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1. The modified structures at the border of the epithelium shown above are immotile in a 23-year-old patient. Which of the following would be a consequence of this lack of motility?

2. A 29-year-old epileptic sanitation engineer is maintained on primidone. Ultrastructural examination of a liver biopsy reveals increased amounts of smooth endoplasmic reticulum. This change is most closely related to increases in the activity of which of the following?

3. A 7-year-old patient presents with a mass in the anterior midline of the neck, slightly above the larynx. The mass is mobile and elevates upon protrusion of the tongue. This mass is most likely a cyst that developed from which of the following embryonic structures?

4. A baby who was apparently normal at birth, develops persistent regurgitation and vomiting in the second and third weeks of life. No fever is present and hematologic studies and blood chemistries are normal. Which of the following therapies is most likely to be effective in this case?

5. A 24-year-old woman presents with a 3-day history of fever, chills, chest pain, and cough productive of rust-colored sputum. Past medical history includes a splenectomy 1 year ago. A chest x-ray film indicates consolidation of the right lower lobe. Blood cultures are positive for a-hemolytic gram-positive diplococci. Immunity to the causative organism is based on

6. The leukocyte pictured above stains intensely with acidic dyes such as eosin. Which of the following substances is contained in the crystalline core of the granule at the arrow?

7. What is the primary function of the cell pointed to in the figure above?

8. An 8-month-old female child is brought to medical attention because her first four teeth show several discrete, discolored, circumferential bands that show very little enamel. Excessive levels of which of the following may have produced this defect?

9. A 24-year-old woman in her third trimester of pregnancy presents with urinary frequency and burning for the past few days. She denies fever, nausea, vomiting, or chills. She takes no medications besides prenatal vitamins and is generally in good health. Physical examination is remarkable for mild suprapubic tenderness, and a urine dipstick is positive for white blood cells, protein, and a small amount of blood. Culture produces greater than 100,000 colonies of gram-negative bacilli. which of the following attributes of this uropathogenic organism is most strongly associated with its virulence?

10. A 72-year-old male is noted as having a 9-pound weight loss over the past few weeks. His past medical history is significant for oat cell carcinoma of the lung, without known metastases, for which he is currently undergoing treatment. The patient states that even though his wife is preparing his favorite meals, he is not hungry. Which of the following would be the best treatment option to improve his eating habits?

11. A 33-year-old woman presents with fever, vomiting, severe irritative voiding symptoms, and pronounced costovertebral angle tenderness. Laboratory evaluation reveals leukocytosis with a left shift; blood cultures indicate bacteremia. Urinalysis shows pyuria, mild hematuria, and gram-negative bacteria. Which of the following drugs would besttreat this patient's infection?

12. A 33-year-old woman presents with fever, vomiting, severe irritative voiding symptoms, and pronounced costovertebral angle tenderness. Laboratory evaluation reveals leukocytosis with a left shift; blood cultures indicate bacteremia. Urinalysis shows pyuria, mild hematuria, and gram-negative bacteria. Which of the following drugs would best treat this patient's infection?

13. A surgeon performs an exploratory laparotomy, producing a large incision in the patient's abdomen. Poor blood supply to which of the following is most likely to cause problems during the healing process?

14. In a genotypic male, the testes fail to develop, and do not secrete testosterone or Müllerian regression factor. Which of the following best describes the in utero reproductive system development of this individual?

15. Which of the following structures is found only in Gram-negative microorganisms?

16. A 57-year-old female is found unconscious on her kitchen floor after having suffered a myocardial infarction. She has pulmonary edema and distended jugular and peripheral veins. A midsystolic gallop is heard upon chest auscultation. EKG shows prominent Q waves in leads II, III, and aVF. Which of the following is most consistent with the patient's condition?

17. A 32-year-old, blood type A positive male receives a kidney transplant from a blood type B positive female donor with whom he had a 6-antigen HL A match. Once the kidney is anastomosed to the man's vasculature, the transplant team immediately begins to observe swelling and interstitial hemorrhage. After the surgery, the patient developed fever and leukocytosis and produced no urine. Which of the following is the most likely explanation?

18. A 67-year-old black man with a history of glucose-6-phosphate dehydrogenase (G-6-PD) deficiency presents with fever, irritative voiding symptoms, and perineal pain. Rectal examination is remarkable for a boggy, exquisitely tender prostate. A urine Gram's stain is positive for gram-negative rods. The risk for development of hemolytic anemia is highest if he receives high-dose, 21-day therapy with

19. A 2-year-old retarded child is evaluated by a metabolic specialist. The child's history is significant for failure to thrive and progressive neurologic deterioration, including deafness and blindness. Physical examination is remarkable for hepatosplenomegaly , as well as a cherry-red spot on funduscopic examination. These symptoms are consistent with a diagnosis of

20. A 42-year-old female presents with a recent onset of fatigue, malaise, constipation, and a 12-pound weight gain. On examination, her thyroid is firm and enlarged. What laboratory test is most likely to confirm the expected diagnosis?

21. A 20-year-old develops weakness accompanied by difficulty in relaxation that is most pronounced in the hands and feet. Muscle biopsy demonstrates prominent ring fibers, centrally located nuclei, chains of nuclei, and disorganized sarcoplasmic masses. This condition been associated with a mutation on which of the following chromosomes?

22. The heart of an embryo first begins beating at which of the following ages?

23. A 45-year-old man presents to the emergency department with severe headache and vomiting. A CT scan shows a well-circumscribed cystic lesion within the 3rd ventricle; there is no calcium deposition. The cyst is surgically removed. On histologic examination, the wall of the cyst consists of a single layer of mucin-producing columnar epithelium with a ciliated apical surface. Which of the following is the most likely diagnosis?

24. A patient develops a swollen and tender lymph node in his popliteal fossa. An infected skin lesion in which of the following sites would most likely induce lymphadenopathy in this region?

25. Maintenance of the corpus luteum during the first trimester of pregnancy is accomplished principally by the secretion of


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