Nbme 16

1.) A 42 yr old woman undergoes biopsy of suspicious calcifications seen on routine

mammograms. Light microscopy shows a poorly demarcated region consisting of poorly
cohesive cells growing in sheets. The nucleus to cytoplasmic ratio approaches 1:1And a
prominent nucleolus is observed. There is microscopic evidence of stromal invasion.
She has no adenopathy. CT scan shows no evidence of hepatic, pulmonary or bone
metastases. These findings are most consistent with which of the following?
A) High grade, High stage neoplasm
B) High grade, low stage neoplasm
C) Low grade, high stage neoplasm
D) Low grade, low stage neoplasm

2) A new anti-platelet agent is developed for the prevention of recurrence of stroke. In a

large Randomized clinical trial with equal numbers of men and women, the rates of
stroke are lower in pts receiving the new agent than in pts receiving the STD treatment.
Results are shown:
Recurrent stroke rates per 1000 person years
STD treatment new antiplatelet drug
Women 0.12 0.04
Men 0.24 0.0
8 Overall 0.18 0.06
Based on the following which of the following is the absolute risk reduction in women?
A) 8% B) 12% C) 16% D) 33% E) 62% F) 67% G) 75%

3) A case control study is conducted to explore a possible association between exposure

to an herbicide and non-Hodgkins lymphoma. Controls are matched to cases by age,
gender and race. Exposure status is determined by interviewing the subjects. On
matched pair analysis, the odds ratio is 3.2 (95% CI: 1.4-5.4) which of the following is
most likely to affect the validity of the study?
A) Biased measurement of the condition
B) Biased measurement of the exposure
C) Confounding by age
D) Type 1 error
E) Type 2 error

4) A 32 yr old woman, gravida 4, para 0, aborta 3, delivers a female new born at term
with dysmorphic features and numerous organ anamolies. She had multiple
spontaneous abortions, and this is her first live born child. Which of the following is the
most likely explanation for the abnormalities seen in this newborn?
A) AD inheritance
B) AR inheritance
C) Gonadal mosaicism
D) Submicroscopic deletion
E) Unbalanced chromosome rearrangement
5) A 60 yr old man with no h/o bleeding problems has coagulation testing prior to CABG.
His prothrombin time is 11.5 sec (INR1.0) and APTT is 160 sec. Which of the following is
most likely to be abnormal in this patient?
A) C5a generation
B) Histamine release
C) Kallikrein formation
D) Phagocytosis
E) Platelet aggregation

6) To determine whether children of workers in a lead foundry sustain neurological

damage from
exposure to dust on their parent's clothing, a test for motor skills was given to 30 first
graders whose parents has worked at the foundry for 5 years or longer and to 30
controls. Which of the following groups of children would be the proper control group for
this study?
A) First graders living with guardians or relatives who worked at the foundry for 5 years
or longer.
B) First graders whose parents had never worked at the foundry
C) First graders with motor impairment whose parents had worked at the foundry
D) First graders without motor impairment whose parents had worked at the foundry for
5 years or longer
E) Random sample of school children from the same community

7) A 65 yr old woman with HTN comes to the ED becoz of a 3 hr. h/o of headache, chest
pain & SOB. Current medications are Aspirin, Furosemide and Lisinopril. Her resp are
20/min & BP- 230/110 mm Hg. The physician plans to initiate treatment with a
nonselective antagonist that blocks alpha-1 & beta receptors. Which of the following
drug is most appropriate?
A) Hydralazine
B) Labetalol
C) Phenoxybenzamine
D) Phentolamine
E) Trimethaphan

8) A yr old boy is brought to the physician for developmental delay. There is an h/o
hearing loss in her mother and delayed speech in his older sister. His maternal uncle
had stroke like episodes at 25 yrs of age. PE shows opthalmoplegia and hypotonia. His
serum LA conc is increased. Which of the following best explains the findings in this
family?
A) AD inheritance
B) Decreased penetrance
C) Heteroplasmy
D) Imprinting
E) X-linked recessive inheritance

9.) A study is conducted to assess 32 pts in a community of 1000 who have devel drug
resistant tb during a 1 yr period. These pts are community for treatment assuming that
the risk for infection and susceptibility to the desease is constant, which of the following
best represents the number of individuals devel subsequent drug resistant tb during the
next yr?
a.27
b.29
c.31
d.32
e.33

10.) A 9 YO M is brought to the physician by his mother because of a 1 yr hx of cough

productive of mucoid sputum, wheezing, and sob with exertion hx of recurrent upper
respiratory tract and sinus infections since birth. He is at the 25th percentile for
heightens weight. The mother says that his younger sibling is being develop similar
problems. Physical examination shows mild clubbing of the fingers. Laboratory studies
show markedly increased sweat chloride and sodium concentration. Which of the
following in this pt's bronchial epithelium is most likely causing these symptoms?
A. adrenoreceptors
B. membrane receptors
C. nuclear receptors
D. protein regulation
E. protein structure

11.) Lesh nyhan syndrome, an x-linked recessive dz is seen in approximately 1/100,000

males. Which of the following is expected prevalence of heterozygous female?
a. 1/1000
b. 1/10,000
c. 1/50,000
d. 1/200,000
e. 1/10,000,000

12.) A 24 yo f was stung on her right thumb by a bee 30 minutes ago. She develops an
urticarial lesion at the site of the sting 6 hrs. later, the area has become indurated and
firm. Which of the following explains the induration at the site of the sting?
A. decrease in the expression of the adhesion molecules on vascular endothelial cells
B. decrease in derum c reactive protein concentration
C. infulx of macrophages producing interleukin 1(IL1), IL6, and tumor necrosis factor
alpha
D. lysis of endothelial cells by the alternative complement pathway
E. vasoconstriction

13.) A 54 yo man has an aneurysm in the distal portion of his abdominal aorta. The
estimated cross-sectional area of the aneurysm is 2 cm2 and the mean velocity of blood
flow through the aneurysm is 20 cm/sec. Which of the following best represents the flow
rate (in L/min) through the aneurysm?
A. 1.0
B. 2.4
C 3.2
D. 3.6
E. 4.0
14.) A 62 yr old woman with chronic renal disease comes to the physician for follow up
Examination. She is 5 ft. 2 inches (157 cm) tall weighs 52 kg (115 lb.); BMI-21. Pulse
-78/min, BP 140/100 mm Hg. Lab studies show Anemia. Rx with recombinant
erythropoietin is started. Measurement of which of the following is most appropriate to
monitor the effectiveness of this pharmacotherapy?
A) Arterial blood Ph
B) Arterial pressure of CO2
C) Oxygen saturation of the blood
D) Plasma Hb conc
E) Serum urea nitrogen conc

15) 2 days after undergoing a right hip replacement operation, a 67 yr old woman has
SOB and pain on the right side of her back with deep breathing. She appears anxious.
Her pulse is 100/min and RR -24/min. A pleural friction rub is heard in the right lung
base. Examination of right calf shows erythema and induration. Immediate treatment
with oxygen, 4L/min via nasal cannula is initiated. ABG shows pH-7.54, pCO2-29mm
Hg, and pO2-61mmHg.CT Angiography of the chest shows a large embolism occluding
blood flow to the right lobe. Which of the following best describes the current ventilation
perfusion relationship in the right lower lobe of this patient?
A) Dead space
B) Diffusion Abnormality
C) Hypoventilation
D) Low FiO2
E)) Shunt

16) A 38 yr old woman comes to the physician because of a 10 week h/o epigastric pain
and frequent stools. She has had 2 episodes of renal calculi during the past 2 yrs. PE
shows multiple superficial lipomata and mild epigastric tenderness. Upper endoscopy
shows two large non bleeding duodenal ulcers. Her gastric pH is 2.3, serum gastrin conc
obtained immediately after the procedure is 2000pg/ml.MEN type 1

17.) Liver showing centrilobular pallor and swelling of hepatocytes and kidneys showing
proximal convoluted epithelial cells. Which is the mechanism?
A) Activation of aspartate-specific caspase
B) Binding of Fas ligand to receptor
C) Decreased function of Na/K ATPase
D) Ribosomal degradation
E) Stimulation of PFKase

18.) 26 yr old dude has tenesmus and bloody diarrhea. Appearance of intestine from
rectum to mid ascending colon shown in pic. Terminal ileum is normal (so we know its
Not chrons!) Biopsy shows micro abscesses within the crypts and depletion of mucus
from goblet cells? Diagnosis? Is this ulcerative colitis? Sounds like it.
Amebic sysentery, collagenous colitis, crohn disease, ischemic bowel disease,
Ulcerative colitis

19) 60 yr old woman has 2 history of hypertension comes to doc for follow up
examination. Hypertension has been poorly controlled during the past six months
despite availability of appropriate pharmacotherapy. Which of the following statements
by the physician is most appropriate to begin a discussion about this patients possible
noncompliance w her medication regimen?
Is it it is hard to take pills every day for a condition that has no symptoms?
I will arrange for nurse to visit to make sure youre taking meds properly
Im sorry but i must say missing your meds can kill you
You clearly have not been taking your meds. You must be more responsible
You realize that your high blood pressure could have been avoided

20.) 12 year old with walking abnormality for 6 months. Mild atrophy and hammer toes.
Nerve biopsy shows
Abnormal myelin sheaths
Absence of shwann cells
Lymphocytic infiltrate
Abnormal astrocytes
Abnormal oligodendrocytes

21) 54 yr old man w/ aneurysm in distal portion of his abdominal aorta.

Estimated cross-sectional area of the aneurysm is 2 cm^2 and the mean velocity of
blood flow thru the aneurysm is 20cm/sec. which of the following best represents the
flow rate in L/min thru the aneurysm? Can someone please help me out with this?
1.0, 2.4, 3.2, 3.6, 4.0

21) It was about the niacin cholesterol mechanism. Which one is the better answer?
Antagonizes VLDL cholesterol secretion or inhibits cholesterol uptake

22) 54y F admitted with acute MI, at which point there were no murmurs or signs of he
Art failure; but 2 days later, she has acute SOB and sweating; HR 100, RR 24, BP
160/98. Crackles bilaterally, +murmur. Which murmur is most likely?
(Then they basically gave a descriptor for each murmur type "grade x/6, diastolic
decrescendo murmur heard best at Y") I searched this up and someone said that the
best answer is 4/6 holosystolic murmur heard best over lower left sternal border and
cardiac apex. What do you think about this one?

23) 28 yr old lady w/ 1 month history of pelvic pain that has be

Come increasingly severe during the past week. Her menstrual flow has been unusually
heavy during her last three menstrual periods. Menses have occurred at 24-28 day
intervals since menarche at the age of 12 years. Phys exam shows a palpable mass in
the left adnexa. Serum studies show an increased CA 125 concentration.
Vaginal ultrasonography shows an 8 cm mass in the left ovary. During surgical removal
of the ovary, which of the following structures passing inferior to the ovary must be
protected? External iliac artery, internal iliac artery, ovarian ligament, round ligament of
the uterus, Ureter

24.) 18 yr old dude w acute lymphblastic leukemia has 3 day history of intermittent fever
and left sided chest pain. Hes in 5th week of induction chemotherapy consisting of
asparaginase, daunorubicin, prednisone, and vincristine. His absolute neutrophil count
has been less than 500/mm for the past month. Temp is 102 F and he has dullness to
percussion and decreased breath sounds on the left side. Chest X-ray shows
A left lower lobe infiltrate and a moderate pleural effusion on the left. Photo of pas-stain
of pleural fluid shown in the pic of the question. Whats the appropriate therapy? I need
help w this one
Amphotericin B, Ertapenem, Ganciclovir, Infliximab, Rituximab

25) A previously healthy 27-year-old woman comes to physician because of a 3 week

history of episodes of left sided chest pain and tenderness. The pain radiates to the back
and is exacerbated when she reaches over her head or behind her back. She has not
had shortness of breath, sweating, or light-headedness. Her temperature is 37.1 pulse is
92/min, respirations are 14/min, and blood pressure is 130/86 mm Hg. Cardiopulmonary
examination shows no abnormalities. Examination shows tenderness to palpation 2 cm
lateral to the midline and 10 cm below the clavicle on the left. An x-ray of the chest and
ECG show no abnormalities. Which of the following is most likely diagnosis?
A) Achalasia
B) Acute pericarditis
C) Costochondritis
D) Dissecting aortic aneurysm
E) Gastro esophageal reflux disease
F) Pleurisy
G) Pneumothorax
H) Stable angina pectoris

26) 23 yr old diagnosed w sjoren syndrome has burning pain in her toes for past month.
Rates pain 3 on 10 point scale. She uses capsaicin cream for pain which produces
partial relief. Neuro exam shows decreased perception of temperature over feet
bilaterally. Sensation to vibration, proprioception, reflexes, muscle strength, muscle tone,
and bulk are normal. Which neurotransmitter mediating pain? Gamma Mino butyric
Acid, dopamine, enkephalin, serotonin, substance P

27) 15 yr old boy, 63 and weighs 165 lb., BMI 21 kg, pulse is 85/min and bounding/ bp is
110/40. Dislocation of right lens. Pectus excavatum. Grade 3/6 decrescendo diastolic
murmur heard at aortic area. Wide mediastinum. Genetic defect in what? Collagen type
2, elastin, fibrillin, hyaluronate, proteoglycan

28) A 23 yr old man comes to the physician because of difficulty maintaining an erection.
He was involved in an automobile collision that damaged his
Thoracic spinal cord, affecting motor sensory functions of the lower trunk and
extremities. He is only able to obtain an erection through physical contact with his penis
by his wife, and the erection does not last a long time. The best explanation
For this type of erection is an intact spinal reflex arc between the sacral parasympathetic
nerves and which of the following?
A) Genitofemoral
B) Ilio-inguinal
C) Lumbo sacral trunks
D) Obturator nerves
E) Pudendal nerves

29) A 6 month old girl is brought to the physician by her mother 3 days after she noticed
that her daughter's smile seemed lopsided. She is at the 50th percentile for length and
weight. Her vital signs are with in normal limits. PE show left sided facial weakness and
decreased hearing in the left ear. A high resolution CT scan of the head shows stenosis
of the internal aoustic meatus on left. The pt. has most likely had a developmental
anamoly involving which of the following cranial nerves?
A) Occulomotor
B) Trigeminal
C) Trochlear
D) Abducens
E) Facial

30) A 43 yr old man comes to the physician becoz of a 6 week h/o sharp, stabbing pain
on the left side of his face that occurs when he touches it. He first noticed the pain when
shaving. Touching the face just lateral to the left nasal ala reproduces the pai
n. The nerve supplying this area of the face exits the skull through which foramina?
A) Lacerum
B) Magnum
C) Ovale
D) Rotundum
E) Spinosum

31) An animal study is conducted to assess the effects of smoking on pulmonary

defense and maintenance mechanisms. For 1 week, normal male rats are exposed to
levels of cigarette smoke comparable to those encountered by humans who smoke
cigarettes. Results of pulmonary testing are compared with baseline levels obtained the
week before the smoke exposure. Which of the following sets of changes is most likely
to be observed?
Mucus production secretion activity of airway cilia Alveolarmacrophage function
Increase Increase Increase
Increase Increase Decrease
Increase Decrease Decrease
Decrease Increase Increase
Decrease Decrease Increase
Decrease Decrease Decrease

32.) A 76-year-old man with a 1-month history of a pulsatile abdominal mass is

diagnosed with an abdominal aortic aneurysm. CT scans of the abdomen with contrast
also showed an incidental finding of a horseshoe kidney. In this setting, the surgical
approach to repair of the aneurysm in this patient is most likely to be further complicated
by the presence of which of the following?
A) Abnormal origin of the superior mesenteric artery
B) Anomalous origins of multiple renal arteries to each kidney
C) Friability of vascular tissue as a result of collagen synthesis abnormalities
D) Multiple ureters with abnormal courses
E) Tumors with malignant degeneration

33.) A 68-year-old man comes to the physician because of a 2-hour episode of loss of
vision in his right eye 2 days ago. He underwent a left femoral-popliteal bypass 3 months
ago for peripheral vascular disease. His vital signs are normal. Funduscopic examination
shows cholesterol emboli. The most likely cause of his condition is an embolus in which
of the following arteries?
A) Abdominal aorta
B) Left common carotid
C) Right anterior cerebral
D) Right middle cerebral
E) Right ophthalmic

34.) A 25-year-old man comes to the physician 8 hours after the onset of severe pain of
his low back that radiates down his left leg. He started a weight-lifting regimen earlier in
the day during which he tried to lift a bar loaded with 91 kg (200 lb.) from the ground to
over his head. The pain began almost immediately after this attempt. Which
Of the following is the most likely cause of this patient's pain?
A.) A fracture of a lumbar vertebra
B.)Rupture of the deltoid tendon
C.)Rupture of an intervertebral disc
D.)A tear in the sciatic nerve
E.)A torn muscle in the low back

35.) The chemox regimen prescribed for a 55 y/o woman with non-Hodking includes VIN
blasting. The normal fx of which of the following cells and tissues in this pte is most likely
to be resistant to this agent?
A...cortical thymocytes
B...enterocytes in duodenal crypts
C...erythroblasts in the bone marrow
D...keratinocytes in the stratum basale
E...ventricular cardiac muscle fibers

36.) A 62 yr old man comes to the physician for a follow up examination. Two weeks
ago, he was discharged from the hosp after sustaining MI. He smokes2 packs of
cigarettes and drinks 4 12 oz. beer daily. His diet mostly consists of cured meats and
fast food. He does not exercise. The pt. tells the physician, "I know that I need to make
some changes in how I live so that my heart can be healthier. I just dont have the
willpower to quit smoking and drinking and all that stuff right now." Which of the following
best describes this patient's stage of behavioral change?
A) Precontemplation
B) Contemplation
C) Preparration
D) Action
E) Maintenance

37.) A 27 yr old man who is being treated for Hodgkin's lymphoma receives a bone
marrow from his first cousin. Two weeks after the transplant he develops a generalized
Erythematous, maculopapular rash, diarrhea and elevated conc of liver enzymes and
bilirubin. No evidence of infection or drug reaction was found. Which of the following
mechanisms is the most likely cause of these symptoms?
A) Donor macrophages secreting cytokines and affecting host cells
B) Donor plasma cells elaborating antibodies against hostcells
C) Donor T-lymphocytes reacting against host cells
D) Host macrophages secreting cytokines and affecting donor cells
E) Host plasma cells elaborating antibodies against donor cells
F) Host T-lymphocytes reacting against donor cells
38.) A 31 yr old woman is diagnosed with invasive Squamous cell carcinoma of the
cervix. A biopsy specimen of the cervix shows that the tumor cells express HPV, type 16
antigens. Which of the following cell types most likely plays a role in recognizing and
killing these virus infected tumor cells?
A) Dendritic cells
B) Macrophages
C) Myeloid precursors
D) T-cells
E) Plasma cells

39.) A 45 yr. old man has fever, chills, dysuria and tender, enlarged prostate. Which of
the following is the most likely causal organism?
A) Adeno virus
B) Chlamydia trachomatis
C) E.coli
D) Pseudomonas aeruginosa
E) Ureapalsma urealyticum

40.) Cells from which of the following areas of the kidney are most likely to show the first
signs of anoxic injury?
A...Bowman capsule
B...DCT
C...Efferent art
D...Glomeruli
E...Prox tub

41.) A 57 year old man comes to the physician because of a 6 month history of
progressive constipation and a feeling of rectal fullness. Digital rectal examination shows
no papable lesion. Test of the stool for occult blood is positive. Colonoscopy
Shows a mass in the sigmoid colon. A biopsy specimen of the mass shows
adenocarcinoma. Metastases from this mass will most likely spread via which of the
following lymph nodes?
A) Inferior mesenteric
B) Internal iliac
C) Left colic
D) Pararectal
E) Superficial inguinal

42.) A 43-year-old woman comes to the physician because of progressive difficulty

walking during the past 3 months. Neurologic examination shows weakness and
decreased muscle bulk of the lower extremities. Patellar and Achilles tendon reflexes
Are diminished. Sensations of joint position, pain, and temperature in the lower
extremities are normal. Which of the following is the most likely cause of the findings in
this patient?
A) Acute peripheral neuropathy
B) Degeneration of motoneurons of the lumbar cord
C) Demyelination of the corticospinal pathways
D) Loss of afferent la axons innervating muscle spindles
E) Myotonic muscular dystrophy
43.) 56 y o male with palpable hard nodule on prostate has an increased pSA.
Fine needle biopsy: adenocarcinoma during radical prostatectomy which of the
structures is at greatest risk for injury?
1) Dome of bladder
2) Obturator nerve
3) Pelvic parasympathetic nerves
4) Penile urethra
5) Ureterovesical junction

44.) 1-A 70-year-old woman is found to have persistent fever despite intravenous broad-
Spectrum antibiotic therapy 3 days after undergoing operative excision of the anterior
pelvic organs for recurrent cervical carcinoma. Her temperature is 38.5C (101.3F).
Physical examination shows the presence of a central venous catheter that was placed
on the day of the operation. There is also a well-healing abdominal wound without
erythema and with two drains in place. Blood cultures and cultures of the tip of the
central catheter on a sheep blood agar plate grow the organism shown in the
photograph. A Gram stain of one of the colonies shows 4-m, elliptical, purple, budding
organisms. Which of the following is the most likely causal organism?
A-Candida albicans
B-Cryptococcus neoformans
C-Escherichia coli
D-Sporothrix schenckii
E-Staphylococcus aureus

45.) Blood Pressure Before Drug Blood Pressure After Drug

Drug Administered Injection (mm Hg) Injection (mm Hg)
Angiotensin II 110/70 150/105
Drug X 108/68 122/84
Angiotensin II + drug X 112/66 126/86
2-On three separate occasions, a 25-year-old man is given an injection of angiotensin II,
an injection of drug X, or an injection of both angiotensin II and drug X. The table shows
his blood pressure (in mm Hg) after each injection. Which of the following best describes
drug X?
A) Aldosterone receptor antagonist
B) Angiotensin II-converting enzyme inhibitor
C) Angiotensinogen inhibitor
D) Partial agonist at angiotensin II receptors
E) Renin inhibitor

46.)-A 56-year-old man is scheduled for repair of an inguinal hernia under spinal
anesthesia. If the spinal needle is inserted posteriorly between the L-3 and L-
4 vertebral arches, which of the following ligaments must be traversed to reach the
spinal canal?
A-Anterior longitudinal
B-Costotransverse
C-Denticulate
D-Ligamentum flavum
E-Posterior longitudinal
47.) A 25-year-old man is brought to the emergency department because of severe
abdominal pain, nausea, and vomiting for 1 hour. The pain originates in the left flank and
radiates to his groin. His pulse is 100/min, respirations are 18/min, and blood pressure is
150/100 mm Hg. Physical examination shows tenderness of the left flank and the left
lower quadrant of the abdomen. Bowel sounds are mildly hypoactive. Test of the stool
for occult blood is negative. Which of the following best explains these findings?
A) Colon neoplasm
B) Diverticulitis
C) Epididymitis
D) Renal infarction
E) Torsion of the testis
F) Ureteral calculus

48.) A 70-year-old woman is brought to the emergency department by her husband 45

minutes after he found her unresponsive on the living room floor. She has generalized
Anxiety disorder treated with diazepam. Her husband said she recently began taking an
over-the-counter medication for heartburn. She is obtunded and responds only to painful
stimuli. An interaction with which of the following drugs is the most likely cause of her
condition?
A-Calcium carbonate
B-Cimetidine
C-Famotidine
D-Magnesium trisilicate
E- Ranitidine

49.)-3-year-old boy is brought to the physician by his parents because of a 1-week

history of nonproductive cough, wheezing, and nausea. Coarse bilateral crackles are
heard on auscultation of the chest. Physical examination shows no other abnormalities.
Stool culture shows a 1.6-cm roundworm larva. A chest x-ray shows bilateral infiltrates.
This disease was most likely caused by ingestion of which of the following?
A) Feces-contaminated soil
B) Improperly canned beans
C) Pork products
D) Raw shrimp
E) Undercooked meat

50.) A 6-week-old boy is brought to the physician for a follow-up examination after
newborn hemoglobin electrophoresis showed homozygosity for hemoglobin S. Daily
treatment with penicillin is recommended. This treatment will most likely decrease this
patient's risk for infection with which of the following organisms?
A) Escherichia coli
B) Haemophilus influenza
C) Neisseria meningitidis
D) Salmonella species
E) Streptococcus pneumonia

51.) 30-year-old woman comes to the physician because of a 1-week history of left eye
pain and blurred vision and a 2-month history of progressive weakness of her right arm
and both legs. Ophthalmologic examination shows swelling of the optic disc on the left.
Physical examination shows spasticity and hyperreflexia of the involved extremities. An
MRI of the brain shows multiple T2-weighted bright signal abnormalities in white matter.
Analysis of cerebrospinal fluid obtained from a lumbar puncture shows increased
mononuclear cells and oligoclonal banding. Cytokines Released by T-lymphocytes
infiltrating this patient's central nervous system are most likely causing inflammation and
destruction of which of the following?
A-Astrocytes
B -Ependymal cells
C-Microglia
D-Neurons
E-Oligodendrocytes
F-Schwann cells

52.) A 30 year old woman with Li-Fraumeni syndrome is found to have adenocarcinoma
of the breast. Her family history includes osteosarcoma. Which ofthe following
mechanisms most likely underlies this condition?
A) Activated proto-oncogenes
B) Defective detoxification enzymes
C) Defective DNA repair enzymes
D) Impaired regulation of apoptosis
E) Impaired signal transduction

53.) A new antiplatelet agent is developed for the prevention of recurrence of stroke. In a
large randomized clinical trial with equal numbers of men and women, the rates of stroke
are lower in patients receiving the new agent than in patients receiving the standard
treatment. Results are shown:
Recurrent Stroke Rates per 1000 Person-Years Standard Treatment New Antiplatelet
Drug
Women .12 .04
Men .24 .08
Overall .18 .06
Based on the results, which of the following is the absolute risk reduction in women?
A) 8%
B) 12%
C) 16%
D) 33%
E) 50%
F) 62%
G) 67%
H) 75%

53.) 65 yr. old woman w/3 month history of headache, flank pain, and weakness of arm
w/31 lb. weight loss. P/E weakness of proximal and upper and lower extremity muscles.
Augmentation of strength with repetitive testing of deltoid muscles. MRI shows well
demarcated mass with surrounding edema in frontal lobe. Specimen of lesion shows
malignant small blue cell neoplasm that has cytokeratin, chrmagrin, and synaptophysisn.
A.anaplastic ependymoma
B. Extranodular CNS lymphoma
C.Glioblasta Multriforma
D. Primary cerebral neuroblastoma
E. Pulmonary Small cell carcinoma with metastasis to Brain
54.) A 20 y man is brought to the physician b/o a 4 hours Hx of abd pin, nausea and
vomiting. He says that he ad been drinking ethanol heavily all weekend, and he took 3
doses of acetaminophen within 2 h after the onset of sevre headache Monday morning.
This pte is an Inc. risk for liver injury b/o which of the following actions of ethanol?
A...Activation ef IgEmediated mast cell degranulation
B... Dec. acetaminophen clearance via glucuronidation
C... Inc. bioavailability of acetaminophen
D Induction of P450 ez that activate acetaminophen to a hepatic metabolite
E...Met. Acid due to an Inc. NADH/NAD ratio

55.) 38 yr. old woman with 10 week history of epigastric pain and frequent stools. 2
episode of renal caliculi in past 2 years. Physical exam shows multiple superficial
lipomata and mild epigastric tenderness. Endoscopy shows 2 large, nonbleeding
duodenal ulcers. Her gastrin level is 2000 (normal is less than 100). PPI is initiated.
Measurement of which of the following is most appropriate as next step?
a) Serum [Ca2+]
b) Serum [cortisol]
c) Serum tissue transglutaminase activity
d) Stool alpha1 antitrypsin concentration
e) Urine 5-hydroxyindoleacetic acid concentration

56. A 27-year-old woman comes to the office because she recently noted a copious
vaginal discharge requiring showering or bathing two or three times daily. She states
that despite bathing frequently, she never feels clean. She has had no other medical
Problems. Results of her last Pap smear 1 year ago were normal. She is not sexually
active at this time and is taking no medications. She has never been pregnant. She
works as a respiratory therapist at a local community hospital and recently broke up with
A boyfriend of several months. Physical examination shows no abnormalities. Pelvic
examination demonstrates no vaginal discharge, bleeding, or mucosal lesions. Uterus is
normal-sized and nontender. Adnexa are palpable and there are no masses. In addition
To obtaining cultures for gonorrhea and chlamydia, which of the following is the most
appropriate next step?
A) Determine serum estrogen concentration
B) Order antibody studies for syphilis and HIV
C) Prescribe an oral anti-trichomonal medication and antifungal cream
D) Question the patient regarding the circumstances surrounding her recent break-up
E) Tell the patient you will wait for the Pap smear results before prescribing anything for
the discharge

57.) Which of the following is decreased in anemic patient?

A) Alveolar PO2
B) Arterial O2 carrying capacity
C) Arterial oxyhemoglobin saturation
D) Arterial P50 ( partial pressure)
E) Arterial PO2

58.) A 9 year old boy brought to the physician by his mother because of a 1 year h/o
cough productive of mucoid sputum, wheezing and SOB with exertion. He has a h/o
recurrent upper resp tract and sinus infection since birth. He is at 25th percentile for ht &
wt. The mother says that his younger sibling is beginning to develop similar problems.
PE shows mild clubbing of the fingers. Lab studies show markedly increased sweat
chloride and sodium conc. A defect of which of the following in this pt's bronchial
epithelium is most likely causing these symptoms.
A) Adrenoceptors
B) Membrane receptors
C) Nuclear receptors
D) Protein Regulation
E) Protein structure

59) A 12 year old girl is brought to the physician for a follow up. 3 months ago she
sustained a complex fracture to left tibia, which required cast immobilization. The cast is
removed. Examination of left calf shows that it is smaller than right calf. Which of the
following processes in this pt's myocytes is resp for the observed findings?
A) Anerobis glycolysis
B) Fatty acid degradation
C) Glycogenolysis
D) Oxidative phosphorylation
E) Polyubiquitination

60.) A 35 yr. old man comes to the physician becoz of a 3yr h/o enlarging nose,
coarseninf of his facial features, muscle weakness and increased hand and foot size. PE
shows prognathism and large fleshy nose. Serum studies show increased IGF-
1 conc. An MRI of the brain shows a pituitary adenoma. Morphologic analysis of the
biopsy specimen of the tumor shows a densely granulated
Somatotroph adenoma. Further studies show that the G-Alpha S subunit of G proteins in
the tumor cells lack GTPase activity. The tumor cells in this pt. most likely have an
increased activity of which of the following enzymes?
A) Adenyly cyclase
B) Gauntly cyclase
C) Janus kinase
D) Phoapho lipase c
E) Tyrosine kinase

61.) An 85 yr. old woman is diagnosed with a fracture of the right femur and begins
treatment morphine by patient controlled analgesic pump. 3 days later, her resp are
6/min. PE show pinpoint pupils. Her serum conc is 1.8mg/dl. Which of the following best
explains this pt's clinical deterioration after the initiation of morphine therapy?
A) Chronic dosing of morphine decreases its bioavailability
B) Morphine bioavailability increases with chronic dosing.
C) Morphine down regulates mu opioid receptors with chronic dosing.
D) Morphine inhibits its own metabolism
E) Morphine is metabolized to active metabolites that accumulate

62.) A 30 yr. old woman with Li-Fraumeni syndrome is found to have adenocarcinoma of
the breast. Her family h/o includes osteosarcoma. Which of the following mechanisms
most likely underlies this condition?
A) Activated protooncogenes.
B) Defectivedetoxification enzymes
C) Defective DNA repair enzymes
D) Impaired regulation of apoptosis
E) Impaired signal transduction
63.) 35 year old woman is given 500 mg of drug X iv .several minutes later the serum
concentration X is 12.5.two hours later the serum concentration is 10mg/L. assuming the
drug X has first order elimination which of the following will be serum concentration of
drug X in mg/L in another two hours
A6
B 6.5
C7
D 7.5
E8

64.) An 8-year-old girl is brought to the physician for a well-child examination. Her
mother says that she has been well except for an occasional cold. Her immunizations
are up to date. She is at the 50th percentile for height and 60th percentile for weight.
Physical examination shows breast bud development and a few pubic hairs.
The mother asks whether her daughter's development is normal. Which of the following
is the most appropriate initial response by the physician?
A) "I am concerned that your daughter may have precocious puberty."
B) "I think that your daughter is likely to begin menstruating in the next few months."
C) "I would like to order laboratory studies to ensure that your daughter's development is
normal."
D) Your daughter's breast development is somewhat less than might be expected for
her age."
E) Your daughter's development is normal."

65.) 26month old boy with SOB & cough who had cutaneous abscesses caused by S.
aureus. Febrile, x-ray shows cavitary infiltrate of left lingual. Culture grows filamentous
gram + rods.
Answer choices are
A. Bacillus anthracis
B. Candida
C. Nocardia
D. Pneumocystis
E. Strep bovis

66.) A 35-year-old man comes to the physician because of a 6-month history of burning
abdominal pain that occurs 1 to 2 hours after he eats. He also has had black stools for 2
days. Use of over the counter antacids and Histamine 2 (h2)-receptor blocking agents
has not been effective in relieving his symptoms He is sweatlng profusely and has light-
Headedness when stands. His blood pressure is 105/70 mm/hg while sitting Physical
examination shows epigastric tendemess A CT scan of the abdomen shows 1 cm mass
in the pancreas. Immunohistochemical labeling of neoplastic Cells in a biopsy specimen
is most likely to involve the use on antibodies directed to which of the following
substances?
A) Amylase
B) Gastrin
C) Glucagon
D) Human pancreatic polypeptide
E) Insulin
F) Lipase
G) Serotonin
H) Somatostatin
I) vasoactive Intestinal polypeptide

67.) A female newborn is delivered at term to a 35-year-old primigravid woman.

Pregnancy was complicated by untreated maternal Graves disease. Her respirations are
66/min Physical examination shows stridor, nasal flaring, intercostal retractions, and an
asymmetric neck mass. Which of the following is the most likely cause of the newborn's
stridor?
A) Cystic hygroma
B) Enlarged thyroid gland
C) Thymglossal duct cyst
D) Tracheomalacia
E) Vascular ling

68.) A 54-year-old woman who works as a nurse comes to the physician for routine
tuberculosis screening. A sample of her whole blood is incubated with a mixture of
synthetic peptides representing two proteins of the suspected pathogen. Three days
later, supernatant is collected for evaluation. Measurement of which of the following
cytokine concentrations is most likely to indicate a positive result?
A) Granulocyte-macrophage colony-stimulating factor
B) Interferon alpha
C) Interferon gamma
D) Interlukein-4
E) IL -10
F) Transforming growth factor-beta

69.) A 24-year-old woman was slung on her right thumb by a bee 30 minutes ago. She
develops an urticarial lesion at the site of the sting. Six hours later, the area has become
indurated and firm. Which of the following explains the induration at the site of the sting?
A) Decrease in the expression of adhesion molecules on vascular endothelial cells
B) Decrease in serum C-reactive protein concentration
C) Influx of macrophages producing interleukin-1, IL-6, and tumor necrosis factor-a
D) Lysis of endothelial cells by the alternative complement pathway
E) Vasoconstriction

70.) a study is designed to evaluate the relationship b/w ambient noise and hearing loss
in an automobile plant .different location in the manufacturing plant have different levels
of ambient noise .each employee is given a test for hearing acuity and the noise level is
measured at his or her workstation which of the following describe this study design a)
case series b) cohort c) crossover d) cross sectional e) randomized c trial

71.) An otherwise healthy 60-year-old man comes to the physician for a follow-
Up examination 2 weeks after he was found to have a serum prostate-specific antigen
concentration of 5.3 ng/mL (N, 4) a biopsy specimen of the prostate shows evidence of
adenocarcinoma. A CT scan of the spine shows osteoblastic lesions at LI. The patient
undergoes bilateral orchiectomy. Five months later, he dies suddenly of a massive
myocardial infarction. At autopsy, which of the following microscopic changes in the
prostate resulting from the orchiectomy is most likely present,
A) Corpora amylacea
B) Edema
C) Hypertrophied cells
D) Necrosis of the blood vessel walls
E) Scattered shrunken cells
F) Widespread necrosis

72.) Poliovirus mRNA lacks a 5' m7G cap but is translated efficiently by cellular
ribosomes. Which of the following additional structural features of poliovirus mRNA is the
most likely cause of its ability to be translated in the absence of a cap?
A) Absence of a 3' untranslated region (UTR)
B) Absence of a 5' UTR
C) Absence of a poly (A) tail
D) Presence of an internal ribosome entry site
E) Very short open reading frame

73.) 70 yr. old African American women come to physician after 1 day onset of back
pain. She's a part time cashier, low income, and smoked 1/2 a pack for 50 years and
drinks 3 caffeinated beverages a day. X-ray shows vertebral compression fracture of L3
and she has decreased bone mineral density.
Answer Choices
A.Ethnicity
B.Gender
C. Occupation
D. Smoking
E. Socioeconomic status

74.) A 10 yr. old girl had fatigue and appears pale. Her father underwent spleenectomy
as a youth and recently underwent cholystectomy. Her blood CT shows
Hb-decreased
MCV-90
Leukocyte-6000
N-58%
E-2%
L-35%
M-5%
Platelet 188,000
Retic-9 %( Increased)
A.Abnormal Hb structure
B.Abnormal Iron absorption
C.Def. Of erythrocyte Spectrin
D.Impaired Oxidatiive enzyme function
E. Inadequate erythropoietin production

75.) 15 yr. old female ingested Vit D in a suicide attempt. Follow up 1 month later show
Ca [C] 10.4 (slightly elevated) what is the mechanism of increased Ca.
A. Decreased Excretion of Ca from GIT
B.Decreased osteoclast activity in bone
C.Increased absorption of ca in GIT
D.Increased 1 Hydroxylase activity in kidney
E.Increased Ostoblast activity in bone
76.) Investigator studying s. Pneumo to monitor effect of conjugate polysaccharide on
dif. capsule types. Strains express capsular type expressed in s. mitts are identified.
After incubation of non-encapsulated s.pneumo with lyste from heat killed s.mittis
colonies from s pneumo expressing new capsular type are identified but no capsule of s.
pneumo are isolated after the addition of DNase to the lysate.
A.Bacteriophage transduction
B.Natural transformation
C. Plasmid Transfer
D. Pt. mutation in plasmid gene
E. Slipped Strand mispairing

77.) It was about the niacin cholesterol mechanism

A. antagonizes VLDL cholesterol secretion
B. increase catabolism of LDL
C. inhibits cholesterol uptake (I think this is the answer)
D inhibit HMG COA
E. stimulates PPARa

78) A 35 year old woman participate in a study of a new diagnostic test of steroid
hormones in saliva. Menses occur at regular 28 day intervals and she has been shown
to ovulate on day 14 when her saliva is tested on a particular day of the cycle, laboratory
studies show an increased concentration of estradiol and decreased concentration of
progesterone. On which of the following days in this patient`s menstrual cycle were
these hormones most likely measured?
A) Day 1
B) Day 6
c) Day 12
D) Day 18
E) Day 26

79.) Pt with CHF with 2 relatives dying from dilated cardiomyopathy and cirrhosis. P/E of
pt. shows cardiac enlargement and hyperpigmentation and glucose is
320.endomyocardial tissue will show excess of
A.Amyloid
B.alpha 1 antitrypsin
C. Cerebroside
D,Copper
E. Eosinophils
F. Iron
G. Lysosomal Glcogen
H. Mucopolysaccharide

80.)-During an experiment endothelial cells are incubated wit 30Mn of glucose compared
w 5Mm of glucose, the results are: G6P 180%, FRUCTO1, 6BP 220%,
GLYCERALDEHYDE 3P 210%
1, 3 BPGLYCERATE 75%, PYRUVATE 70%
Which of the following enzymes is most likely inhibited indirectly by increase of glucose
Concentration

a. Aldoses
b. Glyceraldehyde 3PDH
c. Hexokinase
d. PFK
e. PGlyceraldehyde mutase
f. puruvate kinase

81.) A 42-year-old woman is brought to the emergency department 30 minutes after the
sudden onset of severe headache. She has no history of major medical illness and takes
no medicatons. On arrival, her blood pressure is 163/90 mm Hg. the right pupil is 6 mm
and nonreactive to light. Adduction of the right eye is impaired. Nuchal rigidity is noted. A
CT scan of the head shows Blood in the subarachnoid space. Cerebral aniography is
most likely to show an Aneurysm in which of the following arteries?
A) Anterior Cerebral
B) Internal Carotid
C) Middle Cerebral
D) Posterior communicating
E) Vertebral

82.) 23 year old man comes to emergency department bc of 2-week history of back pain
refractory to treatment with over-the-counter medications. He demands a prescription for
an opioid drug. Nothing seems abnormal about him. What should you do?
A) Determine which drugs have been prescribed for the patient in the past
B) Obtain serum toxicology screening on the patient
C) Order an MRI of the spine
D) Prescribe only a 2-week course of a narcotic medication for the patient
E) Refer the patient to a drug addiction program

83.) The lymph flow question. How do you increase lymph flow through lungs?
A) Administration of endothelia-1 into the pulmonary artery
B) Administration of phenylephrine into the pulmonary artery
C) Decreasing the inspired oxygen conctration from 21% to 10% * I put this WRONG
D) Increasing the inspired carbon dioxide concentration from 0.3% to 3%
E) Intravenous infusion of 0.9% saline for 5 minutes
F) Intravenous infusion of 20% albumin solution (20g/100mL saline) for 5 minutes

84.) What enzyme is inhibited indirectly by increase glucose concentrations?

A) Aldolase
B) Glyceraldehyde-3phosphate dehydrogenase
C) Hexokinase
D) Phosphofructokinase
E) Phosphoglycerate mutase
F) Pyruvate kinase

85.) A 24 year old African American man comes to the physician because of a 3 month
history of red bumps on his face and chin. He says that the bumps are itchy and painful.
Physical examination shows hyper pigmented papules over the cheeks, jawline, and
neck. Which of the following is the most likely diagnosis?
A) Acne vulgaris
B) Cutaneous lupus Erythematosus
C) Keloids
D) Pseudofolliculitis barbae
E) Rosacea

86.) 65 y/o lady with T38.5c, shortness of breath and nonproductive

Cough. Which vaccine might have prevented this findings?
A. DPaP
B. Hib
C. Hep B
D. Inactivated polio v
E. MMR
F. Typhoid
G. 23-valent pneumo (wrong)
H. varicella

87.) 4 month y/o boy with skeletal dysplasia involving abnormal endochondral bone
formation. Electron microscopy of patient will most likely show which?
a) Decreased RER
b) Decreased SER
c) Dilated RER
d) Increased SER
e) Large lysosomes
f) Small lysosomes

88.) A full term female newborn develops respiratory distress shortly after delivery.
Physical examination shows cyanosis, markedly decreased breath sounds bilaterally,
and an occasional bowel sound over the left hemithroax. A chest x-ray taken while the
patient is supine shows multiple cystic appearing areas on the left and decreased
aeration on the right. Which of the following is the most likely diagnosis?
A) Bacterial pneumonia
B) Bullae related pneumothorax
C) Congenital cystic adenomatoid malformation
D) Congenital diaphragmatic hernia
E) Laryngeal atresia
F) Lobar sequestration
G) Tracheal stenosis

89.) A previously healthy 59 year old man comes to the emergency department because
of a 2 day history of fever and headache. His temperature is 39.4 pulse is 84/min,
respirations are 14/min, and blood pressure is 110/70. Physical examination shows no
other abnormalities. He is oriented to person and place but not to time. A lumbar is
performed, and the results of polymerase chain reaction testing of cerebrospinal fluid
show herpes simplex virus. it is most appropriate to administer a drug that inhibits which
Of the following viral enzymes?
A) DNA polymerase
B) Neuraminidase
C) Protease
D) Reverse Transcriptase
E) RNase A
90.) A 53 year old homeless man with alcoholism is brought to the emergency
department by police shortly after he was found collapsed and coughing on a park
bench. he appears cachectic. His temperature is 39, pulse is 90/min, respirations are
18/min, and blood pressure is 112/78 mm Hg. physical examination shows clubbing of
the digits breath sounds over the right lower lung field. His leukocyte count is
11,400/mm^3. Examination of a sputum sample shows gross purulence, gram
Positive cocci in chains, and gram negative bacilli. a chest X-ray shows cavitation in the
right lower lung lobe with a surrounding infiltrate. Sputum cultures will most likely grow
which of the following organisms?
A) Chlamydophila Pneumoniae
B) Haemophilus influenza
C) Mycoplasma Pneumoniae
D) Streptococcus Pyogenes (Group A)
E) Normal Oral Flora

91. Pulmonary embolus results in what type of V/Q relationship?

A. dead space
B. diffusion abnormality
C. hypoventilation
D. low FiO2
E. Shunt

92.) For killing of gram positive diploccoi, which of the following enzymes is going to
initiate intracellular killing?
1) NADPH OXIDASE
2) CATLASE
3) SUPEROXIDE DISMUTASE
4) COX 1

93.) Over the course of 10 years, urine creatinine excretion and clearance increases, but
the serum levels stay the same if the patient is 75 years old now, and takes
supplemental calcium and vitamin d, what causes all this?
High protein diet
Over supp of vit d
Polycystic kidney
Renovasc disease
Normal aging

94.) Pregnant 16 year old came because of a tonic clonic seizure. Unable to urina. Her
bp, respirations, and pulse are elevated. Elevated uric acid, ldh, creatinine, ast, alt. what
is the diagnosis?
Drug od
Eclampsia
Epilepsy
Renal disease
Sepsis

95.) In vsd and truncus arteriosus, is the extraembryonic mesoderm absent or is it the
Splanchnopleuric mesoderm?
Neuroectoderm
96.) 52 yo comes in with 3 week history of polydipsia, polyuria and weight loss. Hes on
metoprolol and simvastatin for hyperlipidemia and htn. What is increased?
Choices:
(a) Fasting glucose concentration
(b) Glycogen synthesis
(c) insulin-mediated glucose disposal rate
(d) Serum calcium concentration
(e) Serum HDL-cholesterol concentration
(f) Urine sodium concentration

97. 23 y/o woman with sjogrens has burning pain in her toes for past month. Neuro
exam shows decreased perception of temp over feet bilat. Sensation is all normal.
Which neurotransmitter is mediating the pain?
gaba
Dopamine
Enkephalin
Serotonin
Substance p

98.) 18 y/o with ALL has 3 day h/o fever and left side chest pain. He is on chemo
(asparaginase, daunorubicin, prednisone, and vincristine). Pmn is below 500. Temp is
102.6. Chest x-ray shows left lower lobe infiltrate and pleural effusion on the left. There
is a pas thoracentesis pic shown. What treatment should be given?
Amphotericin b
Ertapenem
Ganciclovir
Infliximab
Rituximab

99.) The pathogenesis of asthma is involved with

Elastase
Hydrogen peroxide
Ifn gamma
Il-10
Lactoferrin
Leukotriene c4

100.) elevated ptt, normal pt.Hemophilia, vWB

101.) in mcad, I know that the deficiency is in medium chain acyl coa dehydrogenase,
Long chain suffice

102. 38 y/o woman seems to have a gastrinoma (serum gastrin concentration is 2000
(normal <100). She also has multiple lipomas and two large non bleeding ulcers. She is
started on a proton pump inhibitor. What measurement should you follow?
Serum ca
Serum cortisol
Serum tissue transglutaminase
Stool alpha 1 antitrypsin
Urine 5hiaa

104.) a newborn female is diagnosed with hypothyroidism 2 days after birth.

Ultrasonography of the neck shows no gland tissue. P/E and reflexes are normal.
Maternal to fetal transfer of which of the following explains the normal development in
the newborn?
Iodine
Thyroglobulin
TSH
Thyrotropin releasing hormone
t4

105.) Chloroquine spares which two plasmodium species? P. vivax and P. ovale a
dormant stage (hypnozoites) can persist in the liver and cause relapses by invading the
bloodstream weeks, or even years later.

105.) 68 y/o woman has 1 year history of severe ab pain after meals. also has an
unintentional 20lb weight loss. Pain is relieved when she decreases the amount of food
she eats. P/E shows soft, nontender abdomen and abdominal bruit. Pedal pulses
diminished. Which artery is stenosed?
Greater pancreatic
Hepatic
Right gastric
Superior mesenteric
Supraduodenal

106.) Hantavirus with the big chart asking about which segment is associated with
temperature sensitive phenotype associated of Hantavirus A. I think whenever the A
strain had the L segment it was temperature sensitive and that was the answer. (Don't
remember too well but I think the right answer was A)

107.) A 32-year-old man begins to laugh while eating dinner with his friends. A small
particle of food irritates his larynx and provokes him to cough. Which of the following
best describes the position of his vocal cords throughout this sequence?
Immediately After While Swallowing Laryngeal Irritation While Coughing
A) Closed closed open
B) Closed open closed
C) Closed open open
D) Open closed closed
E) Open closed open
F) Open open closed

108) a 33-year-old man comes to the physician because of a 3-month history of muscle
weakness and cramping. He says that the symptoms appear shortly after he begins
exercising. Physical examination shows no abnormalities. Serum creatine kinase
concentration is increased. After the forearm muscles are exercised, venous blood
obtained from the antecubital vein shows that
Lactate concentrations do not increase compared with preexercise values. This patient
most likely
Has a deficiency in the activity of which of the following enzymes in muscle?
A) Carnitine palmitoyltransferase-1
B) Fumarase
C) Glucose-6-Phosphatase
D) Glycogen phosphorylase
E) Succinate Dehydrogenase

109.) 75 year old lady, one alcoholic beverage per day, does knitting gardening reading,
goes to swimming pool occasionally, BMI 21
Which of the following would decrease patients risk for additional hip fractures?
-Discontinue alcohol
-Discontinue gardening
-swimming pool based exercises 3 times
-Long walk outside daily
-Lose weight

110) Fanconics syndrome, what are the Amino Acids, HC03, Phosphate and Glucose
levels?
Everything decreased

111.) When you prescribe appropriate pain medications to a patient who wanted to kill
herself through pain medications which core ethical principal are you using?
Justice
Beneficence
Non maleficence
Dignity
Autonomy

112.) A 64 year old man is evaluated for cough dyspnea and chest pain. Afebrile. a
chest x ray density in hilar region. Lung biopsy shows round cells with little cytoplasm
that are twice the size of lymphocyte infiltrating sheets that are neither glandular nor
squamous in origin. Serum abnormalities?
1 hyperkalemia
2hyperlipidemia
3 hypomagnesaemia
4hypoalbuminemia
5 hypoglycemia
6hyponatremia

113.) An increase in the amount of iron inside cultured hepatocytes leads to an increase
in the amount of ferritin gene products detected by Westem blotting.It does not change
the amount of ferritin gene products detected by Northem blotting or by the
polymerase chain reaction.These results suggest that iron increases the frequency of
which of the following events?
A) Maturation of the ferritin gene transcript
B) Transcription of the ferritin gene
C) Translation of ferritin mRNA
D) Transport of ferritin mRNA out of the nucleus

114.) a 51 yr. old man with 3 month history of HBV negative PAN presents with myalgia
.biopsy will show?
Central vacuolization with gycogen
Central vacuolization with lipid
Mitochondia increase
Mucopolysaccharide
PAS + myofibrillar vacuolization
Segmental ischemic necrosis

115.) test for occult blood for colon cancer has?

Low sensitivity
Low specificity
Uncertain PPV
Uncertain NPV
Potential for False positive

116.) a 62-year-old woman with chronic renal disease comes to the physician for a
follow-up examination. She is 157 cm (5 ft 2 in) tall and weighs 52 kg (115 lb); BMI is 21
kg/m2. Her pulse is 78/min, and blood pressure is 140/100 mm Hg. Laboratory studies
show anemia. Treatment with intravenous recombinant erythropoietin is started.
Measurement of which of the following is most appropriate to monitor the effectiveness
of this pharmacotherapy?
A) Arterial blood pH
B) Arterial pressure of carbon dioxide
C) Oxygen saturation of the blood
D) Plasma hemoglobin concentration
E) Serum urea nitrogen concentration

117.) 70 year old man comes to the emergency department 30 minutes after the onset of
Weakness, nausea, and lower abdominal and back pain that radiates to the lower
extremities. He appears pale and has a cold sweat. Pulse is 110/min and blood pressure
is 90/60mm Hg. pulses in the lower extremities are weak. A Faint bruit is heard in the
lower abdomen. Muscle stretch reflexes are normal in both lower extremities. Which of
the following is the most likely diagnosis?
A) Acute compression fracture of the L3 vertebral body
B) Herniated L3 to L4 intervertebral disc
C) Leaking aortic aneurysm
D) Leaking left renal artery aneurysm
E) Perforated rectum
F) Perforated sigmoid colon

118.) Male with an h/o abd pain and diarrhea, pain relieved by eating and antacids. Labs
show gastrin of 500 and gastric acid secretion of 80. What is the most definitive
treatment? Low protein diet/abx therapy/antihistamine therapy/sectioning of the vagus
nerve/surgical removal of the suspected tumor
119.) 25 year old man that after running his temp is 38, they ask how does the temp
return to normal.
EVAPORATION OF SWEAT
INCREASED MINUTE VENTILATION
INCREASED MUSCLE TONE
PERIP. ARTERIOLAR VASOCONSTRICTION
PERIP. VENOUS VASOCONSTRICTION

120.) what about the woman that thinks she has sleep apnea and came to get checked
for this??
Reassurance

121.) which one of these doesn't have microtubules?

corticol thymocytes
Enterocytes in duodenal crypts
Erythroblasts in the bone marrow
Keratinocytes in stratum basale
Ventricular cardiac muscle fibers

122.) A 5-year-old boy with mental retardation is grossly obese and has facial features of
Prader-Willi syndrome (PWS).
Karyotyping and fluorescent in situ hybridization studies do not show deletion in the
usual site on chromosome 15. Which of the following findings is most likely to confirm
PWS in this child?
~ A) Deletion in the short arm of chromosome 15
B) Duplication within chromosome15
C) Large trinucleotide repeat expansion in the PWS area of chromosome 15
D) Maternal origin of both chromosomes 15
E) Translocation in the short arm of chromosome 15

123.) Old man with fever chills fatigue SOB and weight loss. Underwent urinary
catheterization for prostatic obstruction. High temp/pulse/BP. Soft s1 and normal S2. 2/6
early diastolic murmur and accentuated when pt leans forward with held expiration.
Clear lungs. Which is most likely dx?
Bacterial endocarditis, peritonitis, prostatitis, PE, Viral pneumonia

124.) Cause of patient's sx of stenosisin which artery? She had 1 year hx of severe
abdominal pain after meals and weight loss; pain relieved with less food. hx of
atherosclerosis and underwent CABG 2 yrs ago; exam shows soft nontender abdomen
and abdominal bruit. Diminished pedal pulses
Greaterpancreatic, Hepatic, Right Gastric, SMA, Supraduodenal

125.) Boy homozygous for HbS; daily tx w/ penicillin to decrease risk of infection with
what?
E. coli, H. flu, Neisseria mening, Salmonella, Strep pneumo; I put salmonella but
incorrect

126. The pedigree with fragile x syndrome that asks the probability that III
-5 will have similar expansion? Would love an explanation of the answer.
0% recall that the male only needs one allele to manifest the dz, so
He is diseased and thus cannot have the same trinucleotide repeats as the woman
which is a carrier.

127.) With regards to the erection, asking for an intact spinal reflex arc between the
sacral parasympathetic nerves and which of the following?
Genitofemoral, ilioinguinal, lumbosacral trunks, obdurator nerve,
pudendal nerve

128.) A 35-year-old man is referred for psychiatric evaluation by a work-

sponsored depression screening program. He has no history of serious illness, and his
last routine examination was 12 years ago. He says that for the past 2 years he has felt
down and has not fully enjoyed life. He is generally unmotivated and pessimistic about
the future and has little energy for relationships or work. He wonders if he is just getting
old. He has not had any changes in his appetite or sleep pattern, and his
Symptoms have not a fiected his ability to work. Although he has
Had occasional thoughts that life is not worth living, he has not had suicidal thinking or
planning. Which of the following is the most likely diagnoses?
A) Adjustment disorder with depressed mood
B) Avoidant personality disorder
C) Bipolar disorder
D) Dysthymic disorder
E) Major depressive disorder
F) Schizoaffective disorder

129. A 43-year-old woman comes to the physician because of progressive difficulty

walking during the past 3 months. Neurologic examination shows weakness and
decreased muscle bulk of the lower extremities. Patellar and Achilles tendon reflexes
Are diminished. Sensations of joint position, pain, and temperature in the lower
extremities are normal. Which of the following is the most likely cause of the findings in
this patient?
A) Acute peripheral neuropathy
B) Degeneration of motoneurons of the lumbar cord
C) Demyelination of the corticospinal pathways
D) Loss of afferent la axons innervating muscle spindles
E) Myotonic muscular dystrophy

130.) It was about the niacin cholesterol mechanism

A. antagonizes VLDL cholesterol secretion
B. increase catabolism of LDL
C. inhibits cholesterol uptake (i think this is the answer)
D inhibit HMG COA
E. stimulates PPARa

131.) just to confirm the elliptical, purple budding organism that grows on sheep agar-
candida

132.) 43 yr. old woman, who has immune thrombocytopenic purport resistant to
corticosteroid treatment, will undergo an operation to improve her condition. Removing
which organ in the CT scan will help? Splenectomy
133.) Systolic murmur is loudest at the point marked by X. Which cardiac abnormality is
causing the murmur?
Aortic valve regurgitation (diastolico), aortic valve stenosis (base irradiado a carotidas)
, mitral valve regurgitation (apex y axila), mitral valve stenosis (diastolico), pulmonic
regurgitation (diastolico), pulmonic stenosis, tricus regurgitation (tricuspida)
, tricuspid stenosis (diastolico)

134.) 51 yr. old woman w/ pheochromocytoma. Preoperative treatment w propranolol

prescribed to decrease tachycardia. Which drug should be admins? Before starting
propranol?
Atenolol, clonidine, nifedipine, phenoxybenzaminem sildenafil?

135.) 70 yr old lady brought to er by husband 45 min after he found her unresponsive.
She has anxiety disorder trted w/ diazepam. She recently started taking over the counter
med for heart burn. She only responds to painful stimuli. Interaction with which drug
causing this prob? i know its a cytp450 inhibitor so is it cimetidine or ranitidine?
calcium carbonate, cimitidine, famotidine, magnesium trisilicate, ranitidine

136.) 66 yr old man brought to er sudden substernal chest pain. Jogging when pain
Began. Hypertension trted w indapamide. Pulse 90 min bp 150/90 cardiac exam s4.
Treatment w sublingual med fixed pain in 2 min...Mech of action of which drug let to
relaxation of vascular smooth muscle in this patient? Obv nitroglycerin so is the answer
increased cGMP?
Decreasing intracellular calcium, increasing camp, increased cGmp,inhibiting the sodium
pump, stabilizing depolarization of the vascular smooth muscle cell membranee

137) previously healthy 67 yr old lady w 3 day history of fever, shortness of breath
, nonproductive cough, headache, and muscle pain. Temp is 102 F. lungs clear to
auscultation. Exam shows no abnormalities. Which vaccine could a prevented this stuff?
Diphtheria tetanus a cellular pertussis, h. influ type b, hepatitis b, inactivated polio
, influenza virus, mmr, typhoid, 23 valent pneumococ, varicella

138) 35 yr old man w long history of atrophic gastritis has increased lethargy and
fizziness during past 2 weeks. Pale skin and mucous membranes. No palpabl
adenopathy. Liver edge palpable. Decreased vibratory sensation. Hct of 27%, mcv 112,
and platelet count 200,000. Absence of sufficient numbers of which cell types explains
these findings?
Chief, columnar absorptive, enter endocrine, goblet, mucous, paneth, parietal,
Undifferentiated crypt

139) 80 yr old woman fever cloudy urine after knee replacement. Temp is 100.4 F.
Bandaged left knee and indwelling foley cath. Micro shows numerous gram negative
rods. Urine culture brain heart infusion medium grows more than 100,000 bacterial
colonies predominantly one thats oxidase positive and produces diffusible green
pigment. whig organism? Is this p.aueroginosa?
Ecoli, kleb.pneumoniae, proteus mirabilis, p.aureoginosa, group a step pyogenes

140.) 4 month boy w recurrent sinopulmonary infections since birth. Phys exam shows
hypo pigmentation of skin, eyes, hair, and ecchymosis over trunk and extremities. Blood
smear shows giant granules in neutrophils and eosinophils. I know this is chediak
higashi lol but still want to double checkacute myeloblastic leukemia, ataxia
telangiectasia, chediak higashi syndrome, leukocyte adhesion deficiency, sezary
syndrome

141.) 62 yr. old man has pain in the left hip for 3 wks. X-ray of ship shows 4.5 cm
destructive osteoplastic lesion w an associated fracture in proximal femur and 2
separate similar smaller lesions in the bony pelvis. Needle core biopsy of femur shows
metastatic carcinoma. Whats the most likely primary site of the cancer? Prostate right
cuz of the clues? if its not this then lung (most common metastasis site) colon, kidney,
lung, pancreas, prostate

142.) previously healthy 52 yr old lady has 2 mo history of progressive difficulty

swallowing, double vision, and slurred speech. Pays exam shows ptosis of the eyelids
and waddling gait. Muscle strength shows fatigable weakness of the neck, arms, hands,
and fingers. Repetitive nerve stimulation shows a 25% decrease in muscle action
potentials in several muscles. Which of the following mechanisms is the most likely
cause of this patients disease?

Binding of acetylcholine by an antibody, binding of antibody to the acetylcholine

receptor, deceased acetylcholine production, decreased release of acetylcholine from
the receptor, decreased reuptake of acetylcholine

143.) 5 yr. old stares blankly into space for several seconds. Doesnt respond to
questions during these episodes. Pays exam shows no abnormalities. Reg shows 1-3
second hurts of 3 sec spike and wave activity. No abnormal motor movements are
observed during this reg activity.

Carbamazepine, ethosuximide, gabapentin, phenobarbital, phenytoin

144.) 5 year old boy brought to the ER. With vomiting and sleepiness, he had a flu like
illness 5 days ago that she treated with aspirin. Serum studies show increased
ammonia, lactate, and transaminase levels. Whats the most likely cause of the patient's
coma?
a) Cerebral edema
b) Metabolic alkalosis
c) Subarachnoid hemorrhage
d) Venous sinus thrombosis
e) Viral encephalitis

145.) Liver showing centrilobular pallor and swelling of hepatocytes and kidneys showing
proximal convoluted epithelial cells. Which is the mechanism?
A) Activation of aspartate-specific caspase
B) Binding of Fas ligand toreceptor
C) Decreased function of Na/K ATPase
D) Ribosomal degradation
E) Stimulation of PFKase

146.) 60 yr old woman has 2 history of hypertension comes to doc for follow up
examination. Hypertension has been poorly controlled during the past six months
despite availability of appropriate pharmacotherapy. Which of the following statements
by the physician is most appropriate to begin a discussion about this patients possible
noncompliance w her medication regimen?
Is it it is hard to take pills every day for a condition that has no symptoms?
I will arrange for nurse to visit to make sure youre taking meds properly
Im sorry but I must say missing your meds can kill you
You clearly have not been taking your meds. You must be more responsible
You realize that your high blood pressure could have been avoided

147.) 38 yr. old lady w/ 10 wk history of epigastric pain and frequent stool. She had two
episodes of renal calculi during the past 2 yrs. Physical exam shows multiple sup
erficial lipomata and mild epigastric tenderness. Upper endoscopy show two large non
bleeding duodenal ulcers. Her gastric pH is 2.3, and serum gastrin concentration
obtained immediately after the procedure is 2000 pg/ml (N<100). Proton pump inhibitor
therapy is begun. Measurement of which of the following is the most appropriate next
step in management?
MEN syndrome...so check Parathyroid---> they make PTH-> increased CA2+

148.) 12 year old with walking abnormality for 6 months. Mild atrophy and hammer toes
.nerve biopsy shows abnormal myelin sheaths absence of shwann cells (would be MS
-patient too young and more likely in females) lymphocytic infiltrate abnormal astrocytes
(brain) abnormal oligodendrocytes (oligodendrocytes are in the brain)

149) 54 yr. old man w/ aneurysm in distal portion of his abdominal aorta. Estimated
cross-sectional area of the aneurysm is 2 cm^2 and the mean velocity of blood flow thru
the aneurysm is 20cm/sec. which of the following best represents the flow rate in L/min
thru the aneurysm? Can someone please help me out with this?
1.0, 2.4, 3.2, 3.6, 4.0

150.) 55 yr. old dude w contipationsine taking meds for chronic persistent cough n sinus
congestion. Which ingredient in this med most likely cause of this patients new
symptom? Dextromethorphan right?
Acetaminophen, dextromethorphan, guafenesin, loratidine phenylephrine

151) 54y F admitted with acute MI, at which point there were no murmurs or signs of
heart failure; but 2 days later, she has acute SOB and sweating; HR 100, RR 24, BP
160/98. Crackles bilaterally, +murmur. Which murmur is most likely?
So SOB and Crackles must be fluid backing up into the lung... therefore left sided heart
failure -> the concept is that ischemia of the papillary muscles lead to
Mitral insuff. -> murmur is holosystolic high pitched loudest at apex

152) 28yr old lady w/ 1 month history of pelvic pain that has become increasingly severe
during the past week. Her mensrual flow has been unusually heavy during her last three
menstrual periods. Menses have occurred at 24-28 day intervals since menarche at the
age of 12 years. Phys exam shows a palpable mass in the left adnexa. Serum studies
show an increased CA 125 concentration. Vaginal ultrasonography shows an 8 cm mass
in the left ovary. During surgical removal of the ovary, which of the following structures
Passing inferior to the ovary must be protected?
Ureter

153.) 16 yr. old boy dove into pool, unable to move right upper and lower extremities.
Most likely cause of movement deficits in this patient is damage to which region of the
spinal cord? Is it G, by the ventral cord of the spinal cord?
Don't have the picture but it is upper motoneuron so right side middle cause anterior is
spin thalamic tract

154.) Two sets of patients (Groups X and V) of similar age, weight, gender, and health
status are given general anesthesia by inhalation. In Group X, anesthesia is induced by
administering isofiurane at a concentration 1.5 times the minimal alveolar concentration
(MAC) for this drug. In Group V, anesthesia is induced by administering a combination of
isofiurane and nitrous oxide, each at 0.75 times the MAC for that drug. The
onset of anesthesia is found Abe significantly faster in GmupY than in Group X. The
different response rates between the two groups is best explained by differences in
which of the following properties of isoflurane and nitrous oxide?
A) Blood: gas partition coefficient
B) Brain blood partition coefficient
C) Brain gas partition coefficient
D) Hepatic metabolism
E) Lipid solubility
F) Minimal alveolar concentration
G) Molecular weight

155.) a 48-year old man is referred for evaluation of possible hyper

Tension On the basis of ten measurements, the patients average diastolic blood
pressure is 113 mm Hg, and the standard deviation is 8 mm Hg. If four rather than ten
measurements of the mean blood pressure are made, which of the following is the
expected impact on the size of the 95% confidence interval about the mean blood
pressure?
A) Change, but the direction cannot be predicted
B) Decrease in width
C) Increase in width
D) Remain the same

156.) Gram stain is performed on a sputum specimen. Pink rods and blue cocci are
observed. Which of the following features is characteristic only of the pink rods?
A Endoplasmic reticulum
B Growth inhibition by ciprofloxacin
C Outer membrane
D Peptidoglycan cell wall
E Polysaccharide capsule