Certain patients with non-small cell lung cancer develop constitutive tumor kinase activity due to the production of echinoderm microtubule-associated protein-like 4 – anaplastic lymphoma kinase (EML4-ALK), a fusion protein that contributes to carcinogenesis.  This is most similar to the molecular pathophysiology of which of the following disorders?

A 56-year-old man comes to the office due to several months of progressive neck swelling.  He has also had intermittent epistaxis and headaches.  The patient has no chronic medical conditions and takes no medications.  He does not use tobacco, alcohol, or illicit drugs, and he emigrated to the United States from rural China 12 years ago.  Physical examination shows several enlarged, firm, and nontender cervical lymph nodes.  Nasopharyngeal evaluation reveals a mass arising from the pharyngeal recess.  Histopathological examination of the mass shows undifferentiated malignant cells of epithelial origin.  Further analysis of these cells is most likely to reveal the presence of nucleic acid sequences from which of the following viruses?

Rats subjected to chronic inhalation exposure of formaldehyde develop nasal squamous cell carcinomas.  Decreased activity of which of the following genes is likely to be found on cytogenetic studies of the tumor cells?

A 35-year-old man is brought to the emergency department after collapsing in his garage.  He recently bought a classic 1960s convertible and was repairing it when he collapsed.  The patient was inside the garage but had the door half-open.  He lost consciousness after working on the car for 2 hours with the engine running.  The patient has no known medical problems and takes no medications.  He does not use tobacco, alcohol, or illicit drugs.  Which of the following best reflects the combination of findings that would have been expected in an arterial blood sample taken when the patient lost consciousness?

A 65-year-old man comes to the office due to worsening exertional dyspnea over the past 3 months.  This past year, he had 4 respiratory tract infections that improved with medical therapy.  The patient does not use alcohol or recreational drugs.  He has smoked 1½ packs of cigarettes daily for 30 years.  Temperature is 36.7 C (98.1 F), pulse is 76/min, and respirations are 18/min.  On physical examination, breath sounds are diffusely decreased.  Chest radiograph reveals increased lucency of the lungs.  This patient’s pulmonary function testing will most likely show which of the following patterns of findings?

A 65-year-old man with a long history of smoking comes to the office due to a nonproductive cough over the last several months.  He recently developed left shoulder pain, persistent hiccups, and dyspnea.  His temperature is 36.7 C (98 F), blood pressure is 140/85 mm Hg, and pulse is 76/min.  Physical examination reveals decreased breath sounds on the left side.  Chest x-ray shows a large left lung mass.  Compression of a nerve arising from which of the following locations is most likely causing this patient’s recent symptoms?

A 56-year-old man comes to the clinic due to recent-onset headache and dyspnea.  The patient says he has had a puffy face for 2 weeks along with a persistent dry cough.  He does not have any neck or shoulder pain.  He has no other medical problems.  Physical examination shows symmetrical facial swelling and conjunctival edema.  The pupils are equal, round, and reactive to light.  Dilated veins are noted over his neck and upper trunk.  Heart and lung sounds are normal.  Peripheral strength and sensation are intact.  Which of the following is the most likely cause of this patient’s condition?

A 4-week-old boy is being evaluated in the neonatal intensive care unit.  The patient was born at 29 weeks gestation.  Immediately before delivery, the mother received a dose of terbutaline in an attempt to stop the contractions and a dose of antenatal corticosteroids to help improve fetal lung maturity.  Shortly after birth, the patient developed severe respiratory distress, requiring surfactant administration and supplemental oxygen.  He was weaned off oxygen therapy after a week.  The patient also received routine prophylactic medications, including erythromycin ophthalmic ointment and intramuscular vitamin K, at birth.  Ophthalmic examination today shows abnormal retinal vascularization that extends into the vitreous.  The retinal findings in this patient are most likely related to which of the following?

A 63-year-old man comes to the office due to 3 months of increasing cough with occasional hemoptysis, night sweats, and unintentional weight loss.  The patient recently emigrated from South Africa, where he had worked for many years in the gold mines.  He has a history of silicosis that was diagnosed 10 years ago.  Vital signs show a low-grade fever.  Physical examination reveals diffuse, fine crackles with right upper lobe predominance.  Chest x-ray shows diffuse, small nodules; hilar adenopathy with prominent calcifications; and a cavitary lung lesion in the right upper lobe.  A sputum sample is sent for appropriate staining and culture.  This patient’s increased susceptibility to the current infection is best explained by which of the following factors?

A 52-year-old man comes to the office for a routine health maintenance visit.  The patient feels well.  He is a former cigarette smoker of 15 pack-years but quit 10 years ago.  The patient no longer has cravings or an interest in smoking.  He enjoys restoring and preserving antique paintings, spending considerable time in his basement studio.  The patient has an African gray parrot and lives with his wife in a home built in 1950s.  Cardiovascular and pulmonary examinations are normal.  He expresses concern about his risk for lung cancer.  Protection against which of the following is most likely to lower this patient’s risk for lung cancer?

A 64-year-old patient with frequent wheezing and shortness of breath is started on a new inhaled medication, with significant relief of symptoms.  The medication has a long lipophilic side chain that allows attachment to the plasma membrane.  The side chain also binds to an auxiliary, deeper site different from the one that binds epinephrine, helping to tether the molecule near the beta-2 adrenergic receptor.  Which of the following medications did this patient most likely receive?

A 6-year-old boy is brought to the emergency department by his parents due to persistent nasal bleeding.  The boy picks his nose frequently and has had several nosebleeds in the past, all of which stopped spontaneously after pinching the nose.  The parents say that they have been pinching the nasal alae for over 30 minutes while the boy leans forward.  Family history is negative for bleeding disorders.  The patient takes no medications and has no allergies.  Examination shows continuous blood trickle from his right nostril.  Silver nitrate cautery is performed and the bleeding stops.  Cautery was most likely applied to which of the following locations in this patient’s nasal cavity?

A 35-year-old woman, gravida 1 para 0, at 40 weeks gestation undergoes a cesarean delivery.  Shortly after delivery of the infant, the patient becomes anxious, short of breath, and then unresponsive.  Blood pressure is 70/40 mm Hg and pulse is 120/min.  Oxygen saturation is 83% on room air.  There is profuse bleeding from the abdominal incision and intravenous lines.  The lungs are clear to auscultation.  Intraarterial blood pressure monitoring is established, and pulmonary artery catheterization is performed.  Initial measurements are as follows:

Which of the following additional findings is most likely to be seen in this patient?

A 55-year-old woman with a history of Crohn disease is admitted to the hospital due to perforated appendicitis.  The patient quickly develops respiratory difficulty, and acute respiratory distress syndrome is diagnosed.  She is intubated and mechanically ventilated with positive pressure ventilation.  Despite the use of high positive end-expiratory pressure, the patient’s condition continues to deteriorate.  She is intermittently placed in the prone position while mechanically ventilated.  Which of the following is most likely to occur due to this position change?

A 60-year-old man comes to the clinic due to a 3-week history of fatigue, shortness of breath, and fever.  The patient has a 35-pack-year history of cigarette smoking but has no other significant medical history.  Temperature is 38.6 C (101.5 F), blood pressure is 140/92 mm Hg, pulse is 110/min, and respirations are 24/min.  There is dullness to percussion at the right lung base.  Chest radiograph shows a moderate-sized loculated pleural effusion on the right side.  Ultrasonography reveals multiple separate fluid pockets within the pleural space.  Chest tube placement produces only a small amount of thick pus.  Intrapleural administration of a medication with which of the following effects would most likely improve chest tube drainage in this patient?

A 34-year-old man is being evaluated for acute hypoxemic respiratory failure.  Two days ago, the patient was brought to the emergency department due to opioid and alcohol intoxication.  While unconscious, he vomited profusely and then rapidly developed hypoxia and shortness of breath that has continued to worsen.  Today, temperature is 38.4 C (101.1 F), blood pressure is 108/74 mm Hg, pulse is 120/min, and respirations are 26/min.  Diffuse crackles are heard on auscultation.  The extremities are warm, well perfused, and without edema.  Chest x-ray reveals bilateral alveolar opacities.  The results of arterial blood gas analysis on room air are as follows:

Which of the following pathologic processes is the primary contributor to this patient’s lung findings?

A 4-year-old girl is brought to the emergency department by her parents due to difficulty breathing.  The patient was in her usual state of health until this morning when she developed a fever.  Over the past 8 hours, her breathing has become more rapid and strained.  Temperature is 39.8 C (103.6 F), blood pressure is 88/64 mm Hg, pulse is 134/min, and respirations are 34/min.  On examination, the patient appears scared.  She is sitting up on the bed leaning forward while supported by her arms with her head extended.  Cardiac examination reveals tachycardia and a normal rhythm without rubs or murmurs.  The abdomen is soft and nondistended.  Which of the following additional signs is most likely to be found on examination?

An 18-year-old, previously healthy man comes to the emergency department after being stabbed in the chest.  The patient reports shortness of breath.  Blood pressure is 136/84 mm Hg, pulse is 96/min, and respirations are 20/min.  Oxygen saturation is 96%.  Physical examination reveals a 2.5-cm stab wound on the right lateral chest wall.  Breath sounds are decreased on the right side.  Chest x-ray is shown in the exhibit.  Which of the following changes have most likely occurred in this patient’s right hemithorax and right lung compared to his preinjury state?

A 31-year-old man comes to the office due to progressive dyspnea over the past several months.  The patient states that the shortness of breath improved initially with supine positioning, but lately, it is present even on recumbency and during minimal exertion.  He reports recurrent episodes of nosebleeds since childhood but has no other medical conditions.  Temperature is 36.7 C (98.1 F), blood pressure is 110/50 mm Hg, pulse is 102/min, and respirations are 20/min.  Oxygen saturation is 96% on room air.  Cardiac examination reveals an accentuated S2 over the upper left sternal border.  The lungs are clear to auscultation.  There is digital clubbing.  Skin examination findings are shown in the exhibit.  Which of the following is the most likely underlying cause of this patient’s dyspnea?

A newborn is transferred to the neonatal intensive care unit 4 hours after delivery due to cyanosis.  The infant was born via a spontaneous vaginal delivery at 41 weeks gestation to a 22-year-old gravida 2 para 2 woman.  The pregnancy and delivery were uncomplicated.  Three hours after delivery, circumoral cyanosis was noted after the infant was breastfed.  Pulse oximetry readings were 98% in the right hand and 83% in the left foot.  On physical examination, the patient has subcostal retractions and grunting.  Cardiac examination reveals a 2/6 systolic murmur at the left lower sternal border.  Femoral pulses are strong bilaterally.  Which of the following is the most likely cause of this infant’s cyanosis?

A 44-year-old man comes to the office due to excessive daytime sleepiness and loud snoring.  He undergoes polysomnography for evaluation of obstructive sleep apnea.  During the study, sensors are attached to monitor ocular movements, muscle electrical potentials, brain activity, airflow, and cardiac rhythm.  Based on the ocular and muscle readings, the patient’s sleep stages are classified into rapid eye movement (REM) or non-REM.  In addition, the patient’s body position is tracked by video.  He tosses and turns throughout the night, sleeping on his back, side, and stomach.  Frequent episodes of obstructive apnea and hypopnea are detected.  The highest degree of obstructive apnea is likely to be seen during which of the following categories of sleep?

A 5-year-old girl is brought to the emergency department after having a seizure at home.  Approximately an hour ago, the patient collapsed at the dinner table and developed full body shaking and urinary incontinence.  Her mother says that the girl has had a mild headache and fatigue for the past few days.  On examination, the patient is sleepy and difficult to rouse.  Vital signs are normal.  Cardiopulmonary examination is unremarkable.  CT scan of the head is shown in the image below:

Which of the following historical details is most relevant in establishing this patient’s diagnosis?

A 1-hour-old boy is admitted to the neonatal intensive care unit for respiratory failure.  The infant was born to a 27-year-old mother, gravida 4 para 2, at 29 weeks gestation via cesarean delivery due to maternal preeclampsia with severe features.  Amniotic fluid was clear.  Apgar scores were 7 and 8 at 1 and 5 minutes, respectively.  Birth weight is 1,120 g (2 lb 8 oz).  Temperature is 36.9 C (98.4 F), pulse is 170/min, and respirations are 56/min.  Pulse oximetry is 82% on room air.  There are intercostal and subcostal retractions.  Cardiac examination shows tachycardia without murmurs.  The lungs have decreased breath sounds bilaterally.  The abdomen is soft without organomegaly.  Surfactant is ordered, and the team prepares for intubation.  Prior to these clinical interventions, which of the following best describes the condition of this patient’s lungs compared to a normal neonate?