Numerade

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Lottie Adams

Numerade educator

A 10-year-old boy is brought to the physician because of a 4-day history of nosebleeds and easy bruising. Three weeks ago, he had an upper respiratory tract infection. Physical examination shows ecchymoses over the upper and lower extremities. Laboratory studies show a hemoglobin concentration and leukocyte count within the reference ranges and a decreased platelet count. A bone marrow smear shows an increased number of megakaryocytes. Which of the following platelet abnormalities is the most likely cause of the findings in this patient? A) Antibodies directed against the glycoprotein (Gp) IIb/Illa complex 8) Decreased binding of Gpla/lla (a8,) to collagen C) Decreased concentration of the Gp1b/IX complex D) Decreased concentration of the Gplib/Illa complex E) Decreased synthesis of thromboxane A, F) Deficient binding of von Willebrand factor to the Go1b/IX complex

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Breanna Ollech

Numerade educator

A 65-year-old man is brought to the emergency department because of shortness of breath for 12 hours. He is in moderate distress. His temperature is 36.7°C (98°F), pulse is 110/min, respirations are 22/min, and blood pressure is 90/40 mm Hg. Physical examination shows pallor and 2+ pitting ankle edema. Crackles are heard on auscultation of the chest. An ECG shows no abnormalities. Cardiac enzyme activities are normal. Which of the following changes in renal function is most likely in this patient? A) Decreased CI- reabsorption B) Decreased Na+ reabsorption C) Increased glomerular filtration rate D) Increased K- excretion E) Increased renal blood flow

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Bryan Valdivia

Numerade educator

A 35-year-old woman comes to the physician 7 hours after having a generalized tonic clonic seizure. She also has a 2-week history of fever, arm and leg numbness, fatigue, and an irregular heartbeat. Her temperature is 38.5°C (101.3°F), Pulse is 106/min, and blood pressure is 105/85 mm Hg. Physical examination shows no other abnormalities. Laboratory studies shows mildly increased prothrombin and partial thromboplastin times, a serum urea nitrogen concentration of 20 mg/dL, and a serum creatinine concentration of 2.5 mg/dL. Results of a direct antiglobulin (Coombs) test are negative. A peripheral blood smear shows increased schistocytes and reticulocytes. Which of the following is the most likely diagnosis? A) Cirrhosis B) Immune thrombocytopenic purpura C) Thrombotic thrombocytopenic purpura D) Vitamin K deficiency E) von Willebrand disease

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Bryan Valdivia

Numerade educator

A 65-year-old man has a 7-month history of fatigue and abdominal discomfort. Examination shows splenomegaly and hepatomegaly. A complete blood count shows anemia, teardrop erythrocytes, and a leukoerythroblastic reaction. A bone marrow biopsy shows myelofibrosis. Which of the following findings is most likely to be seen on microscopic examination of tissue from the spleen? A) Decrease of both red and white pulp B) Enlargement of the white pulp C) Erythrophagocytosis in the splenic cords D) Prominent collections of lipid-filled macrophages E) Trilineage hematopoiesis

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Bryan Valdivia

Numerade educator

- A patient with lupus + pericarditis o What physical signs you’ll see?

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Bryan Valdivia

Numerade educator

54-year-old woman is o Clumsier than usual o Stumbles often o Can stand with feet together o But sways + loses balance when eyes are closed o Diminished sensation + proprioception over feet o Sensation to pinprick + temperature intact which of the following is the cause? A. Cerebellar disease B. Meningioma on ventral midline C2 C. Internal capsule ischemia D. Large fiber neuropathy E. Poliomyelitis

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Bryan Valdivia

Numerade educator

A 25-year-old man experiences sudden onset of loss of consciousness and uncontrollable movement of all four extremities while at home. When paramedics arrive 10 minutes later, he has regained control of his body but appears drowsy and confused. On the way to the hospital, he begins displaying alternating stiffening and jerking of the limbs and irregular breathing. Paramedics administer a drug to rapidly control the patient's symptoms. Which of the following is the mechanism of action of the drug most likely administered? • A. Blocks Nat channels • B. Blocks T-type Ca?+ channels • C. Blocks high-voltage activated Ca?+ channels • D. Increases duration of CI-channel opening • E. Increases frequency of Cl channel opening

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A 68-year old woman comes to the physician for routine follow-up for a cardiac arrhythmia. She takes metoprolol and feels well. She has no other medical problems. ECG tracing is shown. The patient is started on anticoagulation. One week later, the international normalized ratio is 2.5 (normal is <1.1) and the partial thromboplastin time is 39 sec. Which of the following is the mechanism of action of the anticoagulant this patient was most likely given? • A. Activation of antithrombin IH • B. Enzymatic conversion of plasminogen to plasmin OC. Inhibition of carboxylation of specific clotting factors • D. Inhibition of glycosylation of specific clotting factors • E. Inhibition of platelet activation by receptor binding © F. Inhibition of the adenosine diphosphate pathway

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Bryan Valdivia

Numerade educator

A 16-year-old boy comes to the physician for an annual wellness examination. Review of systems is notable for heat intolerance and intermittent paresthesias in his fingers. Physical examination reveals small reddish-black papules on the abdomen and scrotum. Results of urine dipstick show Leukocytes: Negative Nitrite: Negative Protein: +1 Glucose: Negative RBC: Negative Which of the following substances is elevated in this patients most likely disorder? • A. Ceramide trihexoside • B. Galactocerebroside • C. Glucocerebroside O D. Lactosyl cerebroside O E. Sphingomyelin

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Bryan Valdivia

Numerade educator

A 25-year-old man is brought to the emergency department receiving cardiopulmonary resuscitation in the ambulance after being found unconscious. Initial physical examination reveals a pulse of 150/min, respiratory rate of 10/min, and blood pressure of 60/40 mm Hg. His skin is thin and transparent, and numerous varicose veins are present on his chest and abdomen. The patient cannot be resuscitated and is pronounced dead. Autopsy reveals a ruptured aortic aneurysm. Which of the following structural proteins is most likely defective in this patient? • A. Elastin • B. Fibrillin-1 • C. Type I collagen • D. Type Ill collagen • E. Type IV collagen

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The Real E.