1. A 45-year-old male is brought to the emergency department by his family, who has noted him to be behaving bizarrely.

There is a family history of early death. e is unable to control pronounced choreiform movements of his upper e!tremities and trun". #hich of the following is the most li"ely neurotransmitter disturbance$ Top of %orm

&epletion of acetylcholine

&epletion of dopamine

&epletion of $ - aminobutyric acid

'!cessive production of acetylcholine

'!cessive production of dopamine

'!cessive production of $ - aminobutyric acid

'!cessive production of norepinephr (ottom of %orm

). A *5-year-old man with a history of asthma, +&&,, and - % presents with wea"ness, confusion, diarrhea, and vomiting. e is currently obtunded. './ reveals T wave inversion and 0T depression, and absent 1 waves. 0erum potassium is low. #hich of the following is the most li"ely e!planation$ Top of %orm

yperglycemia

Theophylline to!icity

&igo!in to!icity

ypocalcemia

%urosemide to!icity (ottom of %orm 2. A 1-year-old boy is noted to have an abdominal mass. 3n ophthalmologic e!amination, he is found to have aniridia of the left eye. 3n physical e!amination, he is found to have a palpable abdominal mass and hypospadias. #hich of the following chromosomes is most li"ely involved in this condition$ Top of %orm

-hromosome )

-hromosome 11

-hromosome 12

-hromosome 14

-hromosome )1 (ottom of %orm 4. A *-year-old boy is found to be anemic. 1eripheral blood smear reveals basophilic stippling. #hich of the following is the source of his current condition$ Top of %orm

'!clusive feeding of goat mil"

0trict vegetarianism

5ac" of iron supplementation in diet

3ld plumbing pipes in the house

b-thalassemia (ottom of %orm 5. A )4-year-old female presents to her primary care physician with complaints of wea"ness and fatigue, worse in the afternoons for the last several months. The fatigue is relieved with a short nap. 0he has prominent bilateral ptosis. #hich of the following is the target of the autoantibodies in this disease$ Top of %orm

Acetylcholinesterase

,uscle fiber acetylcholine-gated ion channels

,uscle fiber membrane

6erve fiber calcium channels

6erve fiber membrane (ottom of %orm

*. A 75-year-old man with dementia re8uires bowel resection for colon cancer. e refuses. is family, including his wife, is very concerned that he is confused and not ma"ing a rational decision, especially given that he is substantially demented. The most important piece of information needed is Top of %orm

the e!tent of his dementia

his understanding of the ris"s of the procedure, including death

the wishes of his wife

his understanding of the ris"s of not getting the procedure

the e!tent of the cancer (ottom of %orm 7. A 19-year-old male presents to the student health service after his roommate noted a yellowish discoloration to his s"in while up late studying for an e!am. After a meal and several hours sleep, the discoloration resolved. 5aboratory tests are obtained, A5T )5 :;d5, A0T )< :;d5, (ilirubin =direct> <.4 mg;d5, (ilirubin =total> ).5 mg;d5. #hich of the following is responsible for this patient?s disease$ Top of %orm

-analicular cholestasis

&ecreased activity of glucuronyl transferase

+mpaired transport of bilirubin into the bile canaliculus

+mpaired upta"e of circulating bilirubin

+mmune hemolysis (ottom of %orm 4. Analysis of the chromosomes of a child with anemia reveals that he is missing a hemoglobin gene on chromosome 11. #hich of the following is true regarding this child$ Top of %orm

e is a silent carrier for a-thalassemia.

e will re8uire fre8uent blood transfusions.

3n radiography, his s"ull will have a @hair-on-end@ appearance.

1eripheral smear of his blood will reveal target cells.

+f he were to have children, there is a )5A chance one will have hyrops fetalis (ottom of %orm 9. A )5-year-old woman begins to ta"e an oral contraceptive pill of the monophasic =estrogen only> type. 0he is at ris" for which of the following conditions$ Top of %orm

3varian cancer

epatoma

epatocellular carcinoma

'ndometriosis

(leeding diathesis

(ottom of %orm 1<. A )<-year-old college student presents with dysuria. 3ver the past two months, he has also noticed some difficulty with his vision, occasionally associated with ocular pain. 5ast wee", he began to feel Boint pain in his wrist and "nees. 5aboratory analysis reveals he has the 5A-()7 mar"er. #hich of the following disorders is he most susceptible to develop in the future$ Top of %orm

&iabetes mellitus

An"ylosing spondylitis

ashimoto?s thyroiditis

odg"in?s lymphoma

/out (ottom of %orm 11. A 57-year-old hardware salesman complains of a si!-month history of vague left-sided flan" pain, with weight loss and night sweats. e comes to the hospital after an episode of fran" hematuria. 1hysical e!amination reveals an emaciated man, (1 17<;1<<, C 4<, T 94.5%, but is otherwise non-contributory. 5abs are 6a 144, -l 1<1, . 4.<, -32 )2, urea 1) mg;d5, creatinine 1.2

mg;d5. A -AT scan of the abdomen is ordered. This man?s most li"ely diagnosis is Top of %orm

nephrolithiasis

#ilm?s tumor

renal cell carcinoma

pancreatic carcinoma

pancreatitis (ottom of %orm 1). A )4-year-old varsity wrestler has his right arm pinned in e!treme abduction and e!tension at the shoulder. #hat is a possible inBury as a result of this forced position$ Top of %orm

Cotator cuff tendon rupture

(iceps tendonitis

1osterior shoulder dislocation

Anterior shoulder dislocation

#inging of the scapula (ottom of %orm 12. A 17-year-old female complains to her pediatrician of bilateral "nee pain, worse on the left side, for the last several months. 0he has also felt fatigued for some time. 0he has mar"ed hepatosplenomegaly. 5aboratory tests are obtained, leu"ocytes 2.4 ; mm2, hematocrit )<A, hemoglobin 7.* g;d5, platelets 15<,<<< ; u5. (one marrow biopsy reveals infiltration with foamy macrophages. #hat is the most li"ely accumulated storage product in this patient$ Top of %orm

/anglioside /,)

/lucosylceramide

/lycosaminoglycans

/lycogen

0phingomyelin (ottom of %orm 14. A *5-year-old man suffers his second stro"e in two years. e is conse8uently put on medication in order to lessen the ris" of having another stro"e. Two months after initiating treatment, the patient notices non-blanching red dots, appro!imately 5 mm in diameter. 1latelet count is severely diminished, and the patient develops a fever. A steadily decreasing white count becomes neutropenia in a few days. The agent most li"ely to have caused these symptoms is Top of %orm

clopidogrel

ticlopidine

aspirin

dipyrimadole

eno!aparin

(ottom of %orm 15. A 21-year-old man whose parents are first cousins complains of difficulties controlling and initiating movements, as well as a resting tremor of the right hand. 1hysical e!amination is remar"able for greenish-brown deposits in &escemet?s membrane of the cornea. 5iver biopsy reveals a micronodular cirrhosis. The ne!t test indicated, with its e!pected result, is Top of %orm

serum ferritin, elevated

serum iron, elevated

serum ceruloplasmin, decreased

serum ceruloplasmin, increased

serum alpha-1-antitrypsin, decreased (ottom of %orm 1*. A 49-year-old homeless alcoholic man is hospitalized for acute pneumonia. Treating physicians note hypo!ia, dar" green sputum, and high-spi"ing temperaturesD sputum stains for gram-negative rods. The most li"ely causative agent of this pneumonia is

Top of %orm

0treptococcus pneumoniae

-lostridium difficile

.lebsiella pneumoniae

0taphylococcus aureus

(ranhamella catarrhalis (ottom of %orm 17. A 24-year-old woman presents to her family physician complaining of fatigue, bac" pain, arthritis, and bone pain. 0he reports having suffered a right femoral and left humeral fracture within the past year. (lood tests reveal calcium of 15 mg;d5, phosphate of 1.5 mg;d5, and an al"aline phosphatase of )<< +:;5. This patient?s most li"ely diagnosis is Top of %orm

hyperparathyroidism

1aget?s disease

vitamin & into!ication

osteoporosis

renal insufficiency (ottom of %orm 14. A 14-year-old female complains to her pediatrician of fatigue and occasional yellowish discoloration to her s"in. 0he has mar"ed splenomegaly. 5aboratory studies are obtained, leu"ocytes 2.4 ; mm2, hematocrit 2<A, hemoglobin 9.* g;d5, ,-E 9< f5, ,- - 45A, platelets )5<,<<< ; u5. 1eripheral smear demonstrates spherocytes. #hich of the following abnormal proteins is most li"ely the cause of this patient?s signs and symptoms$ Top of %orm

a - globin

An"yrin

F - globin

1rotein 4.)

0pectrin (ottom of %orm 19. A *7-year-old woman with chronic recurring deep venous thrombosis is put on warfarin. 'arly the ne!t day, she develops severe leg and finger ulcers, and the s"in sloughs off. 0he later develops a pulmonary embolus. The coagulation factor most li"ely to be involved is Top of %orm

factor ++

factor G

factor E++

protein -

protein 0

(ottom of %orm )<. A 77-year-old retired construction wor"er complains of dyspnea, pleuritic chest pain, and weight loss over the last year. -hest G Cay with follow-up needle biopsy confirm mesothelioma. #hat is the underlying causative agent, particularly in this man$ Top of %orm

0mo"ing

Asbestos

0ilica

-oal dust

Tuberculosis (ottom of %orm )1. A )5-year-old man presents to the emergency department after sustaining blunt head trauma following a motor vehicle accident. 3n the fourth day following admission to the hospital, the patient is noted to be in a deep coma and in the afternoon begins to have seizures. (lood tests reveal the followingH sodium of 12< m'8;5, potassium of 2.) m'8;5, serum osmolality of )*< m3sm;5, urine sodium of 7< m'8;5, and urine osmolality of 29< m3sm;5. The cause of this patient?s condition is most li"ely an elevation of

Top of %orm

aldosterone

vasopressin

angiotensin

renin

parathyroid hormone (ottom of %orm )). A 25-day-old infant is brought to the pediatrician by her parents. 0ince discharge, she has not been feeding well and now seems lethargic. The infant is dehydrated and hypotensive. 0he has an enlarged clitoris. 0erum electrolytes demonstrate hyponatremia, hyper"alemia, and hypoglycemia. #hich of the following is the most common cause of these findings$ Top of %orm

2F - hydro!ysteroid dehydrogenase deficiency

11F - hydro!ylase deficiency

17a - hydro!ylase deficiency

)1-hydro!ylase deficiency

-holesterol side chain cleavage enzyme deficiency (ottom of %orm )2. A 42-year-old female with breast cancer undergoes four cycles of chemotherapy with two different chemotherapeutic agents. 3ver the course of the chemotherapy, she notes dysuria, fre8uency and urgency, and gross hematuria. The agent most li"ely to have caused this is Top of %orm

do!orubicin

tamo!ifen

bleomycin

cyclophosphamide

methotre!ate (ottom of %orm )4. An 14-day-old infant is brought to the emergency department by her parents with a fever of 29- =1<4%>. The infant is lethargic. (lood cultures are obtained and a subse8uent culture isolates a gram-positive cocci. #hich of the following is the most li"ely isolate$ Top of %orm

aemophilus influenza

6eisseria meningitidis

0taphylococcus aureus

0taphylococcus epidermidis

0treptococcus agalactiae

0treptococcus pneumoniae

0treptococcus pyogenes (ottom of %orm )5. A family camps in the mountains and drin"s from a freshwater stream daily. :pon return, all of them have chronic diarrhea. 0tool samples are ta"en for analysis, but the physician should proceed as if the family has contracted Top of %orm

To!oplasmosis gondii

elicobacter pylori

hepatitis (

Trypanosoma cruzi

/iardia lamblia (ottom of %orm )*. A *-year-old boy is brought to the pediatrician for poor school performance. e is unable to pay attention and often daydreams. 5aboratory studies are obtained, leu"ocytes 5.5 ; mm2, hemoglobin *.5 g;d5, hematocrit )<A, platelets 4<< ; mm2, smear is

hypochromic, microcytic red blood cells with basophilic stippling. #hich of the following is the most li"ely e!planation$ Top of %orm

Attention deficit disorder

%olate deficiency

5ead into!ication

,ercury into!ication

Eitamin (1) deficiency (ottom of %orm )7. A 2)-year-old farmer presents with increased salivation, sweating, dyspnea, and confusion. e has severe muscle wea"ness and bradycardia. The most appropriate intervention is Top of %orm

atropine

epinephrine

pralido!ime

prednisone

phenylephrine (ottom of %orm )4. A 14-year-old girl complains of a headache and nec" stiffnessD her parents bring her to the emergency room where the e!amining physician notes s"in purpura, T 1<1%, (1 11<;*<, C 1<1. #hich of the following is a possible complication of her disease$ Top of %orm

-erebral aneurysm

%atal cardiac arrythmia

0ub-arachnoid hemorrhage

1ulmonary embolism

(ilateral adrenal necrosis (ottom of %orm )9. An 45-year-old man has had a -EA. e is able to identify obBects such as bloc"s, pens, chains, "eys, and bottles, visually. owever, when these same obBects are placed in his hands and he is not permitted to loo" at them, he can no longer identify the obBects, although he describes them as @s8uare@, @long@, @sharp@, or @circular@. #here is the most li"ely location of his infarct$ Top of %orm

1rimary sensory area of the parietal lobe

0ensory association area of the parietal lobe

0ensory association area of the occipital lobe

#ernec"e?s area

(roca?s area (ottom of %orm 2<. #hich of the following represents an irreversible step in glycolysis$

Top of %orm

1,2 - bisphosphoglycerate --I 2 - phosphoglycerate

%ructose * - phosphate --I fructose 1,* - bisphosphate

%ructose 1,* - bisphosphate --I glyceraldehydes 2 - phosphate

/lucose * - phosphate --I fructose * - phosphate

/lyceraldehyde 2 - phosphate --I 1,2 - bisphosphoglycerate (ottom of %orm 21. A 15-year-old boy has had a one-month history of worsening tremors, confusion, and abdominal distension. 5iver function tests are elevated, and an ,C+ of the head shows damage to the basal ganglia. The most appropriate treatment is Top of %orm

vitamin (1)

defero!ime

),2, dimercaprol

selenium

penicillamine (ottom of %orm 2). A 54-year-old woman complains of dry eyes and dry mouth. 0he is told she has 0Bogren?s syndrome. #hich of the following autoantibodies should be present$ Top of %orm

Anti-acetylcholine receptor

Anti-s"in basement membrane

Anti-Co, Anti-5a

Anti-centromere

Anti-0mith (ottom of %orm 22. A mother brings her 9-year-old daughter to the doctor because of her uncontrollable behavior. 0he is currently in special education classes and appears to have mental retardation. 0he is short for her age, very obese, and has mild hypotonia. er mother tells you she has had an insatiable appetite almost since infancy. The most li"ely cause of this disorder is Top of %orm

deletion of part of 15p

trisomy

monosomy

deletion of 5p

increased tandem repeats on G chromosome (ottom of %orm 24. A )4-year-old male is brought to the emergency department by ',0. e was stung by a bee several minutes ago and now is having difficulty breathing. This reaction is mediated by which of the following classes of immunoglobulins$

Top of %orm

+gA

+g&

+g'

+g/

+g, (ottom of %orm 25. A patient is ta"ing mega-doses of vitamin supplements in an effort to help him stay @healthy@. Cecently, however, he has noticed that he has developed tingling, numbness, and parasthesias. +n order to combat this, he has increased his vitamin supplementation. Three months later, the parasthesias are worse, and he is also somewhat ata!ic. The most li"ely culprit is e!cessive Top of %orm

thiamine =(1>

pyrido!ine =(*>

tocopheral =vitamin '>

zinc

niacin =(2> (ottom of %orm 2*. A 45-year-old previously healthy ban"er arrives in the hospital complaining of a sudden onset left-sided chest pain that is worst with respirations and when leaning forward. '-/ reveals 0T segment elevation in all leads. 1hysical e!am is notable for fever, tachycardia, and a friction rub. #hat is the most li"ely diagnosis$ Top of %orm

&ressler?s 0yndrome

Acute myocardial infarction

1ulmonary edema

Earicella Joster =0hingles>

Eiral pericarditis (ottom of %orm 27. A )4-year-old student complains of a three-day history of left burning eye pain and tearing. Transillumination of the cornea reveals a dendritic lesion of the corneal epitheliumD there are no foreign bodies, and fundoscopy is normal. The e!amining physician should proceed as if the student has infection with Top of %orm

cytomegalovirus

herpes simple! virus

0taphylococcus aureus

0taphylococcus epidermidis

0treptococcus pyogenes (ottom of %orm

24. A biological researcher conducts tests on different pieces of &6A. All pieces of &6A have the same number of base pairs. The &6A in tube A is found to have a Tm of )7 -. The &6A in tube ( is found to have a Tm of 2< -. The &6A in tube - is found to have a Tm of )4 -. #hich of the following statements is true regarding the &6A in each of the tubes$ Top of %orm

The &6A in tube A has more /-- content than the &6A in tube (.

The &6A in tube ( has more A-T content than the &6A in tube -.

The &6A in tube - has more A-T content than the &6A in tube A.

The &6A in tube - has more /-- content than the &6A in tube (.

The &6A in tube A has more A-T content than the &6A in tube -. (ottom of %orm 29. A 55-year-old female with a history of treatment for refractory gastroesophageal reflu! is prescribed a new medicine. Appro!imately 2< minutes later, the patient feels betterD but, in one hour, the patient develops an uncontrollable facial grimace, protrusion of the tongue, and torticollis. At this point, the most effective treatment is Top of %orm

diazepam

diphenhydramine

neostigmine

prochlorperazine

bromocriptine (ottom of %orm 4<. A 5<-year-old man with "nown liver failure, portal hypertension, and esophageal varices complains of lower abdominal pain and passage of blac" stools. e says he presently feels lightheaded. 5aboratory analysis is most li"ely to reveal Top of %orm

elevated creatinine

elevated urea

elevated sodium

elevated potassium

elevated calcium (ottom of %orm 41. An 4*-year-old right-handed woman is recovering from a cerebrovascular accident. er family notes a paucity of speech with difficulty producing words. -omprehension is intact. The most li"ely location of her infarct was Top of %orm

left area *

right area *

left area 4

right area 4

left area ))

(ottom of %orm 4). A *4-year-old male presents to his primary care doctor with complaints of lower e!tremity edema. e has a history of longstanding congestive heart failure and has used diuretic agents in the past to control his edema. e also has a history of calcium o!alate "idney stones. #hich of the following agents is potentially useful for the treatment of both these conditions$ Top of %orm

(umetanide

'thacrynic acid

%urosemide

ydrochlorothiazide

0pironolactone (ottom of %orm 42. A *-year-old child develops symptoms of an upper respiratory tract infection, and is given antibiotics and analgesics to treat symptoms. 0everal hours later, the child develops vomiting, lethargy, and his breathing becomes rapid and shallow. 5ater, as the patient begins to become more sluggish and obtunded, his

pupils dilate. 5aboratory values show increased ammonia and elevated liver enzymes. The most li"ely etiology is Top of %orm

acetaminophen to!icity

reaction to aspirin

sulfonamide allergy

penicillin hypersensitivity

de!tromethorphan to!icity (ottom of %orm 44. This histopathological slide is from the trachea of a patient from autopsy. #hich of the following processes is depicted in the slide$

Top of %orm

08uamous metaplasia

'pithelialization

Teratoma formation

amartomatous polyp formation

+ntraepithelial neoplasia (ottom of %orm 45. An 11-year-old boy is brought by his mother to a physician?s office because of repeated behavioral problems at school and at home. e has allegedly been trying to steal other children?s lunch money, and has had one school suspension because he set a fire in the boys? bathroom. A month ago, he stopped going to school altogether. is behaviors are best characterized by Top of %orm

conduct disorder

antisocial personality disorder

oppositional defiant disorder

attention deficit hyperactivity disorder

impulse control disorder (ottom of %orm 4*. A 42-year-old male presents to his primary care doctor with complaints of increasing abdominal girth. e has a long history of alcohol abuse and recently stopped drin"ing. 0pironolactone is prescribed to aid in control of the patient?s increasing ascites. #hich of the following is the site of action of spironolactone$ Top of %orm

Ascending loop of

enle

-ollecting duct

&escending loop of

enle

&istal tubule

1ro!imal tubule (ottom of %orm

47. A 2)-year-old man with invasive meningeal aemophilus influenza is found to be resistant to ampicillin and other antibiotics. e is put on chloramphenicol. 3ver time his white blood cell count falls. e also develops peripheral neuropathy. +f chloramphenicol is not discontinued, he will also li"ely get Top of %orm

grey s"in

thrombocytopenia

renal failure

deafness

staining of teeth (ottom of %orm 44. A *7-year-old male is diagnosed with colon cancer. e is scheduled for a hemicolectomy but does not "eep his preoperative assessment appointment for the surgery. #hen confronted he says cheerfully, @+ couldn?t miss such a terrific day on the golf courseD we?ll have to reschedule.@ #hich of the following best describes this patient?s reaction to his illness$ Top of %orm

Acceptance

Anger

An!iety

&enial

&epression (ottom of %orm 49. A )7-year-old female disli"es her boss immensely, yet wishes to succeed in her career at her current place of employment. Today, she is particularly upset with her boss and purposefully withholds pieces of a proBect her boss needs for an important presentation. #hen confronted, she is very apologetic about her mista"e, vowing to ma"e up for it with her ne!t proBect. #hat defense mechanism is this patient using$ Top of %orm

Acting out

&isplacement

1assive-aggressive behavior

1roBection

0uppression (ottom of %orm 5<. A *-year-old boy is brought to the pediatrician by his mother who noticed swelling around his eyes. The boy has prominent periorbital edema as well as pretibial edema. e is hypertensive. A )4-hour urine collection reveals 4.) grams of protein. #hich of the following is the most li"ely microscopic renal lesion$ Top of %orm

(asement membrane immune comple! deposition

(asement membrane thic"ening

%oot process effacement

,esangial proliferation

0ubepithelial immune comple! deposition (ottom of %orm