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This timed examination has been recreated from specifications of the national test part one for
podiatrists. The questions are taken from various board review books. The content is not random
and distributed in the following parts:
Lower Extremity Anatomy 22%
Pharmacology 16%
Microbiology and Immunology 15%
Pathology 15%
Physiology 12%
Biochemistry 10%
General Anatomy 10%

1. Which of the following fibrous sheets or bands would most likely cover the body under the
skin and invest the muscles?
(A) Tendon layers;'allows'tendon'to'glide'freely'when'the'muscle'contracts'or'relaxes'and'prevents'fric$on
(B) Fascia or'damage'to'the'tendon''
(C) Synovial tendon sheath Deep'fascia='layer'of'fibrous'CT'that'can'surround'individual'muscles,'and'also'divide'groups
(D) Aponeurosis Superficial'fascia='immediately'beneath'the'skin'over'the'en$re'surface'of'the'body'

2. If parasympathetic nerves are damaged, which of the following muscles would most likely be
affected? PNS+effects=+cholinergic+muscarinic+receptor+mediated
(A) Muscles in the hair follicles bundle'of'smooth'm.'fibers'innervated'by'SNS Bronchioles=+bronchoconstricLon
(B) Muscles in blood vessels dilates'in'Sk'm.'and'constricts'in'GI;'SNS nodal+conducLon
(C) Muscles enclosed by epimysium skeletal'muscle'is'under'SNS'control' GI+Tract=+increased+moLlity,+relaxaLon+of+sphincters
(D) Muscles in the gastrointestinal (GI) tract Male+sex+organs=+erecLon+(point;+SNS=+shoot)+
Text Bladder+and+ureters=+contracLon+of+detrusor,+

3. Which blood vessel or group of vessels carries richly oxygenated blood to the heart?

(A) Superior vena cava A.'Carries'deoxy'blood'to'right'atrium'of'heart'from'upper'body'(arms'and'head)'

(B) Pulmonary arteries B.'Carries'deoxy'blood'from'heart,'right'ventricle,'to'lungs'via'pulmonary'valves
(C) Pulmonary veins C.'Carries'oxy'blood'from'lungs'to'heart'leS'atrium'via'mitral'valve'
(D) Ascending aorta

4. Axons of neurons

(A) carry impulses toward the cell bodies =Dendrites'

(B) carry impulses away from the cell bodies
(C) carry only motor impulses
(D) are several in number for multipolar neurons

5. Which of the following structures shunts blood from the pulmonary trunk to the aorta,
partially bypassing the lungs?
(A) Placenta 1.+Deoxygenated+blood+entering+the+RA+from+the+SVC+goes:+RA+to+RV+to+main+PA+and+then+either+to+
(B) Umbilical artery either+lung+or+through+DUCTUS+ARTERIOSUS;+from+DA+goes+to+aorta+then+to+the+placenta+via+umbilical+
(C) Ductus arteriosis arteries;+(skips+lungs)+
(D) Foramen ovale 2.+Blood+entering+the+fetus+through+the+umbilical+vein+is+conducted+via+the+DUCTUS+VENOSUS+into+the+

6. Which of the following structures contains cell bodies of unipolar or pseudounipolar neurons?
(A) Ventral horn of the spinal cord ganglion;'the'axon'leaves'the'cell'body'out'of'the'ganglion'and'into'the'dorsal'root'where'it'
(B) Lateral horn of the spinal cord branches;'the'central'branch'goes'to'the'posterior'(dorsal)'horn'of'the'spinal'cord,'where'it'forms'
(C) Dorsal horn of the spinal cord spinal'nerve'all'the'way'un$l'skin,'joint'and'muscle;'these'neurons'have'sensory'receptors'at'
(D) Dorsal root ganglion their'peripheral'sites;'signals'conduct'through'the'peripheral'branch'to'the'dorsal'root'ganglions'
Synapses are most likely absent in or on which of the following structures?

(A) Anterior horn

(B) Dorsal root ganglia
(C) Sympathetic chain ganglia
(D) On dendrites

8. Which of the following structures uld most likely be absent in the spinal cord at the L4
spinal cord level?
(A) Dorsal horn specifically'through'levels'T1:L2
(B) Lateral horn
(C) Ventral horn
(D) Gray matter

9. The pivot (troehoid) joint is found in which of the following joints? Only'2'types'of'movement:'rota$on'and'gliding

(A) Atlanto-occipital joint

(B) Atlanto-axial joint
(C) Carpometacarpal joint of the thumb Condyloid'(ellipsoid'or'saddle)'joint'like'calcaneocuboid'
(D) Proximal tibiofibular joint an'arthrodial'joint;'with'movement'of'foot,'fibula'slides'slightly'upward'as'the'foot'is'

10. A patient presents with a loss of sensation to the skin over the shoulder. Injury to which of the
following nerve cells would most likely affect the conduction of sensory information to the
central nervous system (CNS)?

(A) Multipolar neurons

(B) Bipolar neurons
(C) Unipolar or pseudopolar neurons Dorsal'Root'Ganglion='Sensory'and'are'pseudounipolar''
(D) Neurons in the ventral horn

11. The genitofemoral nerve (L1,'2)'comes'off'the'lumbar'plexus,'piercing'the'psoas'major'and'
(A) runs in front of the quadratus lumborum 2.'Femoral'Branch'(Lumbo:inguinal'nerve)='passes'deep'to'the'inguinal
(B) is a branch of the femoral nerve ligament'and'through'the'femoral'sheath,'lateral'to'the'Femoral'Artery,'
(C) supplies the testis piercing'the'deep'fascia'and'supplying'the'superficial'skin'of'the'proximal'
(D) passes through the deep inguinal ring femoral'triangle''

12. If a stab wound injures structures that leave the pelvis above the piriformis muscle, which of
the following structures is most likely to be damaged?

(A) Sciatic nerve Exi$ng'above:'Superior'Gluteal'N.'(L4:S1);'Superior'Gluteal'Artery'

(B) Internal pudendal artery Posterior'Femoral'Cutaneous'N.'(S1:3),'Pudendal'N.'(S2:4),'and'Inferior'Cluneal'Nerves;'Internal'Pudendal
(C) Superior gluteal nerve and'Inferior'Gluteal'Artery''
(D) Inferior gluteal artery

13. Tearing of the pelvic diaphragm during childbirth leads to paralysis of which of the following
(A) Piriformis Pelvic'diaphragm'is'formed'by'the'levator'ani'and'coccygeus,'whereas'the'urogenital'
(B) Sphincter urethrae
(C) Obturator internus
(D) Levator ani

14. A large tumor confined to the posterior mediastinum may compress which of the following
structures? Posterior'medias$num'is'bounded'superiorly'by'the'plane'through'the'sternal'angle'and'T4/5,'
(A) Ascending aorta this'area'contains'the'descending'thoracic'aorta,'the'azygos'system,'the'esophagus,'the'thoracic'duct,'
(B) Trachea Contents'of'other'medias$num:'
(C) Descending aorta Superior='thymus,'trachea,'esophagus,'arch'of'aorta,'thoracic'duct,'brachiocephalic'a.,'LCC'a.,'lymph'nodes'
(D) Arch of the aorta Middle='ascending'aorta,'bifurca$on'of'trachea'and'the'2'bronchi,'pulmonary'artery,'

15. A patient has a torn rotator cuff of the shoulder joint as the result of an automobile accident.
Which of the following muscle tendons is intact and has normal function?
(A) Supraspinatus Supraspinatus'(suprascapular'nerve):'abducts'arm'ini$ally'(before'ac$on'of'deltoid);'#1'rotator'cuff'injury
(B) Subscapularis Infraspinatus'(suprascapular'nerve):'laterally'rotates'arm;'pitching'nerve'injury
(C) Teres major Teres'Minor'(axillary'nerve):'adducts'and'laterally'rotates'arm
(D) Teres minor

16. If there is loss of the skin sensation and paralysis of the muscles on the plantar aspect of the
medial side of the foot, which of the following nerves is damaged?
(A) Common peroneal medial&and&lateral&plantar&nerves&and&supplies&plantar&intrinsics;&
(B) Tibial Common&Peroneal&N.&(L4,S2):&SH&BF;&divides&into&deep&and&superficial&branches&to&supply&anterior
(C) Deep peroneal and&lateral&leg&muscles&as&well&as&dorsal&intrinsics
(D) Sural Deep&Peroneal&(L4,5):&EDL,&EHL,&TA,&Pt,&EHB,&EDB;&1st&webspace&
17. A patient walks with a waddling gait that is characterized by the pelvis falling toward one
side at each step. Which of the following nerves is damaged?
(A) Obturator nerve to&a&straight&posiPon;&due&to&paralysis&of&gluteus&medius&and&minimus,&dislocaPon&of
(B) Nerve to the obturator internus the&hip&joint&or&an&abnormal&angle&of&femoral&inclinaPon;&the&sagging&pelvis&to&the&
(C) Superior gluteal nerve opposite&side&is&caused&by&the&inability&of&the&ipsilateral&hip&abductors&to&counteract
(D) Inferior gluteal nerve gravity;&the&trunk&is&inclined&towards&the&paralyzed&side;&paralysis&of&gluteus&medius
18. A patient is unable to prevent anterior displacement of the femur on the tibia when the knee is
flexed. Which of the following ligaments is most likely damaged? PosiLve+posterior+draw+sigh

(A) Anterior cruciate ACL='anterior'displacement'of'$bia'on'femur;'posterior'displacement'of'femur'on'$bia

(B) Fibular collateral PCL='posterior'displacement'of'$bia'on'femur;'anterior'displacement'of'femur'on'$bia'
(C) Patellar
(D) Posterior cruciate

19. Lesion of the femoral nerve results in which of the following conditions?
(A) Paralysis of the psoas major muscle
(B) Loss of skin sensation on the lateral side of the foot b+Femoral+Nerve+(DDVR+L2,3,4)+Supplies:+Quads,+Iliacus,+
(C) Loss of skin sensation over the greater trochanter ArLcularis+Genu,+PecLneus,+Sartorius++
(D) Paralysis of the vastus lateralis muscle
20. A patient is unable to invert the foot, indicating lesions of which of the following nerves?

(A) Superficial and deep peroneal Foot+Inverters=+TP+(Tibial+N.),+TA+(DP+N.),+

(B) Deep peroneal and tibial aided+by+triceps+surae+(Gastroc+and+Soleus;+Tibial+N.)+
(C) Superficial peroneal and tibial Everters=+PL,+PB+(SP+N.)
(D) Medial and lateral plantar aided+by+EDL+and+Pt+(Tibial+N.)+

21. A 22-year-old patient is unable to "unlock" the knee joint to permit flexion of the leg. Which of
the following muscles is most likely damaged?
(A) Rectus femoris it+pulls+the+lateral+meniscus++backward+at+the+beginning+of+flexion;+it+flexes+the+leg+and+
(B) Semimembranosus unscrews+the+Lbia+when+standing+up+“unlocking”+the+knee+joint
(C) Popliteus
(D) Gastrocnemius

22. A patient presentswith sensory loss on the adjacent sides of the great and second toes and
impaired dorsiflexion of the foot. These signs probably indicate damage to which of the
following nerves?

(A) Superficial peroneal

(B) Lateral plantar
(C) Deep peroneal
(D) Sural

23. When the superficial peroneal nerve is severed near its origin by a deep gash as a result of a
fall from a motorcycle, which of the following muscles is paralyzed?
(A) Peroneus longus 1.+SensaLon+impairment+or+loss+on+the+dorsum+of+the+foot+and+lateral+aspect+of+
(B) Extensor hallucis longus lower+leg+
(C) Extensor digitorum longus 2.+Eversion+of+the+foot+is+lost;+foot+is+inverted+during+dorsiflexion;+equinovarus+posiLon
(D) Peroneus tertius may+develop+

24. To avoid damaging the sciatic nerve during an intramuscular injection in the right gluteal
region, the needle should be inserted in which of the following areas?
(A) Over the sacrospinous ligament the+midpoint+of+a+line+from+the+upper+boarder
(B) Midway between the ischial tuberosity and the lesser trochanter of+the+greater+trochanter+to+the+PSIS;+ie+upper+
(C) Midpoint of the gemelli muscles lateral+quadrant+of+gluteal+region
(D) Upper right quadrant of the gluteal region

25. Which of the following muscles is damaged if a patient cannot flex and medially rotate the
thigh during running and climbing?

(A) Semimembranosus Semimembranosus=+flex+and+medially+rotate+leg+with+thigh+extended

(B) Sartorius Sartorius=+flex+thigh,+flex+leg,+rotates/abducts+thigh+laterally+
(C) Rectus femoris
(D) Tensor fascia latae

26. A motorcycle accident results in the destruction of the groove in the lower surface of the
cuboid bone. Which of the following muscle tendons is most likely damaged?

(A) Flexor hallicus longus

(B) Peroneus brevis
(C) Peroneus longus
(D) Tibialis anterior

27. A construction worker sustains a fracture of the groove on the undersurface of the
sustentaculum tali of the calcaneus as a result of falling feet first from a roof, Which of the
following muscle tendons is most likely torn?
(A) Flexor digitorum brevis FHLb+passes+along+the+inferior+surface+of+the+sustantaculum+tali+
(B) Flexor digitorum longus FHBb+o:+from+tendon+of+TP,+cuboid+and+lateral+cuneiform
(C) Flexor hallucis brevis FDBb+o:+plantar+aponeurosis+and+medial+calcaneal+tubercle
(D) Flexor hallucis longus

28. The great saphenous vein runs passes&anterior&to&medial&malleolus,&travels&superiorly&at&medial&aspect&of&leg

(A) posterior to the medial malleolus where&it&passes&through&the&saphenous&opening/fossa&ovalis&in&the&deep&fascia&and&
(B) into the popliteal vein joins&the&femoral&v.&
(C) anterior to the medial condyles of the tibia and the femur
(D) superficial to the fascia lata of the thigh

29. The inability to extend the leg at the knee joint indicates paralysis of which of the following

(A) Semitendinosus A=+Flexion

(B) Sartorius B+and+C=+Assist+with+flexion+
(C) Gracilis
(D) Quadriceps femoris

30. Which of the following muscles is damaged if a patient experiences weakness in dorsiflexing
and inverting the foot?
(A) Peroneus longus Plantarflexion=+Gastroc,+Soleus,+Plantaris;+assisted+by+TP,+FDL,+FHL,+PB,+PL
(B) Peroneus tertius Inversion=+TA,+TP;+Gastroc+and+soleus+assist+(Singh),+FHL+assists+(Ohio),+
(C) Tibialis anterior EHL+assists+(southerland)+
(D) Extensor digitorum longus Eversion=+PL,+PB;+Pt+and+EDL+assist+


31. A 62-year-old woman slips and falls on the bathroom floor, which results in a posterior
dislocation of the hip joint and a fracture of the neck of the femur. The woman undergoes hip
surgery. If all of the arteries that are part in the cruciate anastomosis of the upper thigh are
ligated, which of the following arteries maintains the blood flow?

(A) Medial femoral circumflex Cruciate+Anastomosis=+FILM

(B) Lateral femoral circumflex First+perforaLng+of+PF,+Inferior+Gluteal,+LFCA,+MFCA
(C) Superior gluteal
(D) Inferior gluteal

32. Which of the following conditions most likely occurs as a result of occlusion of the dorsalis
pedis artery at its origin? DP+is+conLnuaLon+of+the+TA+artery+at+the+level+of+the+ankle;+branches=+
(A) Ischemia in the peroneus longus muscle Medial+Tarsalb+anastomosis+w/+medial+malleolar+arterial+plexus+
(B) Reduction of blood flow in the medial tarsal artery Arcuateb+anastomoses+w/+plantar+arch+via+perforaLng+branches+to+DMAs+
(C) Aneurysm in the plantar arterial arch Deep+Plantar+Arteryb+is+conLnuous+with+the+deep+plantar+arch;+represents+
(D) High blood pressure in the arcuate artery primary+point+of+connecLon+with+the+plantar+circulaLon++with+the+dorsal+

33. A patient experiences paralysis of the muscle that originates from the femur and contributes
directly to the stability of the knee joint. Which of the following muscles is involved?

(A) Vastus lateralis

(B) Semirnembranosus
(C) Sartorius
(D) Biceps femoris (long head)

34. Which of the following structures remains intact if the structures that pass deep to the inferior or
superior extensor retinaculum of the ankle are damaged?

(A) Anterior tibial nerve

(B) Extensor digitorum longus muscle
(C) Dorsalis pedis artery
(D) Superficial peroneal nerve

35. A knife wound penetrates the superficial vein that terminates in the popliteal vein. Bleeding
occurs from which of the following vessels?

(A) Posterior tibial vein Popliteal+veinb+drains+into+femoral+vein+superiorly;+formed+by+the+union+of+the+venae+comitantes+

(B) eroneal vein of+PT+and+AT+veins+
(C) Great saphenous vein
(D) Lesser saphenous vein

36. A 10-year-old boy falls from a tree house, causing heavy compression of the sole of his foot
against the ground with fracture of the head of the talus. Which of the following structures is
unable to function normally? Medial+longitudinal+arch=+calcaneus,+talus,+navicular,+cuneiforms+and+medial+3+mets;+flat+foot+(pes
(A) Transverse arch
(B) Medial longitudinal arch arch+is+excessively+or+abnormally+high+
(C) Lateral longitudinal arch +
(D) Tendon of the peroneus longus Transverse+arch=+navicular,+cuneiforms,+cuboid+and+5+mets;+each+foot+contributes+1/2+of+arch;+

37. A 24-year-old woman complains of weakness associated with extending her thigh and
rotating it laterally. Which of the following muscles is paralyzed?
(A) Semitendinosus Lateral+rotators=+Gluteus+maximus,+sartorius,+6+deep+gluteal+muscles+(Piriformis+Go+Go+Quad)
(B) Gluteus maximus
(C) Tensor fasciae latae
(D) Sartorius +

38. A radiograph reveals a blood clot in the popliteal artery at its distal end. Blood may reach the
foot by way of which of the following arteries?
(A) Anterior tibial a+branch+of+PT);+however+blood+would+sLll+reach+these+arteries+via+the+genicular+anastomosis+of+knee;
(B) Posterior tibial Femoral+A+gives+off+descending+genicular+which+communicates+with+anastomosis+via+arLcular+a.+and
(C) Peroneal geniculars+and+the+middle+genicular+artery+(does+not+parLcipate+in+anastomoses);++lateral+femoral+
(D) Lateral circumflex femoral circumflex+contributes+via+descending+LFCA+which+anastomoses+with+the+superior+lateral+genicular+and+
39. Pus in the adductor canal damages the enclosed structures. Which of the following structures
remains intact?
(A) Femoral artery Femoral+artery+and+vein
(B) Femoral vein Saphenous+nerveb+end+nerve+of+femoral+nerve
(C) Saphenous nerve Nerve+to+Vastus+Medialis
(D) Great saphenous vein

40. Hypertrophy of the extensor muscles of the leg may cause ischemia due to compression of
which of the following arteries?

(A) Popliteal
(B) Deep femoral opLon+that+makes+sense+would+be+deep+femoral+(profunda+femoris);+descending+branch+of++PF+passes
(C) Anterior tibial inferiorly+in+the+anterior+compartment+of+the+thigh,+intermediate+to+RF+and+vastus+intermedius+at+
(D) Posterior tibial their+lateral+edges,+near+the+vastus+lateralis+muscle;++

41. Which of the following muscles functions normally even if the greater trochanter of the
femur is fractured?

(A) Piriformis
(B) Obturator intemus
(C) Gluteus medius
(D) Gluteus maximus

42. Which of the following muscles is able to dorsiflex and invert the foot?

(A) Extensor digitorum longus

(B) Tibialis anterior
(C) Peroneus brevis
(D) Peroneus longus

43. The obturator and sciatic (tibial portion) nerves both innervate which of the following
(A) Semitendinosus sciaLc+nerve+supplies+hamstring+part+
(B) Adductor magnus
(C) Adductor longus *PecLneus+may+have+dual+nerve+supply;+main+supply+via+femoral+n.+but+when+accessory+obturator
(D) Pectineus

44. A lesion of which of the following muscles most likely causes weakness in flexing the hip
joint and extending the knee?
(A) Sartorius jumping,+rising+from+a+seated+posiLon+and+walking+up+and+down+stairs;+RF+is+the+only+one+that+flexes+
(B) Gracilis thigh+and+extends+leg+because+it+crosses+2+joints;+
(C) Rectus femoris
(D) Vastus medialis

45. The obturator is the sole source of innervation for which of the following muscles?
(A) Pectineus BF=+Lbial+++common+peroneal+
(B) Adductor magnus
(C) Adductor longus Obturator+only=+Gracilis,+Adductor+Brevis,+Adductor+Longus,+Obturator+Externus
(D) Biceps femoris

46. Which of the following bones forms the keystone for the lateral longitudinal arch of the foot?

(A) Calcaneus
(B) Cuboid bone
(C) Head of the talus
(D) Sustentaculum tali

47. While playing football, a 19-year-old college student receives a twisting injury to his knee
when being tackled from the lateral side. Which of the following conditions most likely has
occurred? A+clipping+injury+to+the+lateral+side+of+the+knee+can+cause+
(A) Tear of the medial meniscus 1.+Collateral+ligamentsb+mainly+medial+collateral
(B) Ruptured fibular collateral ligament and+so+both+can+be+injured
(C) Tenderness on pressure along the fibular collateral ligament 3.+anterior+and+posterior+cruciate+ligaments
(D) Ruptured posterior cruciate ligament

48. Before knee surgery, a surgeon ligates arteries participating in the anastomosis around the
knee joint. Which of the following arteries is most likely spared?
(A) Lateral superior genicular artery;+Descending+branch+of+LFCA+anastomoses+with+the+lateral
(B) Medial inferior genicular genicular+artery+and+is+major+collateral+circulatory+alternaLve
(C) Descending branch of the lateral femoral circumflex in+the+event+the+femoral+artery+is+compromised+in+proximal
(D) Saphenous branch of the descending genicular popliteal+fossa;+Saphenous+branch+of+descending+genicular+
(E) Middle genicular= only genicular not participating
in anastomoses
49. The pKa' of acetic acid is 4.76. What is the pH of a 0.1 M solution of acetic acid?

(A) 5.76
(B) 2.88 pH= pKa-log([AH]/[A-])
(C) 2.43 pH=4.76-log(0.1)
(D) 1.88 pH=4.76-(-1)
50. Which of the following amino acids is an imino acid?

(A) Leucine
Proline is only AA that is an imino acid which is a structure with the
(B) Lysine amino group bonded to the alkyl side chain forming a ring
(C) y-Carboxyglutamate
(D) Proline

51. Which of the following does not change length during muscle contraction?

(A) The A band Contraction results in shortening of H and I bands between the Z lines
(B) The I band (“HIZ shrinkage”), but the A band remains the same length (“A band is Always
(C) The H zone the same length”)
Sarcomere= measured from 1 z-line to 1 z-line
(D) The sarcomere

52. Which one of the following characteristics best applies to an allosteric effector? It
Drugs that bind to the same receptor
molecule but do not prevent binding
(A) competes with substrate for the catalytic site of the agonist are said to act allosterically
(B) binds to a site on the enzyme molecule distinct from the catalytic site and may enhance or inhibit the action of
(C) changes the nature of the product formed the agonist molecule
(D) changes the substrate specificity of the enzyme

53. The sugar residues of amylose are best described as

Amylose is a polysaccharide made up of alpha (1,4) bound glucose molecules ie
(A) [3-1,4 linkages the 1-carbon on 1 glucose is linked to the 4-carbon on the next glucose; is one of two
(B) a-1,4 linkages components of starch; because of its tightly packed structure, amylose is more
(C) galactose units only resistant to digestion than other starch molecules and has been found to be an
(D) fructose units only effective prebiotic

54. If the cytosine content of a double-helical DNA is 20% of the total bases, the adenine content
would be

(A) 10%
(B) 20%
(C) 30%
(D) 40%

55. Which of the following pairs of lipids and related compounds exhibits opposite biological

(A) 5-hydroperoxyeicosatetraenoic acid (5-HPETE) and leukotriene D4

(B) Cholic acid and lithocholic acid
(C) Thromboxane A2 and prostacyclin (PGI2)
(D) Lactosylceramide and [3-hydroxybutyrate
(pg 439 1st Aid 2014)
Membrane lipids (eg phosphoatidylinositol) are converted to arachidonic acid via phospholipase A2;
Arachidonic acid is converted to endoperoxides (PGG2, PGH2) via cylocooxygenase; endoperoxidases give rise to
Thromboxane A2 which causes increased platelet aggregation, vascular and bronchial tone
Prostacyclin (PGI2) which causes decreased platelet aggregation, vascular, bronchial and uterine tone
Prostaglandins (PGE2,PGF) which cause increased uterine tone and decreased bronchial tone
Arachidonic acid is converted to HPETEs via lipoxygenase; HPETEs give rise to Leukotrienes
Leukotrienes (LTC4, LTD4, LTE4) cause increased bronchial tone; (LTB4) causes neutrophil chemotaxis

56. Which mutation of the sequence GATCCT is a transition?

(A) GGTCCT Mutations in DNA

(B) GTTCCT Transition= purine to purine (A to G) or pyrimidine to pyrimidine (C to T)
Transversion= purine to pyrimidine (A to T) or pyrimidine to purine (C to G)

57. The factor required only for accurate initiation of transcription in prokaryotes is

Sigma factor is a bacterial protein that can associate with and become a
(A) alpha (a) subunit of bacterial RNA polymerase; it confers specificity of initiation on
the core enzyme; in the presence of sigma factor RNA polymerase chooses
(B) beta 03) the correct strand of duplex DNA for transcription and initiates transcription
(C) transcription factor IID (TFIID) at the appropriate promoter region
(D) sigma (a)
TFIID binds to TATA box and is the first event that occurs in mRNA synthesis
in eukaryotes

58. The "wobble" hypothesis refers to the less stringent base-pairing specificity of the
tRNA wobble= accurate base pairing is required for only the 1st 2 nucleotide
(A) 5'-end base of the codon positions of an mRNA codon, so codons differing in the 3rd “wobble” position
(B) 3'-end base of the antocodon may code for the same tRNA/AA (as a result of degeneracy of genetic code)
tRNA carries anticodon covalently bound to its 3’end; therefore the
(C) middle base of the codon
3’-end base anticodon would be the 1st nucleotide base;
(D) 5'-end base of the anticodon the 3 nucleotide codon sequence is added to the 3’-end of the mRNA during
elongation; therefore, the 5’-end of the codon would be the 1st nucleotide
59. Which primers should be paired to amplify, by the polymerase chain reaction (PCR), the
DNA between the two indicated sequences? 5'-GGAATTCGT---//---AATGCTACC-3'


primers are read in 5’ to 3’ direction so
D is best answer I think

60. An operator is best defined as

(A) the gene product of a regulatory gene

(B) a constitutively regulated gene that produces operon regulatory proteins
(C) the repressor binding region in operons
(D) the site within an operon to which the catabolite activator protein complexed with
cyclic adenosine monophosphate binds
Operator= segment of DNA to which a TF protein binds; in the lac operon (transcription and
metabolism of lactose in E.coli) is defined as a segment between the promoter and the genes
of the operon; repressors and inhibitors bind to the operator site; repressors physically
obstruct RNA polymerase from transcribing genes; inducers can displace a repressor from
the operator site and cause uninhibited gene expression; the operator is a site of gene
expression regulation

61. If a reaction is at equilibrium, which one of the following statements is correct?

(A) The free-energy change (AG) equals zero

(B) AG equals AE0'
(C) AG equals AG''
(D) G equals In Keq

62. Which of the following must be modified to serve as a cofactor for enzymes?

(A) Copper Vitamin B5 (pantothenic acid) is modified to synthesize

(B) Biotin Coenzyme-A (CoA), a cofactor for acyl transfers and
(C) Zinc FA synthase
(D) Pantothenic acid

63. Hydrophilic hormones are best described by which of the following statements? They

(A) include the thyroid and steroid hormones

(B) bind to cell-surface receptors, which transmit a signal to the interior of the cell
(C) enter the cell, bind to intracellular receptors and in a complex with the receptor, alter gene
(D) bind irreversibly to their receptors
Answer=B; C describes a steroid hormone (ie T3/T4); steroid hormones are lipophilic and therefore hydrophobic,
they cross plasma membrane, bind to receptors in nucleus or cytoplasm
64. The receptor potential for which sensory system causes the photoreceptors to hyperpolarize
when stimulated?
Photoreceptors= rods and cones
Chemoreceptors= olfactory, taste, osmoreceptors, carotid body O2 receptors
(A) Taste Mechanoreceptors= hair cells in auditory and vestibular systems, baroreceptors in carotid sinus,
pacinian corpuscles, stretch receptors, joint receptors
(B) Olfaction
(C) Audition
(D) Vision

65. Which of the following decreases the glomerular filtration rate (GFR) and renal blood flow
below normal levels? Constriction of efferent would decrease RPF and increase GFR
Constriction of afferent would cause decrease in both
(A) Glomerulotubular balance Epi and NE both cause vasoconstriction in the kidneys, because,
(B) A small increase in efferent arteriolar resistance alpha receptors greatly outnumber beta; moderate increase in
catecholamines would decrease RBF with little change in GFR
(C) A high plasma catecholamine level but large increases in them could stop GFR completely
(D) A decrease in afferent arteriolar resistance

Aldosterone comes from adrenal cortex and is under tonic control by ACTH but is separately regulated by the renin-angiotensin
system (increased by Ang II) and by potassium (increased by hyperkalemia); aldosterone increases renal Na+ reabsorption via
increasing Na+ channels and Na/K+ pump insertion in principle cells (it acts in the collecting tubule at mineralocorticoid receptors
[intracellular receptors] causing insertion of Na+ channels on the luminal side); also increases K and H secretion by up-regulating
principle cell K+ channels and intercalated cell H+ ATPases
66. Which of the following statements applies to aldosterone?

(A) Its secretion is increased by converting enzyme inhibitors

(B) It acts through basolateral membrane receptors to increase luminal membrane sodium
(C) It increases Na+entry into intercalated cells along the late distal tubule and collecting ducts
(D) It increases the amount of Na+-K+ATPase in the principle cells

67. Extracellular bicarbonate (HCO3-) is not an effective buffer for which of the following?

(A) Phosphoric acid

(B) Lactic acid
(C) Sulfuric acid
(D) Carbonic acid

68. Thyroid hormone is stored primarily in the

(A) extrcellular fluid (ECF) T3/T4 are produced in the follicular cells and stored in thyroglobulin
(B) follicular cells
(C) interstitial fluid (ISF)
(D) parafollicular cells

69. The anti-inflammatory effect of exogenous cortisol is due to

Cortisol decreases inflammatory and immune responses b/c:
(A) increased capillary membrane permeability inhibits production of leukotrienes and postaglandins
(B) increased formation of leukotrienes inhibits leukocyte adhesion—> neutrophilia
(C) decreased release of pyrogens from granulocytes blocks histamine release form mast cells
reduces eosinophils
(D) activation of macrocortin blocks IL2

70. Which of the following statements correctly describes a healthy 30-year-old woman with a
menstrual cycle of 26 days?

(A) Exogenous estrogen treatment will cause hypertrophy of her ovaries.

(B) Menstruation is caused by the secretion of progesterone from the corpus luteum.
(C) The proliferation phase of the endometrium is caused by the mitogenic action of
estradiol secreted by the ovarian follicle.
(D) Plasma estradiol concentration begins to decline prior to ovulation and continues to
decrease until menstruation.

71. In contrast to motor units that fire later during a movement, motor units that fire at the
beginning of a movement Motor unit= 1 motoneuron and muscle fibers it innervates
Small motoneurons innervate a few muscle fibers (type I),
have the lowest thresholds and therefore fire first; have
(A) can be tetanized at a lower frequency of stimulation greater mitochondria content; generate the smallest force
(B) generate a greater amount of force but are highly resistant to fatigue; tetanized at lower freq.
(C) have a greater amount of glycogen stored within them Large motoreurons innervate many muscle fibers (type II),
have highest thresholds and therefore fire last; generate
(D) fatigue more rapidily the greatest force and either fatigue rapidly (IIb) or are
fatigue resistant (IIa); require higher freq to summate
72. A 45-year-old man is studied and found to have a respiratory rate of 15 breaths/min, a tidal
volume of 0.5 L and a dead space of 200 ml. The patient is asked to increase his respiratory rate to
30 breaths/min and his tidal volume is measured at 350 ml. Assuming no change in dead space,
which of the following is true regarding alveolar CO2 tension?

(A) The alveolar CO2 tension will increase because of the decreased ventilation.
(B) The alveolar CO2 tension will increase because of the increased ventilation.
(C) The alveolar CO2 tension will not change because it is not affected by respiration.
(D) The alveolar CO2 tension will not change because alveolar ventilation remains

73. A decrease in the osmolality of arterial blood would lead to an increase in urine volume by

(A) increasing the hydrostatic pressure inside the glomerulus

(B) increasing the permeability of the glomerular capillaries to water
(C) inhibiting antidiuretic hormone (ADH) secretion
(D) stimulating the secretion of aldosterone

74. Stimuli for aldosterone secretion include all the following EXCEPT

(A) angiotensin II
(E) hyperkalemia
(C) hypovolemia
(D) atrial natriuretic peptide (ANP)

75. Alteration in the amount of Ca2+ released from the sarcoplasmic reticulum (SR) alters the
force of contractions in which of the following muscle type or types?

(A) Cardiac muscle

(B) Skeletal muscle
(C) Smooth and cardiac muscle
(D) Smooth, cardiac and skeletal muscle

76. Recruitment of additional muscle fibers alters the force of contractions in which of the
following muscle type or types?

(A) Cardiac muscle

(B) Skeletal muscle
(C) Smooth and cardiac muscle
(D) Smooth and skeletal muscle

77. Amplification of sound stimuli is the function of which component of the auditory system?

(A) Stria vascularis Sound waves are amplified by 2 effects:

(B) Scala media Lever action of the ossicles (malleus, incus, stapes)
Concentration of sound waves from the large tympanic membrane onto the
(C) Auditory ossicles small oval window
(D) Oval window
Scala media= chamber of endolymph that bathes the organ of Corti in the cochlea;
organ of Corti is the site of auditory transduciton
78. Which of the following factors is responsible for regulation of cerebral blood flow?
Cerebral circulation is controlled almost entirely by local metabolites and exhibits
(A) Functional hyperemia autoregulation and active and reactive hyperemia; the most important local vasodilator
is CO2 (or H+); an increase in cerebral PCO2 (producing an increase in H+ concentration
(B) Histamine and a decrease in pH) causes vasodilation of cerebral arterioles, which results in an
(C) Hypertension increase in blood flow to assist in the removal of excess CO2; many circulatory vasoactive
(D) CO2 tension (Pco2) substances do not affect the cerebral circulation because their large molecular size prevents
Text BBB crossing

79. The actions of atrial natriuretic peptide include and increase in

ANP is secreted by the atria in response to increased atrial
(A) Na+ reabsorption in the collecting duct pressure; has multiple effects, but most important is to cause
(B) glomerular filtration rate relaxation of vascular smooth muscle, resulting in vasodilation
(C) extracellular fluid volume and decreased TPR; in the kidneys, vasodilation leads to increased
Na+ and water excretion, thereby decreasing total body Na+, ECF
(D) rennin secretion volume, and blood volume; afferent arterioles are dilated but efferent
are constricted causing increased GFR and decreased Na+ reabsorption
in the late distal tubule and collecting duct
80. Which of the following substances is the most important for the absorption of Ca2+ from the
Ca2+ is absorbed in the small intestine and depends on the presence of the active form of
(A) Intrinsic factor vitamin D (1,25-dihydroxycholecalciferol)
(B) Bile salts
(C) Vitamin D
(D) Trypsin

81. Extracellular bicarbonate ions do not serve as an effective buffer for

(A) sulfuric acid

(B) phosphoric acid
(C) lactic acid
(D) carbonic acid

82. The Kayser-Fleischer corneal ring is associated with which disease?

(A) von Recklinghausen-Applebaum disease

(B) Hepatolenticular degeneration( Wilson's Disease)
(C) Chronic hypoxia
(D) Vitamin D3 deficiency

83. During a pre-employment evaluation for an executive position, a 35-year-old man is found to
have a serum calcium level of 12.4 mg/100 ml (normal 9-11), a serum phosphorus (phosphate) of
2.0 mg/100 ml (normal 3.0-4.5), a serum alkaline phosphatase of 150 U/L (normal 20-70) and a
serum parathyroid hormone of 800 pg/ml (normal 225-650). If untreated, the likely lesion
responsible for these findings will result in consequences mediated by which of the following
mechanisms? (pg. 421 1st Aid 2014)
High Ca2+, ALP and PTH with Low phosphate= describes primary hyperparathyroidsim
(A) Liquefactive necrosis “Brown tumors” due to fibrous replacement of bone, subperiosteal thinning; is either
idiopathic or via parathyroid hyperplasia, adenoma, carcinoma;
(B) Apoptosis (pg. 223) Metastatic Calcification= widespread deposition of calcium in normal tissue
(C) Metastatic calcification secondary to hypercalcemia (ie primary hyperparathyroidism, sarcoidosis,
(D) Oxygen toxicity hypervitaminosis D) or high calcium-phosphate product (eg CRF + secondary
hyperparathyroidsim); calcium deposits predominantly in interstitial tissue of kidneys,
lungs and gastric mucosa

84. Following a football injury, a 16-year-old boy survives a ruptured spleen, hemorrhagic shock and
profound hypotension. However, a period of severe oliguria follows. Which one of the following
renal tubular changes revealed by kidney biopsy represents irreversible cellular injury?
(A) Fatty change Nuclear pyknosis (shrinkage),
Reversible with O2
(B) Formation of cell blebs ATP depletion
karyorrhexis (fragmentation), karyolysis
Cellular/mitochondrial swelling
(C) Formation of myelin figures Plasma membrane damage
Nuclear chromatin clumping
Lysosomal rupture
(D) Nuclear pyknosis Decreased glycogen
Mitochondrial permeability/vacuolization;
Fatty change
phospholipid-containing amorphous
Ribosomal/polysomal detachment
densities within mitochondria (swelling
Membrane blebbing
alone is reversible)

85. A 65-year-old woman fell and sustained a pelvic fracture. The woman died after a short period
of rapidly progressive mental confusion and respiratory insufficiency. Numerous conjunctival
petechiae were noted. These abnormalities were most likely due to which one of the following
conditions? (pg. 603) Pulmonary emboli types: Fat, Air, Thrombus, Bacteria, Amniotic fluid, Tumor (FAT BAT)
Fat- associated with long bone fracture and liposuction, classic triad of hypoxemia,
(A) Epidural hernatoma neurologic abnormalities and petechial rash
(B) Aspiration pneumonia Amniotic- can lead to DIC, especially postpartum
Gas- nitrogen bubbles precipitate in ascending divers; treat with hyperbaric oxygen
(C) Fat embolism
(D) Saddle embolus occluding bifurcation of pulmonary arteries

86. All the following clinical disorders are appropriately matched with effector substances or
cells EXCEPT

(A) a 2-month-old girl with SCID (severe combined immunodeficiency) syndrome who
develops lesions in the skin, gastrointestinal tract and liver following a whole blood
transfusion-mast cells describing TA-GVH, girls immune system cannot defend against donor t-lymphocytes
(B) a severely jaundiced and anemic neonate with a positive direct Coombs (antiglobulin)
test-membrane attack complex (MAC, C5b-9, C5-9) Rh Abs are IgG which cross placenta and fix compliment
(C) a woman with a diffuse goiter, exopthalmos, rapid pulse and warm moist
skin--antireceptor antibody Graves= anti-TSH receptor Ab
(D) a boy with a blistering skin eruption following exposure to poison ivy-CD4+ T cells
Type I Hypersensitivity= anaphylactic/ atopic- free antigen cross links IgE on presensitized mast cells and basophils triggering immediate release of
vasoactive amines (histamines) that act at postcapillary venules; reaction develops rapidly b/c of preformed Ab; type IV involves t cells

87. A 17-year-old girl develops an acute syndrome characterized by low grade fever, lassitude,
pharyngitis, generalized lymphandenopathy and a palpable liver and spleen. A peripheral blood
smear reveals the presence of "atypical lymphocytes." A heterophil test for antibodies reacting
with sheep erythrocytes is negative. Infection with which one of the following viruses is most
Mononucleosis= characterized by lymphadenopathy, hepatosplenomegaly, fever
(A) Cytomegalovirus CMV= Characteristic “owl-eye” inclusions in mononuclear cells; heterophile -
(B) Epstein-Barr virus (EBV) mononucleosis;
EBV= heterophile + mono
(C) Measles virus
(D) Papillomavirus

88. A 70-year-old man is found to have a papillomatous neoplasm of the bladder. Even though
the lesion is extremely well-differentiated, the pathologist makes a diagnosis of transitional cell
carcinoma grade I (urothelial neoplasm of low malignant potential). The distinction of
"malignant" from "benign" in this instance was most likely based on which of the following
known general characteristics of this type of lesion?
pg. 541
Transitional cell carcinoma= most common tumor of urinary tract (can occur
(A) Appearance of oncofetal antigens in renal calyces, renal pelvis, ureters and bladder); painless hematuria (no
(B) Chromosomal aneuploidy casts) suggests bladder cancer; a/w problems in your Pee SAC: phenacetin,
smoking, aniline dyes, cyclophosphamide; histology: papillary growth lined
(C) Loss of contact inhibition in tissue culture by transitional epithelium with mild nuclear atypia and pleomorphism
(D) Clinical behavior
Grade= determined by degree of cellular differentiation and mitotic activity on histology; 1= low grade, well differentiated
Stage= degree of localization/spread on site and size of primary lesion, spread to regional LNs, presence of metastases;
Benign= usually well differentiated, low mitotic activity, well demarcated, no metastasis, no necrosis
Malignant= may be poorly differentiated, erratic growth, locally invasive/diffuse, may metastasize, decreased apoptosis 19
89. A 24-year-old nonsmoker who does not consume alcohol is found to have both pulmonary
emphysema and cirrhosis of the liver. A sister and several close relatives also have had similar
findings. This history suggests that this patients illness may be caused by a deficiency of
a1-antitrypsin deficiency= misfolded gene product protein aggregates in hepatocellular ER leading to cirrhosis
(A) al-antitrypsin (PAS + globules in liver); in lungs decreased a1-antitrypsin leads to uninhibited elastase in alveoli causing
decreased elastic tissue and panacinar emphysema; Codominant trait
(B) galactokinase B= hereditary (AR) deficiency, mild condition, galactose in blood and urine,
(C) glucose-6-phosphatase infantile cataracts; may initially present as failure to track objects or to develop a social smile
(D) phenylalanine hydroxylase C= Von Geirke disease, type I glycogen storage disease; AR deficiency, causes severe
hypoglycemia, hepatomegaly, increased blood lactate, increased glycogen in liver
D= PKU, AR deficiency, tyrosine is essential, increased pheylketones in urine, intellectual
disability, growth retardation, seizures, fair skin, eczema, musty body odor
90. Upper and lower gastrointestinal endoscopic examinations are performed on a 45-year-old
man. A lesion is found and the patient is told that the lesion has NO malignant potential. Of the
following choices, which is the lesion that was most likely found?
A=Adenomatous polyps are precancerous for colorectal cancer (CRC); the more villous
(A) Colorectal villous adenoma the higher cancer risk, also increases with increased size and epithelial hyperplasia;
(B) Crohn disease B=Chron disease carries relative risk of 5.6% for developing colon cancer
(C) Duodenal peptic ulcer C=Duodenal peptic ulcers are generally benign (vs gastric ulcers=increased risk of carcinoma)
D=100% progress to CRC; AD mutation in APC gene, pancolonic, always involves rectum
(D) Familal multiple polyposis

91. A 60-year-old man was seen because of progressive bone deformity and pain, progressive
hearing loss and increasing skull size. Workup revealed generalized increasing bone density with
cortical thickening , normal serum calcium and phosphorus, and markedly elevated serum alkaline
phosphatase. Biopsy revealed a characteristic "mosaic' pattern. Which one of the following tumors
is a known complication of the disorder suggested by this scenario?

(A) Ewing sarcoma Paget’s of bone predisposes to malignant osteosarcoma

(osteogenic sarcoma)
(B) Giant cell tumor
(C) Metastatic duct carcinoma of the breast
(D) Osteosarcoma Note: Paget’s disease of the nipple results from underlying ductal
carcinoma in situ (DCIS); presents as eczematous patches on nipple;
histologically see large cells in epidermis with clear halo; also seen in
vulva but in that case does not suggest underlying malignancy
92. Which of the following pairs of disorders is associated with increased levels of a-feto-protein
(APT)? (AFP)

(A) I-lydatidiform mole and choriocarcinoma

(B) Neural tube defects and hepatocellular carcinoma
(C) Neuroblastoma and pheochromocytorna
(D) Colorectal cancer and breast cancer Elevated AFP seen with: Neural tube defects
(note meningocele= normal AFP); Forebrain anomalies
(i.e. anencephaly), ataxia-telangiectasia, mixed embryonal
carcinoma, teratomas; may be a dating error

AFP is tumor marker for: yolk sac (endodermal sinus) tumors,

hepatocellular carcinoma, hepatoblastoma, testicular cancer,
mixed germ cell tumors

93. A 21-year-old basketball player died suddenly during a game. Autopsy revealed hypertrophy of
the left ventricular wall, especially of the ventricular septum. Histologically, the myocardial fibers
were arranged in a disorganized pattern. Which of the following best characterizes this disorder?
Hypertrophic cardiomyopathy is cause of sudden death in
(A) Can be a manifestation of primary amyloidosis young athletes due to ventricular arrhythmia; 60-70% of cases
are familial, AD (commonly a beta-myosin heavy chain mutation;
(B) Can be a result of mycarditis Finding: S4 systolic murmur; rarely can be a/w Friedreich ataxia;
(C) Often demonstrates autosomal dominant inheritance diastolic dysfunction ensues, myofibrillar disarray and fibrosis,
(D) Is often associated with coronary artery disease ventricular hypertrophy often with septal predominance; (pg. 290)
Restrictive/infiltrative cardiomyopathy a/w amyloidosis; diastolic dysfunction, can have low-voltage ECG despite thick myocardium (esp. w/ amyloid)
Dilated cardiomyopathy a/w Coxsackie B virus myocarditis; systolic dysfunction, eccentric hypertrophy (sarcomeres in series)

94. Which finding would be LEAST expected in disseminated intravascular coagulation (DIC)?
DIC a/w increased BT, PT, PTT, decreased PC
(A) Increased fibrin degradation products Mechanism= widespread activation of clotting leads to
deficiency in clotting factors, which creates a BT
(B) Prolonged activated partial thromboplastin time Causes= STOP Making New Thrombi- Sepsis, Trauma,
(C) Prolonged prothrombin time Obstetric complications, Pancreatitis (acute), Malignancy,
(D) Thrornbocytosis (or Thrombocythemia)= increased platelets Transfusion;
Labs= schistocytes, increased fibrin split products (d-dimers),
Note in von Willebrand disease would see increased BT but decreased fibrinogen and factors V and VIII
normal or increased PTT; PC and PT unaffected
95. Which of the following findings is most likely in the cerebrospinal fluid (CSF) of a 10-dayold
infant with a high fever and nuchal rigidity? CSF Findings in Meningitis
(Opening Pressure) OP Cell type Protein Sugar
Fever + Nuchal Rigidity= Meningitis!
Bacterial up PMNs up down
(A) Decreased protein, decreased glucose Fungal/TB up Lymphos up down
(B) Decreased protein, increased glucose Viral norm/up Lymphos norm/up norm
(C) Increased protein, decreased glucose Causes of Meningitis
Newborns (0-6M)= Group B strep, E coli, Listeria
(D) Increased protein, increased glucose Kids (6M-6Y)= S. pneumoniae, N. meningitidis, H. influ (B), Enteroviruses
6-60y= S. pneumoniae, N. meningitidis (#1 teens), Enteroviruses, HSV
60+= S. pneumoniae, Gram-neg rods, Listeria
96. In an experimental model, an autopsy study of a rat exposed to toxic doses of carbon
tetrachloride (CC14) revealed fatty change and necrosis of hepatocytes. The mechanism of cell
injury exemplified here is
(pg. 224) Free radicals damage cell via membrane lipid peroxidation, protein modification
(A) activation of apoptosis and DNA breakage; can be eliminated by enzymes (glutathione peroxidase, catalase,
superoxide dismutase), spontaneous decay, antioxidants (vitamins A, C, E);
(B) acute phase reaction
(C) arrest of cell cycle Pathologies include: retinopathy of prematurity, bronchopulmonary dysplasia, reperfusion
injury (esp. after thrombolytic therapy), iron overload (hemochromatosis), Acetaminophen OD
(D) free radical injury (fulminant hepatitis, renal papillary necrosis), CCl4 leading to liver necrosis (fatty change)

97. Mutations of the ras oncogene result in a protein product that has
RAS a/w colon, lung, pancreatic cancer; gene product= GTPase
(A) decreased GTPase activity Oncogenes cause gain of function= increased
(B) decreased reverse transcriptase activity cancer risk; only 1 allele need be damaged for
(C) increased protein phosphatase activity expression of disease
Tumor Suppressor Genes cause loss of function=
(D) increased responsiveness to growth factors increased risk of cancer; both alleles must be lost
for expression of disease

98. A 68-year-old woman presents with fever, chills and cough productive of blood-tinged
sputum. Fluid aspirated from the right pleural space would most likely
S. pneumoniae #1 cause pneumonia in adults and elderly
(A) be clear and straw colored in appearance.
(B) contain large numbers of neutrophils.
(C) have a glucose content somewhat higher than the serum glucose .
(D) have a protein content of less than 1g/cll.

99. Prior to the birth of a still-born infant, decreased amniotic fluid (oligohydramnios) for
gestational age was demonstrated on ultrasound examination. Which of the following autopsy
findings of the stillborn is most consistent with this maternal-fetal abnormality?

(A) Infection with Toxoplasrna gondii along with microcephaly, hydrocephaly, chorioretinitis
and micropthalmia
(B) Infection with rubella virus along with microcephaly and heart malformations
(C) Infection with cytomegalovirus along with microcephaly, hepatitis and intracranial
calcifications p.522- Potter Sequence (syndrome)= oligohydraminos via
(D) Bilateral renal agenesis and hypoplasia of one lung ARPKD, posterior urethral valves, or bilateral renal agenesis;
a/w pulmonary hypoplasia, twisted face and skin, extremity
defects, renal failure (in utero)

100. An adult patient is evaluated for splenomegaly. Which of the following sets of associated
findings would be LEAST likely?

(A) Atypical lymphocytes and sheep cell agglutinins EBV

(B) Anemia and positive sickle cell preparation Sickle Cell causes autosplonectomy (howell-jolly bodies)
(C) Marked leukocytosis, many immature granulocytes and increased number of basophils CML
(D) Spherocytosis and acholuric jaundice Hereditary Spherocytosis

101. All the following are associated with carcinoma of the urinary bladder EXCEPT
Transitional Cell Carcinoma of Bladder= a/w aniline dyes
Squamous Cell Carcinoma of Bladder= chronic irritation of bladder leads
(A) early hematogenous metastasis. to squamous metaplasia they dysplasia and carcinoma; risk factors incl.
(B) hematuria. Schistosoma haematobium (middle east), chronic cystitis, smoking,
chronic nephrolithiasis;
(C) high recurrence rate. Both= painless hematuria
(D) increased incidence in analine dye workers.
Carcinomas typically spread lymphatically and sarcomas hematogenously; exceptions to carcinomas= renal cell, hepatocellular,
follicular carcinoma of thyroid and choriocarcinoma, which all spread hematogenously
102. Which of the following parathyroid disorders is characterized by renal end-organ

(A) Primary hyperparathyroidism

(B) Secondary hyperparathyroidism Pseudohypoparathyroidism type Ia= Albright’s Hereditary Osteodystrophy
(C) Pseudohypoparathyroidism - AD disorder, hypocalcemia, shortened 4th/5th digits, short stature
(D) Tertiary hyperparathyroidism - is the result of defective Gs protein in kidney and bone, which causes
end-organ resistance to PTH

103. A 56-year-old woman presents with bone pain, diffuse demineralization of bone,
hypercalcemia, anemia, hypergammaglobulinemia, proteinuria and normal serum alkaline
phosphatase. This set of findings is most suggestive of
Signs of Multiple Myeloma: clasma cell cancer, primary bone tumor in
(A) Ewing sarcoma. adults, is a hyperproteinimic state
Bone pain- increased clasts= lytic lesions, hypercalcemia
(B) hyperparathyroidism. Anemia
(C) multiple myeloma. Renal Failure
(D) osteomalacia. Infection
Neurologic symptoms
Monoclonal antibody spike- usually IgG or IgA (hypergammaglobulinemia)

104. Which of the following organisms is dimorphic?

(A) Viruses Dimporphs:

Coccidiodomycosis= spherule filled with endospores; California, San Joaquin “valley fever”
(B) Fungi Blastomycosis= broad-base budding; Mississippi River, Central America
(C) Prions Histoplamosis= bird and bat poop; hides in macrophages; Mississippi and Ohior
Paracoccidioidomycosis= “captain’s wheel” budding yeast; Latin America
(D) Bacteria Sporothrix schenkii= cigar-shabed budding yeast; rose gardeners disease

105. Which type of phage is used in phage-typing?

Prophages= endogenous, active, insert genome into hosts DNA for replication
(A) Prophage Temperate phages= dormant, may incorporate their DNA into hosts DNA and
(B) Virulent phage replicate with it
(C) Temperate phage Filamentous phages= make house continuously secrete new virus particles,
usually contain a genome of SS DNA
(D) Filamentous phage

106. What type of bacteria lack superoxide dismutase?

(A) Heterotrophs
(B) Aerobes
(C) Obligate anaerobes Lack catalase and/or superoxide dismutase and are thus susceptible to oxidative damage
(D) Facultative anaerobes

107. Bacterial antibiotic resistance is frequently conveyed by

(A) a temperate bacteriophage.

(B) an R factor plasmid.
(C) a replicon.
(D) a lytic bacteriophage.

108. The expression of the lac operon Allolactose is an inducer that binds to the
repressor protein changing its confirmation
so that it cannot recognize the operator
(A) must be initiated by the binding of an inducer protein. and expression of the lac operon takes place
(B) involves the release of allolactose from a repressor protein.
(C) does not involve the expression of structural genes.
(D) necessitates the finding of RNA polymerase followed by transcription.

109. Which of the following requires cell-cell contact?

(A) Transformation
(D) Conjugation
(C) Transduction
(D) Transcription

110. Which of the following organisms is anaerobic?

Obligate anaerobes= Can’t Breathe Air
(A) Nocarclia Bacteroides
(B) Actinomyces Actinomyces
(C) Mycobacteria
(D) Pseudomonas Obligate aerobes= Nagging Pests Must Breathe
111. Which of the following organisms grows in 40% bile?

(A) Enterococcus faecalis S. pneumoniae= bile soluble (lysed by bile)

Viridans group= bile insoluble (not lysed by bile)
(B) Streptococcus pneumoniae
(C) Group B streptococci
(D) Viridans streptococci

112. Which of the following organisms causes relapsing fever and is transmitted by lice or ticks?

(A) Treponema Lice bourne relapsing fever is carried/transmitted by

(B) Borrelia Brucella recurrentis, Rickettsia prowazekii (endemic typhus), and Bartonella quintana
(C) Leptospira
(D) Bruce/la

113. Which of the following organisms invades mucosal epithelial cells?

(A) Vibrio cholerae Shigella invade cells lining the colon, they replicate within in the host cell
(B) Vibrio parahaemolyticus cytoplasm (unlike salmonella, which do so in a vacuole) and thy spread
(C) Salmonella typhi by cell to cell transmission, evading host immune response (salmonella
spread hematogenously); shigella causes infiltration of PMNs in turn destabilizing
(D) Shigella sonnei the integrity of the intestinal cell wall and giving them access to deeper epithelial cells

114. Which of the following is the most frequent cause of blood transfusion-associated hepatitis?
Virus Transmission
(A) Hepatitis A virus HAV Fecal-oral
(B) Hepatitis B virus HBV parenteral, sexual, maternal-fetal
HCV primarily blood (IVDU, post-transfusion)
(C) Hepatitis C virus HDV parenteral, sexual, maternal-fetal
(D) Hepatitis D virus HEV fecal-oral, especially with waterborne epidemics

115. Linear, single-stranded DNA is the genetic material of

(A) caliciviruses
(B) flaviviruses
(C) papovaviruses smallest virus, only SS DNA virus
(D) parvoviruses

116. Which of the following is an RNA virus that has a nuclear phase to its replication process?

(A) Coronavirus Corona= Enveloped, SS + linear

Rhabdo= Enveloped, SS - linear
(B) Rhabdovirus Retro= Enveloped, SS + linear; have reverse transcriptase (synthesizes dsDNA from RNA,
(C) Retrovirus dsDNA integrates into host genome)
Toga= Enveloped, SS + linear
(D) Togavirus

117. A 15-year old dirt biker visiting southern California has pneumonia caused by an organism
whose environmental form consists of hyphae that break up into arthroconidia, which become
airborne. What is the agent?

(A) Aspergillus fumigatus Cocci immitis is a dimorph; has barrel-shaped arthroconidia formed in hyphae
at room temperature; forms endospore filled “spherules” in tissues; causes Valley
(B) Blastomyces dermatitides Fever endemic to southern California
(C) Coceidioides immitis
(D) Histoplasma capsulatum

118. What is the scientific name for a fungal cross-wall?

(A) Coenocyte
(B) Hypha
(C) Mycelium
(D) Septum

119. What characteristically sets fungal cells apart from human cells?

(A) 80S ribosomes

(B) Presence of an endoplasmic reticulum
(C) Egosterol as the major membrane sterol We have cholesterol
(D) Enzymes that allow them to use carbon dioxide as their sole carbon source

120. A patient whose major source of protein is smoked and cooked fish develops what appears to
be pernicious anemia. What parasite is noted for causing a look-alike vitamin B 12 anemia in
certain genetically predisposed infected individuals?

(A) Echinococcus granulosus

(B) Diphylobothrium latum Fish tape worm, causes malabsorption of B12
(C) Hymenolepis nana
(D) Dipylidium caninum

121. How is Leishmania donovani transmitted?

(A) Anopheles mosquito bite Malaria

(B) Black fly bite Onchocerca volvulus= River Blindness
(C) Culex mosquito bite St. Louis and West Nile Encephalitis
(D) Sandfly bite

122. Which of the following is the tapeworm acquired from eating undercooked pork?

(A) Trichinella spiralis Trichinosis via ingestion of undercooked pork that contains encysted larvae
(B) Taenia soliwn Taenia solium= pork tapeworm
(C) Taenia saginata Taenia saginata= beef tapeworm
(D) Echinococcus granulosus associated with sheep farmers, humans are accidental host, eggs ingested, larva hatch
and penetrate the intestinal wall, enter circulation and are carried to various tissues,
primarily liver and lungs but brain and bone also common

123. To which of the following classes of immunoglobulins (Ig) do the allergy-mediating

antibodies belong?

(A) IgD
(B) IgA
(C) IgM
(D) IgE

124. What type of hypersensitivity reaction is responsible for myasthenia gravis?

(A) Type I (anaphylactic) hypersensitivity reaction

(B) Type II (cytotoxic) hypersensitivity reaction
(C) Type III (immune complex) hypersensitivity reaction
(D) Type IV (delayed) hypersensitivity reaction

125. Which of the following is the receptor for interleukin (IL)-2?

(A) CD4 IL 2 stimulates growth of helper, cytotoxic and regulator T cells

(B) CD8 CD25 of regulatory T cells binds alpha chain
Text (C) CD25
(D) CD3

126. Which of the following immunoglobulins (Ig) is at its highest level in a normal adult?
IgG= main antibody in delayed response; most abundant in serum; fixes complement, crosses placenta,
opsonizes bacteria
(A) IgA IgA= prevents bacteria and virus attachment to mucous membranes; does not fix complement; released in
secretions; most abundant produced overall
(B) IgG IgM= produced in immediate response to antigen; fixes complement; doesn’t cross placenta; monomer on
(C) IgM B cells; pentamer when secreted
IgE= binds mast cells and basophils; mediates type I hypersensitivity through release of histamine (etc.);
(D) IgE mediates immunity to worms by activating eosinophils; lowest concentration in serum
IgD= function unclear
127. Which of the following is the antidote for the toxin Benzodiazepines?

(A) Flumazenil
(B) Methylene blue
(C) Deferoxamine
(D) Alkalinize urine

128. Which of the following is the antidote for the toxin Lead? EDTA, dimercaprol, succimer, penicillamine

(A) Naloxone Opiods

(B) Nitrite + Thiosulfate for Cyanide
(D) Dialysis Methanol ethylene glycol (antifreeze)

129. Which of the following is the primary site of activity for the drug Warfarin?

(A) Kidney
(B) Liver
(C) Blood Heparin
(D) Heart

130. Which of the following drugs is associated with the reaction of Cinchonism?

(A) Valproic acid

(B) Quinidine and Quinine
(C) Isoniazid
(D) Ethosuximide

131. Which of the following drugs is associated with the reaction of Stevens-Johnson syndrome?
Anti-epileptic drugs (ethosuxamide, carbamazepine, lamotrigine, phenytoin, phenobarbital)
(A) Valproic acid Allopurinol
Sulfa drugs
(B) Quinidine Penicillin
(C) Isoniazid
(D) Ethosuximide

132. Which of the following drugs is associated with the reaction of Tendon dysfunction?
Flurooquinolones= Ciprofloxacin, norfloxacin, levofloxacin, ofloxacin (the -oxacins), and
nalidixic acid; inhibit DNA gyrase (topisomerase II) and topoisomerase IV; cannot take
(A) Digitalis with antacids; tx gram negative rods of urinary and GI tracts (including pseudomonas),
(B) Niacin Neisseria and some gram positives
(C) Tetracycline
Most common SE= GI upset, superinfections, skin rashes, headache, dizziness; less
(D) Fluoroquinolones commonly cause tendonitis, tendon rupture (pts >60Y and in those taking prednisone),
leg cramps and myalgias

133. A drug ending in the suffix (tidine) is considered a

(A) Antidepressant -etine (SSRIs), -ipramine (TCA), -triptyline
(B) Protease inhibitor -navir (Ritonivar)
(C) Beta antagonist -olol
(D) H2 antagonist

134. Which of the following drugs is associated with the reaction of extreme photosensitivity?
Photosensitivity= STAT For Photo
Sulfonamides, Amiodarone, Tetracyclines, 5-Fu
(A) Digitalis Gynecomastia
(B) Niacin Facial flushing via prostaglandin not histamine, hyperglycemia, hyperuricemia
(C) Tetracycline
(D) Fluoroquinolones

135. Which of the following is not related to a drug toxicity of Prednisone?
SE: weight gain, central obesity, muscle breakdown, cataracts, acne, osteoporosis,
(A) Cataracts hypertension, peptic ulcers, hyperglycemia, psychosis
(B) Hypotension Iatrogenic Cushing Syndrome= buffalo hump, moon facies, truncal obesity, muscle
(C) Psychosis wasting, thin skin, easy bruisability, osteoporosis, adrenocortical atrophy, peptic ulcers,
diabetes (if chronic)
(D) Acne Adrenal insufficiency when drug stopped abruptly after chronic use

136. Which of the following is not related to a drug toxicity of Atenolol?

Class II Antiarrhythmics: Beta Blockers

(A) CHF SE= impotence, exacerbation of COPD and asthma, cardiovascular
(B) Tachycardia effects (bradycardia, AV block, CHF), CNS effects (sedation, sleep alterations),
may mask signs of hypoglycemia
(C) AV block
(D) Sedative appearance

137. Which of the following is not considered a class IA Sodium Channel blocker?
IA= “The Queen Proclaims Diso’s pyrmaid”
Quinidine, Procainaimide, Disopyramide
(A) Mexiletine IB (Amiodarone can be classified under every class)
(B) Amiodarone
(C) Quinidine
(D) Procainamide

138. Which of the following is not directly related to a drug toxicity of Ibuprofen?

SE of NSAIDs= interstitial nephritis, gastric ulcer, renal ischemia

(A) Nausea Ibuprofen causes hemolysis in G6PD
(B) Renal dysfunction
(C) Anemia
(D) Muscle wasting

139. Which of the following is not a side effect of the Ace Inhibitor (Captopril)?
Captopril’s CATCHH: (1st Aid)
Cough (dry), Angioedema (contraindicated in Cl esterase inhibitor deficiency),
(A) Rash Teratogen (fetal renal malformations), increased Creatinine (decreased GFR),
Hyperkalemia and Hypotension;
(B) Angioedema
(C) Cough (wikipedia) CAPTOPRIL= Cough, Angioedema, Proteinuria, Taste change, hypOtension,
(D) Congestion Pregnancy problems, Rash, Increased renin, Lower pressure (lack of vasoconstriction)

140. Which of the following is not a side effect of the Vasodilator (Nifedipine)?
SE of CCBS: Cardiac depression, AV block, peripheral edema, flushing, dizziness,
hyperprolactinemia, constipation; Verapamil and Nifedipine also causes
(A) Nausea gingival hyperplasia
(B) Flush appearance
-dipines= Dihdyropyridine CCBs
(C) Vertigo Diltiazem, verapamil= Non-dihydropyridine CCBs
(D) Sexual dysfunction
Beta blockers and H2 blockers cause
impotence; SSRIs cause decreased
libido and anorgasmia
141. Which of the following is not a side effect of the Sympathoplegics (Clonidine)?

SE= CNS depression, bradycardia, hypotension, respiratory

(A) Hypertension depression, small pupil size
(B) Asthma
(C) Dry oral cavity
(D) Lethargic behavior

142. Which of the following is not an effect of the drug (Midazolam)?

Most common drug used for endoscopy; used adjectively with gaseous
anesthetics and narcotics; may cause severe postoperative respiratory depression,
(A) Amnesia decreased BP and anterograde amnesia
(B) Decreased respiratory function
A benzodiazepines, which are used for general anesthesia because
(C) Anesthetic of amnesia and muscle relaxation; midazolam is an exception to
(D) Dizziness the typical long half-lives of benzo’s and is short acting

143. Which of the following is not an effect of the drug (Clozapine)?

Atypical antipsychotic used to tx Schizophrenia (+ and - symptoms),
bipolar disorder, OCD, anxiety, depression, mania, Tourettes
SE= Clozapine causes significant weight gain,
(A) Agranulocytosis agranulocytosis and seizures
(B) Antipsychotic
(C) Used for Schizophrenia
(D) Increased appetite *Weight gain is due to impaired glucose metabolism not increased appetite

144. Which of the following is not treated with (Epinephrine)?

Anaphylaxis, open angle glaucoma, asthma and hypotension

(A) Renal disease

(B) Asthma
(C) Hypotension
(D) Glaucoma

145. Which of the following are not treated with opioid analgesics like (dextramethorophan and

(A) Pulmonary Edema Dextromethorphan= antitussive (antagonizes NMDA glutamate receptors);

a synthetic codeine analog;
(B) Cough suppression Methadone= maintenance programs for heroin addicts
(C) Sedation Other uses of opioid analgesics= pain, diarrhea (loperamide, diphenoxylate),
(D) Pain acute pulmonary edema

146. Which of the following is not treated with Hydrochiorothiazide?

Thiazide diuretic, inhibits NaCl reabsorption in early distal tubule,

(A) CHF decreased diluting capacity of the nephron, decreases Ca2+ excretion;
(B) Hypertension used for hypertension, CHF, idiopathic hypercalciuria, nephrogenic diabetes
insipidus, osteoporosis;
(C) Nephritis SE= HyperGLUC- hypokalemic metabolic alkalosis, hyponatremia, hyperGlycemia,
(D) Hypercalciuria hyperLipidemia, hyperUricemia, and hyperCalcemia; and sulfa allergy

147. Which of the following are not treated with Methotrexate?

(A) Sarcomas Clinical Uses:

Cancers- leukemias, lymphomas, choriocarcioma, sarcoma
(B) Leukemias Non neoplastic- abortion, ectopic pregnancy, RA, psoriasis, IBD
(C) Ectopic pregnancy
(D) Rheumatic fever

148. Which of the following are not treated with Dexamethasone?

Clinical Uses of Glucocorticoids:
Addison’s disease, immune suppression, asthma
(A) Inflammation
(B) Asthma
(C) Addison's disease
(D) Wilson's disease treat with-Penicillamine or Trientine

149. Which of the following are not treated with Lansoprazole?

Proton Pump Inihibtors (-prazole) clinical uses:

(A) Zollinger-Ellison syndrome Peptic ulcer, gastritis, esophageal reflux, Zollinger-Ellison syndrome
(B) Gastritis
(C) Hypertension
(D) Relax REFLUX

150. Which of the following is the antidote for the toxin Heparin?

(A) Protamine
(B) Methylene blue Methemoglobin
(C) N-acetyleysteine Acetominophen
(D) Glucagon Beta Blockers