A 2-day-old newborn is evaluated for poor feeding and abnormal eye findings. Physical exam shows bilateral cloudy lenses, a pan-systolic pan-diastolic murmur, and numerous purplish-red skin lesions on the trunk and extremities. The infant fails the newborn hearing screening. Which of the following is most likely to have been seen in the mother during pregnancy?

A) Arthritis
B) Chancre
C) Cowdry bodies
D) Owl-eye inclusions
E) Working in a pet store

A 48-year-old man comes to the physician for a follow-up appointment. He has a 2-week history of blisters on his forearms that occurred after he took a long bike ride in a park. He has a long history of alcohol consumption and IV drug use. Decreased activity of which of following is the most likely explanation for this patient’s presentation?

A) Delta-aminolevulinic acid dehydratase
B) Delta-aminolevulinic acid synthase
C) Ferrochelatase
D) Porphobilinogen deaminase
E) Uroporphyrinogen decarboxylase

A 40-year-old man comes to the physician for a follow-up appointment. His brother has rheumatoid arthritis. Laboratory findings are shown:

Sodium                                          138 mEq/L
Potassium                                    6.0 mEq/L
Calcium                                         8.8 mg/dL
Phosphate                                   4.1 mEq/L
Bicarbonate                               20 mEq/L

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

A) Decreased parathyroid hormone
B) Decreased urinary calcium
C) Increased adrenocorticotropic hormone
D) Kaliuresis
E) Zona glomerulosa adenoma

A 59-year-old man is brought to hospital by his wife after 24 hours of progressive neurologic disturbances. Examination shows ptosis of the left eyelid and a 1-mm left pupil. There is loss of pain and temperature of the left side of his face and the right side of his body. His voice is very hoarse and raspy. An infarct at which of the following locations is the most likely explanation for this patient’s findings?

A) Left anterior inferior cerebellar artery
B) Left paramedian branches of anterior spinal artery
C) Left posterior inferior cerebellar artery
D) Right anterior inferior cerebellar artery
E) Right paramedian branches of anterior spinal artery
F) Right posterior inferior cerebellar artery

A 30-year-old woman is evaluated as part of a research study. A change occurs as represented by the blue arrow.

Which of the following is most likely to explain the change in this patient?

A) Decreased acid anhydride
B) Increased hydrophobic interactions
C) More salt bridges
D) More serine residues
E) Decreased temperature

A 50-year-old woman is evaluated in hospital. Her cardiopulmonary auscultatory findings are shown.

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

A) Alcoholism
B) Endocardial fibroelastosis
C) History of radiation to the chest
D) Hyperthyroidism
E) Multiple myeloma

A 24-year-old man is evaluated in clinic following 3 months of progressively worsening self-mumbling and reclusive behavior. He appears disheveled. A pharmacologic agent is commenced. Common adverse effects include QT-prolongation and hyperprolactinemia. Which of the following is most likely to be seen as a result of commencement of this pharmacotherapy?

A) Decreased cAMP
B) Decreased cGMP
C) Decreased IP3
D) Increased cAMP
E) Increased cGMP
F) Increased IP3

A 51-year-old man is evaluated in hospital. His point of maximal impulse is palpated in the subxiphoid space. A chest x-ray is shown.

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

A) Cystic medial necrosis
B) Loud P2
C) Increased FEV1/FVC
D) Mid-systolic murmur
E) Usual interstitial pneumonitis

A 19-year-old man is evaluated in hospital. He recently underwent surgery due to ongoing iron deficiency anemia.

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

A) Failure of 270-degree counterclockwise rotation about the superior mesenteric artery
B) Failure of obliteration of omphalomesenteric duct
C) Failure of recanalization of proximal bowel
D) Mutation in KRAS
E) Telescoping of bowel segments

A 53-year-old man is evaluated in hospital. Scattered petechiae and ecchymoses are noted on his forearms. There is mild bilateral pedal edema. A renal biopsy is shown.

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

A) BUN/Cr of 22
B) 1+ blood on urine dipstick + 0-1 RBCs/hpf
C) 1+ blood on urine dipstick + 20 RBCs/hpf
D) Insulin resistance
E) Platelet count of 50,000/μL