USMLE TAGS

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Wernicke triad

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Squamous carcinoma

squamous pearls

[jeanusmle]

31 A 37-year-old man with AIDS is admitted to the hospital with a 3-week history of chest pain and shortness of breath. An X-ray fi lm of the chest shows bilateral nodularities of the lungs. A CT-guided lung biopsy is shown in the image. The multinucleated cell in the center of this fi eld is most likely derived from which of the following inflammatory cells?

(A) Basophils (B)  Capillary endothelial cells (C) Macrophages (D) Myofibroblasts (E)  Smooth muscle cells

[jeanusmle]

30 Twenty-four hours later, endothelial cells at the site of injury in the patient described in Questions 28 and 29 release a chemical mediator that inhibits further platelet aggregation. Name this mediator of inflammation. (A) Plasmin (B) Prostaglandin (PGI2) (C) Serotonin (D) Thrombin (E) Thromboxane A2

[jeanusmle]

29 The patient described in Question 28 goes to the emergency room to have the sliver removed. Which of the following mediators of infl ammation plays the most important role in stimulating platelet aggregation at the site of injury following this minor surgical procedure? (A) Leukotriene C4 (B) Leukotriene D4 (C) Prostaglandin E2 (D) Prostaglandin I2 (E) Thromboxane A2

[jeanusmle]

28 A 25-year-old machinist is injured by a metal sliver in his left hand. Over the next few days, the wounded area becomes reddened, tender, swollen, and feels warm to the touch. Redness at the site of injury in this patient is caused primarily by which of the following mechanisms? (A) Hemorrhage (B) Hemostasis (C) Neutrophil margination (D) Vasoconstriction (E) Vasodilation

[jeanusmle]

27 A 68-year-old man with prostate cancer and bone metastases presents with shaking chills and fever. The peripheral WBC count is 1,000/μL (normal = 4,000 to 11,000/μL). Which of the following terms best describes this hematologic finding? (A) Leukocytosis (B) Leukopenia (C) Neutrophilia (D) Pancytopenia (E) Leukemoid reaction

[jeanusmle]

26 A 28-year-old woman cuts her hand while dicing vegetables in the kitchen. The wound is cleaned and sutured. Five days later, the site of injury contains an abundance of chronic infl ammatory cells that actively secrete interleukin-1, tumor necrosis factor-α, interferon-α, numerous arachidonic acid derivatives, and various enzymes. Name these cells. (A) B lymphocytes (B) Macrophages (C) Plasma cells (D)  Smooth muscle cells (E) T lymphocytes

[jeanusmle]

25 A 75-year-old woman complains of recent onset of chest pain, fever, and productive cough with rust-colored sputum. A chest X-ray reveals an infi ltrate in the right middle lobe. Sputum cultures are positive for Streptococcus pneumoniae. Phagocytic cells in this patient’s affected lung tissue generate bacteriocidal hypochlorous acid using which of the following enzymes? (A) Catalase (B) Cyclooxygenase (C) Myeloperoxidase (D) NADPH oxidase (E) Superoxide dismutase

[jeanusmle]

24 Which of the following preformed substances is released from mast cells and platelets, resulting in increased vascular permeability in the lungs of the patient described in Question 23? (A) Bradykinin (B) Hageman factor (C) Histamine (D) Leukotrienes (SRS-A) (E) Thromboxane A2

[jeanusmle]

23 An 8-year-old girl with asthma presents with respiratory distress. She has a history of allergies and upper respiratory tract infections. She also has history of wheezes associated with exercise. Which of the following mediators of inflammation is the most powerful stimulator of bronchoconstriction and vasoconstriction in this patient? (A) Bradykinin (B) Complement proteins (C) Interleukin-1 (D) Leukotrienes (E)  Tumor necrosis factor-α

[jeanusmle]

22 A 14-year-old boy receives a laceration on his forehead during an ice hockey game. When he is fi rst attended to by the medic, there is blanching of the skin around the wound. Which of the following mechanisms accounts for this transient reaction to neurogenic and chemical stimuli at the site of injury? (A)  Constriction of postcapillary venules (B)  Constriction of precapillary arterioles (C)  Dilation of postcapillary venules (D)  Dilation of precapillary arterioles (E) Ischemic necrosis

[jeanusmle]

21 A 35-year-old woman presents with a 5-day history of a painful sore on her back. Physical examination reveals a 1-cm abscess over her left shoulder. Biopsy of the lesion shows vasodilation and leukocyte margination (shown in the image). What glycoprotein mediates initial tethering of segmented neutrophils to endothelial cells in this skin lesion?

(A) Cadherin (B) Entactin (C) Integrin (D) Laminin (E) Selectin

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20 Which of the following proteins inhibits fibrinolysis, activation of the complement system, and protease-mediated damage in the lungs of the patient described in the previous questions? (A) Acid phosphatase (B) Lactoferrin (C) Lysozyme (D)  α2-Macroglobulin (E) Myeloperoxidase

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19 Which of the following mediators of infl ammation is primarily responsible for secondary injury to alveolar basement membranes and lung parenchyma in the patient described in Questions 17 and 18? (A) Complement proteins (B)  Fibrin split products (C) Immunoglobulins (D) Interleukin-1 (E) Lysosomal enzymes

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18 Sputum cultures obtained from the patient described in Question 17 are positive for Streptococcus pneumoniae. Removal of bacteria from the alveolar air spaces in this patient involves opsonization by complement, an important step in mediating which of the following leukocyte functions? (A) Chemotaxis (B) Diapedesis (C) Haptotaxis (D) Margination (E) Phagocytosis

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17 A 68-year-old man presents with fever, shaking chills, and shortness of breath. Physical examination shows rales and decreased breath sounds over both lung fi elds. The patient exhibits grunting respirations, 30 to 35 breaths per minute, with fl aring of the nares. The sputum is rusty yellow and displays numerous polymorphonuclear leukocytes. Which of the following mediators of infl ammation is chiefly responsible for the development of fever in this patient?

(A) Arachidonic acid (B) Interleukin-1 (C) Leukotriene B4 (D) Prostacyclin (PGI2) (E) Thromboxane A2