5/28/2015

rfwdata.net/USMLEQBANK/block39questions.html

1>A25yearoldmalepresentstohisfamilyphysicianwiththefollowing
statement:"Doctor,Ican'turinateinpublicrestrooms.Icanif
thereisnoonearound,butifIgototherestroominamovie,an
airport,attheballparkoranywherethatsomeoneelsecomesin,
Ican'turinate.EvenifIhavealreadystarted,itjuststopsand
Ican'tgetitgoinguntiltheotherpersonleaves.Iamso
embarrassed.WhatdotheythinkofmeiftheyseeIcan't
dowhateveryothermancando?"Whichofthefollowing
isthemostlikelydiagnosis?

A.
Anxietydisorderduetoageneralmedicalcondition

B.
Panicdisorder

C.
Socialphobia

D.
Specificphobia

E.
Substanceinducedanxietydisorder
Answer
2>Autopsyofanelderlyindividualwhodiedinanursinghomewithno
knowngeneticdiseasesrevealssmallamountsofamyloiddeposition
intheheart.Amyloiddepositionisnotseeninotherorgans.There
isnohistoryoflongstandinginflammatorydisease.Thistypeof
amyloidwouldbemostlikelytobecomposedofwhichofthe
followingproteins?

A.
Amyloidassociatedprotein

B.
Amyloidlightchainprotein

C.
Beta2amyloidprotein

D.
Beta2microglobulin

E.
Transthyretin
Answer

3>Afamilyisreferredtoageneticspecialistbecauseofmildmental
retardationinseveraloftheschoolagechildren.Laboratoryevaluation
demonstratesaspecificchromosomalbreakagesiteinmetaphasestudies
oflymphocytesculturedwithmethotrexate.Whichofthefollowing
chromosomesismostlikelytobespecificallyaffected?

A.
X

B.
Y

C.
13

D.
16

E.
21

Answer

4>A5yearoldmalewithnopreviousmedicalhistoryisbroughttothe
ERbyhismotherbecauseheaccidentallyingestedalargedoseofrat
poison.Heisconsciousbutappearsquiteagitated.Onphysicalexam,
heisfoundtohaveabloodpressureof110/70andaheartrateof90.
LabsaresignificantforanelevatedPTbutanormalPTT.Thepatient
shouldbeimmediatelytreatedwith

A.
atropine

B.
flumazenil

C.
Nacetylcysteine

D.
protamine

E.
vitaminK

Answer

5>A67yearoldmanisevaluatedforpersistentshootingpains,lower
limbataxia,andbladderdysfunction.Physicalexaminationdemonstrates
smallirregularpupilsthatconstrictwithaccommodationbutnotin
responsetolight.AVDRLtestispositive.ACTscanofthespinal
cordwouldmostlikelydemonstrateatrophyofwhichofthefollowing
structures?

A.
Dorsalcolumn

B.
Dorsalhorn

C.
Lateralcolumn

D.
Ventralcolumn

E.
Ventralhorn

Answer

6>Whatistheearliestageatwhichtoilettrainingislikelytobe
successful?

A.
10months

B.
13months

C.
16months

D.
19months

E.
22months

Answer

7>A13yearoldboyisbroughttoaruralclinicbecauseofpoorschool
performance.Hisparentsstatethathedidnotbegintalkinguntilafter
threeyearsofage,andstilldoesnotuselanguageaseffectivelyas
hissister,whois6yearsold.Acarefulfamilyhistoryrevealsthat
amaternalgrandfatherwasmildlyretarded.Themotherhastwosisters,
bothofwhomareapparentlynormal,butthemotheradmitsthatshedid
notdowellinschool,anddroppedoutattheageof16.Physical

http://rfwdata.net/USMLEQBANK/block39questions.html

1/12

5/28/2015

rfwdata.net/USMLEQBANK/block39questions.html

examinationofthechildrevealslargeears,along,narrowface,
andlargetestes.Whichofthefollowinggeneticmechanismsmost
likelyaccountsfortheobservedfindingsintheson?

A.
Expandedtrinucleotiderepeat

B.
Genomicimprinting

C.
Robertsoniantranslocation

D.
Trisomy13

E.
Trisomy18

Answer

8>A15yearoldisbroughttotheemergencydepartmentinacoma.Analert
ambulanceattendantnotesthatthepatient'sbreathsmellslikeacetone.
Thiswouldbemostconsistentwithwhichofthefollowing?

A.
Alcoholintoxication

B.
Diabetichyperosmolarcoma

C.
Diabeticketoacidosis

D.
Heroinoverdose

E.
Profoundhypoglycemia
Answer

9>A28yearoldmalewithhistoryofmooddisorderpresentswithadecreased
needforsleep,irritability,recklessness,andincreasedenergy.Whichof
thefollowingisthemostlikelyadditionalpresentingsymptom?

A.
Depressedmood

B.
Fearofdying

C.
Insomnia

D.
Racingthoughts

E.
Recurrentthoughtsandactionsthatrelieveanxietywhen
carriedout
Answer
10A10yearoldgirlwhoisasuspectedvictimofchildabuse
isreferredtoapsychologistforevaluation.Aspartofher
workup,thepatientisaskedtoconstructastorybasedonpictures
.Whichofthefollowingpsychometricmeasureswasutilized?

A.
MinnesotaMultiphasicPersonalityInventory

B.
MyersBriggsPersonalityInventory

C.
RorschachTest

D.
ThematicApperceptionTest

E.
TypeAandBBehaviorPatternsTest

Answer

11>
A65yearoldwomanhasalongstandingdementingdisordercharacterized
bydeteriorationinpersonality,neglectofpersonalhygiene,impaired
judgment,anddisinhibitedbehavior.MRIdemonstratesseverecortical
atrophylimitedtothefrontallobesandanteriortwothirdsofthe
temporallobes,whiletheremainingcortexispreserved.Noevidence
ofrecentorremoteinfarctsisfound.Whichofthefollowingdiagnoses
ismostconsistentwiththesepathologicandclinicalfeatures?

A.
Alzheimerdisease

B.
CreutzfeldtJacobdisease

C.
DementiawithLewybodies

D.
Frontotemporaldementia

E.
Vasculardementia

Answer
12>
A50yearoldwomanwhoworksasaparalegalinalawfirmcomestoher
localdoctorbecauseofproblemswithsleep.Thepatientsaysthatover
thepastseveralweeks,shehasn'tsleptwell,feelstired,andhashad
headaches.Shedoesnotsmokeordrinkalcohol,exceptonspecial
occasions,anddoesnottakeanymedications.Thepatient'spupils
are5mminsize,equalandreactive,withboththedirectand
consensuallightreflexesintact.Accommodationisunimpaired.
Examinationofthevisualfieldsandfunduscopyareunremarkable.
Extraocularmovementsrevealnormalconjugate,oblique,and
downwardmovement,butsheisunabletolookupwards.Noother
abnormalitiesarefoundontheneurologicalexamination.Which
ofthefollowingisthemostlikelydiagnosis?

A.
Acousticneuroma

B.
Astrocytomainthecerebellum

C.
Craniopharyngioma

D.
Parasagittalmeningioma

E.
Pinealoma

Answer

13>Aoneyearoldbabypresentswithincreasingflaccidparalysis,lack
ofcoordination,andhyporeflexia.Overthenextseveralyears,the
child'sconditiondeterioratestoabedriddenvegetativestate.
Funduscopicexaminationrevealsopticatrophy.Extensiveenzymological
studiesdocumentadeficiencyofarylsulfataseA(cerebrosidesulfatase)
inleukocytes.Whichofthefollowingisthemostlikelydiagnosis?

A.
Gaucher'sdisease

B.
Krabbe'sdisease

C.
Metachromaticleukodystrophy

D.
NiemannPickdisease

http://rfwdata.net/USMLEQBANK/block39questions.html

2/12

5/28/2015

Answer

rfwdata.net/USMLEQBANK/block39questions.html
E.

TaySachsdisease

14>A60yearoldmaleexecutivewithahistoryofanginapectorisand
depressionhadbypasssurgerythepreviousday.Hisdepressionhas
respondedwelltoselectiveserotoninreuptakeinhibitors(SSRIs)
andthereisnohistoryofpsychosisinthepast.Henowpresents
withconfusion,agitation,irritability,andtriestoremovehis
IVlines.Hislevelofconsciousnessfluctuates,andattimeshe
forgetswhoheis.Heisgivenaneurolepticdrug,andappears
muchimproved.Whatisthemostlikelydiagnosis?

A.
Adjustmentdisorder

B.
Delirium

C.
Dementia

D.
Exacerbationofdepressionwithsuicidalideationand
psychoticfeatures

E.
Schizophrenia
Answer

15>A38yearoldwomanwithahistoryofmultiplesexualpartnersismost
atriskforwhichofthefollowing?

A.
Bladdercarcinoma

B.
Cervicalcarcinoma

C.
Endometrialcarcinoma

D.
Ovariancarcinoma

E.
Rectalcarcinoma

Answer

16>WhichofthefollowingchemotherapeuticagentsisspecificfortheM
phaseofthecellcycle?

A.
Cytarabine

B.
Daunorubicin

C.
Hydroxyurea

D.
Mechlorethamine

E.
Vincristine

Answer

17>A47yearoldmanwithahistoryoftype2diabetes,depression,and
hypertensionpresentstotheemergencydepartmentwithspontaneous
priapism.Whichofthefollowingdrugsisthemostlikelycauseof
hiscurrentcondition?

A.
Atenolol

B.
Furosemide

C.
Glyburide

D.
Paroxetine

E.
Trazodone

Answer

18>TaySachsdisease,anautosomalrecessivediseasecausedbyadeficiency
ofhexosaminidaseA,islethalinchildhood.InapopulationofAshkenazi
Jews,bloodtestingshowsthefrequencyofheterozygotestobe0.1.What
istheprobabilitythatthefirstchildoftwoindividualsfromthis
populationwithnofamilyhistoryofthediseasewillhaveTaySachs?

A.
0.25

B.
0.11

C.
0.0625

D.
0.0025

E.
Cannotbecalculatedfromtheinformationgiven
Answer

19>A44yearoldmalewithahistoryofpolysubstanceabusepresentswith
nausea,vomiting,increasedheartrate,highbloodpressure,sweating,
agitation,andweakness.Healsocomplainsofseeingmonstersonthe
wallduringtheinterview.Whichofthefollowingbestaccountsfor
thispresentation?

A.
Alcoholintoxication

B.
Alcoholintoxicationorcocainewithdrawal

C.
Alcoholwithdrawal

D.
Alcoholwithdrawalorcocaineintoxication

E.
Cocaineintoxication

F.
Cocainewithdrawal

Answer

20>Inwhichofthefollowinglaboratorytestswouldyouexpecttofindthe
greatestdisparityinreferenceintervalsbetweenmenand(nonpregnant)
women?

A.
Meancorpuscularvolume

B.
Serumalkalinephosphatase

C.
Serumferritin

D.
Serumglucose

E.
Serumsodium

Answer

http://rfwdata.net/USMLEQBANK/block39questions.html

3/12

5/28/2015

rfwdata.net/USMLEQBANK/block39questions.html

21>A7yearoldgirliswalkingacrossavacantlotandstepsonanail.The
nextday,herfootissoreandthewoundappearsinflamed.Duringthese
earlystagesofinfection,whichofthefollowingcompoundsexertthe
mostpowerfulchemotacticeffectonneutrophils,causingthemtomigrate
intotheinflamedarea?

A.
C5aandIL8

B.
IL1andtumornecrosisfactor

C.
LTC4andLTD4

D.
PGI2andPGD2

E.
Thromboxaneandplateletactivatingfactor

Answer

22>A23yearoldwomanwithahistoryofsicklecelldiseasepresentswith
feverandseverebonepainlocalizedtoherlefttibia.Xrayrevealsa
lyticlesionandbloodculturesrevealinfection.Aboneculturegrows
gramnegativerods.Whichofthefollowingbestdescribestheinfecting
organism?

A.
Itisafacultativeintracellularparasite

B.
Itisanonmotilefacultativeanaerobe

C.
ItiscommashapedandsensitivetoacidicpH

D.
Itismotileanddoesnotfermentlactose

E.
Itismotileandoxidasepositive
Answer

23>A17yearoldgirllosesherbestfriendinanautomobileaccident.After
thedeath,shestartswritingforhoursdailyinherdiary.Thiswould
mostlikelybeanexampleofwhichofthefollowingdefensemechanisms?

A.
Identification

B.
Projection

C.
Rationalization

D.
Regression

E.
Sublimation

Answer

24>Physicalexaminationofaneonatedemonstratesabnormalfacieswitha
smalllowerjaw,lowsetears,andaprominentocciput.Thefeethavea
rockerbottomdeformation,andtheinfantishypertonic.Cardiac
evaluationdemonstratesaventricularseptaldefect.Whichofthe
followingistheaveragelifespanforinfantswiththisneonate's
syndrome?

A.
23months

B.
12years

C.
47years

D.
1525years

E.
Normallifeexpectancy
Answer

25>Abiopsyofabraintumorfroma42yearoldmanrevealsaglialneoplasm
consistingofatypicalastrocyteswithscatteredmitoses.Besidesmitotic
activity,whichofthefollowingmarkerscanprovideinformationabout
theneoplasm'sproliferativeactivity?

A.
bcl2

B.
Glialfibrillaryacidicprotein(GFAP)

C.
Ki67

D.
p53

E.
Ubiquitin

Answer

26>Apharmacologistisdeterminingthepharmacokineticparametersofanovel
antibioticinordertodeterminetheproperdosage.Thedrugisa
weakorganicacidwithapKaof3.0.AssumingapHof2.0inthe
stomach,approximatelywhatpercentofthedrugwillbeinaform
thatcanberapidlyabsorbedfromthestomach?

A.
0.1

B.
1

C.
10

D.
50

E.
90

F.
99

Answer

27>A38yearoldwomanvacationinginConnecticutisbittenbyatick.
Shedoesnotseekmedicaltreatmentandeventuallydevelopschronic
arthritisofthekneeandhipjointsandparalysisoftheleftfacial
muscles.Aphysicalexaminationduringtheearlystagesofthedisorder
wouldmostlikelyhaverevealed

A.
aphthousulcersinthemouth

B.
erythemachronicummigrans

C.
flaccidparalysisoflimbflexors

D.
purpuriclesionsinabathingtrunkdistribution

E.
spasticparalysisoflimbextensors
Answer

http://rfwdata.net/USMLEQBANK/block39questions.html

4/12

5/28/2015

rfwdata.net/USMLEQBANK/block39questions.html

28>A20yearoldmanwithnewonsetofseizuresandnohistoryofhypertension
isevaluatedwithacontrastenhancedCTscanofthehead,which
demonstratesamixedparenchymalandsubarachnoidhemorrhage.The
parenchymalhemorrhageiscenteredoveronecerebralhemisphere.
Whichofthefollowingisthemostlikelysourceofthehemorrhage?

A.
Arteriovenousmalformation

B.
Berryaneurysm

C.
Bridgingvein

D.
CharcotBouchardaneurysm

E.
Middlemeningealartery
Answer

29>Ababyisbornwithasmallhead,smalleyes,and6fingersoneachhand.
Twodimensionalechocardiographyrevealscongenitalheartdefects.
Whichofthefollowinggeneticconditionsismostlikelytobethe
causeofthischild'spresentation?

A.
Trisomy13

B.
Trisomy18

C.
Trisomy21

D.
XXY

E.
XYY

Answer

30>A35yearoldmalepresentstoaninfectiousdiseasespecialistwith
recurrentinfectionswithencapsulatedbacterialorganisms.Thehistory
indicatesthattheseinfectionshavebecomeapparentinthelast
6months.Laboratoryfindingsindicatesthatthetotalimmunoglobulin
levelexceeded900mg/dLwithalowCH50(hemolyticcomplement)level.
Whichofthefollowingisthecorrectdiagnosis?

A.
Acquiredhypogammaglobulinemia(commonvariablehypogammaglobulinemia)

B.
C3deficiency

C.
HyperIgMsyndrome

D.
WiskottAldrichsyndrome

E.
Xlinkedinfantilehypogammaglobulinemia
Answer

31>AresearcherdevelopsaspecificantibodytothecomplementcomponentC3b
.Assumethatintravenousadministrationoftheantibodypreventsthe
biologicaleffectsofC3b.Administrationoftheantibodywouldbe
expectedtointerferewithwhichofthefollowingbiologicalfunctions?

A.
Decreasedappetite

B.
Fever

C.
Increasedcollagensynthesisbyfibroblasts

D.
Increasedleukocyteadherencetoendothelium

E.
Opsonizationtofacilitatephagocytosis
Answer

32>A42yearoldmanpreviouslydiagnosedwithkidneystonescomplains
ofgnawing,burningepigastricpain.Onquestioning,healsonotes
moderatetoseverediarrhea.Measurementofthepatient'sbasalgastric
acidoutputrevealsthatitismarkedlyelevated.Thesesymptomsare
likelytheresultofwhichofthefollowingneoplasticsyndromes?

A.
Familialpolyposiscoli

B.
MENI

C.
MENIIA

D.
MENIIB

E.
MENIII
Answer

33>DuringtheisolationofMetenkephalin(TyrGlyGlyPheMet)from
postmortemhumanbraintissue,researchersfindthatthepeptide
israpidlydegradedbypeptidasesin1minuteat37C.Detailed
analysisofthepeptidecleavagepatternofMetenkephalinis
investigatedwithtwocandidateenzymes.Usingthedrugbestatin,
theinvestigatorsfoundnodetectableTyrGlyGlyPheMetbutdid
findsignificantconcentrationsofTyrGlyGly.Usingthiorphan,
therewasnodetectableTyrGlyGlyPheMet,buttherewasa
highconcentrationofTyr.Whichofthefollowingisthebest
conclusionaboutMetenkephalinmetabolismthatcanbedrawn
fromthesedata?

A.
Bestatininhibitsanaminopeptidase,andthiorphaninhibitsanendopeptidaseinthedegradativepathway

B.
Bestatininhibitsacarboxypeptidaseinthedegradativepathway

C.
Bestatininhibitsanendopeptidaseinthedegradativepathway

D.
Thiorphaninhibitsanaminopeptidase,andbestatininhibitsanendopeptidaseinthedegradativepathway

E.
Thiorphaninhibitsanaminopeptidaseinthedegradativepathway
Answer

34>Thepharmacokineticpropertiesofanewdrugarebeingstudiedin
normalvolunteersduringphaseIclinicaltrials.Thevolumeof
distributionandclearancedeterminedinthefirstsubjectare
40Land2.0L/hour,respectively.Thehalflifeofthedrug
inthissubjectisapproximately

A.
2hours

http://rfwdata.net/USMLEQBANK/block39questions.html

5/12

5/28/2015

Answer

rfwdata.net/USMLEQBANK/block39questions.html
B.
C.
D.
E.

6hours
14hours
21hours
40hours

35>Thepregnantmotherofa6yearoldsonwithglucose6phosphate
dehydrogenasedeficiencyisveryworriedthatherfemalefetus
willhavethedisease.Thefatherandmotherareclinicallynormal.
Whichofthefollowingistrueaboutherbaby?

A.
Thebabyhasa25%chanceofclinicaldisease

B.
Thebabyhasa50%chanceofbeingacarrier

C.
Thebabyhasa50%chanceofclinicaldisease

D.
Thebabywillbeacarrier

E.
Thebabywillhaveclinicaldisease
Answer

36>Medicalstudentsatamajorteachinghospitalareroutinelyassigned
toobserveobstetricpatientsandtoassistduringdelivery.Whenamale
medicalstudentintroduceshimselftoanobstetricpatient,thepatient
becomesagitatedandrequeststhatnostudentsbepresentduringher
delivery.Thepatienthadbeeninformed,priortoadmission,thatthis
wasateachinghospitalandthatastudentwouldbeassignedtoher
case.Wheninformedofthepatient'srefusal,theattendingphysician
inchargeshould

A.
askthepatient'shusbandforhisconsent

B.
assignafemalemedicalstudenttoobserve

C.
notallowanymedicalstudentstoobservethispatient

D.
havethepatient'snurseseekpermission

E.
havethestudentapproachthepatientagainandexplainthenecessityforstudentobservation

F.
havethestudentobserveinthebackgroundasapartofthehealthcareteam.

G.
meetwiththepatientanddiscussthevalueofobservationinmedicaltraining
Answer

37>A24yearoldmigrantfarmworkerisrushedtoanearbyemergencyroom
afteranaccidentalexposuretoparathion.Heisinrespiratorydistress
andisbradycardic.Whichofthefollowingdrugscanbegiventoincrease
theactivityofhisacetylcholinesterase?

A.
Atropine

B.
Deferoxamine

C.
Dimercaprol

D.
Nacetylcysteine

E.
Physostigmine

F.
Pralidoxime

Answer

38>A74yearoldwomanwithmultiplemyelomaisbeingtreatedwithhigh
dosesofdoxorubicin(Adriamycin).Shehasalsoreceived
cyclophosphamideandprednisonerecently.Duringhisexamination,
thephysicianshouldcheckthepatientfor

A.
abdominaltenderness

B.
bladderdistention

C.
limitationofmovement

D.
papilledema

E.
pulmonaryrales
Answer

39>A60yearoldmanhospitalizedwithmetastaticcoloncancersignsa
DNRorder.Thismeansthatthemedicalstafftreatinghimisrequired
to

A.
discontinuenarcoticpainmedication

B.
notattemptCPRincaseofcardiacarrest

C.
refrainfromprescribingfuturemedications

D.
withholdparenteralnutritionandIVfluidhydration
Answer

40>A27yearoldswimmerwhofeelsinsecureaboutherathleticabilities
harshlycriticizesherteammates'techniques.Whichofthefollowing
egodefensemechanismsisshedisplaying?

A.
Displacement

B.
Projection

C.
Reactionformation

D.
Repression

E.
Sublimation

Answer

41>Inacertainpopulation,thefrequencyofcolorblindmalesis1in100.
AssumingthatthepopulationisinHardyWeinbergequilibriumatthis
locus,thefrequencyofcolorblindfemalesisapproximately

A.
0.0001

B.
0.0005

C.
0.01

D.
0.02

http://rfwdata.net/USMLEQBANK/block39questions.html

6/12

5/28/2015

Answer

rfwdata.net/USMLEQBANK/block39questions.html
E.

0.025

42>Anewbornpresentswithsevereacidosis,vomiting,hypotonia,and
neurologicdeficits.Serumanalysisrevealselevatedlevelsoflactate
andalanine.Theseobservationssuggestadeficiencyinwhichofthe
followingenzymes?

A.
Alanineaminotransferase

B.
Glutamatedehydrogenase

C.
Lactatedehydrogenase

D.
Pyruvatecarboxylase

E.
Pyruvatedehydrogenase
Answer

43>A5yearoldboywhohasbeendiagnosedwithamucopolysaccharidosisis
givenanIQtestandfoundtohavenearlynormalintellectualfunctioning.
Whichofthefollowingarepossiblediagnosesforthispatient?

A.
HuntersyndromeorHurlersyndrome

B.
HuntersyndromeorScheiesyndrome

C.
HurlersyndromeorSanfilipposyndrome

D.
MorquiosyndromeorSanfilipposyndrome

E.
MorquiosyndromeorScheiesyndrome

Answer

44>A72yearoldfemalepatientwithAlzheimer'sdisease,butnoother
medicalproblems,suddenlybecomescomatoseanddiesduetoanintracranial
hemorrhagethatcausedseveredamagetoherentireleftcerebral
hemisphere.Therewasnoevidenceorhistoryoftrauma.Whatisthe
most
likelycauseofthishemorrhage?

A.
Epiduralhematoma

B.
Subduralhematoma

C.
Amyloidangiopathy

D.
Ruptureofberryaneurysm

E.
RuptureofCharcotBouchardaneurysm

Answer

45>A23yearoldmanlivinginagrouphomeforthedevelopmentally
challengedhasanIQof73.Hedoesnotreadorwrite,andcommunicates
withoneortwowordutterances.Hewillnotinteractwithothergroup
homemembers,andsincebirthhehas"pulledback"andbecomesagitated
whenothersgetphysicallyclosetohim.Inhisroom,everythingisin
agivenplace;ifanyofhisbelongingsaremoved,hebecomesquite
disturbed.Whichofthefollowingisthemostlikelydiagnosis?

A.
Asperger'sdisorder

B.
Autisticdisorder

C.
Childhooddisintegrativedisorder

D.
Obsessivecompulsivedisorder

E.
Schizophrenia,catatonic

Answer

46>Whichofthefollowingaminoacidsismostresponsibleforthebuffering
capacityofhemoglobinandotherproteins?

A.
Arginine

B.
Asparticacid

C.
Glutamicacid

D.
Histidine

E.
Lysine
Answer

47>Additionofwhichofthefollowingexhaustively14Clabeledsubstrates
wouldleadtoevolutionof14CO2fromacellfreesuspensioncontaining
alltheenzymesandsubstratesrequiredforthesynthesisofuridylic
acid?

A.
Aspartate

B.
Carbamoylphosphate

C.
Glutamine

D.
Glycine

E.
N10Formyltetrahydrofolate

Answer

48>A54yearoldcollegeprofessorisdiagnosedwithcoloncancerandhas
itresected.Tumorisfoundextendingfromthemucosatotheserosal
surfaceofthecolonandinthreeregionallymphnodes.Histological
examinationdemonstratesthatthetumoriscomposedofcellswith
ovoid,relativelysmallnucleithatformwelldefinedglands.Which
ofthefollowingbestdescribesthistumor?

A.
Highstage,highgrade

B.
Highstage,lowgrade

C.
Lowstage,highgrade

D.
Lowstage,lowgrade

Answer

http://rfwdata.net/USMLEQBANK/block39questions.html

7/12

5/28/2015

rfwdata.net/USMLEQBANK/block39questions.html

49>A52yearoldmanpresentstohisphysicianafteracommunityhealth
screeningtestrevealsafastingglucoseof170mg/dL.Physical
examinationisremarkableforbronzeskinpigmentation,hepatomegaly,
splenomegaly,andlimitationofmotioninthesecondandthird
metacarpophalangealjointsofbothhands.Aliverbiopsyobtained
fromthepatientisshownabove.Themanhasnoknownhistoryof
hemolyticanemia,andtakesdailymultivitaminswithoutminerals.
Whichofthefollowingpigmentsismostlikelypresentinthe
man'sliver?

A.
Bilirubin

B.
Carotene

C.
Ferritin

D.
Lipofuscin

E.
Melanin
Answer
50>Whichofthefollowingenzymesislocatedatarrow1in
theelectronmicrographabove?

A.
CarnitineacyltransferaseII

B.
FattyacylCoAsynthetase

C.
Glucose6phosphatedehydrogenase

D.
Hexokinase

E.
Pyruvatekinase
Answer

Answers

(39)

1ThecorrectanswerisC.Intheconditiondescribed,apersonisinasocialsituationandfearsthatheorshewillnotbeabletoperforminthesamemanner
Anxietydisorderduetoageneralmedicalcondition(choiceA)isdiagnosedwhenamedicalconditionprecipitatesanxiety,e.g.,hypoglycemia.
Panicdisorder(choiceB)ischaracterizedbysuddenparoxysmsofanxiety.Itcanstrikeunexpectedlyinuncuedsituationssoitwouldnotoccuronlywhenothers
Specificphobias(choiceD)areunreasonablefearsofsomeidentifiablething,notsituation(e.g.,elevators).
Substanceinducedanxietydisorder(choiceE)isdiagnosedwhenanxietyisprecipitatedbyingestionofapsychoactivesubstance,e.g.,hallucinogens.

2ThecorrectanswerisE.Thispatienthassenilecardiacamyloidosis,whichisusuallyaclinicallyinsignificantconditionduetodepositionofstructurallynor
Amyloidassociatedprotein(choiceA)isamorecommonproteindepositedasamyloid,andprecipitatesinsecondaryamyloidosisassociatedwithunderlyingchronic
Amyloidlightchainprotein(choiceB)isacommonproteindepositedasamyloid,andprecipitatesinamyloidosisrelatedtomultiplemyelomaandothermonoclonal
Beta2amyloidprotein(choiceC)isdepositedasamyloidinthebrain(notablyinbloodvesselsandcerebralplaques)ofpatientswithAlzheimer'sdisease.
Beta2microglobulin(choiceD)isanormalserumproteinthatisdepositedinamyloidosiscomplicatinglongtermhemodialysis.

3ThecorrectanswerisA.TheheritablementalretardationconditionassociatedwithchromosomalbreakageisfragileXsyndrome.Thebreakpointisatq27.3onth
Ychromosome(choiceB)damageisnotpartoffragileXsyndrome,butlossofthischromosomeisonemechanismofproducing45,X0(Turnersyndrome),characterize
Trisomy13(choiceC,Patausyndrome),trisomy16(choiceD,Edward'ssyndrome)andtrisomy21(choiceE,Down'ssyndrome)areallassociatedwithmentalretardat

4ThecorrectanswerisE.AsyoumighthaveguessedfromhiselevatedPTlevel,theactiveingredientinratpoisoniswarfarin.Itactsasananticoagulantbyin
Atropine(choiceA)isusedasanantidoteforanticholinesterasetoxicity(e.g.,ingestionoforganophosphates).
Flumazenil(choiceB)isusedasanantidoteforbenzodiazepinetoxicity(e.g.,Valium).
Nacetylcysteine(choiceC)isusedasanantidoteforacetaminophentoxicity.
Protamine(choiceD)isusedasanantidoteforheparinoverdose.NotethatheparinenhancestheactivityofantithrombinIII,producingitsanticoagulanteffect.

5ThecorrectanswerisA.Thepatienthastabesdorsalis,whichisaformofneurosyphilisseen10to25yearsorlongerafterprimarydisease.Thepupilsdescrib
Thedorsalgrayhorn(choiceB)containsneuronsthatrespondtosensoryinput.
Thelateralcolumn(choiceC)containsbothdescending(e.g.,lateralcorticospinal,rubrospinal)andascending(e.g.,spinocerebellar,spinothalamic)tracts.
Theventralcolumn(choiceD)containsbothdescending(e.g.,anteriorcorticospinal,tectospinal)andascending(e.g.,spinothalamic)tracts.
Theventralhorn(choiceE)containslowermotorneurons.

6ThecorrectanswerisD.Toilettrainingisnotpossiblebeforetheageof18monthsbecausethelongnervefibershavenotyetmyelinatedandsphinctercontrol

7ThecorrectanswerisA.ThefeaturesdescribedaretypicalofthefamilialformofmentalretardationknownasfragileXsyndrome.Thisdisorderisthesecondm
Genomicimprinting(choiceB)isaphenomenoninwhichthephenotypicexpressionofagenediffersifthegeneisinheritedfromthemother,ratherthanthefathe
ARobertsoniantranslocation(choiceC)causesabout5%ofcasesofDownsyndrome.Generallythemother[typicallywithgenotype45,XX,14,21,+t(14q;21q)]h
Trisomy13(Patausyndrome;choiceD)ischaracterizedbymicrocephaly,mentalretardation,cleftlipandpalate,polydactyly,androckerbottomfeet.Survivalis
Trisomy18(Edwardssyndrome;choiceE)ischaracterizedbymentalretardation,micrognathia,lowsetears,cardiacdefects,renaldefects,androckerbottomfeet

8ThecorrectanswerisC.Thesmellofacetoneonthebreathofacomatosepatientisanimportant,rapiddiagnosticcluethatstronglysuggestsketoacidosisand
Inalcoholintoxication(choiceA),thebreathwillsmelllikealcohol.
Diabetichyperosmolarcoma(choiceB)usuallyisseeninolderpatientswithtype2diabetesandisnotcharacterizedbyketoacidosis.Sincethereisnoacetonep
Inheroinoverdose(choiceD),noacetoneproductionoccursandthereisnospecificscenttothebreath.

http://rfwdata.net/USMLEQBANK/block39questions.html

8/12

5/28/2015

rfwdata.net/USMLEQBANK/block39questions.html

Inhypoglycemiccoma(choiceE),whichcanoccurindiabeticswithinsulinoverdose,noacetoneproductionoccursandthereisnospecificscenttothebreath.

9ThecorrectanswerisD.Thepresentationsuggestsamanicorhypomanicepisodeofamooddisorder.Patientsinamanicepisodeoftenhaveanelatedoreuphoric
Depressedmood(choiceA)canincludeanhedonia,decreasedselfesteem,energy,concentration,appetite,andlibido,aswellasincreasedguiltandsucidality.
Anunreasonablefearthatonemightdie(choiceB)maybeassociatedwithpanicdisorder.Neurovegetativesymptomsincludingsevereanxiety,palpitation,shortnes
Despitepoorsleep,manicpatientsdonotcomplainofinsomnia(choiceC).Theirneedforsleepisdecreased.Duringdepressiveepisodes,patientscomplainofins
Obsessivecompulsivedisorderischaracterizedbydistressingrecurrentthoughts(obsession)andactions(compulsion)(choiceE)thatrelieveanxietywhencarried

10>***

11ThecorrectanswerisD.Notalldementingdisordersmanifestwiththesameclinicalfeatures.Althoughthereisconsiderableoverlapinclinicalsymptomatology
Alzheimerdisease(choiceA)isthemostfrequentformofdementiainindustrializedcountries.AlthoughsymptomsduetofrontaldamagemaybepresentinAlzheime
CreutzfeldtJacobdisease(choiceB)representstheprototypeofpriondiseases.CorticalatrophyisnotaprominentfeatureofCreutzfeldtJacobdisease,whichm
DementiawithLewybodies,alsoknownasdiffuseLewybodydisease(choiceC),isoneofthemostcommonformsofdementiainWesterncountries,possiblymorecom
Vasculardementia(choiceE)isanumbrellatermencompassingdementingconditionsthatarisefrompathologyoflargeorsmallcerebralvessels.Itmanifestswith
Multiinfarctdementia,whichiscausedbymultiple,scatteredbraininfarctssecondarytoatherosclerosisoflargearteriesofthecircleofWillisand/orcaroti
Binswangerdisease,whichinvolvesrarefactionofcerebralwhitematterandiscausedbyhypertensionrelatedarteriolosclerosis.
Lacunarinfarcts,whichconsistofsmall(<1cm)infarctsinthestriatumandthalamus;thisconditionisrelatedtoarteriolosclerosis.

12ThecorrectanswerisE.Thispatienthasapinealoma.Tumorsofthepinealglandcompresstheverticalgazecenterinthetectumofthemidbrain.Thepinealgl
Anacousticneuroma(choiceA)isaschwannomaoftheeighthcranialnerve.Itresultsindeafness,ataxia,anddysarthria.Nystagmusmaybepresent.Thegazecen
Astrocytomasofthecerebellum(choiceB)areusuallyseeninchildren.Thesetumorspresentwithheadache,nausea,vomiting,papilledema,andcerebellarsignssu
Craniopharyngiomas(choiceC)areusuallyseeninchildren.Thereisfailureofgrowth,headaches,andbitemporalhemianopia.
Parasagittalmeningiomas(choiceD)usuallyresultinheadache,spasticparesis,andurinaryincontinence

13ThecorrectanswerisC.Thereareanumberofhereditarysphingolipidosesthathavedevastatingclinicalcourses.Inpractice,thesediseasesmayhaveavariab
Gaucher'sdisease(choiceA)isasphingolipidosiscausedbydeficientbetaglucocerebrosidase.
Krabbe'sdisease(choiceB)isasphingolipidosiscausedbydeficientbetagalactocerebrosidase.
NiemannPickdisease(choiceD)isasphingolipidosiscausedbydeficientsphingomyelinase.
TaySachsdisease(choiceE)isasphingolipidosiscausedbydeficienthexosaminidaseA(alphasubunit).

14ThecorrectanswerisB.Deliriumisacommoncomplicationofgeneralanesthesiaandsurgery.Itismanifestedbyacutechangesinmentalstatuswithwaxingand
Anypsychosocialorbiologicalstressorcanleadtoadjustmentdisorder(choiceA).Thispatient'ssurgerywillrestricthisleveloffunctioning,atleastinthe
Dementia(choiceC)canpresentwithirritability,confusion,andagitation,butusuallyhasaninsidiouscourseandaffectsmainlycognition.Incontrasttodeli
Severedepressioncanpresentwithirritability,suicidalideation,andpsychoticfeatures(choiceD).Thepatienthasahistoryofdepressionthatrespondedwell
Schizophrenia(choiceE)presentswithbizarrebehavior,hallucinations,anddelusions.Itusuallystartsatayoungeragethantheacutesymptomsinthispatient

15ThecorrectanswerisB.Inasense,cervicalcarcinomacanbeconsidereda"sexuallytransmitteddisease,"sincehumanpapillomavirus(typicallystrainsHPV1

16ThecorrectanswerisE.Vincristine(andvinblastine)areVincaalkaloidsthatbindtotubulin,acomponentofcellularmicrotubules.Thisleadstodisruption
Cytarabine(choiceA)belongstotheclassofantineoplasticsthatareantimetabolites.Thisdrugclassinterfereswithnormalmetabolicpathwaysbycompetingfor
Daunorubicin(choiceB)isoneoftheantibioticantineoplasticagents(othersincludedactinomycin,doxorubicin,bleomycin,plicamycin,andmitomycin).Theseage
Hydroxyurea(choiceC)worksbyinterferingwithribonucleosidediphosphatereductase,theenzymeresponsibleforgeneratingthedeoxyribonucleotidesneededforD
Mechlorethamine(choiceD)isanitrogenmustard.Thenitrogenmustards(mechlorethamine,cyclophosphamide,melphalan,chlorambucil)belongtothelargerclassof

17ThecorrectanswerisE.Priapismischaracterizedbythedevelopmentofapainfulerectionforanextendedperiodoftime.Whenuntreated,priapismcancauses
Atenolol(choiceA)isabeta1adrenergicantagonistindicatedforthetreatmentofhypertension.Thisagentiscommonlyassociatedwithimpotenceinmales.
Furosemide(choiceB)isaloopdiureticindicatedforthetreatmentofedemaandhypertension;electrolyteabnormalitiesarethemostcommonsideeffectsseenwi
Thesulfonylureaglyburide(choiceC)isanoralhypoglycemicagentindicatedforthetreatmentoftype2diabetes;hypoglycemiaisthemostcommonsideeffectof
Paroxetine(choiceD)isaselectiveserotoninreuptakeinhibitor(SSRI)usedforthetreatmentofdepression.Thisagentiscommonlyassociatedwithimpotencein

18ThecorrectanswerisD.SinceTaySachsislethalinchildhood,theonlyadultscarryingthegeneareheterozygotes.Theonlymatingthatwillproduceprogeny
ChoiceA,0.25,couldbeobtainediftheparentsarecarriers,sotheprobabilityofaTaySachschildisequaltotheprobabilitythattwoheterozygoteswillpro
ChoiceB,0.11,couldbeobtainedifbothoftheparentshadasiblingwithTaySachs.Thiswouldmeanthatthegrandparentsmusthavecarriedthedisease,andth
ChoiceC,0.0625,isalsoincorrect.Itistheproductof(0.25)(0.25).
ChoiceEincorrectlyassumesthatbecauseq2,thefrequencyofthedisease,cannotbecalculated,andhencetheallelefrequenciescannotbecalculated,thatane

19ThecorrectanswerisD.Thisman'spresentationcanbeexplainedeitherbyalcoholwithdrawalorbycocaineintoxication.Nausea,vomiting,sympatheticnervous
Alcoholintoxication(choiceAandB)ischaracterizedbydisinhibition,aggression,impairedattentionandjudgment,unsteadygaitandimbalance,slurredspeech,
Othersymptomsassociatedwithalcoholwithdrawal(choicesCandD)includeinsomnia,headache,andtremorsofthetongue,eyelids,andoutstretchedhands.
Withdrawalfromcocaine(choicesBandF)ischaracterizedbydysphoria,lethargy,psychomotorretardationoragitation,increasedappetite,sleepdisturbances,a
Othersymptomsassociatedwithcocaineintoxication(choicesDandE)includegrandiosity,paranoidideation,andpupillarydilatation.Orientationusuallyremain

20ThecorrectanswerisC.Menhavehigherreferenceintervalsthanwomenintestsrelatedtoironandhemoglobin(Hb)concentrationinblood.Thenormalreferenc
Themeancorpuscularvolume(choiceA),serumalkalinephosphatase(choiceB),serumglucose(choiceD),andserumsodium(choiceE)aresimilarinbothsexes.

21ThecorrectanswerisA.ThemostimportantchemotacticfactorsforneutrophilsarethecomplementfactorC5aandtheinterleukinIL8.
ThecytokinesIL1andtumornecrosisfactor(choiceB)havecomplex,similaractions,includingstimulationofproductionofmanyacutephasereactions,stimulat
LeukotrienesLTC4andLTD4(choiceC)causeincreasedvascularpermeability.
ProstaglandinsPGI2andPGD2(choiceD)mediatevasodilationandpain.
Thromboxaneandplateletactivatingfactor(choiceE)induceplateletchanges

http://rfwdata.net/USMLEQBANK/block39questions.html

9/12

5/28/2015

rfwdata.net/USMLEQBANK/block39questions.html

22ThecorrectanswerisD.Thepresenceofsicklecelldiseaseinaquestionstemisusuallyasignificantclue.Thisquestiontestsifyouknowthatpatientswit
Afacultativeintracellularparasite(choiceA)isLegionella,acatalasepositivegramnegativerod.ItcontaminatesairconditioningcoolingtowersandcausesL
Anonmotile,facultativeanaerobe(choiceB)isShigella,agramnegativerodthatdoesnotproduceH2S.AllShigellacontainanendotoxiclipopolysaccharide.The
AcommashapedorganismthatissensitivetoacidicpH(choiceC)isVibriocholerae,agramnegativerodthatcausessevereenterotoxininduceddiarrhea,with"r
Amotileandoxidasepositiveorganism(choiceE)isPseudomonas,agramnegativerodwithpilithatsometimesproducesapolysaccharideslimelayer.P.aeruginos

23ThecorrectanswerisE.Sublimationisthediversionofunacceptableimpulsesintomoreacceptableones.Inthiscase,thegirlwouldliketocontinuetotalk
Identification(choiceA)istheadoptionofcharacteristicsoractivitiesofanotherperson.
Projection(choiceB)occurswhensomeoneattributestheirownthoughtstoadifferentperson.
Rationalization(choiceC)istheofferingofafalse,butacceptable,explanationforbehavior.
Regression(choiceD)istheadoptionofbehaviormoreappropriatetoayoungerage.

24ThecorrectanswerisA.ThesyndromedescribedisEdwards'syndrome(trisomy18),whichistypicallycharacterizedbythefeaturesnotedandadditionallycause

25ThecorrectanswerisC.Ki67isanuclearfactor(ofuncertainfunction)whoseexpressioncorrelateswithneoplasticreplicativeactivity.Itsexpressioncan
Thebcl2gene(choiceA)suppressesapoptosisbydifferentmechanisms.Itsabnormalactivationisinvolvedinthepathogenesisoflowgradelymphomasbutnotast
GFAP(choiceB)isanintermediatecytoskeletalfilament(analogueofkeratinandvimentin)expressedexclusivelybycertaintypesofglialcells,e.g.,astrocyte
Thegenep53(choiceD)encodesaproteinthatblocksthecellcyclewhendamagetoDNAoccurs.Ifthedamageissuccessfullyrepaired,p53allowsthecellcycle
Ubiquitin(choiceE)isalowmolecularweightheatshockprotein.Itsfunctionistotagaberrantproteinsfordegradation.Itispresentinmanyabnormalintran

26ThecorrectanswerisE.First,itisnecessarytoknowthatitistheuncharged,lipidsolubleformthatcanberapidlyabsorbed.Foranacid:HA<>H+
pH=pKalog[protonatedform/unprotonatedform]
Inthiscase,
2.0=3.0log[HA/A]
1.0=log[HA/A]
10=HA/A=10/1
HA/(HA+A)=10/(10+1)=91%,orapproximately90%

27ThecorrectanswerisB.LymediseaseshouldbesuspectedinapatientwhoisbittenbyatickinthenortheasternU.S.Lymediseasewasnamedafteratownship
Skinmanifestationsdonotincludeaphthousulcers(choiceA).
Flaccidorspasticparalysisoflimbs(choicesCandE)doesnotaccompanyLymedisease;neurologicinvolvementisgenerallylimitedtocranialnervesandmeningi
Purpura(choiceD)isassociatedwithvasculitisanddoesnotoccurinLymedisease.

28ThecorrectanswerisA.Arteriovenousmalformationsarecomposedofcomplextanglesofcongenitallymalformedvesselsthattypicallyinvolvethesuperficialor
Berryaneurysms(choiceB)canproducebothsubarachnoidandparenchymalhemorrhage,butareusuallycenterednearthebaseofthebrain.
Bleedingfrombridgingveins(choiceC)causessubduralhematoma.
CharcotBouchardaneurysms(choiceD)aresmall,intraparenchymalaneurysmsthatarerelatedtohypertension.
Ruptureofthemiddlemeningealartery(choiceE)causesepiduralhematoma.

29ThecorrectanswerisA.ThisisPatausyndrome,ortrisomy13.Thisdisorderisalsoassociatedwithseverementalretardation,abnormalforebrainstructures,
Trisomy18(choiceB)isEdwardssyndrome,characterizedbyseverementalretardation,rockerbottomfeet(alsosometimesseeninPatausyndrome,sobecareful!),
Trisomy21(choiceC)isDownsyndrome,andischaracterizedbymentalretardation,flatfacialprofile,prominentepicanthalfolds,simiancrease,duodenalatres
XXY(choiceD)isKlinefeltersyndromeandisassociatedwithmalehypogonadismandinfertility,eunuchoidbodyhabitus,gynecomastia,andlackofmalesecondary
XYY(choiceE)isdoubleYsyndrome.Affectedindividualsoftengoundetected,butmaybetallerthanaverage,andmaybemorelikelytoexhibitaggressive,antis

30ThecorrectanswerisB.IndividualswithC3deficiencyhaveanincreasedsusceptibilitytorecurrentbacterialinfections,especiallywithencapsulatedbacteri
Acquiredhypogammaglobulinemia,alsoknownascommonvariablehypogammaglobulinemia,(choiceA)isruledoutbythefactthatthetotalimmunoglobulinlevelisgr
InhyperIgMsyndrome(choiceC)thereisverylittle,ifany,isotypeswitching,resultinginpatientswhoareIgGandIgAdeficient,butsynthesizelargeamount
InWiskottAldrichsyndrome(choiceD),acombinedimmunodeficiencysyndrome,immuneabnormalitiesareapparentatbirth.PatientsusuallyhavelowIgMlevelswit
PatientswithXlinkedinfantilehypogammaglobulinemia(choiceE)aredetectedinthefirst48monthsoflifeandhavetotalimmunoglobulinlevelslessthan200

31ThecorrectanswerisE.C3bactsasanopsonin,alongwithIgG,tofacilitatephagocytosis.Noneoftheotherfunctionslistedintheanswerchoicesisattribu
Decreasedappetite(choiceA)istypicalduringanacuteillness(suchresponsesarecalledacutephasereactions).Otheracutephasereactionsincludefever(cho
Fibroblastsproliferateandincreasetheirsynthesisofcollagen(choiceC),collagenase,protease,andprostaglandinEinresponsetoIL1andTNF.
EffectsofIL1andTNFonendotheliumincludeincreasedsynthesisofmediators(prostaglandins,IL1,IL8,plateletderivedgrowthfactor),increasedleukocyte

32ThecorrectanswerisB.Pancreaticislettumors,whichmayproducegastrinandsecondarilyZollingerEllisonsyndrome,areafeatureofmultipleendocrineneop
Endocrinetumorsarenotafeatureoffamilialpolyposiscoli(choiceA),whichisinsteadcharacterizedbycolonicpolypsandcoloncancer.
MENtypeIIA(choiceC)featurestumorsoftheadrenalmedulla(pheochromocytoma),medullarycarcinomaofthethyroid,andparathyroidhyperplasiaoradenoma.
MENtypeIIB(choiceD)closelyresemblestypeIIAbutalsoincludesmucosalneuromas,andlessoftenincludesparathyroiddiseases.
MENtypeIII(choiceE)isnowconsideredtobethesameasMENtypeIIB.

33ThecorrectanswerisA.Metenkephalin,themostabundantopioidpeptideinthehumanbrain,undergoestworoutesofmetabolism.Oneroutereleasesatripeptid
Thescientistshaveusedtwodrugstohighlightthetwoenzymaticpathways.Withbestatin,Metenkephalinismetabolizedonlytothetripeptide;thereforebestati

Tyrosinecannotbetheresultofcarboxypeptidaseactivity(choiceB),sincethecarboxylterminusofMetenkephalinisamethionine.
Bestatininhibitsanaminopeptidase,notanendopeptidase(choiceC).Anendopeptidasewouldnotreleaseafreeaminoacidresidue.
Metenkephalinisindeedmetabolizedbyanaminopeptidaseandanendopeptidase,butbestatininhibitstheaminopeptidaseandthiorphaninhibitstheendopeptidase
Thiorphandoesnotinhibitanaminopeptidase(choiceE);furthermore,suchanenzymewouldreleaseafreeTyrandatetrapeptide.

34ThecorrectanswerisC.Thehalflifeofadrugcanbedeterminedusingthefollowingequation:
t1/2=(0.693Vd)/Cl

http://rfwdata.net/USMLEQBANK/block39questions.html

10/12

5/28/2015

rfwdata.net/USMLEQBANK/block39questions.html

35ThecorrectanswerisB.Glucose6phosphatedehydrogenasediseaseisanXlinkedcondition.ThefatherhasanormalXchromosomesincehedoesnothaveclinica
Glucose6phosphatedehydrogenasedeficiencyisadefectinthepentosephosphatepathwayofglucosemetabolism,leadingtodefectiveproductionofreducedNADPH.

36ThecorrectanswerisC.Thepatienthastherighttodecidewhowillorwillnotbepresentduringhercare.Thisincludestherighttorefusetobeapartof
ChoiceAisincorrectbecausethepatient'sconsent,notherhusband's,isrequired.Thehusbandcannotgiveconsentforanalert,competentpatient.
ChoiceBisincorrectbecausethepatientisnotrejectingmalestudents,butallstudents.
ChoiceDisincorrectbecausethepatienthasalreadyrefused.Sendingthenursetogetpermissionsuggeststhatthephysicianisnotrespectingherexpressedwis
ChoiceEisincorrectbecausethepatienthasalreadyrefused.Havingthestudentgobackandaskagainwillonlymakethestudentuncomfortableandmaymakethe
ChoiceFisincorrectbecausesneakingthestudentintoobserveinthebackgroundisadirectcontradictionofthepatient'swishes.
ChoiceGisincorrectbecausemeetingwiththepatienttodiscussthevalueofteachingencounterssuggestsputtingpressureonthepatienttochangehermind.Th

37ThecorrectanswerisF.Pralidoxime(2PAM)isanacetylcholinesterase(AChE)reactivatingagent.ItisonlyusefulforcounteractingAChEinhibitorswhichact
Atropine(choiceA)isanonselectivemuscarinicantagonist.Althoughatropinewouldbeanappropriateagentforthispatient,itactsbypreventingtheexcessAC
Deferoxamine(choiceB)isachelatorusedforironpoisoning.
Dimercaprol(choiceC)isachelatorusedaloneforarsenic,mercuryandgoldpoisoning,andalsoinconjunctionwithedetatecalciumdisodium(EDTA)forthetrea
Nacetylcysteine(choiceD)isusedtotreatacetaminophenoverdose.
Physostigmine(choiceE)isacarbamylatingacetylcholinesteraseinhibitorthatcanbeusedtotreatantimuscarinicoverdose.Thisdrugwouldcertainlyexacerbate

38ThecorrectanswerisE.Doxorubicin(Adriamycin)isananthracyclineantibioticwhich,whengiveninhighdoses(>550mg/m2),canproducecardiomyopathyleadin
Abdominaltenderness(choiceA),bladderdistention(choiceB),limitationofmovement(choiceC),orpapilledema(choiceD)arenottypicallyassociatedwithadm
39ThecorrectanswerisB.TheDNR(donotresuscitate)ordermeansthatthepatientasksthathisorherlifenotbeprolongedbyartificialmeans.Itdoesnot

40ThecorrectanswerisB.Projectioninvolvesattributingone'sowntraits,feelings,andattitudestosomeoneelse.This27yearoldswimmer'sharshcriticismo
Displacement(choiceA)involvestheautomatictransferringofawishoranaffectfromoneobjecttoasubstitute.Forexample,amanwhoisangryathiswifere
Reactionformation(choiceC)involvesturningarepressedimpulseorunconsciouswishtoitsopposite.Forexample,amanwhoisattractedtohisbrother'swife
Repression(choiceD)occurswhentheconflictingthoughtorfeelingisautomaticallyhiddenfromtheperson'sawareness.Forgettinganemotionallychargedevent
Sublimation(choiceE)isaverymaturemechanismthatinvolvesconsciouslyturningsociallyunacceptableimpulsesintoacceptableormorebenignforms.Forexamp

41ThecorrectanswerisA.ColorblindnessisanXlinkedrecessivetrait.AmaleishemizygousfortheXchromosome,andthushasonlyonecopyofeachtrait.Th
ChoiceB,0.0005,isincorrect.Ifyourememberedthatcolorblindnesswasmorefrequentinmales,butdidnotknowhowtousetheequationstogetthetrueestim
ChoiceC,0.01,makestheassumptionthatthetraitisautosomal,andsothefrequenciesofaffectedmalesandaffectedfemalesareequal.
ChoiceD,0.02,assumesthatq=0.01,andthencalculatesthefrequencyofcarrierfemales(2pq).
ChoiceE,0.025isalsoincorrect;itisadistracter.

42ThecorrectanswerisE.Pyruvatedehydrogenase(PDH)catalyzestheirreversibleconversionofpyruvatetoacetylCoA.IfPDHisabsent,pyruvatewillbeusedi
Glutamatedehydrogenase(choiceB)isinvolvedinoxidativedeamination,releasingammoniumionforureasynthesis.Deficiencyofthisenzymewouldnotcausethe
Pyruvatecarboxylase(choiceD)isagluconeogenicenzymethatcatalyzestheconversionofpyruvatetooxaloacetate.Deficiencyofthisenzymewouldnotcausethe

43ThecorrectanswerisE.Allofthediseaseslistedaremucopolysaccharidoses,duetodefectivedegradationofmucopolysaccharides.Featurestypicalofmucopoly

44ThecorrectanswerisC.Alzheimer'sdiseasepatientsarepronetolarge"lobar"hemorrhagesthatareusuallycenteredintheparietallobe(thusthename"loba
Anepiduralhematoma(choiceA)isacollectionofbloodabovetheduramater,usuallyduetoablowtothesideoftheheadthatfracturesthetemporalboneoft
Asubduralhematoma(choiceB)formswhenslowflowingvenousbloodcollectsbelowtheduramaterduetoleakagefromstretchedcorticalveinsastheydraininto
Ruptureofaberryaneurysm(choiceD)usuallycausesasubarachnoidhemorrhage,inwhichbloodleaksintothespacebetweenthearachnoidmembraneandthebrain.
RuptureofaCharcotBouchardaneurysm(choiceE)mightcauseasuddenhemorrhagewithinthebraincausingcomaanddeath,butitisnotespeciallyassociatedwit

45ThecorrectanswerisB.Themanisdisplayingtheclassicsignsofautism,whichincludewithdrawalfrominteractionwithothers,failuretousespeechforcom
EventhoughpatientswithAsperger'sdisorder(choiceA)displayasocialinteractiondeficit,thereisnolanguagedelay.Also,stereotypedpatternsofbehavior
Childrenwithchildhooddisintegrativedisorder(choiceC)developnormallyforthefirsttwoyearsoflife,andthendemonstratedeterioration,butthispatient
Obsessivecompulsivedisorder(choiceD)doesnotincludewithdrawalfromphysicalcontact,languageimpairment,orpresencefrombirth.
Schizophrenicdisorder,catatonictype(choiceE),hasitsonsetinlateadolescence,andischaracterizedbydifficultiesinmovement,andeitherimmobilityore

46ThecorrectanswerisD.RememberthatabufferismosteffectivewhenitspKaiswithinthepHrangeofthesurroundingmedium.Histidineistheonlyaminoaci
Arginine(choiceA)andlysine(choiceE)arebasicaminoacidswithpKa'sof12.5and10.5,respectively;atphysiologicpHbothwillbehaveasbasesandaccept
Asparticacid(choiceB)andglutamicacid(choiceC)areacidicaminoacidswithpKa'sofapproximately4;atphysiologicpHtheywillbehaveasacidsanddonate

47ThecorrectanswerisA.Inthefirststepofpyrimidinesynthesis,carbamoylphosphatecondenseswithaspartatetoformcarbamoylaspartate,inareactioncata
Carbamoylphosphate(choiceB)condenseswithaspartatewiththelossofinorganicphosphatetoproducecarbamoylaspartate.Thecarbamoylmoietyofcarbamoylpho
Glutamine(choiceC),glycine(choiceD)andN10formyltetrahydrofolate(choiceE)areallusedinpurinesynthesis.GlutaminealsodonatesanaminogrouptoUTP

48ThecorrectanswerisB.Gradereferstotheseverityofthemicroscopicchanges.Thepresenceofwellformedglandsestablishesthetumoraswelldifferentiate

49ThecorrectanswerisC.Thispatientissufferingfromhemochromatosis.Normally,thebody'sironloadisregulatedbytheamountofironabsorbedbytheintes
Bilirubin(choiceA)maybedepositedinperipheraltissuesinjaundice.
Carotene(choiceB)accumulatesinskininassociationwithexcessdietaryintake.
Lipofuscin(choiceD)accumulatesintracellularlyduetolipidperoxidationoccurringwithcellularaging.
Melanin(choiceE)mayappearasabrownblackpigmentinnormalskin,orinmelanoma.

http://rfwdata.net/USMLEQBANK/block39questions.html

11/12

5/28/2015

rfwdata.net/USMLEQBANK/block39questions.html

50>***

http://rfwdata.net/USMLEQBANK/block39questions.html

12/12