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1.Anincreaseinwhichofthefollowingbestexplainsthemechanism
bywhichthecardiacoutputincreasesinsevereanemia?

A.
Arteriolardiameter

B.
Bloodviscosity

C.
Peripheralvascularresistance

D.
Splanchnicbloodflow

E.
Tissueoxygentension
Answer

2.A2yearoldretardedchildisevaluatedbyametabolic
specialist.Thechild'shistoryissignificantforfailureto
thriveandprogressiveneurologicdeterioration,includingdeafness
andblindness.Physicalexaminationisremarkableforhepatosplenomegaly
,aswellasacherryredspotonfunduscopicexamination.Thesesymptoms
areconsistentwithadiagnosisof

A.
Huntersyndrome

B.
NiemannPickdisease

C.
Pompe'sdisease

D.
tyrosinosis

E.
vonGierke'sdisease

Answer

3.An8montholdfemalechildisbroughttomedica
lattentionbecauseherfirstfourteethshowseveraldiscrete,
discolored,circumferentialbandsthatshowverylittleenamel.
Excessivelevelsofwhichofthefollowingmayhaveproducedthisdefect?

A.
Bilirubin

B.
Fluoride

C.
Parathormone

D.
Thyroidhormone

E.
VitaminC

Answer

4.Whichofthefollowingcomplicationsiscurrentlythemajo
rlimitationtothelongtermsuccessofcardiactransplantation?

A.
Allograftrejection

B.
Graftarteriosclerosis

C.
Graftatherosclerosis

D.
Opportunisticinfections

E.
Lymphoma

Answer

5>.Achilddevelopsatumorofthecerebellum.Biopsyreveals
evidenceofbothneuronalandglialdifferentiation.Whichofthe
followingisthemostlikelydiagnosis?

A.
Astrocytoma

B.
Glioblastomamultiforme

C.
Medulloblastoma

D.
Meningioma

E.
Oligodendroglioma
Answer

6>.A56yearoldmanvisitshisphysicianwithcomplaintsof
completeexhaustionaftermowingthelawninhissmallfront
yard.Healsocomplainsofdizziness,irritability,difficulty
sleeping,andlossoflibido.Onphysicalexamination,theman's
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skin,conjunctiva,andoralmucosaarepale.Abloodtestindicates
theman'shemoglobinis7g/dL.Whichofthefollowingfindingsis
alsolikelytobepresentinthisman?

A.
Bradycardia

B.
Cyanosis

C.
Lowstrokevolume

D.
Warmhands

E.
Widepulsepressure

Answer
7>.A55yearoldmanhadbeeningoodhealthsincereceivingaheart
transplantforsevereatheroscleroticdisease.Fiveyearsafter
transplantation,thepatientdiedsuddenly,withoutanypremonitory
symptoms,whileworkinginhisgarden.Hehadbeenmaintainedon
cyclosporinsincehistransplant.Whichofthefollowingcomplications
wouldmostlikelybefoundatautopsyinthetransplantedheart?

A.
Allograftrejection

B.
Atherosclerosisofcoronaryarteries

C.
Graftvasculardisease

D.
Hyalinearteriolosclerosis

E.
Hyperplasticarteriolosclerosis
Answer

8.Anelderlyladyisbroughttotheemergencyroomafterdrinking
insecticidethatshethoughtwastea.Afterherstomachispumped,
hersenseofsmellistestedanditisfoundthatshecannotdistinguish
commonsmells(e.g.,anorange,coffee).CTscanoftheheaddemonstrates
amassintheolfactorygroovearea.Theaxonslikelycompressedbythis
massprojecttowhichofthefollowingstructures?

A.
Insula

B.
Nucleusambiguus

C.
Postcentralgyrus

D.
Precentralgyrus

E.
Pyriformcortex
Answer

9.A27yearoldmandevelopsbilateralparotidglandswellingand
orchitis,andisgenerallyillwithfeverof102F.Whichofthe
followingsubstancesismostlikelytobesignificantlyelevatedin
thepatient'sserum?

A.
Alanineaminotransferase(ALT)

B.
Amylase

C.
Aspartateaminotransferase(AST)

D.
Ceruloplasmin

E.
Creatinephosphokinase,MBisoenzyme(CPKMB)
Answer
10.A55yearoldmanpresentstotheemergencyroomwithcrushing
substernalpainandleftshoulderpainof2hoursduration.Thepain
isnotrelievedbysublingualnitroglycerin,andtheelectrocardiogram
showsSTelevationinseveralleads.Aspirinandstreptokinasetherapy
areinitiated,andthepatientisadmittedtotheintensivecareunit.
Thenextmorning,serumcardiacenzymesareelevatedto4timestheupper
limitofnormal,andtheelectrocardiographicchangesarestillpresent.
Whichofthefollowingisthemostlikelydiagnosis?

A.
Prinzmetal'sangina

B.
Stableangina

C.
Subendocardialinfarction

D.
Transmuralinfarction

E.
Unstableangina
Answer

11Whichofthefollowingaminoacidsisposttranslationally
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hydroxylatedinthecytoplasmoffibroblasts?

A.
Cysteine

B.
Glycine

C.
Proline

D.
Serine

E.
Tyrosine

Answer

12.Microscopicexaminationofacancercellrevealsacell
inanabnormaltelophaseinwhichthreeclustersofchromosomes
areseen.Anabnormalityofwhichofthefollowingwouldbemost
likelytoproducethisalteration?

A.
Chiasma

B.
Mitoticspindle

C.
Mosaicism

D.
Polarbody

E.
Synapsis

Answer
13.A58yearoldmanwithfaintingspellsandexerciseintolerance
isfoundtohaveabicuspidaorticvalvewithmarkedaorticstenosis.
Whichofthefollowingphysicalfindingswouldbeprominentinthispatient?

A.
Diastolicmurmur

B.
Heaveatleftparasternalborder

C.
LoudS2heartsound

D.
LoudS3heartsound

E.
Weakperipheralpulse
Answer

14.A57yearoldfemaleisfoundunconsciousonherkitchenfloorafter
havingsufferedamyocardialinfarction.Shehaspulmonaryedemaand
distendedjugularandperipheralveins.Amidsystolicgallopisheard
uponchestauscultation.EKGshowsprominentQwavesinleadsII,III,
andaVF.Whichofthefollowingismostconsistentwiththepatient's
condition?

Preload
CardiacoutputPAWP CVP
Vascularresistance
Mixedvenousoxygen

A.
Increased
Decreased
Decreased
Increased
Increased
Decreased

B.
Increased
Increased
Decreased
Decreased
Decreased
Increased

C.
Increased
Decreased
Increased
Increased
Increased
Decreased

D.
Increased
Increased
Increased
Increased
Decreased
Decreased

E.
Decreased
Decreased
Increased
Decreased
Increased
Decreased

F.
Decreased
Increased
Decreased
Increased
Decreased
Increased

G.
Decreased
Decreased
Increased
Decreased
Decreased
Decreased

Answer

15.A48yearoldmancomplainingofchestpainisbroughttothe
emergencyroom.Physicalexaminationfollowedbyechocardiography
demonstratesaorticstenosis.Hiscoronarybloodflowisincreased.
Whichofthefollowingisthemostlikelyexplanationfortheincreased
coronarybloodflowinthisindividual?

A.
Decreasedleftventricularoxygenconsumption

B.
Decreasedleftventricularpressure

C.
Decreasedleftventricularwork

D.
Increasedcardiactissueadenosineconcentration

E.
Increasedcardiactissueoxygenconcentration
Answer

16.A45yearoldmanpresentstotheemergencydepartmentwithsevere
headacheandvomiting.ACTscanshowsawellcircumscribedcysticlesion
withinthe3rdventricle;thereisnocalciumdeposition.Thecystis
surgicallyremoved.Onhistologicexamination,thewallofthecyst
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consistsofasinglelayerofmucinproducingcolumnarepitheliumwith
aciliatedapicalsurface.Whichofthefollowingisthemostlikely
diagnosis?

A.
Colloidcyst

B.
Craniopharyngioma

C.
Cysticercosis

D.
Echinococcuscyst

E.
Pilocyticastrocytoma
Answer

17.A36yearoldfemaleisbroughttotheemergencyroombyher
husbandwhosaysthatshe"complainedofasevereheadachethenlost
consciousness."Shehasahistoryofhypertensionandhadbeenonseveral
differentmedications.Theexaminingphysiciannotesthatsheisunable
tomoveherarmsandlegs,butcanblinkhereyes.Whenthephysicianasks
hertoblinktwiceifshecanhearhim,shepromptlydoesso.Inwhichof
thefollowingstructuresisthiswoman'slesionmostlikelylocated?

A.
Cervicalspinalcord

B.
Medullaoblongata

C.
Midbrain

D.
Pons

E.
Thalamus

Answer

18.A71yearoldmanhasbeeninexcellenthealth,andpracticing
competentlyasanattorney.Heisbroughttotheemergencyroom
followingamotorvehicleaccident.Aworkup,includingimagingof
thespine,thorax,andhead,isnegative,butthepatientisadmitted
forovernightobservation.Hisinjuriesincludeseverallacerationsto
thefaceandextremitiesaswellasseveralcontusionstothethorax.
Threeweekslater,heisadmittedtothehospitalforconfusion.
Aneurologicexamisnormalexceptthatheisnotorientedtotime
orplace,andcanrecallonly1outof6objectsafter3minutes.
Whichofthefollowingisthemostlikelydiagnosis?

A.
Alzheimer'sdisease

B.
Brainmetastases

C.
Epiduralhematoma

D.
Normalpressurehydrocephalus

E.
Subduralhematoma

Answer

19.Aworkdiagramshowingchangesinleftventricularvolumeand
pressureduringonecardiaccycleisshownaboveforanormalheart
(diagramA)andfollowingaorticvalvulardisease(diagramB).DiagramB
showswhichofthefollowingcomparedtodiagramA?

A.
Decreasedworkforagreaterstrokevolume

B.
Decreasedworkforalowerstrokevolume

C.
Decreasedworkforthesamestrokevolume

D.
Increasedworkforagreaterstrokevolume

E.
Increasedworkforalowerstrokevolume

F.
Increasedworkforthesamestrokevolume

Answer

20.An80yearoldwomandiesafteralonghistoryofprogressivememoryloss,
apraxia,andrecurrentepisodesofconfusion.Inthelastmonthsoflifeshe
wasbedriddenandunabletorecognizefamiliarfacesandobjects.The
pathologistidentifiesnumerousflameshapedintracytoplasmicinclusions
inneuronsoftheneocortexandhippocampus.Theseconsistofpaired
helicalfilaments(PHFs)onelectronmicroscopy.Whichofthefollowing
biochemicalchangesmostlikelyaccountsforthedevelopmentofPHFsin
thiscondition?

A.
Abnormaldegradationofamyloidprecursorprotein(APP)

B.
Abnormalphosphorylationoftau
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Answer

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C.
D.
E.

Accumulationofadvancedglycosylationend(AGE)products
IncreasedexpressionofAPP
Precipitationofinsolubleatubulin

21.Theactivityofwhichofthefollowingenzymesisdirectlyaffected
bycitrate?

A.
Fructose2,6bisphosphatase

B.
Isocitratedehydrogenase

C.
PhosphofructokinaseI

D.
Pyruvatecarboxylase

E.
6phosphogluconatedehydrogenase

Answer

22.WhichofthefollowingstructuresisfoundonlyinGramnegative
microorganisms?

A.
Cellenvelope

B.
Exotoxin

C.
Peptidoglycan

D.
Periplasmicspace

E.
Teichoicacids

23.Ascientistwishestostudyfreeradicalproductionunderischemic
conditions.Hedecidestoproducecerebralischemiabytyingoffanartery
ofthebrain.Ligationofwhichofthefollowingarterieswouldbemost
likelytoproducesignificantischemicdamage?
A.Anteriorcerebralarteryatitsoriginfromtheinternalcarotidartery
B.Anteriorcommunicatingartery
C.Middlecerebralarteryatitsoriginfromtheinternalcarotidartery
D.Posteriorcerebralarteryatitsoriginfromthebasilarartery

E.
Posteriorcommunicatingartery
Answer

24.A52yearoldwomanhaslongstandingrheumatoidarthritis(RA)and
isbeingtreatedwithcorticosteroidsandnonsteroidalantiinflammatory
drugs(NSAIDs).Whichofthefollowingcardiaccomplicationsmayarisein
thisclinicalsetting?

A.
Constrictivepericarditis

B.
Dilatedcardiomyopathy

C.
Hypersensitivitymyocarditis

D.
Hypertrophiccardiomyopathy

E.
Restrictivecardiomyopathy

Answer

Answers

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