1.
Which one of the following conditions results in prolongation of the partial thromboplastin time (PTT), but not the prothrombin time (PT)?
2.
A 37 year old man enters the hospital with a history of recent onset of hemoptysis and acute renal failure. He had been in good health until 6 weeks ago when he noted the onset of a cough which, over the ensuing 3 days, produced streaky, blood tinged sputum. His local physician ordered laboratory studies which revealed a serum creatinine of 1.2 mg/dl. A chest x-ray at that time revealed bilateral fluffy infiltrates. The patient was treated with antibiotics and followed over the next 3 weeks; during that time, the lung picture worsened and the serum creatinine rose to 2.5 mg/dl. Now, the man appear ill and in moderate distress. His blood pressure is 120/80 mm Hg, his pulse is 110 bpm, his respiratory rate is 22, and his temperature is 99pF. Examination of the chest shows bilateral rales and a few Scattered wheezes. Examination of the heart reveals tachycardia but is otherwise normal. Laboratory examination shows a blood urea nitrogen (BUN) of 65 mg/dl, a creatinine of 4.3 mg/dl, and electrolytes within normal limits. The hemoglobin level is 8.3 mg/dl, and the hematocrit is 28%. A chest x-ray reveals bilateral fluffy alveolar infiltrates. Examination of the sputum reveals blood. Urinalysis reveals many red blood cell casts. Serum antineutrophilic sytoplasmic antibody (ANCA) levels are negative, as are serum complement levels. The serum antiglomerular basement membrane (anti-GBM) antibody titer is elevated to 1:64. The most likely ethology of this disorder is
3.
Which one of the following statements regarding the esophageal webs of plummer-Vin-son (Peterson-Kelly) syndrome is true?
4.
Shortly after symptoms of an asthmatic attack have resolved pulmonary function testing is most likely to show
5.
A renal biopsy to determine the nature of glomerular disease in a patient with heavy proteinuria is absolutely contraindicated if the patient
6.
A patient with nodular lymphoma involving the neck, mediastinum, and retroperitoneum would be expected to require all of the following staging procedures EXCEPT
7.
A 71-year-old man is seen in the surgical intensive care unit for acute renal failure. The patient had an operation for removal of gallstones, after which he had a persistent drainage from his biliary catheter associated with spiking fevers to 102oF. The patient has been taking gentamicin (70 mg every 8 hours) and cephalothin (2 g four times a day) for the past 10 days. Over the last 4 days the serum creatinine level has increased at a rate of 1 mg/dl/day, but his urine output of 1.5 L/day has not diminished. He has had no history of hypotension at any time during this hospitalization at any time during this hospitalization. Physical examination shows normal blood pressure and vital signs. Result of laboratory studies show a creatinine level of 7.1 mg/dl, and renal ultrasonography reveals no evidence of obstruction. The most likely cause of this patient’s acute renal failure is
