Board Prep

A 73-year-old woman who resides in a nursing home is being examined for an infection on her foot and increasing fatigue. She has had similar infections in the past year, typically after small scrapes to her lower extremities. She takes atorvastatin and a daily multivitamin. Physical examination shows an erythematous lesion on her foot measuring 2 cm by 2 cm. Results of laboratory studies show: Hemoglobin:  9.8 g/dL  Mean corpuscular volume:  110 RBC count: 3.5 million cells/mcL WBC count: 3000 cells/mcL A bone marrow biopsy specimen shows hypercellularity and dysplasia with 10% myeloblasts. This patient's current disorder may progress into which of the following conditions?

A. Acute lymphoblastic leukemia B. Acute myelogenous leukemis C. Aplastic anemia D. Chronic lymphocytic leukemia E. Hairy cell leukemia

A 57-year-old man is brought to the emergency department because of blurry vision, difficulty standing, and mental confusion. The patient’s companion says he is having difficulty remembering to do everyday tasks. On physical examination, the patient appears malnourished, and his gait is wide-based and unsteady. His abdomen is distended, and thin branching telangiectasias are noted. There is bilateral nystagmus on lateral gaze. A comprehensive metabolic panel shows: Albumin:  1.8 g/dL Total bilirubin:  3.2 mg/dL Aspartate aminotransferase:  302 U/L Alanine aminotransferase:  149 U/L Alkaline phosphatase:  85 U/L Which of the following neuropathologic findings are most consistent with this patient’s symptoms?

A. Atrophy of the caudate nucleus B. Depigmentation in the substantia nigra pars compacta C. Lesion of the subthalamic nucleus D. Neurofibrillary tangles and widening of ventricles E. Symmetric lesions in the mammillary bodies

A 57-year-old man comes to the office because of a 4-month history of fever, weight loss, fatigue, and generalized weakness. He also has a sense of abdominal fullness and “tightness.” Physical examination reveals enlarged cervical, supraclavicular, axillary, and inguinal lymph nodes. CT scan reveals no thoracic adenopathy, but a lymph node-based large mass in the abdomen and evidence of liver masses. Which of the following types of neoplastic cells are most common in this patient’s condition?

A. B cell B. Myeloblast C. Plasma cell D. Reed-Sternberg cell E. T cell

A 56-year-old man was brought to the emergency department with crushing chest pain beneath his sternum. He was sweating profusely and breathing rapidly. Initial ECG in the field revealed ST-segment elevations in the anterior leads. During transportation to the hospital, he dies unexpectedly. Which of the following is the most likely cause of death in this patient?

A. Cardiogenic shock B. Mural thrombosis C. Ruptured coronary artery aneurysm D. Ruptured papillary muscle E. Supraventricular tachycardia F. Ventricular arrhythmia

A 74-year-old nursing home resident is brought to the emergency department after her caretaker noticed she was having difficulty speaking since waking up that morning. She has a history of atrial fibrillation, long-standing diabetes, hypertension, and a 40-pack-year smoking history. Her vital signs are within normal limits, and she is able to follow commands, but her speech is effortful, producing short phrases that often omit prepositions. She has moderate weakness of her right lower face and right arm with loss of all forms of sensation on the right side. Which of the following vessels is most likely to be occluded or abnormal due to this patient’s stroke?

A. Anterior cerebral artery B. Anterior communicating artery C. Posterior communicating artery D. Right middle cerebral artery E. Superior branch of left middle cerebral artery