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 1:1 and 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 rceiving 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 0.08
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 a
herbicide and non-hodgkin's 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 reaarangement
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 (INR-1.0) 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 non-selective 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 a 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 height ans 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 aproximatly 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, BP140/100 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, 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 multipe
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-spcific 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. Apppearance 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
lymphycytic 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 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?
(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 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?
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) Gastroesophageal 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 minobutyric acid, dopamine, enkephalin, serotonin, substance P
27) 15 yr old boy, 63 and weights 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 doesnot 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 pain. 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 encounterd 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 bee 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 smokes 2 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 don't 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 behavioural 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
transplant from his first cousin.Two weeks after the transplant he develops a generalized
erythematous, maculopapular rash, diarrhoea 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 host cells
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)plama 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 influenzae
C ) Neisseria meningitidis
D ) Salmonella species
E ) Streptococcus pneumoniae

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 of the 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 IgE mediated 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 hiss mother because of a 1 year h/o cough
productive of mucoid sputum, wheezing and SOB with exertion. H ehas 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 pitutary
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)Guanylyl 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 increses with chronic dosing.
C)Morphine downregulates 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)Defective detoxification 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. asuming 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
b6.5
c7
d7.5
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. 26 month old boy with SOB & cough who had cutaneous abscesses caused by S. aureus.
febrile, x-ray shows cavitary infiltrate of left lingula. 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 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) Transsforming 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
automoblile plant .different location in the manufacturing plant have different levels of ambient
noise .each employe is given a test for hearing acuity and the 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 erytrhopotein 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%
Wich of the following enzymes is most likely inhibited indirectly by increase of glucose
concentration
a. Aldolase
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 communiating
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 an 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 shrtly 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
adminster 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 influenzae
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
splanchopleuric mesoderm?Neuroectoderm
96. 52 yo comes in with 3 week history of polydipsia, polyuria and weight loss. he's 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, vincristine). pmn is below 500. temp is 102.6. chest xray shows left
lower lobe infiltrate and pleural effusion on the left. there is a pas thoracocentesis pic shown.
what treatment should be given?
amphotericin b
ertapenem
ganciclovier
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 los. 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 followning 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
lymphocye infiltrating sheets that are neither glandular nor squamous in origin.serum
abnormalities?
1 hyperkalemia
2hyperlipidemia
3 hypmagesemia
4hypoalbuminemia
5 hypogylcemia
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?
cental vacuolization with gycogen
central vacuolization with lipid
mitochondia increase
mucopolysaccharide
PAS + myofibrillar vacuolization
segmental ishemic 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 intervertbral disc
C) Leaking aortic aneurysm

D) Leaking left renal artery aneurysm

E) Perforated rectum
F) perforated sigmoid colon
118. Male with a 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 PraderWilli syndrome (PWS).
Karyotyping and uorescent in situ hybridization studies do not show deletion in the usual site on
chromosome 15. Which of
the following ndings is most likely to conrm PWS in this child?
~ A) Deletion in the short arm of chromosome 15
B) Duplication within chromosome 15
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 stenosis in 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
Greater pancreatic, 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 aected 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 diagnosis?
A) Adjustment disorder with depressed mood
B) Avoidant personality disorder
C) Bipolar disorder
D) Dysthymic disorder
E) Major depressive disorder
F) Schizoaective 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 minmech 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. Exanm shows no
abnormalities. which vaccine coulda prevented this stuff?
diphteheria tetanus acellular 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, enteroendocrine, 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, ecchymoses over trunk and extremities. Blood smear shows giant
granules in neurtophils and eosinophils. I know this is chediak higashi lol but still wanna double
check
acute myeloblastic leukemia, ataxia telangiectasia, chediak higashi syndrome, leukocyte adhesion
deficency, 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
osteoblastic 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. what's 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-spcific caspase
B) Binding of Fas ligand to receptor
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 epigatric pain and frequent stool. She had two episodes of
renal calculi during the past 2 yrs. Physical exam shows multiple superficial 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 syndrom...so check Parathyroids---> 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)
lymphycytic 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) 28 yr 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
spinathalamic 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 hypertension 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