A) Conjugated hyperbilirubinemia
B) Hematuria + flank mass
C) Hematuria + no flank mass
D) Intercellular bridges
E) Serum sodium of 125 mEq/L

A 54-year-old woman is evaluated in hospital. She has a long smoking history. A biopsy specimen is shown.

Which of the following is most likely to be seen in this patient?

A) Direct hyperbilirubinemia
B) Hematuria without flank mass
C) High serum calcium
D) Low serum sodium
E) Painful flank mass

A 49-year-old man is evaluated in hospital after experiencing severe bilateral tinnitus. Physical examination shows severe lethargy and markedly elevated respirations. He has a 1-year history of osteoarthritis. BMI is 35. Which of the following is most likely to improve this patient’s acute presentation?

A) Epley maneuver
B) Increasing chloride channel opening frequency
C) Sodium channel dissociation
D) Stabilization of myocardium
E) Urinary alkalinization

A 47-year-old man is evaluated in hospital following a 2-week history of darkening of his urine. He reports no recent illnesses.

Which of the following is most likely to be seen in this patient?

A) Anti-Hu antibodies
B) Insulin resistance
C) Serum calcium of 12 mg/dL
D) Serum sodium of 125 mEq/L
E) Urinary specific gravity of 1.030

A 45-year-old man is evaluated in hospital. His cardiac auscultation is shown.

Which of the following is the most likely explanation for this patient’s findings?

A) Bicuspid aortic valve
B) Carcinoid syndrome
C) Dissection
D) History of rheumatic heart disease
E) Myxomatous degeneration

A 31-year-old woman comes to the physician for a follow-up appointment. She has a history of recurrent flares of joint pain and low platelets. Today she presents with two small mouth ulcers. Her prior HLA-B27 screening was negative. Serum creatinine and BUN are mildly elevated. Which of the following is most likely to be seen in this patient?

A) Anti-cyclic citrullinated peptide antibodies
B) Anti-microsomal antibodies
C) Decreased serum C3
D) IgM targeting the Fc region of IgG
E) Type II hypersensitivity

A 9-year-old girl is brought to the physician by her mother for a 1-month history of skin changes to the right forehead and periorbital region. She has acute lymphoblastic leukemia in remission and received her last dose of chemotherapy 4 months ago. Which of the following is the most likely explanation for this patient’s findings?

A) Bacterium
B) DNA virus
C) Stevens-Johnson syndrome
D) RNA virus
E) Toxic epidermal necrolysis

A) Autoimmunity
B) Deficiency of erythrocyte spectrin
C) Deficiency of NADPH production
D) Inhibition of ferrochelatase and δ-ALA dehydratase
E) Loss of lymphoid organ

A 29-year-old man is evaluated in hospital. His father had a history of “anemia” treated with splenectomy and cholecystectomy. MCV is 85 fL. Hemoglobin is 14 g/dL. MCHC is elevated. The patient has a diagnostic modality performed that is abnormal. Below is an imaging result using the same modality from a healthy individual.

Which of the following most likely explains the patient’s abnormal diagnostic result?

A) Coombs test positivity
B) Gallstone ileus
C) Gallstone pancreatitis
D) Increased erythrocyte turnover
E) Increased HbS

A 78-year-old woman is evaluated in hospital for yellow eyes and skin. She has no overt past medical history apart from a cholecystectomy at age 58. She’s a non-smoker. Laboratory studies show:

Total bilirubin                                        4.0 mg/dL
Conjugated bilirubin                         3.0 mg/dL
Pancreatic amylase                            Normal
Pancreatic lipase                                 Normal

Which of the following is the most likely explanation for this patient’s findings?

A) Choledocholithiasis
B) Cholelithiasis
C) Malignancy
D) Reduced activity of hepatic enzyme
E) Sphincter of Oddi dysfunction