What is your age? What is your gender? 1. While shaving one morning, a 23 year old man nicks his lip with a razor. Seconds after the injury, the bleeding stops. Which of the following mechanisms is most likely to reduce blood loss from a small dermal arteriole? 2. A 73 year old man was diagnosed 1 year ago with pancreatic adencarcinoma. He now sees his physician because of a transient ischemic attack. On auscultation of the chest, a heart murmur is heard. Echocardiography shows a 1-cm nodular lesion on the superior 3. A 21 year old woman sustains multiple injuries, including fractures of the right femur and tibia and the left humerus, in a motor vehicle collision. She is admitted to the hospital, and the fractures are stabilized surgically. Soon after admission to the 4. For the past week, a 61 year old man has had increasing levels of serum AST and ALT. On physical examination, he has lower leg swelling with grade 2 + pitting edema to the knees and prominent jugular venous distention to the level of the mandible. Based 5. A 55 year old woman has had sicomfort and swelling of the left leg for the past week. On physical examination, the leg is slightly difficult to move, but on palpation, there is no pain. A venogram shows thrombosis of deep left leg veins. Which of the foll 6. A 25 year old woman who has had altered consciousness and slurred speech for the past 24 hours is brought to the emergency departement. A head CT scan shows a right temporal hemorrhagic infarction. Cerebal angiography shows a distal right middle cerebral 7. A 66 year old woman comes to the emergency departement 3 hours after the onset of chest pain that radiates to her neck and left arm. She is diaphoretic and hypotensive; the serum tropinin I level is elevated. Thrombolytic therapy is b3eugn. Which of the f 8. A 49 year old man is in stable condition after an infarction of the anterior left ventricular wall. He receives therapy with antiarrhythmic and pressor agents. Three days later, he develops severe breaathlessness, and an echocardiogram shows a markedly de 9. A 27 year old man is on a scuba diving trip to the Caribbean and descends to a depth of 50 m in the Blue Hole off the coast of Belize. After 30 minutes, he has malfunction in his equipment and quickly returns to the boat on the surface. He soon experience 10. A 39 year old woman comes to the physician because she has noticed a lump in her breast. Over the past 2 months, the left breast has become slightly enlarged compared to the right breast. On physical examination, the skin overlying the left breast is thic 11. A 29 year old woman has a history of frequent nose-bleeds and increased menstrual flow. On physical examination, petechiae and purpura are present on the skin of her extremities. Laboratory studies show normal partial thromboplastin time, prothrombin time 12. A 70 year old man who was hospitalized 3 weeks ago for a cerebral infarction is ambulating for the first time. Within minutes of returning to his hospital room, he has sudden onset of dyspnea with diaphoresis. He cannot be resuscitated. The gross appearan 13. A 25 year old woman has had multiple episodes of deep venous thrombosis during the past 10 years and one episode of pulmonary thromboembolism during the past year. Prothrombin time, partial thromboplastin time, platelet count, and platelet function studie 14. A 76 year old woman is hospitalized after falling and fracturing her left femoral trochanter. Two weeks later the left leg is swollen, particularly below the knee. She experiences pain on movement of the leg; on palpation, there is tenderness. Which of th 15. A 12 year old boy has a history of multiple soft tissue homorrhages and acute upper airway obstruction from hematoma formation in the neck. On physical examination, he heas decreased range of motion of the large joints, particularly the knees and ankles. 16. Within 1 hour after a gunshot wound to the abdomen, a 19 yearold man exhibits tachycardia. His skin is cool and clammy to the touch, and blood pressure is 80/30 mm Hg. Which of the following organ-specific changes is most likely to occur within 2 days aft 17. A 56 year old man with a history of diabetes mellitus goes to the emergency department because he has had left-sided chest pain that radiates to the arm for the past 5 hours. Serial mouvements of serum creatine kinase-MB levels show an elevated level 24 h 18. An experiment is conducted in which platelet function is analyzed. A substance is obtained from the dense bodies (delta granules) of normal pooled platelets from healthy blood donors. WHen this substance is added to platelets obtained from patients with a 19. In an experiment, thrombus formation is studied in areas of vascular damage. AFter a thrombus forms in an area of vascualr injury, the propagation of the thrombus to normal arteries is prevented. Researchers identify a substance that diminishes thrombus p 20. A 44 year old man has an acute myocardial infarction. Four days later, his ejection fraction is 25%, and cardiac output is reduced. The patient becomes increasingly dyspneic, and a chest radiograph shows bilateral pulmonary edema. These pulmonary findings 21. A 70 year old man with a history of diabetes mellitus died of an acute myocardial infarction. The appearance at autopsy of the aorta, opened longitudinally, is seen in the figure above. Which of the following complications associated with aortic disease w 22. A 49 year old man with congestive heart failure develops Streptococcus pneumoniae after a bout of influenza. After recuperating for 2 weeks, he develops pleuritic chest pain. The pain is caused by the development of the lesion shown in the figure above. W 23. A 58 year old man with hyperlipidemia and severe atherosclerosis has had anginal pain for the past 24 hours. Laboratory finding show no increase in serum troponin 1 or creaine kinase-MB. Two weeks later, he is in a stable condition and has no chest pain, 24. A 28 year old woman with a 15 year history of recurrent thrombosis form a prothrombin gene mutation develops speticemia following a urinary tract infection with Pseudomonas aeruginosa. Despite aggressive therapy, she dies of multiple organ failure. At aut 25. A 78 year old woman falls in the bathtub and strikes the back of her head. Over the next 24 hours, she becomes increasingly somnolent. A head CT scan shows an accumulation of fluid beneath the dura, compressing the left cerbral hemisphere. Which of the fo 26. A 58 year old woman with breast cancer in the left breath underwent a mastectomy with axillary lymph node dissection. Postoperatively, she developed marked swelling of the left arm that has persisted for several months. On physical examination, her temper 27. A 61 year old woman has had a fever and felt faint for the past 2 days. On physical examination, her temperature is 38.4 C, pulse 101/min, respirations 17/min, and blood pressure 85/40 mm Hg. She has marked peripheral vasodialtion. The serum lactic acid l 28. A 71 year old man died of pneumonia following a cerebral hemorrhage that left him bedridden for 3 months. AT autopsy, a section through a branch of the right main pulmonary artery shows a band of fibrous connective tissue that extends across the lumen. Wh 29. A 59 year old obese woman with a history of diabetes mellitus had a myocardial infaction 3 months ago. She is now taking a low dose of aspirin to reduce the risk of arterial thrombosis. On which of the following steps in hemostasis does aspirin have its g 30. A 60 year old woman fractured the right femur, pelvis, and left humerus in a motor vehicle collision. The fractures were stabilizied, and the patient's recovery was uneventful. During a physical examination 3 weeks later, the physician observes a swelling 31. A 45 year old woman who works as a bank teller notices at the nd of her 8 hour shift that her lower legs and feet are swollen, although there was no swelling at the beginning of the day. There is no pain or erythema associated with this swelling. The woma 32. A 23 year old woman with an uncomplicated pregnancy develops sudden dyspnea with cyanosis and hypotension during routine vaginal delivery of a term infant. She has a generalized seizure and becomes comatose. Her condition does not improve over the next 2
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