1.

Block 1 part 1

1. An animal study is conducted to assess the effects of smoking on pulmonary defense and maintenance
mechanisms. For 1 week, normal male rats are exposed to levels of cigarette smoke comparable to those
encountered by humans who smoke cigarettes. Results of pulmonary testing are compared with baseline
levels obtained the week before the smoke exposure. Which of the following sets of changes is most
likely to be observed?
- Mucus secretion goes up, macrophage activity goes down, ciliary action goes down?

2. 20-year-old F secretary with 8yr histtory of intermittent headaches. Flashing lights in her right visual
field, followed 20 minutes later by a unilateral throbbing headache accompanied by nausea and vomiting.
occur around time of menses. Dx?
- Migraine

3. 57-year-old M with 6mo hx of progressive constipation and a feeling of rectal fullness. Digital rectal
examination shows no palpable lesion. Occult blood positive. Coolonoscopy shows mass in sigmoid
colon. Adenocarcinoma. Mets spread via which of the following lymph nodes?
- Inferior mesenteric?

4. 70 yr old african american women come to physician after 1 day onset of back pain. She's a part time
cashier, low income, and smoked 1/2 a pack for 50 years and drinks 3 caffeinated beverages a day. X-ray
shows vertebral compression fracture of L3 and she has decreased bone mineral density. Biggest risk
factor?
- Gender

5. 5-year-old-boy with mental retardedation is grossly obese and has facial features of Prader-Willi
syndrome. Karytoyping and flourescent in situ hybridization studies do not show deletion in the usual site.
Which to confirm PWS?
- Maternal origin of both chromosomes 15

6. 83yo M from Puerto Rico with weight loss and abdominal pain and blood in his stool for 1 month.
Possible colon cancer. Poor english. Needs colonoscopy but family doesn't want to hear bad news and
wants to make decision for about his treatment. Next step?
- Use a Spanish-speaking interpreter to determine how much the patient wishes to know about diagnosis
and treatment

7. 38-year-old F undergoes laparoscopic cholecystecomy with general anesthesia. Afetr she awakens
postoperatively, she is nauseated and vomits threee times in 20 minutes. Treatment for N/V?
- Ondansetron

8. During an experimental study of oxygen consumption in the kidney, experiemtnal animals are
ventillated with 100% nitrogen. Cells from which of the following areas of the kidney first show signs of
anoxic injury?
- Proximal convoluted tubule

9. 7-year-old girl 30 minutes after being hit in the mouth with basketball. Something stuck in her throat.
Part of one tooth is missing. Lateral x-ray of the neck and chest is shown; arrow shows part of the tooth.
Greatest risk for aspiration into which lobes?
- Right lower

10. Poliovirus mRNA lacks a 5' m7G cap but is translated efficiently by cellular ribosomes. Which of the
following additional structural features of poliovirus mRNA is the most likely cause of its ability to be
translated in the absence of a cap?
- Presence of an internal ribosome entry site

11. 67-year-old F brother and mother have history of colon cancer. Physician recommends colonscopy,
but patent only wants her stool to be tested for blood. Most likely concerned about which of the following
regarding this test?
- Low sensitivity

12. 69-year-old African American woman has moderate hypertension and type 2 DM. BMI 31. On
hydrohlorothiazide. Labs show microalbuminuria. Most appropriate to add which drugs?
- Irbesartan

13. 36-year-old man with 2-hour history of pain and swelling of his right calf. No shortness of breath or
chest pain. 18-hour airplane trip 4 hours ago. Noninvasive vascular studies show an occlusion of right
femoral vein. Immediate therapy has which mechanisms of action?
- Activation of antithrombin III

14. 64 yr old alcoholic man with 1 day of confusion. Disoriented, disheveled. Dehydrated, jaundiced. and
has spider angiomata over face and chest. Has flapping up and down of the hands when his arms are
outstretched. Abdominal distention and bulging flanks. He is administered oral neomycin. Question asks
which of the following primary mechanisms of action is most likely to occur in this patient as a result of the
drug treatment?
- Killing of bacteria in the gut that generate ammonia

15. 1 year old boy is brought in. Has white, pale hair that hasn't changed color since birth. His eyes are
blue. During opthalmic examination, the patient turns away from the flashlight and starts crying. Which of
the following is the most likely cause of the pale skin color?
- Inability to make melanin

16. 2-year-old boy with developmental delay. Hx of hearing loss in mother and delayed speech in older
sister. Maternal uncle had stroke-like episodes at the age of 25 years. Physical shows ophthalmoplegia
and hypotonia. Lactic acid concentration increased. Explanation?
- Heteroplasmy

17. Male newborn at 28 weeks' is tachypneic and hypoxemic. Which altered structure changes in the type
II pneumocytes is the most likely cause?
- Decreased numbers of lamellar bodies

18. 16-year-old girl with cystic fibrosis with 3-week history of generalized weakness, numbness and
tingling of her arms and legs, and difficulty walking. Not adhered to medications. Bilateral weakness and
decreased deep tendon reflexes in the upper and lower extremities. Walks with an ataxic gait. Cause is
deficiency of which?
- Vitamin E

19. 48-year-old woman with 6-month hx of irregular menstrual periods and hot flashes. LMP 35 days ago,
and had scant blood flow. Menses had previously occurred at regular 28-day cycles. Mild thinning of the
vaginal tissue. Labs most likely to show which of the following serum concentrations?
- Decreased follicle-stimulating hormone

20. 62-year-old M with unstable angina pectoris undergoes coronary catheterization. To visualize the
anterior interventricular (left anterior descending) artery, the tip of the catheter would need to be placed
into the orifice of which arteries?
- Left coronary

21. 35-year-old F with intermittent sharp chest pain exacerbated by deep breathing, and can be
decreased by leaning forward. 2-month hx of pain and swelling in her hands and knees accompanied by
morning stiffness that lasts 1 hour. Pulsus paradoxus less than 10 mm Hg. Harsh scratchy sound present
in systole and diastole. Warmth, swelling, and tenderness of the metacarphophalangeal joints and knees.
Cause?
- Pericarditis
22. 60-year-old M with a systolic murmur is a heard, which is loudest at the point indicated by the X in the
diagram. Which cardiac abnormality is the cause?
- Aortic valve stenosis

23. 31-year-oldwoman with invasive squamous cell carcinoma of the cervix. Biopsy shows tumor cells
express human papillomavirus, type 16 antigens. Which cell types plays a role in recognizing and killing
these virus-infected tumor cells?
- T lymphocytes

24. An 85-year-old woman is diagnosed with a fracture of the right femur and begins treatment with
morphine by patient-controlled analgesic pump. Three days later, her respirations are 6/min. Physical
examination shows pinpoint pupils. Her serum creatinine concentration is 1.8 mg/dL. Which of the
following best explains this patient's clinical deterioration after the initiation of morphine therapy?
- Morphine is metabolized to active metabolites that accumulate

25. 35 y/o man with 3 yr history of enlarging nose, coarse facies, muscle weakness, increased hand/foot
size. Large fleshy nose and prognathism on exam. High IGF-1 in serum. MRI shows pituitary adenoma.
Morphologic analysis of the tumor shows a densely granulated somatotroph adenoma. Further studies
show that the G alpha-s subunit of the tumor G proteins lack GTPase activity. The tumor cells most likely
have an increased activity of which enzyme?
- Adenlyl cyclase

2.

orthopod
Guest

#3orthopod, Feb 10, 2016

Block 1 part 2
26. 30-year-old woman with Li-Fraumeni syndrome found to have adenocarcinoma of the breast. Family
history includes osteosarcoma. Which mechanisms underlies this condition?
- Impaired regulation of apoptosis

27. 56-year-old with palpable hard nodule on prstate has increased serum prostate-specific antigen
concentration. Fine-needle biopsy specimen shows adenocarcinoma. Patient undergoes radical
prostatectomy. Which structure is at greatest risk for injury during removal of prostate?
- Pelvic parasympathetic nerves

28. 56-year-old woman frequently burned herself while cooking. Loss of pain and temperature sensation
in both upper extremities and portion of her trunk from clavicles to just below the nipples. Touch, vibratory
sensation, and proprioception normal. Findings on MRI of head and spine?
- Syrinx of the central region of the spinal cord from C-4 to T-5

29. 66-year-old man surgical excision of a brain mass; photomicrograph of excised tissue shown.
Smoked 1 pack daily for 50 years. Labs show polycythemia, hypercalcemia, and microscopic hematuria.
Immunostaining of the tissue is positive for epithelial membrane antigen and negative for
carcinoembryonic antigen. Site of primary neoplasm?
- Kidney?

30. 25-year-old man comes to the physician 8 hours after the onset of severe pain of his low back that
radiates down his left leg. He started a weight-lifting regimen earlier in the day during which he tried to lift
a bar loaded with 91 kg (200 lb) from the ground to over his head. The pain began almost immediately
after this attempt Which of the following is the most likely cause of this patients pain?
- Rupture of an intervertebral disc

31. 43-year-old man with 6-week hx of sharp, stabbing pain on the left side of his face that occurs when
he touches it. Pain when shaving. Pain just lateral to the left nasal ala reproduces the pain. Nerve
supplying this area exits the skull through which foramina?
- Rotundum

32. 33-year-old man with 3-month hx of muscle weakness and cramping, appears shortly after he begins
exercising. Serum creatine kinase increased. Venous blood from antecubital vein show lactate
concentrations do not increased compared with preexercise values. Deficiency of which enzymes in
muscle?
- Glycogen phosphorylase

33. 67-year-old man with 2-month hx of weight loss. Has type 1 DM, gallstone removal 12 years ago,
smoked 1 pack daily for 45 years. BMI 34, Calcium concentration of 11 mg/dL. Abdominal CT shows a
pancreatic mass, biopsy shows pancreatic adenocarcinoma. Strongest predisposing factor?
- Cigarette smoking

34. 28-year-old woman with 1-week history of fever and chills. 4.5-kg weight loss, 5-year hx of chronic
sinusitis. Mildly distressed. BMI 18. Temp is 39 C (102.2 F). Has markedly diminished nasal septa. Chest
x-ray shows multiple pulmonary nodules. Serologic studies hsow presence of antibodies against
proteinase 3. Dx?
- Wegener granulomatosis

35. 52-year-old man with 3-week history of increased thirst and urinary frequency; 4.5-kg weight loss. Has
hypertension and hyperlipidemia treated with pravastatin and metoprolol. BMI 34. Which is most likely to
be increased?
- Fasting serum glucose concentration

36. 48-year-old man with possible hypertension. On basis of ten measurements, the patient's average
diastolic blood pressure is 113, and standard deviation is 8. If four rather than ten measurements are
made, which is the expected impact on 95% confidence interval?
- Increase in width

37. 66-year-old M with 6-month history of decreased exercise tolerance and shortness of breath with
exertion. Vitals stable. Auscultation shows bilateral basilar crackles. Cardiac examination shows S3
gallop. Grade 2/6 holosystolic murmur heard best at the apex. Apical impulse palpated at the anterior
axillary line at the sixth intercostal space. Echocardiography shows left and right ventricular enlargement
with decrease systolic function. Dx?
- Dilated cardiomyopathy

38. 29-year-old woman for advice on losing weight. Has been taking thyroxine for several months in
attempt to lose weight. Her thyroid function is normal. Which findings is most likely on histopathologic
eam of the thyroid gland?
- Follicular atrophy

39. 44-year-old man with 2-month history of abdominal pain and diarrhea. Pain relieved after eating and
antacids. EPigastric tenderness. Serum gastrin concentration of 500 pg/mL (N=50 - 100) and gastric acid
secretion of 80 (N=6-40). Most definitive treatment?
- Surgical removal of the suspected tumor

40. 50-year-old man with progressive bulge in his abdomen during past 6 months. No changes in bowel
habits. Midline hernia above umbilicus that cannot be reduced be gently pushing on it. Operative repair
initiated. Which extracellular matrix components required to increase tensile strength of postoperative
incision?
- Collagen

41. 5-year-old boy with 8-month hx of recurrent middle ear and upper repiratory tract infections. Impared
motor and cognitive functions. Hepatosplenomegaly. Cultured skin fibroblasts shows presence of
inclusion bodies and a deficiency in the activity of N-acetylglucosamine-1-phosphotransferase. Cells
secrete abnormally large amounts of acid hydrolases into the culture medium. Enzymes are unable to
target which organelles?
- Lysosomes

42. 53-year-old man in ED 1 hour after right-sided weakness. Right perioral droop. Babinski sign present
on the right. CT scan of the head shows no abnormalities. One week later, a repeat CT scan shows a
small area of hypodensity involving the left internal capsule consistent with loss of tissue. Which cell types
is most likely to have cleared necrotic tissue in this area?
- Microglial cells

43. 38-year-old woman in for pre-employment exam. No illness. No meds. Labs show Hb 8.2, HCT 25%,
MCV 69. WBC 5.9k, Retics 0.8%, platelets 350k. Dx?
- Iron deficiency anemia

44. 27-year-old man with acute myelocytic leukemia receives high-dose cyclophosphamide in preparation
for hematopoietic stem cell transplantation. Which will decrease toxicity from this chemotherapy regimen?
- Mesna

45. 30-year-old man develops hemoptysis, dyspnea, weakness, and hematuria. Diffuse pulmonary
hemorrhages bilaterally. Renal biopsy shows focal glomerular necrosis with crescent formation and linear
deposition of IgG and C3 in glomerular capillary loops. Pathogenic mechanisms responsible?
- Autoantibodies against host cell basement membranes

46. 21-year-old woman with 2-week hx of blood-tinged vomiting. 2-year hx of self-induced vomiting after
gorging on food. BMI 24. Which drugs is most appropriate?
- Fluoxetine

47. 56-year-old man scheduled for physical therapy 3 days following right shoulder operation. Therapy to
strengthen the infraspinatus and teres minor muscles. Which should this patient perform against
resistance?
- Lateral (external) rotation

48. 58-year-old African American man with congestive heart failure. Cardiac exam shows S3.
Echocardiography shows a left ventricular ejection fraction of 30%. Treatment with hydralazine and
isosorbide dinitrate. Which medications is contraindicated in this patient?
- Sildenafil

49. A healthy 24-year-old woman participates in a study to determine the role of ghrelin in appetite. She is
given free access to food during the study. The graph shows plasma concentrations of ghrelin in the
woman during the study period. Which of the following labeled points on the curve most likely represents
the consumption of a meal?
-B

50. 1400-g female newborn delivered to a 33-year-old primigravid at 37 weeks'. Cardiac exam shows
rough, grade 2/6, continuous, machine-like murmur along the left sternal border, as well as increased
precordial activity and bounding peripheral pulses. Appropriate treatment will inhibit activity of which of
the following enzymes?
- Cyclooxygenase
 3.

orthopod
Guest

#4orthopod, Feb 10, 2016

Block 2 part 1

1. 8-year-old girl is brought to the physician for a well-child examination. Her mother says that she has
been well except for an occasional cold. Her immunizations are up to date. She is at the 50th percentile
for height and 60th percentile for weight. Physical examination shows breast bud development and a few
pubic hairs. The mother asks whether her daughter's development is normal. Which of the following is the
most appropriate initial response by the physician?
- “Your daughter's development is normal."

2. 9-year-old boy with 1-yr hx of cough productive of mucoid sputum, wheezing, and shortness of breath
with exertion. Hx of recurrent URI and sinus infections since birth. 25%ile for height and weight. Younger
sibling is beginning to develop similar problems. Mild clubbing of the fingers, markedly increased sweat
chloride and sodium concentrations. Defect in which of bronchial epithelium causing symptoms?
- Protein structure

3. 52-year-old M with alcoholism collapsed and coughing on park bench. T 39C. Clubbing of the digits,
Halitosis, missing teeth, dental caries. Chest exam shows increased fremitus, dullness to percussion, and
tubular breath sounds over the right lower lung field. WBC 11.4k. Sputum shows purulence, gram-positive
cocci in chains, and gram-negative bacilli. CXR shows cavitation of right lower lung lobe. Sputum cultures
will most likely grow which?
- Normal oral flora

4. 25-year-old M develops temp of 38.6C after running first 10-km race. Temp returns to normal because
of which mechanism?
- Evaporation of sweat

5. 12-year-old girl with progressive fatigue and generalized weakness for 5 months. Erythematous,
maculopapular rash over elbows and proximal muscle weakness. Difficulty lifting her upper extremities.
Trouble standing from a seated position. Increased serum kinase activity; serum antinuclear antibody
assay positive. Dx?
- Dermatomyositis

6. 27-year-old F concerned she has sleep apnea. Snores twice during past year. Feels rested in the
morning, no daytime sleepiness. BMI 23. Most appropriate initial action?
- Reassurance

7. Two days after admission for sickle cell disease crisis, 24yo M has blood in urine and flank pain. HCT
was decreased to 11% from 25%. U/A shows blood, rare WBC's, and no WBC casts. Cause?
- Renal papillary necrosis

8. 51-year-old M with 3-mo hx of hepatitis B antigen-negative polyarteritis nodosa has progressive

proximal muscle weakness and myalgia. A biopsy specimen of involved muscle would show?
- Segmental ischemic necrosis

9. 62-year-old F with chronic renal disease. BMI 21, BP is 140/100. Labs show anemia. Rx with
intravenous recombinant erythropoietin is started. Measurement of which is best to monitor effectiveness
of Rx?
- Plasma hemoglobin concentration

10. 27-year-old nulligravid inability to conceive for 2 years. Menses at 3- to 4-month intervals since
menarche at 14 years Follicle-stimulating hormone, luteinizing hormone, and estrogen wnl. Most
appropriate Rx?
- Clomiphene

11. 65-year-old M with peripheral vascular disease has 4-hour hx of vomiting and severe abd pain. T 38
C, bp 80/40. CT angiography shows thrombosis of the superior mesenteric artery. Ischemia caused by
thromosis affects which structures?
- Jejunum

12. 45-year-old M has fever chills, dysuria, and a tender, enlarged prostate. Organism?
- Escherichia coli

13. 76-year-old M with a 1-month hx of pulsatile abdominal mass dx with an abdominal aortic aneurysm.
CT scan with contrast also showed incidental finding of a horseshoe kidney. Surgical approach to repair
aneurysm to be further complicated be presence of which?
- Anomalous origins of multiple multiple renal arteries to each kidney

14. Investigator studying strains of streptococcus pneumoniae to monitor effect of a conjugate

polysaccharide vaccine on expression of different capsule types. After incubation of a nonencapsulated
strain of S. pneumoniae with the lysate from heat-killed S. mitis, colonies of S. pneumoniae expressing
the new capsular tpe are identified. However, no colones of S. pneumo are isolated after addition to
DNAse to the lysate. Mechanism causing transfer of genes encoding new capsular type?
- Natural transformation?

15. 18-year-old M with anxiety and confusion for 6 hours. No A/V hallucinations. T 38.2 C, pulse 130/min,
BP 180/110. Diaphoresis, pupillary dilation, and muscle weakness. Substance?
- Amphetamines

16. Hantavirus strain A grows poorly at temp of 39 C, whereas strain B displays normal growth at that
temperature. Hantaviruses contain genome consisting of three RNA segments Large (L), medium (M),
and small (S). Growth of reassortant viruses shown in table. Which viral gene segments associated with
the temperature-sensitive phenotype of hantavirus strain A?
-L

17. 68-year-old M with 2-hour episode of loss of vision in his right eye 2 days ago. Underwent left
femoral-popliteal bypass 3 months ago for peripheral vascular disease. Funduscopic exam shows
cholesterol emboli. Cause is embolus in which arteriers?
- Right ophthalmic

18. Study to assess 32 patients in a community of 1000 who have developed drug-resistant tuberculosis
during a 1-year period. Patients removed from the community for Rx. Assuming risk for infection and
susceptibility to disease is constant, which best represents the number most likely to develop drug-
resistant TB during the next year?
- 32?
- Or is it 31?

19. Study to evaluate the relationship between ambient noise and hearing loss in automobile
manufacturing plant. Each employee is given a test for hearing acuity, and then the ambient noise is
measured at his/her workstation. Study design?
- Cross-sectional

20. 25-year-old M lives at 10,000 feet above sea level for 4 weeks. Two weeks after return to sea level,
ventilation returned to normal, but oxygen delivery to muscles is greater than before. Explanation is
increase in which of the following?
- Hematocrit

21. 15-year-old girl in ED after ingested bottle of vitmain D in suicide attempt. No pain. Labs normal. 1
month later, her serum calcium concentration is 10.4. Which mechanism is the cause?
- Increased absorption of calcium in the gastrointestinal tract

22. 24-year-old woman stung on her right thumb by a bee 30 minutes ago. Urticarial lesion at site of sting.
Six hour later, area has become indurated and firm. Explanation of the induration?
- Influx of macrophages producing interleukin-1 (IL-1), IL-6, and tumor necrosis factor-alpha

23. 10-year-old girl appears pale. Father underwent splenectomy as youth for "low bloow" and recently
had cholecystetomy. CBC shows Hb 6.4, MCV 90.2, WBC 6K, platelets 188K, reticulocytes 9%. Blood
smear shown. Most common underlying abnormality that accounts for these clinical manifestations?
- Deficiency of erythrocyte spectrin

24. 25-year-old M with 2-hour hx of n/v, abdominal cramping, and difficulty passing flatus. face shows the
lesions in the photograph; similar lesions on fingers and toes. Labs show hypochromic microcytic anemia.
Stool is occult blood positive. Dx?
- Peutz-Jeghers syndrome

25. 55-year-old F has headache, T to 40 C, stiff neck and confusion. Spleen removed due to injury in
MVC 7 months ago. Most likely organism in cerebrospinal fluid?
- Streptococcus pneumoniae

4.

orthopod
Guest

#5orthopod, Feb 10, 2016

Block 2 part 2
26. 43-year-old F diagnosed with immune thrombocytopenic purpura resistant to corticosteroid treatment
to undergo operation to improve this condition. Removal of which labeled organs in the CT scan will be
helpful?
-B

27. 19-year-old M plays basketball, with 3-week hx of shortness of breath with exertion. Intermittent
dizziness. P 60/min, BP 100/60. Echocardiography shows a heterogenous pedunculated mass in the left
atrium. Dx?
- Myxoma

28. 18-year-old F with fever, malaise, blood in urine since she began oral antibiotic therapy for a UTI 5
days ago. 3-day hx of rash. T 38C, petechial rash over the chest, back, and upper and lower extremities.
U/A shows: Blood 3+, Protein 1+, WBC 150 (30% eosinophils). Dx?
- Interstitial nephritis

29. 83-year-old M with 3-day hx of painful blisters on his torso. Numerous 0.5- to 1-cm, clear-fluid-filled,
tense blisters over the trunk. Histopathologic exam shows a subepidermal blister. Production of
autoantibodies directed at which?
- Bullous pemphigoid antigen
30. 15-year-old Native American boy 1 hour after he ingested broth made from jimsonweed. Has
hallucinations. Pulse 128/min. Flushing and dry mouth. Disoriented to person, place, and time. The
pharmacologic antidote must be carefully titrated to avoid potential cardiac effects. Most appropriate
antidote?
- Physostigmine

31. 6-month-old girl smile seemed lopsided. 50th %ile for length and weight. Vitals wnl. Left-sided facial
weakness and decreased hearing in the left ear. High-resolution CT scan of the head shows stenosis of
the internal acoustic meatus on the left. Most likely has a developmental anomaly involving which cranial
nerves?
- Facial

32. Female newborn delivered to 35-yo F. Pregnancy complicated by untreated maternal Graves disease.
Respirations are 66/min. Stridor, nasal flaring, intercostal retractions, and an asymmetric neck mass.
Cause of the stridor?
- Enlarged thyroid gland

33. Gram stain performed on a sputum specimen. Pink rods and blue cocci are observed. Which features
is characteristic only of the pink rods?
- Outer membrane

34. 20-year-old M with 6-month hx of diarrhea and 16-kg weight loss. BMI 22. Pallor and pitting edema of
the lower extremities. Labs show microcytic hypochromic anemia, hypoalbuminemia, and an increased fat
concentration in stool Anti-endomysium IgA and anti-tissue transglutaminase IgA antibodies positive.
Biopsy will show?
- Loss of villi and increased number of intraepithelial lymphocytes

35. 49-year-old woman with breast cancer develops increased numbness of both hands and feet between
chemotherapy doses. Sensation to pinprick and fine touch decreased over hands, wrists, ankles, and
feet. Which is most likely disrupted in this patient as a result of the chemo?
- Microtubules for axonal transport

36. 70-year-old M with difficulty sleeping since wife died 8 mo ago. Wakes up earlier than usual, cries
when he thinks about his wife. He once briefly followed a woman down the street who resembled her.
Patient continues to enjoy visits with his grandchildren, remains active in bowling team. Most appropriate
action?
- Schedule regular appointments to monitor the patient

37. 22-year-old M with infertility. photomicrograph shows tissue obtained on biopsy of the scrotal testes.
Most likely genetic abnormality?
- 47,XXY

38. 46-year-old M with 6-month hx of sleep disturbances, difficulty walking, and pain of his extremities.
Trouble getting dressed. Retired professional boxer. Mask-like features, stooped posture, slow and rigid
movements, shuffling gait, and resting tremor. Which alterations in brain?
- Neuronal degeneration

39. 65-year-old F with 3-mo hx of headache, weakness of her arms, and left flank pain; also had 14-kg
weight loss. Weakness of proximal upper and lower extremity muscles. Augmentation of strength with
repetitive testing of deltoid. MRI shows single well-demarcated mass in right frontal lobe. Stereotactic bx
shows malignant, small blue cell neuplasm expresses cytokeratin, chromogranin, and synaptophysin. Dx?
- Pulmonary small cell carcinoma metastatic to the brain

40. 54-year-old woman who works as a nurse comes to the physician for routine tuberculosis screening.
A sample of her whole blood is incubated with a mixture of synthetic peptides representing two proteins of
the suspected pathogen. Three days later, supernatant is collected for evaluation. Measurement of which
of the following cytokine concentrations is most likely to indicate a positive result?
- Interferon gamma

41. 20-year-old F with BP 140/100. BUN 50, glucose 90. U/A shows numerous WBCs and WBC casts;
protein excretion is 3000 mg/24h. GFR is 20% of normal. Ultrasonography shows small asymmetric
kidneys with broad scars and blunted calyces, with vesicoureteral reflux. Dx?
- Chronic pyelonephritis

42. 62-year-old F with recurrent non-small cell carcinoma of the lung is treated with chemo including
vincristine. Which intracellular targets most likely affected by this drug?
- Tubilin

43. 20-year-old M with 4-hr hx of abdominal pain, nausea, and vomiting. Had been drinking ethanol
heavily all weekend and took three doses of acetaminophen. Increased risk for liver injury because of
which factor of ethanol?
- Induction of cytochrome P450 enzymes that activate acetaminophen to a hepatotoxic metabolite

44. 12-year-old girl. THree months ago, sustained complex fracture of the left tibia. Cast is removed, and
left calf is smaller than the right calf. Which process in myocytes is cause?
- Polyubiquitination

45. 45-year-old M with congestive heart failure. Two 1st degree relatives died in 40s with dilated
cardiomyopathy and cirrhosis. Has cardiac enlargement and generalized hyperpigmentation. Glucose is
320. Histologic exam of endomyocardial tissue is most likely to show an excess of?
- Iron

46. 64 y/o man with cough, dyspnea, and chest pain. CXR shows abnormal density in hilar region. Biopsy
shows round cells with little cytoplasm that are twice size of lymphocytes. Cells are arranged in infiltrating
sheets that have neither glandular nor squamous organization. Which abnormality would you find?
- Hyponatremia

47. 4-month-old boy with autosomal recessive skeletal dysplasia involving abnormal endochondral bone
formation. Genetic analysis shows null mutations in a gene for a protein that controls the traffic of vesicles
into the Golgi complex. Electron microscopy of cells will show?
- Dilated rough endoplasmic reticulum

48. 42-year-old M with hepatitis C gets liver biopsy, showing lymphocytic infiltration and collagen
deposition. Most characteristic of which inflammatory processes?
- Chronic inflammation

49. 25-year-old F with irregular menstrual periods and progressive acne. BMI 35. Voice is deep. Dark hair
over the upper lip and chin, and open and closed comedones over the face, chest and back. Serum will
show?
- Fasting insulin INCREASED, Testosterone INCREASED, Luteinizing Hormone INCREASED

50. 65-year-old F with HTN with 3-hr hx of headache, chest pain, and shortness of breath. BP 230/110.
Initiate treatment with a nonselective antagonist that blocks alpha-1 and beta. Which drug most
appropriate?
- Labetalol

5.

orthopod
 Guest

#6orthopod, Feb 10, 2016

Block 3 part 1

1. 79-year-old F fracture of the right hip. BMI 21. She swims, knits, gardens. What is most likely to
decrease the patient's risk for additional fractures?
- Walk every day

2. 24-year-old African American M with 3-mo Hx of red bumps on his face and chin, istchy and painful.
Hyperpigmented papules over the cheeks, jawline, and neck. Dx?
- Pseudofolliculitis barbae

3. 29-year-old W with 1-mo hx of pelvic pain.. Unusually heavy periods. Palpable mass in the left adnexa,
increased CA 125 concentration. Vaginal ultrasonography shows an 8-cm mass in the left ovary. During
surgery, which passes inferior to the ovary?
- Ureter

4. 19-year-old F been increasingly withdrawn and isolated since graduating high school 1yr ago. Not
interested in old friends/activities. Anxious and depressed, listening to radio broadcasts that only she can
hear. Thinking about a government scheme to control the "psychic pain." Pharmacotherapy?
- Risperidone

5. 5-year-old boy with 16-hr hx of severe vomiting and increased sleepiness. Had flu-like illness she
treated with aspirin. Prothrombin time is prolonged. Becomes comatose in hospital. Serum shows
increased ammonia and lactate concentrations and increased transaminase activities. Cause of the
patients coma?
- Cerebral edema

6. 12-year-old boy with 6-mo hx of difficulty walking and leg pain. Mild atrophy of the lower extremities
and hammer toes. High-stepping gait. Nerve biopsy will show?
- Abnormal myelin sheaths

7. 24-year-old M with nasal congestion, discharge, and sneezing. Happen each spring. Which drugs is
most effective in relieving these sx in the short term?
- alpha-adrenergic agonist

8. 40-year-old F. Eats only natural organic foods. Serum triglyceride of 380. Suggests to try taking fish oil
and a supplement to treat dyslipidemia. Which describes mechnaism of action of appropriate vitamin for
this patient?
- Increases catabolism of LDL-cholesterol

9. 27-year-old M with Hodgkin lymphoma receives BMT from first cousin. 2 weeks later, develops
generalized erythematous maculopapular rash, diarrhea, and elevated concentrations of liver enzymes
and bilirubin. Cause?
- Donor T lymphocytes reacting against host cells

10. 60yo F with 2-year hx of HTN. Poorly controlled. Which statements by the physician is most
appropriate to about noncompliance with medication regiment?
- "It is hard to take pills every day for a condition that has no symptoms."

11. Investigator studying regulation of pulmonary lymphatic flow. Catheters in femoral vein, pulmonary
artery, and main lymphatic vessel drainig the lungs in animals. Which will most likely increase the flow of
pulmonary lymph in these animals?
- Intravenous infusion of 0.9% saline for 5 minutes
12. 18-year-old M with acute lymphoblastic leukemia with 3-day hx of fever & left0sided chest pain.
Taking chemo asparaginase, disorubicin, prednisone, and vincristine. ANC less than 500. T 39.2. Lower
lobe infiltrate and a moderate pleural effusion on the left. Photomicrograph of a periodic acid-Schiff stain
of pleural fluid obtained via thoracentesis is shown. Appropriate Rx?
- Amphotericin B

13. Experiment, the concentration of glycolic intermediates is measured in human endothelial cells
incubated with 30 mM glucose compared with 5 mM. Results shown. Activity of which enzymes is most
likely inhibited indirectly by increased glucose concentrations?
- Hexokinase

14. 40yo F 1 hour after gunshot wound to the abdomen. Develops ventricular fibrillation and dies 30 min
later. Autopsy shows 3 L fresh blood in peritoneal cavity, liver and kidnes show centrilobular pallor and
swelling of the hepatocytes and proximal convoluted epithelial cells. Mechanism of renal findings?
- Decreased function of Na-K-ATPase

15. Chemo regimen prescribed for a 55-year-old F with non-Hodgkin lymphoma includes vinblastine.
Normal function of which cells and tissues in this patient is most likely to be resistant to this agent?
- Ventricular cardiac muscle fibers

16. 2-year-old boy with increased thirst, urinary frequency, and failure to thrive. T 38C, dehydration and
decreased muscle tone. Diagnosed with Fanconi syndrome. Which change in fractional reabsorption in
kidneys?
- Amino Acids DECREASED; Glucose DECREASED, Phosphate DECREASED, HCO3 DECREASED

17. 35-year-old M at work-sponsored depression screening program. For past 2 years has felt down.
Unmotivated and pessimistic about the future, little energy for relationships or work. No change in
appetite or sleep, and able to continue to work. No suicidal thinking. Dx?
- Dysthymic disorder

18. 27yo F with 3-week hx of episodes of left-sided chest pain and tenderness, radiating to the back and
exacerbated when reaching over her head or back. No SOB, sweating, or light-headedness. T 37.1.
Tenderness to palpation 2 cm lateral to the midline and 10 cm below the clavicle on the left. CXR and
ECG normal. Dx?
- Costochondritis

19. 27yo nulligravid with 24-hr hx of pain with urination and increased urinary frequency. Sexually active
with 1 partner and takes oral contraceptive, no condoms. T 37C. Suprapubic tenderness. Cause?
- Escherichia coli

20. 54yo F with acute myocardial infarction. No signs of heart failure, no murmur. 2 days later becomes
SOB and diaphoretic. P 100/min, BP 160/98. Crackles bilaterally, murmur is heard. Most likely murmur?
- Grade 4/6, holosystolic murmur heard best over the lower left sternal border and the cardiac apex

21. 10yo girl 30 minutes after sudden onset of progressive SOB. Similar episodes in past 3 months. RR
24/min. Diffuse wheezes are heard on auscultation of the chest. Sputum sample shows numerous
eosinophils and Charcot-Leyden crystals. Which substance involve in pathogenesis?
- Leukotriene C4

22. Genetic counceling for family Hx of fragile X syndrome as shown in pedigree. I-1 and I-2 undergo
DNA-based testing for the FMR1 gene. If I-2 has gene, what is likelihood III-% has similar expansion of
gene?
- 0%

23. 55yo M with constipation since starting OTC medication 2 weeks ago for a chronic, persistent cough
and sinus congestion. Which ingredients is causing new symptom?
- Dextromethorphan

24. 23-year-old F with Sjogren syndrome 6 years ago has 3/10 burning pain in her toes. Uses capsaicin
cream to help. Has decreased perception of temperature over the feet bilatearlly. Sensation to vibration,
proprioception, reflexes, muscle strength are normal. Which neurotransmitter is mediating pain?
- Substance P

25. 26yo M undergoes colonscopy for tenesmus and bloody diarrhea. Biopsy shows microabscesses
within the crypts and depletion of mucus from goblet cells. Dx?
- Ulcerative colitis

6.

orthopod
Guest

#7orthopod, Feb 10, 2016

Block 3 part 2

26. 20-year-old F with severe dysuria and a painful vulvar rash for 2 days. Vescicular lesions on an
erythematous base on the right vulva. Organism?
- Herpes simplex virus

27. Newborn female dx with hypothyroidism 2 days after birth. Ultrasonography of the neck shows
absence of any thyroid gland tissue. Physical is normal. Maternal to fetal transfer of which explains
normal development?
- Thyroxine (T4)

28. 54-year-old F with terminal metastatic pancreatic cancer. Asks doc to prescribe her medication to
commit suicide if the pain becomes unbearable. Physycian refuses, but will manage pain. Consistent with
which ethical principles?
- Beneficence

29. Study of antiretroviral agents to identify which agents inhibits entry of the HIV virus into the CD4+ T
lymphocytes. Which agents is most likely to be identified?
- Enfuvirtide

30. 38yo F with 10-week hx of epigastric pain and frequent stools. Has had two episodes of renal calculi
in 2 yrs. Superficial lipomata and mild epigastric tenderness. Upper endoscopy shows two large,
nonbleeding duodenal ulcers. Gastric pH is 2.3, gastrin concentration is 2000. PPI started. Measurement
of which is next step?
- Serum calcium concentration

31. Lesch-Nyhan syndrome, an x-linked recessive disease, seen in 1/100,000 males. Expected
prevalence of heterozygous females?
- 1/50,000

32.16yo boy 30 minutes after he dove into a 3-foot-deep pool at night. Unable to move right upper/lower
extremities. Damage to which labeled region of cross section of spinal cord?
-G

33. 54yo M has aneurysm in the distal portion of his abdominal aorta. Cross-sectional area is 2cm^2 and
mean velocity of blood flow is 20 cm/sec. Which is the flow rate (L/min)?
- 2.4

34. 18-month-old boy with lethargy for 3 hours. Not eaten well. Had cardiorespiratory arrest ass'd with
hypoglycemia after episode of diarrhea 10 months ago. T 37C. Hepatomegaly. Labs show Serum:
glucose, ketones, and carinitine decreased. Urine ketones decreased, D-carboxylic acids present.
Medium-chain triglycerides are administered daily for 6 months, which helps. Deficiency of which
enzymes is cause?
- Long-chain acyl-CoA dehydrogenase

35. 55-year-old F with 3-month hx of shortness of breath. Takes daily multivitamin. Scattered crackles
heard over lung bases. Labs show WBC 8k, Ca 12, BUN 10, Cr 1, Phosphorus 4.2. CXR shows enlarged
hilar lymph nodes and reticulonodular infiltrates in the upper lung fields, Bx shows noncaseating
granulomas. Which additional serum finding present?
- Parathyroid hormone DECREASED, 1,25-Dihydroxycholecalciferol INCREASED

36. 39-year-old F with T1DM with fatigue for 3 weeks. Having hypoglycemic events. Needs injection of a
drug with which mechanism?
- Stimulation of hepatic glucose production

37. Studying bacterial virulence factors. Ferric uptake regulation protein (Fur) binds to DNA at 5' end. Fur
efficiency increases as concentration of iron increases. Fur regulates which processes?
- Transcription

38. Test for lead and neuro damage to dust on parent's clothing. Test for motor skills was given to 30 first-
graders whose parents worked at foundry for 4 years or longer and to 30 controls. Which group would be
proper control?
- First-graders whose parents had never worked at the foundry

39. 68-year-old F diagnosed with cystitis caused by vancomycin-resistant Enterococcus faecalis.

Mechanism of resistance?
- Substitution of d-lactate for d-alanine in peptidoglycan

40. 5-year-old girl often stares blankly into space for several seconds. EEG shows 1- to 3-second bursts
of 3/sec spike-and-wave activity. Pharmacotherapy?
- Ethosuximide

41. 52-year-old M with 2-month hx of difficulty swallowing, double vision, and slurred speech. Ptosis of
eyelids and a waddling gait. Fatigable weakness of the neck, arms, hands, and fingers. Repetitive nerve
stimulation shows a 25% decrease in muscle action potentials in several muscles. Mechanisms of
disease?
- Binding of antibody to the acetylcholine receptor

42. Full-term female develops respiratory distress shortly after delivery. Cyanosis, markedly decreased
breath sounds bilatearlly, and occasional bowel sound over left hemithorax. CXR shows multiple- cystic-
appearing areas on the left and decreased aeration on the right. Dx?
- Congenital diaphragmatic hernia

43. 15-year-old boy BMI 21. Pulse 85 and bounding, BP 110/40. Ophthalmologic exam shows dislocation
of right lens. Pectus excavatum. 3/6 decrescendo diastolic murmur at aortic area. CXR shows wide
mediastinum. Genetic defect in production of?
- Fibrillin

44. 60-yo-M has coagulation testing prior to CABG. PR is 11.5, and activated PTT is 160 seconds. Which
inflammatory responses is most likely to be abnormal?
- Kallikrein formation
45. Study of Plasmodium infection in animal model. Animals inoculated with various species. Chloroquine
is administered. Which two Plasmodium species will stay viable?
- P. falciparum and P. vivax

46. 68yo F with 1-yr hx of severe abdominal pain after meals. 9-kg weight loss. Pain relieved when she
decreases amount she eats. Hx of atherosclerosis and had CABG. Has nontender abdomen and bruit.
Cause is stenosis of which arteries?
- Superior mesenteric

47. 6-mo boy with recurrent upper and lower respiratory tract infections. Has hypocalcemia Rx with
calcium supplementation. Underwent repair of coarctation of aorta. Broad nasal bridge and dysplastic
pinnae. Cause of infections?
- T-lymphocyte deficiency

48. 3-year-old boy with 30-minute hx of severe pain in right arm began when sister ran into him. Third
time this year he had to come in. Always in cast. Blue sclerae and normal teeth. X-ray of upper extremity
shows fracture of humerus and osteopenia. Defect in which biochemical processes?
- Procollagen synthesis

49. Screening program for detection of vaginal Chlamydia trachomatis infection. seen in 500 of 2500
students. One year later, infection in additional 200 students. Annual incidence?
- 8%

50. 7-year-old boy with tender lump in right armpit for 6 days. Two weeks ago had tender lump on right
index finer. They have cats. T 37.8, Biopsy shows necrotizing granulomatous adenitis with stellate
microabscesses. Causal organism?
- Bartonella henselae

7.

orthopod
Guest

#8orthopod, Feb 10, 2016

Block 4 part 1

1. 42-year-old F undergoes bx of suspicious calcifications on mammograms. Poorly cohesive cells

growing in sheets. Nucleus to cytoplasmic ratio 1:1. Invasinon into stromal tissues. No adenopathy. CT
shows no hepatic, pulmonary, or bone metastases. Consistent with?
- High-grade, low-stage neoplasm

2. 50-year-old M with fever and SOB for 3 days. Gram stain shows numerous neutrophils, gram-positive
diplococci. Which enzymes initiate intracellular killing of the diplococci?
- NADPH oxidase?
or is it catalase

3. 43-year-old F with difficulty walking for 3 months. Weaknessand decreased muscle bulk of the lower
extremities. Patellar and Achilles tendon reflex diminished. Pain/temp, position normal. Cause?
- Demyelination of motoneurons of the Lumbar cord

4. 2 days after right hip replacement, 67yo F has SOB and pain on right side of back with deep breathing.
Appears anxious. P 100/min, rr 24/min. Pleural friction rub heard in right lung base. Right calf shows
erythema and induration. Rx with Oxygen, rL/min. ABG shows: pH 7.54, PCO2 29, PO2 61. CT
angiography shows large embolism occluding blood flow to the right lower lobe. Which describes
ventillation-perfusion relationship in right lower lobe?
- Dead space

5. 6-week-old boy after hemoglobin electrophoresis showed homozygosity for hemoglobin S. Daily Rx
with penicillin decreases risk of infx from which organism?
- Streptococcus pneumoniae

6. 75yo F with osteopenia. Takes tylenol, and suppleental calcium and vitamin D. No tobacco/alcohol.
Follows a high-protein diet, walks 3 mi/day. BMI 24. TODAY: Cr 1.0, Urine Cr excretion 1000, Cr
clearance 69.4; 10 YEARS AGO: Cr 1.0, Ucr excretion 1200, Cr clearance 83. Cause of decreased Cr
clearance rate?
- Normal aging

7. 51yo M farmer cur his right foot. 15-year-hx of poorly controlled T2DM. T 38.5. Erythema up to the mid
calf, edema, and exquisite tenderness of the ankle. WBC 57k. Which is response to injury?
- Leukemoid reaction

8. New antiplatelet agent for prevention of recurrence of stroke. Results shown. What is absolute risk
reduction in women?
- 8%

9. Case-control study for ass'n between herbicide and diagnosis of non-Hodgkin lymphoma. Odds ratio is
3.2. Which is most likely to affect the validity of this study?
- Type I error

10. 23yo M with difficulty maintaining an erection. Damaged his thoracic spinal cord, affecting motor and
sensory function of the lower trunk and extremities. Able to obtain erection through physical contact and
erection does not last long. Explanation is intact spinal reflex arc b/w sacral parasympathetic nerves and?
- Pudendal nerves

11. 18yo M hiding from intruders "from the other place." Has heard two male voices in his head for 2
weeks. Dx?
- Brief psychotic disorder

12. 35yo M with 6-month hx of burning abdominal pain 1 to 2 hours after he eats. Had black stools for 2
days. Sweating, light-headedness when he stands. CT shows 1-cm mass in the pancreas.
Immunohistochemical labeling will show antibodies to which substances?
- Vasoactic intestinal polypeptide

13. 60yo M 2 weeks after found to have serum prostate-specific antigen concentration of 5.3. Bx shows
adenocarcinoma. Ct scan shows osteoblastic lesions at L1. Undergoes bilateral orchiectomy. Dies 5
months later of MI. At autopsy, which changes in the prostate resulting from orchiectomy is present?
- Scattered shrunken cells

14. 23yo M with 2-week hx of back pain recractory to OTC meds. Demands opioid drugs. Physical is
normal. Most appropriate action by physician?
- Determine which drugs have been prescribed for the patient in the past

15. 35yo M with chronic atrophic gastritis with lethargy and dizziness for 2 weeks. Pale skin and mucous
membranes. No adenopathy. Liver edge is palpable. Stool for occult blood is negative. Decreased
virbatory sensation. Labs show HCT of 27%, MCV 112. Absence of which cell types explains?
- Parietal

16. 70yo F with persistent fever despite intravenous broad-spectrum antibiotic rx after surgery for
recurrent cervical carcinoma. T 38.5. Has central venous catheter, well healing wound, two drains. Blood
cultures grown on sheep agar plate. Gram stain shows 4-um, elliptical, pruple, budding organisms.
Which?
- Candida albicans

17. 3yo boy with 1-week hx of nonproductive cough, wheezing, and nausea. Coarse bilateral crackles
heard. Stool cx shows 1.6-cm roundworm larva. CXR shows bilateral infiltrations. Caused by ingestion of
which?
- Pork products

18. 70yo F 45 minutes after unresponsive in living room. Has generalized anxiety disorder treated with
diazepam. Recently began taking OTC med for heartburn. Interaction ith which drug is cause?
- Cimetidine

19. 24yo F has 8-year history of seizure disorder that is refractory to medication. Flesh-colored papules in
the nasolabial folds accompanied by hypopigmented ash-leaf macules. MRI of brain shows
subependymal nodules. Cause?
- Tuberous sclerosis

20. 76yo M has hypertension rx with a B-adrenergic antagonist. Lives on farm, always distilled his own
liquor. Smoked 2 packs daily for 55 years. Has had episodes of swelling of right great toe. Gouty tophi
over elbows. Cause?
- Drinking home-distilled liquor

21. 16-year-old girl 20 minutes after generalized tonic-clinic seizure at home. Two more seizures after
arrival. Unable to urinate, confused. P 120/min rr 24min, BP 170/109. Enlarged uterus. Ultrasonography
shows normal fetus consistent in size with 30-week gestation. Diagnosis?
- Eclampsia

22. 32yo F G4P0A3 delivers female with dysmorphic features and numerous organ anomalies. Mother
has had spontaneous abortions, and this is her first liveborn child. Explanation?
- Autosomal dominant inheritance?
Ans is not autosomal recessive

23. 62yo M with pain in the left hip foe 3 weeks. X-ray of the hip shows 4.5-cm osteoblastic lesion with
fracture in the proximal femur and two separate similar smaller lesions in pelvis. Biopsy shows metastatic
carcinoma. Most likely primary?
- Prostate

24. 12yo girl immigrated to USA from central Africa with 5-week hx of increasingly severe abdominal pain
and vomiting blood. T 37.8, P 110/min rr 27/min. Hepatosplemonmegaly. Labs shown, Photomicrograph
of stool specimen shown. Appropriate Rx?
- Answer is likely Praziquantel
- Metronidazole was another suggested answer

25. 30yo F with 1-week hx of left eye pain and blurred vision and a 2-month hx of weakness of right arm
and both legs. Swelling of optic disc on the left. Spasticity and hyperreflexia. MRI shows T2-weighted
bright signal abnormalities in the white matter. CSF shows oligoclonal banding. T-lymphocytes infiltrating
this patient's CNS causing inflammation of which?
- Oligodendrocytes