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Question Id: 10

A 25 year old woman returning from a 4 year stay in Africa presents with complaints of vomiting and diarrhea. On further examination, you notice that her breath smells like “garlic”. Biochemical studies reveal that she is deficient in a key compound of the Krebs cycle. A blood smear shows normal red blood cells. She denies any recent exposure to fire. Which of the following is the most likely cause of this patient's presentation?

  • A

    Lead 

  • B

    Garlic

  • C

    Arsenic

  • D

    Carbon monoxide

  • E

    Mercury

Question Id: 11

A 2-day-old neonate becomes lethargic and uninterested in breast-feeding. Physical examination reveals tachypnea with a normal heart rate and breath sounds. Initial blood chemistry values include normal glucose, sodium, potassium, chloride, and bicarbonate (HCO3–) levels; initial blood gas values reveal a pH of 7.53, partial pressure of oxygen (PO2) of 103 mmHg, and partial pressure of carbon dioxide (PCO2) of 27 mmHg. Which of the following is the most appropriate treatment?

  • A

    Administer acid to treat metabolic alkalosis 

  • B

    Administer alkali to treat metabolic acidosis 

  • C

    Administer alkali to treat respiratory acidosis

  • D

    Decrease the respiratory rate to treat metabolic acidosis

  • E

    Decrease the respiratory rate to treat respiratory alkalosis

Question Id: 12

A 90-year-old woman presents for her routine doctor’s checkup. She complains of lethargy, weakness, and tingling sensation in her fingers and toes. Her eyesight has also deteriorated. On physical examination, her tongue is inflamed, and her conjunctivae are pale. Labs show that her haemoglobin is 9.8 g/dL, and her MCV is 115 µm3. Which of the following nutritional deficiencies does she most likely have?

  • A

    Folate

  • B

    Iron

  • C

    Vitamin B2

  • D

    Vitamin B3

  • E

    Vitamin B12

Question Id: 13

A 24-year-old, thin, African man comes to your office as a new patient. He has recently moved to America and speaks little English. When you ask about previous medical history, he says that he has a problem with his blood and has frequent pain, but cannot explain any more. His sclerae are icteric. Upon questioning, he reports that his family members also have the same problem with their blood. What type of hematologic disorder should be suspected in this patient?

  • A

    Genetic hemoglobinopathy 

  • B

    Iron-deficiency anemia

  • C

    Prothrombotic state 

  • D

    Porphyria

  • E

    Thalassemia

Question Id: 14

X is an oncogene. Y is a tumor suppressor gene. Which of the following molecular events is commonly implicated in the pathogenesis of cancer?

  • A

    X deletion

  • B

    X inactivating mutation

  • C

    Y activating mutation

  • D

    Y amplification

  • E

    Y deletion

Lab Values
Search SI Reference Intervals
* Included In Biochemical Profile
Blood,Plasma,Serum Reference Range SI Reference Intervals
* Alanine aminotransferase (ALT at 30EC) 8-20 U/L 8-20 U/L
Amylase, serum 25-125 U/L 25-125 U/L
Bilirubin, serum (adult) Total // Direct 0.1-1.0 mg/dL // 0.0-0.3 mg/dL 2-17 μmol/L // 0-5 μmol/Lc
* Calcium, serum (Ca2+) 8.4-10.2 mg/dL 2.1-2.8 mmol/L
* Cholesterol, serum Rec:< 200 mg/dL < 5.2 mmol/L
Cortisol, serum 0800 h: 5-23 μg/dL 82-413 nmol/L 1600 h: 3-15 μg/dL 138-635 nmol/L 2000 h: < 50% of 0800 h Fraction of 0800 h: < 0.50
Creatine kinase, serum Male: 25-90 U/L Female: 10-70 U/L 25-90 U/L 10-70 U/L
Creatinine, serum 0.6-1.2 mg/dL 53-106 μmol/L
Electrolytes, serum
Sodium (Na+) 136-145 mEq/L 136-145 mmol/L
* Potassium (K+) 3.5-5.0 mEq/L 3.5-5.0 mmol/L
Chloride (ClB) 95-105 mEq/L 95-105 mmol/L
Bicarbonate (HCO3-) 22-28 mEq/L 22-28 mmol/L
Magnesium (Mg2+) 1.5-2.0 mEq/L 0.75-1.0 mmol/L
Estriol, total, serum (in pregnancy)
24-28 wks // 32-36 wks 8-20 U/L30-170 ng/mL // 60-280 ng/mL 30-170 ng/mL // 60-280 ng/mL
28-32 wks // 36-40 wks 40-220 ng/mL // 80-350 ng/mL 140-760 nmol/L // 280-1210 nmol/L
Ferritin, serum Male: 15-200 ng/mL Female: 12-150 ng/mL 15-200 μg/L 12-150 μg/L
Follicle-stimulating hormone, serum/plasma Male: 4-25 mIU/mL 4-25 U/L
Female: premenopause 4-30 mIU/mL 4-30 U/L
midcycle peak 10-90 mIU/mL 10-90 U/L
postmenopause 40-250 mIU/mL 40-250 U/L
Gases, arterial blood (room air)
pH 7.35-7.45 [H+] 36-44 nmol/L
PCO2 33-45 mm Hg 4.4-5.9 kPa
PO2 75-105 mm Hg 10.0-14.0 kPa
* Glucose, serum Fasting: 70-110 mg/dL 3.8-6.1 mmol/L
2-h postprandial: < 120 mg/dL < 6.6 mmol/L
Growth hormone - arginine stimulation Fasting: < 5 ng/mL < 5 μg/L
provocative stimuli: > 7 ng/mL 7 μg/L
Immunoglobulins, serum
IgA 76-390 mg/dL 0.76-3.90 g/L
IgE 0-380 IU/mL 0-380 kIU/L
IgG 650-1500 mg/dL 6.5-15 g/L
IgM 40-345 mg/dL 0.4-3.45 g/L
Iron 50-170 μg/dL 9-30 μmol/L
Lactate dehydrogenase,serum 45-90 U/L 45-90 U/L
Luteinizing hormone, serum/plasma Male: 6-23 mIU/mL 6-23 U/L
Female: follicular phase 5-30 mIU/mL 5-30 U/L
midcycle 75-150 mIU/mL 75-150 U/L
postmenopause 30-200 mIU/mL 30-200 U/L
Osmolality, serum 275-295 mOsmol/kg 275-295 mOsmol/kg
Parathyroid hormone, serum, N-terminal 230-630 pg/mL 230-630 ng/L
* Phosphatase (alkaline), serum (p-NPP at 30EC) 20-70 U/L 20-70 U/L
* Phosphorus (inorganic), serum 3.0-4.5 mg/dL 1.0-1.5 mmol/L
Prolactin, serum (hPRL) < 20 ng/mL < 20 μg/L
* Proteins, serum
Total (recumbent) 6.0-7.8 g/dL 60-78 g/L
Albumin 3.5-5.5 g/dL 35-55 g/L
Globulin 2.3-3.5 g/dL 23-35 g/L
Thyroid-stimulating hormone, serum or plasma 0.5-5.0 μU/mL 0.5-5.0 mU/L
Thyroidal iodine (123I) uptake 8%-30% of administered dose/24 h 0.08-0.30/24 h
Thyroxine (T4), serum 5-12 μg/dL 64-155 nmol/L
Triglycerides, serum 35-160 mg/dL 0.4-1.81 mmol/L
Triiodothyronine (T3), serum (RIA) 115-190 ng/dL 1.8-2.9 nmol/L
Triiodothyronine (T3) resin uptake 25%-35% 0.25-0.35
* Urea nitrogen, serum (BUN) 7-18 mg/dL 1.2-3.0 mmol urea/L
* Uric acid, serum 3.0-8.2 mg/dL 0.18-0.48 mmol/L
Hematologic Reference Range SI Reference Intervals
Bleeding time (template) 2-7 minutes 2-7 minutes
Erythrocyte count Male: 4.3-5.9 million/mm3 4.3-5.9 x 1012/L
Female: 3.5-5.5 million/mm3 3.5-5.5 x 1012/L
Erythrocyte sedimentation rate (Westergren) Male: 0-15 mm/h 0-15 mm/h
Female: 0-20 mm/h 0-20 mm/h
Hematocrit Male: 41%-53% 0.41-0.53
Female: 36%-46% 0.36-0.46
Hemoglobin A1c < 6% < 0.06
Hemoglobin, blood Male: 13.5-17.5 g/dL 2.09-2.71 mmol/L
Female: 12.0-16.0 g/dL 1.86-2.48 mmol/L
Hemoglobin, plasma 1-4 mg/dL 0.16-0.62 mmol/L
Leukocyte count and differential
Leukocyte count 4500-11,000/mm3 4.5-11.0 x 109/L
Segmented neutrophils 54%-62% 0.54-0.62
Bands 3%-5% 0.03-0.05
Eosinophils 1%-3% 0.01-0.03
Basophils 0%-0.75% 0-0.0075
Lymphocytes 25%-33% 0.25-0.33
Monocytes 3%-7% 0.03-0.07
Mean corpuscular hemoglobin 25.4-34.6 pg/cell 0.39-0.54 fmol/cell
Mean corpuscular hemoglobin concentration 31%-36% Hb/cell 4.81-5.58 mmol Hb/L
Mean corpuscular volume 80-100 μm3 80-100 fl
Partial thromboplastin time (activated) 25-40 seconds 25-40 seconds
Platelet count 150,000-400,000/mm3 150-400 x 109/L
Prothrombin time 11-15 seconds 11-15 seconds
Reticulocyte count 0.5%-1.5% of red cells 0.005-0.015
Thrombin time < 2 seconds deviation from control < 2 seconds deviation from control
Volume
Plasma Male: 25-43 mL/kg 0.025-0.043 L/kg
Female: 28-45 mL/kg 0.028-0.045 L/kg
Red cell Male: 20-36 mL/kg 0.020-0.036 L/kg
Female: 19-31 mL/kg 0.019-0.031 L/kg
Cerebrospinal Fluid Reference Range SI Reference Intervals
Cell count 0-5 cells/mm3 0-5 x 106/L
Chloride 118-132 mEq/L 118-132 mmol/L
Gamma globulin 3-12% total proteins 0.03-0.12
Glucose 40-70 mg/dL 2.2-3.9 mmol/L
Pressure 70-180 mm H2O 70-180 mm H2O
Proteins, total < 40 mg/dL < 0.40 g/L
Sweat Reference Range SI Reference Intervals
Calcium 100-300 mg/24 h 2.5-7.5 mmol/24 hc
Chloride Varies with intake Varies with intake
Creatinine clearance Male: 97-137 mL/min Female: 88-128 mL/min
Estriol, total (in pregnancy)
30 wks 6-18 mg/24 h 21-62 μmol/24 h
35 wks 9-28 mg/24 h 31-97 μmol/24 h
40 wks 13-42 mg/24 h 45-146 μmol/24 h
17-Hydroxycorticosteroids Male: 3.0-10.0 mg/24 h 8.2-27.6 μmol/24 h
Female: 2.0-8.0 mg/24 h 5.5-22.0 μmol/24 h
17-Ketosteroids, total Male: 8-20 mg/24 h 28-70 μmol/24 h
Female: 6-15 mg/24 h 21-52 μmol/24 h
Osmolality 50-1400 mOsmol/kg
Oxalate 8-40 μg/mL 90-445 μmol/L
Potassium Varies with diet Varies with diet
Proteins, total < 150 mg/24 h <0.15 g/24 h
Sodium Varies with diet Varies with diet
Uric acid Varies with diet Varies with diet
Body mass index Adult: 19-25 kg/m2
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