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Đề Thi Ngày Tháng 24/06/2010
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1. A 44-year-old obese man has extremely high plasma triglyceride levels, but cholesterol levels are within normal limits. Following treatment with a drug specifically indicated for hypertriglyceridemia, triglyceride levels decrease to almost normal. Which of the following agents is most likely to have caused this desired change?
A. Atorvastatin
B. Cholestyramine
C. Colestipol
D. Ezitemibe
E. Gemfibrozil
2. A 27-year-old woman is diagnosed with hypercorticism. To determine whether cortisol production is independent of pituitary gland control, you decide to suppress ACTH production by giving a high-potency glucocorticoid. Which of the following glucocorticoids is the best for this indication?
A. Dexamethasone
B. Hydrocortisone
C. Methylprednisolone
D. Prednisone
E. Triamcinolone
3. A 50-year-old man is well aware of the benefits of aspirin in terms of reducing the risk of death from an acute myocardial infarction, mainly because he has seen and carefully studied many of the ads and internet posts about this. He notices that the usual recommended dose of aspirin for cardioprotection is 81 mg/day, but reasons that the bigger the dose, the bigger the protective effect. He has taken "at least" 1000 mg of aspirin twice a day for the last 6 months. While he is fortunate in terms of having no apparent gastrointestinal adverse effects, he suffers an MI. Autopsy results show considerable platelet occlusion of several coronary vessels. Which of the following most likely explains the mechanism by which aspirin triggered these events?
A. Acetylated platelet glycoprotein IIb/IIIa receptors, triggering aggregation
B. Favored adhesion of platelets to the vascular (coronary) endothelium
C. Ruptured atherosclerotic plaque in the coronaries, exposing platelets to collagen
D. Suppressed hepatic synthesis of vitamin K–dependent clotting factors
E. Triggered excessive activation of platelets by ADP
4. A 10-week-old infant is diagnosed with meningitis. A lumbar puncture reveals numerous neutrophils and gram-positive rods. She is admitted to the hospital and started on IV -lactams. Which of the following targets would most likely play a role in the development of resistance to the antibiotics?
A. Bactoprenol
B. DNA gyrase
C. Penicillin-binding proteins (PBPs)
D. Reverse transcriptase
E. RNA polymerase
5. After a hemisection of the spinal cord takes place at T3, a patient experiences marked weakness in the right leg. Which of the following best accounts for this weakness?
A. There was muscle damage in the right leg
B. There was damage in his left frontal lobe
C. There was damage to the right corticospinal tract
D. The dorsal root was damaged
E. There was damage to the right femoral nerve
6. A 36-year-old man sustains a gunshot wound to the left buttock. He is hemodynamically stable. There is no exit wound, and an x-ray of the abdomen shows the bullet to be located in the right lower quadrant. Which of the following is most appropriate in the management of his suspected rectal injury?
A. Barium studies of the colon and rectum
B. Barium studies of the bullet track
C. CT scan of the abdomen and pelvis
D. Angiography
E. Sigmoidoscopy in the ER
7. A 37-year-old woman with a history of migraines presents to the ED complaining of crampy lower abdominal pain for 3 days. Workup reveals an intrauterine pregnancy and early prenatal care is arranged with obstetrics as an outpatient. You are concerned because her headaches are controlled with a significant number of medications. She uses medications for both abortive therapy and for prophylaxis. Which of the following classes of medications do you advise she discontinue while pregnant?
A. Anticonvulsants
B. Beta- Blockers
C. Triptans
D. Acetaminophen
E. Antiemetics
8. A 50-year-old salesman is on a yacht with a client when he has a severe vomiting and retching spell punctuated by a sharp substernal pain. He arrives in your emergency room 4 hours later and has a chest film in which the left descending aorta is outlined by air density. Which of the following is the most appropriate next step in his workup?
A. Contrast esophagram
B. Echocardiogram
C. Flexible bronchoscopy
D. Flexible esophagogastroscopy
E. Aortography
9. A 70-year-old woman is treated with sublingual nitroglycerin for occasional bouts of effort-induced angina. Which of the following best describes the mechanism by which nitroglycerin causes its desired antianginal effects, or a mediator involved in it?
A. Blocks -adrenergic receptors
B. Forms cyanide, much like the metabolism of nitroprusside does
C. Increases local synthesis and release of adenosine
D. Raises intracellular cGMP levels
E. Stimulates phosphodiesterase
10. 10. A 78-year-old male presents with loss of voluntary control of bladder functions. Which of the following conditions most likely accounts for the loss of bladder functions?
A. Loss of vagal and sacral efferent fibers only
B. Loss of vagal, sacral, and descending fibers from the cerebral cortex
C. Loss of lumbar and sacral efferent fibers only
D. Loss of lumbar, sacral, and descending fibers from the cerebral cortex
E. Loss of upper thoracic and cervical fibers only
11. A 34-year-old man reports a 1-day history of hematemesis. He feels well, but does describe occasional abdominal discomfort. He denies alcohol use. On examination, his abdomen is slightly tender without peritoneal signs. His stool is not bloody, but his fecal test for occult blood is positive. Which of the following is the most appropriate next step?
A. Gastric lavage
B. Barium study
C. Endoscopy
D. Red cell scan
E. Angiography
12. A patient has had progressive, chronic liver failure for the past 5 years. At the time of death, he would be expected to exhibit changes in which type of brain cells?
A. Oligodendrocytes
B. Striatal neurons
C. Pigmented cells of the substantia nigra
D. Astrocytes
E. Inferior olivary neurons
13. You are evaluating 34-year-old woman reports amenorrhea for 4 months. She has never been "regular," but has never gone this long without a period. Her laboratory evaluation is normal, including a negative pregnancy test. You give her medroxyprogesterone acetate (Provera) for 7 days, and the next week, she reports having a period. Which of the following is the most likely cause of her amenorrhea?
A. Premature ovarian failure
B. Ovarian neoplasm
C. Turner syndrome
D. Asherman syndrome
E. Polycystic ovarian syndrome
14. A 6-month-old child is brought to the emergency room after having a generalized seizure at home. She is found to have a temperature of 102.5°F (39.16°C). Which of the following correctly reflects why this patient should be investigated with a spinal tap?
A. All febrile seizures justify spinal taps.
B. Most febrile seizures are due to bacterial infections.
C. Febrile seizures cause increased intracranial pressure that must be relieved by withdrawing cerebrospinal fluid (CSF).
D. Intrathecal antiepileptics must be given.
E. Children this age may have meningitis with no manifestations other than fever and seizures.
15. A middle-aged man presents with congestive heart failure with elevated liver enzymes. His skin has a grayish pigmentation. The levels of liver enzymes are higher than those usually seen in congestive heart failure, suggesting an inflammatory process (hepatitis) with scarring (cirrhosis) of the liver. A liver biopsy discloses a marked increase in iron storage. In humans, molecular iron (Fe) is which of the following?
A. Stored primarily in the spleen
B. Stored in combination with ferritin
C. Excreted in the urine as Fe2+
D. Absorbed in the intestine by albumin
E. Absorbed in the ferric (Fe3+) form
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