Otázky s chybnou odpovědí, č.j. 5158142
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TEST:usmle1en  Varianta:1         Tisknuto:04/06/2019
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  1. ( 29.orig.) Lactation does not occur during pregnancy because the action of prolactin is blocked by increased concentrations of which of the following hormones? 
 3) + Estrogen and progesterone (nezaškrtl-a)
 4) - Human chorionic somatomammotropin and prostaglandin (zaškrtl-a)
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 11. (  5.orig.) A 4-week-old infant has a loud systolic murmur with a systolic thrill; otherwise, the infant appears healthy. There is no cyanosis. The most likely cause of the murmur is
 3) - patent ductus arteriosus (zaškrtl-a)
 5) + ventricular septal defect (nezaškrtl-a)
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 12. ( 33.orig.) While smoking crack cocaine, a 16-year-old boy develops substernal chest pain. An ECG is consistent with anterior wall myocardial ischemia. The drug most likely had which of the following effects on the heart? 
 2) + Indirect stimulation of -adrenergic receptors (nezaškrtl-a)
 5) - Direct stimulation of -adrenergic receptors (zaškrtl-a)
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 19. ( 40.orig.) A patient with an aneurysm of the aortic arch develops hoarseness. Paralysis of which of the following muscles on the left side is most likely? 
 2) + Posterior cricoarytenoid (nezaškrtl-a)
 5) - Cricothyroid (zaškrtl-a)
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 20. ( 25.orig.) A 50-year-old man is awakened in the middle of the night with acute pain and tenderness of the right knee.  He has a low-grade fever.  His knee is hot, red, tender, and swollen. Analysis of the fluid from the right knee shows: Leukocytes: 70,000/mm3 with 75%  neutrophils; Crystal analysis: negatively birefringent; Gram's stain: negative. The most likely diagnosis is 
 1) - Chondrocalcinosis (pseudogout) (zaškrtl-a)
 3) + Gout (nezaškrtl-a)
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 22. ( 26.orig.) After fasting, a patient has no gastric acid secretion when chewing and no receptive relaxation of the proximal stomach when swallowing. Which of the following best explains these findings? 
 3) - Absence of chief cells (zaškrtl-a)
 4) + Vagally denervated stomach (nezaškrtl-a)
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 27. ( 28.orig.) A 60-year-old man undergoes excision of an obstruction in the large intestine. Which of the following microscopic features in the obstructing lesion most strongly suggests malignant growth? 
 1) + Sheets and cords of epithelial cells in the serosal layer (nezaškrtl-a)
 2) - Formation of new vascular channels and hemorrhage (zaškrtl-a)
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 31. ( 17.orig.) A 17-year-old girl sustains a contaminated deep puncture wound while helping repair a barn. Her immunization record indicates that her last tetanus immunization was 12 years ago. In addition to wound care, which of the following is the most appropriate management? 
 3) - Tetanus toxoid (zaškrtl-a)
 4) + Tetanus antitoxin plus toxoid (nezaškrtl-a)
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 33. ( 37.orig.) A 38-year-old man reports with some embarrassment that he is unable to urinate in a public urinal, but at home he experiences no difficulty.  The most likely diagnosis is 
 4) - agoraphobia without history of panic disorder (zaškrtl-a)
 5) + social phobia (nezaškrtl-a)
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 35. ( 12.orig.) An 18-year-old female athlete reports easy fatigability and weakness. Findings on physical examination are unremarkable.  Laboratory data are:  SERUM: Na+ 141 mmol/l (136-145), Cl- 85 mmol/l (95-105), K+ 2,1 mmol/l (3,5-5), HCO3- 35 mmol/l (22-28); URINE: Na+ 80 mmol/24h, K+ 170 mmol/24h. The most likely diagnosis is 
 1) + Surreptitious use of diuretics (nezaškrtl-a)
 4) - Aldosterone deficiency (zaškrtl-a)
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 41. ( 36.orig.) A 4-year-old girl has been unable to eat for 2 days because of a gastrointestinal tract disorder. Which of the following is the major source of fuel being oxidized by her skeletal muscles? 
 2) - Muscle glycogen (zaškrtl-a)
 3) + Serum fatty acids (nezaškrtl-a)
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 54. ( 11.orig.) Patients X and Y both have respirations of 12/min and tidal volumes of 500 mL. However, patient X has an arterial PCO2 of 35 mm Hg, while patient Y has an arterial PCO2 of 45 mm Hg. The difference in PCO2 between these patients is best explained by a difference in which of the following? 
 1) - Lung compliance (zaškrtl-a)
 5) + Dead space ventilation (nezaškrtl-a)
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 63. ( 35.orig.) A 45-year-old man has abnormal circadian variation disruption of the sleep-wake cycle, and an impaired nocturnal surge of secretion of melatonin. An MRI of the head is most likely to show a lesion involving which of the following nuclei? 
 2) - Pretecal (zaškrtl-a)
 4) + Suprachiasmatic (nezaškrtl-a)
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 64. (  3.orig.) A 40-year-old man with a 20-year history of alcohol abuse is brought to the hospital by his friends because he was difficult to rouse. He ate a large meal several hours ago. He is emaciated and lethargic. Examination shows severely restricted horizontal eye movements and ataxia of both upper extremities. The most likely cause of these findings is a deficiency of which of the following nutrients? 
 1) - Vitamin B12 (cobalamin) (zaškrtl-a)
 2) + Vitamin B1 (thiamine) (nezaškrtl-a)
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 71. ( 19.orig.) A 32-year-old man is unable to adduct his right eye during conjugate gaze but is able to adduct it during visual convergence. A lesion of which of the following structures on the right side is most likely to produce this finding? 
 1) + Medial longitudinal fasciculus (nezaškrtl-a)
 2) - Medial rectus muscle (zaškrtl-a)
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 76. ( 20.orig.) Breast carcinomas often cause the skin of the breast to become puffy and pitted, resembling orange peel. The pits most likely correspond with which of the following? 
 3) + Attachments of suspensory ligaments (retinacula cutis) to the dermis (nezaškrtl-a)
 5) - Focal invasion of the dermis by neoplastic cells (zaškrtl-a)
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 80. ( 27.orig.) A patient with an injury to the gluteal region has difficulty rising from a seated position and straightening his trunk but no difficulty walking on level ground or flexing his leg. Which of the following muscles is affected? 
 3) - Iliopsoas (zaškrtl-a)
 5) + Gluteus maximus (nezaškrtl-a)
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 93. ( 30.orig.) A neonate develops meningitis. Streptococcus is isolated from the mother's vagina. The organism agglutinates with antiserum directed against type B surface carbohydrate. The virulence of this organism is related to a bacterial constituent that interferes with	 which of the following host phagocyte functions? 
 2) - Aggregation (zaškrtl-a)
 5) + Ingestion (nezaškrtl-a)
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 96. ( 10.orig.) A 16-year-old girl is incoherent and has a fever, severe lower abdominal pain, and a foul-smelling cervicovaginal discharge. A self-induced abortion is suspected. Which of the following methods should be used to collect a sample of the cervical discharge for bacterial culture? 
 1) - Placing a swab in transport medium at room temperature (zaškrtl-a)
 3) + Taking samples of the discharge with a syringe and transferring them directly to the laboratory (nezaškrtl-a)
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105. (  9.orig.) A 48-year-old woman has loss of pain and temperature sensation in the left upper and lower limbs. Which of the following labeled areas in the medulla is the most likely site of the causal lesion?  
 1) + C (nezaškrtl-a)
 2) - E (zaškrtl-a)
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109. (  6.orig.) A 36-year-old woman has a hysterectomy and bilateral salpingo-oophorectomy because of uncontrolled hemorrhage. She is very concerned because her mother has vertebral compression fractures due to osteoporosis. Which of the following is the most appropriate single treatment to prevent bone loss?
 1) + Estrogen (nezaškrtl-a)
 3) - Vitamin D (zaškrtl-a)
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111. ( 18.orig.) A 23-year-old woman has a progressive increase in serum human chorionic gonadotropin (hCG) concentrations over an 8-week period. A hydatidiform mole is removed, but the hCG concentration continues to increase. The most likely diagnosis is 
 2) - pituitary insufficiency (zaškrtl-a)
 3) + choriocarcinoma (nezaškrtl-a)
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117. ( 34.orig.) A healthy 19-year-old man receives a tetanus immunization booster prior to induction in the Marines. Six hours later, he has pain and massive swelling at the site of injection. The following day, the skin breaks down, forming an ulcer at the site. Which of the following events plays a critical role in this reaction? 
 1) + Local fixation of complement by preformed circulating antibodies (nezaškrtl-a)
 2) - Local release of histamine (zaškrtl-a)
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TEST:usmle2en  Varianta:1         Tisknuto:04/06/2019
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  2. ( 37.orig.) A 7-year-old boy is brought to the physician 3 days after sustaining a small laceration of the left eyebrow. His temperature is 38.8°C (101.8°F). Examination shows erythema and edema of the left eyelid and periorbital region with moderate proptosis and decreased ocular movement; eye movement is painful. The disc margins are sharp, and there are no retinal abnormalities. Which of the following is the most likely diagnosis? 
 1) - Sagittal sinus thrombosis (zaškrtl-a)
 4) + Orbital cellulitis (nezaškrtl-a)
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 15. ( 10.orig.) A 45-year-old woman comes to the physician because of a 3-month history of episodes in which she becomes overwhelmingly hot and sweats so much that her clothes become wet. The episodes last approximately 5 minutes and have increased in frequency; they now occur at least once daily, mostly at night.  During an episode, her heart rate increases, and she feels anxious; she has a chilled feeling afterward.  Menses are regular, but the intermenstrual interval has decreased by 5 days over the past 6 months. She takes no medications. She drinks five cups of coffee daily. Her temperature is 37°C (98.6°F), pulse is 74/min, and blood pressure is 110/70 mm Hg. Examination shows no other abnormalities. Which of the following is the most likely explanation for these findings? 
 1) - Carcinoid tumor (zaškrtl-a)
 5) + Hot flash (nezaškrtl-a)
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 32. ( 40.orig.) A 6-year-old man with emphysema is brought to the emergency department 1 hour after becoming lethargic and incoherent. Over the past 3 days, he has had increasing episodes of dyspnea, cough, and sputum production. Oxygen was administered en route to the hospital. On arrival, the patient is confused and lethargic but responsive to painful stimuli. Arterial blood gas analysis while breathing 6l/min of oxygen shows: pH 35 [H+] nmol/l (36-44), pCO2 12,7 kPa (4,4-5,9), pO2 13,3 kPa (10,0-14,0). Which of the following is the most appropriate next step in management?
 2) - Administration of 2l/min of oxygen by nasal prongs (zaškrtl-a)
 4) + Endotracheal intubation and mechanical ventilation (nezaškrtl-a)
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 49. ( 36.orig.) A 20-year-old primigravid woman delivers a full-term 3200-g (7-lb 1-oz) newborn vaginally under epidural anesthesia. A second-degree midline episiotomy was required.  On postpartum day 1, she has perineal pain.  The perineum is slightly edematous with no evidence of purulent drainage or episiotomy breakdown. Which of the following is the most appropriate next step in management? 
 1) - Intravenous ampicillin therapy (zaškrtl-a)
 5) + Sitz baths twice daily (nezaškrtl-a)
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 56. ( 17.orig.) A 70-year-old man comes to the physician because of severe myalgias and malaise over the past 2 months.  He has had a 2.7-kg (6-lb) weight loss during this period.  Examination shows no abnormalities. His hematocrit is 30%, leukocyte count is 11,300/mm3, and erythrocyte sedimentation rate is 112 mm/h.  Serum creatine kinase activity is within normal limits. Which of the following is the most likely diagnosis? 
 3) - Hyperthyroid myopathy (zaškrtl-a)
 4) + Polymyalgia rheumatica (nezaškrtl-a)
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 61. ( 31.orig.) A previously healthy 34-year-old woman is brought to the physician because of fever and headache for 1 week. She has not been exposed to any disease. She takes no medications. Her temperature is 39,3°C (102°F), pulse is 104/min, respirations are 24/min, and blood pressureis 135/88 mm Hg. She is confused and oriented only to person. Examination shows jaundice of the skin and conjunctivae. There are a few scattered petechiae over the trunk and back. There is no lympadenopathy. Physical and neurologic examinations show no other abnormalities. Test of the stool for occult blood is positive. Laboratory studies show:BLOOD: hematocrit 0,32 (0,36-0,46), with fragmented and nucleated erythrocytes; leukocyte count 12,500/mm3 (4,500-11,000); platelet count 20,000/mm3 (150,000-400,000); prothrombin time 10 sec (11-15); partial thromboplastin time 30 sec (40);fibrin split products - negative. SERUM: urea nitrogen (BUN) 6,0 mmol urea/l (1,2-3,0); creatinine 265 mmol/l (53-106); bilirubin total 50 mmol/l (2-17); bilirubin direct 10 mmol/l (0-5); lactate dehydrogenase 1000U/l (45-90). Blood and urine cultures are negative. A CT scan of the head shows no abnormalities. Which of the following is the most likely diagnosis?
 1) + Thrombotic thrombocytopenic purpura (nezaškrtl-a)
 5) - Disseminated intravascular coagulation (zaškrtl-a)
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 65. (  5.orig.) A full-term 2-month-old boy appeared well until 3 weeks ago when he became dyspneic and had difficulty feeding.  A loud holosystolic murmur is heard at the left lower sternal border.  An ECG shows left and right ventricular hypertrophy. Which of the following is the most likely diagnosis? 
 3) + Ventricular septal defect (nezaškrtl-a)
 4) - Pulmonary hypertension (zaškrtl-a)
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 73. ( 18.orig.) A hospitalized 60-year-old man has had no urine output for 8 hours.  He underwent a total hip replacement 36 hours ago. He has a history of type 1 diabetes mellitus and takes nitrates for stable angina pectoris. During the operation, the estimated blood loss was 1500 mL. Intraoperatively, he had one brief episode of hypotension that resolved spontaneously. His temperature is 37.2°C (99°F), pulse is 80/min, respirations are 16/min, and blood pressure is 130/85 mm Hg. There is suprapubic fullness and a clean incision over the left hip. Examination shows no other abnormalities. His hemoglobin concentration is1,4 mmol/l (2,09-2,71), leukocyte count is 11,000/mm3 (4,500-11,000), and platelet count is 150,000/mm3 (150,000-400,000). A fingerstick blood glucose concentration is 10,3 mmol/l (3,8-6,1). Which of the following is the most appropriate initial step in management? 
 3) - Transfusion of packed red blood cells (zaškrtl-a)
 4) + Placement of a Foley catheter (nezaškrtl-a)
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 77. ( 14.orig.) A 20-year-old woman is brought to the emergency department because of fever, severe myalgias diarrhea, and a diffuse scarlatiniform rash for hours. She recovered from a similar illness 6 months ago. She is menstruating and using a tampon. She appears very ill.  Her temperature is 40°C (104°F), pulse is 130/min, and blood pressure is 75/30 mm Hg Which of the following is the most appropriate pharmacotherapy?
 2) - Ampicillin (zaškrtl-a)
 4) + Oxacilin (nezaškrtl-a)
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 83. ( 16.orig.) A 32-year-old homosexual man comes to the physician because of a purulent urethral discharge for 2 days. A culture grows Neisseria gonorrhoeae sensitive to penicillin. One week after cessation of penicillin therapy, the patient has a recurrence of the urethral discharge. A culture again shows N. gonorrhoeae sensitive to penicillin.  Both the patient and his sexual partner are HIV negative. Examination of the patients sexual partner shows an anal fissure; urethral culture does not grow N. gonorrhoeae. Which of the following is the most likely cause of the recurrence of urethral infection? 
 1) - Inadequate treatment with penicillin (zaškrtl-a)
 5) + Reinfection from the partner (nezaškrtl-a)
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 91. ( 30.orig.) A 22-year-old man with a seizure disorder has had increasing cough and shortness of breath for 3 days and fever for 1 day. He has foul-smelling sputum. He had a generalized tonic-clonic seizure 1 week ago. His temperature is 39,4°C (103°F). Crackles are heard on auscultation of the chest. An x-ray of the chest shows a right upper-lobe infiltrate of the lung. Which of the following is the most likely cause?
 1) - Chemical pneumonitis (zaškrtl-a)
 3) + Pneumonia secondary to anaerobes (nezaškrtl-a)
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 97. ( 22.orig.) A 6-month-old boy bruises easily and has bleeding gums on several occasions for 2 months. A maternal uncle has a bleeding disorder. Examination shows several small bruises on the legs. Partial thromboplastin time is prolonged, and prothrombin time is normal. Which of the following is the most likely coagulation factor deficiency?
 4) - Factor XIII (zaškrtl-a)
 5) + Factor VIII (nezaškrtl-a)
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100. (  8.orig.) A 54-year-old woman comes to the physician 2 months after her husband died of a myocardial infarction. She tires easily and has chest pain when she inhales deeply at rest. She has had frequent crying spells associated with thoughts of her husband and feels uninvolved in daily activities. Which of the following is the most likely diagnosis? 
 1) - Pathologic grief (zaškrtl-a)
 2) + Normal grief (nezaškrtl-a)
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102. ( 25.orig.) A 50-year-old woman comes to the physician because of a 4-week history of aching limbs, difficulty climbing stairs, and difficulty rising from a chair. Examination shows tenderness of the quadriceps muscles. There is purple-red discoloration of the skin over the upper forehead, eyelids, and cheeks and flat-topped, purple nodules over the elbows and knees. Which of the following is the most likely diagnosis? 
 3) + Dermatomyositis (nezaškrtl-a)
 5) - Psoriasis (zaškrtl-a)
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106. ( 23.orig.) A 67-year-old man comes to the physician because of a nontender lesion on the top of his forehead that has recently bled. He states that the lesion has been there since he was hit on the head with a bottle 18 months ago. Examination shows erythematous areas on other parts of his forehead. The lesion is 1 cm in diameter with a rolled-up, darkened border and a translucent, ulcerated center. Which of the following is the most likely diagnosis? 
 1) + Basal cell epithelioma (nezaškrtl-a)
 5) - Actinic keratosis (zaškrtl-a)
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119. (  1.orig.) A 54-year-old woman with a 10-year history of progressive systemic sclerosis (scleroderma) undergoes an emergency laparotomy for a perforated appendix with peritonitis. During the immediate postoperative period, she has a blood pressure of 180/110 mm Hg. Over the next 3 days, her serum creatinine concentration increases, and her urinary output decreases to 250 ml/day. On postoperative day 4, she has mild shortness of breath. Her peripheral oxygen saturation on room air is 89%. Serum studies show a potassium concentration of 6.2 mmol/l (3,5-5,0), a urea nitrogen concentration of 5,8 mmol/l (1,2-3,0), and a creatinine concentration of 344,5 mmol/l (53-106). Which of the following is the most appropriate next step in management? 
 2) + Hemodialysis (nezaškrtl-a)
 4) - Intravenous administration of morphine (zaškrtl-a)
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120. ( 24.orig.) A 13-year-old boy has nasal discharge and itching of the eyes each year in the early summer. Fifteen minutes after skin testing with a mixture of grass pollens, he develops erythema and a 15-mm wheal at the site.  The skin test response is most likely a result of which of the following mechanisms? 
 1) + Release of histamine from mast cells (nezaškrtl-a)
 2) - Antigen-antibody complexes being formed in blood vessels in the skin (zaškrtl-a)
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TEST:usmle3en  Varianta:1         Tisknuto:04/06/2019
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  3. ( 16.orig.) A 28-year-old woman of Scandinavian descent comes to the office because of fatigue, weakness and palpitations. She is divorced and lives with her 4-year-old daughter. Complete evaluation shows that this patient has hyperthyroidism and mild ophthalmopathy caused by Graves disease. Before initiating therapy, the patient wants to know what she can expect in the future. In advising her about the prognosis, which of the following is the most accurate statement? 
 3) + Untreated patients are at increased risk for cardiac arrhythmias (nezaškrtl-a)
 4) - The thyroid will continue to increase in size with any nonsurgical treatment (zaškrtl-a)
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 14. ( 37.orig.) A male colleague asks you to write a prescription for a narcotic analgesic for one of his female patients. You have noticed that this patient frequently has been coming by the office to see your colleague, and that several of the visits have been marked "No Charge." When you ask your colleague why he cannot write the prescription himself, he seems defensive and says, "Because I don't want anybody to get the wrong idea." Which of the following is the most appropriate response to your colleague? 
 3) + "It sounds like there is more to this story than you are telling me; maybe we should talk about it." (nezaškrtl-a)
 4) - "I wish I could help you, but I never prescribe that medication for a patient unless I have seen the patient myself." (zaškrtl-a)
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 24. (  2.orig.) A 75-year-old woman comes to the clinic because she has band-like burning pain in the right upper quadrant extending from the epigastrium around to the midline of the back. On physical examination, there is no abdominal tenderness. Findings on ultrasonography of the gallbladder are normal; serum amylase concentration is normal. Which of the following is the most likely diagnosis? 
 4) + Herpes zoster (nezaškrtl-a)
 5) - Chronic relapsing pancreatitis (zaškrtl-a)
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 36. ( 10.orig.) A 3-year-old boy is brought to the office by his father because of a 3-month history of decreased activity, poor appetite, sporadic vomiting, clumsiness and speech regression. Since his birth his family has lived in an old area of the city where there is demolition of old buildings. Examination of a peripheral blood smear is likely to show which of the following? 
 2) - Howell-Jolly bodies (zaškrtl-a)
 4) + Basophilic stippling of erythrocytes (nezaškrtl-a)
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 38. (  9.orig.) A 44-year-old Irish-American woman has had arthritis for 10 years, for which she has seen many physicians. She has used many medications and devices, including copper bracelets from Mexico given to her by friends. She seeks your help because for the past several months she has had increasing pain and stiffness in her hands. Her hands now show moderate ulnar deviation of the fingers and she says her wrists and knees also hurt. She has had increasing fatigue for about 1 month, along with a weight loss of 1.8 to 2.2 kg (4 to 5 lb). Review of her medical records, which she has brought with her, convinces you that the initial diagnosis of rheumatoid arthritis is correct. She says, "I had several drop attacks during the past 3 months." She characterizes these attacks as episodes of weakness and loss of feeling in her legs for several minutes. During one of these episodes, she became incontinent. She currently takes aspirin about four times a day and an occasional dose of ibuprofen. On physical examination she has facial plethora and swollen and painful metacarpophalangeal and knee joints, bilaterally. The rest of the examination is normal. Which of the following is the most likely cause of her "drop attacks?" 
 2) - Cardiac arrhythmia (zaškrtl-a)
 5) + Atlanto-axial instability (nezaškrtl-a)
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 47. ( 29.orig.) A 38-year-old nurse comes to the emergency department after leaving work early because of a "horrible headache." She has had a "cold" with sinus congestion for the past week, and yesterday she began taking an over-the-counter combination of diphenhydramine and pseudoephedrine. She tells you she has a history of "migraines," multiple allergies, premenstrual syndrome and depression, for which she takes phenelzine (a monoamine oxidase inhibitor). Vital signs are: temperature 37.2°C (99.0°F), pulse 90/min, respirations 16/min and blood pressure 210/118 mm Hg. Which of the following is the most appropriate action? 
 2) - Order CT scan of the head (zaškrtl-a)
 3) + Administer phentolamine, intravenously (nezaškrtl-a)
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 60. ( 40.orig.) A 74-year-old man with urinary frequency and urgency has benign prostatic hyperplasia. He refuses operative intervention but agrees to a trial of finasteride therapy (5-a-reductase infibitor). During the trial, synthesis of which of the following substances is most likely to be inhibited?
 1) - Androstenedione (zaškrtl-a)
 5) + Dihydrotestosterone (nezaškrtl-a)
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 68. ( 17.orig.) A 58-year-old man comes to the office because of a lesion on the lip, which is shown. The patient says he has had the lesion for about 9 months. He has not seen a physician for 5 years and he is in the office today only because, he says, "My wife made me come." On physical examination the lower lip is fixed to the anterior aspect of the mandible. Which of the following is the most likely diagnosis? 
 2) - Basal cell carcinoma (zaškrtl-a)
 3) + Squamous cell carcinoma (nezaškrtl-a)
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 69. ( 38.orig.) A husband and wife, ages 29 years and 34 years, respectively, come to the office for advice regarding their risk for having hearingimpaired children. They are both hearing-impaired and require hearing aids. Their hearing loss is sensorineural and is not associated with any other health problems. The wife tells you, "We have both learned to live with this disability, but we want to take it into account before we decide to have children." Their pedigree is shown with the patients identified as II2 and II3. Which of the following is the most appropriate advice to the couple? 
 3) + Accurate risk estimation is impossible without further evaluation (nezaškrtl-a)
 5) - Because they are hearing-impaired, all their children will be hearing-impaired (zaškrtl-a)
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 81. (  3.orig.) An obese 10-year-old boy with diabetes mellitus is admitted to the hospital because of severe ketoacidosis and cardiovascular collapse. Initial management consists of cardiac monitoring and intravenous administration of fluids, electrolytes and insulin. Because of the difficulty in obtaining satisfactory peripheral venous access, the left femoral vein is catheterized percutaneously. Six hours later, his mental status is improved, blood pressure is 120/70 mm Hg and serum glucose concentration is 13,6 mmol/l (3,8-6,1). Physical examination at that time shows a cold left foot with diminished pulses compared with those of the right foot. Which of the following is the most likely explanation for this patient's diminished pulses? 
 2) + Inadvertent injury of the femoral artery (nezaškrtl-a)
 3) - Thrombosis of the catheterized femoral vein (zaškrtl-a)
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 98. ( 15.orig.) A 19-year-old white woman returns to the office 2 months after having a medroxyprogesterone injection for contraception. She is complaining of nonstop bleeding since her menses 3 weeks ago. She is using eight pads a day. She denies any sexual activity since she received the injection. She realizes that spotting is a side effect; however, she is anxious about the length of time and the amount of the bleeding. She tells you, "I can't stand this, Doctor. I want the bleeding to stop now!" Repeat pregnancy test is negative. Which of the following is the most appropriate treatment option for her bleeding? 
 2) - Triphasic oral contraceptive therapy for one cycle (zaškrtl-a)
 4) + Conjugated estrogen therapy for 2 weeks (nezaškrtl-a)
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110. ( 23.orig.) A 50-year-old woman is in the recovery room following an uneventful cholecystectomy. Two hours after the procedure she begins to have ventricular extra-systoles and her systolic blood pressure falls from 110 mm Hg to 90 mm Hg. Arterial blood gas values while breathing room air are: PO2 7,7 kPa (10,0-14,0),  PCO2 6,9 kPa (4,4-5,9), pH [H+]36,8 nmol/l (36-44). These signs are most likely the result of which of the following? 
 3) - Pulmonary embolus (zaškrtl-a)
 5) + Alveolar hypoventilation (nezaškrtl-a)
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114. ( 35.orig.) A 47-year-old Italian-American man comes to the office for the first time for routine medical care. He has been referred to you by his psychiatrist who has informed you that the patient has paranoid personality disorder. The patient has no other medical problems at this time. He is unmarried, lives alone and has no close friends, but he occasionally attends family gatherings. He functions well working alone in a technical position in an engineering firm. Which of the following is the best way to structure the physician-patient relationship with this patient? 
 3) - Go out of your way to be warm and friendly so that he can develop trust in you (zaškrtl-a)
 4) + Explain the rationale for any diagnostic procedures and treatment regimens in some detail, adopting a professional, but not overly friendly stance (nezaškrtl-a)
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116. (  6.orig.) You plan to discharge an 81-year-old woman in a few days following a 3-week stay in the hospital for repair of a fractured hip that she sustained while gardening. She now ambulates with difficulty using a walker, but she is determined to become independent again and to return to her own home. Her daughter, who is in the room with the patient, says, "I want to take Mother home with me because I'm concerned that she could fall and break her hip again. Mom says she doesn't really want to leave her own home, but she will do what is best." The daughter turns to her mother and says firmly, "Isn't that right, Mom?" The mother says, "Yes, I guess so," averting eye contact with both her daughter and you by looking down toward the floor. Which of the following is the most appropriate response to the mother? 
 1) - "Are you sure you want to go home with your daughter?" (zaškrtl-a)
 5) + "I would like to talk with you in private now." (nezaškrtl-a)
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118. ( 11.orig.) A 32-year-old man and his 29-year-old wife are being evaluated for infertility. The woman's gynecologist reports that the woman had a normal anatomic and physiologic evaluation and suggests the need for assessment of potential male factors. On examination, the man is 188 cm (6 ft 3 in) tall with fair skin and little facial hair. His testicles are small and firm, and he has mild gynecomastia. No sperm are seen on analysis of his semen. Which of the following tests is most likely to establish the underlying cause of the infertility? 
 1) + Karyotype from peripheral leukocytes (nezaškrtl-a)
 3) - Serum gonadotropin concentrations (follicle-stimulating hormone and luteinizing hormone) (zaškrtl-a)