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Question 1 of 10
A 35-year-old previously healthy woman comes to the hospital due to several days of productive cough associated with chills and fever. Her sputum is purulent with faint pink streaks of blood. The patient also has sharp pain over the right shoulder and neck area brought on by deep inspiration. Past medical history is unremarkable. Her temperature is 38.3 C (101 F), blood pressure is 130/70 mm Hg, pulse is 98/min, and respirations are 22/min. Examination reveals crackles and dullness over the right lower pulmonary lobe. While listening with the stethoscope over the right midback, the examiner has the patient say the letter “E,” and the sound is perceived by the examiner as a loud letter “A.” A chest x-ray is obtained and is shown in the image below.
The pain experienced by this patient is most likely carried by which of the following nerves?
Question 2 of 10
A 66-year-old man hospitalized 3 days ago for left lower lobe pneumonia is evaluated for persistent fever. He has been receiving the appropriate intravenous antibiotics as determined by antibiotic susceptibility testing of his sputum cultures. The patient has a history of diabetes mellitus and hypertension. His temperature is 38 C (100.4 F) and pulse is 87/min. Examination shows dullness to percussion and decreased breath sounds over the left lower lung. Imaging studies reveal a loculated, left-sided pleural effusion. A tube is placed to drain the fluid via an incision at the 5th intercostal space in the midaxillary line. Which of the following muscles is most likely to be dissected during the procedure?
Question 3 of 10
A 22-year-old man is brought to the emergency department after being involved in a fight at a nearby bar. His blood pressure is 88/60 mm Hg and heart rate is 114/min. Physical examination shows a penetrating right-sided stab wound just above the clavicle, between the midclavicular and lateral sternal lines. The course of the wound appears to be perpendicular to the skin. Which of the following structures was most likely injured?
Question 4 of 10
A 63-year-old man is admitted to the hospital after suffering a cerebral infarction. A swallow study performed during the acute recovery period shows oropharyngeal dysphagia. Despite being maintained on the appropriate dietary restrictions, the patient experiences an episode of vomiting while lying on his back and subsequently develops pneumonia. Which of the following lung regions is most likely to be affected?
Question 5 of 10
A 32-year-old man comes to the hospital due to 1 week of progressive shortness of breath and cough. He also reports sharp right-sided chest pain that is worsened by deep inspiration. Examination reveals decreased tactile fremitus, dullness on percussion, and decreased breath sounds over the right lower lung. During diagnostic thoracentesis, the needle is inserted along the upper border of the 10th rib at the right midaxillary line. Which of the following structures is most at risk of being injured as a result of the intervention?
Question 6 of 10
A 53-year-old man comes to the emergency department due to a few weeks of severe heartburn and difficulty swallowing. He has had mild to moderate heartburn for several years and has tried weight loss, elevating the head of the bed while sleeping, and several months of proton pump inhibitor therapy. Other medical problems include hypertension and hypothyroidism. Temperature is 36.7 C (98.1 F), blood pressure is 130/80 mm Hg, pulse is 78/min, and respirations are 16/min. BMI is 25 kg/m2. Physical examination is unremarkable. An upper gastrointestinal endoscopy is performed, and esophageal biopsy shows columnar epithelium with interspersed goblet cells. A similar adaptive response can be seen in which of the following scenarios?
Question 7 of 10
Fourth-year medical students are recruited for a research study assessing their ability to interpret biopsy samples obtained during routine clinical practice. As part of the study, they are given samples of normal respiratory mucosa and asked to identify the cell types present after staining with hematoxylin and eosin. The students observe that the respiratory epithelium changes in composition as the airways continue distally from the trachea to the alveolar ducts. Which of the following features is last to disappear?
Question 8 of 10
Physicians involved in regenerative medicine research conduct a series of animal experiments to determine pulmonary tissue regeneration capacity. During one of the experiments, lung alveoli are exposed to N02 and massive necrosis of the epithelial lining ensues. Histologic examination of the injured tissues a month later shows partial recovery of the alveolar epithelial lining. This regenerated tissue is most likely derived from which of the following cell types?
Question 9 of 10
A 36-year-old man is rushed to the emergency department after the sudden onset of shortness of breath and difficulty swallowing. He has visited the emergency department several times before for food and skin allergies. He is unconscious on arrival. Examination shows excessive accessory respiratory muscle use and edematous swelling of his face, lips, and tongue. There is also scattered urticaria over his upper body. Attempts at intubation are unsuccessful due to massive soft tissue edema involving his pharynx. A decision is made to perform an emergency cricothyrotomy. The incision made during this procedure will most likely pass through which of the following structures?
Question 10 of 10
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?
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