A patient presents with chronic pelvic pain and infertility. Laparoscopy shows endometrial tissue outside the uterus. What is the most likely mechanism?

Retrograde menstruation

A 25-year-old woman has irregular periods, acne, and hirsutism. Ultrasound shows multiple ovarian cysts. What is the underlying mechanism?

Insulin resistance and hyperandrogenism

A woman with untreated chlamydia develops pelvic pain and infertility. What is the diagnosis?

Pelvic inflammatory disease (PID)

A woman presents with postcoital bleeding. Biopsy confirms cervical cancer. What is the most common cause?

HPV infection

A marathon runner develops amenorrhea. Labs show low GnRH. What is the most likely cause?

Hypothalamic dysfunction

A 21-year-old woman delivers a term infant after an uncomplicated pregnancy. The placenta cannot be deivered, however, and there is substantial hemorrhage, requiring transfusion of 10 U of packed RBCs. She must undergo a hysterectomy. Over the next 3 months she is unable to produce sufficient breast milk to breastfeed her infant, and she becomes increasingly fatigued. Laboratory studies show Na, 134 mmol/L; K, 5.2 mmol/L; Cl, 88 mmol/L; CO2, 23 mmol/L; glucose, 59 mg/dL; calcium, 9.3 mg/dL; phosphorus, 3.5 mg/dL; and creatinine, 0.9 mg/dL. Over the next 5 months, her menstrual cycles do not return. Which of the following conditions is now most likely to be present?

Lack of prolactin, LH deficiency, & FSH deficiency (all of the above)

Which of the following is a condition in which the blood supply to the myocardium is completely or partially blocked due to the atherosclerosis that develops in the arteries that encircles the heart, narrowing the arteries, and blocking the flow?

myocardial ischemia

Which of the following is the MOST common reason for myocardial ischemia?

atherosclerotic plaque

A patient comes to the doctor with severe persistent chest pain, that he refers to as "a truck sitting on my chest".. He is sweating profusely, yet cool and clammy, his BP initially dropped but shortly after heart rate and BP went back Cardiac murmurs, pericardial friction rub, and crackles in the lung are present. Which of the following is consistent with these findings?

myocardial infarction

All of the following are risk factors for cardiovascular disease except
a. hypotension
b. smoking
c. sedentary lifestyle
d. diabetes mellitus

hypotension

Which of the following terms best describes what happens when leaflets or cusps fail to shut or close completely leading to the continuous back flow into the chamber that has to be pushed "upstream" increasing the workload of the atrium and ventricle? Most likely to occur in the left heart mitral and aortic valves

valvular regurgitation

Which of the following is true regarding right ventricular hypertrophy
a. hypertrophy may result from aortic stenosis
b. hypertrophy may result from mitral insufficiency
c. hypertrophy is secondary to hypertension
d. hypertrophy may result from pulmonary valve stenosis

hypertrophy may result from pulmonary valve stenosis

All of the following are clinical manifestations of left-sided heart failure except
a. tachycardia
b. orthopnea
c. peripheral edema
d. cyanosis

peripheral edema

A 68-yo man has had progressive dyspnea for the past year. On physical examination, extensive rales are heard in all lung fields. An echocardiogram shows that the left ventricular wall is markedly hypertrophied. A chest radiograph shows pulmonary edema and a prominent left-sided heart shadow. Which of the following conditions has most likely produced these findings?

hypertension

Which of the following terms refers to soft deposits of intra-arterial fat and fibrin in the vessel walls that hardens over time?

atherosclerosis

What is the name of this condition (underdeveloped right ventricle)

pulmonary atresia

A 50 yo man experiences episodes of severe substernal chest pain every time he performs a task that requires moderate exercise. The episodes have become more frequent and severe over the past year, but they can be relieved by sublingual nitroglycerin. On physical examination, he is afebrile, his pulse is 78/min and regular and there are no murmurs or gallops. Lab studies show glucose, 100mg/dL; and total serum cholesterol, 223 mg/dL. Which of the following cardiac lesions is most likely to be present?

coronary atherosclerosis

A 59 yo main has experienced chronic fatigue for the past 18 months. On physical examination, he is afebrile. A chest X-ray shows bilateral pulmonary edema and a prominent border on the left side of the heart. Laboratory studies show serum glucose 74 mg/dL, total cholesterol 189 mg/dL, total protein 7.1 mg/dL, albumin 5.2mg/dL, creatinine 6.1 mg/dL, and urea nitrogen 58 mg/dL. What is the most likely diagnosis?

systemic hypertension

A 45 yo man has smoked two pack of cigarettes per day for 20 years. For the past 4 years, he has had a chronic cough with copious mucoid expectoration. During the past yea, he has had several episodes of respiratory tract infections that were diagnosed as "viral flu". He developed difficulty breathing tightness of the chest, and audible wheezing. His breathing difficulty was relieved by inhalation of a beta-adrenergic agonist and disappeared after the chest infarction had resolved. Which of the following pathologic conditions best described these findings?

chronic bronchitis

A 34 yo man suddenly develops severe dyspnea with wheezing and is taken to the emergency department. On PE, his vital signs are temperature 37 degrees Celsius, pulse 95/min, respirations 15/min, and blood pressure 130/80 mm Hg. A chest radiograph shows increased lucency in all lung fields. A sputum cytological specimen shows acute inflammatory cells in a background of abundant mucus. Many of the inflammatory cells are eosinophils. What is the most likely diagnosis?

asthma

A 49 yo man has had increasing dyspnea for the past 4 years. He has an occasional cough with minimal sputum production. On PE, his lungs are hyper resonant with expiratory wheezes. Pulmonary function tests show increased total lung capacity (TLC) with slightly increased FVC and decreased FEV1 and FEV1/FVC ratio. Arterial blood gas measurement shows pH of 7.35; PO2 65mm Hg; PCO2 45mm Hg. Which of the following diseases should most often be suspected as a cause of these findings?

emphysema

A 64 yo man who is a chain smoke, sees his physician because he had a cough and a 5kg weight loss over the past 3 months. PE shows clubbing of the finger. He is afebrile. A chest radiograph shows no hilar adenopathy, but there is cavitation within 3cm lesion near the right hilum. Laboratory studies are unremarkable except for a calcium level of 12.3 mg/dL, phosphorus concentration of 2.4 mg/dL, and albumin level of 3.9 g/dL. Bronchoscopy shows a lesion almost occluding the right main stem bronchus. A biopsy is performed. Based on the pathologist's report and further testing, including chest and abdomen CT and bone scans, the patient is told that a surgical procedure with curative intent would be attempted. Which of the following neoplasms is most likely to be present in this patient

squamous cell carcinoma

Lung cancer is the leading cause of cancer death in the US. Which of the following is the primary causative agent for lung cancer?

cigarette smoking

Which disease is characterized by too much fluid in the interstitial space?

pulmonary edema

Which disease is characterized by a decreased oxygen level leading to chronic hypoxemia and air trapping in the thorax cavity?

emphysema

In a patient with emphysema, a nurse may observe a barrel chest. What causes this physical abnormality?

too much air trapped in the thoracic cavity

Which disorder is characterized by air taking up normal space where lung is, then causes a decrease in lung size and lung tissue, and a decrease in gas exchange?

pneumothorax

All of the following are possible causes of an obstructed airway except
a. inflammation
b. tumor
c. alveoli destruction
d. narrowed lumen

alveoli destruction

A patient with chronic pulmonary disease undergoes emergency surgery. Postoperatively, the arterial PO2, PCO2 and pH are 50 mm Hg, 50 mmHg, and 7.20 respectively. How would the acid-base status be best described?

metabolic acidosis

A 2 yo child is brought to the family physician because of failure to thrive. Physical examination shows that the child is short and has coarse facial feature, a protruding tongue, and an umbilical hernia. As the child matures, profound mental retardation becomes apparent. A deficiency of which of the following hormones is most likely to explain these finding?

thyroxine (T4)

A 28 yo man has been using insulin injections to control his diabetes mellitus for the past 10 years. One morning, his roommate is unable to awaken him. The man is unconscious when he arrives at the emergency department. On PE, his temp is 37 degrees Celsius, pulse is 91/min, respirations are 30/min, and forceful, and BP is 90/65 mmHg. Laboratory findings include a high plasma level of insulin and a lack of detectable C peptide. Urinalysis shows no blood, protein, or glucose, but 4+ ketonuria. Which of the following conditions is most likely to be present?

hypoglycemic coma

A 47 yo woman visits her physician because she noticed a "lump" in her neck 1 week ago. On PE, there is a 2cm nodule in the right lobe of the thyroid gland. A fine-needle aspiration biopsy is performed, and microscopic examination of the specimen shows cells consistent with a follicular neoplasm. She undergoes a subtotal thyroidectomy. Which of the following laboratory tests should be performed on this patient in the immediate postoperative period?

calcium

A 40 yo man see his physician because he has had headache, and a 5kg weight gain over the past 3 months and has been prescribed antidepressants. On PE his face is puffy. His temp is 36.9 C, pulse is 79/min, respirations 15/min, BP is 160/75. He has cutaneous striae over the lower abdomen and ecchymoses scattered over the extremities. A radiograph of the spine shows a compressed fracture of T11. Laboratory findings show a fasting plasma glucose level of 200 mg/dL, serum Na+ 150 mmol/L, and serum K+ of 3.1 mmol/L. The plasma cortisol level is a 38 microgram/dL at 8 am and 37 microgram/dL at 6 pm. Administration of low and high doses of dexamethasone fails to suppress the plasma cortisol level and excretion or urinary 17-hydroxycorticosteroids. The plasma corticotropin level is 0.8 pg/mL. Which of the following condition is most likely to be present in this man?

cushing's disease

A 40 yo man visits physically because of weakness and easy fatiguability of 2 months duration. PE yields no remarkable findings. Laboratory studies show serum calcium of 11.5 mg/dL, inorganic phosphorus of 2.4 mg/dL, and serum parathyroid hormone of 58 pg/mL, which is near the top of the reference page. What is the most likely cause of these findings?

Parathyroid adenoma

A 45 to woman reports a feeling of fullness in her neck, but has no other complaints. The enlargement has been gradual and painless for more than 1 year. PE confirms diffuse enlargement of thyroid gland without any apparent masses. Laboratory studies of thyroid function show a normal free T4 level and slightly increased TSH level. What is the most likely cause of these findings?

goiter

A study of patients recently diagnosed with type 2 diabetes mellitus follows them for 20 years to determine the prevalence and severity of complications of the disease. The records of these patients are analyzed to identify the laboratory methods used to monitor patients' ability to maintain disease control and reduce the potential for complications. Which of the following laboratory studies is most likely to afford the best method of monitoring disease control in these patients?

glycosylated hemoglobin

A 25-year-old woman has noted breast secretions for the past month. She is not breastfeeding and has never been pregnant. She has not menstruated for the past 5 months. Physical examination yields no abnormal findings. MRI of the brain shows a 0.7-cm mass within the sella turcica. Which of the following additional complications is she most likely to have?

Infertility

A 62 year old man has had several episodes of hematuria over the past week. He has not experienced increased urinary frequency or dysuria. On PE there are no remarkable findings. Urinary analysis shows 4+ hematuria. The urine culture is negative. A cystoscopy is performed, and a 2 cm mass is seen on the right bladder wall. Which of the following risk factors is most important in the pathogenesis of this bladder lesion.

Smoking habits

Which of the following patients is NOT at risk for developing chronic kidney disease?

45 year old female with polycystic ovarian disease

A condition responsible for Prerenal Acute renal failures would be

Dehydration

Which kidney disease is known to be inherited?

Polycystic kidney

The Nephrotic syndrome is a kidney disease characterized by

Massive proteinuria,hypoalbuminemia, and edema

All of the following are characteristics of Nephrotic Syndrome except
a. Important proteinuria is a hallmark of Nephritic syndrome
b. Patients present hypertension
c. Hematuria, oliguria, and azotemia are present
d. The most common causes are lupus and glomerulonephritis post-infection

Important Proteinuria is a hallmark of Nephritic syndrome

Distension of the kidney and atrophy of the parenchyma due to accumulation of urine in the renal pelvis, usually due to obstruction of outflow of urine is known as

Hydronephrosis

A patient with Chronic kidney diseases will be having low levels of which of the following hormone

Erythropoietin

A 58 year old man is in stable condition after an acute myocardial infarction. Two days later, his urine output decreases and the serum urea nitrogen level increases to 3.3 mg/dL. Oliguria persists for 5 days, followed by polyuria for 2 days. He is discharged from the hospital. WHich of the following renal lesions best explains these renal abnormalities?

Acute Tubular Necrosis

The most common etiological factor in Pancreatitis is

Alcohol intake

Which Is not an acute systemic complication of primary GI disease?

Malabsorption

Gastroparesis is a disorder of

Motility

1Which of the following would result from an autoimmune disease that attacks parietal cells?

Vitamin B12 deficiency & impaired protein digestion

Which of the following statements about Pancreatic cancer are true, except?
A. Cancer that arises from pancreatic islets account for 85% of the cases
B. Usually causes no symptoms on early stages
C. Obesity is one of the risk factors
D. It is one of the deadliest cancers due to not being detected till it develops more severe

Cancer that arises from pancreatic islets account for 85% of the cases

A 45-year-old obese woman with cholelithiasis presents to the emergency room complaining of nausea and vomiting for 2 days, along with severe continuous mid-abdominal pain. She has a low-grade fever and the ER physician finds that she has a slightly elevated WBC count (12,000) and an elevated serum amylase. The most likely diagnosis is

Acute pancreatitis

A 60-year-old patient has epigastric pain and weight loss of a few pounds. The consulting gastroenterologist's evaluation includes upper GI endoscopy, and he discovers a gastric ulcer. Now, the gastroenterologist should?

Biopsy the area of the ulcer

A 58-year-old man is a longtime alcoholic comes to the emergency room after vomiting small amounts of bright red blood 4 times a day. Your differential diagnosis is constructed around causes of bleeding from the?

Upper GI tract

The medical term for refer vomiting of blood is

Hematemesis

A patient in your office tells you that he had an episode of vomiting bright red blood twice in 1 day about 1 week ago, followed the next day by 3 or 4 episodes of vomiting material that looked like coffee grounds. He could not afford to seek medical help then and he said that "it got better except for the pain". The past 3 days he noticed black sticky tools and he finally came to see you. What is the first concern?

Bleeding peptic ulcer

The clinical signs and symptoms resulting from kidney failure and increased levels of nitrogenous waste products are known collectively as?

Uremia

A male patient has low testosterone and high LH/FSH. What is the diagnosis?

Primary Hypogonadism