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My State Exam

I took my written state exam on June 9th, 2009.

Note: This is an exact copy of my exam (I wrote everything down directly from my hardcopy!) and the order of the answer alternatives has been shuffled on some of the questions compared to older exams. Just a heads up :-)

Here are the questions (total of 180 points)

1. Which of the following methods is appropriate for evaluating the severity of late occurring toxemia of pregnancy?

A) the measurement of blood pressure
B) the measurement of urinary protein concentration
C) assessing the severity of edema as well as the patient's subjective symptoms
D) all of the above
E) only answers (B) and (C) are true

2. Valid statements regarding cohort studies include:

A) these are descriptive studies
B) these are analytic studies
C) these are usually longitudinal studies

3. The blood-brain barrier is composed of:

A) capillary endothelium
B) basal membrane
C) podocytes of the astrocytes
D) all of the above

4. Associate the following statement(s) with their corresponding term(s)!

4.1 Paget's disease

A) vitamin A intoxication
B) it is complicated by sarcoma
C) neurologic complications; fractures
D) skin pigmentation
E) a saddle-nose deformity
F) uneven cartilage
G) in the differential diagnosis angina - pectoris

4.2 Hyperostosis

4.3 Osteoporosis

4.4 Fibrotic dysplasia

4.5 Ollier's syndrome

4.6 Relapsing polychondritis

4.7 Tietze's syndrome

5. Case Study:
A 40-year-old worker had a massive upper gastrointestinal hemorrhage accompanied by splenomegaly. He never consumed alcohol. Which of the following could have caused this gastrointestinal bleeding?

A) esophageal varices
B) gastric carcinoma
C) a peptic ulcer
D) gastritis
E) esophagitis

6. Lumbar and low extremity pain, peripheral low extremity paresis and urination disorders occur in:

A) lumbar spondylosis
B) lumbar disc hernia
C) a tumor of the cauda equina
D) all of the above

7. Salivary stones (sialoliths):

A) develop most freqently in the parotid gland
B) can develop in association with urinary calculi
C) are easily palpable
D) are readily detected on roentgenograms
E) can be detected by palpation, using a lacrimal probe

8. The term "incidence" is defined as:

A) the contingence of the occurrence of diseases
B) the total number of cases over a specified time-period
C) the number of chronic cases over a specified time-period
D) the number of new cases occurring over a specified time-period

9. Currently, the most effective contraceptive method is the:

A) oral (hormonal) contraceptive
B) intrauterine device
C) condom
D) cervical diaphragm
E) calendar rhythm method (periodic abstinence)

10. Which of the following ECG changes are typical of Printzmetal's angina during a fit?

A) diffuse ST elevation
B) ST elevation in a localized area
C) diffuse ST depression
D) ST depression in a localized area
E) none of the above

11. Case Study:
A 45-year-old male patient complains of lumbar pain radiating to his leg. Ipsilateral Achilles areflexia and hypesthesia in the small toe were found.
At which spinal root level does the patient have a disc hernia compression?

A) L4 root
B) L2 root
C) S1 root
D) L3 root
E) L5 root

12. Leukemia may develop insidiously with prolonged exposure to:

A) benzene
B) carbon tetrachloride
C) methylbromide
D) trichlorethylene

13. The proportion of suicides which have already been preceded by earlier suicie attempts is:

A) 10%
B) 50%
C) 60%
D) 100%
E) 20%

14. The most pronounced gastrointestinal fluid absorption occurs in the:

A) duodenum
B) jejunum
C) ileum
D) colon
E) none of the above

15. The most frequently occurring chromosomal abnormality that can be reliably detected by amniocentesis is:

A) trisomy 21
B) translocation 21/22
C) trisomy 18
D) trisomy 13
E) translocation 13-15/21

16. Case Study:
You are summoned to an emergency at a nearby café. Arriving on the scene, you find a middle-aged, obese man sagging in his chair. Bystanders inform you that the patient had ordered a coffee and two croissants. After he had been served, he began to make forceful and wild gestures, swept everything off from his table, howled incoherently, then collapsed back into his chair.
On physical examination he is still uttering incoherent sentences. The patient resists physical examination and beats about with his arms. Ifis skin and mucous membranes are of normal colour, but the patient is streaming -with perspiration. Me chest and abdomen are normal on physical examination. A Babinski-tendency is observed on the left side and patellar clonus can be elicited on the right. Breath: no characteristic odour is scented.
Pulse: 88/min with sporadic extrasystoles. Blood pressure: 190/ 100 mmHg.
The most likely diagnosis is:

A) acute psychosis
B) a cerebral embolism
C) hypoglycemia
D) a transient cerebral ischemic attack
E) alcoholic psychosis

17. A ball on the foot develops in patients with:
1) a bronchogenic carcinoma
2) a lung abscess
3) bronchiectasia
4) chronic obstructive pulmonary disease

A) 1, 2, and 3 are true
B) 1 and 3 aretrue
C) 2 and 4 aretrue
D) only 4 is true
E) all of the above

18. Negative symptoms of schizophrenia include all of the following, EXCEPT:

A) anhedonia
B) flat affect
C) auditory hallucinations
D) poverty of thought content
E) lack of motivation and initiative

19. Possible causes of a fever of unknown origin include all of the following, EXCEPT:

A) pyelonephritis
B) thyroiditis
C) subacute bacterial endocarditis
D) hypothyroidism
E) Salmonella enteritis

20. All of the following statements regarding polyhydramnios are valid, EXCEPT:

A) therapeutic amniocentesis is indicated solely for the alleviation of maternal distress
B) in polyhydramnios, the incidence of major congenital abnormalitiesis 20%
C) the rapid removal of amniotic fluid is contraindicated
D) occasionally, it can be treated safely and effectively with diuretics as well as restricting the intake of water and dietary salt
E) polyhydramnios is associated with an increased incidence of premature separation of the placenta, uterine dysfunction and post-partum bleeding

21. The typical memory loss occurring in Korsakoffs syndrome is due to a lesion of which of the following structures?

A) habenula
B) frontal associative cortex
B) parietal associative cortex
C) mammilary body, limbic cortex

22. Epidemiology can be regarded as the study of:

A) the incidence and causes of human death
B) the etiology of human diseases
C) the functional parameters of the health care delivery system
D) the distribution of human diseases and the incidence of their determining factors

23. The most prevalent cause of mortality due to a duodenal ulcer can be:

A) an esophageal rupture associated with the regurgitation of the acidic gastric contents
B) hemorrhage
C) an untreatable disease
D) pyloric obstruction and inanition
E) peritonitis resulting from acute perforation

24. Case Study:
The family history of a 2-year-old child reveals, like both his parents,
Allergic rhinitis caused by ragweed. The child also has had pseudocroup (thymic
asthma) twice. Is an allergological examination indicated in this case?

A) no, because there is no relationship between ragweed allergy and pseudocroup, plus sensitivity for other allergens cannot be usually demonstrated
B) yes, because there is a positive family history for allergy
C) yes, because desensitization with the demonstrated allergen can be used to prevent the development of a pseudocroup
D) yes, because pseudocroup is a forerunner of bronchial asthma

25. The diganosis of endometriosis refers to:

A) the precancerous stage of endometrial carcinoma
B) fibrosis resulting from chronic endometritis
C) endometrial lesions caused by IUDs
D) the presence of extrauterine endometrium implants
E) viral endometritis

26. All of the following are characteristic features of full-blown traumatic (hypovolemic) shock, EXCEPT:

A) an increased blood viscosity
B) peripheral vasoconstriction
C) bradycardia
D) stupor
E) oliguria

27. Case Study:
The history of a 48-year-old female patient contains 2 vaginal deliveries and an uncomplicated arteflcial abortion. Her last menstruation has occurred 3 years ago. She has observed slight, speckling vaginal bleeding occurring after intercourse and defecation. Her body weight
is stable; constipation is a frequent symptom.
Physical examination: Breasts show no particular finding. The abdomen is soft and palpable. External genitals are normal. Hemorrhoids are visible in the anal orifice. Capacious vagina; scar of a previous episiotomy. The surface of the portio vaginalis of the cervix is irregular; with an exophytic, coated neoplasm that bleeds easily on touch. The anteflexed uterus is of regular size; its vicinity and the cul-de-sac are normal.
Colposcopy: swollen, irregular portio vaginalis wth an exophytic, coated neoplasm that bleeds easily. Malodorous vaginal discharge, slight bleeding after the examination.
Rectal examination: No abnormality is palpable, the parametrium is normal on both sides. Several inflamed, moderately hemorrhoids are visible in the anal orifice.
Colposcopy: the ventral labium of the portio vaginalis is covered by rough epithelium with numerous atypical capillaries that bleed easily.
Tumor cytology: P5.
What is the likely diagnosis?

A) inoperable carcinoma of the uterine corpus
B) primary affection on the surface of the portio vaginalis
C) malignant neoplasm of the portio vaginalis of the cervix
D) cervicitis
E) grade I stress incontinence + vaginitis with acute cervicitis

28. All of the following are risk factors for hypertension, EXCEPT:

A) a high bodyweight
B) a hereditary disposition
C) an excessive intake of sodium
D) the regular use of alcohol
E) smoking

29. The most appropriate method for maintaining patent airways in a patient with multiple trauma resulting from a car accident due to drunken driving is:

A) tracheostomy
B) intubation with a cuffed endotracheal tube
C) thrusting the jaw and lifting the chin
D) oropharyngeal intubation
E) endotracheal intubation

30. Case Study:
An 80-year-old alcoholic male patient complains of a headache probably due to skull injury. He has had left-sided hemiparesis for a month. The right carotidangiography showed detachment of the cerebral vessels from the internal surface of the skull. The most probable diagnosis is:

A) right-sided glioblastoma of the frontal lobe
B) occlusion of the right middle cerebral artery
C) cerebral contusion
D) right-sided subdural hematoma
E) right-sided epidural hematoma

31. All of the following can occur as a complication of chronic obstructive pulmonary disease EXCEPT:

A) respiratory insufficiency
B) left ventricular insufficiency
C) polycythemia
D) cor pulmonare
E) bronchogenic carcinoma

32. In which of the following do pulmonary abscesses develop?
1) pneumococcus type-III pneumonia
2) mitral stenosis
3) pulmonary infarction
4) scleroderma
5) regional enteritis

A) 1, 2, and 3 are true
B) 1 and 3 are true
C) 2 and 4 are true
D) only 4 is true
E) all of the above

33. Case Study
A 6-month-old infant is referred to the hospital by the physician. The infant has been ill for 5 weeks. The disease started with the symptoms of bronchitis and cough, for which penicillin therapy had been initiated.After a transient improvement, the cough became more severe, and subfebrility, then febrility developed. Following this, tetracycline (Tetraolean) and penicillin had been administered in injection form. These did not relieve the cough. The physical symptoms were characteristic for bronchitis. Current symptoms: are loss of appetite, stagnation of somatic growth, the stool is bulky, loose and fetid. Family history: the parents mention that they lost their first child: she had an operation on the 2nd day of her life and 3 days later she died. They remarked that: "There was something wrong with her intestine".

33.1 The most likely diagnosis is:

A) interstitial plasmocytic pneumonia
B) gastroesophageal reflux
C) apiration pneumonia
D) ascariasis
E) cystic fibrosis

33.2 Which of the following diagnostic tests is the most important?

A) testing of the gastrointestinal passage
B) bronchography
C) rectal digital examination
D) chest x-ray
E) native abdominal x-ray

33.3 Which of the following, additional tests would you order to confirm your diagnosis?

A) laryngoscopy
B) the demonstration of worm eggs in the stool
C) determination of the chloride concentration in the sweat
D) liver biopsy
E) barium enema

33.4 Which of the following additional tests is also useful?

A) determination of the enzyme activities in the duodenal fluid
B) a lung biopsy
C) an explorative laparotomy
D) an oral glucose tolerance test
E) abdominal ultrasound

33.5 Based on the anamnestic data, which of the following drugs would you order?

A) penicillin
B) a strict diet; mucolytics; enzyme substitution
C) broad spectrum antibiotic
D) metronidazole (Klion)
E) trimethoprim-sulfamethoxazole (Sumetrolim)

34. Cerebral metastatic carcinomas usually originate from the:

A) bones
B) lungs
C) prostate gland
D) esophagus
E) salivatory glands

35. The most important etiological factor of epididymitis is:

A) gonorrhea
B) syphilis
C) listeriosis
D) blastomycosis
E) brucellosis

36. The most common hepatic lesion in cystic fibrosis is:

A) postnecrotic cirrhosis
B) fat atrophy
C) multinodular biliary cirrhosis
D) Laennec's cirrhosis
E) none of the above

37. Alcohol and drug abuse:

A) are equally prevalent in both sexes
B) are more prevalent among males
C) have an age-dependent prevalence
D) are more prevalent among females

38. The most accepted hypothesis explaining the biological basis for schizophrenia is:

A) the dopamine hypothesis
B) the transmethylation hypothesis
C) the double bind hypothesis
D) the serotonin hypothesis
E) the endogenous opiate hypothesis

39. Cataplexy occurs in:

A) grand mal epilepsy
B) Kleine-Levin's syndrome
C) psychomotor epilepsy
D) narcolepsy
E) "status epilepticus"

40. Case Study:
A 29-year-old multiparous woman (4 pregnancies, 4 deliveries) undergoes laparoscopic fulguration of the oviducts. Thirty-six hours after the operation, the patient begins to complain about abdominal pain and nausea. Her body temperature is 38.3 °C and slight abdominal distention is palpated. The most likely diagnosis is:

A) pelvic inflammation
B) tubal abortion
C) a perforating injury to the gut resulting from a stab wound
D) hemorrhage from the uterine tube
E) thermal injury to the gut

41. In a chronic subdural hematoma:

A) the EEG can be normal
B) the EEG exhibits a slow-wave focus
C) the EEG has decreased amplitude
D) all of the above
E) none of the above

42. The time to seek needed medical help is determined by:

A) the personality of the given individual
B) the intensity of the signs and symptoms
C) the pain-sensitivity of the individual
D) all of the above
E) none of the above

43. Which of the following statements characterize the function of the hypothalamo-pituitary-ovarian system correctly in true precocious puberty?

A) menstruation is irregular with prolonged episodes
B) menstruation is usually absent, the appearance of sexual changes depends on hormonal effects
C) menstruation is regular but ovulation is absent
D) regular ovulatory cycles similar to those in reproductive age

44. Case Study:
A 65-year-old male patient passes tarry and loose stools (melena) three days after aortobifemoral bypass surgery. The most likely cause of this condition is:

A) an aortoduodenal fistula
B) DIC (disseminated intravascular coagulation) related to a transfusion
C) a bleeding stress ulcer
D) ulcerative colitis
E) ischemic colitis

45. Case Study:
A 6-hour-old newborn exhibits tachypnea and dyspnea and vomits repeatedly. The body temperature of the newborn is normal. The physical examination reveals a tympanic resonance over the left side of the chest-, no respiratory sounds are audible over this side. The surface of the abdomen is concave. What is the most likely cause of this condition?

A) neonatal sepsis
B) left-sided pneumonia
C) IRDS
D) a diaphragmatic hernia on the left side
E) pneumothorax
F) congenital valvular disease

46. The anion gap can be increased in:

A) pyloric stenosis
B) bromide intoxication
C) liver cirrhosis
D) ammonium chloride intoxication
E) multiple myeloma

47. Case Study:
A 25-year-old unconscious female patient was admitted to the hospital. No friends or witnesses could give any further information on what had happened Centrifugation of the urine obtained by catheter revealed fat drops in the sample. Which of the following diagnoses is possible?

A) eclampsia
B) bone fracture
C) CO intoxication
D) all of the above
E) none of the above

48. All of the following polysystemic autoimmune diseases contribute to the development of Mixed Connective Tissue Disease (MCTD), EXCEPT:

A) systemic lupus erythematosus (SLE)
B) polymyositis/dermatomyositis
C) rheumatoid arthritis
D) progressive systemic sclerosis (scleroderma)
E) Sjörgen's syndrome

49. During which childhood age is the onset of acute lymphoblastic leukemia most frequent?

A) 6 months
B) 3-5 years
C) adolescence
D) the neonatal period
E) 10-12 years

50. In infectious mononucleosis, preventive measures include that:

A) reporting is not required
B) laboratory testing is mandatory
C) the patient should be isolated
D) continuous disinfection is necessary

51. All of the following statements are valid regarding tenosynovitis, EXCEPT:

A) starting from the wound of the thumb, the infection spreads to the radial bursa and the interstitial spaces of the thenar
B) the infection of the other four fingers spreads to the ulnar bursa
C) postoperative physiotherapy must be started early to preserve tendon functions
D) poor natural resistance of the region is characteristic
E) early surgical drainage is essential

52. Which type of abortion is characterized by cramping lower abdominal pain, vaginal bleeding, an open cervix but no passage of the products of conception?

A) imminent abortion
B) post-abortion residue
C) incipient abortion
D) missed abortion
E) incomplete abortion

53. To properly develop a good behavior in a child, it is advisable to:

A) punish the child
B) reward the child
C) both of the above
D) none of the above

54. Asbestos causes cancer in which of the following organs?

A) the pleura
B) the kidneys
C) the brain
D) the adrenals

55. Therapy of hypotonic contraction failure includes the administration of:

A) gestogens
B) spasmolytics and ergotamine
C) oxytocin infusion
D) corticosteroids

56. Case Study:
A round-shaped shadow of 3 cm in diameterwas found on an X-ray screening of a 65-year-old, complaint-flee, smoking male patient. 15 years ago the patient had undergone a successful operation for colon carcinoma. Select the most probable diagnosis:

A) pulmonary abscess
B) carcinoma metastasis
C) bronchial carcinoma
D) tuberculosis
E) aspiration pneumonia

57. Clavicular fractures of children under 10 years of age should be treated as follows:

A) open reduction is appropriate
B) the medial third of the clavicle should be removed
C) no therapy is necessary in most cases
D) reduction and the application of a "figure-of-eight" splint dressing
E) open fixation by a medullary rod is necessary

58. Which of the following is used as health indicators of a population?

A) demographic parameters
B) somatometric parameters
C) epidemiologic parameters
D) all of the above
E) none of the above

59. The most appropriate therapy for clean, fresh lacerations of peripheral nerves is:

A) the administration of antibiotics only
B) delayed suture
C) immobilization of the limb only
D) debridement of the wound only
E) immediate approximation of separated nerve endings

60. In Crohn's disease, the most frequent indication for surgery is:

A) an intra-abdominal mass (intestinal conglomerate)
B) stagnant bowel syndrome
C) intestinal obstruction
D) an external fistula
E) an intra-abdominal fistula

61. Embolization of the cerebral vessels occurs:

A) as a sequel of mitral valve prolapse
B) as a sequel of atrial fibrillation
C) if a lateral thrombus develops
D) as a sequel of subacute bacterial endocarditis
E) after cardiac surgery
F) all of the above

62. A 45-year-old female patient has undergone a cholecystectomy. Three days following the procedure, she developed a deep-vein thrombosis. The treament of choice is:

A) anticoagulation therapy
B) ligation of the great saphenous vein
C) active exercises
D) elevation of the lower extremities
E) thrombolytic therapy with streptokinase or urokinase

63. Case Study:
You are examining an 18-month-old boy. The parents have noted the occurrence of large hematomas on the skin following mild traumas during the last6 months. The results of the laboratory tests are not yet ready, when theparents inform you that the child's finger started to bleed again, two hoursafter the puncture. What is the most likely diagnosis?

A) thrombocytopenia
B) thrombocytopathy
C) vasculopathy
D) von Willebrand's disease
E) hemophilia

64. Cheilosis develops as a result of:

A) a vitamin D deficiency
B) a vitamin A deficiency
C) a vitamin B deficiency
D) a riboflavin deficiency

65. The most common histological type of thyroid carcinoma is:

A) papillary carcinoma
B) undifferentiated small-cell carcinoma
C) undifferentiated large-cell carcinoma
D) follicular carcinoma
E) medullary carcinoma

66. Case Study:
Shortly after a penetrating foot injury a pediatric patient developed trismus, risus sardonicus, opisthotonus, abdominal rigidity. The most probable diagnosis is:

A) drug allergy
B) meningitis
C) tetanus
D) hysteria
E) gas gangrene

67. Should a mother with active tuberculosis nurse her baby?

A) yes
B) no
C) only if she has been receiving antituberculotic chemotherapy during her pregnancy

68. Case Study:
A 41-year-old multiparous (7 pregnancies ,7 deliveries) woman is undergoing a vaginal hysterectomy and reconstructive surgery for uterovaginal prolapse. She has been taking oral contraceptives for the last 10 years. Which of the following potential complications is the most likely associated with contraceptive use?

A) pulmonary embolism
B) pneumonia
C) retinal detachment
D) periorbital cellulitis
E) ileus

69. In puerperal mastitis, the pathogen most often cultured from the excretions of the mammary glands is:

A) Staphylococcus aureus
B) Streptococcus fecalis
C) Staphylococcus epidermidis
D) Bacteriodes species
E) Escherichia coli

70. Combined tumors of the salivary gland:

A) usually have a submaxillary localization
B) are usually malignant
C) usually develop in the parotid gland
D) usually cause facial nerve paralysis
E) typically cause sialolithiasis

71. Typical electric signs of a paradox sleeping behavior are:

A) high amplitude, low frequency
B) low amplitude, high frequency
C) low amplitude, low frequency
D) high amplitude, high frequency

72. Eczema, blond hair, blue eyes and mental retardation are typical of:

A) phenylketonuria
B) Down's syndrome
C) toxoplasmosis
D) cretinism
E) tuberous sclerosis

73. Supraclavicular lymph nodes are often involved in:

A) following injury to the anterior two-thirds of the tongue
B) the metastatic spread of primary malignancies
C) gastric and lung cancer
D) carcinoma of the lip
E) a neuroblastoma

74. According to data obtained in many hospital patients, hyperuricemia is primarily caused by:

A) poorly treated hypertension
B) chronic diuretic therapy
C) obesity and an increased consumption of purines
D) diabetes mellitus in adults
E) chronic renal insufficiency

75. A 4-month-old baby boy, born at term with 3400 g birth weight, currently weighs 6000 g. What is your opinion?

A) the infant is overweight
B) the body weight of the infant is normal
C) the infant's nourishment is deficient

76. Which of the following statements concerning congenital megacolon is correct?

A) constipation is always present; diarrhea never occurs
B) the cause of this condition is the lack of parasympathetic ganglia in the distended portion of the colon or rectum
C) on rectal digital examination, the rectal ampulla is found empty
D) both the narrow and the distended portion have to be removed during the neonatal period
E) it may cause paralytic ileus

77. Select the most important effect of a normal dose of nitroglycerin in angina pectoris (apart from coronary dilation!):

A) relaxation of bronchial smooth muscles
B) dilation of the peripheral vessels
C) constriction of the peripheral arterioles
D) constriction of the peripheral venules
E) none of the above

78. Hypothermia occurs in:
1) myxedema
2) high-dose sedatives
3) alcohol intoxication
4) hyperthyroidism

A) 1, 2, and 3 are true
B) 1 and 3 are true
C) 2 and 4 are true
D) only 4 is true
E) all of the above

79. Select the correct localization of a concretion in case of hydrops vesica felleae:

A) Vater's papilla
B) the common bile duct
C) Wirsungian's duct
D) the hepatic duct
E) the cystic duct

80. In dysmenorrhea:

A) nausea and vomiting, etc. are the primary symptoms, not abdominal cramps
B) abdominal cramping is the leading symptom, seldom associated with nausea and vomiting, etc.
C) symptoms are present from the time of the menarche
D) the symptoms develop after the first delivery
E) initially, menstruation is normal becomes associated with cramps subsequently

81. Exploration of the kidney through the transabdominal route is indicated in:

A) pyelonephritis
B) cystic disease
C) hydronephrosis
D) neoplastic disease
E) tuberculosis

82. The portal of entry for the tetanus pathogen is:

A) the oral mucosa
B) the gastrointestinal tract
C) the conjunctiva
D) the excoriated skin

83. Contraindications to lithium administration include:

A) an administration in combination with imipramine (Tofranil)
B) any occurrence of the symptoms of schizophrenia
C) the presence of depression
D) an administration in combination with chlorpromazine (Thorazine)
E) the presence of a renal disease

84. The most frequent cause of arterial occlusion is:

A) embolism
B) arteriosclerosis
C) varicose veins
D) all of the above

85. Cerebral posterior arteries:

A) originate from the basilar artery
B) can join with the superior cerebellar artery
C) supply the occipital lobe
D) all of the above
E) none of the above

86. Case Study:
A routine test has revealed proteinuria in a 35-year-old male patient. Electrophoresis of the urine proteins showed low molecular proteins at high concentration and only sustained albuminuria. RIA (radioimmunoassay) identifiedthe predominance of beta 2microglobulins.
Which of the following caused the proteinuria?

A) cadmium intoxication
B) mercury intoxication
C) penicillin intoxication
D) glomerulonephritis
E) none of the above

87. Oocytes in the ovaries of a neonate are in the following developmental stage:

A) in the prophase of the first meiotic division
B) at the appearance of oogonia (primordial germ cells)
C) in the stage of maturation
D) in the anaphase of the second meiotic division
E) none of the above

88. Which of the following is the characteristic feature of the Mallory-Weiss syndrome?

A) portwine stains (naevus flammeus) of the stomach
B) rupture of the esophageal mucosa and the gastric mucosa in the region of the cardia
C) bleeding from a gastric polyp
D) mucosal rupture in the esophagus
E) rupture of the gastric mucosa

89. Case Study:
A 4-week-old infant is brought to the physician by the mother. The mother reports that the physiologic jaundice has never ceased completely. The stool is greyish-white and the baby's urine stains the diaper brown. The severity of the baby's jaundice soon increases.

89.1 What is the most likely diagnosis?

A) sepsis
B) hepatitis
C) biliary tract atresia

89.2 The most informative laboratory test is:

A) a hemoculture
B) the RBC sedimentation rate; blood cell counts and the differential count
C) a hepatic functional test
D) a renal functional test
E) a native abdominal x-ray

89.3 What is your diagnosis if the non-conjugated bilirubin fraction is exclusively elevated?

A) sepsis
B) biliary tract atresia
C) hemolytic anemia
D) viral infection

89.4 What is your diagnosis if both the conjugated and non-conjugated bilirubin fractions are elevated?

A) Crigler-Najjar syndrome
B) hemolysis
C) biliary tract atresia

89.5 Which of the following tests are needed for the differential diagnosis of biliary tract atresia and hepatitis?

1) liver biopsy
2) intraoperative cholangiography
3) further observation for 4 weeks
4) administration of prednisone

A) (1) and (2) are correct
B) (2) and (3) are correct
C) (1) and (4) are correct
D) (2) and (4) are correct
E) (3) and (4) are correct

90. A disorientation to time is characteristic of:

A) hypomania
B) depressive psychosis
C) Korsakoff's syndrome
D) an acute schizophrenic episode
E) agoraphobia

MORE COMING SOON!