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

A 49-year-old man comes to the physician for a follow-up appointment. Stool is positive for staining with Oil Red O and Sudan Black. Laboratory studies show direct bilirubin, ALP, amylase, and lipase within the normal range.

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

A) Acute cholecystitis
B) Chronic cholecystitis
C) Acute pancreatitis
D) Chronic pancreatitis
E) Porcelain gallbladder

A 27-year-old woman comes to the physician for a 3-month history of worsening pain in her hands, wrists, and knees. Her father has type I diabetes mellitus. In addition to ibuprofen and prednisone, the most appropriate pharmacotherapy has which of the following mechanisms of action?

A) Inhibition of CD20
B) Inhibition of dihydrofolate reductase
C) Inhibition of dihydropteroate synthase
D) Monoclonal antibody against soluble TNF-alpha
E) Monoclonal antibody against TNF-alpha receptor
F) Recombinant receptor against soluble TNF-alpha

A 43-year-old man comes to the physician for a follow-up appointment. He has a 4-month history of occasional regurgitation of undigested food.  Physical examination shows tightening of the skin of the fingers, with small calcium deposits in the pulps of some of the fingers. Which of the following is most likely to be seen in this patient?

A) Bird’s beak appearance
B) Cricopharyngeal muscle spasm
C) Esophageal fibrosis
D) Loss of NO- and VIP-secreting neurons
E) Schatzki ring

A 51-year-old man is evaluated in hospital. Which of the following is the most likely explanation for this patient’s findings?

A) Bleomycin
B) Cor pulmonale
C) Doxorubicin
D) Lymphatic insufficiency
E) Subapical bleb rupture

An 80-year-old woman is brought in by ambulance in the summer after being found in her home by her husband dazed and confused. Body temperature is 106 F.

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

A) Asplenia
B) Coombs test-positive hemolytic anemia
C) Liver failure
D) Microangiopathic hemolytic anemia
E) Sepsis

A 16-year-old boy is brought to the physician for a follow-up appointment.

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

A) Abnormal endoderm of foramen cecum
B) Decreased serum sodium
C) Galactorrhea
D) Remnant of primitive oral cavity
E) Upward gaze palsy

A 31-year-old woman comes to the physician for a health maintenance examination. She had a prior imaging modality performed, the results of which are shown below. “A” represents a healthy control individual; “B” is the patient’s imaging results.

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

A) Anti-microsomal antibodies
B) Anti-thyrotropin receptor antibodies
C) Calcium of 7.9 mg/dL
D) Calcium of 11.0 mg/dL
E) Post-viral illness state

A 24-year-old man is evaluated in hospital. He occasionally uses cocaine and consumes alcohol. He is 6’5″. BMI is 22.

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

A) Aortic dissection
B) Bicuspid aortic valve
C) Myxomatous degeneration
D) Pulsus paradoxus
E) Wide pulse pressure

A 45-year-old man comes to the physician for a follow-up appointment.

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

A) APC gene mutation
B) C-MYC gene mutation
C) Hashimoto thyroiditis
D) High-grade hepatocellular carcinoma
E) Polycystic kidneys