2022浙大二院臨床博士后選拔考試真題

2022浙大二院臨床博士后選拔考試

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1.您的姓名：

2.您的證號：

3.不含高能磷酸鍵的化合物是（）？

A.1,3-二磷酸甘油酸

B.磷酸肌酸

C.腺首三磷酸

D.磷酸烯醇式丙酮酸

E.1,6-二磷酸果糖

4.三竣酸循環(huán)的中間產(chǎn)物是（）？

A.乙酰乙酰CoA

B.丙二酰CoA

C.琥珀酰CoA

D丙酰CoA

E.HMG-CoA

5.男,66歲。上腹脹痛10余年。胃鏡檢查:胃體黏膜變薄，血管透見，皺裳稀疏。病理檢查:胃體腺體萎縮。

該患者不應(yīng)出現(xiàn)的生理變化是（）？

A.胃蛋白酶原分泌減少

B.鐵吸收減少

C.維生素B2吸收減少

D.血清促胃液素降低

E.胃酸分泌減少

6.胰島A細胞分泌的激素是（）？

A.胰島素

B.胰高血糖素

C.生長抑素

D.血管活性腸肽

E.胰多肽

7.與CD4分子結(jié)合的配體是（）?

A.MHCI類分子

B.MHCn類分子

C.MHCHI類分子

D.TCR

E.BCR

8.彌漫性新月體性腎小球腎炎因腎小球囊新月體形成，阻塞囊腔，患者可迅速出現(xiàn)的異常情況是（）？

A.蛋白尿

B血尿

C少尿

D.管型尿

E.乳糜尿

9.醫(yī)患溝通中的非言語溝通形式不包括（）？

A.引導(dǎo)話題

B.人際距離

C.面部表情

D.身段姿態(tài)

E.目光接觸

10.醫(yī)學(xué)倫理學(xué)中尊重原則所涵蓋的權(quán)利不包括（）？

A.自主選擇權(quán)

B.社會免責權(quán)

C.個人隱私權(quán)

D.知情同意權(quán)

E.人格尊嚴權(quán)

11.王某，女,75歲?；疾『笫冀K不愿意就診，而是在家中燒香拜佛祈求病愈。王某的兒子見母親病情加

重，便請社區(qū)醫(yī)師到家里為母親診治，但遭到王某的拒絕。醫(yī)師符合倫理的做法是（）？

A.鑒于患者拒絕，社區(qū)醫(yī)師應(yīng)放棄診治

B.患者行為影響健康，應(yīng)及時報告派出所處置

C.對患者信佛不信醫(yī)的行為進行批評

D.在家屬的協(xié)助下,對患者實施強制診治

E.向患者進行耐心解釋，規(guī)勸其接受相應(yīng)治療

12.下列說法符合我國人類輔助生殖技術(shù)倫理原則的是（）？

A.對已婚女性可以實施商業(yè)性代孕技術(shù)

B.對離異單身女性可以實施商業(yè)性代孕技術(shù)

C.對任何女性都不得實施代孕技術(shù)

D.對自愿的單身女性可以實施代孕技術(shù)

E對已婚女性可以實施親屬間的代孕技術(shù)

13.女,36歲。因患子宮肌瘤在縣醫(yī)院接受手術(shù)治療,術(shù)后患者因?qū)κ中g(shù)效果不滿意訴至法院。法院經(jīng)審

理認為醫(yī)院存在《侵權(quán)責任法》規(guī)定的過錯推定情形，判決醫(yī)院敗訴。該推定情形是（）？

A.未盡到說明義務(wù)

B.未盡到與當時醫(yī)療水平相應(yīng)的診療義務(wù)

C.偽造病歷資料

D.泄露患者隱私

E.限于當時的醫(yī)療水平難以診療

14.可授予特殊使用級抗菌藥物處方權(quán)的醫(yī)務(wù)人員是（）？

A.主治醫(yī)師

B.住院醫(yī)師

C.鄉(xiāng)村醫(yī)生

D.副主任醫(yī)師

E.實習醫(yī)生

15.女,76歲。1小時前被家屬發(fā)現(xiàn)意識不清急送入院。有慢性阻塞曲市疾病病史20年，近1周來嗜睡。

查體:BP150/90mmHg,昏迷，球結(jié)膜水腫，口唇發(fā)組雙下肺可聞及濕啰音。該患者最可能的診斷是（）？

A.電解質(zhì)紊亂

B.左心衰竭

C腦梗死

D.肺性腦病

E.感染中毒性腦病

16.對明確支氣管擴張咯血患者出血部位，最有價值的檢查是（）？

A.支氣管動脈造影

B胸部CT

C.肺動脈造影

D.支氣管鏡

E.胸部X線片

17.男性,68歲。因腦梗死住院半月，近1周出現(xiàn)高熱，咳嗽，咳血痰。查體:T39.2°C,意識模糊，呼吸急促,

口唇發(fā)組，雙肺散在濕啰音?血常規(guī)WBC20.0X10的9次方/L。胸部X線片:右肺大片陰影，其中可見多個氣

囊腔。該患者最可能的診斷是（）？

A.金黃色葡萄球菌肺炎

B.肺炎鏈球菌肺炎

C.肺炎支原體肺炎

D.干酪性肺炎

E.真菌性肺炎

18.提示早期慢性肺源性心臟病的臨床表現(xiàn)是（）？

A.胸悶，呼吸困難

B.心悸，心音遙遠

C.發(fā)組,乏力，易疲勞

D.可見劍突下明顯心臟搏動

E.頸靜脈怒張

19.最常用于判斷漏出液和滲出液性質(zhì)的胸腔積液生化檢查項目是（）？

A.酸堿度（pH）

B.乳酸S兌氫酶（LDH）

C葡萄糖

D膽固醇

E.腺甘脫氨酶(ADA)

20.肺疾病發(fā)生單純低氧血癥最主要的機制是()？

A.彌散功能障礙

B通氣/血流比例失調(diào)

C.氧耗量增加

D.肺動靜脈分流

E.肺泡通氣量下降

21.慢性心力衰竭時推薦使用的B受體拮抗劑為()？

A.所有已上市的B受體拮抗劑

B.美托洛爾

C.阿替洛爾

D.普奈洛爾

日引口朵洛爾

22.男,38歲。因間斷心悸1天就診。查體:心率72次/分，偶可聞及期前收縮。心電圖示提前出現(xiàn)的P

波形態(tài)與竇性P波略有不同,PR間期0.13秒,QRS波群形態(tài)正常，代償間歇不完全。最恰當?shù)奶幚硎?)?

A.靜脈注射阿托品

B.口服美托洛爾

C.口服普羅帕酮

D.尋找和去除病因

E.口服胺碘酮

23.慢性支氣管炎的診斷標準是除外其他已知病因所致的慢性咳嗽后病人每年咳、痰、喘多長時間（）？

A.至少6個月日寺續(xù)10年以上

B.至少1個月，持續(xù)3年以上

C.至少2個月，持續(xù)5年以上

D.至少6個月才寺續(xù)5年以上

E.至少3個月，持續(xù)2年以上

24.女,62歲。間斷咳嗽、咳少量白黏痰10年。查體:雙肺呼吸音粗，未聞及干、濕啰音。血常規(guī)正常，胸

部X線片示肺紋理增粗紊亂，肺功能示FEV1占預(yù)計值的百分比為83%,FEV1/FVC67%（舒張后）。該患者最

可能的診斷是（）？

A.支氣管哮喘

B.支氣管結(jié)核

C.支氣管擴張

D.慢性阻塞性肺疾病

E.特發(fā)性肺纖維化

25.女，62歲。反復(fù)咳嗽、喘息15年,1個月前搬入新居后再發(fā)加重，口服"茶堿類”藥物有所緩解。

查體:雙肺呼吸音低，呼氣相延長。胸部X線片未見明顯異常。肺功能檢查示FEV1/FVC56%,舒張試驗示FEV1

改善率12%0該患者應(yīng)首先考慮的診斷是（）？

A.慢性阻塞性肺疾病

B.支氣管哮喘

C.慢性充血性心力衰竭

D.過敏性肺炎

E.嗜酸性粒細胞性肺炎

26.男，67歲。患高血壓18年，2年前患急性前壁心肌梗死，門診測血壓170/100mmHg,心率96

次/分，該患者的最佳藥物選擇是（）？

A美托洛爾

B.維拉帕米

C.卡托普利

D』引達帕胺

E.哌理嗪

27.病毒性心肌炎的確診有賴于（）？

A.血腸道病毒核酸陽性

B.血清柯薩奇B組病毒IgGl:640

C.心肌組織內(nèi)病毒的檢出

D.血C反應(yīng)蛋白水平增高

E.血清柯薩奇B組病毒IgMl:320以上

28.當風心病二尖瓣狹窄程度加重時（）？

A.心尖部舒張期滾簡樣雜音增強，肺動脈瓣第二心音減低

B.心尖部舒張期滾筒樣雜音減低肺動脈瓣第二心音減低

C.心尖部舒張期滾筒樣雜音減低，肺動脈瓣第二心音增強

D.心尖部舒張期滾筒樣雜音增強，肺動脈瓣第二心音增強

E.心尖部收縮期吹風樣雜音和舒張期滾筒樣雜音增強

29.影響肝硬化患者出血傾向的原因不包括（）？

A維生素A缺乏

B.毛細血管脆性增加

C.維生素K缺乏

D.凝血因子合成障礙

E.血小板質(zhì)和量異常

30.治療肝性腦病時，具有糾正氨基酸代謝紊亂作用的藥物是（）？

A.甘露醇

B.支鏈氨基酸

C.糖皮質(zhì)激素

D.左旋多巴

E.乳果糖

31.肝硬化食管靜脈曲張大出血后，可能出現(xiàn)的表現(xiàn)不包括（）?

A.血尿素氮增高

B.脾臟縮小

C.腹水減少

D.意識障礙

E.少尿

32.女，18歲。咽痛、發(fā)熱1天，濃茶色尿半天。首選的檢查項目是（）?

A.尿滲透壓

B.尿蛋白定量

C.尿細菌培養(yǎng)

D.尿蛋白電泳

E.尿常規(guī)加沉渣鏡檢

33.導(dǎo)致尿路感染最常見的致病菌是（）？

A.大腸埃希菌

B.腸球菌

C.金黃色葡萄球菌

D.p溶血性鏈球菌

E.厭氧菌

34.慢性腎功能不全繼發(fā)甲狀旁腺功能亢進癥患者應(yīng)給予（）？

A.糖皮質(zhì)激素

B.磷結(jié)合劑

C.促紅細胞生成素

D.血管緊張素轉(zhuǎn)換酶抑制劑

E.碳酸氫鈉

35.符合MDS的是（）？

A.血間接膽紅素增高，貧血，網(wǎng)織紅細胞增高

B.血間接膽紅素增高，貧血，網(wǎng)織紅細胞正常或升高

C.血間接膽紅素增高，無貧血，網(wǎng)織紅細胞正常

D.血間接膽紅素正常，貧血，網(wǎng)織紅細胞降低

E.血間接膽紅素正常，貧血，網(wǎng)織紅細胞正常

36.男，40歲。無痛性雙側(cè)頸部淋巴結(jié)進行性腫大伴發(fā)熱半個月，發(fā)病以來體溫最高37.5℃,無盜汗,

體重無明顯變化。查體:雙側(cè)頸部各觸及一個2cmx2cm大小淋巴結(jié)，左腋窩一個2cmxlcm大小淋巴結(jié)，

活動，無壓痛，腹軟，肝脾肋下未觸及?；?Hbl26g/L,WBC5.3xlO的9次方/L,Pltl55xlO的9次方/L.

胸腹部CT未見明顯淋巴結(jié)腫大。右頸部淋巴結(jié)活檢為彌漫性大B細胞淋巴瘤。最可能的分期是（）？

A.IIIA

B.IIIB

C.IIA

D.IIB

E.IVB

37.有高血壓的內(nèi)分泌疾病中,尿兒茶酚胺增多見于（）?

A.甲狀腺功能亢進癥

B.庫欣綜合征

C.肢端肥大癥

D.原發(fā)性醛固酮增多癥

E.嗜鋁細胞瘤

38.低鉀血癥錯誤的臨床表現(xiàn)是（）？

A.肌無力為最早的臨床表現(xiàn)

B.均有典型的心電圖改變

C.常與鎂缺乏同時存在

D.嚴重時可發(fā)生多尿

E.發(fā)生堿中毒時尿呈酸性

39.血壓下降在休克中的意義為（）？

A.是診斷休克的唯一依據(jù)

B.是休克最常見的臨床表現(xiàn)

C.是估計休克程度的主要指標

D.是組織細胞缺氧的主要指標

E是休克最早的摘示

40.女，65歲。左手示指外傷11天，陣發(fā)性肌痙攣3天。查體:神志清，查體合作，苦笑面容。左手

示指指間可見傷口，已結(jié)痂。最可能感染的病原體是（）？

A.艱難梭菌

B.大腸埃希菌

C.金黃色葡萄球菌

D.產(chǎn)氣莢膜梭菌

E破傷風梭菌

41.深n度燒傷創(chuàng)面處理不正確的是（）？

A.去除水皰皮

B.創(chuàng)面使用抗生素預(yù)防感染

C.油質(zhì)紗布包扎創(chuàng)面

D.面部創(chuàng)面不包扎

E.l:2000氯已定清洗創(chuàng)面,去除異物

42.易造成小腦幕裂孔疝的疾病是（）？

A.顱內(nèi)動脈瘤

B.后顱凹腫瘤

C.題部巨大硬腦膜外血腫

D.腦挫裂傷

E.腦膜膨出

43.腦膜瘤復(fù)發(fā)的重要因素是（）？

A年齡

B.組織類型

C.腫瘤部位

D.'ttSO

E.術(shù)后腫瘤殘余

44.青春期甲狀腺n度腫最佳的治療方法是（）？

A.多食含碘食物

B.甲狀腺次全切除術(shù)

C.放射性碘治療

D.口服碘劑

E.口服小劑量甲狀腺素片

45.T1乳腺癌其W塊最長徑不超過（）？

A.lcm

B.2cm

C.3cm

D.4cm

E.5cm

46.不符合張力性氣胸病理生理改變的是（）?

A.嚴重皮下及縱隔氣腫

B.血壓下降，脈速

C.肺破口形成活瓣

D.縱隔擺動

E.患側(cè)肺萎陷，縱隔向健側(cè)移位

47.腹股溝斜疝與直疝最有意義的鑒別點是（）？

A.發(fā)病年齡

B.突出途徑

C疝期卜形

D.疝內(nèi)容物是否進入陰囊

E.還納疝內(nèi)容物后，壓迫深環(huán)疝內(nèi)容物是否再突出

48.下列哪項不是腹部損傷后手術(shù)探查的可靠指征（）？

A.腹痛

B.腸鳴音消失

C.膈下有游離氣體

D.血壓有下降趨勢

E.脈搏增快，體溫升高

49.引起繼發(fā)性腹膜炎的病因不包括（）？

A.急性闌尾炎

B.潰瘍穿孔

C.膽囊穿孔

D.肝硬化腹水感染

E.手術(shù)污染

50.男，55歲。食欲下降、消瘦半年。胃鏡示:胃竇大彎潰瘍1.2cmx1.0cm,邊緣隆起。超聲胃鏡:黏

膜下層及淺肌層結(jié)構(gòu)不清。病理:胃腺癌。幽門螺桿菌陽性。最適宜的治療是（）？

A.手術(shù)治療

B.放射治療

C.化療

D.胃鏡下切除

E.抗幽門螺桿菌治療

51.急性機械性腸梗阻引起的首要病理生理改變是（）?

A.呼吸衰竭

B.感染

C.體液喪失

D.毒素中毒

E.休克

52.Charcot三聯(lián)征出現(xiàn)于（）？

A.急性胰腺炎

B.膽石繼發(fā)膽管炎

C.急性十二指腸憩室炎

D.急性胃炎

E.急性膽囊炎

53.常用于胰腺癌診斷和術(shù)后隨訪的腫瘤標志物為（）？

A.CA19-9

B.CA153

C.CA125

D.AFP

E.CEA

54.男，40歲。慢性膀胱刺激癥狀，伴排尿困難及尿流中斷，改變體位后可繼續(xù)排尿，應(yīng)首先考慮（）？

A膀睚石

B.急性腎盂腎炎

C.泌尿系結(jié)核

D.膀胱腫瘤

E.急性膀胱炎

55.上尿路結(jié)石出現(xiàn)血尿的特點是（）？

A.尿頻

B.活動后絞痛并有血尿

C.間歇性無痛血尿

D.下腹部疼痛并有惡心

E.排尿突然中斷

56.膀胱腫瘤最常見的組織類型是（）？

A.移行細胞癌

B.透明細胞癌

C橫紋肌肉瘤

D.鱗癌

E.腺癌

57.關(guān)于開放性骨折表述正確的是（）？

A.骨折有移位，畸形

B.骨折處軟組織破裂,骨折端與外界相通

C.骨折部碎成3塊以上

D.骨折處皮膚黏膜完整，骨折端不與外界相通

E.發(fā)生于肌腱附著部位的骨折

58.老年女性。不慎摔倒，左馥部著地，當即左毓劇痛，不能站立，急診來院。檢查見左下肢縮短，外

旋畸形。其最可能的診斷是（）？

A.左骸關(guān)節(jié)前脫位

B.左髓關(guān)節(jié)后脫位

C.左髓關(guān)節(jié)中心脫位

D.左股骨頸骨折

E.左股骨干骨折

59.肩關(guān)節(jié)脫位時，肱骨頭最容易脫出的方向是（）？

A.前方

B.外側(cè)

C.內(nèi)側(cè)

D.上方

E后方

60.男性,26歲。不慎被翎草機皮帶絞傷左手，拇指骨折，皮膚及軟組織損傷嚴重。對其治療正確的

做法是（）？

A.清創(chuàng)應(yīng)不遲于傷后24小時

B.清創(chuàng)無須應(yīng)用止血帶

C.清創(chuàng)按從淺層到深層進行

D.骨折可以暫不處理

E.肌腱神經(jīng)損傷必須一期修復(fù)

61.屬于肩周炎診斷依據(jù)的是（）？

A.男性多于女性

B.右側(cè)多于左側(cè)

C.肩部疼痛，與動作無關(guān)

D.肩關(guān)節(jié)外展，外旋，后伸受限

E.肩部三角肌無萎縮

62.女,21歲。1小時前被人發(fā)現(xiàn)昏迷，身邊有空瓶，瓶內(nèi)有刺激性氣味。查體:P60次/分，全身大汗，呼吸

有蒜臭味,瞳孔針尖大小，兩肺滿布濕啰音。最可能的診斷是()？

A.糖尿病酮癥酸中毒

B.鎮(zhèn)靜催眠藥中毒

C.有機磷殺蟲藥中毒

D.乙醇中毒

E.一氧化碳中毒

63.A57-year-oldwhitemanisbroughttotheemergencydepartmentbyambulancebecause

ofsudden-onset,brightredemesis.Hisbloodpressureis80/40mmHgandheartrateis124/min.

Physicalexaminationisnotableforjaundiceandanenlargedabdomenthatisdulltopercussion

andpositiveforafluidwave.Whichofthefollowingvesselanastomosesisresponsibleforthe

patient'sbleeding?

(A)Leftgastricarteryandleftgastricvein

(B)Leftgastricveinandazygosvein

(C)Paraumbilicalveinandinferiorepigastricvein

(D)Portalveinandinferiorvenacava

(E)Splenicveinandleftrenalvein

64.A78-year-oldmanisbroughttothehospitalbecauseoffeverandacuteonsetofleftlower

quadrantabdominalpain.Aboutaweekago,hewasseenbyhisfamilyphysicianforpainless

rectalbleeding.Laboratorytestsshow:RBCcount:5million/mm3zHematocrit:36%,Hemoglobin:

12g/dL,WBCcount:93,000/mm3,Meancorpuscularvolume:75fL.Whichofthefollowingisthe

mostappropriatefollow-uptestafterthepatientisdischarged?

(A)Abdominalultrasound

(B)Colonoscopy

(C)CToftheabdomen

(D)MRIoftheabdomen

(E)UprightabdominalX-ray

65.A51-year-oldmanwithalengthyhistoryofmedication-dependentrefluxesophagitissees

hisphysicianforanannualphysicalexamination.Laboratorytestsrevealabloodgastrinlevelthree

timestheupperlimitofnormal.Hisphysicianexpressesconcernthatthepatientisatriskof

developingatrophicgastritis.Whichofthefollowingmedicationsisthispa-tientmostlikelytaking?

(A)Aluminumhydroxide

(B)Bismuth

(C)Cimetidine

(D)Misoprostol

(E)Omeprazole

66.A64-year-oldmanisbroughttotheemergencydepartmentforchestpain.An

electrocardiogramdemonstratesanST-elevationmyocardialinfarctionintheposteriorleads.After

theinitialmanagement,heisadmittedtothecriticalcareunitformonitoring.Onthefifthhospital

day,heexperiencesasuddenonsetofdyspneaandhypotension.Anechocardiogramshows

severemitralregurgitation.Anocclusioninwhichvesselisresponsibleforthesefindings?

(A)Leftanteriordescendingartery

(B)Leftcircumflexartery

(C)Le代marginalartery

(D)Posteriordescendingartery

(E)Rightmarginalartery

67.A56-year-oldwomanpresentstoherphysicianduetorecentonsetofchestpainand

dyspnea.Sixweeksprior;thepatientsufferedamyocardialinfarction.Herphysicalexaminationis

remarkableforafrictionruboverthefifthintercostalspaceinthemidclavicularline,alongwith

anelevatedjugularvenouspressure.Whatisthemostlikelycauseofthispatient'spresentation?

(A)Cardiacarrhytllmia

(B)Dressiersyndrome

(C)Leftventricularfailure

(D)Thromboembolism

(E)Ventricularrupture

68.A65-year-oldwomanwithtype2diabetesmellitusisprescribedadrugbyherphysician

totreatherhypertension.Shereturnscomplainingoffacialswellingandacough.Herphysician

promptlyswitcheshertoanewdrug,whichhasthesamedesiredeffectbutfeweradverseeffects.

Whatisthemechanismofactionofthereplacementdrug?

(A)Blockadeofplreceptors

(B)inhibitionofangiotensinIIreceptors

(C)inhibitionofangiotensin-convertingenzyme

(D)inhibitionofcalciumchannels

(E)inhibitionofNaCIreabsorptionintheearlydistaltubule

69.Inanattempttobetterunderstandthepathophysiologyofobesityhypoventilation

syndrome,amedicalstudentisreviewingthewaysinwhichbodyexertscontrolofrespiration.

Whichofthefollowingistruewithregardtoregulationofrespiration?

(A)Breathingiscentrallyregulatedviathehypothalamusandamygdala

(B)Centralchemoreceptorsaffectbreathingbydirectlydetectingbloodlevelsofhydrogen

ions

(C)Peripheralchemoreceptorsstimulatebreathingwhenthepartialpressureofoxygendips

below60mmHg

(D)Stretch,irritant,andJreceptorsallfunctionoutsidethelungtoregulatebreathing.

(E)Theaorticandcarotidbodiesareconsideredcentralchemoreceptors

70.A37-year-oldmanisbroughttotheemergencydepartmentafterbeingstabbedsuperior

tohisrightnipplewithaknife.Hisbloodpressureis100/60mmHg,heartrateis126/min,

respiratoryrateis26/min,andoxygensaturationis90%on100%oxygenfacemask.Thewoundis

bubbling,andtheskinimmediatelyaroundthewoundismovinginandoutwithrespirations.

Whichofthefollowingwillmostlikelybefoundontherightsideduringx-rayofthispatient's

chest?

(A)Hemothorax

(B)Ninthribfracture

(C)Pleuraleffusion

(D)Pneumothorax

(E)Upperlobeconsolidation

71.A65-year-oldmanwitha110-pack-yearhistoryofsmokingpresentstohisprimarycare

physicianbecauseofshortnessofbreath,dyspneaonexertion,andcoughforthreemonths'

duration.X-rayofthechestrevealsflatteneddiaphragmsbilaterally.Thedoctororderspulmonary

functionteststoevaluatethepatientWhichofthefollowingpulmonaryfunctiontestresults

wouldmostlikelybefoundinthispatient?

(A)DecreasedFEV1:FVC

(B)Decreasedfunctionalresidualcapacity

(C)Decreasedtotallungcapacity

(D)IncreasedFEV1

(E)IncreasedFEV1:FVC

72.A32-year-oldmanisbroughtintotheemergencydepartmentbyambulanceafterfalling

fromaladderwhilecleaninghisroofgutters.Hisvitalsignsarestable,heisfullyalertandoriented,

andhereportshavingnopastmedicalproblems.Heisinexcruciatingpain,whichhestatesis

locatedinhisleftarm.Anx-rayoftheleftupperextremityisshownintheimage.Ifleftuntreated,

whichofthefollowingmusclesisatriskoflosingfunctionduetothisinjury?

(A)Firstandsecondlumbricals

(B)Brachioradialis

(C)Flexorcarpiulnaris

(D)Opponenspollicis

(E)Palmarislongus

73.Alargebodyofepidemiologicresearchhasshownthatadietinsodiumcancontributeto

hypertension,resultinginleftventricularhypertrophy.TheIntersaltEpidemiologyStudyrelates

increasedsodiumintaketohigherbloodpressuresacrossdiversepopulations.Also,rigorous

prospectiveclinicaltrialsdemonstratethatloweringsodiumintakecanlowerarterialpressurein

normotensiveandhypertensiveindividuals.Whichofthefollowingisamechanismofhowthe

kidneyrespondstohighsodiumintake?

(A)Increaseinatrialnatriureticpeptideanddilationofglomerularafferentarterioles

(B)Increasedreleaseofreninduetochemore-ceptorrecognitionofincreasedplasma

osmolarity

(C)Increasedsecretionofpotassiumintotheurine

(D)Mechanoreceptordetectionofconstrictionofglomerularafferentarterioles

(E)Mechanoreceptordetectionofdilationofglomerularafferentarterioles

74.A63-year-oldhomelesswomanisbroughttotheemergencydepartmentbythepolice

becausesheisdisorientedandconfused.Onquestioningthepatientfrequentlyforgetswhatshe

hasbeenasked.Sheprovidesseeminglyplausibledetailsoftheeventspriortohercomingtothe

hospital,butheraccountsareentirelyinconsistentwiththepolicereport.Onphysicalexamination

sheisemaciatedandhasnystagmusandanunsteadygait.EDrecordsindicatethatshehas

presentedmultipletimesinthepastforalcoholwithdrawalandalcohol-relatedinjuries.Thelesion

accountingforthepatient'ssignsandsymptomsislocatedinwhichpartofthebrain?

(A)Amygdala

(B)Basalganglia

(C)Brocaarea

(D)Mamillarybodies

(E)Wernickearea

75.A32-year-oldmancomestothephysicianbecauseofheadachesthatoccuratnightand

withoutwarning.Theybegininhislefteyeandthengeneralizetotheleftsideofhisface.Alcohol

canprecipitatetheattacks,whichlastforlessthanonehour.Thepatientratesthepainasa10/10,

andmultipleover-the-counteranalgesicshaveresultedinminimalbenefit.Heisgivena

prescriptionforsumatriptantotreathissymptomsandisprescribedverapamilforprophylaxis.

Whichofthefollowingisthemostlikelydiagnosis?

(A)Clusterheadache

(B)Medication-overuseheadache

(C)Migraineheadache

(D)Temporomandibularjointdysfunctionsyndrome

(E)Tensionheadache

76.A28-year-oldpreviouslyhealthywomanwhoissixmonthspregnantcomestothe

physiciancomplainingofexcessivefatigueforthepastseveralmonths.Physicalexamination

revealspallorofhermucousmembranes.AperipheralbloodsmearshowssmallRBCscontaining

anarrowrimofhemoglobinattheperiphery.Whichofthefollowinglaboratoryvaluesaremost

likelytobefoundinthispatientzaboutFerritin,Iron-bindingcapacity,andMeancorpuscular

volumerespectively?

(A)IINormal

(B)IIt

(C)ItI

(D)Itt

(E)ttI

77.A50-year-oldmancomestothephysician'sofficewithweightloss,fatigue,nightsweats,

easybruising,andnosebleeds.Healsocomplainsofpainnearhisfirstmetatarsophalangealjoint

inhisleftfoot.Physicalexaminationisremark-ableforhepatosplenomegaly.Laboratorystudies

3

showapreponderanceofWBCs(>50/000/mmandafullspectrumofmyeloidcellsinthe

peripheralbloodsmear.Ongeneticanalysis,atranslocationofchromosomes9and22isfound.

Whichofthefollowingisthefirst-linetreatmentforthiscondition?

(A)Allopurinol

(B)Busulfan

(C)Hydroxyurea

(D)Imatinib

(E)Interferon-a

78.A45-year-oldmanwithtype2diabetesmellituspresentstohisphysicianforregularfollow-

up.Onneurologicexamination,thepatientdemonstratesthemostcommoninitialsensory

impairmentinpatientswithdiabetesmellitus.Whichofthefollowingreceptorsismostlikely

affectedinthispatient?

(A)Krauseendbulbs

(B)Meissnercorpuscle

(C)Merkelnerveendings

(D)Paciniancorpuscle

(E)Ruffinicorpuscle

79.A27-year-oldwhitewomancomestothephysicianbecauseofasix-monthhistoryof

progressiveweaknessandfatigue,andoccasionalmildabdominalpain.Shealsohasnoticedthat

herskinhasbecomemoretan,especiallyattheelbows,knees,andknuckles,despitethefactthat

sheisnotusuallyinthesun.Laboratorytestsshowdecreasedserumlevelsofsodium,bicarbonate,

chloride；andglucoseandincreasedlevelsofpotassium.Whichofthefollowingisthemostlikely

diagnosis?

(A)Addisondisease

(B)Connsyndrome

(C)Cushingsyndrome

(D)Pheochromocytoma

(E)Waterhouse-Friderichsensyndrome

80.A35-year-oldHIV-positivewomanwithaCD4+countof175/pL(normal=500-

1500/pL)presentstotheclinicwithatwo-weekhistoryoffever,nonproductivecough,and

progressivedyspnea.Shehasahistoryofsulfaallergy.Physicalexaminationrevealsdiffuse

cracklesandrhonchi.X-rayofthechestshowsdiffuse,bilateralinterstitialinfiltrates.Laboratory

studiesareremarkableonlyforanelevatedlactatedehydrogenaselevel.Whichofthefollowingis

thebestchoiceforprophylaxisagainstthisinfectioninapatientwithsulfaallergy?

(A)Aerosolizedpentamidine

(B)Ciprofloxacin

(C)Fluconazole

(D)Terbinafine

(E)Trimethoprim-sulfamethoxazole

81.A19-year-oldmotheroftworushestoherobstetrician'sofficeat35weeks'gestation

becauseofcrampingabdominalpainandmildvaginalbleeding.Bothcrampsandbleedingstarted

abouttwohoursago.Painisconstant,withintermittentepisodesofseverecrampingBleedinghas

beensufficienttosoakthroughfourtofivepadswithinthepastfewhours.Shedeniesahistory

oftraumaorleakageofclearfluid.Shedoesadmittousingcocainethreetimeswithinthepast

month,mostrecentlylastnight.Sheisafebrile,bloodpressureis155/95mmHg,andheartrate

is100/min.Bi-manualexaminationrevealstendernessoverthefundusandanondilatedcervix.

Ultrasoundrevealsanormallyimplantedplacentawithnovisibleabnormalities.Fetalheartrateis

inthel70-180/minrange.Whichofthefollowingisthemostlikelydiagnosis?

(A)Abruptioplacentae

(B)Concealedabruption

(C)Labor

(D)Placentaaccreta

(E)Placentaprevia

82.A2-year-oldJapanesegirlisbroughttotheclinicbyherparents,whoareconcernedabout

apersistentfeverof40℃(104°F)andanerythematousrashonhertrunkthathasbeenpresent

forthepastweek.Laboratorytestsshowanerythrocytesedimentationrateof80mm/hr,aC-

reactiveproteinlevelof15mg/L,andaplateletcountof700,000/mm3.Thedoctorsdecideto

treatherwithintravenousimmunoglobulinandaspirintoavoidalife-threateningcomplication.

Whatothersignsmightthispatient'sdoctorshaveseenthatledthemtothisinitiatethistherapy?

(A)Hypothermia

(B)Opticneuritis

(C)Proteinuria

(D)Pulmonaryedema

(E)Strawberrytongue

83.A40-year-oldschoolteacherdevelopsnauseaandvomitingatthebeginningofthefall

semester.OverthesummershehadtaughtpreschoolchildreninasmalltowninMexico.Sheis

sexuallyactive,buthasnotusedintravenousdrugsandhasnotreceivedbloodproducts.Physical

examinationrevealsscleralicterus,rightupperquadranttenderness,andapalpableliver.Liver

functiontestsshowaspartateaminotransferaseof750U/L(normal<40)andalanine

aminotransferaseof1020U/L(normal<45).Thebilirubinis13mg/dL(normal<1.4)andthe

alkalinephosphataseisnormal.Whatfurtherdiagnostictestismostlikelytobehelpful?

A.Liverbiopsy

B.Abdominalultrasound

C.IgMantibodytohepatitisA

D.AntibodytohepatitisBsurfaceantigen

E.DeterminationofhepatitisCRNA

84.Youareseeingapatientwhoreportstheabruptonsetofdeepepigastricpainwith

radiationtothebackassociatedwithnausea,vomiting,sweating,andweakness.Onexamination,

hisabdomenisdistendedandtenderintheepigastricarea.Whichofthefollowingisthemost

commoncauseofthiscondition?

A.Gallstones

B.Alcoholabuse

C.Iatrogeniccause

D.Idiopathiccause

E.Hyperlipidemia

85.A39-year-oldpreviouslyhealthymaleishospitalizedfor2weekswithepigastricpain

radiatingtohisback,nausea,andvomiting.Initiallaboratoryvaluesrevealedanelevatedamylase

levelconsistentwithacutepancreatitis.Fiveweeksfollowingdischarge；hecomplainsofearly

satiety,epigastricpain,andfevers.Onpresentation,histemperatureis38.9℃(102°F)andhisheart

rateis120beatsperminute;hiswhitebloodcell(WBC)countis24/000/mm3andhisamylaselevel

isnormal.HeundergoesaCTscandemonstratinga6-cmby6-cmrim-enhancingfluidcollection

inthebodyofthepancreas.Whichofthefollowingwouldbethemostdefinitivemanagementof

thefluidcollection?

A.Antibiotictherapyalone

B.CT-guidedaspirationwithrepeatimagingin2to3days

C.AntibioticsandCT-guidedaspirationwithrepeatimagingin2to3days

D.Antibioticsandpercutaneouscatheterdrainage

E.Surgicalinternaldrainageofthefluidcollectionwithacyst-gastrostomyorRoux-en-Ycyst

jejunostom

86.Apatientpresentstoyourofficeindistresswithoutanappointment.Heis23yearsold

andiscomplainingofseverechestpain.Hereportsafamilyhistoryofcoronarydisease,complains

offrequent“heartburn,“andsaysheisrecoveringfromarecentviralupperrespiratoryinfection.

Hesmokesonepackofcigarettesaday,andadmitstoillegaldruguseinthepast.Onexamination；

hisbloodpressureis138/90mmHg,hispulseis126beatsperminuteandregular,andheis

diaphoretic.Hisexaminationisotherwiseunremarkable.Hiselectrocardiogramshowsmyocardial

ischemia.Whichofhishistoricalfeaturesaremostsuggestivethatmyocardialischemiawouldbe

thecauseofhissymptoms?

A.Familyhistoryofcoronarydisease

B.Historyof"heartburn"

C.Recentviralupperrespiratoryinfection

D.Smokinghistory

E.Druguse

87.A32-year-oldwomanreportsthatshesometimes“skipsheartbeats?Hermedicaland

socialhistoriesincludemoderatedailycaffeineuse,butareotherwiseunremarkable.Herphysical

examinationand12-leadECGarenormal,asareherCBC,electrolytes,andTSH.Whichofthe

followingisthenextappropriatestepinherworkup?

A.Reassureherandcontinueobservation

B.PerformambulatoryECGmonitoring(a24-Holtermonitor;oracontinuousloopevent

recorder)

C.Electrophysiologyconsultation

D.Stresstesting

E.Echocardiography

88.An82-year-oldmanpresentstotheEDfeelingweakanddizzy.Hehasapastmedical

historyofhypertensionanddiabetesandbotharewellcontrolledonhydrochlorothiazide,

benazepril,atenolol,andmetformin.Onreviewofsystems,hedenieschestpain,gastrointestinal

bleeding,andsyncope,butstatesthathefeelsshortofbreath.Histemperatureis98.6°Forally,BP

is86/60mmHgzHRis44beatsperminute,RRis18breathsperminute,oxygensaturationis98%

onroomair,andglucoseis116mg/dL.Heisimmediatelyconnectedtothecardiacmonitor.Which

ofthefollowingchoicesbestdescribestheECGseenbelow?

A.Normalsinusrhythm

B.First-degreeAVblock

C.Second-degreeMobitzI(Wenckebach)AVblock

D.Second-degreeMobitzIIAVblock

E.Third-degreeAVblock

89.An88-year-oldresidentofalocalnursinghomeistransferredtoyourfacilitywith

shortnessofbreath.Shehasbeencoughingforthepast2to3days.Thepatienthasahistoryof

milddementia,buthashadnowitnessedepisodesofcoughingorchokingwheneating.Vital

signsincludeaheartrateof103/minute；respiratoryrateof22/minute,bloodpressure158/68

mmHg,temperatureof37.9℃(100.2°F)withaweightof52kg.Uponexamination,sheispleasant

butdisoriented.Chestauscultationrevealscracklesintheleftlowerlungfield.WBCcountis11,000,

BUNis32；andcreatinineis1.3.Chestradiographshowsaninfiltrateintheleftlowerlobe,and

inducedsputumsamplehasbeensentforGramstainandculture.Whatisthebestinitialcourse

oftherapyforthispatient?

A.Beginathird-generationcephalosporinandmacrolideandadmithertothehospital.

B.Beginarenal-dosedthird-generationcephalosporinandmacrolideandadmithertothe

hospital.

C.Beginarespiratoryfluoroquinoloneanddischargehertothenursinghomeforfollow-up.

D.Beginanantipseudomonalcarbapenem,antipseudomonalrespiratoryfluoroquinolone,

andglycopeptideandadmither