1. Aol nys oun sn by pret ea we exmetn Hews btn a 30 wee sateen an compte ogra, wba ery He ee ‘cor eng and wept sd Th peat fr teadcruntrne, Herel engeaare 257262 Fspase IS and epraters ate ine Pace Smee on lam a eho nO) Eaton of OP atte npthanb sadn atte urs seg ga ne. Tae apc pce spat ahre 2 tbh sean ee reco sace. Tee ctmanie “ace. maar gi ney aig srs wag ig Ws louet nt sean! tet space nator Sun eb cos Sarr Perera pee in ‘Tears The enue othe aren shows to somatostatin ena fe ese Maas? Bérard teat )Ewaer ghte lt et Ch lcardas tal ati st jhe stale tt Bi dart shat Filceds vera nile tn1. A2monolny sou sin by pret ea we met He wes Btn at 20 nen ‘cor eng an wept sd Th peat fortes ceunfrne. Herel engeaare 257262 Fspase IS and repraters ate nr Pace Smee on lam a eho noe Eaton of GP atte npthand sadn tte furs seg ga ne. Tae op mpd spat ahre 2b be sean rarcoaa space. Tee crane “ace. maar gi ney aig srs wag ig Ws louet nt sean! tet space nator Sun eb cos Sarr Perera pee in ‘Tears The enue othe aren shows to somatostatin ena fe ese Maas? Birra ot eat BE) Ewaer ghte et nt heads tal ei st Cjhmscaraa sal nee ht Bi rica sat Flees vera gilSECO ae ores on? ae rear a sure et Paty esta, dermis Hein et. ea sunaneftanss tl re pn ahve mena we eth ‘terete sedmenaen rate 28 mh Ursongapy efi et pa sw 2 eal eRsn Ro oe awn th ot pea pamacaeah/™ ona idee hon baecten 2) means stroone yeeros anconen2. Asura voy ooh neierey parent Wyre becaise ole Np pa 2 oy and an assocted np fe as «hus. 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Ateyeu-lttor's woud toe in bao e covered ate as tad beg sun He a eds ve bea shang Hel aed a vena mos fn i ae irene hagond tpt we: Euneton hae nll pron tl ona degre a ge 2 Te ona fe pe ) Merounr ot sran enters coneematon lene tones ssrenng D)cTacan ote ese[Shark an ach esl reset bating te Perr halo the mp membrane, Thee is minimal movement on presto stonspy The gt exteral ear sar canal snd fhmpanc membrane Spe ‘roma heh afte ale ete rot hay sapere” 1 ang poston erin E}Chetenora ©} Pertratan fe ynpanementrae Ratan goshet the rgane menteeShite ae ar horas preset eating ne fatte pune sunbrane The ene erent moss Seep, Tey eral sarceaendbyepane ree spe ‘aa Whe tthe we the ro aly Baer 2 oun Aone ee c}Pertzatin ef he pan entane Ratan pocket ot heegane mentee2, Athyn by ree oe sys becuse of ty hry. abril pa, ad dark Ha ste onan wpe enna act Hedin 10 ays 92 at ‘uated pearance li tenpatns ae Sn an od ares 1000 mils Examnaten shoes towel une eee rae shes ove wih RBC ne (fone sass cnt alourg he mo al macana othe ge? ‘A aie boa nme cope etl erson ofthat xk 1} Deseo oft eta ca2, tyne oe py becuse of yt hat abril pa, ad dark ute Ha ste onan wpe estar act Hein 10 ys a2 at ‘uated pure He pues i temas ae Sn an oes ares 1000 mils Examnaten shoes ie ewe une eee rae shes ove ih RBC ne {fone saste Went alourg he mo al acannon age? © A aie boa mane cope etl aon oth opt xk 1) Deseo oft ep =yaa erty pit re tes fing i mah he ed ond lseegan conse rary and IBeastieang He topes ebuge He wei 2009 (7B3. ‘C1ian) pase tina, er ‘trea ete mosses foray " fate of sal min of anon ae1 Ace teat tery earner Sh ee al fis ail peed oe sty Sika fr re ant ot rn rps hear vt oan ape ne mow neh cure tree was? " Fata sa mien of anton a‘atte set ‘ate postr ih othe lige mos yea eae 1} Sancralsenarce ©) sige smar 10) Saphyosoecs vous Yoana enecoten DLP pases our reopen ae Sn rd ood15. Asjaroldbe's wont te anegey deanna fay Wy of et, abel pa nde ett Yoed mus He es sey fect ea ers ated ‘atv He emt Toc cere of ammerilerserate Gy ape He specs oct eee 501011 Fh pare eS repro ne Soran ood reas i! rong Ader xamnson se ase lout gue! ercerars theo sind The ena’ enamine ne sera Tes oe al Set ‘ate postr Wi othe lige mo yeu eae A) Clem ie ©) sige swe 10) Sapryosocs vous Yosh enecoten9. A G-yeat-old boy has progressive acute myelogenous leukemia despite numerous therapeutic intervertions, During a meeting wth his parents to dscuss te prognosis andthe ftity of futher treatment his parents request thatthe patent not be tld his prognosis. Dwing an exarrination when fis parents are net present, the patient asks if he fs going to die soon. Which af the folowing isthe mast appropcate response? 'A)"Have you talked to your parents about thle?" B) "Thave talked to your parents about this, and they do not want you to know" (C) "Most ctiéren wth your condton ive alone time. D) "No one realy knows, t's ard to say.” ) "That's not the spin ike to see in my patients.”9. Atjearoldbeyhaswouese sete myogenesis dsp nneons tape retin, Du 8 eta WI pues Be ago an eye Rte eae fares rena ale tert hoe ans egos Dugan un whens pense ha eke a ahs aed toe ie of ob ek aos ‘A Me youtadto yourptets abu Thee tad you prs so hah 6 wart ys kw ©) Mos ere uh your conton re a bg te” 1) one ety rows Po aro"9. Atjeroltbeyhaswouese sete myogenesis dese mmeons tape retin, Du ett WI Huet dsss De ago an eye Rute eae fares rena ale tert hoe ans egos Duo un whens pense he eee anaes gaye dace ie ofertas © A ie youtuedto yourptets abut Thee tad you prs sb hs shy $6 ar yous kw (©) Mos ere uh your conton re a bg te” 1) Mo ne ety rows. 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The emanse of e earnForen pater eg re pin. slate ost aly ages ‘5 Ghonaomate oe pteta ‘sets D)ropemay sone eta Rand syne suena ry W)Osead eens Hoswenyets 4) Fletonara eames Rees spate steph Rtmunwns are © W Sepa ae Arey ty ymca ti eet th pyscon 2 hus srt an of ee an nergy see i in pin ang Sh wos eo ep at igh bein hep, Se ‘eas uncamanie rs leben st harap Hertempeste 3077 0} TF) pe eam teste me Sin sto precare = 6 mn On earns he (Stine tester red arm, nd easy teen Snohle th tee Mat degrees of tse She res emote he kee a esss pate eden an foun. The emanse of te earn12 AzaTmg (Si +20 nebomts dated tte a 30a pny wean wo hadtnted rota cre. Te ate rk on tn bes dy il se ay ds. 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He Rint antsy cere Hs torgeutne 309° (01 pare fan, ee tinh Guest maah esses od spit strata oe suns aprery ‘arson tare we of setesope hfe owing met ey set pg athe pa Blane17 Azeem Satay tute mn pat en of ay ei 2TH ea eal psi oy se 2 He Rint reaptany acre Hs torgeutne 309°C (OTP pare fan eet Guest maak esses ond apt sr ret on suns aprery ‘str son eared ie we of setsope fe owing met ey set pg athe pa ‘vel annette = Blam18, Aprevaotheatyéealdboy #8 Woke ssn eae a «2k ro Mtg ea a see en of bss ns sab Exton so ee lo [Erctatptan morn poser sap ah rumeou hrs Wotan oh cnests Be Sno: Serra sa rpc Dena ie ple Toaranda ot heaton shows ho ‘Sree inch otc long ete moa ena erenn Cand aicaos 5) Enemy erssum Teton fran18, Age ay ly mi ate ran ene oth iy gtd dee wn hi Ean hv se sl a fete of apnea mete poser apna onan of doses He ‘etre Which othe wing the ot ay neal oan? 19 Cane aie 3 Enierophon erscsum 16) Totton onan10. 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He as ypetensin weed wh cerca! acing Sort at trl been gts eaten, Chai he's warcarate,Heeod pears 25/4 mi amano sows plese hey, ahs nr pee Hck fe ‘weg ete mos appepne cts aac? ‘Ai lanide ey Rcemise SiyaasaneSort et ta teen gts redcaten, Cnt he's warcarate,Heeo peers 25/4 mi amano sows pte hey, ahs nr pee WNch fe ‘ale ete mos appears aaa? ‘Ai lanide Sheers Shyer21 Arey ey 7 ea tons ec nity ta ‘Tet concerned that her Gage maybe depose because the as beso treanrgy mood) The pat ake: no medeatons. Shain 160 m5 84) tl ans weighs 64 ig (142 By, Sic tigi trams shows aise or be sodonen Tere ieoGremepa Te ronan tte mean omen nema. ka te oun hem SPT hd oP Measure of sro roan coceaton Ct Mewnsort exer erect en, 0) sant samen E)MRl ote21. 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ASyeald oy tout oe emery dept ocae of lente! seat cbsenaanig ee te ast 3 days Me has hdro og bt as assoc sts regs pt the SSE ae ey nego fe pt CT we ane ee npg no ma he 2)coms here pee 0) Pep er » Vi pao15, Ad-syelé eum ee ote sys Dees of 2h of rogesse tune He Was bar a 38 wats yes o a Z7-yeuelé wean, gia 2 pra 2. tog on Seaman progeny and day and weighs 8009 (Ss 1 ot Terenure Mend gras, Repost, athe tle’ ood up 8, Reaves bern aoe See beth ane ‘Meoves tear os seman oy mts ema ser Here on eat eas he at srr wet pee Sb she le ae ylow oh sany He cargos 390 “ig at ude gel en meno weghy Meg eb) Fe tompurare 3507 (0847) pr‘ 13h rratoe ae 3, ond eos rts Sito mH Eamnan cout ‘Sct iersanlamae tome ace tt owe shabnen Te here's eed? ben eg costal ath, tata ses 8 has foe eno show Be Hears Age Now aati 6) s 2 Binon tating) 82 tas ‘re ma) a 3 iol olor te ay itn tae fs? yearn ©) beryanten 1) Enterta cetet Pyle mae Fr Pebeent‘Atay netomat the ssn pesaue oe 2 Naty ot pogesshe nc, He was ey a3 wh gettin 1 Z7-yeu-dweman, guia 2, pa. flog Seaman progeny and dave and weighs 8009S 1 co Terenure Mond gras. Rpt, ante te ood up 8, Rava He a brn aoe See th and ‘Meoves too os emanates ema sur Herta on et eas he at saan wet pas Sse ale ae plow oh sany He care oye ‘obra 20896 8 at he nw meh tie 9S 13 i wopersre ec (084 F) pace Tito reese ae nm mls petro t/a my. eamen ‘Soe iersanalauae Hom te acetate ove sbaonen Te here's eed? ben eg costal ath. tts 8 has fae eho show Ma Hnn Age How inp tastingt) 82 es ‘reat ma) a 3 iol te alow se ay enn fr tes fs? 2) 80 otneton 2) ay ebsron ©) peryaton 1) Eyton ease cefet ) Plog pace FPebewm‘A yeyearatgcomesto te psa because ofa oe ary ofa ass ihe ae fe ee progeny an a ada {iety wet bas dns ie ped anata avs to tr scorlnen Dery of the swe a (ifaw "nansed etn stdmesion ae te nase nn fn cocenten A ose apy span tt senate neg? ‘ees etn Hoagie asta ©) sareoose2. 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Azmorthaboyis tou wee yan Wo wuld exanaten Me eed we Sloth ad despnetaeagromate or age. maeis e uptodate He al ors ew tna toa fr 35 tls mamta athe neater th uate eg he erm A ae papae ae Wt ora ‘dor kbdomrlecanton shows no storms Fano uses re aaa EGG Suen stamens te cet shane sh ensgedlen stim Washo lowing whe ot Wie sores? 1) ral sepa et ©) Panny ase 1) aragy oF Fam Vener ep eect27. Azmorthvoyis toute yan Wo wuld exanaten Me eda we Cloth ad deep aeagroate agers ae uptodate Hs al ov ew tna trae fr 3 lsat mrt athe enteral bre th ua vou ear A ae l= papa ae Wt sera ‘dor Rbdonrleanton howe no strates amoral pues re aaa EGG Suen stromata, te cet shane sh ensgealen stim Washo lounge ot Wie sore? ari tence. 1) ra sepa tet ©) Panny ase 1) eragy oF Fam err cop detect28, A 1Syeatld ot bout te py ton ect fot sane ad dyed bey. Se has eh e mean peed. hoe He pate’ et as Snshr wort tn oun he ed pcre, Map af Yury tee an wt ewe bone aoe area crag age Herre tem 10m akan weg Sg.) aul ssh Her pce Pow nd Mand pee © apc oma, ree Senepne Timer 9, pa ar Samet Tame sg 1 ANNE {arts mm. Eearaion sows mute er te face and rk That tava se est ey doers? 4) clone yt oe ache daze) #)comtntrs toe ate )cranerhanmpome ©} Fama so ee Gonadal eer 45 (Tate sone) yop potato29. A 12tuwldmaeveabor aga uated eh He was bom a 38 wees! gestae a 180 egal tl weg 2259 (SB 208 Age Sets wee Tanda {dS rine, reaper Hamar recoed oem oe, Daher rege. he sad oneal pct ot artes Sly nd enh aan re aaron So beats nthe ‘ected Sach the enoum hae eeves one aso ana racbace oul tat organ a assed one sal consol heats sete Hertenperstce OE IGE", pacas 98m andrepesion ronan Ecmtn chow to naa sree ingen arto uration, eat ange ara The mor heen ene wh 3 2) ecto 5) Congetl seenl owes Meco 1 Napvobitona (WoNEN Poster weal29. A 12tuw-ldnae web aga wate eth He was bom a 38 wees! gestae a 1580 pega pale ad waged 2259S b 208 Ae Sctes wee Tanda 1 Srna, reaper marred oom ae, Dai rete. he sraed oneal pact ot artes Sly death aan rasan So bears nthe ‘edeenae Sec the enoum hae eves one as ona rac bace oral tat organ a assed one alam sol heat sd setie ertenpestce OEE IGE'F, paces 198i and repesion ron Exmtn chow fo emargicsreTh nge ae arto uration et ange ara The mo heen ene 3 Ay ecto 1 Conger paras (Mecano 1 Naprobtona (WbosNEN 6) Pentaor ales50. An ewvorthald gt oug ecregeny dotnet 1 Hou! ate ost tong and oul She ad been fate ne coe! ne fe 2 fr mbes bee set oe ion, ei eta ear tps. eye, ae rove be omg Pt yee a ot oy {na bed pres 1 2160 nm Hg. Eamon hows to sal riper UEsrs on he x an tongue’ Teeside ofthe erarnaton shows ho sborae The ost Maly exe of hese fens ‘Sager of ict eal? Ay hstietn ) Opkeniyeronbe ©) bran seer Dy hete Oncpospate50. An ewer gts ou he eregeny dotnet Hout ater ol tang an ool. She ad been fate ne cam oe! ee 2 fw mbes eee sel oe Srapans The mi Hope uel engi acetamrepes, ple, eoe, Sa dese, ond rane apy nto. ut Sayan ae a ane apy ‘Lytton aad wat rues seanges cong oneephee re estonegies. 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Th ah ay Began on he face cet at redo mot er sbcmen, acy rdw bere He pers 20 (12 PF goes Ton expen rein ood pes Stormy anton (Ghtvek acd pps och nny ce sa eto ese lessee pe tc hcl lung we ay ages? ‘Aaa F) Roy Mata sted ee tenor san pas Graco hlerason i Seales 1) eoraareous rh ede yan Kavash doce) Sate er J aphieael53. Anearold gs wot tte ian bese ea de ash or 24M he as dew, ogestn ee dcage at a. TR ah ay eg on he fe ance at fs predto mote er bomen, acy ander betes He operas 20 (12 PF gues loin expen eh ood pes Sma Hs Eaton ee ¢ (Ghat vek macdaran paper och eeu eronee ese lessee pe tse Whol lung we ay age ‘at Roy ert sted ee Hench sedan pas = G)Raeoe Ghlerason i Sealer Pays sea J apheae4. AS ag i tl aria Hie se i sum Ht iw wt inl Eni hove ai Tt 8 api ne ak ‘A Messen trom eter onenraton {) Merron tne anand ad hncane 3 concent 0) ue) ate chest E) Utes abdomen24. 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Aya sbrgohe pycn becase of ogress Medes ate past mth, She ceed te dag oft | bees mau years go adie ln ee day: ste es tem maseds dose Twa wets a2, her hee cng Shean her Wty of rus ner and tae eae eat, Sasha te hagestappteigeraebe {Scie ate ap years Mefer svar sinegit 3 tos doy rea Farha monhe ty tvs lselege’ rie au tororen ear er nar pod wae fea Sota pre im anton pera)! The tte ga sey taped Tha onan eb ya cambio rhour fo aromas. Bese ard a eyo io iene stage Sain sa ste ea teh show anbeated cone sh eh lounghrmores? Dayerceinenerone ste Chest Oy nerarg © 6) MyrstraaingPrapstenste abomon shone sonal cheseed maein te ean repentant our pebies mst a? (meat)Prpetenctte abomon shone sonal che sced maein te epgn epan an fe lowra pebies mst nea? (wat)‘A previously healty 17-year-old gi comes tothe piysician with her mather because ofan Bmonth history of inereasing facial ar growih, The patient also has had a 5.4-kg (12) weight gan during this time. Menarche was atthe age of 10 years. Menses began to occu al regular 23-day intervals ater the fst 6 months. During the past year, menses have occurred al aregular 45-day interval. The patient's mother is concerned that her daughter may be depressed because she has become lncreasinay moody. The Patient takes no medzations. She is 163 cm (54 in tall and weighs 64 kg (142 Ib); BI is 24 kal? Examination shows striae over the abdomen, There is no eitoromegaly. The remainder of the examination shows no abnormalities. Which of the following isthe most appropriate ned step in agnosis? A) Measurement of morning serum fasting cortisol concentration B) Measurement of serum prolactin concentration C) Measurement of serum testosterone concertraton D)-CT scan ofthe abdomen ) MRI ofthe brain22, A4-dayeold nevis brought tothe physician because ofa 2-day history of progressive jaundice, He was born at 30 weeks’ gestation to a 27-year-old woman, gravida 2, para 2 folowing an "uncomplicated pregnancy and delivery and weighed 2608 9 (5b 12 02). The newborn's bload group is 0. Rl-postive, and the mather's blood group is B, R’-poslive. He has been breast-fed since bith and receives 1 te 2 ounces ofa suoplemental soy milk-based formula every day. His mother says that he has had about seven wat clapers dally. and his stocs are yelow and seedy. At discharge 2 days 290, his ‘weight was 2495 g (5 bb 8 cz) he now weighs 2608 g (5 fb 1202), His temperature is 36.9°C (88.4°F), pulse is 138!min, respirations are 32imin, and blood pressure is 05/40 mm Hg, Examination shows soleralcterus and jeunlice from the face tothe lower abdomen. The Iver edge is palpated 2 cm below the right costal margin. Laboratory studes at 36 hours of age and new show AL 36 Hours of Age Now Hematocrit (%) 84 52 Serum Bini, total (mg/d) 82 125 Deect (mgidL) on 03 Which ofthe folowing i the mest likely explanation for these ndings? |A) ABO iscbmmunizaton B) Bilary obstruction (6) Detyaration| s D) Enjtivocyte ereyme defect ) Physiologic jaundice F) Polyeytheria25. A.4-yearold gil is admitted to the hospital because of a G-hou history of fever, decreased alertness, ancl arash over her chest, ams, and legs. On admission, the patent is obtunded, Her temperature is 88°C (100.4'F), pulse is 120/min, respirations are 80Vmnin anc sallow, anc blood pressure is 70/80 mm Hg. Examination shows a purple macular rash over the tk and extremities. Te face and extremities are edematous. Flies administered by intravenous bols, and rtravencus administration of cetriaxcne and vancomyein is started, Fiteen minutes after acmission, the patient becomes apnelc. She ls intubated, and mechanical ventlationis started, Serum studies shove Na 135 mEgL & 4 meqiL Heo, 15 meqit Ureantrogen 35 maid Creatine 0.8 grat Her urine output is 1.5 mUkgih Arterial blood gas analysis on 40% oxygen shows pH 72 Peo, 35 mm Hg Pao: 100 mm Hg ‘One hour later, her wine out decreases to less than 0.5 mLikalh. A chest ray shows hazy ung elds bilaterally and earciomegaly. Which ofthe following isthe most appropriate next step in ‘maragement? A Intravenous administration ofan isotonie fd bolus B} Intravenous administration of dopamine © Intravenous administration of furosemide D} Intravenous adrnistration of nitroprusside E) Increased inhaled oxygen concentration‘A 12-montold gi is brought tothe plysican because of chickenoox for 4 weeks, She developed vesicular lesions on her heady, turk, and extremities 2 weeks after her okler brother developed lesions, and she has continued to ave new lesions since then. She is atthe 10th percentile for length, weight, an head circumference. Her temperature is 28°C (100.4°F). Examination shows papules, Mid-ited ‘esicles, ane crusted small cers scattered over the head, trunk, and proximal extrerites, Indvect fuorescent antibody testing of the material ram te bate of one ofthe vesicles le postive fr the varicella artigen, Which ofthe folowing isthe most Skely immunologic abnormality? A Impaired B-bmphocyte function B) Impaired complement function Impaired neutrophil adhesion D) Impaired nevtrophil chemotaxis E) impaired T-lymphocyte function F) Neueropél oxaton burst38, A S-menth-old boy is broug to the physician by his mather because of a T-day history of fever, voting, and fussiness. He was born at 29 weeks’ gestation following an uncomplicated pregnancy and elvery. He is alert and mildy Writable bit easly consoled by his mother. His rectal temperature is 38°C (102.2°F), pulse is 18D/min. and respirations are 38/min. Examination of the skin shows no abnormalties. The tympantc membranes are mild erythematous with nermal landmarks and metity. The ngs are clear to auscutation. Tae abdomen is soft with no palpable masses. The patent I Unereumeised, Laboratory studies show: Hemoglobin 11.8 gtd Leukocyte count 12,200rmm® Platelet count 240.0004 Urine Nites 2 Leukocyte esterase 3+ Resuits of blood and urine cutures are pening. Wrich ofthe folowing isthe most appropriate pharmacotherapy? 8) Cefazolin B) Cefotaxdme (C)Natetin D) Peniciin E) Vancomycin