A 25-year-old woman comes to the physician because of a 3-year history of

irregular menses. Menarche was at the age of 14 years. Puberty began at the
age of 12 years and progressed normally. Her blood pressure is 116/62 mmHg.
Physical examination shows increased hair growth on the face and chest. Pelvic
examination shows clitoromegaly and a normal-appearing uterus. Serum studies
show increased concentrations of 17-hydroxyprogesterone and androstenedione.
This patient most likely has a deficiency of which of the following enzyme
activities?
A) 11-Hydroxylase
B) 17a-Hydroxylase
C) 21-Hydroxylase
D) 3-Hydroxysteroid dehydrogenase
E) 5a-Reductase
A 15-year-old girl comes to the physician's office for a health maintenance
examination Her mother was recently diagnosed with squamous cell carcinoma
of the face and her maternal grandfather died of metastatic melanoma. During
the visit, the physician advises her about methods of photoprotection including
daily use of a sunscreen. In a patient of this age which of the following factors is
most likely to predict compliance with photoprotection?
a Ability to tan
b Advice of the physician to wear sunscreen
c Concern about premature aging of skin
d Desire to prevent sunburn
e Family history of skin cancer
f Use of sunscreen by her peers
A 40-year-old African American woman comes to the physician because of a 2week history of fever, malaise, and dyspnea. Her temperature is 36.7C (98F),
and respirations are 20/min. Physical examination shows erythema nodosum,
parotid enlargement, and hepatosplenomegaly. Her serum calcium concentration
is 16 mg/dL. A CT scan of the chest shows bilateral hilar adenopathy. Serum
studies are most likely to show an increased concentration of which of the
following?
A Calcitonin
B Cholecalciferol
C 1,25-Dihydroxycholecalciferol
D 24,25-Dihydroxycholecalciferol
E Parathyroid hormone
1 a 55 year old woman has left flank pain and gross hematuria. a mass is
palpable in the left upper quadran of the abdomen. abdominal ultrasonography
shows a 12 cm solid mass on the lower pole of the left kidney. angiogram shows
hypervasc mass.
a nephrobastoma
b papillary transitional cell ca
c renal cell adenocarc
d renal cell adenoma
e squamous cell ca

a 53 year old man who recently returned from africa, has fever, headache and
abdominal disconfort. he received appropiate vaccinations prior to the trip. his
temp is 39. physical exam no abnorm. a peripheral blood smears is shown (cant
show the image). dx?
a babesiosis
b leishmaniasis
c malaria
d toxop
e trypanosomiasis

2 a 40 year old woman comes to the physician because of a 1 year history of

episodes of crampy abdominal pain, intermittent diarrhea, and rectal bleeding
with passage of mocus. she is 173 cm tall and weighs 55kg. BMI 18. abdominal
exam shows diffuse tenderness with no rebound tenderness. sigmoidoscopi
shows diffuse ulcers, initial tx?
a amoxicillin
b bismuth subsalicylate
c loperamide
d octeotide
e sulfasalazine (maybe?)
3 a 50 year old man comes tot he physician because of a persistent cough for
the past 2 months. he has had a 5 kg weight loss during this period. he is a
farmer and started itraconazole or 4 weeks ago for histoplasmosis. current med
hydrochlorothiazide, enalapril, atenolol, omeprazole and metoclop. he appears
thin. physical exam shows no other abdn. an interaction betwn itraconazole and
which of the following accounts for the lack of effect of itraconazole?
a atenolol
b enalapril
c hydroclorot
d metoclopramide
e omeprazole
4 a previously healthy 17 year oldgirl is brought tot he emergency department
because of a 1 day hsitory of shortness of breath, weakness, and muscle
tenderness. she completed a triathlon the previous day, appears restless. bmi
19, tem 38, bp 150.90. bilateral crackless at lower lungs, muscle tenderness.
creat 4 mg/dl. urinalisis 3 protein and 4 hemog. inc realease of?
a aldolase
b ck
c hemogl
d myog
e troponin I

A physician is sad because he has to inform a patient of progression of

carcinoma to terminal phase. When the patient sees the physician's face, he
begins to cry and says, "it's bad news, isn't it? Which of the following responses
is most appropriate?
A) How have you been since the last time I saw you?
B) Let's talk about the positive aspects first.
C) Look on the bright side of things.
D) Tell me how you are feeling.
E) There are other people who have it a lot worse than you.
F) Yes, it is.
G) You've had several years better off than many others with this disease.

8.old woman with DVT. Platelet dropped significantly after a week of tx. Drug of
action?
a. activate tissue plasminogen -----action of tPA
b. Interferes with carboxylation of coag factors ----action of warfarin
c. irreversibly inactivate COX -----Aspirin
d. Potentiates the action of antithrombin iii (correct answer, action of Heparin,
and this is Heparin induced Thrombocytopenia HIT)
e. selectively inhibits factor Xa (Heparin does thrombin factor 2 and factor Xa)
--------------------------------------------------------------14.ER doctor successfully delivered a baby, womanis now having severe
bleeding. Pelvic exam shows an ope cervix and heavy vaginal bleeding. Ligation
of a branch of which of the following arteries is most appropriate?
a. external iliac (gives femoral and inferior epigastric artery)
b. internal iliac ( Correct answer I think, bcz Uterine artery is a branch of internal
iliac artery)
c. internal pudendal (supplies the external structure, but also a branch of internal
iliac)
d. median sacral (supply coccyx)
e. Obturator (gives blood supply to the leg obturator muscles)
32. A guy with chrons disease. You give antibiotics and prednisone, he got better
in 3 weeks, in addition to resolving the infection, the most likely MOA of this
pharmacotherapy is which of the following?
a. antibody binding
b. complement activity
c. mast cell degranulation
e. neutrophil function
f. T-lymphocyte function (prednisone supresses both B and T cell = decrease
cytokines)
I marked e. but it's wrong....so I'm guessing T-lymphocyte fumction F? as to
decrease T and B cell couns. However, neutrophil count is increased.
----------------------------------------------------------------------------------

10. 45 year old lady diagnosed with invasive ductal cell CA breast . she was
started on tamoxifen and serum analysis showed decreased conc. of enoxifen
the active metabolite of prodrug tamoxifen. Genetic analysis showed
homozygous presence of CYP450 2D6*4 alleles. WHich of following best
represents the likelihood that this patient sister has same alleles?
1.0% 2. 25% 3. 50% 4. 75% 5 100%
Can anyone solve for this one??? thanks!
-------------------------------------------49. Old man with 2 year history of decrased force of his urinary stream and
increase frequency. BUN is 55 and Creatinine is 5. Ultrasound of Urinary tract
shows bilateral hydronephrosis and dilated ureters. What is the mechanism of
this patient's renal failure?
a. Decreased hydrostatic pressure in the glomerular capillary
b. decreased renal plasma flow
c. Increased hydrostatic pressure in Bowman space
d. Precipitation of protein in the renal tubules
e. Precipitation of uric acid in the renal tubules
--------------------------------------------------------------------4. A 27 yo woman with fever, malaise, abdominal pain, vaginal discharge for 4
days. Pregnancy test is negative, Leukocyte count is up. Bilateral lower quadrant
tenderness with rebound and guarding. Pelvic exam shows cervical bilateral
adnexal tenderness. Most likely diagnosis?
a. appendicitis
b. bacterial vaginosis
c. Chancroid
d. Diverticulitis
e. Gonorrhea
f. Herpies genitalis
g. Trichomonias
Gonorrhea...I picked chancroid on the exam...because I thought chancroid can
have those bubonic thing bilaterally....i guess the answer is gonorrhea?!
------------------------------------------6. A study is designed to evaluate the efficacy of coenzyme Q10 in improving
cardiac output in pts with CHF. 60 pts with CHF are recruited for the study. Each
subject is assigned by coin toss to one of two groups (standard care or standard
care plus coenzyme). Which of the following best describe this study design?
a. case-control
b. case-series
c. Crossover
d. Cross-sectional
e. Historical cohort
f. Randomized clinical-trials
I'm guessing F. is the correct answer bcz by giving q10, you're giving a treatment
(intervention) to the study. And the coin toss gives the randomness.
a. Case-control: have 2 groups, one health as the control and one diseased.
Trying to evaluate the risk factor. So the example will be: 60 pt with CHF drink
more and smoke more. Healthy individuals smoke and drink less. Risk factors are
smoking and drinking alcohols.

d. Cross-sectional: snap shot, trying to find out in a population who have CHF. You
know the prevalence but not incidence.
e. I don't think it is either retrospective or prospective
---------------------------------------------------------------------A guy completed amoxillin develop watery-brown stools in the past 24 hours.
Clostridium difficile toxin is positive. Pathological finding is most likely to be
present?
a. Bacterial Overgrwoth of the colonic surface
b.Flask-shaped ulcers in the colon
c. Giardia trophozoites linning the duodenal mucosa
d. Necrotizing granulomatous inflammation
e. PEsudomembranes of fibrin and inflammatory debris
They want us to pick e. But I have seen many qbank and wiki sources say a). Can
someone tell me why not AAAAAAAAAAAAAAA??
--------------------------------------------------------A 1 week old girl screening sho a possible defectin fatty acid oxidation, physical
exam shows no abnormality. Which of the following is the most appropriate next
step in diagnosis?
a. arterial blood gas analysis
b. measurement of serum acylcarnitine conc.
c. measurement of serum amino acid conc.
d. measurement of serum electrolyte conc.
e. measurement of serum lactic acid conc.
-------------------------------------------------------------34. 40 yo woman has a mole on her back that has increased in size during the
past 4 mo. PE shows Raise irregular lesion with variegated black-tan
pigmentation and ill-defined margins. Examination of tissue from the tissue
shows pleomorphic, hyperchromatic cells within clear islands that tend to
coalesce and are present at all levels of the epidermis, with extension into the
paipillar dermis. What is it?
a. basal cell carcinoma
b. blue nevus
c. cafe au lait spot
d. intradermal nevus
e. lentigo simplex
f. melanoma
g. seborrheic keratosis
I think it is f melanoma
------------------------7. A 42 year farmer has a 7mm red scaly plaque on helical rim of left ear . A
photomicrograph of tissue obtained on biopsy of plaque is shown. whats the
diagnosis ( Picture was shown)
a. Actinic keratosis b. Basal cell CA c. Keratocanthoma d. Malignant melanoma e.
Merkel cell CA
I think it's a. actinic keratosis

1) 25 year old female, hx of joint pain unresponsive to aspirin treatment, with bilateral
swelling of proximal interphalangeal joints, metacarpophalageal joints, and the wrists; there
is weakness of grasp. Small nodules palpated beneath the skin around the joints of fingers.
Dx?
a) gout
b) osteoarthritis
c) RA
d) SLE [wrong]
e) systemic sclerosis
2) 15y/o girl emigrant from india, several lesions on her neck for 2 weeks. PE
hypopigmented, hypoesthetic area over left side of forehead and 4cm lesions on neck. Biopsy
specimen shows acid-fast bacilli. Which of the following explains why the organism results in
dermal rather than in visceral infectins?
a) CO2 requirement
b) innate antibacterial compounds
c) lipid content
d) oxygen tolerance [wrong]
e) temperature sensitivity
3) Abnormal pap smear. Biopsy shows microinvasive cervial carcinoma. which of the
following microscopic features led to the dx?
a) full thickness of epithelium occupied by neoplastic cells [wrong]
b) more than half of the epithelium occupide by neoplastic cells
c) neoplastic cells in sub-basement membrane connective tissue
d) neoplastic cells invading blood vessels
e) neoplastic cells invading nerves

A 6 week old girl is brought to the physician by her mother because of 6 day history of
vomitting a small amount of milk 2-3 times daily. She appears well. She is at the 50th
percentile for length and weight. Physical examination shows now abnormalities. Which of
the following is most likely cause of the patients findings.
A. Esophageal spasm
B. Gut malrotation
C. Immature lower esophageal sphincter
D. Neuromuscular abnormality of esophagus
E. Pyloric Stenosis
F. Tracheoesophageal fistula
-----------------------------------------------------------------------------------A protein found in the brown adipose tissue of mice causes a leak of H+ ions inward across
inner mitochondrial membrane. Which of the following is the most likely effect of this
protein on oxidative phosphorylation and energy metabolism?
A. Decreased ratio of oxygen consumption to ATP generation
B. Decreased ratio of oxygen consumption to CO2 production

C. Increased ratio of oxygen consumption to ATP generation

D. Increased ratio of oxygen consumption to CO2 production
E. No change in ratios of oxygen consumption to ATP generation and oxygen consumption to
CO2 production
Oxygen still bening consumed at normal rate to create proton gradient. But some of these
protons are leaking across inner mitochondrial membrane instead of passing through ATP
synthase.
-----------------------------------------------------------------------------------An 80 year old woman is being evaluated for suspected temporal arteritis. Her ESR is
100mm/hr. Treatment of TA involves the use of glucocorticoids, which could have serious
adverse effects. The pretest probability for TA is 50% in this patient. In evaluation of TA,
ESR has sensitivity of 99%, and a specificity of 60%. Based on the results of the ESR testing
in this patient, which of the following is the most appropriate step in management?
A. Additional testing to confirm dx of TA
B. Corticosteroid therapy, since the diagnosis of TA has been established with 99% certainty
C. Elimination of TA from further diagnostic consideration
D. Repeat ESR; if again positive, corticosteroid therapy
E. Repeat ESR; if normal, additional testing to confirm diagnosis of TA