A 28-year-old woman is brought to hospital for a 1-week history of abnormal movements and sensation. She also reports decreased visual acuity in her right eye. Neurologic examination shows reduced motor function of the left leg, loss of pain and temperature in the right leg, and reduced vibration and proprioception of the left leg. Ophthalmologic examination shows visual acuity of 20/200 in the right eye; the left eye is normal. CSF analysis shows IgG oligoclonal bands. Which of the following is the most likely explanation for this patient’s findings?

A) Antibodies against aquaporin-4
B) Recent trauma
C) T cell attack against myelin basic protein
D) T cell attack against Schwann cells
E) Viral infection

A 21-year-old woman comes to the physician for a 2-month history of an intermittent pulling sensation in her left groin. Ultrasound shows a 1-cm heterogenous mass. A biopsy confirms dysgerminoma. Physical examination shows a well-appearing female at 4’10”. Her neck is webbed. There is a systolic murmur. Which of the following is most likely to be seen in this patient?

A) Aortic regurgitation
B) Decreased blood pressure
C) Decreased serum FSH
D) Endometrial hyperplasia
E) 45XO/46XY mosaic karyotype

A 61-year-old woman comes to the physician for a 4-month history of progressively worsening double vision and fatigue. Physical and neurologic examination show a partial ptosis of the right eyelid and a right pupil that is fixed at 1mm.

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

A) Impingement of lower brachial plexus
B) Impingement of upper brachial plexus
C) Impingement of the C8 sympathetic chain
D) Loss of parasympathetic outflow
E) Reduction in oculomotor efferent outflow

A 66-year-old man is evaluated in hospital. A non-contrast CT of the head is shown.

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

A) Alcoholism
B) Blood pressure of 180/100
C) Cystic kidneys
D) Limited crossing of suture lines
E) Lucid interval

A 51-year-old man is evaluated at hospital. A normal patient’s left hand is shown on the left; the patient’s left hand is shown on the right.

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

A) Abduction of fingers
B) Forearm supination
C) 2nd finger flexion
D) Thumb opposition
E)  Wrist extension

A 4-year-old boy is brought to the physician by his mother for a high fever and lethargy for the past 24 hours. He has also developed skin lesions on his legs during this time.

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

A) Deficiency of adenosine deaminase
B) Deficiency of C1q
C) Deficiency of cell-mediated immunity
D) Deficiency of mucosal immunoglobulin
E) Deficiency of total hemolytic complement

A 49-year-old man comes to the physician for a follow-up appointment. His blood pressure 2 months ago was 150/90. He attempted lifestyle modification with limited success. His blood pressure today is 145/92. He is commenced on hydrochlorothiazide. Which of the following is most likely to be seen in this patient as a result of this pharmacotherapy?

A) Calciuresis
B) Inhibition of early-DCT antiporter
C) Inhibition of late-DCT symporter
D) Reduction in cortical collecting duct ENaC activity
E) Secretion of potassium via ROMK

A 59-year-old man comes to the physician for a 5-month history of progressively worsening shortness of breath. Physical examination shows diffuse dry inspiratory crackles. Blood pressure is 120/80.

Which of the following is most likely to be predominant in this patient’s pathology?

A) Aleveolar dead space
B) Anatomic dead space
C) Physiologic dead space
D) Shunt
E) V/Q elevation

A 7-year-old boy is brought to the physician by his mother. A blood smear is shown.

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

A) Decreased NADH production
B) Decreased disulfide group production
C) Decreased thiol group production
D) Dominant inheritance pattern
E) Howell-Jolly bodies

A 25-year-old man comes to the physician for a follow-up appointment. Hydroxyurea therapy is prescribed. Which of the following is most likely to be seen in this patient as a result of this pharmacotherapy?

A) Decreased sickle hemoglobin expression
B) Decreased sickling due to decreased acidification
C) De-repression of fetal globin chain genes
D) Increased HbA2 production
E) Increased thymidine fraction