Q 1. A 73-year-old male presents to the clinic with 3 months
of increasing back pain. He localizes the pain to the lumbar
spine and states that the pain is worst at night while he is lying
in bed. It is improved during the day with mobilization.
Past history is notable only for hypertension and remote cigarette
smoking. Physical examination is normal. Laboratory
studies are notable for an elevated alkaline phosphatase. A
lumbar radiogram shows a lytic lesion in the L3 vertebra.
Which of the following malignancies is most likely?
A. Gastric carcinoma
B. Non-small cell lung cancer
D. Pancreatic carcinoma
E. Thyroid carcinoma
Q 2. Patients from which of the following regions need
not be screened for glucose-6-phosphate dehydrogenase
(G6PD) deficiency when starting a drug that carries a risk
for G6PD mediated hemolysis?
C. Southeast Asia
D. Southern Europe
E. Sub-Saharan Africa
F. None of the above
Q 3. All the following are vitamin K–dependent coagulation
A. factor X
B. factor VII
C. protein C
D. protein S
E. factor VIII
Q 4. A 31-year-old male with hemophilia A is admitted
with persistent gross hematuria. He denies recent trauma
or any history of genitourinary pathology. The examination
is unremarkable. Hematocrit is 28%. All the following
are treatments for hemophilia A except
A. desmopressin (DDAVP)
B. fresh-frozen plasma (FFP)
D. recombinant factor VIII
Q 5. Which of the following statements regarding incidence
of and risk factors for hepatocellular carcinoma is true?
A. A chemical toxin produced by Aspergillus species,
aflatoxin B has a strong association with development
of hepatocellular carcinoma and can be found
in stored grains in hot, humid places.
B. In the United States, the incidence of hepatocellular
carcinoma is decreasing.
C. Nonalcoholic steatohepatitis is not associated with
an increased risk for hepatocellular carcinogen.
D. Fewer than 5% of individuals diagnosed with hepatocellular
carcinoma in the United States do not
have underlying cirrhosis.
E. The risk of developing hepatocellular carcinoma in
individuals with hepatitis C infection is 50%.
Q 6. You are asked to review the peripheral blood smear
from a patient with anemia. Serum lactate dehydrogenase
is elevated and there is hemoglobinuria. This patient is
likely to have which physical examination finding? (See
Figure III-6, Color Atlas.)
B. Heme-positive stools
C. Mechanical second heart sound
E. Thickened calvarium
Q 7. All of the enzyme deficiencies that lead to porphyrias are
inherited either as autosomal dominant (AD) or autosomal
recessive (AR) traits with one exception. Which of the following
most commonly occurs sporadically?
A. 5-ALA dehydratase-deficient porphyria
B. Acute intermittent porphyria
C. Erythropoietic porphyria
D. Porphyria cutanea tarda
E. Variegate porphyria
Q 8 . A 55-year-old female presents with progressive incoordination.
Physical examination is remarkable for nystagmus,
mild dysarthria, and past-pointing on finger-to-nose
testing. She also has an unsteady gait. MRI reveals atrophy
of both lobes of the cerebellum. Serologic evaluation reveals
the presence of anti-Yo antibody. Which of the following
is the most likely cause of this clinical syndrome?
A. Non-small cell cancer of the lung
B. Small-cell cancer of the lung
C. Breast cancer
D. Non-Hodgkin’s lymphoma
E. Colon cancer
Q 9. A 36-year-old African-American woman with systemic
lupus erythematosus presents with the acute onset of lethargy
and jaundice. On initial evaluation, she is tachycardic,
hypotensive, appears pale, is dyspneic, and is somewhat difficult
to arouse. Physical examination reveals splenomegaly.
Her initial hemoglobin is 6 g/dL, white blood cell count is
6300/μL, and platelets are 294,000/ μL. Her total bilirubin is
4 g/dL, reticulocyte count is 18%, and haptoglobin is not
detectable. Renal function is normal, as is urinalysis. What
would you expect on her peripheral blood smear?
A. Macrocytosis and PMN’s with hypersegmented nuclei
D. Sickle cells
E. Target cells
Q 10 You are investigating the cause for a patient’s anemia.
He is a 50-year-old man who was found to have a
hematocrit of 25% on routine evaluation. His hematocrit
was 47% 1 year ago. Mean corpuscular volume is 80,
mean corpuscular hemoglobin concentration is 25, mean
corpuscular hemoglobin is 25. Reticulocyte count is 5%.
Review of the peripheral blood smear shows marked
numbers of polychromatophilic macrocytes. Ferritin is
340 μg/L. What is the cause of this patient’s anemia?
A. Defective erythroid marrow proliferation
B. Extravascular hemolysis
C. Intravascular hemolysis
D. Iron-deficiency anemia
E. Occult gastrointestinal bleeding