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1>Mostfasciaofthebodythatattachtobonesattachbywhichofthe
followingmechanisms?

A.
Blendingwiththecoveringperiosteum

B.
Insertingdeeplyintothecancellousbone

C.
Insertingdeeplyintothecartilage

D.
Insertingdeeplyintothediaphysis

E.
Insertingdeeplyintothemarrow

Answer

2>A35yearoldwomannoticesachangeintheappearanceofamoleonher
neck.Physicalexaminationrevealsthatthelesionisanirregular,nodular,
superficialmasswithavariegatedappearance.Biopsydemonstratesaprimary
malignanttumor.Whichofthefollowingfactorsismostpredictiveofthe
patient'slongtermprognosis?

A.
Circumferenceoflesion

B.
Darknessoflesion

C.
Degreeofcolorvariation

D.
Depthoflesion

E.
Sharpnessofborderbetweenlesionandadjacentskin
Answer

3>A43yearold,insulindependentdiabeticpatientisdiagnosedwith
hypertensionandbeginstherapywithanantihypertensiveagent.Three
dayslater,hemeasureshisbloodglucoseathomeandfindsthatit
is53mg/dL.Herecalibrateshisglucosetestingapparatusandrepeats
thetest,onlytofindthatthefirstreadingwasaccurate.Heis
concernedthathishypoglycemiadidnotproducethenormalpremonitory
signsandsymptoms.Whichofthefollowingmedicationswasmostlikely
prescribedtotreathishypertension?

A.
Captopril

B.
Diltiazem

C.
Methyldopa

D.
Prazosin

E.
Propranolol
Answer

4>A33yearoldwomanpresentswithfever,vomiting,severeirritative
voidingsymptoms,andpronouncedcostovertebralangletenderness.
Laboratoryevaluationrevealsleukocytosiswithaleftshift;blood
culturesindicatebacteremia.Urinalysisshowspyuria,mildhematuria
,andgramnegativebacteria.Whichofthefollowingdrugswouldbest
treatthispatient'sinfection?

A.
Ampicillinandgentamicin

B.
Erythromycin

C.
Gentamicinandvancomycin

D.
Phenazopyridineandnitrofurantoin

E.
Tetracycline

Answer

5>A32yearold,bloodtypeApositivemalereceivesakidneytransplantfrom
abloodtypeBpositivefemaledonorwithwhomhehada6antigenHLAmatch.
Oncethekidneyisanastomosedtotheman'svasculature,thetransplant
teamimmediatelybeginstoobserveswellingandinterstitialhemorrhage.
Afterthesurgery,thepatientdevelopedfeverandleukocytosis
andproducednourine.Whichofthefollowingisthemostlikely
explanation?

A.
Acuterejectionduetoantibodymediatedimmunity

B.
Acuterejectionduetocellmediatedimmunity

C.
ChronicrejectionduetocellmediatedimmunitytominorHLAantigens

D.
Hyperacuterejectionduetolymphocyteandmacrophageinfiltration

E.
HyperacuterejectionduetopreformedABObloodgroupantibodies

Answer

6>Acardiovascularphysiologistisperformingexperimentsusinga
newalpha1adrenergicagonisttodeterminetheamountofvasoconstriction
thenewdrugcanproducecomparedwithaphenylephrinecontrol.Whichof
thelabeledstructuresisthecellulartargetofbothofthesedrugs?

A.
A

B.
B

C.
C

D.
D

E.
E
Answer

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7>Apatientwithfamilialhypercholesterolemiaundergoesadetailed
serumlipidandlipoproteinanalysis.Studiesdemonstrateelevated
cholesterolintheformofincreasedLDLwithoutelevationofother
lipids.Thispatient'shyperlipidemiaisbestclassifiedaswhichof
thefollowingtypes?

A.
Type1

B.
Type2a

C.
Type2b

D.
Type3

E.
Type5
Answer
8>Achronicalcoholicdevelopsseverememorylosswithmarked
confabulation.Deficiencyofwhichofthefollowingvitamins
wouldbemostlikelytocontributetotheneurologicdamage
underlyingthesesymptoms?

A.
Folicacid

B.
Niacin

C.
Riboflavin

D.
Thiamine

E.
VitaminB12

Answer

9>Intheclottingprocess,asthehemostaticplugdevelops,fibrin
polymerizesintomonomericthreadswhichareheldtogether
bynoncovalentbonds.Whichclottingproteinincreasesthe
strengthoftheclotbycrosslinkingthenewlyformedfibrinthreads?

A.
FactorXIII
B.Highmolecularweightkininogen(HMWK)

C.
Plasminogen

D.
Thrombin

E.
vonWillebrandFactor(vWF)

Answer

10>A72yearoldmaleisnotedashavinga9poundweightloss
overthepastfewweeks.Hispastmedicalhistoryissignificant
foroatcellcarcinomaofthelung,withoutknownmetastases,for
whichheiscurrentlyundergoingtreatment.Thepatientstatesthat
eventhoughhiswifeispreparinghisfavoritemeals,heisnothungry.
Whichofthefollowingwouldbethebesttreatmentoptiontoimprovehis
eatinghabits?

A.
Amitriptyline

B.
Megestrolacetate

C.
Methotrexate

D.
Neostigmine

E.
Prochlorperazine
Answer
11>AnarchaeologistwhohasbeenexcavatingaveryoldMiddle
Easternsitedevelopsapustuleonhishand.Thepustulethen
rupturestoformablackescharsurroundedbyexpandingbrawny
edema.Whichofthefollowingorganismsisthemostlikelycause
ofthiscondition?

A.
Bacillusanthracis

B.
Borreliaburgdorferi

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Answer

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C.
D.
E.

Francisellatularensis
Spirilliumminus

Yersiniapestis

12>A48yearoldwhitefemalesecretarypresentswithprogressive
difficultytypingoverthepastmonth.Shealsonotesthatherhands
begintofeelnumbandweakaftertypingforlongperiodsoftime.
Upontesting,whichofthefollowingdeficitswouldbepredicted?

A.
Difficultyinabductingthefifthfinger

B.
Difficultyinadductingthethumb
C.Difficultyinflexingdigitstwoandthreeatthe
metacarpophalangealjoints

D.
Lossofsensationoverthelateralhalfofthedorsum
ofthehand

E.
Lossofsensationoverthelateralhalfofthepalm

F.
Lossofsensationoverthemedialhalfofthedorsum
ofthehand

G.
Lossofsensationoverthemedialhalfofthepalm
Answer

13>AboywithDuchennemusculardystrophy(DMD)wasborntoparents
withnofamilyhistoryofthedisease.Themostlikelyexplanationfor
thisoccurrenceis
A.aCGGexpansionthatresultedinthedisruptionofthepromoterofthedystrophingene

B.
infidelity

C.
apointmutationinthedystrophingene

D.
arecombinationeventinthedystrophingenethatgaverisetoaframeshiftmutationleadingtoanuntranslatablemRNA

E.
atranslocationthatresultedinthedisruptionofthedystrophingene
Answer

14>Anobesepatientisbroughtintotheemergencyroominshockand
inneedofintravenousfluids.Nosuperficialveinscanbeseenor
palpated.Theemergencyroomphysiciandecidestomakeanincision
tolocatethegreatsaphenousveinfortheinsertionofacannula
("saphenouscutdown").Inwhichofthefollowinglocationsshould
theincisionbemade?

A.
Anteriortothelateralmalleolus

B.
Anteriortothemedialmalleolus

C.
Onthedorsumofthefoot,lateraltotheextensorhallucislongustendon

D.
Posteriortothelateralmalleolus

E.
Posteriortothemedialmalleolus
Answer

15>A2yearoldchildwithleukemiadevelopsnephroticsyndrome.
Lightmicroscopicstudiesarenormal.Electronmicroscopicstudies
demonstratefusionofepithelialfootprocesses.Thecurrenthypothesis
forthepathogenesisofthischangeisthatitissecondarytowhich
ofthefollowing?

A.
Consumptionofcomplementfactors

B.
IgGdirectedagainstbasementmembrane

C.
Immunecomplexdeposition

D.
LymphokineproductionbyTcells

E.
MesangialIgAdeposition

Answer
16>A4yearoldboyisseenbyhispediatricianforepistaxis.
Thepatienthasahistoryofmultiplebacterialandviralrespiratory
tractinfectionsandeczema.Anunclehadsimilarproblems.Physical
examinationisremarkableformultiplepetechiallesionsontheskin
andmucousmembranes.SerumIgEisincreased,andplateletsaredecreased.
Whichofthefollowingisthemostlikelydiagnosis?

A.
Acquiredhypogammaglobulinemia

B.
Ataxiatelangiectasia

C.
DiGeorgesyndrome

D.
SelectiveIgAdeficiency

E.
WiskottAldrichsyndrome
Answer

17>Ahealthy,37yearold,recentlydivorcedwomanlosesherjob
attheautofactory.Shepicksupherthreeyoungchildrenfromthe
factorydaycarecenterandgetsintoanautomobileaccidentonthe
wayhome.Her5yearoldson,whowasnotwearingaseatbelt,sustains
asevereheadinjury.Thewomanwasnothurtintheaccident,
butishyperventilatingasshesitsinthewaitingroomatthe
hospital.Shecomplainsoffeelingfaintandhasblurredvision.
Whichofthefollowingisdecreasedinthiswoman?

A.
Arterialoxygencontent

B.
Arterialoxygentension(PO2)

C.
ArterialpH

D.
Cerebralbloodflow

E.
Cerebrovascularresistance

Answer

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18>A32yearoldwomencomplainsofamenorrheasincedeliveryof
ababy15monthspreviously,despitethefactthatshedidnotbreast
feedherbaby.Thedeliverywascomplicatedbyexcessivehemorrhagethat
requiredtransfusionof2.5litersofblood.Shehasalsobeenfatigued
andhasgainedanadditional10poundssincethebabywasborn.Laboratory
datashowthefollowing:SerumLH<1IU/L(normal,424IU/L)Serum
estradiol5pg/mL(normal,20100pg/mL)Serum
TSH0.1mU/L(normal,0.55mU/L)SerumGH3ng/mL(normal,<5ng/mL)
SerumACTH28pg/mL(normal,1050pg/mL)Serumprolactin2ng/mL
(normal,<20ng/mL)Injectionof500mgofTRHfailedtoproducethe
expectedriseinbothserumTSHandprolactin.Whichofthefollowing
diagnosesmostlikelyexplainsthefindingsinthispatient?

A.
Hashimoto'sthyroiditis

B.
Isolatedgonadotropindeficiency

C.
Primaryamenorrhea

D.
Prolactinoma

E.
Sheehan'ssyndrome

Answer

19>A7yearoldgirldevelopsbehavioralchanges,andher
performanceinschoolbeginstodeteriorate.Severalmonths
latershedevelopsaseizuredisorder,ataxia,andfocal
neurologicsymptoms.Sheiseventuallyquadriparetic,spastic,
andunresponsive.Deathoccurswithinayear.Thispatientmay
havehadwhichofthefollowingviraldiseasesat1yearofage?

A.
Chickenpox

B.
Germanmeasles

C.
Measles

D.
Mumps

E.
ParvovirusB19
Answer
20>A40yearold,moderatelyobesemanpresentswithapersistent
productivecough.Thecoughhasbeenpresentforseveralweeks,
butrecentlythemannotedthathissputumhasassumedagreenish
color.Furtherquestioningelicitsahistoryofproductivecough
,usuallyinthewintermonths,overthepastseveralyears.He
hassmokedtwopacksofcigarettesperdaysincehewas16yearsold.
Onexamination,themanisfebrile(100F),andcoarserhonchiand
wheezescanbeappreciatedbilaterally.Whichofthefollowingis
themostlikelydiagnosis?

A.
Bronchogeniccarcinoma

B.
Chronicbronchitiswithsuperimposedinfection

C.
Cysticfibrosis

D.
Emphysema

E.
Pulmonarytuberculosis
Answer

21>A7yearoldpatientpresentswithamassintheanterior
midlineoftheneck,slightlyabovethelarynx.Themassismobile
andelevatesuponprotrusionofthetongue.Thismassismostlikely
acystthatdevelopedfromwhichofthefollowingembryonicstructures?

A.
Firstpharyngealcleft

B.
Firstpharyngealpouch

C.
Secondpharyngealcleft

D.
Secondpharyngealpouch

E.
Thyroglossalduct
Answer

22>Anelderlymancomestomedicalattentionbecauseofanemiaand
multipleinfections.Physicalexaminationisremarkablefor
hepatosplenomegaly.Anautomatedbloodcountdemonstratespancytopenia.
Reviewoftheperipheralsmearbyahematologistdemonstratesrare,
distinctive,neoplasticwhitecellscoveredbyfine,hairlikeprojections.
Whichofthefollowingcharacteristicswouldlikelybeassociatedwith
thesecells?

A.
Birbeckgranules

B.
Elevatedleukocytealkalinephosphatase

C.
Philadelphiachromosome

D.
Positivetartrateresistantacidphosphatase

E.
ProductionofBenceJonesproteins

Answer
23>Apatientdevelopsaswollenandtenderlymphnodeinhispopliteal
fossa.Aninfectedskinlesioninwhichofthefollowingsiteswouldmost
likelyinducelymphadenopathyinthisregion?

A.
Lateralsideofthedorsumofthefoot

B.
Lateralsideofthethigh

C.
Medialsideofthelegbelowtheknee
D.Medialsideofthesoleofthefoot

E.
Medialsideofthethigh
Answer
24>1.Internaloblique
2.Externaloblique

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3.Peritoneum
4.Transversusabdominis
Asurgeonperforminganappendectomymakesanincisionthroughthe
ventrolateralwall.Whichofthefollowingcorrespondstotheorder
ofpenetrationofthelayersoftheabdominalwall?

A.
1342

B.
2134

C.
2143

D.
4123

E.
4213
Answer

25>A50yearoldphysicianisrecoveringfromasepticmeningitisthat
begantwoweeksago.Heappearstohavelostconsiderablecognitivefunction,
andhesayshewillnotgoonlivingifhiscognitiveabilityremains
compromised.Todemonstratetohimthatrecoveryisoccurring,serial
evaluationswithwhichofthefollowingpsychologicalassessmentsis
indicated?

A.
HalsteadReitanBattery

B.
StanfordBinetIntelligenceTest

C.
VinelandAdaptiveBehaviorScale

D.
WechslerAdultIntelligenceScale

E.
WideRangeAchievementTest
Answer

26>A37yearoldwomanisabducted,beaten,andrepeatedlyraped.For
fivemonthsaftertheattacksheisnervous,tearful,easilyfatigued,
andhasdifficultyconcentrating.Shealsonotesdifficultysleepingand
lackofappetite,andishyperreactivetounexpectedorloudstimuli.
Bysixmonthsshehasreturnedtohercharacteristicpreattackbehavioral
patterns.Whichofthefollowingisthemostlikelydiagnosis?

A.
Acutestressdisorder

B.
Adjustmentdisorderwithmixedanxietyanddepressedmood

C.
Majordepressivedisorder

D.
Panicdisorderwithoutagoraphobia

E.
Posttraumaticstressdisorder
Answer
27>A67yearoldblackmanwithahistoryofglucose6phosphate
dehydrogenase(G6PD)deficiencypresentswithfever,irritative
voidingsymptoms,andperinealpain.Rectalexaminationisremarkable
foraboggy,exquisitelytenderprostate.AurineGram'sstainis
positiveforgramnegativerods.Theriskfordevelopmentofhemolytic
anemiaishighestifhereceiveshighdose,21daytherapywith

A.
ampicillin

B.
cefaclor

C.
ciprofloxacin

D.
sulfamethoxazole/trimethoprim

E.
tetracycline

Answer
28>Apatient,whoappearstobefemale,isfoundtobe46,XY.The
patient'svaginaisveryshallow,endinginablindpouch,andthere
arepalpablemassesinthelabia.Thediagnosisoftesticularfeminization
syndromeismade.Whichofthefollowingwasmostlikelypresentduringthe
earlyfetallifeofthisindividual?

A.
Astreakovary

B.
Auterus

C.
Anoviduct

D.
Depressedlevelsoftestosterone

E.
MIF(Mullerianinhibitoryfactor)
Answer

29>Apatientdevelopsaformoflungcancerthatspreadstoocclude
thethoracicduct.Edemainvolvingwhichofthefollowingsitesmight
beexpectedasapotentialcomplication?

A.
Entireleftsideandrightleg

B.
Entirerightsideandleftleg

C.
Leftarmonly

D.
Rightarmandrighthalfofheadonly

E.
Rightarmonly
Answer
30>Apatientdevelopsanacutefebrileillnesswithshivers,nonproductive
cough,andpleuriticchestpain.Fivedayslater,hepresentstothe
emergencyroomafterabruptlyhaving"coughedup"nearlyacupof
bloodstainedsputum.Whichofthefollowingismostlikelytobeseen
onchestxray?

A.
Acavitywithafluidlevel

B.
Bluntingofdiaphragmaticcostalangles
C.Completeopacificationofonelobewithnoadditionalfindings

D.
Patchyconsolidationcenteredonbronchi

E.
Prominentbronchithatcanbefollowedfaroutintothelungfields
Answer
31>Maintenanceofthecorpusluteumduringthefirsttrimesterof
pregnancyisaccomplishedprincipallybythesecretionof

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Answer

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A.
B.
C.
D.
E.

antidiuretichormone(ADH)
folliclestimulatinghormone(FSH)
humanchorionicgonadotropin(hCG)
luteinizinghormone(LH)
progesterone

32>A15yearoldboyisevaluatedbyaclinicianforfailureto
developnormalmalesecondarysexualcharacteristics.Physical
examinationrevealssmalltestes,asmallpenis,andgynecomastia.
Theboyhashadsomedifficultiesinschool,andtheparentssaythat
theschoolpsychometristsaidhehadanIQof90.Thispatient'scondition
ismostlikelytoberelatedtowhichofthefollowing?

A.
Deletion

B.
Nondisjunctionofanautosomalchromosome

C.
Nondisjunctionofasexchromosome

D.
NonRobertsoniantranslocation

E.
Robertsoniantranslocation
Answer
33>A52yearoldfemalepresentswithgroinpain.Physicalexamination
revealsabulgeinthegroinareaimmediatelyinferiortotheinguinal
canal.Thephysiciansuspectsthatthepatienthasafemoralhernia
containingaloopofsmallintestine.Whichofthefollowingstructures
islocatedimmediatelymedialtotheherniasac?

A.
Femoralartery

B.
Femoralnerve

C.
Femoralvein

D.
Inferiorepigastricartery

E.
Lacunarligament
Answer
34>Themodifiedstructuresattheborderoftheepitheliumshown
aboveareimmotileina23yearoldpatient.Whichofthefollowing
wouldbeaconsequenceofthislackofmotility?

A.
Implantationfailure

B.
Kartagener'ssyndrome

C.
Malabsorptionsyndrome

D.
Reductioninnumberofdisaccharidases

E.
Uptakeanddigestionofspermatidresidualbodies
Answer

35>Apatientwithtuberculosisdevelopsbrightorangeredurineandcallshis
physicianinapanicbecauseheisafraidheisbleedingintotheurine.
Thepatienthasnootherurinarytractsymptoms.Whichofthefollowing
medicationsismostlikelytoproducethissideeffect?

A.
Ethambutol

B.
Isoniazid

C.
Pyridoxine

D.
Rifampin

E.
Streptomycin
Answer
36>WhichofthefollowingStarlingforcechangesistheprimarycauseof
theedemaseeninpatientswithnephroticsyndrome?

A.
Decreasedcapillaryhydrostaticpressure(Pc)

B.
Decreasedcapillaryoncoticpressure(pc)

C.
Decreasedinterstitialhydrostaticpressure(Pi)

D.
Decreasedinterstitialoncoticpressure(pi)

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E.
F.
G.
H.

Increasedcapillaryhydrostaticpressure(Pc)
Increasedcapillaryoncoticpressure(pc)
Increasedinterstitialhydrostaticpressure(Pi)
Increasedinterstitialoncoticpressure(pi)

Answer
37>HbNl:AAGUAUCACUAAGCUCGCHbCr:AAGAGUAUCACUAAGCUCGCUUUC...UAUUAA
Hemoglobinisisolatedfromtheerythrocytesofayoungchildwithanemia.
Hemoglobinelectrophoresisrevealsthepresenceofanunstablehemoglobin,
knownashemoglobinCranston(HbCr),containinganabnormalbglobinchain.
Thenormalsequenceofthebglobingene(HbNl)andthesequenceofthe
HbCrbchainarepresentedabove.Whichofthefollowingwouldaccount
forthedevelopmentofHbCr?

A.
Aframeshiftmutationresultedinthedeletionofseveralaminoacidresiduesinthebchain

B.
Amutationinthestopcodonresultedinelongationofthebchain

C.
Apointmutationresultedintheinsertionofastopcodoninthebchain

D.
Atwobasepairadditionresultedintheeliminationofastopcodoninthebchain

E.
Atwobasepairdeletionresultedintruncationofthebchain
Answer

38>
Whatistheprimaryfunctionofthecellpointedtointhefigureabove?

A.
Itproduceslowmolecularweightpolypeptides

B.
Itsecretesbactericidalenzymes

C.
Itsecreteslipases

D.
Itsecretesmucins

E.
Itsecretespepsinogen
Answer

39>A37yearoldwomanwhowasdiagnosedwithAIDS3yearsearlieris
unabletowork,isphysicallydebilitated,andrequestsherphysicianto
provideherwithmedicationswithwhichtotakeherownlife.Themost
commonemotionaldisorderthatresultsinsuchrequestsbypatientsis

A.
bipolarIdisorder,manictype

B.
borderlinepersonalitydisorder

C.
factitiousdisorder

D.
majordepressivedisorder

E.
schizophrenicdisorder
Answer
40>IVadministrationofdrugXtoananesthetizedanimalproducesan
increaseinbloodpressure.AfteradministrationofdrugY,
readministrationofdrugXproducesadecreaseinbloodpressure.
Whichofthefollowingpairsofdrugscouldproducethissequenceofevents?

DrugXDrugY

A.
Acetylcholine Neostigmine

B.
Epinephrine
Phentolamine

C.
Isoproterenol Atropine

D.
NorepinephrinePropranolol

E.
Phenylephrine Hexamethonium
Answer
41>A25yearoldwomanwithsicklecellanemiacomplainsofsteadypain

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inherrightupperquadrantwithradiationtotherightshoulder,
especiallyafterlargeorfattymeals.Herphysiciandiagnosesgallstones.
Ofwhichofthefollowingcompoundsarethesestonesmostlikelycomposed?

A.
Calciumbilirubinate

B.
Calciumoxalate

C.
Cholesterol

D.
Cholesterolandcalciumbilirubinate

E.
Cystine
Answer
42>Apatientwithprolongeddiarrheaundergoesesophagogastroduodenoscopy.
Biopsyofthesmallintestinedemonstratesnumerouscrescentshaped
protozoaadjacenttotheepithelialbrushborder.Whichofthefollowing
organismsisthemostlikelypathogen?

A.
Entamoebahistolytica

B.
Escherichiacoli

C.
Giardialamblia

D.
Naegleriafowleri

E.
Trichomonasvaginalis
Answer
43>Aneuroscientistisinvestigatingthedevelopmentofthenervous
system.Inhisexperiments,hemicroinjectsadyeintotheembryoof
ananimalsubjectinvivo.Afterbirth,heperformshistological
studiestodeterminethedestinationofthedye.Inoneanimalsubject,
helocatesthedyeinthedorsalhornofthespinalcord.Whichofthe
followinglocationsintheembryowasthemostlikelysiteoftheinjection?

A.
Alarplate

B.
Basalplate

C.
Neuralcrest

D.
Rostralendofneuraltube

E.
Sulcuslimitans
Answer
44>Theheartofanembryofirstbeginsbeatingatwhichofthefollowingages?

A.
2weeks

B.
3weeks

C.
4weeks

D.
6weeks

E.
8weeks
Answer
45>Whichofthefollowingrespiratorysystemcomponentsisderived
fromneuralcrest?

A.
Endothelialcells

B.
Epitheliumofprimarybronchi

C.
Laryngealcartilage

D.
Trachealglands

E.
TypeIpneumocytes
Answer
46>A36yearoldAsianmalecomplainsofdifficultyswallowing.
Esophagoscopyrevealsapolypoidmassthatissubsequentlybiopsied.
Inadditiontotumorcells,theesophagealbiopsyshownormalsmooth
muscleandstriatedmuscleinthesamesection.Whichportionofthe
esophaguswasthesourceofthisbiopsy?

A.
Loweresophagealsphincter

B.
Lowerthirdoftheesophagus

C.
Middlethirdoftheesophagus

D.
Upperesophagealsphincter

E.
Upperthirdoftheesophagus
Answer
47>Whichofthefollowinghormonesissecretedbyanteriorpituitary
cellsthatstainwithacidicdyes?

A.
ACTH

B.
FSH

C.
LH

D.
Prolactin

E.
TSH
Answer
48>A20yearolddevelopsweaknessaccompaniedbydifficultyinrelaxation
thatismostpronouncedinthehandsandfeet.Musclebiopsydemonstrates
prominentringfibers,centrallylocatednuclei,chainsofnuclei,and
disorganizedsarcoplasmicmasses.Thisconditionbeenassociatedwitha
mutationonwhichofthefollowingchromosomes?

A.
X

B.
Y

C.
4

D.
5

E.
19
Answer
49>A24yearoldwomaninherthirdtrimesterofpregnancypresents
withurinaryfrequencyandburningforthepastfewdays.Shedenies
fever,nausea,vomiting,orchills.Shetakesnomedicationsbesides

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prenatalvitaminsandisgenerallyingoodhealth.Physicalexamination
isremarkableformildsuprapubictenderness,andaurinedipstickis
positiveforwhitebloodcells,protein,andasmallamountofblood.
Cultureproducesgreaterthan100,000coloniesofgramnegativebacilli.
whichofthefollowingattributesofthisuropathogenicorganismismost
stronglyassociatedwithitsvirulence?

A.
Bundleformingpili

B.
GVVPQfimbriae

C.
Heatlabiletoxins

D.
Heatstabletoxins

E.
Ppili

F.
Type1pili

Answer

50>Ababywhowasapparentlynormalatbirth,developspersistent
regurgitationandvomitinginthesecondandthirdweeksoflife.
Nofeverispresentandhematologicstudiesandbloodchemistries
arenormal.Whichofthefollowingtherapiesismostlikelytobe
effectiveinthiscase?

A.
Antacids

B.
Bariumenema

C.
Gastricresection

D.
Oralantibiotics

E.Pyloromyotomy
Answer

Answers

1>ThecorrectanswerisA.Fascialstraps(retinacula)andfascial
coveringsofmusclesormusclegroupscharacteristicallyattachto
nearbybonesbyblendingwiththecoveringperiosteum.Nodeep
attachmentsareusuallymadebyfascia.
Cancellousbone(choiceB)isspongybone,whichisusuallyfound
inmarrow,andisnotthesiteforfascialattachment.
Fasciadonotusuallyattachtocartilage(choiceC).
Fasciaattachestobonyshafts,ordiaphyses(choiceD),superficially
viatheperiosteum.
Fasciadonotpenetratethebonetoreachthemarrow(choiceE).
2>ThecorrectanswerisD.Thelesionisamalignantmelanoma.
Melanomascandevelopeitherdenovoorinanexistingmole.Sunlight
exposureisasignificantriskfactorandfairskinnedpersonsareat
increasedriskofdevelopingmelanoma.Themostsignificantfactorfor
longtermprognosisisthedepthofthelesion,sincethesuperficial
dermisliesabout1mmundertheskinsurface,andpenetrationtothis
depthisassociatedwithamuchhigherincidenceofmetastasisthanis
seenwithamoresuperficiallocation.
Thecircumferenceofthelesion(choiceA)ismuchlessimportantthandepth
,sinceoneformofmelanoma(superficialspreading)canstillhavegood
prognosisdespitelargesize,ifithasnotextendedtothedepthofthe
superficialdermallymphaticbed.
Thedarkness(choiceB)ordegreeofvariationincolor(choiceC)donot
haveprognosticsignificanceoncemelanomaisdiagnosed.
Irregularity,orfuzzinessattheborder(choiceE)ofamolelikelesion
isagoodcluetopotentialmalignancy,butdoesnotaffectprognosisonce
amelanomaisdiagnosed.
3>ThecorrectanswerisE.Betaadrenergicblockademaybluntorprevent
thepremonitorysignsandsymptoms(e.g.,tachycardia,bloodpressure
changes)ofacuteepisodesofhypoglycemia.Nonselectivebetablockers,
suchaspropranolol,mayevenpotentiateinsulininducedhypoglycemia.
Eventhoughthiseffectislesslikelywithcardioselectiveagents,the
useofeithercardioselectiveornonselectivebetablockersindiabetics
isnotrecommendedduetotheir"masking"effectofthenormalwarning
signsandsymptomsofhypoglycemia.Noneofthedrugslistedintheothe
rchoiceswillbluntthepremonitorysignsandsymptomsofhypoglycemia.
Captopril(choiceA)isanangiotensinconvertingenzyme(ACE)inhibito
rthatcanbesafelyusedforthetreatmentofhypertensionindiabetic
patients.
Diltiazem(choiceB)isacalciumchannelblockerthatisalsoconsidered
tobesafeandeffectiveforthetreatmentofhypertensionindiabetic
patients.
Bothmethyldopa(choiceC),acentrallyactingalphaadrenergicagonist
,andprazosin(choiceD),analpha1adrenergicantagonist,canbesafely
usedtotreathypertensionindiabeticpatients.However,duetotheside
effectprofileofthesemedications,theyaregenerallyusedonlyin
diabeticpatientswhoareunresponsivetoACEinhibitorsandcalcium
channelblockers.
4>ThecorrectanswerisA.Acutepyelonephritisisaninfectiousdisease
involvingthekidneyparenchymaandtherenalpelvis.Gramnegative
bacteria,suchasEscherichiacoli,Proteus,Klebsiella,andEnterobacter,
arethemostcommoncausativeorganismsinacutepyelonephritis.

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Laboratoryevaluationwilloftenrevealleukocytosiswithaleftshift,
andurinalysistypicallyshowspyuria,varyingdegreesofhematuria
,andwhitecellcasts.Sincebacteremiaispresent,thepatientshould
behospitalizedandempiricallystartedonIVampicillinandgentamicin
.Thisregimenmaybeneedtobechanged,however,oncethesensitivity
resultsareavailable.
Erythromycin(choiceB)andtetracycline(choiceE)arebothbacteriostatic
antibioticsandwouldnotberecommendedinapatientwithasevere
infection,suchasacutepyelonephritiswithbacteremia.
Vancomycin(choiceC)isprimarilyusedinthetreatmentofsevere
grampositiveinfections.
Phenazopyridine(choiceD)isaurinaryanalgesic,andnitrofurantoin
(choiceD)isaurinarytractantiinfective.Althoughnitrofurantoinis
indicatedforthetreatmentof"mild"casesofpyelonephritis,aswell
ascystitis,thispatient'sconditionissevereandshouldbetreatedwith
appropriateantibiotics.
5>ThecorrectanswerisE.Thepatientissufferingfromhyperacute
rejectionduetothepreformedantiBABObloodgroupantibodyfound
inalltypeApositiveindividuals.Hyperacuterejectionoccurswithin
minutestoafewhoursofthetimeoftransplantation,andisdueto
thedestructionofthetransplantedtissuebypreformedantibodies
reactingwithantigensfoundonthetransplantedtissuethatactivate
complementanddestroythetargettissue.Preformedantibodiescan
alsobeduetopresensitizationtoapreviousgraft,bloodtransfusion,
orpregnancy.
Acuterejectionduetoantibodymediatedimmunity(choiceA)isincorrect
becausethispatientsufferedfromhyperacuterejection(immediate)
occurringwithinminutestohours,ratherthandays.
Acuterejectionduetocellmediatedimmunity(choiceB)willnotoccur
untilseveraldaysoraweekfollowingtransplantation.Acuterejection
isduetotypeIIandtypeIVreactions.
Chronicrejection,duetothepresenceofcellmediatedimmunitytominor
HLAantigens(choiceC),occursinallografttransplantationmonthsto
evenyearsafterthetransplant.Chronicrejectionisgenerallycaused
bybothhumoralandcellmediatedimmunity.
Anacceleratedacuterejection,occurringin35days,canbecausedby
tissueinfiltrationanddestructionbypresensitizedTlymphocytesand
macrophages(choiceD)and/orantibodydependent,cellmediatedcytotoxicity
(ADCC).Notethatthisisnotahyperacutereaction.
6>ThecorrectanswerisE.ArrowEpointstoasmoothmusclecellin
themediaofthearteriole.Alpha1agonistsstimulatealpha1receptors
presentonthesmoothmuscle,whichleadstoanincreaseinintracellular
calciumviaphosphatidylinositolhydrolysis.Thisincreaseincalciumis
necessaryforsmoothmusclecontraction.
ArrowAindicatesanendothelialcelllocatedintheintimaofthearteriole.
Nitricoxide,alsoknownasendothelialcellrelaxingfactor(EDRF),
isproducedfromargininebyendothelialcells.Amuscarinicagonist
canleadtotheevolutionofNO,producingvasodilatation.
ArrowBindicatesapolymorphonuclearleukocyteinthebloodstream.
ArrowCindicatesthebasallaminaunderlyingtheendothelium.
ArrowDindicatesthearteriolaradventitia.
7>ThecorrectanswerisB.Hyperlipidemiahasbeensubclassifiedbasedon
thelipidandlipoproteinprofiles.Type2a,whichthispatienthas,can
beseeninahereditaryform,knownasfamilialhypercholesterolemia,and
alsoinsecondary,acquiredformsrelatedtonephriticsyndromeand
hyperthyroidism.TherootproblemappearstobeadeficiencyofLDL
receptors,whichleadstoaspecificelevationofcholesterolinthe
formofincreasedLDL.Heterozygotesforthehereditaryformgenerally
developcardiovasculardiseasefrom30to50yearsofage.Homozygotes
mayhavecardiovasculardiseaseinchildhood.
Type1(choiceA)ischaracterizedbyisolatedelevationofchylomicrons.
Type2b(choiceC)ischaracterizedbyelevationsofbothcholesteroland
triglyceridesintheformofLDLandVLDL.
Type3(choiceD)ischaracterizedbyelevationsoftriglycerides
andcholesterolintheformofchylomicronremnantsandIDL.
Type5(choiceE)ischaracterizedbyelevationsoftriglycerides
andcholesterolintheformofVLDLandchylomicrons.

8>ThecorrectanswerisD.WernickeKorsakoffsyndromereferstothe
constellationofneurologicsymptomscausedbythiaminedeficiency.
Amongthese,aseverememorydeficit,whichthepatientmayattempttocoverbymakingupbizarreexplanations(confabulation),isprominent.Anatomicaldamage
Folicaciddeficiency(choiceA)producesmegaloblasticanemiawithout
neurologicsymptoms.
Niacindeficiency(choiceB)producespellagra,characterizedbydepigmentingdermatitis,chronicdiarrhea,andanemia.
Riboflavindeficiency(choiceC)producesariboflavinosis,characterized
byglossitis,cornealopacities,dermatitis,anderythroidhyperplasia.
VitaminB12deficiency(choiceE)producesmegaloblasticanemiaaccompanied
bydegenerationoftheposterolateralspinalcord.

9>ThecorrectanswerisA.Fibrinogeniscleavedbythrombintwiceasitisactivatedtoformfibrin.Theinitialcleavagecausesittopolymerizeandthesecond
HMWK(choiceB)isacofactorintheintrinsicpathwaythatconvertsFactorXItoXIa.
Plasminogen(choiceC)isacentralproenzymeinclotlysis.Whenplasminogenisconvertedtoplasmin,itdigestsfibrinthreads,aswellasanumberofproteinf
Thrombin(choiceD)isanenzymederivedfromprothrombin.Itconvertsfibrinogentofibrin,andactivatesfactorXIII.
vWF(choiceE)isatissueboundproteinwhichisexposedwithvasculartraumaandhelpsintheprocessofplateletadhesion.

10>ThecorrectanswerisB.Oneofthemostcommonsideeffectsofanyantineoplastictherapyisweightlosssecondarytodecreasedappetiteand/ornauseaandvom

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Amitriptyline(choiceA)isatricyclicantidepressantusedinthetreatmentofdepression.Thereisnothingmentionedinthecasestudytosuggestthatthepatie
Methotrexate(choiceC)isanantimetaboliteandfolicacidantagonistcommonlyusedinvariousneoplasticdisordersandinthetreatmentofrheumatoidarthritis.
Neostigmine(choiceD)isacarbamylatingacetylcholinesteraseinhibitorthatwouldnotincreaseappetite.
Prochlorperazine(choiceE)isaphenothiazinederivativeusedprimarilytocontrolseverenauseaandvomiting.Thispatientisnotexperiencingnausea.Furthermo

11>ThecorrectanswerisA.Anthraxformsextremelystablesporesandhas,infact,beenencounteredinveryold(i.e.,deep)dirtinIsraeliandArabianexcavati
Borreliaburgdorferi(choiceB)causesLymedisease.Inthefirststageofthisdisease,thereisalocalizedexpandingerythematousrashratherthananeschar.F
Francisellatularensis(choiceC)causestularemia.Theorganismcanpersistforweekstomonthsbutdoesnotformsporesthatcouldsurviveforhundredsorthous
Spirilliumminus(choiceD)isoneofthecausesofratbitefever.Thereisnoindicationthemanwasbittenbyarat.
Yersiniapestis(choiceE)causesbubonicplague.Thisorganismdoesnotformstablesporesthatcouldsurviveforextendedperiodsoftime.

12>ThecorrectanswerisC.Thisisaclassicpresentationofapatientwithcarpaltunnelsyndrome,whichtypicallyaffectsfemalesbetweentheagesof40and60
Abductionofthefifthdigit(choiceA)isafunctioncontrolledbytheulnarnerve,whichdoesnotpassthroughthecarpaltunnel.
Adductionofthethumb(choiceB)isafunctionoftheadductorpollicis,whichistheonlyshortthumbmusclethatisnotinnervatedbythemediannerve,butrat
Sensationofthelateralhalfofthedorsumofthehand(choiceD)ismediatedbytheradialnerve,whichalsodoesnotpassthroughthecarpaltunnel.
Sensationoverthelateralaspectofthepalm(choiceE)ismediatedbythemediannerve,howeverthebranchinnervatingthepalm(palmarcutaneousbranchofthe
Sensationoverthemedialaspectofthedorsumofthehand(choiceF)ismediatedbytheulnarnerve.
Sensationoverthemedialaspectofthepalm(choiceG)ismediatedbytheulnarnerve.

13>ThecorrectanswerisD.Duchennemusculardystrophy(DMD)isalethal,Xlinkedrecessivediseaseaffectingapproximately1in3300livemalebirths.Thedise
DiseasessuchasfragileXsyndromeandHuntingtondiseasearecausedbytheexpansionofatrinucleotiderepeat(choiceA).
Infidelity(choiceB)isnotaplausibleexplanationforthechildbecausethetraitisanXlinkedrecessivecondition.AmalechildmustreceivetheDMDtraito
DMDinapatientwithnofamilyhistoryisnotgenerallyduetoapointmutationinthedystrophingene(choiceC).
RarecasesofDMDinfemaleshavebeencausedbyanXchromosomeautosometranslocation(choiceE)withthebreakpointontheXchromosomewithintheDMDgene.Be

14>ThecorrectanswerisB.Thegreatsaphenousveinisoneofthetwomajorsuperficialveinsofthelowerlimb.Itisfoundinthesuperficialfascia,whereit
Nomajorveinisfoundanteriortothelateralmalleolus(choiceA).
Veinsonthedorsumofthefoot(choiceC)aresmalltributariesofthegreatandsmallsaphenousveins.
Thesmallsaphenousveinpassesposteriortothelateralmalleolus(choiceD).
Therearenomajorsuperficialveinsthatpassposteriortothemedialmalleolus(choiceE).Inthisregion,underthedeepfascia,willbefoundtheposteriorti

15>ThecorrectanswerisD.Thechildissufferingfromminimalchangeornildisease(lipoidnephrosis),whichhasapeakincidenceat23yearsofage.Minimal
Consumptionofcomplementfactors(choiceA)isobservedinmanyconditionsinwhichcomplementactivationoccurs,forexample,membranoproliferativeglomerulonep
IgGdirectedagainstrenalandpulmonarybasementmembranes(choiceB)isfoundinGoodpasture'ssyndrome,acauseofrapidlyprogressiveglomerulonephritisandh
Immunecomplexdeposition(choiceC)isassociatedwithtypeIIIhypersensitivityreactions,includingpostinfectiousglomerulonephritis,lupusnephritis,Henoch
MesangialIgAdeposition(choiceE)isassociatedwithBerger'sdisease,orIgAnephropathy,acauseofglomerulonephritis.

16>ThecorrectanswerisE.WiskottAldrichsyndromeisanXlinkedconditioncharacterizedbyeczema,thrombocytopenia,andrepeatedinfections.Affectedchildre
Acquiredhypogammaglobulinemia(choiceA)isadiseaseofadultscharacterizedbynormalnumbersofBcellsbutlowimmunoglobulinproduction.
Ataxiatelangiectasia(choiceB)isanautosomalrecessivediseasecharacterizedbyprogressivecerebellardysfunction,telangiectasias,andavariableimmunodefi
DiGeorgesyndrome(choiceC)isadevelopmentalmalformationleadingtothymicaplasiaand,sometimes,hypoparathyroidism.
SelectiveIgAdeficiency(choiceD)isarelativelycommonconditioncharacterizedbylowlevelsofIgA.

17>ThecorrectanswerisD.Thekeysymptomishyperventilation.Hyperventilationresultsinhypocapnia,alkalosis,increasedcerebrovascularresistance,anddecr
Hyperventilationincreasesthearterialoxygencontent(choiceA)andPO2(choiceB)inanormalperson.
AdecreaseinarterialPCO2causesthearterialpH(choiceC)toincrease,i.e.,thepatientbecomesalkalotic.

18>ThecorrectanswerisE.Sheehan'ssyndromeishypopituitarismduetoischemicdamagetothepituitaryresultingfromexcessivehemorrhageduringparturition.
Hashimoto'sthyroiditis(choiceA)isanautoimmunedisorderthatproducesprimaryhypothyroidism.BecauseofdiminishednegativefeedbackeffectsofT4,serumTS
Isolatedgonadotropindeficiency(choiceB)producesamenorrheaandisassociatedwithlowserumLHandestradiol.Hypogonadotropichypogonadismcanoccurinfema
Primaryamenorrhea(choiceC),bydefinition,meansfailureofmenstrualcyclestoeverbegin.Sincethiswomanhasdeliveredababy,primaryamenorrheaishighly
Aprolactinoma(choiceD)isafunctionalpituitarytumorthatsecretesexcessiveprolactin.ThiscancauseamenorrheabysuppressingtheGnRHpituitarygonadaxi

19>ThecorrectanswerisC.Thechildhassubacutesclerosingpanencephalitis(SSPE),whichisfortunatelyaveryrare,latecomplicationofmeaslesinfectionat
NoneoftheotherdiseasesprogressestoSSPE.

20>ThecorrectanswerisB.Thediagnosisofchronicbronchitisrequiresthepresenceofchronicproductivecoughoveratleast3monthsoftheyearfor2success
Althoughthepatientisasmokerandisatincreasedriskforbronchogeniccarcinoma(choiceA),thisisunlikelytobethecauseofhissymptoms.Hemoptysisand
Cysticfibrosis(choiceC)presentsearlierinlifeandmaybeassociatedwithsevereproductionofmucus,especiallyifbronchiectasissupervenes.Theageofthe
Thispatientmayalsohaveemphysema(choiceD),aschronicbronchitisandemphysemaareoftencoexistent.However,althoughpureemphysemamightcausedyspnea,i
Pulmonarytuberculosis(choiceE)wouldtypicallypresentwithahistoryofhemoptysisratherthanabundantgreensputum.Weightloss,nightanorexia,malaise,an

21>ThecorrectanswerisE.Thethyroglossalductdevelopsasanevaginationofthefloorofthepharynxintheregionwherethetonguedevelops.Theadultforame
Thefirstpharyngealcleft(choiceA)formstheexternalearcanal.Thiscleftnormallyremainspatent.
Thefirstpharyngealpouch(choiceB)formsthemiddleearcavityandtheauditorytube.Thispouchnormallyremainspatent.
Thesecondpharyngealcleft(choiceC)normallydoesnotremainpatent.Itistypicallycoveredoverbytheovergrowthofthesecondpharyngealarch.Ifpartoft
Thesecondpharyngealpouch(choiceD)formsthetonsillarfossaofthepharynx.Thepharyngealmucosainthisareaarisesfromtheendodermofthepouch.Ingrowt

22>ThecorrectanswerisD.Thediseaseishairycellleukemia,which,unlikemostformsofleukemia,ischaracterizedbypancytopeniaratherthanincreasednumbe
AssociateBirbeckgranules(choiceA)withLangerhanscellhistiocytosis(histiocytosisX).
Associateelevatedleukocytealkalinephosphatase(choiceB)withmyeloidmetaplasia.
AssociatePhiladelphiachromosome(choiceC)withchronicmyeloidleukemia(andoccasionallywithacutelymphocyticleukemia).
AssociateproductionofBenceJonesproteins(choiceE)withmultiplemyeloma.

23>ThecorrectanswerisA.Mostofthevenousdrainageoftheskinofthelowerextremityistothelongsaphenousvein,theaccompanyinglymphaticsofwhichdra
Thelateralsideofthethigh(choiceB),themedialsideofthelegbelowtheknee(choiceC),themedialsideofthesoleofthefoot(choiceD),andthemedial

24>ThecorrectanswerisC.Questionsliketheseareparticularlyamenabletotheuseoftesttakingstrategiesbecauseevenifyoudon'tknow100%oftheanswer,

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25>ThecorrectanswerisA.TheHalsteadReitanBatteryisagroupofteststhatreflectsthebasicandhigherlevelcognitiveandneurosensoryfunctioningofth
TheStanfordBinetIntelligenceTest(choiceB),usedintheadult,mainlyreflectsverbalskillsandconsequentlywouldmisslargeportionsofthisman'ssituati
TheVinelandAdaptiveBehaviorScale(choiceC)assessesdevelopmentalandsocialfunctioning,notcognitiveandneurosensoryabilities.
TheWechslerAdultIntelligenceScale(choiceD)confinesitsresultstointelligenceassessmentanddoesnotassessmorebasicissueslikeaphasiaandneurosens
TheWideRangeAchievementTest(choiceE)assessesacademicachievementonly.

26>ThecorrectanswerisB.Thereactionwasprecipitatedbyastressfuleventthatwouldcauseanyonetoexperienceasevereandintenseemotionalresponse.The
Acutestressdisorder(choiceA)andposttraumaticstressdisorder(choiceE)bothrequirethatthepersonreexperiencethetraumaticeventinwakefulordreams
Thisisnotamajordepressivedisorder(choiceC)becausehersymptomsarenotofpsychoticproportionandthereisaclearprecipitatingstimulus.
Panicdisorderwithoutagoraphobia(choiceD)isincorrectbecausethepanicepisodesareuncuedandnottheresponsetoanenvironmentalstressor.

27>ThecorrectanswerisD.Thepatienthasacuteprostatitis,whichischaracterizedbyfever,chills,anddysuria,withaswollen,extremelytenderprostateon
Ampicillin(choiceA)isabroadspectrumpenicillinantibioticcommonlyusedinthetreatmentofinfectionsinthegenitourinary,respiratory,orGItracts,asw
Cefaclor(choiceB)isasecondgenerationcephalosporinindicatedforavarietyofbacterialinfections,includingthoseoftherespiratoryandGItracts.
Ciprofloxacin(choiceC)isafluoroquinolonecommonlyusedinthetreatmentofseriousinfectionscausedbygramnegativeorganisms.
Tetracycline(choiceE)ismostcommonlyusedinthetreatmentofacnevulgarisandgonococcalinfections.

28>ThecorrectanswerisE.Testicularfeminizationisadisorderoftheandrogenreceptor.Phenotypically,thepatientappearsfemale,buthasablindlyendingv
Thispatientwouldnothaveastreakovary(choiceA),afindinginTurner'ssyndromethatisassociatedwitha45,XOgenotype.Infact,thepatientwouldhavete
Thispatientwouldnotpossessauterus(choiceB)oranoviduct(choiceC).Bothofthesestructuresarederivedfromtheparamesonephricduct,whichissuppress
Depressedlevelsoftestosterone(choiceD)wouldnotoccurinthispatient.Infact,individualswithtesticularfeminizationsyndromehavenormalorevenslight

29>ThecorrectanswerisA.Therightlymphaticductdrainstherightarm,therightsideofthechest,andtherightsideofthehead.Thethoracicductdrainst
Theleftsideandrightlegwouldbeaffected,ratherthantherightsideandleftleg(choiceB).
Theentireleftside(ratherthanjusttheleftarm,choiceC)andrightlegdrainintothethoracicduct.
Therightarmandtherighthalfofthehead(choicesDandE)draintotherightlymphaticduct.

30>ThecorrectanswerisA.Thisisaclassicpresentationofapulmonaryabscess.Chroniccourseswithlessseveresymptoms(withintermittentimprovementfollow
ChoiceBisthexrayappearanceofpleuraleffusion.
ChoiceCisthexrayappearanceoflobarpneumonia.
ChoiceDisthexrayappearanceofbronchopneumonia.
ChoiceEisthexrayappearanceofbronchiectasis.

31>ThecorrectanswerisC.Thecorpusluteumsecretesestrogens,progesterone,andrelaxin.hCG,secretedbythesyncytiotrophoblastliningtheplacentalvilli,
Antidiuretichormone(vasopressin;choiceA)doesnotplayasignificantroleduringpregnancy.
FSH(choiceB)actsongranulosacellstopromotetheconversionofandrostenedionetoestradiol.
LH(choiceD)actsonthecacellstopromoteandrostenedionesecretion.
Progesterone(choiceE)isimportantformaintainingthepregnancy,however,itdoesnotacttomaintainthecorpusluteum.

32>ThecorrectanswerisC.TheboyprobablyhasKlinefelter'ssyndrome(47,XXY),whichhasthetypicalpresentationdescribedinthequestion.Theconditionari
Deletions(choiceA)areacommonformofgeneticdiseaseandcontributetomanygeneticrecessivediseases.
Examplesofnondisjunctionofautosomes(choiceB)includetrisomiessuchasmostcasesofDown'ssyndrome(trisomy21),Edwards'syndrome(trisomy18),andPatau
Therearetwotypesoftranslocations:nonRobertsonian(choiceD)andRobertsonian(choiceE).NonRobertsonian(reciprocal)translocationsresultwhentwononh

33>ThecorrectanswerisE.Afemoralherniaexitstheabdominalcavitythroughthefemoralringtoenterthefemoralcanal.Thefemoralringisboundedmedially
Thefemoralartery(choiceA)iswithinthefemoralsheathalongwiththefemoralhernia,butislateraltothefemoralvein,whichseparatesthearteryfromthe
Thefemoralnerve(choiceB)isnotinsideofthefemoralsheath,butislateraltothesheath.
Thefemoralvein(choiceC)islateraltothefemoralcanalwithinthefemoralsheath.
Theinferiorepigastricartery(choiceD)isnotrelatedtoafemoralhernia.Thisarteryisontheanteriorabdominalwallandpassesimmediatelymedialtothed

34>ThecorrectanswerisB.Thebordermodificationconsistsofciliaonthesurfaceofpseudostratifiedcolumnarepithelium.Ciliaareshorterthanstereociliaa
Implantation(choiceA)isnotaffectedinpatientswithKartagener'ssyndrome.Thefertilizedovumcanstillreachtheendometriumandimplantationcanoccur.Al
Thebordermodificationconsistsofcilia,notmicrovilliandthespecimenisnotasectionoftheintestine,thereforemalabsorption(choiceC)isincorrect.Bot
Disaccharidases(choiceD)arepresentinthecellmembraneofmicrovilli.Deficienciesindigestionoccurwiththelossofmicrovilli.

35>ThecorrectanswerisD.Whilenotofmajormedicalconcern,urinecolorchangesasaresultofmedicationscanbeverydistressingtopatients.Thesechanges
Ethambutol(choiceA)isanantituberculosisagentthatisaddedifisoniazidresistanceissuspectedanddoesnotalterurinecolor.
Isoniazid(choiceB)remainstheprincipleantituberculosisagentanddoesnotalterurinecolor.
Pyridoxine(choiceC)isusedprincipallyinprophylaxisagainsttuberculosisanddoesnotalterurinecolor.
Streptomycin(choiceE),whichmustbegivenintramuscularly,issometimesusedasanadjunctiveagentveryearlyinantituberculosistherapyandhassometimesbe

36>ThecorrectanswerisB.Thisquestionillustratesanimportantstrategy:knowingwhatyou'relookingforbeforeyouconsidertheanswerchoices.Ifyouthough
Thefirstthingtorememberisthatnephroticsyndromeisdefinedasproteinuria(over3.5gm/day)withconcurrenthypoalbuminemiaandhyperlipidemia.Thelossof
Decreasedinterstitialoncoticpressure(pi;choiceD)wouldactuallypromotethemovementoffluidintothevasculature;itwouldnotleadtoedema.Thesamethi
Whiledecreasedinterstitialhydrostaticpressure(Pi;choiceC)wouldleadtoedema,itisnotthemechanismofactioninnephroticsyndrome.
Whileincreasedcapillaryhydrostaticpressure(choiceE)doesleadtoedema,itisnotthemechanismatworkinnephroticsyndrome.Itis,however,themechanism
Increasedcapillaryoncoticpressure(choiceF)wouldnotleadtoedema.
Increasedinterstitialhydrostaticpressure(choiceG)wouldnotleadtoedema.
Increasedinterstitialoncoticpressure(choiceH)wouldcauseedema,butnotinthesettingofnephroticsyndrome.Instead,thisisthemechanismofedema(typic
37>ThecorrectanswerisD.Lookingatthecodingsegmentofthenormalbgeneofhemoglobin,oneshouldreadtheinformationcodonbycodon,asfollows:
AAG
UAU
CAC
UAA
GCU
CGC

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1
2
3
4
5
6
Thenormalbglobingenehasastopcodon(UAA)atthe4thposition,thereforethelast2codons(GCUandCGC)arenottranslatedanddonotcodeforaminoacidr
AAG
AGU
AUC
ACU
AAG
CUC
GCU
UUC
...UAUUAA
1
2
3
4
5
6
7
8
...etc
Theinsertionoftwobasepairs(AG)resultsinaframeshiftmutationthateliminatesthestopcodonatposition4,therebycausingtheadditionofaminoacidsno
Aframeshiftmutationresultingindeletionofseveralaminoacids(choiceA)iswrong,sincesuchamutationwouldhaveinsertedastopcodon(UAA,UGAorUAG)b
Amutationinthestopcodon(choiceB)wouldhaveresultedinalongerthannormalbglobingene,buttheinformationgivendoesnotindicateanychangesinthe
Apointmutation(choiceC)istheresultofasinglebasepairchange,whichisnotthecasehere.Apointmutationresultingintheinsertionofanewstopcodo
Atwobasepairdeletion(choiceE)isnotevidencedbythecodingsequencegiveninthestem.Itwouldalsocauseaframeshiftinthereadingframewiththeposs
Strategynote:SincethehemoglobinCranstonbchainisclearlylongerthanthenormalbchain,choicesA,C,andE,whichwouldproduceashorterchain,canbee

38>ThecorrectanswerisB.Thedrawingdepictsthehistologyofthesmallintestinalvillusandcrypts.ThearrowpointstoaPanethcell.Panethcellsareuniqu
Theenteroendocrinecellsofthestomachproducelowmolecularweightpolypeptides(choiceA).
Therearenolipasesecretingcellsinthesmallintestine(choiceC).Lipasesaresecretedbycellsinthesalivaryglands,stomach,andexocrinepancreas.So,e
Thegobletcellsofthesmallintestinalvilliareresponsibleforproducingprotectiveglycoproteinscalledmucins(choiceD).Aftersecretion,theyarehydrated
Pepsinogen(choiceE)issecretedbythechiefcellsofthestomach.

39>ThecorrectanswerisD.Manypeoplewhorequestphysicianassistedsuicidehaveoneoftwoconditionspresent:eitherapoorlycontrolledpainfulconditionor
Whilepatientswhoarediagnosedasbipolardisorder(choiceA),borderlinepersonalitydisorder(choiceB),andschizophrenicdisorder(choiceE)oftenmakesuic
Personswithfactitiousdisorder(choiceC)areseekingprimarygain,oftenfordependencyneeds,andareseekingtoenterthe"sickrole"notthe"deadrole.

40>ThecorrectanswerisB.First,eliminateallanswersinwhichDrugXdoesnotproduceanincreaseinbloodpressure(BP).ChoiceAshouldbeeliminatedbecaus
Epinephrine,norepinephrine,andphenylephrineallincreaseBP,sotheremaininganswersmustbeeliminatedbyexaminingtheeffectsofDrugYonDrugX.Startwi
ChoiceD:Norepinephrineisanagonistatalpha1,alpha2,andbeta1receptors;propranololisanonselectivebetaantagonist.Afteradministrationofpropranol
ChoiceE:Phenylephrineisanalpha1agonist;hexamethoniumisanicotinicganglionicblocker.Hexamethoniumadministrationwouldbepredictedtoeliminatetheb

41>ThecorrectanswerisA.Bilirubinisadegradativeproductofhemoglobinmetabolism.Bilirubin(pigment)stonesarespecificallyassociatedwithexcessivebil
Calciumoxalatestones(choiceB)andcystinestones(choiceE)arefoundinthekidney,ratherthanthegallbladder.
Purecholesterolstones(choiceC)arelesscommonthanmixedgallstones,buthavethesameriskfactors,includingobesityandmultiplepregnancies.
Mixedstones(choiceD)arethecommon"gardenvariety"gallstones,foundespeciallyinobese,middleagedpatients,withafemalepredominance.

42ThecorrectanswerisC.TheprobableorganismisGiardialamblia,whichcharacteristicallyinfectsthesmallintestine.Whenseeninsmearsfromduodenalaspir
Entamoebahistolytica(choiceA)usuallyinfectsthelargeintestineand/orliver.
Escherichiacoli(choiceB)isabacterialcauseofdiarrhea.
Naegleriafowleri(choiceD)causesmeningoencephalitis.
Trichomonasvaginalis(choiceE)causesvaginitis.

43ThecorrectanswerisA.Thespinalcordarisesfromthecaudalendoftheneuraltube.Duringdevelopment,analarandabasalplateisformed,separatedbya
Theneuralcrest(choiceC)developsintomultipolarganglioncellsofautonomicganglia,pseudounipolarcellsofspinalandcranialnerveganglia,leptomeningeal
Thebrainformsfromtherostralendoftheneuraltube(choiceD).

44>ThecorrectanswerisC.Whilethethirdweekembryoisaprimitivetrilaminarplate,inthefourthweek,theheartbeginstoformandbeginsbeatingalmostim

45>ThecorrectanswerisC.Laryngealcartilages(e.g.,thethyroid,cricoid,arytenoidcartilages)arederivedfromneuralcrest.
Theendothelialcells(choiceA)inthesimplesquamousepitheliumthatlinesthepulmonarycapillariesarederivedfromvisceralmesoderm.
Theepithelialliningofprimarybronchi(choiceB)isderivedfromendoderm.
Trachealglands(choiceD)andepitheliumbothderivefromendoderm.
TypeIpneumocytes(choiceE)arederivedfromendoderm.

46ThecorrectanswerisC.Themuscularisoftheupperthirdoftheesophagus(choiceE)iscomposedentirelyofstriatedmuscle.Themiddlethird(choiceC)cont

47>ThecorrectanswerisD.Thecellsoftheanteriorpituitarycanbeclassifiedaschromophils(lovedyes)orchromophobes(donotstainwithdyes).Thechromop

48>ThecorrectanswerisE.Thediseaseismyotonicdystrophy,whichisanautosomaldominantdisease;theaffectedgenehasbeenlocalizedtochromosome19.Myot
AmutationontheXchromosome(choiceA)causesDuchennemusculardystrophy.
NoneofthemusclediseasesareknowntoberelatedtodefectsontheYchromosome(choiceB).
Facioscapulohumeraldystrophyisassociatedwithadefectivegeneonchromosome4(choiceC).
Infantilehypotoniahasbeenrelatedtodefectivegenesonchromosome5(choiceD).

49>ThecorrectanswerisE.Urinarytractinfectionsarethemostcommonbacterialinfectionsencounteredduringpregnancy,andEscherichiacoliisthemostcommo
Bundleformingpili(choiceA)arefoundinenteroaggregativeE.coli(EAEC).
GVVPQfimbriae(choiceB)arefoundinEAEC.
Heatlabiletoxins(choiceC)arepathogenicfactorsinenterotoxicstrains(ETEC).
Heatstabletoxins(choiceD)arepathogenicfactorsinETECorEAEC.
Type1pili(choiceF)areamajorpathogenicfactorinETEC.

50>ThecorrectanswerisE.Thebabyprobablyhascongenitalhypertrophicpyloricstenosis,whichusuallypresentsatseveralweeksofage.Partialsurgicalincis
Antacids(choiceA)arebeneficialinesophagealrefluxandpepticulcerdisease.
Bariumenema(choiceB)canreverseintussusceptioninachild,butwouldnotbetherapeuticinthiscase.
Gastricresection(choiceC)isnotindicated,sincethemuchlessinvasiveprocedureofpyloromyotomyisactuallymoreeffective.
Oralantibiotics(choiceD)arenotindicated,sincethisisnotaninfectiousprocess.

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