosple- nomegaly. The peripheral blood smear shows 65% atypical lymphocytes. A Paul-Bunnell antigen test (heterophile anti- body test) is positive. The serum ALT, AST, and bilirubin are slightly elevated. The atypical lymphocytes in this patient’s peripheral blood are described as which of the following?

Q60253. Which of the following is the most likely complication for the patient described in Question 1?

Q60254. A 19-year-old woman presents with vague lower abdominal pain and a swollen, painful right knee. She denies any trauma to the knee or history of arthritic disorders. Physical examina- tion reveals an enlarged joint that is red, warm, and painful. Pelvic examination is exquisitely painful and reveals an ill- defi ned thickening in both adnexae. A green-yellow purulent vaginal discharge is noted. The patient is febrile and has an elevated WBC count of 15,000/μL. Which of the following etiologic agents is most likely responsible for this patient’s condition?

Q60255. A 54-year-old man presents with a worsening skin rash of 10 days in duration. Physical examination shows an exten- sive, desquamative maculopapular rash of the palms and soles (shown in the image). The VDRL and FT-ABS tests are both positive. Which of the following lesions is also expected in this patient at this stage of his disease?

Q60256. A 3-year-old child attending a daycare center develops fever, chills, generalized rash, and a stiff neck. The child becomes hypotensive and expires the next day. Postmortem examina- tion demonstrates bilateral adrenal hemorrhages (shown on right). Which of the following etiologic agents is the most likely cause of this child’s disease?

Q60257. A 45-year-old woman from India develops paroxysms of fever, chills, and severe headache while visiting her brother in the United States. Physical examination demonstrates hepatosple- nomegaly and general pallor. Laboratory studies show anemia and hyperbilirubinemia. Her urine appears dark on visual inspection, and a urine dipstick is positive for hemoglobin. The patient develops tonic-clonic seizures and becomes coma- tose. Which of the following pathogens is most likely respon- sible for this patient’s symptoms?

Q60258. A 35-year-old man presents with multiple skin lesions on his left forearm. He had worked in a garment factory, where he sorted wool imported from Iran. Physical examination shows an elevated cutaneous papule with bloody purulent exudate. An adjacent lesion displays a black scab. There is prominent axil- lary lymphadenopathy. This patient’s necrotizing skin lesions are most likely caused by which of the following pathogens?

Q60259. A 24-year-old man, who has just returned from a trip to India, complains of fatigue and severe, unremitting, watery diarrhea. Laboratory studies show severe hypernatremia and hypokalemia. Which of the following metabolic changes in enterocytes is chiefl y responsible for the pathogenesis of this patient’s acute gastrointestinal disorder?

Q60260. A 12-year-old girl develops fever, abdominal pain, and bloody diarrhea 1 to 2 days after eating a hamburger at a fast food restaurant. Physical examination reveals an extensive purpuric skin rash. The patient develops oliguria, and laboratory stud- ies show elevated serum levels of BUN and creatinine. Which of the following is the most likely etiologic agent responsible for this patient’s condition?

Q60261. A 65-year-old man undergoes cardiac bypass surgery and is placed on postoperative, broad-spectrum, antibiotic prophy- laxis. Several days later, he develops fever, abdominal pain, and bloody diarrhea. Colonoscopic biopsy demonstrates a thick mucopurulent exudate. Which of the following is the most likely etiology of this patient’s gastrointestinal disorder?