1.

Block 1 Part 1
1. 70yo M dies in a motor vehicle collision. Was undergoing evaluation for occult blood in the stool.
Photo of transverse colon shown. Dx?
- Tubular adenoma
2. 38yo M with 1-week hx of watery, itchy eyes and a runny nose. Physical shows inflamed nasal
mucosa. No congestion in lower lung. Pharmacotherapy?
- Loratadine
3. 16yo girl with 3-day hx of fever, nonproductive cough, and fatigue. T 38.3, P 88/min, BP 102-70.
PE shows pale conjunctivae. CXR shows bilateral interstitial infiltrates. Blood spontaenously
agglutinates while awaiting transport to the laboratory. Antibody isotypes causing agglutination?
- IgM??
4. 24yo M with small tender blisters on his penis 3 days after unprotected sex. Photograph shown.
Causal agent?
- Herpes simplex virus type 2
5. 42yo F with 3-year hx of an intermittent facial rash, including the forehead, eyelids, nose, and
cheeks. Rash seems to be getting worse since she moved from New York to Florida last year. Spicy
foods precipitate a flushing reaction that seems to exacerbate the rash. PE shows erythema over
the nose and cheeks, with scattered telangiectasias and a few papules. Dx?
- Rosacea
6. 53yo M returned from Africa, has fever, headache, and abdominal discomfort. Received
appropriate vaccinations prior to the trip. T 39.4C. A wright-stained peripheral smear shown. Dx?
- Malaria
7. 68yo F with T2DM and hypertension that has eben poorly controlled despite hydrochlorothiazide
treatment. BP 150/96, Labs show serum glucose concentration of 130 and proteinuria. In addition to
current Rx, which is most appropriate pharmacotherapy?
- Lisinopril
8. 66yo M with stage IV colon cancer with 3-day hx of severe diarrhea after receiving chemotherapy
with flourouracil, leucovorin, and irinotecan. perscribed opioid antidiarrheal agent with no CNS
effects. Which med?
- Loperamide
9. 35yo M in ED with 2-hour hx of sever fatigue and dizziness. Had profuse, watery diarrhea for 8
hours despite a lack of oral intake. Recently returned from a medical relief trip to a remove village in
Honduras. T 36.7 C, P 122/min, BP 90/50. PE shows dry skin and decreased capillary refill. Stool
for occult blood is negative; stool is gray and turbid. Gram stain shows gram-negative, commashaped bacteria; no erythrocytes of leukocytes. MOA of toxin?
- Activation of adenylyl cyclase
10. 59yo F with gradual onset of lack of muscle control in her left arm and leg. Sx 1 mo ago after dx
with metastatic breast cancer. PE shows ataxia of left upper and lower extremities. Muscle strength,
DTR, sensation, proprioception normal. Metastatic tumor in which location?
- Cerebellum
11. Newborn delivered at 38 weeks' gestation weighs 1800 g. PE shows petechial rash,
microcephaly, and hepatosplenomegaly. Serologic test for CMV: IgG + in mother, + in newborn; IGM
- in mother, + in newborn. Explanation?
- Congenital cytomegalovirus infection

12. Female newborn is delivered at 38 weeks' gestation. Apgar 8 and 8 at 1/5 min. PE shows a
bulging, fluod0filled mass approximately 5 cm in diameter in the midline over the lumbosacral
region. No spontaneous movements of the lower extremities. Abnormality most likely occurred
because of abnormal development during which periods of postconception (in days)?
- 15 to 40
13. 64yo M in ED 3 hours after SOB with exertion and extreme fatigue. Has ischemic heart disease.
P 125/min, BP 105/60. ECG shows atrial fibrillation. Intravenous ibutilide is administered. Ten
minutes later, ECG shows normal sinus rhythm. Risk for which drug effect in the next 6 hours?
- Torsades de pointes
14. 65yo F with 20-year hx of osteoarthritis of the hands now has pain radiating down the distal
anterior thigh, knee, medial leg, and food. Bony outgrowth of vertebrae compressing one of the
spinal nerves is suspected. Nerve root in which intervertebral foramina is effected?
- L-3 to 4
15. 38yo M with 3-year hx of T2DM. Taking an oral antihyperglycemic agent, he has tried diet and
exercise. BMI 32. PE normal. Hb A1c is 10%. Physician recommends initiation of insulin injections.
Responds, "I know that insulin would help control my blood sugar. But a lot of people in my family
have diabetes, and insulin made them really sick at times. Patient is at which stage of change?
- Contemplation
16. 24yo M with 2-day history of an itchy rash on his arms and legs. Returned from a camping trip in
the woods 5 days ago. PE shows edematous, erythematous rash with linear vesicles. Cause is
activation of which cell types?
- T lymphocytes
17. 70yo M from china with poorly differentiated monoclonal carcinoma of the nasopharynx. DNA
probes of neoplastic cells are most likely to detect genome of which virus?
- Epstein-Barr virus
18. Epidemiologic study of aniline dye, 500 workers with bladder cancer and 200 workers without.
Exposed to aniline dyes/Have Bladder cancer: Yes/Yes (250), Yes/No (50), No/Yes (250), No/No
(150). Odds ratio?
-3
19. 24yo M with hx of IVDA could not be aroused. Friend reports that the patient injected himself
with a drug 6 hours ago. Labs show drug concentration of 0.3. Assuming first-order onecompartment kinetics, has a half-life of 2 hours, and a volume of distribution of 200 L in this patient.
What is quantity of drug (in mg) injected?
- 480
20. Compound is taken up by bacterial cells. No energy is necessary for uptake, and the compound
is not concentrated in the cell. Which describes this mechanism of transport?
- Carrier-mediated diffusion
21. Newborn has male genital ducts but female external genitalia. Cytogenetic analysis shows a
46,XY karyotype, and genetic testing shows a mutation of the gene encoding 5alpha-reductase. In
absence of this mutation, labia majora would have been?
- Scrotum
22. Study designed to evaluate the efficacy of coenzyme Q10 in improving cardiac output in
patients with CHF. Sixty patients with CHF are recruited. Each assigned by coin toss to one of tw
groups. Design?
- Candomized clinical trial

23. 12yo boy immersed up to his neck in 60F water for 20 minutes. Physiological changes?
- Central blood volume DECREASED, ADH (vasopressin) INCREASED, Atrial Natriuretic Peptide
INCREASED??
24. Rndomized controlled study of 2000 patients with insomnia is conducted to evaluate the efficacy
of a new medication to treat this condition. Ten subjects from both the control and treatment groups
do not complete the study are are not included in the analysis. Treatment group able to fall asleep 5
minutes faster than control (p=0.001). Neither group report an improvement in quality of life.
Conclude that new med is efficacious in treating insomnia. Type of error?
- Failure to distinguish between statistical significance and clinical significance
25. 50yo M with increasing cough for 6 month and hemoptysis for 1 week. Smoked 1 pack per day
for 32 years. Plays squash, swims. CXR shows a 3 x 4-cm hilar mass. Cytologic examination of
sputum shows a non-small cell carcinoma. Tells patient he has lung cancer. The patient reponds,
"How can this be happening to m? I eat right and exercise." Appropriate resposne?
- "It must be difficult for you to accept this diagnosis when you feel healthy."

#3orthopod, Jan 28, 2016

Block 1 Part 2
26. 18mo girl. Separation of the umbilical cord was delayed after birth. Has had four severe skin
infections Staphylococcus aureus; No pus formation at infection sites. Persristent leukocytosis in
absence of infection. Mechanisms impaired?
- Leukocyte adhesion and transmigration
27. 32yo M with 6-month hx of low back pain and stiffness, worse in morning and improve during
the day; the pain radiates to his buttocks but not down his legs. Back stiffness if he sits for
prolonged periods. Which to confirm diagnosis?
- X-rays of the sacroiliac joints
28. 17yo boy with 8-kg weight gain during the past year. No medical illness. BMI is 32. He asks, "Do
you think that my weight gain is inherited from my father?" Appropriate response?
- "Yes, your weight gain can be caused by genes and environment combined."
29. 52yo M neighbors have reported that he has been confused and not taking care of himself. 4mo Hx of diarrhea. PE shows extreme muscle wasting, stomatitis, and a diffuse rash that is worse in
sun-exposed areas. Diagnosis?
- Pellagra
30. 80yo F with suspected temporal arteritis (TA). ESR is 100, Pretest probability for TA is 50% in
this patient. In the evaluation of TA, ESR has a sensitivity of 99% and specificity of 60%. Based on
the restults of the ESR testing, most appropriate next step?
- Additional testing to confirm the diagnosis of TA
31. Sequence surrounding the first two exons of the human beta-globin gene shown, with exons in
bold. Translation start codon is underlined. A mutation from G-->A at position 355 is most likely to
lead to beta-thalassemmia by which mechanism?
- Disruption of normal splicing by creation of a new 3' splice site??
32. 42yo M in ED because of a 10-day history of progressive fever, SOB, and nonproductive cough.
20-kg weight loss. Immigrated to USA from the Ivory Coast 4 years ago. T 38C. Lungs clear, CXr
shows diffuse interstitial infiltrate. Silver stain obtained via bronchoscopy shows Pneumocystis
jiroveci (formerly P. carinii). High dose prednisone and trimethoprim-sulfamethoxazole is initiated,
and workup for HIV infection is done. HIV ELISA positive, HIV western blot positive, CD4 22; HIV
viral load <50. Explanation?

- Infection with HIV-2

33. 27yo F with vaginal bleeding for 3 weeks. First pregnancy ended with a spontaneous abortion 8
months ago. No Rx since dilatation and curettage at that time. PE shows enlarged uterus, beta-hCG
markedly increased. Ultrasonagraphy of pelvis shows material within the endometrial cavity and no
intrauterine pregnancy. CT scan shows a necrotic intrauterine mass and metastatic nodules in the
lungs. Site of Origin?
- Trophoblastic tissue
34. 65yo M emigrated from Brazil with 8-month history of shortness of breath and fatigue, edema of
lower ext. CXR shows cardiomegaly. endomyocardial biopsy specimen shows myofiber necrosis
with a mixed inflammatory infiltrate of PMNs, T lymphos, m.phages, and eosinophils. Causal org?
- Trypanosoma cruzi
35. 40yo F with mole on her back that has increased in size during past 4 months. PE shows raised
irregular lesion with variegated black-tan pigmentation and ill-defiined margins. Pleomorphic,
hyperchromatic cells within clear islands that tend to collapse. Extend from epidermis into papillary
dermis. Dx?
- Melanoma
36. 42yo farmer has a 7-mm red scaly plaque on helical rim of left ear. Photomicrograph shown.
Dx?
- Actinic keratosis
37. 30yo F training for a marathon, running 20 mild/day. Fasting glucose is 60. After her glucose
stores have been depleted, which organ, in addition to liver, releases glucose?
- Kidney
38. Male newborn at 28 weeks'. Given ventilatory support with up to 80% oxygen for the next 72
hours, but dies of resp. failure. Cause is inadequate secretion from which labeled cell types?
- D?? Not sure about this one. Looking for surfactant.
39. 9yo girl with poor growth during the past year. < 3rd %ile for height and at 10th percentile for
weight. PE normal. Visual field testing shows bitemporal hemianoia. Labs show GH deficiency. MRI
shows calcified cystic mass in suprasellar region. Tumor derived from?
- Diverticulum of the roof of the embryonic oral cavity
40. 28yo F G1P1 with 2-day history of a painful mass in her right breast. Delivered healthy female
newborn 3 weeks ago, and been breast0-feeding since. T 37C, PE shows 3-cm tender mass
surrounded by an area of erythema beneath the right areola. Causal org?
- Staphylococcus aureus
41. 3yo boy with bacterial colitis caused by Salmonella enterica serovar arizonae. Which factor
accounts for recruitment of PMNS to inflammatory site by intestinal epithelial cells?
- Interleukin-8 (IL-8)
42. 27yo F with fever, malaise, abdominal pain, and vaginal d/c for 4 days. LMP 5 days ago. Had
ectopic 1 year ago. T 38.3 C, bilateral lower quadrant tenderness with rebound and guarding. Pelvic
exam with cervical motion tenderness and bilateral adnexal tenderness WBC 18k. Pregnancy test
neg. Dx?
- Gonorrhea
43. 20M with 3-month hx of progressive thirst (drinking a lot of fluids) and urinary frequency during
past 3 days. U/A shows specific gravity less than 1.006. Most likely has dysfunction of which
endocrine structure?
- Posterior pituitary gland

44. 21yo M in ED with excruciating anal pain for 4 hours. Exam shows 15-mm, blue tinged rounded
mass at anal margin. Represents thrombus in a tributary of which blood vessel?
- Inferior rectal vein
45. 6-week-old girl with 6-day hx of vomiting small amount of milk 2 to 3 times daily. 50 %ile for
length and weight. Cause?
- Immature lower esophageal sphincter
46. 37yo M with 4-day hx of diarrhea and abdominal pain, worse in past 24h, with watery-brown
stools. Completed a 10-day course of amoxicillin for a sinus infection 5 days ago. Stool shows:
Fecal fat negative; ova and parasites negative; Cx for infx negative; C. Diff toxin positive. Which
pathologic findings present in intestinal tract?
- Pseudomemnbranes of fibrin and inflammatory debris
47. 28yo M in ED 30 minutes after SOB. 3-year hx of cocaine abuse. T 38.1, P 100/min, BP 150/45.
PE: diminished pulses in left upper extremity. Crackles heard over all lung fields. 2/6 diastolic
murmur at left sternal border. CXr shows a widened aortic arch. Dx?
- Dissecting aneurysm
48. 1-week-old girl. screening showed a possible defect in fatty acid oxidation. PE normal. Next
step?
- Measurement of serum acylcarnitine concentrations
49. 79yoM 30 minutes after LOC for 30 seconds. Alert, but dizzy. No urinary or fecal incontinence.
Pulse 40/min, BP 92/56. PE shows no tongue biting. Lungs clear, Variable intensity S1. Oriented
X3. ECG shows a third-degree atrioventricular block. Next step?
- Insertion of transvenous pacemaker
50. 55yo M with chronic bronchitis in ED after being unresponsive. Found bottles of albuterol,
ampicillin, codeine, and theophylline bedside. T 37.2 C, p 112/min, respirations are 6/min, BP 95/60.
Acute Rx should include?
- Naloxone

#4orthopod, Jan 28, 2016

Block 2 Part 1
1. 50yo man has persistent cough for 2 months. He has had a 5 kg (11 lb) weight loss. He is a
farmer and on itraconazole 4 weeks for histoplasmosis from chicken coops. Medications:
hydrochlorothiazide, enalapril, atenolol, omeprazole, and metoclopramide for hypertension and
gastroesophageal reflux. Thin. Physical exam otherwise normal. Itraconazole interacts with which
drug and account for lack of effect of itraconazole?
- Omeprazole
2. 20yo man with 6-hour difficulty breathing and vomiting. 10-year history of type 1 diabetes on
insulin. Pulse 90, respirations 30 and deep, bp 90/60. Physical shows dehydration. Labs: Na+ 130,
K+ 6.5, HCO3 5, glucose 500, pH 7.2, pCO2 25 mm Hg. Which compound stimulated hormonesensitive lipase in adipocytes causing accumulation of metabolites causing acidosis?
- Epinephrine
3. Physician sad to inform patient of progression of carcinoma to the terminal phase. Physician's
face makes patient cry and ask, "It's bad news, isn't it?" Which is best response?
- "Yes, it is."
4. 75yo man 2-year history of decreased force of urinary stream, urinate several times throughout
night. BUN 55, Cr 5.0. Ultrasound shows bilateral hydronephrosis and dilated ureter. Mechanism of
renal failure?

- Increased hydrostatic pressure in Bowman space

5. 4yo boy two bacterial urinary tract infections past year. Physical exam normal. Radiologic studies
show dilation of left ureter and renal pelvis, minimal left-sided renal function. Left nephrectomy
done. Photo: dilated renal pelvis and ureter. Which is cause of renal disease?
- Congenital ureteral obstruction
6. 45yo man poorly controlled type 2 diabetes 1-month low-grade fever. Getting hemodialysis for
end-stage renal disease. T 37 C (98.6 F), pulse 72, bp 144/92. Physical subclavian catheter below
right clavicle. Lungs clear. Cardiac exam no murmurs. Blood cultures grow nonhemolytic, catalasenegative, gram-positive cocci in pairs and chains. Which organism?
- Enterococcus faecalis
7. 3yo boy sickle cell disease with fever and pain over left foot 3 weeks. Hematocrit stable.
Leukocyte count 15,000 predominance of neutrophils. Which is most likely explanation for findings?
- Osteomyelitis
8. 10yo girl well-child examination. No menstrual period. 50th percentile height and weight. Physical
exam absence of breast bud development and no pubic or axillary hair. It is most appropriate to tell
mother that first objective sign of puberty will be which?
- Breast bud development
9. 45yo woman follow-up exam after 8 weeks tamoxifen therapy for estrogen- and progesteronepositive invasive ductal carcinoma of breast. 50yo sister also hormone-sensitive breast cancer.
Physical exam normal. Serum decreased concentrations of endoxifen, active metabolite of prodrug
tamoxifen. Genetic analysis shows homozygous cytochrome P450 2D6*4 alleles. Likelihood
patient's sisters has same alleles?
- 25%
10. 60yo man progressive shortness of breath past 3 months. Worked in shipyard. Respirations 25.
Bilateral basilar crepitant crackles. Xray chest reticulonodular pulmonary infiltrates consistent with
interstitial fibrosis. Picture: sputum sample of elongate structures (ferruginous body). Fibrosis
initiated by interaction of structures with which cell?
- Alveolar macrophage
11. 30yo woman 20 weeks gestation, uncomplicated pregnancy. Fundal height is greater than
expected for gestational age. Ultrasound shows increased amniotic fluid. Which abnormality is
cause?
- Tracheoesophageal atresia
12. 43yo woman for health maintenance exam. Physician 30 minutes late for appointment because
of emergency, when enters, patients checks watch. Which is best initial response?
- "I'm sorry I got delayed. I hope I haven't made you late somewhere else."
13. 27yo woman 12-hour history of fever and abdominal pain. History of recurrent urinary tract
infections. Temperature is 39 C (102.2 F). Physical exam tenderness of right flank. Abdominal xrays
bilateral staghorn renal calculi. Urinalysis pH 8, many RBCs, WBC, bacteria. Calculi composed of?
- Struvite
14. 48yo nulligravid woman with excessive uterine bleeding for 3 months. Bleeding during menses
and at irregular intervals. Menses were regular before. BMI 27. Pelvic exam: adnexae are
nonpalpable. Endometrial curettage shows abundant tissue. Which is cause of symptoms?
- Endometrial hyperplasia
15. 65yo woman surgical repair of aneurysm right internal carotid artery in cavernous sinus. Three
days later, physical exam right pupil larger than left pupil. Weakness of eye movement. Diagram of

coronal section through middle cranial fossa shown. Which nerve is damaged?
-A
16. 55yo woman 6-week history low energy, irritability, crying spells, difficulty falling asleep, wakes
up during night, cannot focus. Taking lorazepam for 15y for generalized anxiety disorder. Taking
estrogen replacement therapy for postmenopausal symptoms. Vital signs normal. Physical exam
normal. Mental status shows constricted affect. Mood is "testy." Speech is slowed. No psychosis.
Wishes she wouldn't wake up but doesn't plan to harm herself. Cause of symptoms?
- Major depressive disorder
17. Ten years after total gastrectomy, 60yo man difficulty walking. Diffuse spasticity in arms and
legs, impaired proprioception in his feet, increased muscle stretch reflexes in arms and knees,
absence of muscle stretch reflexes in ankles, bilateral extensor plantar responses. Which vitamin is
deficient?
- B12 (cobalamin)
18. 80yo man type 2 diabetes 2-month history severe constipation. Laxatives haven't relieved
symptoms. Abdominal exam shows distention. Colonoscopy shows no abnormalities. Patient has
dysfunction of which nerve?
- Pelvic splanchnic
19. 34yo man lightheaded after running 12 miles of marathon hot day. Pulse 130 bp 80/60. Which
changes to autonomic nervous system occurred?
- Sympathetic efferent activity increased, parasympathetic efferent activity decreased
20. 6-Mercaptopurine (6-MP) used to treat acute lymphoblastic leukemia (ALL). 6-MP acted on by
enzymes to make 6-thioguanine nucleotides (6-TGN). Efficacy and toxicity of 6-MP correlated with
6-TGN. 6-MP acted on by xanthine oxidase (XO), thiopurine methyltransferase (TPMT), leading to
inactive metabolites. Which are clinical consequences of ALL patients homozygous for low-activity
alleles of TPMT?
- They may be given normal doses of 6-MP (?)
21. Ten human subjects given new oral drug to monitor drug effect and toxicity. Blood analyzed for
human pharmacokinetics of drug for first time. Which trial type?
- Phase 1
22. 15yo girl health maintenance exam. Mother dx squamous cell carcinoma face, maternal
grandfather died of metastatic melanoma. In patient this age, which factor most predicts compliance
with photoprotection?
- Use of sunscreen by her peers
23. 34yo AIDS patient with pulmonary tuberculosis. No CD4+ T lymphocytes in peripheral blood.
Which cellular components most likely to have deficient function in tuberculous lesions in lungs?
- Macrophages
24. 44yo woman follow-up after two Pap smears showing atypical squamous cells of undetermined
significant. Test shows viral E6 protein of human papillomavirus. This protein promotes cell growth
and malignancy by causing cellular p53 protein degradation. This degradation beings when p53
protein targeted to which type of cell enzymes?
- Ubiquitin ligase
25. 40yo woman hx of 6 month episodic sinusitis with 2-week intermittent headaches, fatigue, and
generalized joint pain, worsening cough productive of blood-tinged sputum. Failed antibiotics,
decongestants and nasal corticosteroids. Physical exam: erythema nasal mucosa, two small
ulceration. Lungs scattered crackles. Xray patchy bilateral opacicites. Labs: Hemoglobin 13, ESR

70, leukocyte 10,500, antineutrophil cytoplasmic antibody increased. Dx?

- Wegener granulomatosis
Administrator

#5orthopod, Jan 28, 2016

Last edited by a moderator: Feb 10, 2016

Block 2 Part 2
26. 25yo woman 6-month history of joint pain poorly responsive to aspirin. Physical exam: bilateral
swelling of proximal interphalangeal joints, metacarpophalangeal joints, and wrists; weakness of
grasp. Small nodules palpated beneath skin around joints of fingers. Dx?
- Rheumatoid arthritis
27. 50yo woman 1-year hx of hot flashes and irregular menses. Decreased bone mineral density.
Alendronate prescribed. Mechanism of drug?
- Inhibition of osteoclast-mediated bone resorption
28. Female newborn at 36 weeks gestation has respiratory distress. Apgar 3 and 5 at 1 and 5
minutes. Physical shows cyanosis. Endotracheal and NG tubes placed. Xray shows nasogastric
tube in left hemithorax, mediastinum displacement to right, absence bowel gas in abdomen. Which
embryological event led to these findings?
- Incomplete formation of pleuroperitoneal membrane
29. 65yo women progressive vulvar itching past 2 months; miconazole for yeast infections
ineffective. Exam: atrophy of labia minora and thin, parchment-like skin over vulva and anus. Dx?
- Lichen sclerosus
30. 75yo man 2-day ear ringing, nausea, fatigue. Temp 37 C (98.6 F), pulse 100, respirations 24, bp
140/85. Physical: mild epigastic tenderness. ABG pH 7.42 pCO2 30 pO2 95 HCO3 19. Dx?
- Salicylate poisoning
31. 15yo girl 1-day hx redness and painful skin following sunbathing. She used sunblock. No
medications. Physical exam: severe erythema of back and extremities, no blisters. Dx?
- First-degree burn
32. 58yo man supraventricular tachyarrhythmia refractory to pharmacotherapy gets ablation of
accessory excitatory pathway in atrial endocardium. Which area should be avoided to leave
sinoatrial (pacemaker) node intact?
- The junction of the superior vena cava and the right atrium
33. 81yo woman massive pulmonary embolism from deep venous thrombosis. Platelet count
160,000. Appropriate pharmacotherapy is started. One week later, platelets 55,000.
Thrombocytopenia most likely caused by a drug with which of the following mechanism of action?
- Potentiates the action of antithrombin III
34. 22yo woman, g1p1, 2-day hx of fever, severe vaginal bleeding. four days ago delivered healthy
male newborn. Temp 38.1 C (100.6 F). Pelvic exam: open cervix, heavy vaginal bleeding. US
shows uterus with no placental tissue or thrombi. If operation required to control bleeding, ligation of
branch of which artery required?
- Internal iliac
35. 35yo woman abnormal Pap smear. Cervical biopsy shows microinvasive cervical carcinoma.
Which microscopic features led to dx?
- Neoplastic cells in sub-basement membrane connective tissue

36. 17yo girl 1-day shortness of breath, weakness and muscle tenderness. Did triathlon previous
day. BMI 19. Temperature 38 C (100.4 F), respirations 20, bp 150/90. Physical bilateral crackles
lower lobes, muscle tenderness. Creatinine 4. Urinalysis 3+ protein, 4+ hemoglobin. Patient's
condition is from increased release of which substance?
- Myoglobin
37. 16yo boy with no signs of puberty. Sex development Tanner stage 2. Physical exam:
circumcised penis, soft small tests 5 mL, prostate firm, nontender, no discharge or lesions.
Testosterone low. Which hormone is cause of decreased serum testosterone and lack of pituitary
hormone stimulus?
- Luteinizing hormone
38. 28yo woman wants to lose weight. She binges on high-carbohydrate foods 2 to 3 times a week,
forcing herself to vomit after. BMI 23. Which physical finding is likely?
- Parotid gland enlargement
39. 15yo girl emigrated from India and with several lesions on neck for 2 weeks. Physical exam
shows hypopigmented, hypoesthetic area on left side of forehead and 4-cm lesions on neck. Biopsy
shows acid-fast bacilli. Best explanation why the organism results in dermal rather than visceral
infections?
- Temperature sensitivity
40. 59yo man has total thyroidectomy for 4-cm follicular carcinoma of thyroid. Twelve hours after
procedure, has paresthesias of hands and feet. Vitals stable, carpal spasm on inflamation of bp
cuff. Lab findings?
- Decreased parathyroid hormone, decreased calcium
41. 41yo man with asthma and allergy to grass pollen wheezes and difficulty breathing 10 min after
mowing lawn. Drug for immediate relief of acute symptoms?
- Albuterol
42. 14yo boy daily headaches for 2 months. Headaches are bilateral aching in temples. "Has not
been himself" for months. Confused, forgetting names, dates, places, clumsy, frequent falls. School
performance declined. Physical exam: broad-based ataxic gait. Slow to answer questions. Chronic
abuse of which substance?
- Inhaled glue
43. 40yo African American woman 2-week hx fever, malaise, dyspnea. Temperature 36.7 C (98 F),
respirations 20. Physical exam: erythema nodosum, parotid enlargement, hepatosplenomegaly.
Calcium 16. CT chest bilateral hilar adenopathy. Increased in which in serum?
- 1,25-Dihydroxycholecalciferol
44. 56yo woman with restrictive cardiomyopathy, proteinuria, renal failure. 35-year history of
rheumatoid arthritis. Renal biopsy shows glomerular deposition of eosinophilic hyaline material.
Congo red statin: birefringent pattern under polarized light. Structure of material?
- beta-pleated sheet structure
45. 63yo man 3-month hx difficulty sleeping. Sleeps better upright. HR 90, bp 110/60. Physical
exam: increased jugular venous pressure, mild ankle edema. Cause of edema?
- Increased capillary hydrostatic pressure
46. 14yo boy come to ER 1 hour after colliding with teammate playing soccer. Physical exam:
edematous tissues of left eye, mild depression of left zygomatic bone. Skin between eye and upper
lip numb. Double vision look upward. Nerve damaged causing sensory loss?
- Maxillary division of trigeminal nerve

47. 35yo man increasingly depressed, impulsive and difficult over past year. Grimaces intermittently
with rapid, jerking, purposeless movements of fingers. Historical factor relevant in dx?
- Family history of a similar illness
48. 18yo man Crohn disease 1-day hx severe abdominal pain and intermittent bloody diarrhea.
Temperature 38 C (100.4 F), pulse 98, respirations 18. Physical exam: draining anal fisutla.
Treatment with antibiotics and prednisone over next 3 weeks recovers. Mechanism of
pharmacotherapy is suppression of which?
- T-lymphocyte function
49. 34yo woman with pyelonephritis treated with bactericidal antibiotic 4 days no improvement.
Antibiotic added that inhibits binding to 30S ribosome, blocking protein synthesis intracellularly.
Antibiotic?
- Gentamicin
50. 3yo boy and his 5yo brother with recurrent hemarthroses. Both parents healthy, but mother with
two younger brothers with same sx and maternal uncle who died at 8 of mild head trauma. Partial
thromboplastin time is prolonged. Defect?
- Factor VIII (antihemophilic factor)
Administrator

#6orthopod, Jan 28, 2016

Block 3 Part 1
1. 6yo boy from Russia with unstable gait and incoordination for 2 weeks. Pale, bulky stools for 4
years and two episodes of bacterial pneumonia and chronic cough since age 1 year. 3%ile for
height/weight. Neuro exam shows ataxia, no DTRs, loss of proprioception. Stool shows inc fat
concentration. Vitamin deficient?
- Vitamin E
2. 54yo F 1 week after sudden loss of vision in left eye, returned within 1 day. 3-month hx of
progressive SOB with exertion. Echocardiography shows mass in the left atrium of the heart. Lesion
is resected, photomicrograph of it is shown. Which describes the lesion?
- Myxoma
3. 27yo primigravid woman at 34 weeks' with nausea and vomiting, and abdominal pain for 12
hours. Everything's been normal. BP is now 164/102, and right upper quadrant tenderness. Labs
show Hb 7.4, HCT 24%, Platelets 72k, Cr 1.2, total bili 2.3, AST 112, ALT 126. Peripheral blood
smear will show?
- Schistocytes
4. 60yo F 3 hours after sudden onset ankle pain. 4-year Hx of increasing serum creatinine
concentrations. Began furosemide 1 month ago, also takes glipizide. P 120/min, resp 25/min, BP
150/100. Joint fluid shows negatively birefringent crystals. Increased risk of which complications of
underlying process causing joint findings?
- Nephrolithiasis
5. 56yo F follow-up 8 weeks after recovering from pneumococcal pneumonia. Chest X-rays normal.
Which allowed this resolution to occur?
- Answer is NOT E
- Answer might be D, Metaplasia of mesenchymal cells to pneumocytes?
6. 29yo F with 5-week hx of fatigue and 4-day hx of heart palpitations and anxiety. Has primary

hypothyroidism Rx with triiodothyronine, but she has doubled the dose because of fatigue. TFT will
show which?
- TSH DECREASED, Free thyroxine DECREASED, Free triiodothyronine INCREASED
7. 20yo F has multiple neurofibromas. Mom, uncle, and brothers with similar lesions. Mode of
inheritance?
- Autosomal dominant
8. 45yo M with yellow skin. Drinks eight to ten 12-ounce cans of beers daily for 10 days. Liver is
tender. Serum: total bili 5.9, Alk Phos 210, AST 110, ALT 69, gamma-glutamyltransferase 25 (n = 030). Liver biopsy will show?
- Mallory hyaline
9. 50yo M smoked 2 packs per day for 34 years, with SOB on exertion, chronic cough, and
wheezing. Increased AP diameter, diminished breath sounds, scattered rhonchi. Which Lab
abnormalities is expected?
- Increased urinary excretion of HCO3?
10. 35yo M uses crack cocaine daily, with 2-hour Hx of substernal chest pain. T 37C, P 110/min, BP
160/100. Most appropriate next step?
- Admit the patient to the hospital for possible myocardial ischemia
11. 54yo F with hypertension and bilateral renal artery stenosis starts taking NSAIDS for back pain.
Her Cr concentration increases from 1.0 to 5.0. Cause is due to inhibiting which?
- Vasodilating prostaglandins at the afferent arteriole
12. 83yo M brought to ED after being found at home bedridden and confused. No meds. P 100/min,
BP 85/50. BP unchanged after 1L IV saline. Pulmonary artery catheter shows: Cardiac output high,
PCWP low, systemic vascular resistance low. Cause of hypotension?
- Early septic shock
13. 32yo M with 3-month hx of swelling and breast tenderness. Receiving thyroid hormone and
steroid replacements since removal of pituitary adenoma 2 years ago. Began hCG injections 4
months ago. Most likely binding site of hCG causing gynecomastia?
- Tissue: Testicle; Effect: estradiol production
14. 38yo F with 3-day hx of sore throat. Photo shown of throat. Which nerves is tested by saying
"ah," elevating area at tip of the arrow?
- Vagus
15. 8yo boy with disruptive behavior, interrupts, always moving, trouble completing tasks. Drug with
which mechanism is appropriate?
- Increased release of dopamine and norepinephrine
16. 62yo M with alcohol-induced liver disease develops ascites. Infection ruled out. Most
appropriate diuretic, in addition to loops, is which?
- Spironolactone
17. 72yo M with weakness and fatigue. Hemogrlobin concentration is 9.2, WBC 5400, platelets
350k. Peripheral blood smear is shown. Cause?
- Gastrointestinal blood loss
18. 65yo F with widely metastatic breast cancer unresponsive to chemo. No family. "close friend," at
all her visits and now she is moved to inpatient hospice after she decides she wants no further
curative therapy. Says, "We can't bear to be apart. It would be cruel to separate us now.". Which
response is appropriate?

- "The two of you seem to have a very important relationship. Of course you may stay together."
19. 46yo M treated with oral cyclosporine after cardiac transplant. Cyclosporine decreases
likelihood of rejected by which actions?
- Suppressing the early response of T lymphocytes to activation
20. 30yo M in ED 15 minutes after found unconscious. Comatose, pupils 4 mm in diameter, not
reactive to light. CT head shown. Cause of coma is bleeding from which structures?
- Middle meningeal artery
21. 68yo M with 6-month hx of erectile dysfunction. PE and labs normal. If pharmacotherapy is
indicated, drug with which MOA?
- Inhibition of phophodiesterase
22. 35yo M with recurrent sinusitis and bronchitis. Cardiac examination shows PMI at fourth
intercostal space within the midclavicular line on the right. Hepatic margin is palpable on the left.
Endoscopy shows nasal polyps. Biopsy shows thickened, ciliated, pseudostratified epithelium with
small patches of squamous metaplasia and mild lymphoid infiltration. Which structure most likely to
be absent on electron microscopic exam of epithelium?
- Dynein arms
23. 30yo primi at 22 weeks' gestation with 1-day hx of fever, chills, and muscle aches. T 39.4, P
114/min, resp 15/min, BP 104/72. PE shows uterus consistent with 22-week gestation. Fetahl heart
sounds are heard. WBC 12K, Blood cultures grow gram-positive rods. Causal organism?
- Listeria monocytogenes
24. 42yo M with multiple lesions over his body. PE shows flaccid bullous erosions involving upper
and lower extremities and torso. Biopsy shows extensive epidermal acantholysis resulting in the
formation of intraepidermal blister. Intact basal layer of keratinocytes adherent to basement
membrane is identified. Which is related to pathogenesis?
- Development of autoantibodies against desmosomal proteins
25. 50yo M 3 days after his first generalized tonic-clonic seizure. 1-month hx of frequent episodes of
pins-and-needles sensation around the mouth, hands, and feet, involuntary contraction of muscles.
Neuro exam shows mild, diffuse hyperreflexia. Which serum electrolyte is abnormal?
- Calcium

#7orthopod, Jan 28, 2016

Block 3 Part 2
26. 52yo F with hot flashes. Menses have been irregular for the past 6 months. Physiologic cause?
- Failure of the ovaries to secrete 17beta-estradiol
27. 32yo F G2P1 at 7 weeks' gestation with vaginal bleeding for 3 days and increasingly severe left
abdominal pain for 18 hours. Direct and rebound tenderness with guarding in left lower quadrant.
Cervical os is closed. serum beta-hCG is 6000. U/S shows empty uterus. Dx?
- Ectopic pregnancy
28. 26yo F 5 weeks after birth of first child. Worries constantly that the infant is ill and wakes up to
make sure he is well. Washes her hands 30 times per day. Worried about people braking into her
house, checks lock 3-4 times a night. Not breast feeding. Rx?
- Sertraline
29. 10yo boy has had anemia since birth. Spleen is five times normal. Splenectomy is indicated if
anemia is caused by which?
- Hereditary spherocytosis

30. 62yo F in ED for 2-day hx of fever, abdominal tenderness, and painful urination. Agitated. T
38.8C, Labs show WBC 14k. Admitted to hospital, nurses note she has torn up four breakfast
menus because she is confused. Cause?
- Delirium
31. 60yo F with 3-year Hx of hyperlipidemia. Low-cholesterol diet and exercise program ineffective
after 1 year. Lovastatin initiated, but unable to tolerate greater than 20 mg daily. Additional drug is
added that inhibits transport of cholesterol through intestinal wall. Which drug?
- Ezetimibe
32. 48yo M with bronzing of his skin, weakness, and fatigue during the past 3 months. PE shows
hepatomegaly, and small testes. Serum: AST INCREASED, ALT INCREASED, iron INCREASED,
transferrrin sat INCREASED, ferritin INCREASED, testosterone DECREASED, LH DECREASED,
FSH DECREASED. Explaination?
- Increased intestinal iron absorption
33. 45yo M with intermittent bloody diarrhea and abd pain. Sigmoidoscopy and rectal biopsy show
IBD. Monoclonal antibody is begun, which is directed against what components?
- Tumor necrosis factor
34. 41yo F with increasingly severe headaches for 6 weeks. BP 160/100. bruit over left
costovertebral angle. U/A norma. Angiogram of left renal artery shows alternating areas of stenosis
and aneurysmal dilatation ("string of beads" sign). Dx?
- Fibromuscular dysplasia
35. 55yo M with sepsis. Appears anxious and confused. Rx with vancomycin and ceftriaxone
initiated in ED. T 39.8, P 132/min, BP 85/48. PE shows warm, flushed skin. No aedema. Administrer
which solutions?
- 0.9% Saline
36. 36yo M undergoes elective liposuction under general anesthesia. Operation is terminated when
patient develops hyperthermia, tachycardia, and marked muscle rigidity. MOA of drug that should be
administered?
- Decreases release of Ca from the sarcoplasmic reticulum
37. In a survey of 100 households (average three residents per household), 45 with asthma are
detected. Prevalence?
- 15%
38. While lifting weights, 24yo M swelling in right inguinal region. Photograph shown of small
intestine resected. Dx?
- Strangulation
39. 24yo with second-degre burn. Two weeks after, tissue shows increased fibroblast migration and
proliferatoin, increased collagen and fibronectin, and decreased metalloproteinases. Caused by
production of which?
- Transorming growth factor-beta
40. Protein found in brown adipose tissue of mice causes leak of H ions inward across inner
mitochondrial membrane. Effect of this protein on oxidative phosphorylation and energy
metabolism?
- Increased ratio of oxygen consumption to ATP generation
41. 57yo M with alcoholism has distended abdomen with shifting dullness, fluid wave, caput
medusae, palmar erythema, spider angiomata. Additional finding?
- Gynecomastia

42. 16yo girl with 2-year hx of fainting; increased in frequency during past 6 months. BP 110/80
supine and 60/40 standing. Neuro exam normal. Plasma shows undetectable noreipinephrine and
marked increase in dopamine concentration when standing. Deficiency of which?
- Dopamine beta-hydroxylase
43. 20yo M with suspected appendicitis has periumbilical burning and discomfort, localizes to RLQ
5 cm superomedial to anterosuperior ilica spine. This is because periumbilical region and appendix
are both supplied by afferent fibers in dorsal root ganglia of which levels?
- ??
44. 60yo M from china to USA with 1-month hx of confusion and swelling of abdomen and legs.
Peanut farmer in china. Smoked 1 pack per day for 40 years. No alcohol. PE shows ascites and
ankle edema. Liver palpable, spleen isn't.
Serum: Albumin 4, total bili 2.5, Alk Phos 200, AST 45, ALT 60, IgG anti Hep A positive; Anti hep B
negative, anti hep C negative.
U/S shows 10 cm lesion. Biopsy shows dysplastic hepatocytes in small clusters and rows with no
normal architecture. Exposure to which?
- Aflatoxin
45. 42yo M in ED for 5-hour hx of fever, chills, and severe pain and swelling of his left arm.
Scratched his arm on a nail yesterday. Appears confused, T 40C, BP 71/38. Labs show Hb 14, HCt
42%, WBC 15K (35% PMNs, 40% bands, 25% lymphos), Platelets 50K, Serum BUN 28, Cr 2.8.
Symptoms due to systematic release of which cytokines?
- IL-1 and tumor necrosis factor (TNF)-alpha
46. 62yo M dies suddenly while playing tennis. No cardiac risk factors, no hx of CAD. Autopsy,
cardiac valve defect and concentric LVH. Which valve abrnomalities is most likely involved?
- Aortic stenosis
47. 67yo M has urinary urgency after placement of urinary bladder catheter during transurethral
resection of the prostate. Most appropriate Rx has which MOA?
- Inhibition of muscarinic receptors
48. Mouse embryos are produced with two pronuclei, both of same parental origin. When the
pronuclei are maternal, produces have poorly developed extraembryonic structures. When both
pronuclei are paternal, produces have poorly developed embryonic tissue. Which genetic
mechnanisms?
- Imprinting
49. 18-yo F with sepsis after an abortion. Within 24 hours she becomes dyspneic, oliguric, and
develops petechiae, ecchymoses, and bleeding from venipuncture sites. Which lab finding?
- Decreased plasma fibrinogen concentration
50. 63yo M with 6-month hx of exertional chest pain relieved by rest. smoked for 45 years. Mild
HTN, no meds. Which lesion in LAD is most likely cause?
- Calcified 80% stenosis
Administrator

#8orthopod, Jan 28, 2016

Block 4 Part 1
1. 65yo F with ovarian cancer treated with cyclophosphamide and other chemotherapeutic agents.
Cyclophosphamide affects which target?

- DNA replication
2. Pharm co trying to develop a long-acting weight-loss agent that mimics activity of a naturally
occurring peptide originates in adipose tissue, signals brain about stored fat, and suppresses
appetite by its action in the CNS. Which chemical mediator?
- Leptin
3. 45yo F has thyroidectomy because of asymmetric enlargement of thyroid noticed 6 weeks ago.
Underwent adrenalectomy for pheochromocytoma 3 years ago. Bilateral thyroid lesions with spindle
cells arranged in small clusters. Amyloid deposits b/w neoplastic cells. C-cell hyperplasia,
malignant. Which marker to monitor?
- Calcitonin
4. 45yo F intubated, mechanically ventilated with fungemia with Candida albicans. Rx with
caspofungin is started. Feature of causal organism targeted by this drug?
- Beta-Glucan carbohydrates in the cell wall
5. 56yo M 4 hours after sudden onset of uncontrollable irregular movements of the left side of the
body. PE shows flailing movements of the proximal appendicular muscles on the left. Nuclei
damaged?
- Right subthalamic
6. 60yo M 1-month Hx of progressive SOB with exertion.
Breath sounds: Dec on right lung base, normal on left lung base
Percussion note dull on right lung base, nml on left lung base
Tactile fremitus decreased on right lung base, nml on left lung base
Adventitious sounds none on right lung base, crackles on left lung base
Dx?
- Pleural effusion
7. 68yo M with difficulty swallowing solids for 2 months. Hx of dilated cardiomyopathy. X-rays of
esophagus w/ barium contrast show indentation and posterior displacement of the esophagus.
Enlargement of what caused dysphagia?
- Left atrium
8. 25yo F with 3-year hx of irregular menses. Menarche was at age of 14 years. BP 116/62. PE
shows increased hair growth on the face and chest. Pelvic exam shows clitoromegaly and a normalappearing uterus. Serum shows increased 17-hydroxyprogesterone and androstenedione.
Deficiency of ?
- 21-hydroxylase
9. 60yo M in ED for sudden onset of acute abdominal pain and tenderness, nausea, vomiting, and
bloody diarrhea 2 hours ago. He has a Hx of cirrhosis and hepatocellular carcinoma. BP 99/50.
Loss of bowel sounds. Surgery shows small intestine with dark purple-red hemorrhagic appearance.
Cause?
- Mesenteric venous thrombosis
10. 38yo M in ED 30 min after unable to stand upright. Lethargic, pulse 110/min, BP 90/62. PE
shows dry mucosa and poor skin turgor. Midepigastric tenderness. Labs show:
Serum: Na 143, K 3.2, Cl 101, HCO3 11
ABG: pH 7.28, Pco2 23, Po2 98
Acid-base status in this patient?
- Metabolic acidosis
11. 2mo boy given vaccine to convert T-independent antigens to T-dependent forms to enhance
protection in young children. Which vaccine given?

- Haemophilus influenzae type b

12. A study conducted to assess effectiveness of injections of lidocaine into "trigger points" of pain
symptoms in patients with fibromyalgia. Fifty patients randomly assigned - 0.9% saline only or
saline plus lidocaine. Graph shows self-reported pain scores. Explanation?
- Placebo effect
13. 58yo F in ED for 2-hour hx of SOB and chest pain radiates to her back between the shoulder
blades. Resp 28/min, PE shows diaphoresis. ECG normal. Coronary angiography shows occlusion
of marginal branch of LAD coronary artery. Revascularization done with stent placement. CK-MB
and troponin I increased. Mechanism of these lab findings?
- Protease inactivation by cytplasmic free calcium ions ??
NOT SURE ABOUT THIS ONE
14. In a clinical study, a polymorphic marker with three alleles, 1, 2, and 3, is found to be tightly
linked to the gene for polycystic kidney disease. Pedigree shown. If III, 1 is unaffected by this
disease, patient is most likely carrier of?
- 2,3
15. 6yo girl with 4-day hx of round shiny bumps in areas where she has eczema. Her mother saw
similar bumps on a playmate at pool party 3 weeks ago. No other Sx. PE shows firm, smooth,
umbilicated papules 2 to 4 mm diameter in clusters. Causal organism?
- Poxvirus
16. 80yo F in ED for 2-day hx of "feeling funny." "Lost my pep." Hx of poorly controlled hypertension.
Just started medication 2 weeks ago. BP 130/85. Pe normal. Serum potassium is 3. Which drug?
- Hydrochlorothiazide
17. 69yo F with weakness of left leg since awakening. PE shows weakness. Babinski present on
left. Decreased somatic sensation in left foot, agraphesthesia on plantar surfaces of the toes, and
decreased position sense in the toes. MRI shows edematous area in cerebral cortex of right
hemisphere. Lesion?
-G
(Does anyone know what part of the brain this corresponds to?)
18. 68yo M in for a hemiorrhaphy. Surgeon gives info of risks and benefits. Patient says that he
understands what he has been told, and his family will be able to discuss later. In this patient, which
combination of components fulfill the criteria for fully informed consent?
- Information, competence, voluntariness
19. 47yo F with psoriasis for follow-up. Was given several topical creams, to be used in specified
sequence twice daily. No improvements apparent at this appointment. How to begin discussion of
compliance?
- "using something twice daily can be difficult. I assume you are like most patients who miss at least
10% of treatments."
20. Male newborn has macrocephaly with poor skull mineralization, shortened extremities with
misshaped long bones, and several fx. Defect in which?
- Collagen
21. 27yo F in ED 30 min after ejected through windshield during MVC. Unrestrained front-seat
passenger. PE shws marked edema and tenderness of the jaw. Panorex x-ray of mouth shown.
Which is injured?
- Levator labii superioris
22. Girl for well-child exam. Normal development includes pincer grasp, finger feeding, standing

while holding onto a table, and playing peekaboo. Age (in months)?
-9
23. 60yo M exam prior to employment. PE normal. Labs show
Hb 14, HCT 42%, WBC 12k (PMN 45%, lymphos 50%, Monos 5%), platelets 250k
Flow cytometry analysis of peripheral lymphocytes shows:
CD3 50%, CD4 40%, CD8 10%, Kappa 47%, lambda 3%
Which is most predictive of a clonal lymphoid proliferation?
- Surface kappa:surface lambda ratio
24. 18yo M with yellow nodules on achilles tendons of his feet and extensor tendons of his hands.
Exam shows collection of foamy histiocytes within the dermis. Serum cholesterol is 980, and
lipoprotein electrophoresis shows a selective increase in LDL. Underlying disorder?
- Absence of functional LDL receptors in hepatocytes
25. 35yo M with 4-day Hx of high-grade fever, sever muscle aches, malaise, loss of appetite, and a
nonproductive cough. wife and kids had similar illness. Temp 39.2, PE normal. CBC and CXR
normal. Causal virus replicates its genome within the cell's nucleus. Organism?
- Influenza virus
30 rofhalpcervicalbumAdministrator

#9orthopod, Jan 28, 2016

Block 4 Part 2
26. 28yo F at 18 weeks' gestation has palpitations. Labs show increased serum total thyroxine (T4)
concentration. Best test to confirm hyperthyroidism?
- Thyroid antibodies
27. 21yo M in ED 45 minutes after sustaining multiple injuries in a MVC. His BP is 90/50, PE shows
diffuse abdominal tenderness. Dx with laceration of the spleen and undergoes splenectomy.
Predisposed to infection with?
- Streptococcus pneumoniae
28. 70yo F in longitudinal study of effects of aging on pulmonary function tests. Which represents
woman now compared with results at age of 20 years?
- Residual volume UP, Arterial Po2 DOWN, Alveolar-arterial Po2 difference UP
29. 45yo F farmer in ED for 2-day hx of confusion, lethargy, fever, headache, muscle pain, vomiting,
and a rash on her wrists and ankles. Bitten by a tick a few days ago. T 38.5 C, Red-purple papules
on distal extremities progress to trunk. Rx?
- Doxycycline
30. Study of breast cancer in women. Hundred healthy women observed for 10 years. Goal is to
determine if number of family members who previously received dx of breast cancer correlates with
incidence of future development of cancer. Best design?
- Cohort
31. 62yo F with recurrent pulmonary emboli comes for follow-up. PE normal. Labs show PT of 12
seconds. Warfarin begun. Which clotting factors is first to be decreased by 50% after initiation of
Rx?
- VII (proconvertin)
32. 48yo F with 2-month hx of fatigue and intermittent headaches. BP 180/110, PE normal. Serum
show a decreased potassium concentration and increased aldosterone. CT abdomen shows tumor

on adrenal gland. Which additional findings supports aldosterone-secreting adrenal adenoma?

- Decreased plasma renin activity
33. 20yo F with 1-day hx of increasing urinary frequency and a burning sensation with urination.
One sexual partner, uses condoms. VSS. PE shows mild suprapubic tenderness to deep palpation.
Urine shows rare epithelial cells and 10 WBC/hpf. Urine grows E. coli > 100k. This bacterial strain
has which virulence factors?
- Mannose-binding (type 1) fibria
34. 6yo boy with 3 systemic infections with Neisseria meningitidis over the past 2 years. Healthy
otherwise. Which lab test is most likely abnormal?
- Total hemolytic complement concentration
35. 13yo girl 2/6, holosystolic murmur heard best over left fifth intercostal space adjacent to the
sternum; it increases with inspiration. Abnormality of which valves?
- Tricuspid
36. 55yo F with left flank pain and gross hematuria. Mass is palpable in LUQ of abdomen.
Ultrasonography shows a 12-cm solid mass on lower pole of left kidney. Angiograms show
hypervascular mass. Dx?
- Renal cell adenocarcinoma
37. 28yo F with 3-week hx of double vision. Episode of blurry vision in left eye that improved during
next 2 months w/o Rx. Neuro exam shows right eye does not adduct past the midline on horizontal
gaze when looking to the left. When convergence is tested, the right eye is able to adduct past the
midline. Rightward horizontal gaze is normal. Lesion is where?
-C
38. 19yo M in MVC. Penetrating wound to right cerebral cortex with paralysis of the left lower
extremity, fracture of right mid humerus with severing of the radial nerve, and a fracture of right tibia.
After 10 weeks, DTR strongest in which locations?
- Left Achilles tendon
39. 40yo F with 1-year hx of episodes of crampy abdominal pain, intermittent diarrhea, and rectal
bleeding with passage of mucus. BMI 18. Abdomal exam: diffuse tenderness with no rebound.
Sigmoidoscopy shows diffuse ulcers. Initial Rx?
- Sulfasalazine
40. 27yo M for employment exam. No Hx of major illness. Never been sexually active. Minimal
contact with parents and siblings, no hobbies. Doesn't feel depressed. Shrugs in response to
congratulations about his new job. Flat affect. Personality disorder?
- Schizoid
41. 30yo F has ptosis, ophthalmoplegia, and diplopia. Serum shows autoantibody with affinity for
acetylcholine receptor at the postsynaptic neuromuscular junction. Which neoplasm?
- Thymoma
42. Exam scaled so scores are normally distributed with mean of 500 and SD of 100. Which % are
between 400 and 600?
- 67%
43. 62yo M with pericardial friction rub 3 days after acute myocardial infarction. Cause of rub?
- Fibrinous pericarditis
44. 42yo F with 1-mo Hx of abdominal pain, after eating fatty meals. BMI 31. PE shows jaundice
and tenderness of RUQ. Increase of which liver function?

- Cholesterol synthesis
45. 70yo M with recent loss of mental function. Hx of weight loss. No drugs. VSS, not dehydrates.
Mild anemia. Labs show
Na 110, Cl 85, K 4.4, BUN 15, Cr 15; Plasma osmolality 250; Urine osmolality 750. Dx?
- Pulmonary neoplasm
46. 38yo F with 2-year hx of pain and heavy flow with menses causes her to miss work. Ibuprofen
not effective. One 6yo daughter; unable to conceive another child. PE shows mildly enlarged left
ovary and retroflexed uterus. U/S shows substantial evidence of ovarian cysts and one peritoneal
cyst. Bx of cyst will show?
- Proliferative endometrial tissue??
NOT SURE ABOUT THIS ONE
47. 40yo M skin extremely sensitive to sunlight, which causes formation of vessicles and blisters on
the skin which take weeks to heal. Diagnosed with disorder caused by increased synthesis of
compounds in the skin that are subject to excitation by visible light. Which biochemical pathway is
defective?
- Heme synthesis
48. 60yo M with 6-month hx of fatigue. Four years ago, had subtotal gastrectomy after gunshot
wound. Drinks 6-8 beers daily. PE shows paresthesias of both hands. Labs show: Hb 8, HCT 24%,
MCV 115, WBC 5k, Platelets 165k, RBC Folic acid 500 (N = 125-600), B12 10 (N = 160-195).
Cause is absence of?
- Parietal cells
49. RCT to compare wound healing and cosmetic differences between two surgical procedures for
closing skin after C section. Surgical specialists cannot be blinded to the procedure. Results show
procedure A has a lower rate of wound infection compared with B (relative risk 0.66, 95% CI 0.3 1.45). Which accurately represents comparison bewtween A and B?
- Neither procedure is superior
50. 40yo M with interstitial pulmonary fibrosis has greater maximal expiratory flow rate than
predicted. Which best explains this?
- Increased radial traction on airways
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