MSC QBank – Block 7

A 72-year-old man comes to the clinic with complaints of shortness of breath and pitting edema. Administration of what medication would primarily act to decrease preload?

An MRI and ophthalmic examination showed that a patient had a stroke of a branch of the middle cerebral artery supplying the right optic tract.  Which of the following visual defects would most likely be seen in this patient?

A 34-year-old female is in a motor vehicle accident with significant internal injuries and blood loss. When the EMTs arrive, the patient’s vital signs are: heart rate 122 /min; BP 96/44 mmHg.

The tachycardia is due to the sympathetic stimulation of the SA node cells at what level?

A 25-year-old female presented to the emergency room complaining of muscle weakness and decreased sensation in her right upper and lower limbs. The neurological exam indicated there was increased reflexes and loss of touch on her right upper and lower limbs with the loss of pain and temperature on her left upper and lower limbs. The right eyelid had a slight droop, and the right pupil was constricted.  A lesion in which of the following areas would result in these clinical findings?

A 52-year-old male with a history of hypertension and hyperlipidemia presents to the emergency room with severe persistent angina, diaphoresis, and nausea. The intake physician orders an EKG and medication to control symptoms. On evaluation of the EKG there are ST elevations in leads V1-V4. What portion of the myocardium is effected by this pathological process?

A 67-year-old male presents to the clinic with complaints of dyspnea and swelling of his feet and ankles. On physical exam you identify crackles in the bases of the lungs bilaterally. What other physical exam findings would you expect?

A 72-year-old man presents to his physician complaining of hearing problems. He told the physician that he was having significant trouble telling which directions sounds were coming from when his family was talking to him at home. The auditory exam indicated that he had slightly reduced hearing in both ears and showed that he was having a significant problem determining the direction of sounds. What is the most likely site of the lesion causing this patient’s hearing difficulties?

An 84-year-old male patient in assisted care is being evaluated by the physician because the staff at his facility noted that he is developing shortness of breath when he walks and has swollen feet at the end of the day. On physical examination, the patient has pitting edema to his ankles, JVD, and bibasilar crackles in his lungs. Pulses are seen in the image.

There is a new murmur best heard over the lateral sternal border, represented in the image:

The most likely cause of the new murmur is

A mother brings her 3-year-old son into the clinic because he has difficulty walking. He did not start walking until age 2 years. He now has an unstable gait and often trips and falls. He cannot yet run and has to be helped when ascending or descending stairs.

Physical examination confirms these symptoms. The child walks on his toes and cannot hop. His calf muscles appear disproportionately larger than his other leg muscles.

Laboratory testing shows an elevated creatine kinase.

The first life-threatening complication in this patient can best be anticipated by assessing

A 48-year-old African American male presents to the clinic for a follow up visit of his long-standing hypertension. On the previous visit, he was prescribed amlodipine in addition to his previously prescribed hydrochlorothiazide and lisinopril. He has had type 2 diabetes mellitus for 12 years.

Vital signs: BP 146/92 mmHg

Physical examination: BMI = 31 kg/m^2; otherwise non-contributory

Laboratory testing:

• Chemistry:

Further investigation is mostly likely to reveal a/an

A 26-year-old female presents to her physician because she has started getting pain in her right arm when she plays tennis. She has been feeling increasingly unwell for the past several months with an unplanned weight loss of 10-15 pounds. She has a low grade fever in the evenings. She is experiencing vague aches in her joints and muscles.

Vital signs: Temperature: 99.9 F; HR: 88 /min; RR: 16 /min;  SpO2: 98% on room air.

Physical examination: There is a bruit in the right subclavian fossa. There is no palpable radial pulse in the right arm. The skin and musculature of the right forearm and hand appears normal.

• Brachial BP (left): 124/83 mmHg
• Brachial BP (right): 91/43 mmHg

Laboratory testing

• ESR: 91 mm/hour

Management of the most likely diagnosis would likely include

A 28-year-old male is brought to the emergency room after rescue from a house fire. He has suffered burns. He complains of a mild headache with tightness across his forehead.

Vital signs: BP: 124/82 mmHg; HR: 92/min; RR: 18/min; Temperature: 98.8 F; SpO2: 97%

Physical examination: There are 14% third degree burns over his upper back and shoulder area with second degree burns over his lower face. There is soot in his oropharynx.

ABG shows PaCO = 16%.

The patient is admitted to the burn unit. Hours later he develops a cough and wheezing. He coughs up sputum stained black. The patient is placed on high flow oxygen and his carbon monoxide levels drops to 3% overnight.  The coughing and wheezing resolve over the next 2 days. On day 4 post-burn, the patient develops shortness of breath.

Physical examination: Bilateral crackles most prominent in the bases.

Chest x-ray shows patchy infiltrates, predominant in the lower lobes (seen in the image).

Arterial blood gases (on room air): PaO2: 54 mmHg; PaCO2: 32 mmHg; pH; 7.21

The patient has most likely developed

An experimental scientist performing vaccine trials for a novel pathogen observes that tissue changes can be observed within hours of the inoculation. Which of the following is most likely to be the cause of such changes?

The monoclonal antibody brodalumab was cleared for subcutaneous administration in patients with moderate to severe psoriasis in 2017.  It acts by binding the IL-17 receptor used by multiple IL-17 family cytokines.  Both the palliation of keratinocyte and vascular response changes as well as increased incidence of Candida infections in treated individuals are predicted by the most common side effect of therapy:

A 3-month-old infant is brought into the emergency department, coughing, wheezing, and unable to catch his breath. His parents state that the symptoms developed quickly; they also note the infant was born prematurely.  Epidemiology makes the medical team suspect a syncytial virus.  Which of the following immune mechanisms is most important in the resolution of this infection?

A 52-year-old man is evaluated for a 3-week history of abdominal discomfort associated with weight loss, nausea and vomiting.  He now reports difficulty swallowing and has not been able to eat or drink in the past 24 hours.  The patient was diagnosed with HIV 18 years ago, and despite appropriate therapy, he now has 30 CD4 cells/µL.  On physical examination his temperature is 38.2 C (100.8 F), blood pressure 130/83 mmHg, pulse rate 90/min, and respiration rate 24/min. Palpation reveals a soft abdomen and there are active bowel sounds. There is generalized lymphadenopathy, but no masses are palpable. Deep epigastric palpation elicits flinching. A biopsy of a supraclavicular node is shown:

(Image from CDC public health image library)

For which of the following reasons is an AIDS patient especially susceptible to this disease?

Drug X is a potent blood pressure drug which works through renin-angiotensin inhibition. Drug Y is a competitive antagonist of drug X. If drug Y bound covalently to the drug receptor site for drug X, how would the resultant log-dose curve change?

*EC50=effective concentration required to reach half-maximal effect

A 30-year-old male is affected with X-linked dominant porphyria. The penetrance of the disease genotype is 60%. Assuming he marries a woman who does not carry the mutation, what is the probability that a daughter will be affected with the disorder?

A 66-year-old male presents to the emergency room complaining of fever, cough and shortness of breath. He is coughing up rust-tinged yellow-green mucus. He feels unwell, with generalized myalgia and chest pain when he breathes. He says the symptoms started about 4 days ago.

Vital signs: Temperature: 102.8 F; HR: 112 /min; RR: 28 /min, BP: 128/88 mmHg; SaO2: 94% on room air.

Physical examination: Crackles over his left lower chest with whispered pectoriloquy.

Sputum shows neutrophils, erythrocytes, amorphous debris, and Gram positive encapsulated cocci.

What would be the gross appearance of the lungs at this time?

A 12-year-old boy takes a fall from his bicycle and damages his axilla and brachial plexus on one side. The clinical exam indicated that pronation was normal and he could extend his wrist without difficulty, but supination was weakened and there was loss of sensation on the lateral side of the forearm. Which of the following structures did the fall most likely damage?