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Question 1 of 9
1. Question
A 20-year-old man comes to the office due to pain in the left thigh. Three months ago, a horse kicked him in the left midthigh, resulting in deep pain and swelling in the thigh muscles; x-ray was normal, and, over the next several days, the symptoms resolved with rest and ice packs. However, a few weeks later, the patient gradually developed recurrent pain and swelling in the same area. Vital signs are normal. Examination shows a solitary, hard, mobile, oval mass of approximately 4 × 5 cm in the anterior aspect of the left thigh. Excision of the mass is performed. Histologic examination is likely to show which of the following?
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Question 2 of 9
2. Question
A 50-year-old man comes to the office for evaluation of a nodule in his palm just proximal to the third metacarpophalangeal joint. It has grown larger since it first appeared several months ago and he now has mild flexion of the finger, which he is unable to straighten. The patient reports that his mother had similar problems with her fingers. Examination of the affected hand is shown in the exhibit. Which of the following pathologic processes is most likely involved in this patient’s condition?
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Question 3 of 9
3. Question
A 38-year-old man is evaluated due to a 2-year history of gradually worsening low back pain, bilateral buttock pain, and stiffness. Symptoms are worse in the morning and relieved with stretching and hot showers. The patient also has fatigue but no fever, chills, night sweats, or weight loss. Vital signs are normal. The patient appears healthy but has a stooped walking posture. Deep palpation over the lumbar spine at the midline and both sacroiliac joints elicits tenderness. Erythrocyte sedimentation rate is 75 mm/hr. Which of the following pathologic findings is most likely causing this patient’s symptoms?
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Question 4 of 9
4. Question
A 28-year-old man comes to the office due to a 4-month history of pain and stiffness in the lower back and neck. Symptoms are worse with prolonged rest and in the early morning. The patient also has fatigue and poor sleep. He has no other medical conditions and takes no medications. Vital signs are normal. Examination shows limited forward bending of the trunk. Lower extremity muscle power and reflexes are normal. Which of the following is most likely to confirm the diagnosis?
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Question 5 of 9
5. Question
A 20-year-old woman comes to the office due to intermittent pain and swelling of both knees over the past 3 months. She has no fever, chills, or abnormal vaginal discharge. The patient has no other medical conditions and is not sexually active. Temperature is 37.2 C (99 F), blood pressure is 150/90 mm Hg, and pulse is 78/min. Small, nontender oral ulcers are present. Examination shows mild tenderness of the knee joints but no effusion. The remainder of the examination shows no abnormalities. Laboratory results reveal anemia, thrombocytopenia, and elevated serum creatinine. Urinalysis shows proteinuria and red blood cell casts. Which of the following pathogenic mechanisms is most likely responsible for this patient’s renal disease?
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Question 6 of 9
6. Question
A 64-year-old man comes to the office due to progressive low back pain for the past several months that is beginning to interfere with his job. The patient describes pain in the lower back and buttocks, which worsens with prolonged standing or walking and improves with lying down. He also has occasional sharp, shooting pain that radiates down his right leg. The patient works as a greeter for a local supermarket and was recently given a written warning for taking too many breaks during his shift. He has a history of hypertension and osteoarthritis. Spine imaging reveals degenerative joint changes and a large osteophyte compressing the spinal nerve root exiting through the right neural foramen between the L5 and S1 vertebrae. Which of the following examination findings is most likely present in this patient due to the nerve lesion?
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Question 7 of 9
7. Question
A 58-year-old man comes to the office due to worsening right upper extremity weakness over the past 4 weeks. The patient frequently travels for work and has had difficulty carrying heavy bags and getting luggage into or out of the overhead bins. He also has had neck and shoulder pain for the past several months, which he attributes to stress. The patient reports no trauma, and medical history is significant for hypertension. Physical examination shows weakness of shoulder abduction and loss of the biceps reflex on the right side. Pinprick sensation is decreased over the right lateral arm and forearm. Which of the following pathologic processes is most likely underlying this patient’s current symptoms?
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Question 8 of 9
8. Question
A 22-year-old woman comes to the office because of a 6-month history of increasing neck and low back pain that is most severe in the morning. Her pain improves as the day passes. The patient has no history of trauma, rashes, or urinary symptoms. Vital signs are within normal limits. Examination shows tenderness over the lumbosacral area and at the insertion site of the Achilles tendon. Forward flexion is reduced. This patient’s symptoms are most likely attributable to upregulation of which of the following cytokines?
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Question 9 of 9
9. Question
A 64-year-old man comes to the office due to right hip pain. The pain began 5 months ago and has now started to interfere with ambulation. He also has had recent onset right occipital headaches. Medical history is notable for chronic obstructive pulmonary disease and type 2 diabetes mellitus. The patient has a 30-pack-year smoking history and drinks 2 to 3 alcoholic beverages a day. Blood pressure is 130/60 mm Hg and pulse is 80/min. Physical examination shows increased anteroposterior diameter of the chest with hyperresonance to percussion. Serum calcium level and phosphorus levels are normal, but serum alkaline phosphatase is elevated. Which of the following is the most likely cause of this patient’s hip pain?
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