MCQ Book Questions

Q60522. A 60-year-old man presents with a 3-week history of weight loss, vague abdominal pain, and progressive yellowing of his skin and sclerae. He also reports the recent onset of intermit- tent pain in the upper and lower extremities. Laboratory stud- ies show a serum bilirubin level of 15 mg/dL, mostly in the conjugated form. A CT scan of the abdomen reveals a mass in the head of the pancreas. The patient develops sudden shortness of breath and is diagnosed with pulmonary throm- boembolism. Which of the following is the most likely cause of thromboembolism in this patient?

Q60523. A 63-year-old woman presents with a 6-month history of recurrent epigastric pain and nausea. Abdominal ultrasound reveals a 13-mm hypoechoic lesion in the tail of the pancreas. Physical examination shows fl ushing of the face, periorbital edema, and hypotension (blood pressure = 90/50 mm Hg). Laboratory studies disclose normal serum levels of gastrin, amylase, insulin, and vasoactive intestinal polypeptide. Uri- nalysis demonstrates elevated levels of metanephrines (10 mg per 24 hours). Which of the following is the most likely diagnosis?

Q60524. A 65-year-old man with a history of acromegaly complains of recurrent epigastric pain and dark-colored tarry stools. Labo- ratory studies reveal moderate hypercalcemia, hyperlipidemia, and elevated serum levels of PTH and gastrin. Serum glucose is within normal limits. Abdominal ultrasound shows a mass in the tail of the pancreas. Which of the following is the most likely diagnosis?

Q60525. A 36-year-old woman complains of a 4-week history of unremitting watery diarrhea. She reports that she is always thirsty and drinks continuously. Laboratory studies show achlorhydria, hypokalemia, and mild acidosis. A CT scan of the abdomen demonstrates a 1.5-cm pancreatic mass. Which of the following is the most likely diagnosis?

Q60526. A 45-year-old woman complains of right upper quadrant abdominal pain, weight loss, dry mouth, increased urine pro- duction, and foul-smelling fatty stools. She has a recent history of mild diabetes mellitus. Abdominal ultrasound examination reveals gallstones and a solitary 1.5-cm mass in the pancreas. Which of the following hormones would most likely be ele- vated in the blood of this patient?

Q60527. The mother of a 2-month-old child palpates a mass on the left side of the child’s abdomen. Vital signs are normal. A CT-guided renal biopsy shows undifferentiated tubules sur- rounded by undifferentiated mesenchyme, smooth muscle, and islands of cartilage. The mass is removed (shown in the image) and displays variably sized cysts. Which of the follow- ing is the most likely diagnosis for this child’s fl ank mass?

Q60528. A 38-year-old man presents with vague fl ank pain and describes the passage of blood clots in his urine. Physical examination reveals bilateral fl ank and abdominal masses. Laboratory studies show elevated blood urea nitrogen and creatinine. Urinalysis reveals hematuria, proteinuria, and oliguria. A CT scan discloses bilaterally, massively enlarged kidneys. The patient subsequently develops end-stage kidney disease and receives a renal transplant. The patient’s kidneys are removed during surgery (shown in the image). What is the most likely diagnosis?

Q60529. The patient described in Question 2 carries an increased risk for which of the following abnormalities?

Q60530. A 49-year-old man with a history of heavy smoking presents with a 5-year history of shortness of breath and cough and production of abundant foul-smelling sputum. A pulmonary work-up demonstrates chronic bronchiectasis. Laboratory studies reveal hypoalbuminemia and hyperlipidemia. Uri- nalysis shows heavy proteinuria (>4 g per day). Which of the following is the appropriate diagnosis?

Q60531. A 12-year-old boy complains of swelling of his feet for the past 3 weeks. He is otherwise healthy, with no known previous illness. Vital signs are normal. Physical examination reveals pitting edema of the lower legs and a swollen abdomen. Uri- nalysis shows 4+ protein but no RBCs or WBCs. Which of the following are the most likely diagnoses to consider in your evaluation of this patient?

Q60532. A 4-year-old girl presents with swelling of the legs and ankles. Physical examination reveals pitting edema of the lower extremities. Urinalysis show 2+ proteinuria. The urinary sediment contains no infl ammatory cells or red blood cells. Serum levels of BUN and creatinine are nor- mal. The patient recovers completely after a course of cor- ticosteroids. Which of the following pathologic fi ndings might be expected in the urine prior to treatment with corticosteroids?

Q60533. A 46-year-old woman presents with a 6-month history of vague upper abdominal pain after fatty meals, some abdomi- nal distension, and frequent indigestion. Physical examination shows an obese woman (BMI = 32 kg/m2) with right upper quadrant tenderness. A CT scan discloses gallstones and an ectopic kidney. Which of the following is the expected loca- tion of the ectopic kidney?

Q60534. A 12-year-old girl complains of swelling of her eyelids, abdo- men, and ankles. She had been in good health until several months ago, when she gained some weight and noted swelling of her lower legs. An X-ray fi lm of the chest shows bilateral pleural effusions, without evidence of lung disease. Urinalysis reveals heavy proteinuria (8 g per 24 hours) without hematu- ria. A percutaneous needle biopsy of the kidney discloses no morphologic abnormalities by light microscopy. Which of the following best describes this patient’s medical condition?

Q60535. An 8-year-old boy presents with headaches, dizziness, and malaise. He was seen for a severe sore throat 2 weeks ago. Physical examination reveals facial edema. The blood pressure is 180/110 mm Hg. A 24-hour urine collection demonstrates oliguria, and urinalysis shows hematuria. Which of the fol- lowing best describes this patient’s medical condition?

Q60536. What fi nding on microscopic urinalysis indicates that hematuria in the patient described in Question 6 is caused by a renal pro- cess, rather than bleeding from another site in the urinary tract?

Q60537. A 14-year-old girl presents with a 5-day history of hypertension, oliguria, and hematuria. She was seen 2 weeks earlier for a severe throat infection with group A (β-hemolytic) strepto- cocci. A kidney biopsy displays glomerulonephritis. Immu- nofl uorescence staining for which of the following proteins would provide the strongest evidence that this patient’s glom- erulonephritis is mediated by immune complexes?

Q60538. A 28-year-old man complains of nasal obstruction, bloody nose, cough, and bloody sputum. A chest X-ray displays cavi- tated lesions and multiple nodules within both lung fi elds. Urinalysis reveals 3+ hematuria and red blood cell casts. Laboratory studies show anemia and elevated serum levels of C-ANCA (antineutrophil cytoplasmic antibody). Peripheral eosinophils are not increased. A renal biopsy exhibits focal glomerular necrosis with crescents and vasculitis affecting arterioles and venules. What is the appropriate diagnosis?

Q60539. Which of the following best describes the renal disease of the patient described in Question 17?

Q60540. For the patient described in Question 11, electron microscopy of a renal biopsy specimen prior to treatment would most likely demonstrate which of the following abnormalities?

Q60541. A 44-year-old man complains of swelling of his legs and puffi - ness around his eyes. His abdomen has become protuberant and he feels short of breath. Physical examination reveals gen- eralized edema and ascites. Total serum protein is 5.2 g/dL (reference = 5.5 to 8.0 g/dL), and albumin is 1.9 g/dL (reference = 3.5 to 5.5 g/dL). Serum cholesterol is elevated at 530 mg/dL. There are 5 g of protein in a 24-hour urine collec- tion. The urinary sediment contains many hyalin casts but no RBCs or infl ammatory cells. A renal biopsy stained by direct immunofl uorescence for IgG is shown in the image. Which of the following is the most likely diagnosis?