BLOCK 1

1) 76 yo man 30mins severe substernal chest pain while arguing with brother. 3 sublingal nitroglycerin no
relieve. 5y h/o ischemic heart disease. P110, R20, BP120/80. Cardiac exam normal. EKG ST elevation at
leads I, aVl, and V4-V9. What happened during argument with brother?
Coronary vasospasm due to alpha 1 stimulation?

2) 40yo G0 women delivered newborn. CVS at 15 wks results male chromosome fetus. Physical exam
show female external genitals and absent internal genitals. Mutation prevent reponse to what?
Testosterone

3) 13yo girl grew 3in over summer. What accounts for increased Ca absorption?
Hormones derived from 7-dehyrocholesterol

4) 56 yo man lethargy. No meds, no postural hypotention, no edema. Na: 125. Others normal. Dx?
Small Cell Carcinoma of lungs

5) 15 yo girl received BMT 1 year ago due to AML. Now karyotype 46, XY. Dx?
Nonautologous donor

6) 23yo women strenuous exercise. X-sectional area of pulmonary microcirculation?

increased, as a result of distention and recruitment of microvessels.

7) 33yo woman had weakness of right lower 2/3 of face. Where is brain lesion?
C (precentral gyrus, lower motor cortex)

8) 30 yo man and 24 yo woman genetic counseling. Mans brother has type 1 oculocutaneous albinism
(AR). Single gene disorder 1/40,000 in population. Pedigree shown. What are the odds?
1:600?

9) Chemical disrupts tight junction between cells in the testes. Autoimmune response to products of germ
cells entered circulation. What cells disrupted?
Sertoli

10) Case control study

11) 25 yo woman w/ AIDS in ICU treated for sepsis by Cryptococcus neoformans. Drug?
Amphotericin B

12) 27yo man 4 days of cough producing blood-tinged sputum. BP160/100. Creatine: 4.8, erthyrocyte
casts in urine. IgG deposites in IF microscopy. What glomerulus histologic abnormalities?
Crescent formation.

13) 48yo man. 3 yrs ago removed right kidney and adrenal gland of encapsulated renal cell carcinoma. 2
annual exams normal. No EtOH and no smoking. P75, BP130/88. Physical exam normal. Serum mild
increased bilirubin, ALT, AST and ALP. CT abdomen shows widening hepatic venules. Radiographic
fluorography pressure: R Atria: 5, Hepatic vein: 25, Hepatic wedge: 30. Dx?
Budd-Chiari syndrome

14) Picture represent eukaryotic translation. Only mRNA and rRNA shown. Whats next step?
binding of aminoacyl-tRNA to the A site.

15) 48 yo man in hospital for idiopathic pulmonary hypertension. 6 months progressive dyspnea. Cadiac
catheterization show decreased in cardiac function. Whats increased?
Right ventricular afterload.

16) 65 yo man low back pain. Multiple osteoblastic lesions in vertebrae on x ray. Whats increased in
serum?
Prostate-specific antigen

17) 43 yo man severe hip pain after fall. 15y h/o RA. Fracture and marked osteopenia of hip on xray. What
drug responsible?
Prednisone

18) 35 yo man w/ HIV. 2 yrs of HAART. Physical exam thin extremeties, wide abdominal girth, and buffalo
hump on upper back. Labs: CD4: 43, viral load: 1190, glucose: 110, cholesterol: 225, Triglycerides: 260.
Glucose tolerance test is abnormal. Cause?
Protease inhibitor

19) 80 yo woman SOB and fatigue. Dx severe aortic stenosis. Undergoes AV replacement. After
operation, dicumarol is given, result in prolonged PT. Cause?
induces a vitamin K deficiency like state.

20) 23 yo woman DVT at 6 months pregnant. IV heparin started. 7 days later platelet count: 44,000. Dx?
Antiplatelet antibodies.

21) 52 yo man 30mins of substernal chest pain. Pain persisted even w/ 3 doses of sublingual
nitroglycerin. P90, BP114/70. Diaphoresis. Lungs clear. S4, ST elevation in inferior leads. IV morphine
started. 1 min later develops generalized pruritus. P120, BP90/50. Physical exam facial flushing. What
substance cause new symptoms?
Histamine.

22) 19 yo man stabbed in abdomen. Denies starting fight and intends to get even. Incarcerated for past
3 yrs for armed robbery but says he was set up. Dx?
Antisocial personality disorder

23) 45 yo man major depressive disorder. Taking Fluoxetine. Increased risk of serotonin syndrome w/
what in food?
Tryptophan.
24) 40yo man increased malaise, nausea, abdominal pain and light colored stools. Tenderness to RUQ.
Bilirubin:4, ALP: 180, AST: 1500, ALT: 1700. HBeAg, HBsAg, HBV-DNA, IgM anti-HBc antigen: positive.
Further observation shows CD8 T cells bind to antigens resulting in liver injury. Wheres antigen from?
Hepatocytes.

25) 52 yo man severe headache, anxiety, sweating and palpitations. Well controlled HTN w/ clonidine and
HCTZ, but ran out of Rx 3 days ago. P120, BP170/110, Physical exam diaphoresis. What happens after
injection of propranolol?
Increase total peripheral resistance and decrease cardiac output
ock 1 part 2
26) ABG values in a resting patient.
PO2: 96, PCO2: 40, A O2 content: 12% (N=20), Mixed V PO2: 36 (N=40), Mixed V O2 content: 8%
(N=15). Dx?
Anemia

27) Neck irradiation risk factor for thyroid cancer study. Identified a group of patients with thyroid and
similar group of patients without thyroid. History of prior neck irridation is obstained from each group.
Study type?
Case-control

28) Investigator experient prevented 3rd pharyngeal pouches from forming in mouse embryo. Which
organs failed to develop?
Thymus

29) Microtubule-associated (MAP-1C) ATPase (dynein) production blocked in neuronal cell body. What
neuronal process is reduced?
retrograde axonal transport

30) Graph shows rate of breakdown by phosphorylase in the presence and absence of AMP. Based on
data, the action of AMP?
Allosteric activator.

31) 39yo police man w/ 6m headache, muscle aches and fatigue. 1m crampy epigastric pain, which he
think its stress. Become increasingly irritable and distractible while instructing people at firing range. Wife
reports irritable and forgetful at home. Vitals normal. Neuro exam shows b/l distal motor weakness of
extremities and impaired concentration. Memory function intact. Hemoglobin: 11, Hematocrit: 36%,
MCHC: 31%, MCV: 78. Blood smear?
Basophilic stippling.

32) 20m girl T101 and upper respirator infection. Condition worsens and develops dyspnea and cyanosis.
Crackles heard on chest auscultation. CXR show cardiac enlargement. Hemoglobin, hematocrit and WBC
count is WNL. Cardiac arrest day after admission and dies. Autopsy finding is diffused lymphocytic
infiltrate in the myocardium w/o evidence of inclusion bodies or microorganisms. Dx?
Coxsackievirus
33) 44 yo man with following pulmonary functions. Dx?
COPD only

34) Skin from male mouse grafted on back of female. Within 2 wks graft becomes necrotic and must be
removed. What cells responsible?
Netrophils

35) 41 yo woman at 34wk gestation has amniocentesis due to uncontrolled HTN. Amnionic fluid shows
decreased lecithin:sphingomyelin of 1.5:1 (N=3:1). What condition to newborn born at this time?
Decreased FRC

36) 49yo woman ask risk of osteoporosis. Mother had osteoporosis and bone fractures after menopause.
Pt work as landscaper and plays tennis 3/wk. no smoking, drinks 1 glass wine/wk, no meds. Wt: 121lbs.
what more info needed for evaluation of osteoporosis?
Diet history

37) 25 yo woman request prenatal diagnosis at 12 wk b/c sister has infant w/ Down. Woman karyotype is
45,XX,t(14q21q). what test needed?
Chorionic Villi sampling.

38) Study conducted to determine effects of drug X on Airflow, Phrenic nerve activity and Abdominal.
Tracing shown. Whats drug X?
Tubocurarine

39) 25 yo man severe pain on left side chest after falling off ladder. Pain sharp, stabbing and more intense
when pt is coughing or takes deep breath. CXR shows 4 rib fracture on left. No pneumothorax. Whats
pattern of respirator change?
RR: increase, TV: decreased, Airway resistance: no change.

40) 45 yo w/ chronic alcohol dependence w/ 3 days of foul smelling brownish sputum. Pt has severe
episodes of LOC and binging past month. Which CRX is his?
D

41) 74 yo man for f/u. 5 yrs ago MI and taking thyroid replacement meds for 25ys for hypothyroidism. Past
BP normal. Today BP200/115. Physical exam continuous systolic/diastolic bruit over right posterior flank.
Labs normal. Dx?
Renal artery stenosis.

42) 26yo woman 3m pain and stiffness of both hands. Physical exam shows swelling and redness of PIP
joints. Xray shows joint space narrowing and marginal erosions of PIP joints. DIP joints spared. Biopsy
show?
Synovial pannus formation.

43) 45 yo man lost in Rockty mountains for 10days. 11lb lost. Glucose concentration 92. Serum glucose
constant because glucose synthesized in liver and?
Kidney

44) 43 yo woman 3 day black tarry stools. Taking ASA for 1 wk for sprained ankles. Which steps is
inhibited.
Arachidonic acid X Prostaglandin G2

45) 24yo woman severe vomiting, flushing and headache after wine. Taking med for Trichomonas
vaginalis. Whats drug?
Metronidazole

46) Isolated skeletal muscle is isolated w/ glucose bath. Muscle is contracted w/ electrical stimulation.
What intracellular increase indicates fatigue?
pH

47) 24 yo man sharp left chest pain and dyspnea 4 hrs ago. CXR shown. Whats cause of CXR finding?
Loss of negative intrapleural pressure

48) 65 yo man w/ prostate cancer has severe fatigue and bone pain. Suspect metastasis to bone.
Androgen ablation therapy recommended for relief using IM monthly leuprolide and daily PO flutamide.
Why?
Flutamide blocks the initial androgen action of leuprolide.

49) 30yo woman visual difficulty. 3 yo h/o MS. Vitals normal. When lights off, both pupils 6mm, ambient
light pupils 4mm. Light at left eye, both pupils 2mm. light on right eye, both pupils 4mm. where is lesion?
right optic nerve.

50) 19yo woman 1st prenatal visit, feels well w/ some spotting. 10wk gestation by dates. Uterus is
englarged to level of umbilicus. Beta HCG = 350,000. Dx?
Hydatidiform mole
BLOCK 2

1) 31 yo man 4 hr severe right flank cramping pain radiating to groin. Pain 10/10. T99, P90, R20,
BP130/88. R flank tender to percussion. Tx is given and pt stabilized. Whats dietary change decrease
risk?
increased fluids.

2) 69 yo woman tremor in hands. Muscle tone increased, difficulty stopping abruptly when moving
forward. Short shuffling gait. Affect is blank. Neurotranmitter system most likely result these symptoms at
where in brain?
D

3) 22 yo man lost during hiking. He survives by eating plants. One plant causes nausea and vomiting.
Which structure cause his vomiting?
Area postrema
4) 46yo man suffers DCS while SCUBA. Small gas bubble form in spinal vessels supplying dorsal white
matter of supper thoracic spinal cord. What neuro Sx?
Discriminative sensation of lower extremities

5) 24 yo woman studied for renal function. Her renal O2 consumption is 20ml/min. Which function uses
most O2?
Tubular reabsorption

6) 22 yo man involve in MVC. BP not detectable on arrival. BP returns to normal with IV fluids and PRBC.
X lap shos lacerated spleen and liver. Splenectomy and liver repaired. 24 hr later, urine output is 350cc.
Dx?
Acute tubular Necrosis.

7) 23 yo woman w/ vagina sore. Sexually active, inconsistent condom use. Pelvic exam nontender ulcer
on vulva. Spirochetes positive on dark field. Whats biopsy histology?
Obliterative endarteritis w/ lymphocytes and plasma cells.

8) 6m male infant h/o severe viral and bacterial infections. Dx as SCID. Which enzyme deficient?
Adenosine deaminase

9) Rifampin MOA.
RNA

10) 17yo boy collapsed while working as traffic controller on hot summer day. At 4yo had numerous skin
grafts due to full thickness burns on 30% of body. Examine shows hyperthermia. Dx?
Burn scars and skin grafts lack eccrine glands, limit sweating

11) 30yo woman pap smear w/ high intraepithelial lesion undergoes cervical biopsy. What location of
tumor cell is consistant as in situ?
Superficial of basement membrane

12) 18yo women with sever, painful blistering after day at beach. Which antibiotic cause photosensitivity?
Tetracycline

13) 52yo woman with non-small cell carcinoma treated w/ cisplatin. What other drug needed?
Ondansetron

14) Man w/ light complexion develops ulcerated nodule on face under the sun. biopsy shows invasive
squamous cell carcinoma. What is DNA damage?
Pyrimidine dimers

15) 47yo man w/ rheumatic valve disease w/ chest pain and difficulty breathing. ECG shows acute MI.
Examination shows systolic murmur. Pressure tracing shown. Dx?
Ruptured of chordae tendineae.
16) 8yo girl lost of consciousness. Family travel in truck overnight and girl slept in truck bed. She was
difficult to arouse, with severe headache and nausea. Vomit during transit to hospital. P150. Perioral
Cherry red skin. Tx?
Oxygen

17) 2 yo boy 2 days fever, cough. h/o Strep. Pneumoiae and multiple ear and sinus infection since birth.
T101. No tonsillar tissue. Crackels heard in lower right lung. Dx?
bruton agammaglobulinemia

18) 45yo woman fever, cough, runny nose, sore throat, muscle aches. Moderately ill. T101.
Cardiopulmonary exam normal. Influenza virus antigen positive. Tx?
Neuraminidase inhibitor

19) Immunocompromised patients, positive PPD skin test changed from 10mm of induration to 5mm.
whats effect on incidence and prevalence?
Both increase.

20) 52 yo woman with CAD with right dominant coronary circulation. After angioplasty of circumflex artery.
Which structure receive blood flow?
Left Ventricle

21) Mouse thymocyte obtained from normal active bone marry was altered to express bcl-2 and combined
with normal marrow cells was injected into mice w/ destroyed active marrow. Control mouse with
destroyed marrow was injected w/ normal marrow only. After recovery, whats different between mouse?
increased number of circulating plasma cells?

22) 35yo woman 3 months fatigue. Vegan for 12 yrs. Loss of vibratory sensation of lower distal
extremities. Labs. Hemoglobin 9.1, MCV:114. Dx?
Vitamin B12

23) 40yo man with cardiac phonogram shown. Dx?

Mitral regurg.

24) 6 wk boy with projectile vomiting. Nothing change symptoms. No bile in vomit. Dehydrated, stools
decreased. Metabolic alkalosis. Dx?
Pyloric Stenosis

25) 65 yo woman stage 4 breast cancer need meds for severe pain. Drugs A-E graph shown, Log Dose
vs Response(pain relief). Which med best?
Drug C
26) 52 yo man w/ hypercholesterolemia tx w/ lovastatin. Gemifibrozil added. 2 wks later develop renal
failure. Dx?
Myoglobinuria

27) 54yo man for exam. P80, R14, BP140/95. Physical exam normal. ACE inhibitor given. Where is MOA
in kidney?
F

28) 60yo woman 1 yr involuntary rhythmic jerking of right leg and foot. Increased right ankle jerk reflex.
Babinski sign + on right. MRI shows 2cm round lesion at interhemispheric fissure at the central sulcus.
Dx?
Meningioma

29) 35yo man want to donate kidney to his sister who is T1DM and chronic renal failure. Healthy, physical
exam normal. How likely his HLA type is a match?
1:4

30) 60 yo man 20y h/o HTN with SOB and fatigue. P80, BP100/70. Physical exam shows peripheral
cyanosis. Crackels heard bilateral lungs. Cardiac exam shows S3. 2+ pitting ankle adema. Whats CO and
CVP findings?
CO: decreased, CVP: decreased?

31) 11 yo boy pain in right mid-thigh. Warm and tenderness around mass. Femur XR shows solitary mid-
diaphyseal osteolytic lesion w/ permeative margins. Lesion surrounded with layers of reactive bone.
Biospy composed of poorly differentiated sheets of small, uniform, hyperchromatic cells w/ highly
nuclear:cytoplasmic ratio, scant stroma and no visible matrix. Dx?
Ewing Sarcoma

32) Oral fluid therapy used to tx vibrio cholerae. Which membrane transport stimulated?
C (Na/Glucose port)

33) 16 yo girl 2 day h/o thick, yellow vaginal discharge and burning urination. Pt does not want parents to
know shes sexually active. T98, P80, BP 110/70. Exam shows mucopurulent discharge at the cervical os
and friability. Uterus is small, firm and nontender. No adnexal mass or external vaginal lesion. Stain Gram
negative diplococci in pairs with greater than 30WBC. Urine WNL. Test for gonorrhea and chlamydia
ordered. Action?
Prescribe antibiotic w/o notifying parents.

34) 59 yo woman yellow skin and dark urine. Return from Asia 3 wks ago. Physical exam shows jaundice.
IgM anti hepatitis E antibodies. Whats different between HAV and HEV?
Mortality among pregnant women

35) 53 yo man w/ angina pectoris tx w/ nitroglycerin. MOA?

increased concentration of cGMP in smooth muscles.

36) 32 yo woman absent tactile fremitus, hyperresonance on percussion and absent breath sounds at left
lung base. Dx?
Pneumothorax on the left.

37) 36 yo woman w/ T2DM. taking sulfonylurea. BMI: 32. Physical exam shows Acanthosis nigricans. Tx
with metformin. MOA?
inhibit hepatic gluconeogenesis

38) Autopsy of 20yo women died of MVC 8hrs ago. Greats amount of alveolar endothelial surface covered
by what cells in lungs?
Type 1 pneumocytes.

39) 26yo woman losts 290 lb after jejunoileal bypass . Fecal fat excretion excessive. Deficiency?
Vitamin A

40) Members of same family have progressive dementia, major depressive disorder and movement
disorder. Autosomal dominant trait with great variability of symptom severity and age at onset. Dx?
Number of triplet repeat sequences.

41) 27yo woman treated pneumococcal pneumonia with penicillin become afebrile and improved
pulmonary function. Then she became jaundiced and anemia with increased reticulocyte count and
increased unconjugated bilirubin. Test?
Direct Coombs Test

42) Induction of galactorrhea by metoclopramide? Dx?

Stimulation of release of prolactin from adenohypophysis.

43) 67yo man dx of primary lung carcinoma metastasis to adrenal glands, liver and bone. 8Kg wt loss,
cachexia and muscles wasting. Conjugation of what protein cause breakdown of muscle proteins?
Ubiquitin

44) 20yo man in MVC. Contusion to chest and abdomen. Unsteady gait and slurred speech. Admitted for
damage to spleen. 3rd night became restless and having generalized tonic-clonic seizures. Dx what
substance withdraw and treatment?
Ethanol, diazepam

45) 30yo woman with Marfan with tearing chest pain. 1 yr ago echocardiogram show aortic root to be
5.5cm. Stopped taking propranolol 1 yr ago. P120, BP80/40. Physical exam show JVD 6cm above sternal
angle. Maximum impulse is not palpable and heart sound cannot be distinguished. Whats cardiac
catheterization findings?
C

46) 30yo man with urinary incontinence after tx of left pelvis fracture. Physical exam show distended
bladder, absence of micturition reflex. After bladder fills to capacity, overflow of urine occurs through
urethra by few drops. What other nerve injury?
Pelvic nerves.

47) 3 day newborn female with unusual sweet order in diaper. Not feeding well. Lab shows hypoglycemia,
metabolic acidosis, ketonemia and hyperammonemia. Isoleucine increased in urine. What metabolic
pathway defective?
Branched-chain amino acid degradation.

48) 25 yo man fever, swelling of left calf since injury while mountain biking. Awake but confused.
Exquisitely tender, edematous left calf, swollen with crepitus. Foul smelling, watery discharge from wound.
Gram stain shown. Bug?
Clostridium perfringens

49) 1 day old newborn tested for anti-HIV antibodies. Western blot confirm presense of IgG antibodies
which react with virus envelope and core glycoproteins. Dx?
The mother is infected; the status of newborn is uncertain.

50) 2 wk old full term female newborn develops pale stools and progressive jaundice. Nuclear scans show
no excretion of bile. A1AT deficiency ruled out. Liver biopsy shows inflammation and proliferation of small
bile ducts and increased portal fibrosis. If not treated, what develops?
Budd-Chiari syndrome
BLOCK 3

1) 38yo woman depressed mood, joint pain, muscle weakness, memory problems, insomnia, palpitations,
blurred vision, varied duration and severity. h/o erythema migrans. Dx?
Lyme disease

2) 32 yo womans sister recently died of melanoma. Other 1st degree family members have similar
illnesses, with large pigmented skin lesions. Which lesion most likely on sun/no sun exposed areas of
skin?
Dysplastic nevi

3) 25 yo man stress exercise test. What changes to exercising skeletal muscles?

Art diameter, Tissue adenosine conc, vascular conductance. All increase

4) 29 yo man left testicular mass. Frozen section during orchiectomy shows seminoma. Whats greatest
predisposing risk?
Cryptoochidism.

5) 62 yo woman abdominal cramping, pain and constipation. Tx w/ simethicone provided some relief. 20lb
weight loss, increasing fatigue, and need more sleep. Endoscopy, colonoscopy, Abdomen CT normal. Pt
believes insomnia due to worries about her son whos been using drugs. She worry cancer will never get
better. Vitals stable. Not anemic, all labs WNL. Next?
evaluate for Major Depressive Disorder

6) Study found malformations of embryos exposed to retinoic acid involved changes in homeobox (HOX)
gene expression. Retinoic acid and HOX gene products recognize and bind to specific DNA sequences at
various chromosome sites. Function?
Transcription factors

7) 42 yo man progressive weakness of hands. Physical exam shows hand muscle atrophy and tongue,
and trapezius muscle fasciculations. Electromyography confirms Amyotrophic lateral sclerosis. Physician
statement?
You have Lou Gehrig disease. Have you ever heard anything about this disease?

8) 45 yo man gradually worsening heartburn. Physical exam unremarkable. Endoscopy shows stomach
with thickened nodular mucosa w/ no discrete ulcerations. Steiner silver stained gastric biopsy shown.
Abnormality commonly associated w/ what disease?
Peptic ulcer Disease

9) 48 yo woman fatigue, weakness, loss of appetite, and weight loss. Serum PTH increased. Xray of
skeletal system shows generalized osteopenia with subperiosteal resorption of bone within the phalanges.
MOA?
Paracrine stimulation of osteoclasts by osteoblasts

10) New humanized monoclonal antibody investigated for treatment. This antibody is monomeric, crosses
placenta, serum life of 21 days. Which antibody?
IgG

11) 29yo woman inability to conceive. 10 menstrual periods in past year, but very erratic and
unpredictable. May not be ovulating. 4 days Right pelvic pain. Pt suspects pain indicating ovulation. What
hormone changes indicate ovulation occurred?
Increased in progesterone

12) 73 yo man localized back pain. HTN and T2DM. mild discomfort but able to walk. Pain with
percussion over lower thoracic spine. Neuro exam normal. Xray show vertebral cortical thickening of the
end-plates, creating picture frame vertebrae. Serum study?
Calcium, Phosphorus, PTH: no change, ALP: increased

13) Diagram of proximal renal tubular epithelium. Which is pathway for transepithelial transport of water?
C?

14) 61 yo man erectile dysfunction due to L-2 spinal injury. Sildenafil corrects ED by acting on which
structure?
D (Cavernosum)

15) Sexually active 20 yo woman painful, erythematous vesicular lesion on vulva. Examination by
speculum shows lesion in vaginal vault and on cervix. Photo of scraping of base of unroofed vesicle
shown. Dx?
Genital herpes

16) 25 yo man upper respiratory infection w/ features of common cold. What viral/host features most
critical for infection?
Presense of viral receptor molecules on epithelial cells

17) Action potential cause current to flow deep within the skeletal muscle fiber by what?
Transmission along T tubules

18) 3 month old girl congenital HIV, diaper rash spread to abdomen and highs. Physical exam shows
clusters of erythematous papules and pustules distributed over the abdomen, groin and thighs. Photo of
scraping shown. Dx?
Normal skin flora

19) 30 yo woman nausea and vomiting. T1DM. confused and sleepy. P130, R30. BP 80/60. Urine output
is scant and dark. Given IV insulin and isotonic saline. What changes 4 hrs after treatment?
K: decrease, HCO3: increase, BUN: decrease, pH: increase, PCO2: increase

20) 10 yo girl painful 2mm subcutaneous nodule on chin. 10 wks ago required sutures after laceration.
Photo of tissue biopsy given. Dx?
Granuloma

21) A substance produced in the GI tract is isolated and examined. This substance cause activation of
pancreatic trypsinogen to trypsin, also activation of other proteolytic zymogens. This substance resembles
what?
Enteropeptidase

22) 30yo man stung by several wasps. Confused, difficulty breathing. T100, P122, R34, BP80/40.
Physical exam shows dry skin and decreased capillary refill. Multiple erythematous inflamed marks on
back and ankle pitting edema. Other than IV normal saline, whats next?
Sympathomimetic agent

23) 7yo boy emigrated from Africa, headache, recurrent fever with back pain. Mother reports a child in
village had similar condition. T102. Physical exam shows weakness of left lower extremity. Knee relax
weaker on left. Neuro exam shows fasciculations of lower extremeties. Dx?
Poliomyelitis

24) Case control study. 100men with bladder cancer compared to 100 controls. Case and control asked
about EtOH consumption. Odds ratio of 3. 95% confidence interval was 1.8-6.6 for association of bladder
cancer to EtOH consumption. Interpretation?
The likelihood is 95% that the true value for the odds ratio is between 1.8-6.6.

25) 18yo man with pain in multiple joints and fatigue. 2 months ago, rash and flu-like illness while working
as a counselor at a camp on the New England Coast. Dx?
Lyme disease
26) 12 yo boy asthma and wheezing. Tx w/ inhaled bronchodilator did not resolve symptoms. What part of
airway most susceptible to flow limitation due to smooth muscle contraction?
Bronchiole

27) 75 yo man Alzheimer dementia in hospital because of cough, difficulty breathing and agitation after
breakfast. Resident of skilled nursing care. Wife and children visit often. Wife mention coughing during
meals and longer to finish meals. Imaging consistent with aspiration pneumonia with developing
compromised swallowing functions. No advance directive. Speaking to family regarding feeding tube?
follow only the wishes of the wife

28) Instillation of lipid into duodenum leads to release of hormonal substance from endocrine cells in
duodenal mucosa. Action?
Gallbladder contraction

29) Histone acetyltransferase cataylze acetylation of lysine residues on histones. Whats effect?
Decreases affinity of histones for DNA.

30) 24 yo man generalized tonic-clonic seizure. Somnolent. Na: 118, K: 4. Urine gravity: 1.005. Na slowly
return to normal over 36 hrs. 3rd hospital day, serum osmolality: 280, uring osmolality: 260, 272. Pt
becomes more alert and active. He drinks more than 6L/day water. Serum Na begin to decrease. Dx?
Psychogenic polydipsia

31) 45 yo woman cancer treated w/ vinblastine. What changed end of treatment?

Decreased number of neutrophils.

32) 32 yo woman with fecal incontinence after child birth. Dx?

Damage to anal sphincter.

33) 2 people return from 5 day hike in Arizona admitted for infection. Sudden onset fever, chills, weakness
and headache, followed by unilateral, intensely tender lymphadenopathy in the groin. Gram stain of lymph
show gram negative coccobacilli. Dx?
Yersinia pestis

34) 25 yo man significant blood loss after fracture of right tibia. Prior to emergency treatment, how
compensate decreased blood volume?
Reabsorption of fluid into systemic capillaries.

35) 60 yo woman increasingly severe joint pain and swelling. Physical exam shows irregular, asymmetric
enlargments of multiple joint of fingers, toes, left elbow, right knee. Focal ulceration of overlying skin.
Photo shown. Uric acid : 9.1. Dx?
Gout

36) 48 yo woman urinary frequency and urgency. Physical exam normal. MOA of medication prescribed?
Blockade of parasympathetic innervation of detrusor muscle.

37) Pulmonary artery pressure study, subjects with hypertension experience decrease in this pressure
after receiving phosphodiesterase inhibitor. This decrease in pressure is mediated by increase in
intracellular concentration of what?
cGMP

38) 24 yo woman painful menstrual periods. No pain during midpoint of menstrual cycle. Also rectal
bleeding associated w/ menses. Dx?
Endometriosis

39) 10 yo girl pain and swelling of right index finger. T99, right hand shows tender erythematous,
edematous index finger with intact wooden splinter. White exudate during removal of splinter. Whats in
pus?
Neutrophils

40) Cholesterol measured on community. Mean and SD given. Assume Gaussian distribution. Whats
probability woman between ages 50-54 year has cholesterol greater than 296?
16%

41) 3 day old male abdominal distention and increasing distress. Sibling has cystic fibrosis. No bowel
movements since birth. Abdomen XR shows small bowel obstruction. Dx?
Meconium ileus

42) 3month old infant immunization with tetanus toxoid results in IgM anti-tetanous antibody then anti-
tetanous IgG antibody response. What B-T cell interaction?
CD40-CD40L

43) 25 yo woman nervousness and emotional lability. P110, BP 135/70. Wide eyed, staring gaze, skin
warm and moist and fingers show fine tremor when extended. Thyroid gland diffusely inlarged. Cause?
Thyrotropin receptor autoantibodies.

44) Decrease activity of what causes scurvy?

Prolyl hydroxylase

45) 2 day old newborn jaundice. Jaundice caused by reduction of what?

Conjugation of bilirubin to glucuronic acid

46) 25 yo man eczematous dermatitis. Biopsy shows Langerhans cells infiltrating dermis. What
characteristic?
Birbeck granules.

47) 40yo woman chorionic villus sampling. Chromosome analysis shows 46XY in 14 cells and 47, XY+15
in 25 cells. Chromosome analysis of amniotic fluid shows 46XY in 50 cells. Dx?
confined placental mosaicism

48) 24 yo man MVC. Lost 2L blood from left femoral fracture. BP70/40. Post surgery, multiple
ecchymoses over medial aspect of upper arms. Bleeding from IV sites. What coagulation abnormal?
Consumption coagulopathy

49) 70 yo man progressive disinhibition syndrome characterized by emotional outbursts, inappropriate use
of language, socially inappropriate behavior. Whats damaged?
B (frontal)
50) 42 yo woman hearing loss while treated for pyelonephritis. What drug class?
Aminoglycosides
BLOCK 4

1) 60yo man congestive heart failure, bacterial bronchopneumonia in ICU. Responds to antibiotics. But 3
days after develops maculopapular rash over extremities with central vesicles and bullae having a
targetoid appearance. Biopsy shows subepidermal blisters and degeneration of basal cell layer,
keratinocyte necrosis and lymphocytic infiltration at dermal/epidermal junction. Dx?
Erythema multiforme

2) 64 yo man fever, cough and purulent sputum. 60 pack year. T103. Physical exam shows erythematous
tympanic membranes. Rhonchi on auscultation of chest. CXR shows consolidation in right middle lobe.
MOA of drug inhibit protein synthesis by binding to 50s subunit of bacterial ribosomes. Drug?
Azithromycin

3) Niemann-Pick diease pathophysiologic process?

decreased lysosomal hydrolase

4) Biopsy of neoplasm on scalp of 45 yo man shows early invasive squamous cell carcinoma. Site of
incision is not sutured. One week later, mass is widely excised. Biopsy site most likely show what?
Granulation tissue?

5) 29 yo man untreated HIV, with fever, severe diarrhea, and fatigue. T101. Physical exam shows oral
thrush and enlargement of cervical and axillary lymph nodes. CD4: 190 (N>500). CD8: 200 (N>200).
Which mechanism cause decreased CD4?
CD8 T lymphocyte mediated killing

6) 35 yo man nephrotic syndrome. Renal biopsy shows uniformly thickened glomerular capillary basement
membrane. Immunofluorescent shos granular deposits of IgG and C3. Dx?
Membranous nephropathy.

7) Adhesion of platelets to subendothelial surface requires interaction of platelet membrane glycoprotein

and?
von Willebrand factor

8) 62 yo woman weakness of left leg. Smoked 1 pack for 40 yrs. BMI 27. P85, BP140/100. Left lower
extremity shows muscle strength of 1/5 and deep tendon reflexes of 3+. When eyes closed, she cannot
tell left great toe is raised or depressed. Embolism of what arteries?
Right anterior cerebral

9) What distinguishes tumor-suppressor gene from proto-oncogenes?

inhibition of cell-cycle regulation

10) 73 yo man changed in behavior, decreased appetite and intermittent constipation. 10lb weight gain.
Wife claims pt takes forever to get out of bed and talks slowly, and forgetful. Pt claims no memory
problem but feel apathetic all the time. Physical exam shows enlarged tongue. Slowed speech and
difficulty following complex commands. Recalls only 1 of 3 objects after 5 mins. Next?
Measure thyroid-stimulating hormone concentration.

11) Determine ACE inhibitors superior to CCB in preventing renal disease progression in pt with T1DM.
whats advantage of randomized controlled trial versus prospective cohort study?
Better control for confounding variables

12) Healthy 36 yo woman think she had a heart attack during grocery shopping. Palpitations, shortness of
breath, dizziness, numbness and tingling of hands and feet and shaking. Symptoms 30 mins and resolved
spontaneously. 2 similar episodes before. Once at home, another at work. Physical exam, EKG, and labs
normal. Dx?
Panic disorder

13) 40yo man buttock pain extends down to posterior left lower extremity to heel. Pain on passive flexion
of hip beyond 30 degrees with straight knee. Decreased power on plantar flexion. Left Achilles tendon
reflex is absent. All other reflexes are 2+. Decreased pinprick over lateral left foot and fourth and fifth toes.
Which nerve root?
S1

14) 22 yo woman frequent headaches and fatigue. Overeats when shes anxious and induce vomit and
using laxatives. BMI 21. Exam shows what?
Dental caries

15) 2 yo girl exposed to sun has progressive development of dry skin and excessive freckling and
keratosis. Skin fibroblasts cultured most likely defective in what?
Nuclear excision repair of pyrimidine dimers

16) Pt early stages of hemorrhagic shock ?

A weak pulse due to decreased stroke volume

17) 32 yo man, international health worker given primaquine as prophylaxis against malaria. Becomes
jaundiced. Lab shows hemolytic anemia. MOA?
Enzyme deficiency in the erythrocytes.

18) 60 yo man flank pain and blood in urine. Weakness and 10 lb weight loss. Lab shows hypercalcemia
and polycythemia. Chest CT shows multiple nodules in both lungs. Abdomen CT shows 8cm mass in
upper pole of right kidney. Biopsy of lung nodule shows?
Metastatic renal cell carcinoma.

19) 53 yo man malaise and increased fatigue and 20lb weight loss. Physical exm shows splenomegaly.
Leukocyte count is 75,000. Bone marrow biopsy shows hypercellularity with maturing granulocytes,
increased megakaryocytes, and normal erythroid elements. Blood smear shown. Pt treated w/ imatinib
mesylate. This drug block what?
Tyrosine kinase
20) 40 yo woman had Strep pneumonia pneumonia comes for follow up exam. CXR normal. Which
produced by cell type responsible for restitution of normal lung structure?
Surfactant

21) 18 yo woman screen for colon cancer. Father and grandfather died of colon cancer at ages 36, 45.
Physical exam normal. Colonoscopy shows 200 lesions. Colectomy done and shown. What chance pt
offspring will develop same condition?
50%

22) 13 yo girl check up. Girl and mother healthy. Girl doing well in school and participate in soccer and
lacrosse. How physician ask regarding sexual activity?
Ask the mother to leave the room before asking the pt any questions.

23) 50 yo man chronic abdominal pain. Intermittent mild knee pain 30 years. Pain more constant recently.
Physical exam shows mild epigastric tenderness and decreased range of motion of both knees.
Endoscopy shows antral ulcer. What med best for knee pain?
Acetaminophen

24) New drug developed designed to stimulate epithelial cell turnover in small intestine. Drug target?
Crypt cells

25) 48 yo man left leg injury. Physical exam shows obvious lateral swing of the left lower extremity when
walking. NO fracture on Xray. Injury to left obturator nerve which passes through the obturator foramen.
Which movement to strengthen?
Adduction
26) Study function of voltage-gated sodium channel. A mutant form that inactivates more rapidly than
normal is developed. Whats effected?
Decreases the amplitude of the action potential

27) cDNA clone of ovalbumin contains 1872 bp. Genomic clone contains 7700 bp. why?
Introns

28) 3 tests evaluate children with diarrhea for rotavirus. Sensitivity and specificity are summarized. If only
treat children actually have disease because of toxicity of treatment, which tests should be run?
Test 3 followed by test 1 if test 3 positive.

29) 11 yo boy repeated staph pneumonia. When incubated w/ Staph. Aureus, his neutrophils fail to make
respiratory burst and do not kill staph. Even through EM the neutrophils shows bacterial cells in
phagosomes. Def?
NADPH oxidase

30) newborn is cyanosis, tachypnea, and retractions of muscles of chest wall during inspiration. Weighs
2500g. ABG given. Describe acid-base balance.
Respiratory acidosis, Metabolic Acidosis.
31) 5 yo boy pain in right eye at night. No Fx of neoplasia. Exam shows strabismus and tenderness in
eye. Left eye normal. Retina show presence of mass. Physician explain unlikely to develop other
neoplasms. Mutation occurs?
Retinal cells

32) 12 yo girl unable to walk. Parents very anxious but pt unconcerned. T98, P70, BP115/70. Deep
tendon reflex of legs equal bilaterally. Pain/light touch variable. Dx?
Conversion disorder

33) 2 yo boy cerebral palsy. Surgical correction of early adduction contracture and subluxation of right hip.
Difficulty sitting up and learn to crawl by dragging his legs. Which nerve relieve adduction contracture?
Obturator

34) 65 yo man radical prostatectomy and lymph node dissection for adenocarcinoma of prostate.
Grading?
Tumor cell appearance and arrangment

35) 66 yo man inability to maintain erection. Fatigue and difficulty sleeping and concentrating. Cerebral
infract 3 months ago with right hemiparesis that gradually improved. Physical exam normal. What other
findings?
Lidido, Nocturnal erections: normal

36) 28 yo man urinary frequency and discomfort. Uro exam normal. Urinalysis shows pyruia. Clean catch
urine culture yields no growth. Dx?
Chlamydia trachomatis

37) Efficacy of autoclave sterilization. Autoclave generates pressure 15-20 psi and temperacture of 121-
126C. What can be retained?
Prions

38) 3 month boy difficulty breast feeding and gasp for breath. 50% for length and 5% for weight. Lungs
clear. Grade 3/6 holosystolic murmur. Cardiac test show normal O2 tension in right atrium, increased O2
tension in right ventricle and normal systemic O2 tension. Dx?
VSD

39) 48 yo woman fever and frequent slimy stools. Emigrated from Uganda. T101. Abdominal exam mild
tenderness of RUQ. Stool shows mucus. Colonscopy shows multiple ulcers that have undermined and
destroyed large areas of intestinal epithelium. Dx?
Entamoeba histolytica

40) 4 yo boy fever and acute renal failure. Stool specimen grows E coli O157:H7. Blood smear?
Schistocytes and thrombocytopenia

41) 6 yo girl difficulty hearing bilaterally. Multiple fractures. Teeth has yellowish brown discoloration. Photo
of eyes shown. Whats gene coding defect?
Procollagen type 1

42) 50 yo woman decreased energy. Does not trust doctors. Lots of health problems. Physician primary
focus?
Establishing a therapeutic alliance with patient

43) 14 yo boy extremity tremors and greenish rings at the margin of cornea near limbus. Lab shows
ceruloplasmin below 95% and 12 fold increase of serum ALT. Tx?
Periodic IM injections of Penicillamine

44) 53 yo woman w/ GERD. Dietary change and stress reduction no effect symptoms. Physical exam
shows mild epigastric tenderness. Tx?
Omeprazole

45) 22 yo woman polydipsia and polyuria. Wakes up at night with urge to urinate. Taking Lithium for
bipolar. Dose increased 6 months ago. Vitals/physical normal. 24 hr urine output 6.5L. after tx of
desmopressin, uring output and osmolality does not change. Which part of nephron defective?
collecting duct

46) 40 yo woman lump in neck became larger recently. 8x10mm mass lateral to midline over thyroid
cartilage. Soft, mobile and moves upward when patient protrudes tongue. Whats structure?
Thyroglossal cyst.

47) 62 yo woman with abdominal aortic aneurysm repaird. 48 hr later right distal leg dusky, cool and dark
purple to black necrotic lesions on several toes. Biopsy of lesion shows occluded small arteries with
needle shaped clefts. Dx?
Cholesterol emboli

48) MRI of brain of 54 yo man. Lesion indicated w/ arrows. Lab shows decreased gonadotropin
concentration. Transbronchial biopsy shows granulomas indicative of sarcoidosis. Where?
Hypothalamus

49) 2070g stillborn male delivered by cesarean at 36 wks. Autopsy shows cyclopia and cleft lip and
palate. Chromosomal analysis shows 47, XY+13 karyotype. What congenital central nervous system
malformation?
Holoprosencephally

50) 62 yo right handed man cerebral infarction. Decreased fluency of spontaneous speech, phrases less
than 4-5 words. Comprehension normal. Neuro exam shows weakness of lower 2/3rd of face on right.
Where is lesion?
A (Brocas)