‘A65.year-ld woman has the recent appearance of @ lesion athe ste ofa parperal scar onthe hing. The scar develgped atthe site ofa pulmonary infarct 20 years ago. It wa rot present on her ast xray 2 years ago. She has nt stoked cigarettes for he past 20 years. lobectomy is dane. Which ofthe folowing isthe most ikely typeof maignancy A) Adenocarcinoma 8) Malignant lymphoma ©) Metastatic carcinoma ) Small cet carcroma ) Squamous cell carcinoma e Or7 An otnawise heathy 82-year-old man s brought to the physician by his wie Because ofa 6-ment history of ptoaressive numbness and tnging in is foes blatorally. His wo says that ho also has had mld incroasod she {erm memory dficutes dung ths period. He as not en exananed By a pryscian for fe past 3 years. His Vial ‘Sans are writin norma lms Physical scamnation shows normal muscle mass and fone. Muscle engi s 5/39 {ne lower exttamiies. Patel and calcaneal (Aches) dasptandon reflexes are normal. Sensation to pnprck s decreased inthe lower extremities below the level of Uo knees. He waks wih a mde based gat. Laboratory studies ‘Sow a hemoglobin concentraten of 9 gt hematocrt of 2%, and platelet count of 175.000/mm? A _hotomicograph ofa peripheral blood smear is shown. Which of he falling isthe most ikely eagnasis? 1A) Anterior cord syndrome 8) Central cora synaremna (©) Hemicord syndrome 1) Posterior cord syndrome ©) Segmentary syndrome e Or oP protean1d man comes othe physican because: ‘Serum sties show Ne: s38meqL Ke At megl Ast Agu att 74UL Testosterone 7 nmol (N=10-35) \Wich ofthe folowing serum concentrations is most likely to be abnormal inthis patient? A) Adeenocortcotopic hormone 8B) Cortisol ©) Femtn ) Taytoi-stmalatng hormone £) Une acid e Or‘A65.year-ld weman develops deep venous thrombosis of the right lower extremity 10 days afr she underwent a ight hip replacement. She has been receiving subcutaneous ‘anfeaagulant hereny since the procedure, Her patolet count pew 76,000/mn?, Compared wih 300 000%mm 10 days ago, Which of he folowing the mest mel Underyng Cause ol hs patient's conaiion? A) Acute myeloblatcleukenis '8) Henocn-Schonlen purpura ) Heparn-nduced thrombocytopenia D) Immune trombecytopenc purpura EE) Tiwombotic trombocytopenic purpura e Or‘47-year-old woman win multiple sclerosis is brought tothe physician because of a 2-day history of bsteral ower extremity numbness. Muscle sengh i 5S inthe upper extremes, There & spas parapaesis ofthe ower exremives, Deep tendon reflexes ero brisk nthe ewer oxomiis, and tore sustased conus a he ankes, Babinski 'S present biateraly Propriceepton and sanaton to vibration are diminished inthe toes, Sensation fo pinprck and temperaiure are normal When asked! 0 stand with her eye Closed and arms extended outward, ho patient's unable to maintain balance. This patents symptoms of abnormal Sonsaton are most Ikely caused by damage to which of he fotowing tracts? ‘A) Dorsal spinocerebellar 8) Fasoculus cuneatus ©) Fasccuke gracits D) Spinotatamic ) Ventral sprcereteliar e Or‘32-year-old woman comes the emergency department ater aking 40 1-9 iblets of eprazolam. She says that her boyiend threatened to leave her, and she feels "empty ‘Sho drnks several sx-packs of Boer weckly and uses cacaine dally She has oufoursts of ege whether or not she s intoxcatod. Which of te flowing the most IRON persone serdar? A) Antisocial 8) Boederine ©) Dependent ) Nareissisic e Or‘62-year-old woman i brought to the emergency department 30 minutes ater her husband found her onthe bedroom for, ake ut unebe to mave he arms or legs. She h Fislory of pe 2 diabetes melts, hypertension, and hyperipidemia. Her crrent medicaons are insulin, crigine, and srwastan Her blood pressures ocean monet ee irpeed satay vata emeveneis we rit er pooch art ne a SS | bran i moot ely to Show a lesion at wich o te fling locauons? A) Media 8B) Midbrain ©) Pons ) Putamen ) Thalamus e Or oy 8Le —= - 2 1 “ A 13,year-ol its brought to the of because ofa fay tumad 1 day ago from a ip oa neighboring stale for a swim et Her team had sayed ata hotel where he and several of hot tes noled smal Bugs beds She caplured ve of tse ang brought them home. He mate pu ham are to kil ham and hugh them to the pyran’ ale The Hage 8 shown the phogcaphe Th pater ea inseased ck tr ncn wth whieh Tha folowing as resut of these fnangs? ofitehy red spots on he and neck S 1) Cytomegaiovi 8) Horpes simpiex virus o) HV D) Stonny aureus e @ Car ad ens oven tp Pw4. A.64¢yoa-olf woman s found dead atthe fot of her basomont stops. A photograph of the Iver obtained at autopsy s shown, ‘hci of tie folowing the most ikely agnosis? 1) Abscess 8) Cihosis () Focal nodular hyperplasia ) Hepatts B infecton ) narct, F) Notastate broastcancor e Or4. A.64¢yoa-olf woman s found dead atthe fot of her basomont stops. A photograph of the Iver obtained at autopsy s shown, ‘hci of tie folowing the most ikely agnosis? 1) Abscess ZC) Focal nodular hyperplasia F) Notastate broastcancor e Car‘A 1.onn.o boys bough physician fra flown examination He nas had recurent bacon infctons since he age of 8 moths. Findings on a compete loos Count lange deer we win be efron ranges Frertetng a he poente aces shows rama Oke Hs stun nestbuln 8) Leukocyte akaline phosphatase activity grear than 250 UL, ) 0% Basoptis onthe peripheral smear ) 0% Blasts on the peripheral smear ) More than 60% mature neutophis on the penpheral smear‘coher study is conducted to examine the association between cigarete smoking and lung cancerin @ sample of 4000 people. One thousan paricipants smoke cigarettes, an £3000 participants do not smoke. Aer 10 years of folw-up there are 20 cases of lung cancer among the smo and 30 cases of lung cancer among the nonsmokers. Accord to these results how many lung cancer cases allbulable to smoking would be expected to ccrurin a grup ef 10,000 smokers over the same period of ma? A) 30 8) 100 ©) 150 ) 200 E) 300‘An 18year-old woman comes tothe physician because of 6-month history of progressive muscle weskness, poor exercise tolerance. and shorness of breath wih exertion. Sh ‘G0 has had diffe folowing moving abjects wit her eyes, especialy whon she fs ied. Her pulse 170i. respirations are 22Inin, and blood pressure is 105/85 rm Physical scamnation shows blaeral poss Muses engin 25 to m all exttemies. Examination of amuscle biopsy specimen shows abnormal accumulations of ‘mibenondsia nthe subsarclemmal regions. Which of tho Tolowng addtional sets of dings most Kelyn ths patent? Maximum Oxygen Venous Blood Energy Production ‘Consumption (VO sna) Lactate by Glycelysis, a : + ° 8) i t °) 4 D) : £) 4 F 1 ») t\Which of the folowing types of vaccine s most appropate to prevent mumps? A) Bactoral by products 8) Bactoral polysaccharides ©) Inactivated bacteria D) Inactivated vius ) Inactve vel antigen F) Live attenuated bactoria 6) Lwo attenuated viusa jo wae Ze es 'A45.yoar-old man comes foe of for a health maintanance examination. He had smoked 1 pack of cigateltes daly for 30 oars unt ne qul 3 yoars ago. Physical ‘amination shows a panies wha pach on The lateal bade athe league A phalomierogiaph ofa hepmy cpaciman af tha iain shown Wir the flewing changes ic ‘most Ikely fo occur next this patents lesan Ist untested? A) Dissemination of val infection 8) Disseminaton to dstant sos ©) Infivaton ofthe porinual spaces D) Invasion ofthe submucosa ) Spontaneous regression @ e ar‘A 75.year-ld woman has stress unnary incannence wih sphinctenc incompetence. Pelvic oor muscle exercises and the use ofa vaginal essary provide inadequate Improvement and the patent refuses surgical intverton. Administaion ofa drug wth which ofthe folowing mechanisms of action most propriate? 1) Antagonism of o-adrenorecoptors 8) Antagonism of f-adrenorocoptors ©) Sumation of «-asrenoreceptars D) Stimiation of P-adrenoreceptors ) Simulation of muscarine receptors e Or‘A female neutom develops respiratory tress Her respirations are 80min. There was poor prenatal care. Physical examination shows intercostal retractions. A chest2-ray Shows mutiple fractures Skoell ays show mulipe fractures of the ng bones al vrious stages oF healing, the Skul bones have awoerian appearance. Ther sno fa Fistor of racurent Fectures Which ofthe folowing ie the most ely agnosis? A) Enlers-Danios syndrome, hypermatily type 8) Enlers-Danios syndrome, vascular ype ©) Maan syndzome ) Osteogenesis imperfecta, ypo E) Rockets‘A22.year-ld mans brought to the emergency depariment 20 minutes afer a fend found him unconscious onthe floor A dun overdose is suspected. His pulse is 120imi, respirations are dimin wit apparent ow ial voumes, and blood pressure 120/100 mm Hg. Phystal examination shows mig cyanosis He intubated and mechanically ‘ential! uth postive pressure ventiation (ata = 12min V7 mLka) usng 10cm HD postive end sxpralory pressure (PEEP) Whe ofthe folowing sets of ndings bast ‘eserbes te elects a he mecnancal venation with PEEP on ths patents aveola (P,) and intaplowal (P,) pressures? Peak inspiratory P, End-TidalP, Peak inspiratory P, End-Tidal a Posie posiive postive postive 5) Posie 2210 postive negative °) Zero 2010 220 rogatve D) Zero negative 20 20 E) Negative postive postive postive A ‘Noga 0 gate gavea. A 3-month-o its brought to he physican by her parents because ofa 2-monthhstoy oF an enlarging fed spot on ner abdomen. She ‘appears well developed and well nourished. Sho atthe Sth percentile fr longth and 7otn percenio for woah A photograph ofthe lesions shou Microscopic examination ofthe lesin Is most key to show which ofthe folowing? |) Arenotes in a thous stoma 8) Arterovenous malformations ©) Cavernous vascular spaces D) Densely packed capiianes E) Diltediymphatic vesselsa. A 3-montn-o git s brought to he physican by her parents because ofa 2-month story of an enlarging fed spat on her abdomen. She ‘appears well developed and well nourished. Sho atthe Sth percentile fr longth and 7otn percenio for woah A photograph ofthe lesion 5 shoun Microscopic examination ofthe lesion #5 mest kel fo snow wich othe flowing? |) Arenles in a tlvous stem 8) Arterovenous malformations ©) Cavernous vascular spaces ) Densely packed capiianes E) Diltediymphatic vessels cond‘44-year-old woman, gravida 2, para 2, comes tothe physican fora heath maintenance examination Physical nd pelvic examinations show 90 abnonmaiiies, Resuts ofa Pa Smoat Show dase colrmat std cls his patent wee Realy columnar as een on he patents Pa shear woud mat Rely gate fom uc of owing A) Cervical canal 8) Endometnum ©) Posterior fornix ofthe vagina D) Vaginal porion of ne con ) Vaginal vesobula\Wnich of the flowing best explains impaired action potentials in theetlected axons in patents with demyelinsting diseases? A) Cossation of fast axonal transport 'B) Dageneration ofthe axon C) Degeneration of volage-gated Ca? channels ) Depoymoriton of axonal microtubules ) Increase in exonal capectance‘A To-year-ld man with severe congestive near flue nas had progressive orthopnea forthe past 4 weeks, He has not been taking hs medications. Dunng ths tme, his urine ‘utbut has progressively decreased to 300 mLidey Which othe flowing Sets a lsberatory ndings is mast IMG? serum Urine Urea Nitrogen (BUN) Creatinine Nas specie (gia) ‘malat) (meq) Gravity a 10 1 50 1010 5) 2 2 ro 1.025 °) 30 2 20 1.005 D) 0 2 5 025, F) 50 4 10 1010right-sided back and abcominal pain. The pst rive the pan. The most ‘44-year-old man with invasive pancreatic cancers brought to the emergency department because of 8 2sweek history of se States tat he has had @ 6 8-49 (15-8) weight oss during he past month. Physica examination shows no abnomliiesAn operation's scheduled to ssn tim photograph ofa myeinsanad cross sechon ofthe spinal cord shown? Left Right cond @Aa-yo-léman esha ens ess ss forte past mets. He began arg are Banh go ncn he flown gs mst hey cused hs evese ct? A) Amiloride 8) Furosemdo ©) Hysrochiowniaide D) Spironolactone ) Tiamiorene‘A. 35.year-ld woman comes the physician because ofa 6-month history of interment fever, fatigue, and unexplained weight oss, She has ha an 18-kg (400) weight loss ‘uring ts period Her tomperature © 372°C (99°F). Laboratory stucies stow CD4~ T-ympiocyte court of 60mm (N=£00) and a plasma HIV via oad of600 000 cates. ‘most appropiate reatment for is patent includes a drug tha largets which ofthe folowing steps of ural replicon? {A) Absorption to and penetration ino susceptible host cals 8) Discuption of wral receptors ©) Release of vil partes from the cols ) Syninesis of vial DNA ) Uncoating of wral nucleic act‘A 78-year-old man s found unresponsive in his yard by @ neighbor Paramedics arive and begin resusciton. Twenty-five minutes later, he regains a stable cardiac rhythm. He brought fo the emergency deparment, and mechanical ventilation i intated. Hs temperature fs 36 4°C (67 5°F), pulse is 76min, resprations re |4imin (with spontaneous ‘espatory efforts) and blood pressure 92/60 mm Hj He femains unresponsiv=. After the pabant ws adm’ fo the hosp his nego says, "Hs aay sade oun to be kop onto support there was na nope of fecavery. His wife ed 5 Years ago, and ve baen cooking or him and heping him wih errands sine thon The patent has Na Chien or close feletves. Te physician Deleves that he patient has sustaned sievicantahoxe bain Inury nd hs prognass fs poor & mos appropiate fr te pysican Slate fo he neighbor which ofthe folng ats time? A) “The hospital lawyor must bo consulted since we do not know if your neighbor had an advance drectve, 8) “Sinco me patient nas already boen put on Ife suppor, ne wil have to remain on ie suppor at hs me ©) “Thank you for teling me this. Your Mena previous Statements to you can be helpful n making decisions for ti. D) “Thank you fer your concern, but since you are not felave ofthe patient you cannot make decisions fr him, ) “Unfortunately, your end is brain-dead, so there no need to make lif support decisions at this point O>SEe‘60-year-old man as had easy faigabity, oss of appetite, and signticant weight loss over the past 3 mont, Route blood studes show a marked increase in serum calcium ‘oncenitation. Radiographic examination does not shew bone meastases. Ths pation mest kel to have cancer of which ofthe folowing Organs? A) Colon 8) Lung ©) Pancreas D) Prostate ) Thyroid aland‘A. 39.year-1d woman win obesty and recently dlagnosed nypesralycendemia comes tothe physician fora follow-up examination She stated a diet 3 months ago that was recommended by the physician She also has peptic ulcer disease. Sh has smoked pack of cgaretes daly for 10 years. She does nt appear to ben distress Her pulse is Simin and regula resprations are 12min. ard blood pressures 14512 mmHg, The ngs are clear fo auscultation and percussion Card examina shows no abnodmal ‘Abdominal examination shews normal Bowel sounds, there are no masses of oiganomogaly. Tore mia epgastc ndorness to deep papaton. Serum studies show a toll Chotestera concentration of 210 mgiL, HDL-cholesterol concentration of20 mg/@., and rgioende concentration of 350 mgic.. Which of he folowing Is the most appropnate ‘harmacotrerapy fr this patient? A) Atowastatin 8) Cholestyramine ©) Covestipat D) Ezetmibe E) Gernibrozi‘A6-month-old gi is brought othe offce for welkchid examination She has no history of majr medical iiness and receives no medications. The patient and her mother rece ‘migrated fom 2 rural region of China, where they didnot receive requiat healthcare. The pales gronth and development sre appropiate for age. Physical examination shov fo abnormalities. Screening for whch a the folowing is the most appropiate next stop in management? A) Adenovirus 8) Cytemegaiovius ©) Epstoin Bam vius D) Hepatitis B E) Pavowius F) Respiralory syncytal vis‘A prospective study s dane ta assess the relative effcacy of to diferent anthypertensive medications, oh of which were shown to be eficacous in placebo-contlied rials. the sty. patons with hypertension were randomly assigned fo receive one of te antinypertansive medications Al the Concusion of he study, some participants eporied Inconsistent adherence other medication regen, whl others eporied discontinang thet study medeaton alogethe before the primary outcome (aleed pressure measure ‘ater 30 days) was colaned. A Tow of these patlonts Who discontinued hor sludy medicaton were presctbod the oer group's study medication by Nee primary care paysican fd were tang tat he hme of the pemary outcome measurement In hel rmaryanalyss, wich of he flowing methods shoud The swestgators use fo analyze data om Dates who wore no adherent fo the medication regen? ‘A) Exclude the outcome for ony those wh inadvertently switched othe other study modicaton '8) Exclude the aulcome fr only thse who reported stopping the medication atogethor ©) Ince te cutcome or aac partspantin the group to which he o she Was randomized D) Incude the culcome for hose who look more than a prespecified acon of medication doses O>SEe‘A65.year-ld man s scheduled for physical therapy 3 days folowing a nght shoulder operstion. A par ofa regimen to strengthen fis ight rotator cutf muscles, he begins thera to-stengiben the subscapular muscle. Which of he folowing movements ofthe atm should his patent perform against resistance? A) Abduction 8) Adducton ©) Extension D) Lateral externa) tation ) Medial (internal rotation‘A61-year-0ld mani prescribed fuoxetine for major depressive disorder This drug has its ital eflects on neurons ansing in which ofthe following structures? A) amygdala 8) Insular cortex ©) Locus caerueus ) Raphe nucle E) Substante nigra‘50-year-old man who lve in eastern Minnesota comes to me physician in July because ofa 3-day history of fever and malase. His temperature is 394°C (1029°F), uses ‘84min respirations are Himin, and blood pressure 100/70 mm Hg. Physical exaanaiion shows no abromaliies Laboratory studies show a hemoglobin concentration of 138 gl leukocyte count of 350mm? and plate count of 89 OOGram? The result ofa polymerase chan reacion fst for Angplasima phagacylophium s postive. The caus cfganism in is palont is ransmtiog vane Same vector as which of to folowing pas Of pathogens? A) Babesia microti and Boraia burgdortert 8) B mivot and Rickotsa rickets ©) 8. mivot and Yersinia pests D) B burgdovfen and R. rickets ) 8. bugdovon and ¥ posts F) oko and ¥ pasts‘child win septcemia has an antbite clearance (Cl of 09 Lik he steady sate serum concentration forthe antibiotics 12 pgm. Which of te folowing is the maintenan ose (inmaikg'day?? a) 25 8) 54 ©) 288 b) 518 E) 550‘A63.year-ld weran comes the physician because ofa 2-month history of progressive shorness of breath with exertion. Her puse is 80lmin, respretons are min, and blo pressures 125/80 mm Hg. Physical examination shews no offer abnomaiies A chest xray shows @ mass pressing egas the ouside ofthe trachoa ust above he carina PPuionary functon testo is most ikely fo show which ofthe folowing sets of results this patent? Peak Expiratory Peak Inspiratory FvcFEV/FVC Flow Rate Flow Rate a Noxmal nota normal 1 5) Nomal normal noimal °) Nomal ——hotmal i i D) Normal i noimal nosmnal E) t roimal normal rormal A i T foxmal T 8 1 1 1 noimal|A26.year-ld woman comes o the physician because ofa progressive thy red rash on her arms over the past 2 weeks. She began wocking in an animal cic 2 months 290. < ‘says hal she has ol been bitten. bul Sho was seratched on bah arms who caring Tor itr of ions, Physical examinaton shows annular eryhematous plaques wth conta ‘eating and advancing scaly borders. There no regonal ymphadenopatny Which ofthe folowing s tne most Easy ceagnosis? A) Atypical mycobacterial infection 8B) Cat-scratcn disease ©) Disseminated toxoplasmosis ) Psoasis ) Tinaa corps‘A 48.year-ld man comes to he physician because a @24-nour history of severe abdominal pin an biood-inged vomiting. He smokes 2 packs of cgaretes and drinks eight ‘ounce cans of beer dally HE temperatures 377°C (88°F), pulses 10min, respirations are 16min, and blood pressure 12080 mm Hp, Abdominal examination shows abs Bowel sounds, ivoluniary guarding, and epigasnc fenderess with ebound londemness. An xray shows Fee arin he abdorialcauiy Wich of he flxning fs the most Ike agnosis? A) Acute cholecystitis 8) Acute pancratiis ©) Alconoic gastritis D) Appendiis ) Portoratod poptc ulcor‘A 45.year-ld man s brought tothe emergency depariment eter being found unconscious in the desert. Twenty-four ours ago, he had been hiking and est conscousness ate faling and srg his head on a rock His pube & 124min and tod pressure 80140 rim Hg. He is migly confused. Physial examination shows mulipe ecchymoses on te Uuppe and loner extremities and alaige contusion onthe left forehead. Which of te folowing best explans the hypotension? A) Anaphyixis 8) Hypotnerma ©) Hypovolame shock D) Increased inacania pressure ) Myocartialintrcton‘A21-year-ld man comes to he physician because of 7-mentn history of ever and abdominal pai; he also hes had a 68-49 (15) weightloss dunn this pend. He is @ ‘Consultant to nongovernmental otgaizatons tal suppetarganic farming. He rlumed from a 2morth tip to tie Middle East $ woeks a0. His temperature 30°C (102 2°F). Physical amination shows generalized hmphadenopatty and hepaiosplenomegaly Laboratory siudies show pancytopenia The most ks cause ofthese fnngs an ‘organism belonging to wnen of te folowing genera? A) Acinetobacter 8) Leishmania ©) Plasmodiom D) Schistosoma £) Trypanosoma‘21-year-old man is brought to the emergency deparment 20 minutes afer sustaining knife wounds tothe abdomen in a gang-rleted fight He sin shock He undergoes Immetate operative repa of@ perforation of the smal niestine anda beeding puncture wound tothe Iver. Recovery fs uneventful andthe patents charged. Six morihs ak he's admfled fo the haspta er eatnent ofan iestnal ebstucton caused by peroneal adhesions During the covtecive abdominal operatic, iis observed thal one sit of Prowous injury has fogeneratod winout any ewdonce of Morous scarring, Wich of bw folowing sts Is most Ikay Deng described? A) Fibroadpose subcutaneous tissue ®) Liver ©) Skeletal muscle ) skin ) Smallintesino‘21-year-old man is brought to the emergency deparment 20 minutes afer sustaining knife wounds tothe abdomen in a gang-rleted fight He sin shock He undergoes Immetate operative repa of@ perforation of the smal niestine anda beeding puncture wound tothe Iver. Recovery fs uneventful andthe patents charged. Six morihs ak he's admfled fo the haspta er eatnent ofan iestnal ebstucton caused by peroneal adhesions During the covtecive abdominal operatic, iis observed thal one sit of prevous inary has regenerated winout any evidence of Morous Scarring, Which of be folowing sts Ie most Ivey Deng described? A) Fibroadpose subcutaneous tissue ®) Liver ©) Skeletal muscle ) skin ) Smallintesino e Or‘40-year-old man comes to the physician fer @ routine heath maintenance examination. He has an actveitesyie hat nclues swimming and cycing, Physical examination sho no abnormalities. He concomed that his mise-patem baldness i affecting both his professional mage and hs aity to attract sexual partners. Which ofthe folowing treaimen {She most aperopnats recommendation for his paint? A) Danazol 8) Fnastende ©) Motyltestostrone D) Oxanaroione E) Stanazoto e OrA 16-year-old g's brought tothe emergency depariment 30 minutes afer being injured in metor vehicle colision. Her blood pressure is 70/40 mm Hg. Physical examination shows cod, clammy skin. A chest xray shows facture ofthe tb onthe left An exploratory operation shows 3 rupture of he spleen Ligaton ofthe blood supply to tre spleen ‘most kal io damage wich ofthe folowing acitional sructures? 88) Horzontal duodenum ) Tall of me pancroas e Or‘An 18.month-old gis brought to the physican because of faire to tive and frequent wet capers. She's athe 3rd percentile fe length and weight. Physical examination show denyeraton, decreased musce fone, end bawng of he ‘Sit amp examination shows cystls in te comeas Serum studies show hypophosphatema, ‘and 8 nonanion gap melabotc acosia Une stsies sow a Hf. ghrosurta, phosphatiia and genarelzed amnoaciiurm. Which of te folowing ie tha most ely case ofthe motabote acidosis nts patiot? A) Decreased carbonic anhydrase activ inthe distal tubule 8) Decreased carbonic anhydrase activi in the proximal tubule ) Decreased nysrogen ion secretion nthe distal tubule ) Decreased hydrogen ion secretion the proximal tubule ) Docreased sodium bicarbonate reabsorpton into distal tubule F) Decreased sodum bearbonate reabsorption in te proximal tubule e Or‘40-year-old man comes tthe physician because ofa 3-manth history at episodes ofan abnormal tnging cr pins-and-needes sensation that starts inhi le hand and then prea ois ot rm and face. The episodes lst approximatoly 1 minulo. Physical and neuroogk examinations show no abnormalies. Tho most Ikely cause ofthese s¥plon 'Saeson in which of te folowing gy ofthe cerebral cortex? A) Cinguate 8) Ocopitatemperal ©) Postcontal ) Precental ) Superior amporal‘33-year-old woman comes tothe physician fra routine follow-up examination. She nas GBIBESPIG and fat malabsorption Physical examination shows asthenia. Laboratory studies show a serum calcium concentration ofTSMQMGL. Which ofthe flowing additonal sets of serum findings & most Iely i this pabent? Inorganic Parathyroid Phosphorus Hormone Caleitrol D) Decreased increased «—ncreasea E) Decteased ——incteased.-«—«decreased‘48-year-old man has complete loss of nearing in his right ear Which ofthe following labeled cranial newes on the photograph ofthe ventral suriace ofthe brain stem is most Tkely tobe damaged? 7a year history of an enlarging. p 258 08 nar right wit Evaminaten af the rht Photograph. The mass fim and nontendor and tansilumates with the application ofa pon ight Without Wealmont, wich ofthe folowing is most ily to ‘A) Malignant degeneration cur inthis pion? ©) Racil ) Spontaneous regression E) Symovtis ry @ 2 © Car‘An otheurse neath 26-year-old scuba dver has acuity breathing immediately alr ascencing Yom a 20-minute dve o a depth of 15 fm. Which of te folowing physical sgns © most consisterk wi the xray oho chest shown? |A) Bronchial breath scunds over the mile lobe 8) Cardiac mouse dsplaced tothe lot () Hyperesonance over most of hele side of he chest D) Increased parasternal dulness due toa modiastinal shi to tho lot ) Increased lace tetas over te let ower lobe e Or : Pf prontoIna study of he use of ultrasonography for he early detection of prostate cancer, 35 of 50 men with prostate cancer have abnormal test results, and 20 of 100 men without post cancer have abnormal est esuls, Which of te flowing best represents the specioly of fis West? a) 20% 8) 30% ° D) ) 80%‘Aman accidentally touches the surface of hot stove; 20 minutes later, a blister develops atthe site. Blochemical analysis of te bster fic t this time is most ikely to show th presence of which ofthe follwing? A) Histamine 8) oe ©) ynterteron D) Intreukint (4) E) Intrioukin2 0L.2) e Or ent 2‘A’3.day.0d female newborn delivered a term is brougnt othe emergency department by he mother because of a 4-nour history of yelowing of te eyes Pregnancy and deve ‘were uncomplicated. The newborn has been breast-fed. Physical examination shows jaundice. Serum studies show a total brubin concentration of 14.8 mgidL(N=t2). The rewbom = placed man nedbalor equeped lor phototherapy When ofthe falonang best describes the mechanism of he undarying photeherapy? {A) Decreased conjugation of rub to amino acids 8) Decreased conversion of biverdin to lrubin C) Decreased rate of homolysis D) Increased conjugation of bruit glucuronide E) Increased conversion of rub to water-soluble somars F) Increased synthesis of UDP glucuronesyransierass e Or‘female neonate is detveres at 38 weeks gestation by cesarean section. Physical examination shows macrocepaly and shortening ofthe proximal segments of alimbs. A ‘agnosis of achondroplasa's made. DNA Sequencing shows & GA mutaton i the robles grawlh faciox 3 receptor gene on chromosome 4. The bosynihesis of fs protein equres a funciona signal recogntion parle recepor This receptor most isl found in which of he fllonng celia locations? A) ois Golgi complex 8B) mRNA ©) Ribosome ) Rough endoplasmic reteutum E) Secretory granulo F) Smooth endoplasmic reticulum 6G) trans-Golgi complex‘A 28.year-ld man has hypestilycenéemia that has net responded to gem Nicotinic acid therapy is started, and he dose is gradual increased to 3 giday Wich of he following cugs shouldbe acministered concurenty o prevent the most common adverse effect of is therapy? A) Acetaminophen 8) Aspicn ©) cryburae D) Hydrochiorotiazde ) Raniiine e Or{A 74.year-1d woman comes the physician because ofa 3-month history of progressive shortness of breath with exertion; her symptoms are not exacerbated by ying down, S has smoked 1 pack of cigaretes daly for 5B years She's soatod wih er hands placed on her knees, using aceessory muscles of espraton. Her tomperalure is 31 2°C (09°F) pulse min and resprabons are 17imin Physical examination shows no jugular venous dstanion, Chest examination shows an meteased anteroposterior clam Ereath Sounds are docreasod, ang heart sounds are stat on auscutation of to chest Thor ne perpheral adoma, In addton 1o abu, which of to folowing to Most ‘spropratepharmacetnerapy fr ts patent? A) Acotyeysteine 8) Amantasine ©) Cromalyn D) Ipratropium E) Montetuxast e Or‘44-year-old woman comes to the physician because of stestormhee, fatulence, anda 10-kg (22-0) weightloss over the pest 6 months. Findings on physical examination are unremarkable, Laboratory studies show Hemoglobin 6g Mean corpuscular votame 74 um? ‘Serum ren 40yg!dL Fema song Testof tie sta! for occult Dood is negative, stool cultures and stoo| examination for parasios are nogative. A latral x-ray ofthe chest shows mid osteopenia. Which ofthe folowing ¥ the most ikely explanation for these fraings? A) Avopnic gastiis 8) Bacteral overgrowth ©) Caliac sproe D) Intestinal pseudo-cbstructon E) Imtabe baw! syndrome e Or‘An 85-year-old woman i brought othe physician by her daughter because of@ 3-year history of progressive forgetuness, Mental status examination shows mederat cificuty Tearing and recaling new verbal and norworbal material. She also has mld dic with naming and calculations, Which ofthe folowing isthe most appropriate pharmacaer toimprove her symptoms? AA) Coenzyme @ £8) Donepezi ©) Rituzolo ) Salegiine E) ze e OrInvestigators conducts prospective, communty-based study to assess the effectiveness ofan intervention to promte ear language scqustion among chien durng the frst 3 years of fe. Delivered over 6 months across fve daycar9 cries, the infeventon conssied of provide monthly classes fo cohor of mothers, beginning when each child 2 Yeats of age. Each chids language sis were assessed independently al he ages of 2 ard 3 years, scates were nomalized for age. The results are summarized as flows Mean Change in Child Language Number of Case Sessions ‘Score (Standard Deviation) ‘Attended by Mother ‘Atte Age of 3 Years 52031) 3332) 18 17904) 18207) 20020) Wich ofthe flowing sets of characteristics o this study best supports a causal relationship between the intrventon and child language scores? ‘A) Dose-response gradiont, spectety, biologie plausity B) Dose-response gradient speci, sensivty ©) Dose-esparse gradient. temporal relafenship, sensivily 1) Swergtn of associaton, dose response grasiont,consietncy of other stustee ) Strength of associaton, speci, senstvty F) Strength of asseciation temporal relationship, dose-response gradient e Or‘A. 26.year-1dnuligrvid woman and her 40-year-old husband come tothe physican for genet counseling rir to concestion. They have no family history of genetic syndrome ‘They have been reading onthe Ifornet about certain ierted dseases and ask about the risk for being carers ofan autosomal recessive neuredegeneralve disorder tha, cceursin tn 10,000 indiduats. Which ofthe folowing best represents the carer requency of his cniion? A) 10125 8) 10150 ©) 10175 D) tot 100 E) 108150 e Or‘A. 26.year-1dnuligrvid woman and her 40-year-old husband come tothe physican for genet counseling rir to concestion. They have no family history of genetic syndrome ‘They have been reading onthe Ifornet about certain ierted dseases and ask about the risk for being carers ofan autosomal recessive neuredegeneralve disorder tha, cceursin tn 10,000 indiduats. Which ofthe folowing best represents the carer requency of his cniion? A) 10125 8) 10150 ©) 10175 D) tot 100 E) 1081500. A.44-yoar-olf man Brough o tha emergency department by police 45 minutes ator ne sustained injuries n a bar fight. There are multpl aval actures and contusions, including a severely swollen aght eye. Complete physica ‘examinaten cannot be done because of facia edema. He retuses try to open nis eyes because when Ne Joes, he has double sion CT scan ofthe head is done, er acoronal mage Hough the midiace i shown. Which ofthe Totbwing s tho most ikely explanation for is pation’ wsual complanis? A) Avision of the opt neve 8) Disiocatod options ® ) Enlvapment of tne introrrctus muscio 1) Foe blood wie the anteror enamber ) Globe pierced by bone fragment F) Injury to the opti ract posterior to the cies O>SEe @‘A. 45.yearld woman is scheduled to undergo a mph node biopsy under local anesthesia. surgical resident aks atirc-year medical student 1o get signed consent rom the ‘ate befor the procedures performed. Which of re flowing acon by the student fs most appropriate? {A) Accompany the resident whe the resident obtains signed consent 8) Got signed consent fom to pation ©) Get signed consent om te paint with anotner medical student acting asa wanes D) Rluse o cbt signed consent e Or‘A17-year-1d git with ype 1 siabetes mettus comes to the physician fore fotow.p examination. She has hed multiple admission to the hospital dunng the past 5 months for ‘abeicKetoscidess, She appea's well Physical examination shows ro abnomilves Laboratory sues show a emoglobin A, of 11%. She ils he physica that she doe rol take her nsuln regularly because she eter lerge's to o's oo busy Which of the folowing the mest approprats tt sep by the physician? A) Acknowledge the patient’ reasons fr missing insulin injections 8) Discuss the patent's noncompliance with ner parents ©) Educate the patent about tho long-erm complications of unreatod deabotes D) Tol ine patients parents to ensure mat tatr daughters complant E) Rofer the patient toa psychologist e Or‘60-year-old woman win ype 2 diabetes metus comes to he offce because ofa 6-weok history of gh shoulder pan. The pan occurs when she attempts to raise her arm a wen ing on her right side, She has not had weakness, tnging or numbness, Physical examination shows tenderness to papain inte region of te right det muscle just lateral tothe crombclaicuia ont Whe siting uni she able lo abduct he ar io nearly 60 degrees, bul adonal abducton 's prevented by pal Muscle sength the rant upper extremity, sensation is tac, and tnero Is no impingement sign, Vncn of te folowing is tbe most Ima agnosis? A) Adhesive caps 8) Biciital tennis ©) Pancoast tumor ) Rotator cut tear ) Rotator cuff tendinitis F) Suacromial busts e Or‘A 2.weekold female newbom of Mexican descentis brought to the physician by her mother for @ well-chid examination. The mather epocs tht the baby has been doing wel, ‘except hat she often cries nconsolbly for sbout an hour afer feeding wih frm. The mother says. "lam suro thal she hes got the evil eye The mother hes been passing a gover the baby’s body. then cracking the ea9 a glass of water and placing the las underneath he baby's bed. However, thre has been no change inthe baby's Behan ‘The nowbom i a te 30m porconble for ongih and woight and 35th percontle fr nead excunverenco, Her vial signs are wit normal ims. Physical and abdominal examinations Shaw no abaarmaltes, Which of he falling isthe mos! appropriate statement By Ne physician? A) “Have you considera talking to fh Neale o ee if thera mght be ater measures you should ty? 8) “Ithunk your baby has gas, net the evi eye. Why dort we try giving her mecicabon’” C) “Tm not very knowledgeable about your folk bela Would you ike ma orafer you to @ doctar who is” D) “There's not alot of evidence in modern medicine o support what you ae doing, but tsnit harming the baby’ ) “Why dont you contnue uth what youre doing, andes try changing este diferent formula”‘A.65.year-old man comes tothe physician because of 1fer history of erectile dysfunction. He has a 20.year-istory of type 2 diabetes melits and is curentytaeng insulin Physical examination and laboratory siudes show no abnionmalies Its most appropriate forthe pivsician to prescribe a drug that increases the actions of cGMP in which of th folowing cel ypesin the pens? |) Endothetal cel ofthe deep artery 8) Endotnetil cel ofthe deep dorsal vein ©) Endotneal cols ofthe dorsal artory 1) Smoot muscle cats ofthe dep artery £E) Smooth muscie cals of the deep dorsal vein e Or‘A. 35.year-ld woman, gravida 2, para 1, undergoes vaginal delivery aterm. Physical examination shows crowning ofthe neubom's head and penneal blanching A median éisiotomy s done fo hasten delivery Dung ths procedure, an inosion is made posteriory fom he posterior vaginal carmmissure. Which othe folowing muscles fs at greatest Fak for damage fs incon tom further durng dalvery? AA) Bubospongiosus 88) Extemal anal sphincter ©) Ischiecavernosus ) Cbturatorintornus ) Sprinctr rota e Or‘A65.year-ld man develops a progressive ataxia wth gat unsteadiness. There an intention tremer onthe right side. The mest ikely cause is damage to which ofthe fallowng ‘reas ofthe brain? A) Loft cerebellar homisphere 8B) Let fonta lobe ©) Lot pyramidal act D) Let ventolatral nucleus of the thalamas E) Right cerebellar hemisphere F) Right pyramidal tract, e Or‘A To-year-ld woman i brought tothe physician by her son who is concerned that she has become more forgetul during the past few mont; ne thinks she shoul be placed i Tong term care facity She says she fe wel, tink tether son is every concerned. and clearly does not want to leave her apartment. She has no medical problems ahd appears cheerful Which of the folomang findings is most crucal in delermning her decsion makng capaci? A) She can wre a sentence 8) She correcty identiespolical leaders ©) Sho expresses car and consistent values D) She folows simple waiten comands ) She has memory of cdhood events e Or‘A 1-year-ld woman comesto the physician fora heath maintenance examination, She says tat she has been feeling wel. A splt S's heard over the let sternal border. Whi ‘of he flloning best expans the fret component ef ths sound? 1) Closure of he aoc valve 8) Closure of to mitral valve ©) Closure of te pulmonic valve D) Closure ofthe cusp valve ) Opening ofthe aortic valve F) Opening of the mits vale 6G) Opening ofthe pulmonic valve H) Opening ofthe ticuspd vavo e Or{A 7-yea-0 boy is brought tothe physician by his mother because of @ 2-day history ofan itchy red rash on his ght arm and trunk ater @ hike inthe woods, His mother says th the rash began on fis arm 1 day afer the tp, bu thes now spread to his ttunk Phsical examination shows 2-om patches of raised, red, elongated Disers thal ooze clear fi the upper exrembes and unk: The bistes ae n 2 linear distbuton wih patches of eryhema, Which af he lellowing best describes tbe mechanism of his patient's reaction? A) Activation of mast cols by IE £8) Deposition of antigen-antibody complexes ©) Late paso reaction of type hypersonstivty D) Release of interferon gamma by Tt cols ) Syminesisofhigh-mity 19s by 8 Iymhocytes e Or{A 7-yea-0 boy is brought tothe physician by his mother because of @ 2-day history ofan itchy red rash on his ght arm and trunk ater @ hike inthe woods, His mother says th the rash began on fis arm 1 day afer the tp, bu thes now spread to his ttunk Phsical examination shows 2-om patches of raised, red, elongated Disers thal ooze clear fi the upper exrembes and unk: The bistes ae n 2 linear distbuton wih patches of eryhema, Which af he lellowing best describes tbe mechanism of his patient's reaction? A) Activation of mast cols by IE £8) Deposition of antigen-antibody complexes ©) Late paso reaction of a type hypersensitivity }D) Release of interoron gamma by Tt cols ) Syminesis ofhigh-amnty 19s by 6 iymphocytes e Or‘A 44-year-old man who isa farmer andhas been spraying his orchards wth insecticides brought tothe emergency deparment by is wie because of vmtng, dares, \wheseng, and sweating forthe past 12 hours He has excess salvaion and generalized muscle woskress. He s confused and Ns pups are smal A drug acting wich of th folowing labeled sess most appropriate ater slabizabon offs pabant's anway? Receptors ‘Muscarinic cholinergic A) 8) ec) oD) OB 7 e OrA study was conducted to investgate the mean age at onset in one typeof muscular dystrophy Based ona mental evauaten, patients were divided into two groups: normal inteligence and subnormalintligence “The resus are given in he able. [Age at Onset in Years Inteligence Level ©) Mean Standard Deviation Nowa! 8 38 18 ‘Subaormal 6 35 15 tage at onset has normal (gaussian) disrbuton, the percentage ofchicren with normal inebigence wo will have onset of the disease at less than 9 years of age is closest hich of he folowing? A) 90% 5) 95% ©) 90% D) 63% £) 50% e Or‘A15.year-ld boy is brought othe physician for a well-child examinaton. During the nterview, ne ask the physician ithe wil develop severe acne ike hes 18-year-old brother d althis age. He says" was anful My parents took fim fo the doctor, but nthig helped. Then one day it seemed to go ray on its own” Physical examination shows mi, Scallored open and closed comednes Il this patent develops severe acne vulgaris Val resclves spontaneously over the neXt 3 Years, a rapid increase inthe secretin of Wt : ihe flowing substances wal have been the most bkay cause of te acne? A) Androstanediol 5) Estatiol ©) Gonacetrepin-eleasing homone ) Luteinizing hormone ) Testosterone e Or/Aninvestgator is conductng a study to determine the cause ofan outbreak of iness ata skiled nursing cae fact, A total of 13 residents developed fees, en erythematous ‘and varying degrees of renal mparment curing @2-week peed. A previously unidentified vius fs recovered from urine specimens collected from seven of these patents. Phys Cheracterzaton ofthe uus shows at vial inlet s essential destroyed by heating io 60°C for 30 minutes Based on ts trang, thes vis most ikely has which ofthe fotowing characteristics? A) Enveloped 8) Genome consisting of DNA ©) Genome consisting of RNA D) leesehedeal capsid symmety ) Nonenveloped e Or1A 24-year-old man has a grade 36 systolic murmur Cart caeteriztion shows Pressure (mm Hg) ©, Saturation (%) ° 75 Rigntatnum Right vertrle 20 % Pumonaty artery 3070 1s Lett num +0 % Lettventncle e010 98 pate ‘0770 % Which ofthe folowing isthe most ikely agnosis? A) Aostie stenosis B) Aa septal detect ©) bial regurgitation D) Pulmonic stasis ) Tricuspid regurptaton F) Ventricular soptal defect, e Or‘32-year-old man has a diastolic bloodpressure that consistently ranges between 100 and 110 mm Hg. He's otherwise heathy ands not taking any medications. Serum ‘oncenifations of potassium. glucose, creatine, cholestro. and rc acid are within the reference range. Urine contains onl Wace amauns of poten and ro aburin. He is Untkely lo develop perpheral issue edema because of regulary adjustments in which of te flloning? A) Capitry membrane permeability 8) Lymonatic tow ©) Plasma oncobe pressure D) Postcapiary resistance ) Procapllay resistance F) Systemic venous pressure e Orloctopnysiology of ne heat studied in an anestnotzod experimental animal. Intaly, an ECG shows no abnoxmaiies. Which ofthe flowing procodures s most Maly to produce the ECG anormalty shown? A) Abiation ofthe alrioveneular node 8) Ablation of bundle-branch bers ©) Ableton ofthe sroanal nose D) Destruction of pat ofthe loft ventricle ) Destruction of part ofthe ght atium e Or‘A 16-year-14 gt with bulimia nervosa s brought to the physician by er mather because of @4-month history of nonbody darmea. Her mother is concemed that she's abusin laxatives to maintain alow body wont. The patient 165 cm (55 i fall and wighs 52 kg (1151). BMl is 19 Km Her lemperaiue 637 5°C (68 6°F).puse 120/mn, resprtions are 20!mn, and blood presste = 89161 mm Hy Wiech of fe following sas of serum alactralye concentrations most kal nts pent? Potassium Chloride Bicarbonate a Increased increased normal 5) Increased decreased croasod ©) Unchanged increased © decreased D) Decreased increased creased E) Decteasod “normal »=——ncreasod e Or‘A.43.year-ld woman comes to the physician because she has fainted on three separate occasions dung the past 5 months. After the most recent episode 2 weeks ago, she noticed weakness of her face and right arm, which resolved over the nex 2 days. Her vial sins ae with normal ims. Cardiac examinaton shows amid grade 206 diastolic ‘murmur Ove the apex that becomes more pronounced hen the patent rses from a prone postion. Which of te foloning she most ikely cause of hs pants syncops? A) Atal septa dooct 8) Bicuspé soi vave ©) Fixinous pecicardial etsion ) Lot ail myxoma E) Right venticularoutiow vact obstruction e Or‘A2-yea-0 boy i brought tothe emergency department because of severe abdominal pain end vorntng for 3 hours. He also has had episodes of abdominal pan during the p ‘year Physical examination shows yellowish white papules onthe back, generalized abdominal tendemess, and hepstosplenomegaly. Serum studies show an increased amylas betty ad increased concentrations of fal coleseral tngycerdes and chylomcons. This patent mast likely has a afency inthe achvty of whch ofthe followrng proteins A) LDL-cholesterol receptor 8) Lipoprotein pase ©) Lysosomal acid paso ) Pansat pase ) Phospnoipase © e Or‘A 2-weekold male newborns brought to the physician by his parents because of yellow son for 7 days. The masher is extremely obese. Aith, the newborn was severely Tether and hypoglycomic and was fed both iiravenoush a: wol&s orally with soybosn formula untl the age o 4 days, He has been breast-fed since then. But he has Been \vorstng most of his fedings Physical examinaton shows juice. There's no glucosuria, bul reducing substances are deleced inthe urne. His serum dec! Bruin, Conceritation sIereased. An assay fr wich of the folowlng would have most inal established the agnosis n tvs patent al the ago O 3 oays? A) Fructoknase 5) Fructose ©) Geiactose-1-phosphate undytranstersse D) Glucose.8 phosphatase £) Giucutony transferase F) Lactase e Or‘A65.year-ld man s brought tothe emergency depariment because of iermtentsubstemel chest discomfort over the past 24 hou's Which of the flowing eicosanoids is mo Toi Connbuting ois symptoms? A) Leukotriene By 8B) Loukotnone Dy ©) Loukotnene Fy D) Prostaglandin E, ) Prostaiondin F, |F) Thromboxane As e Or ae‘35-year-old man who isa veterinarian na rural area comes tothe physician because of headache, cough, fatque, and myalgias 2 weeks afer assisting in delvery ofa amb. Temperature is 389°C (102"F) Leukocyte counts 12.000!mm? and hepatic ransamenase actviy is migy increased. An xray ofthe Chest shows the presence of palchy ee eee e eee ee ee eee nee eee Nee ee ete, Tolowng i the most ely causal organism? A) Bacis antracis 8) Cham psitact ©) Coweta bumeti D) Franciseta tularensis ) Reketisianckots“Transmission of a bacterial agent ty person-to-person contacts most ely to occur in which of the fotowing infectious ciseases? A) cholera 8) Logiomaies disease ©) Lyme disease D) Meningococcal meningitis ) Rocky Mountain spotted feverA study's planned to assess oierences in hypertension contal between patients n the USA and those in Westem Eu “The man outcome measure is hyperens ‘contol defined as 2 most recent Blood pressure reading less than 140/90 mm Hig When of he fllonng best describes ts study Gesign? ©) Cross-sectional study‘32-year-old man who lves at ses level aves to @ mountainous region for a2-menth king vacation. On arrival tthe mountainous area, he develops shortness of breath wt ‘exertion Al the end ofhisfst2 weeks of vacation, his exercise tclerance has increased. Its patents bone marrow wore examined at iste, would most TROY Show ‘neteased numbers of which cf te folowing cals? A) Adipocytes 8) Megekeryocjtes ©) Motamyolocyis D) Normabiasts E) Sideropnages e Or‘A. 35.year-ld man comes to he physician because af month history of persistent cough and intermitent nasal discharge He foes well ost of he day, but ater gong tase he wll often awaken with shorness ofbresih. wheezing, diy cough. and chest ighiness. Viel signs ae within normal mits Physical examination shows no dbnormalies, The ‘most appropiate drug for this pabert blocks the receptors fr an endogenous substance thal sa melabolte of whieh ofthe lowing? A) Arachidonic acd 8) Histamine ©) Prostacyin (GI) D) Teranyarotoe acd ) Tryptophan e Or‘A 12.year-1 git is admitted to the hospital fr treatment folowing a generalized tonic-clonic seizwe. She has mid mental retardation and scoliosis. She underwent surgical re foc pata dislocation ofthe fonses in both eyes 3 years ago. Her plasma cystathionine cancentraton is decreased. ACT scan ofthe hosd shows a smal infrcton inthe rh cerebral hemisphere, Which ofthe folowing serum arnino acid concentations's most kely creased inthis patent? A) Glutamine 8) Giycine ©) Loucine ) Methionine ) Phenylalanine e Or‘40-year-old man wit termina smal cellcrcinoma ofthe lung becomes anorectic an lethargic. Fluid restriction sinned because ofa Serum sodium concentration of 120 ‘mEq/L. but there & no inal improvement afr 3 days. Which ofthe folowing is the next most appropiate therapy? |) Cyclophosphamide 8) Demectocycine ©) Indometnacin D) Tncyetic antidepressant E) Vierstine e Or‘60-year-old man comes to he physician because of ¢t-mentn history of headache end czziness, His blood pressure 1 160/86 mm Hg. Physical exeminstion shows madera splenomegaly. Laboratory studies show Hemogbin 2059 Hematoent 55% Erytrocyo count Tema? Moan corpuscular volume eum Lekooye count 48,000/mm* ‘Segmented neurosis Eosmophis Basophis Monocytes Lymphocytes Rod call station with 20% (n ‘Aferal O, saturation aormal \Whsch of the following analytes s most Skly fo be decreased inthis patient? A) Erythropoietin 8) Loukocytoakalino phosphatase ©) Piatott count D) Total ed cell mass £) Une acid e Or‘A 6-month-old male infants bought to the physician because of @2-month history of faire tothe and intractable cares thats worse afer he feeds. Physical examination shows eczemaous detmatis and mild immphadenopaty Fs heesick bod glucose concentrations 200 mgidL.(N-60-100). Genetic testing shows a mutation in the gene fSncading he wanscrptonal poten, FOXPS, The mas Ikely cause of his palens condi sa dacrease im which ofthe folowing T-lymphocyte populabons? AA) CD8+ Tymphocytes 8) Natural ker ces ©) Roguatory T phocytes D) Tyt bmpnocyios E) Ty2 bmpnocyios‘A 31-yoar-la primigavid woman at 32 weeks’ gestation comes othe physician because ofa 3-day isor ot fover and chil. She recently numigrated tothe USA fom Giana. She appears drowsy. Her omporature is 30.4°C (03°F), pues 136!min,respratons are 24%, and blood pressure is 95162 mmm Hg. Prysial examination Shows a bterus consistent size wih a 32 week gestaton. A photomicrograph ofa peripheral bloed smear Shown Ths pants at reales isk for wane of te olewing complications? 1A) Adrenal insuticiency 8) Diabetes insipidus ©) Hypoatycema ) Hypoparainyriasm E) Thyrotoxicosis e Or a eeGenetic analyses of cals obtained on amniocentesis confrm tata fetus has @ familial oss-fsunction genetic mutation hat leads to impairment of G-proteh-coupled receptor. ‘mediated signal ransducton. This defect would most del impair ranscripon of genes whose expression i regulated by which of he folowing hormanes? A) Epineptrine 8) Esvadol ©) Hysrocortsone D) Insulin ) Progesterone F) Testosterone G) Thyroid armone e Or‘The parents ofa 1-year-ol boy wth a bilteral cet plate come tothe physicin for counseling porto conception Both parents have fami history of cet peate. They as ab thertsk of recurrence in future ofspring Which ofthe folowing best describes the pater ofinertance of tis Gsorder? A) Autosomal domeant 8) Autosomal recossivo ©) Mustactona D) Sporadic mutation ) Xinkod e Or‘25-year-old man's brought to the emergency deparment 30 minutes after he sustaned bunt trauma othe abdomen ina motor vehicle colisen. Abdominal examination show mld tenderness but no distention During the next 3 hours, he dovelops progressive abdominl tenderness and swelling. Hs blood pressure decreases fo 90160 mm Hg. ATOR Mid therapy ts baled, and operalverepar ofa ruptured spleens scheduled. Dunng Ine operation, several epsodes of hypotension occur, but he Bloedg is conolled During to next 24 nous, ho develops azotomia. Hoi uly volum-estore, buLTS urine voUme remains Iss than 2D MLN. Line studes aro most Ikaly to show which of te feowing Frings in ts pabent a ts tne? |A) Fractal excretion of sodium groaer than 2% 8) Hemoglobinuria ©) Numerous RBC casts D) Numerous WBC casts ) Ure esmtatty greeter then 1000 mOsm HO e Or‘44-year-old woman comes tothe physician because of a 3:week history of severe heedache. She 157 om (5 2) tl and weighs 86 kg (190 Ib) BM 35 kim? Funduscs texarmnaton shows paplledema. An MR of he bain shows no abnormalities lumbar puncture s done. Cetetrospial fluid (CSF) anal shows an opening pressure of 32mm H.O. In adaton to recommendations regarding deary Changes and waght loss, teatment wth acstazolamde = bagun. Ths drag wll most Ielyimprove the poet's Symotems by which of te following mochanisms? [A) Decreased CSF production by the choroid plus 8) Decreased venous pressure sround the arachnoid ranuitions C) Increased permesbiy of ton junctons (zonulae occludentes) between endothelial cols D) Increased sedium permeably ofthe ependyma £) Increased water transport by astocyte ond-oot processes e Or‘A 30-year-old man reports increesing fatigue and dyspnea on exertion. There ' @ right ventrcular Hf, xed wide spliting ofS and a grade 216 early syste murmur thats heard best a heft Upper stemal border Which of th flowing s the most key clagnosts? A) Aosteinsuficincy 8) Aa sopta dfoct ©) Innocent murmur D) Mil stenosis ) Mil valve prolapse e Or/A62.year-0ld man wth a blood pressure of 20/760 mm Hg requires treatment wth a drug that decreases Near rate and systemic vascular resistance. Which ofthe folowing dru \would acutely dacroase his heat rate and systemic vascular resistance? A) Autor 8) Labotaol ©) Phentolamine D) Prazesin E) Propranolo! e Or‘A65.year-old man with 2 history of gout comes tothe physician because of a 3-day history of pain and sweling of his lt knee related to his condition. The physician prescrnes ‘soproprate medication and recommends thal fhe patent slay as active as possible. Al the follow-up vst 2 dayé lar, the patie states Pat he coninues fohave episodes of Inte actly because of pam. Between episcdes he's ableto wak up toa half mi, but he fhasneted tha he pin in as Kes causes hum to walk more slowly He says," thi \Would ealyNolp mo f you cous authorze a asabled parking pert arm” Which o te following We most aporopnate response by to physician? A) “I cannot authorize the parm because itis intended ony for individuals who are wheelchaic dependent 8) “Iwi authorize the permit, but recommend that you continue wit reguar exercise and onty use the permit when you ae having severe pain ©) “Lwalreter you to physical medicine and rehabitaton spect for a full assessment before | dece fo authonze tis pert ) “Iwould be glad to euhorze the permit but not unt you become more disabled” ®) “would be glad to authorize the part, but you fist need the motor vehicle agency to determine your eligbity™‘A 124year-ol6 woman is severely burned over 35% of her total body surface area ina re. Which ofthe folowing is mast kel fo occur in this patient over he next 7 days? A) lnesoased exracetuar volume 8) Increased metabobe rate C) Increased serum cholesterol concentrabon D) Loss ofB vitamins through denied skin E) Loss of nsuln.dependent glucose transporters e Or‘A 3-day-old male infant wh Down syncrome has had repeated episodes of voting bile. stained fia and has passed only small amounts of meconium-stained stool since bith His stomach s distended Pregnancy was compicated by polinydramnos. Which ofthe folowing s the most Ike diagnosis? A) Duodenal atresia 8) Exvahopatic bar atresia ©) Omphatocete D) Pylorestenesis ) Tracheoesophagea! fistula e Or‘A 70-year-ld man comes to he physician because of decreased urinary output and fatigue during the past 2 days Ais last vst 2 weeks agp, he had 8 Sent history of bilatorsl pan nthe jonts of hs tgers. Hs pue was 72min, and blood pressure was 12082 mm Hg_ Physical examination showed tenderness with ful loon ofthe proximal sll nirphalengeal nis, there was no synovial ickening There were Dory prominences on he distal erphalangeal ans Laborairy studies were ordered, Treatment wi Tbuproten (600 mg ie times day) was started 2 weoks ago. Laboraory studios show. 2Weoks Ago Today Serum ‘Urea nitrogen (ia.) 5 7 Creatinine (maa) " 43 vse oH = 50 Specte gravity = 1015 Blood - negative Glucose 7 hegative Proten = gate snaps = regatve \nich of the fotowing most ikely caused the change in his patents serum urea trogen and creatinine concentrations? A) Increase in blood viscosity 8) Induton of eistl tubular acidosis ©) Inhibition of prostaglandin synnoss D) Postobstructive urepathy ) Preciptaton of myogobin in te tubules4. A’Syoar-old boy who has recently recovered om an upper respiratory tact nection develops easy busing, Examination ‘hows pelochize on the loner exromites. Laboratory studies include Homogoon = 12 gid Hematoent 26 Leukocyte count 000mm? Plait count 18,000"? ‘The entrocyts are normochromic and normecytc A photomicrograph of tssue obtained on bone mow biopsy showm Wh ofthe fallowing is the most ikely mechanssm ofthe tembocylopena?” A) Consumption of plats by intravascular thrombosis 8) Disseminated myecbactaia infacton C) Immune destucton of pales 1) Replacement of bons marc by Stross ) Replacement of bone marow by leukemic els Bre tt oleae‘A pregnant 26:yer-old women is found to have symmetrical enlargement of the ptutary gland on an MR pertomed for head trauma. Which af he following cel ypes accounts the pituitary enirgement? A) Corticotrope 8) Gonadotope ©) Lactate ) Somatalrape E) Tanyowte e Or r Pr edad‘A 48.year-old wornan has severe gastroesophageal efx. Antacds donot provide symptomatic relief Which of the followings the mechanism of action ofthe most effective ‘suppressor of id production? A) Blockade of gastric histaminergic receptors 8) Blockade of gastric mottyrocoptors ©) Innbion of gasine H-K-ATPaso D) Inhibition of gastc muscarnic (M_) receptors E) Inhibition of gastric secretion of prostaglandins e Or‘An 82,yar-old woman is brought othe physician by her daughter because of fecal ncontnence for 2 months, Physical examination shows no abnormalities. Which of he folen 's the most ikely underiyng mechanism of his patents Condon? A) Agangtonoss inthe rectosigmoid region of te large intestine 8) Docroased functon of tho puborectas muscle ©) Enanced sensitwiy ofthe anal canal below he dartate tne ) Hypertrney ofthe intemal anal sphincter E) Painful hemorrhods e Or‘A 45.year-ld woman comes to the physician fora follom-up examination. She has mild renal alu, cholelthasis, and eczema. She is 163 cm (6 fin) tall and weighs 95 kg ( Ip, Bhs 36 kgm Physical examination shows hoarseness and coarse hair Serum studies show typeralycems, increased thyrod slimulang hormone concentration hypercholsterolmia, and hypercalcemia In adcien fo eaiment for hypolnyiissm. pravastatin is prescrbed. This pabent i at lcreased isk or which of te allowing cond ‘a ares of tis woatment? A) Myopatny 8) Neptrothiass, ©) Pancreat ) Toxic hepaitis E) Type 2 diabetes mottus e OrA patent wth « 20-year history of pe 1 dlabetes melitus has episodes ofprotonged hypoglycemia folowing injectonsofnsuin, Which of te folowing isthe most ikely cause the prolonged hypoaiycemia? {8) Decreased hepatic glycogen concentrations 8) Docreased numberof pat catocholamine recoptors ©) Decreased numberof insulin recepios in muscle D) Impaired release of glucagon E) Increased rate of nactvaton of insulin e Or‘A.60.year-ld woman comes to the physician 1 week after she discovered a lump in er night breast. Examination a he right breast shows a 2-cm, palpable mass in the upper Thedilespec Sxamneton oa care heeds ban speci stews env ducal cachons nriunotochmasy shor ovonresin of esvogon an roecerare A) Amplification 8) Anticipation ©) Chromosoma eerrangement ) Imprinting ) Loss ofhetorozygosity e Or Pr edo‘34-year-old woman wit long-standing history of alcoholism comes tothe physician because of Frequent fou-smeting stools for 2 weeks. She has been aomtted to the hosp fo: treatment of slconainduced pancreas eight times within the past 10 years, Vial signs te normal. Abdominal examination shows mild dtention and ympany. The remain he psi! examination shows no abnormalies Treaiment wih a pancreatic enzyme replacement prsparaion begun For dosage adjustments, t's most appropriate 0 ‘monitor whieh ofthe folowing in tis pabonts stoo"? A) Amylase 8) Baciora ©) Fat D) Hydrochloric acid ) Solubo fibers F) Water e Or‘A 70-year-old woman comes to the physician because ofa 3-month history of increasingly severe pan of herons. She says that her fngers have become so st that she can Tonge pay the piano. Physial exaunation shows rheumatod nodules underneath the skin dose fo he ans ofthe Bows and hands The immunelogie mechanism of his patent flarnmation is most sila fo which ofthe lowing? A) Apoptosis of macrophages 8) Mast cell degranuation ©) Natural ke cel king ) Serum sickness E) Wheal and fare roacton e Or‘A32.year-ld woman. gravida 2, para 4, at 39 weeks’ gestation 's admitted to the hospi in bor Her membranes ruptured spontaneously with clear fu. Epidural analgesia initted. Te cervix 8 cm dated and 80% effaced, and the vertex fal ~1 station External electronic fetal monitoring shows « normal fet Hoar rate of 150Tin with variable Spontaneous deceleratons fo 110m. Umblcal cord compressions suspected Which ofthe folowing bes! explans the decease the fla heart ale because of this compression? A) Decreased fetal systemic vascular resistance 8) Decreased maternal systemic vascular resistance ©) Increased fetal systemic vascular resstance D) Increased matemal system vascue resistance ) Nogalve inotropic effect onthe fetal heart muscle F) Posie intopic eect onthe fetal eat muscla e Or‘A. 39.year-ld man comes to he physician fora routine health maintenance examnation. He has no history of major medical ness. His pulse is 62/min, and blood pressure is ‘24/80 mm Hg A grado 36, stole cjechan murmur & hoard st the apex and does not rackato. The murmur Is ouder when the patients staring, An ECG shows lef votricl hypertepny. Ths pabent mest kel has a mulahon in wich of the folowing? A) Collagen, type 1v 8) Cytochrome P50 ©) Endotnein stucturo D) Lysesomal enzymes E) peyosn e Or‘A23.year-old wornan comes to the physician for advice regarding det. She has afamiy history of breast cancer Last week she ead a magazine article that stated that garnm Fadiaton i used as a strlizaion method or many food ifems, such as met and raw poultry She says. Tn concerned thal exposing mys oonzing radio by consuming ‘radaled food cout lead le cancer” Which ofthe olowng nial responses by the phiysican s most apprpa {A) Although there sa small increased risk for adverse health fects rom consuming radiated food itis small compared wit hersk for foodbome ines from improper terization 8) “Because inated food isnot ratoacve, you wi nat be exposed to ionizing ration by consuming i" ©) “Because of your young age, you should avod consumption of iradited ood to minenize your Hetime exposure to ionaing radon. ) “You should be sure to heat wradated food thoroughly so thatthe hazardous by-products of radiation break down during the cooking process” ) “You should imi your consumption of radiated foods to one serving wockly."‘Aninvestaator is studying two drags, Drugs X and Yo determine which has te greterbiosvalabilty na heathy human volunteer The drugs have similar mechanisms of act (Dra ase eae cavalo compared wit run, whch fe fetown parameters sms bebe ret fr Dr X then fr Duy ¥fboth we asi A) Area under the cue 8) Bota hateife ©) Clearance D) Epa (0k eect) ) Volume of strbuton e Or‘A.65.year-old man has had increasing sherness of breath over te last 3 months ana slow increasing low back and hip pain forte last 5 years. High output carcac fale ‘diagnosed. Radiologic sues show exionsve, intermixed osteosclerobc and esteaytic areas his poWe bones Serum calelum concerto fs win the reference range, and Serum alkane phosphatase eclily is markedly ncreased. Whach ofthe followings the most Ikely chagnasis? 1) Aneurysmal bone cyst 8) Angosarcoma ©) Niacin defeioncy D) Ostet detormans (Pagat disease) ) Ostoosarcoma F) Prostatic earcnoma e Or‘A prevcusty heathy 45-year-old man comes tothe physician because of 3-day history of let arm pan and weakness. Use of buproten has proved no relet He does not sm ‘rink elcoho. Hs wil signs are wth normal ints Examinaton of te let upper extremity shows weakness with exeral ration ofthe spaulder ut fl strength with the ek Im edension. There = no weakness on shoulder mi.arc abduction oinlernal elaion. Theres No pain oF Weakness on flexi of the shouler al 30 degroes aga! resistance te elbow tay extended andthe aim uly supinated. The most ikely cause of Ins patents condition is jury fo which of he flowing tendons? A) Biceps 8) Infaspinatus ©) Subscapuienis D) Supraspinatus E) Ticops|ASé.yearold woman win meumatc hear disease is brought othe emergency department 45 minutes afr the onset of severe shormess of rea. Her pulse is 115imin and imegulr respirations are 247m. are blood pressure 110780 men Hg. Crackle are hoard ove he lower lung elds bisteraly Cardia: examination shows a grade 210 syst {echon murmar radiating lo the ight side of be neck thats heard besa the second nght inercostal space. a dastelc murmur heard best atthe apex also present. At ECG ‘Shows ail Wolauon andi al enlargement there no Schema, Which ofthe folowing pumenary mechanisms best explains Ove pavent's dyspnea? A) Arterial hypertension 8) Atelectasis ©) Hemorrnage D) Inve-avecartransudtes ) Vascular consticton e Or{teyucawonan onesto ne pyacen bens oa 7k nay tpg: srs ot MEAS NGM DUES Tvs esos fost2600 30 mines suranga xeton anarchy asi spn She appects mul enmows Fer enooteture ss COHN lce HO ‘expratons aren, end Bood presse TH hyoeaexarinaton shows no aber cbnomalins An ECS show cS SEM Labo steies wee thay o sow wnt tio toning as Une? |A) Decreased arterial Poo 5) Decreased arterial Pos ©) Decreased pH D) Increased serum bicarbonate concentiation ) Increased serum thyroid simulating hormone concentration F) Presence ofan anion gap e Or PP‘40-year-old woman comes to the physician because of 9 1-year history of progesswe facial pufiness and weight gain. She also has had several upper respiratory tract infect uring the past 8 months. Her temperature s 37 2°C (89°F), pulse fs 82min, respiraons sre 18min, and blood pressure i 160/95 mm Hg. Physical examination shows inress fat around the neck local plahora moon facies, red stige over the breasts abomen and butlocks and prooral muscle weakness. Serum sludes show a muy mereased ‘arenoconicorope normono concontrauont “The most kal cause of he ndings in is patien Fyperseereton of hormone Fam a tumor lecsted im which of he folowing organs? A) Aonal conox 8) Hypothalamus ©) Lung D) Pancress JE) Prtary gina e Or a a oe‘49 yeaa man's reered for evaiston of poste hypetenson. On the bai of our measurements, he patents axerage dette Dood pressure i mm Hg, wih 2 ontence rtsrval OCHO MSM. When ofthe fleang Grr MOS ly repr osants Me Bs Condens intent for these data? A) 10810114 8) 1081018 ©) toto 16 D) 1121014 E) 11210 120 F) 1125101135, e Or ere Le‘A 75-year-old man has had progressive lss of hesring in his right ear over the past year Bone conlctes beter thanai-condition inbeHl@ATS. Wich ofthe following sth ‘most kel cause of the heating loss? {) Acoustic neuroma (vestibular schwannoma) 8) Losion of the cochlear nut ©) Loss othair cots ) Maniere dsease E) Otosdorosis e Or a Pf prohtammay‘A 24.year-ld woman comes to the physician because of a 2:week history of smal purple spots ver her legs. She eels wel othensse. Three months ago, she underwent splenectomy for immune trombocytopenic purpura. Her temperatures 37 5°C (895°F), pulses 00min and regular, respirations are 14/min, and blood pressure is 120775 mm Physical seaman shows a wel ealad surgi scar The ngs are lear Cardhac and abdominal examinations show no abnormalities Laboratory stades SO Hemogibin 1359, Hematocnt 40% Loukooyte count 40.000!mm2 Pitot count 25,000mmm> Paria thrombopiastn ime 29sec Pitelet counts done preoperatvely, 1 week postoperatively, and 6 weeks postoperatively were 20,000/mm?,100,000'men» and 220,000imm?, respectively Today a penpherl blood smear shows normal enthrocyte morphology and no HowelJoly bodies, a peripheral blood smear done 6 weeks postoperatively showed the presence of Howell-Joly, bodies: Which ofthe lelowg best explains ths pabents current laboratory Enings? A) Accessory spleen 8) Acute iymphocytc leukemia () Heparin nduced thrombocytopenia D) Postoperative sepsis E) Primary megakaryocyte deficiency e Or rr‘A. 35.year-ld man comes to @ new physician for heath maintenance examination, He has @hisory of itravencus drug use, but he has not used ict rugs for 10 years. He ‘sis fo consuming Sx 12-07 beers Gall He fakes no medications, He i not sexvaly active and has no sferest in iniatng @ relaionship. Physical examination shows gynecomastia, ypogonadism, and spider anglomata. There sno hepalospleramegaly ascies or edema Further evaluation is most likely fo show metabole dystuncion of wi tthe folowing oroans? |A) Adeenal lands 8) Kidneys ©) Liver D) Pituitary gind ) Thyroid oland e Or‘A 10-year-1d boy sustains an abrasion on his left knee. One week ater the injury, epidermal cells cover many arees ofthe abraded skn. Ths stage of wound healing is best ‘explained byte fact that epidermal celts belong fo which ofthe folloing casses of proeratve activity? A) Labia cols 8) Pormanent cols ©) Stabe cls D) Terminal cals ) Transttonal cols e Or‘An 18-fou-d mate newbom i 61cm (24 in) ong and weighs 5483 g(12b). Hs mother has type + diabetes metus His serum glucose concentration is 20mgldL. Which of folowing fl condone modi por pth most Mo precbtsted te newoons DOsMat DORMS? A) Decreased gluconaogenosis 8) Decreased alycogen concontraton ©) Decreased glycogen syninetase acuity 1) Decreased serum inulin concentration E) Increased serum insult growth factor e Or a Pf proiahay‘Amale newbom is delvered at 39 weeks’ gestation afer an uncomplicated pregnancy labor, 2nd delivery Physical exannaton shows prerusion of a short segment of small Intestine trough he abdominal wolf he nant otha umblcus. Thermo ayer covengthis intestine When ofthe lowing ste most hey dagnces? A) Gastoschisis 8) Midgut voWwtus ©) Omphalocete ) Umbical emia E) Urachal fistula e Or‘A.68.year-ld woman has @ S-month history of weskness, fatigue, and weightloss associated wih widespread autommune destructon of both adrenal glands. She has no othe Slandulr dysfunction, Which of the fllring Sts of fds Serum m0 ko? Ne KH a : 5) ft °) 1 4 TF 5) 5) ane 5 8) #) e Or‘Amale newbom s delvered at erm to 8 30-yesr-old woman. The newoom has & malformed ight upper extremity. The woman's husband, mother, and sister aso are in he de room Which ofthe folowing isthe most appropriate nal acbon by the physician? |) Ask th mother and sister to lave the room and inform the parents ofthe abnermalty 8) Cal for the hospital podiatcians to come to the delivery room immodiatoly ©) Conceal he abnormality but alow the parents to noid the baby D) Immediately consult wth the hospalatomey ) Immediately inform the ene family ofthe abnormality inthe devery room ry e Or errr‘A31-year-0ld woman comes the emergency department because of @ headache. She is eer and appears ervieus. Examination shows mutiple contusions on the face and torso, Neurologic examination shows no sbnormalttes, When asked directly about domestic volence, she says hat het husband assaulted her and tht she is afal or he fe, ‘She pleads withthe physician nt fo alow her husband fo en the ireatmant ars he arives inte mrgancy department Win afew menutes har husband arivs an ey tage nurse thane concerned about his wo. Ho says sho fs montaly unstablo and has Deon thetorung to harm hersol, He insists that he be allowed into the weatment aro “wih his wf. Wich ofthe folowing isthe most appropiate next step forthe physician? 'A) Allow the patents husband to jon his wile in the eaten! area, accompanied by hospital secu stat '8) Offer the patents husband information about bateer invention groups and ask him to fave C) Offer th patients husband information about bateer intervention groups an alin he mt remin inthe waling area unt hie wife's evaluation is compe ) Tell the patents husband that he snot alowed nthe treatment area, and that he must remain inthe waitng area ry e Or rrr‘A. 50.year-ld wernan win idepathic careiomyopatny is evaluated by the physician prior to reclving @ hear transplant She immigrated tothe USA from the Dominican Republic 20 years ano, Properatvesetooge studs shor 8 esiveStongyods anita er This pat ast el Gcured his nfecon vs wich fhe folowing modes of A) Drinking water contaminated with larvae 8) Eating watercress contaminated win metacercarae ©) Ingoston of og fom focally contaminatod soil ) Penoration of vae tom sol into te skin E) Porson-o-porson spread of 99s e OrA28yea-o1d woman Wi) TT aT LSTSI Which ofthe folowing labeled segments ofthe nephron was most key involved in the development of phospatur in his patent? 7 e Or‘.43.year-ld woman undergoing chemesherapy fr acute myelogenous leukemia given a blood transfusion for anemia. Shorty after the transfusion i inbted, she develops Chest pain and shortness of ea Her temperature is 36°C (102 2°F) pulse 120/nin resprations are 24imn, and blood pressure fs 8D'50 rm Hy. The ransfusion Immeditay hailed. and samples ofthe patent's Bood and of he remaring unranstused bleed are set for anaiysis. Results show thatthe pabent's blood group is O and the twanstused blood group is A. Which of he folowing oectrs is te most Inet cause of ie symptoms in his patent? A) Bacal products 8) Grcuating immune complexes ©) Mast cel mediators D) Preformed IgM antbodies ) Sonsitzed T bmehocytos e Or‘42 yea-a woman undergoing chematherep fr ast myelogenos edema ena taed enstscn fo enema. Shorty eer the tenstiscn nated she doves Oeetham and stotnows of teal Her eeratnec SIOCES), puso 20san, recprsos are att an Good provare 8660 mm ye tachstn \mmedatalyhaed and aries of th pnts Dood and ol fe cemaning unrated Sd are sat for ans Rises he i at's OOS yo AE ‘Tantus ood tu Vn oto Yotowng ones te mas inet causa othe smote Ns Pala 8) Girculating immune complexes ©) Mast cel mediators D) Preformed igh antbodes e Or a a ee‘50.49 (110-6) experimental enimal eceNes 1L6FS3N Sine nMaENGUSW Which of he following changes in body tid volume ar osmolat s most kel in response tote sale? Inteseetulor Extracellular Volume Osmolality Volume Osmolality a 4 D) 1 E) nochange no change - 7 " e Or a Pe prod‘A32.year-old woman comes othe physician aftr (occured al regular 24- to 35-day tora si {hat datos to 8 wooks Fam ino last monstual port 1 resul of a home pregnancy last was found to be positive. Hor last monstual porod was 8 mooks ago. Menses tad narch at the age of 13 years. Transvaginal ulrasonography confirms a single abo inrautonne prognancy with an ombryo ‘A singio trancaxal utrasound mage of tne uirus shown, he arow indiatos a cyte structure, Which of tho following bo e © ©‘A prevcusty heathy 32-year-old man s brought tothe emergency department by tends 45 minutes afer the sudden onset of severe headache, segues, leftsied weakness ‘nausea thal Bogan wile they were atendng & pay Hs Trends Blove tere may have beon diugs al he pety On arial, nes alert and cooperative. He appears tobe n pai His pulses 120)min resprations are Tame, and bload pressure is 100/100 mmHg. Neurologic examination shovtsbialeraldlaied pups, hyperreflexia and mid hemparesis the loft sido. He is ononted io person. place, and ume. A'CT scan of he Nead shows a 15-cm nemormnage in thong basal gangia. Wiech of to following iste most appropi next step in iagnos:s? A) Echocardiography 8) Lumbar puncture C) Measurement of plasma fee metanepine concantation ) Measurement of urine §hyéroxyindolescetic acd concentration ) Torcology screening e Or‘A27-year-ld woman has headaches and blued vsion. She does net smoke, dink. oF use ilegal drugs. Temperature is 37°C (98 6°F), and blood pressure is 196/142 mm Ho Physical examination shows pepiledems and biatralcostvertebral angle buts. Which ofthe folowing serum concentrabon is mst ikely fo be increased? A) Angetonsn 8) Catocholamines ©) Exytvopoietn D) Serotonin E) Thyroxine e Ora. A 25-year-old man has an ofchectomy fo a receaty detected testicular naoplasm.A bgpsy specimen tm the neoplasm = shown, Which ‘ofthe following are the most ikety calls of onigin of his neoplasm? 8) Germcels ©) Leydig oes ©) Seto cots‘14-year-old boy wih tibial fractures filed with leg cast and progresses satsfaconly or 6 weeks. One week afer the st cast has een replaced, he has pain and numb in tho foot ofthe casted extremnty There is docreased sensation te pinprick onthe anterolateral aspec of fe eg ard dorsum ofthe fot The most key cause fs nerve Compression by ight cast al which ofthe folowing ses? A) Letra malleolus 8) Medial malleolus ©) Modal thal conde }D) Nock of tne tua ) Teal tubocosty e Or‘A 43-year-old women sustains multiple fractures and lacerstons in an automobile colsion. On the second hosptal day she develops tachypnee, tachycardia, and cyanosis, An n Xray ofthe chest shows no abnormatis. but a subsequent xray shows difuse corsoldaton of both lungs, DespteIniensive therapy sho des on the fourth hospital day Which the folowing is most ikely on examination of te lungs at autopsy? A) Bronchiocasis 8) Bronchiots obliterans ©) Hyaline membranes D) Intrstia bosis ) Lobar pneumonia e Or‘A 42.year-old woman comes tothe physician because ofa 2-year history of fatigue and abnarmally heavy. prolonged menses. She has not had abdominal or pec pain, pan wit Urnattono increased urharyfequency, changes in bowel habits. or woghtloss. Pelvic examnation shows a nel ized uterus with no adnexal masses. Her herogioon oncentaton 84 4L_Allotherlaboraloy studies ae win the ralerence ranges Examination of an andometal bopsy specimen shows simple glandular hyperplasia without alypia. Which of folowing best describes the paogenosis of ts patent's endometial disorder? A) Actvaion of G protein coupled receplr by guanosine inphosphate 8) Binding of permeable ligand to nucoar transcription factor ©) Gytekine.induced activation of surface receptor and Janus kinase proteins ) Dimesizatio of surface receptor wih intrinsic twosin kinase ectvity ) Overexpression of epidorma gro factor receptor e Or‘65-year-old man whois @ farmer comes tothe physician because of skin lesions that have been present on his face, arms, and uppe trunk fr the past several years. Biopsies Showa estns tobe acim ertoses bu ore stusmoUs cal crcnora Where elowng set a fesponste ore develope of Sasol crear tpt? |) Decreased function of skin 8 a barrie to carcinogens 8) Disuption of DNA strands secondary to enzaton effect ©) Increased conversion of25-dinycronycholecalcorl to 125-dinydroxychotocaleerot 1) Increased mtote actly Pvough stimulation of melanocytes E) Increased suscoptnity of shan to trauma e Or 5 oy 8/\52.year-old man comes to the physician because of nab o achieve an erecton 6 weeks after undergoing operative removal ofa tumor onthe distal portion ofthe rectum. During the excision, the tumor was found ta be extensively stached fo he pastor aspect of he prostate Damage fo which ofthe olowng nerves the mast kel eause of ti patents symptoms? A) Gray rami rom the sympathatic chain 8) Pete spianchnics ©) Pudonda 1) Superior nypogasine ) Vonial ami of S24 e Or‘A S6.year-old woman comes tothe physician fra heath maintenance examination. Paysica examination shows no abnormalities. Rests of @ Pap smear show epithelial cll abnermaltes, Incuding high rade Squamous intraepithelial lesions, Which of the folowing mechanisms i he most Ikely undevng cause of ho lesions In Ps patent? |) Integration ofa microbial genome into the host genome to induce @ celular proto-oncogene 8) Microbe-induced tvomesomalranstocation ©) Microbe-naucesetvonicitamatory response 1) Microbial oncoprctai hat interferes wih tumor suppressor proteins E) Microbial transcription factor tht induces cellular proto-oncogenes e Or‘45-year-old man's brought tothe physician by his parents because he is reclusive. has "Wer ideas” and stil wants to lve at home. He is dressed in several layers of comes, During te interview he is Cooperative bu he has poor eve contac and seems uninterested nthe nteviow. He says, beseve some people can read oer people's minds | ca these crystals to help me eal self actualzation He has no delusions or hallacnations, This patent most ley has which ft follwing pateonalty disorders? A) Bordering 8) Dependent ©) Histionic D) Narcissistic E) Senzoa F) Schizotypal‘45-year-old woman win coronary artery disease and anemia comes to the physician for assessment of her cardiac persion. Transthoracic color Doppler echocardiography is done. Results sow hal blood flow in Te ante intrventcular (eR areriog descending) branch ofthe coronary artery fs 30 mLman, Arterial blood oxygen concentration i O.15mL OJmL_ Based on ts information, which offs falloaing most Cosel approomales the myocardial oxygen supply to tne lot vente nts patent (mL Onn]? A) 05 8) 15 ©) 20 D) 30 E) 45 F)501 48-year-old man uno is 2 farmer in @remete are of India develops muscle spasms, tismus, and seizures 1 week after sustaining @ puncture wound o his hand from a diy fa tool Which of fhe folowing best describes tre mechanism of action ofthe foxin causing ths Gsease? A) Binding to he MHC class I eceptor and tiggerng the release of cytokines 8) Binding to tre neuromuscular junction and prevention of acetyicholino reloaso| ©) Blockade of a GTP-pnaing protein resulting in no accumulation of CANE D) Blockade of postsynaptic inibiton of spinal mote refiaxes E) Prevention of protein synthesis by blocking elongation of the polypeptide chain e Or/A52.year-old man comes to the physician because of severe recurrent abdominal pain for 6 years. He has a 3-month history of bulky, fou-smeling stools that foat he has hae 8 a 20.) weight oss during ths period He has @ 20-year hestory of alcoholism Agdominal examination shows fenders and le Usper quadralocazation ofthe pan. Which the folomng lps ss most kel o be found in an excessive amount inthe feces ofthis patent? A) Cholesterol 8) Linoleic ecis ©) Oleic acid ) Paimtc aca ) Tagycenas e OrUnite the ONA polymerases found in Escheritva col, RNA polymerase trom this bacterum lacks prooteading activity. Which of te folowing isthe most key reason tat he of proffeading ivy m RNA polymerase does nol compromise ine suvival ofthe species? {A) Messenger RNAS ate too smal o be afeced by tanscrpten erors '8) Mossengor RNAs containing mutations aro not ranslatod ©) Mistakes in tansenpton aro not ransmitd to progeny 1) RNA repair enzymes usualy comct rors made by RNA polymerase durng ranscription ) The fidelity of RNA polymerase exceeds that of DNA polymerases‘A 35,year-la man comes tothe physician because ofa tremor and dict nating body movements since staring haloperidol therapy or schizopivenia 6 weeks ago. Physic ‘exaimation shows masked facies and resting em In addition to daceasing the dose of haloperidl, ls most sppropiate forthe physican fo prescribe which of he (Oo types of medication? A) Anicholnergic agent 8) Antidepressant ©) Hh-potoncyantipsychote agent ) Mood staitzer ) suman e Or\ench of te folowng s present inearalplsma membrane-ssecsted proteins buts absent fom secreted proteins? A) Nike gycosyiaton sto 8) Oinked ayeosyatn sta C) Prosphoryation ste D) Sina sequence ) Transmembrane region e Or © proratA study's conducte to examine the efecveness ofa neuly developed antinyperenswve drug (Drug X) ‘epertnsonaneocimatly 10040200 subst wil esto. Ory X= mart hey n whch he elon phase of on Covecnment™ A) Phase 1 8) Phase 2 ©) Phase 3 D) Phase 4 e Or‘A22.year-ld woman at 12 weeks gestation comes to the physician because of a nour histor ef vagina leeding Physicel examinaton shows a uterus consistent in size wit ‘6.week gosiaton Utresonography shows muliple grapelko ntrauterne structures and na fetus. The paint undergoes removal ofthe abnormal ssue by distaton and Cratiage Which ofthe folowing components ol he issue best corrsses withthe grapetke structures dented daring witasonography? A) Balltke masses of proliferating decidua 8) Hysropic vil rh central cisterns ©) Marko diatod foal blood vossols D) Snootika masses of smeytotropnobiast E) Tortuous loops of unica cod e Or‘A St.yearld woman comesto the physician because of a 1-week history of painin ne ight shoulder. The pan is more severe when she its obects over her head, and tis ‘afecing her work aa eal sore where she is responsibe for stocking shelves. She ais has del sleeping at night because of creased pan when sho lies on er right i She has no histery of mar medical less. Physcal examination shows lenderness ofthe right della regan. There ful passive range of melon bul decreased actve range ‘ation io abduction. Abducion and passive shoulder Nexon ove the hoad produce pain. Duing svengih testing, Te patent nas pan and weakness wit abducvon, pariculary ‘th simuraneous shoulder ntemal rotation, Which of te folowing muscles fs most key acted mths patent? A) Dotoa 8) Subscapuiais JC) Supraspinatus D) Teres minor ) Trapezius e Or‘Soar boy wis ndeging intcton cemnerepy or aie ympobesc leskemiahes 32.5 nr of fever cough, end shoes of beh Hs emperate 3 ote sere aera, yc cmaon sar en ods ee ina rho mth at: AS A) Aderoves 8) Infuenza vas ©) Moasles vius ) Paraintuonza vius ) Varcota-zostor ves e Or ES LL hema‘A25.year-ld woman and her 25.jear-ola husband come to he physician tr counseling pri to cencepton, They both are of Vietnamese descent, Previous seeening showed man crac vou oss han 8 mma ‘henogobirsctophotasshoweanosbnomnaties Ths coupes opxng at rete! tk tr wich Pe blowing |A) Hemoglobin H £8) Hemogiobin S ©) Hemoglobin SC D) @-Thalassomia vat E) p-Thalassemia e Or a © rons‘A 15.year-ld boy has nasal polyps and develops bronchospasms ate taking 8 cup. The drugs mast likey to inhibit which ofthe foowing enzymes inthe biochemical scheme eee 09 eure Ponce A) 08) ec) oD) of‘A 34-year-old woman i brought to the emergency department 30 minutes afer being invoWed in a motor vehicle colision. Sensation o pain 's decreased over the letlower textremty Which of he folowing labeled regions onthe diagram ofthe spinal cord shown is most ikely damaged in his patent? ry e Or rr‘20-year-old man with HIV infection comes tothe office for a folow-up examination He i asymptomatic and tkes no medications. Physica examinaton shows no abnormal His CDés T-lymphocyte counts 584mm? (N2500), and plasma HIV viral load is 180,000 copies. He is prescribed anrevovial therapy, inching ritonavir and another pote ‘aitor (1, Which ofthe following best explain the nlecivenass of rfonavin combination wha second Pints patient? A) It decreases the increased sorum amylase sctvites caused by other Ps, 8) It decreases the risk or pancreatitis ©) Itinereases plasma concentratons of othr Ps also metaboleed by cytochrome P45 D) It signicanty shortens inlvals between dosages of Pis E) It stows tho rat of ipodystiophy associated win aaminisraon of other Pls e Or{A 40.year-1d woman win a history of low-grade folicula ell ymphoma comes to the physician for «flow examination. One week ago, she completed a 4.month course "huenab and isn complete remission She appears wel. This pao at ncreased rsk or which of he folowing Condiions as result of her Weatmen?? A) Bacterial pneumonia 8) Bone marrow falure ©) Development ofa sold tumor ) Hematopoietic malignancy E) Serum sickness e Or{A.26.year-o1d man who js a Peace Corps volunteer comes tothe physician because of @ 2-day history ofnausea ater eating and profs, watery dlarhea without blood. Ther bbeen no fever or chil, He returned frm T-year assignment in Hal 1 day ogo. His temperature is 37 9°C (100.2°F), pulse s 120min, respirations are 20min, and blood press |S 8069 men Hg| Physical examination shows dry mucous membranes, Slool culture grows an oxidase-postve, curved, gars negaive baclus, Which ofthe llomng isthe mo ‘2pproprate immediate Veatment or is patont? |A) Bismuth subsaicyate 8) Ivermectin ©) Metroidazo.e D) Nitazoxande £) 00% Saine e Or‘Amale newbom has a myelomeningacele hat involves the vertebeal aches of L2, Physical examination also shows bisteralcubfeet. Which of the folowing developmental processes is most tkely affecied in tis newborn? A) Axis specticaton 8) Closure of te caudal nourepore ©) Closure of te rostral neuropore D) Development of the apical ectodermal ge E) Development ofthe notochord F) Development ofthe zone of polarizing activity {G) Posanty specication H) Scheduled apootesis e Or‘An asymptomatic 30-year-old woman comes tothe physician fre heath maintenance exeminaton. Physical examination shows a nontender adnexal mass onthe lf Utrasonography confms the presence of a single 6c fudiled cyt. Which of he flowing fs the most Ike cause of tis oveian cyst? 1) Anowlation 8) Ectopic prognancy ©) Endometriosis ) Ovarian malignancy E) Pobic infarmatory disease e OrPhysical analysis of the isolated genomic DNA from a mutant strain of Escherichia co shows that can now be digested info numerous small egmens witha restrcton endonuclease (fo at recognizes the GATC sequence. The DNA fom the wilde parental strain is resistant o digestion vith tis resticion endonuclease. The mutation f Causes ths pe of phenctype i most ikly to oceurin the gane encoding whch of the following acttes? AA) DNase 8) Gyrase ©) Helicase ) Lipase ) Matnyase e Or{yack man cones to he eneency Sepaent becuse of sees soni pg fo hou. He hs poten vera nds equity ised aportnats ha Rhone maior i mol et exanator 2 wens om rpm aborins Pyecal amen tows mid sco AA) Bud. Chiari syndrome 8) Hepatic cmos ©) Pancreate carcinoma D) Portal von thrombosis ) Primary hemochromatosis e Or eS TL heen‘34-year-old woman win a 5-year history of heats G comes tothe physician because of progressive fatigue during he past month. Her veal signs are win nocmal mits. H Tver not palpable. Serum staes show ‘Abumn 39. “otal birt 18 maa, ‘Aaine phosphatase 68 UIL ast S8UL ‘Atr Sau Hor soxum a fetoprotein concentration is within the reference rango. iver bigpsy specimen s most ikely to show which of te following? A) Hepatocelular carcinoma 8) Infitraton oflymohocytes, plasma cls, and macrophages ©) Infitraton ofneurophis and eosinophis, ) Palsscing iympnacytes and giant ces, ) Normal hepatic histology e Or‘An 11-year-old toy is brought tothe physician by his mother because she recently found him naked in bed with his 4-yeer-ol4 male cousin. The cousin was crying. Nether wit toher about the incident But she and her faly are very concerned that something wrong The mati describes Ret son as quiet and says fat hei arly rouble. She ad thal his seno0l pariormancs has decined during the past? months i's most appropriate or vs pen o be evaluated for which ft fowng? A) Altention deciuhyperactvity dsorder 8) Conduct esorder ©) Major depressive disorder 1) Precocious puberty ) Sonual abuse e Or‘An investor is studying the adverse effec of proteasome inhibitor, bortezomib, on immune responses, Bortezomibis administered to a group of patents wth rlepsed ‘multele myeloma, and immune responses are observed: Which of he folowing mune processes i primariyaflected by this drug? A) Activation ofthe complement cascade 8) Actvaton ofporterin ©) Presentation of antgons io GOs T ymphocytes D) Secreton of histamine by mast cas E) Secretion of interleukin (IL-1) by macrophages e Or‘20ers man's tought the emergency Seprment bys end 8 nar er he cite onset ot onson folonng an -ght dance pay 4s pulses 140i, ond Blood pessoa. Physic examination sows bel, ol rents: Theres no Saoheeas ANEGS Shaws snasaveade. This patent mos Ik ae heh of he folowing substances? A) Ketamine 8) Levogepa ©) uso ) Manjuana E) 3-4 Motnyeneaiqymetnampnotamina (MOMA) e Or a © propecia‘Amedical students caring fo @72-yee-cld man who has been admited to the hospital because af @ lung mass. Blopsy shows carcinoma, butthe resident physician instructs student not inform the patient ofthe results unl fer he oncologist has evaluated the patient the next day. The next morning te patient asks the student, "What did my bops Show?” Which of he fellowng responses is most appropriate? 1A) “Eventing is okay” 8) “I don't know, but the oncologist wil be seeing you ater today’ ©) “itwas postive fr cancer: D) “Let me get no esidont physician so we can go over the resus ) “The results are not back yo.” e Or‘A68.year-1d woman comesto the ofce because of 8 3-month history of increased daytime and nightime urineton and pan of her low back. She had cervical cancer 15 years ‘ago. at which me she underwent hysterectomy wih bilateral salingo-cophoreciomy Sie also recived extemal beam radiation tothe pels. Physical examination shows no palpable abdominal mastes’ Laboratory sides show increased serum concentrations cl urea mifogen and creatine and dacreased yrne esmolaty Renal ulrasonography Sows Diatoral nyaronophrosis and hydrouto, wit distal ureteral narrowing Diaieraly. Wcn of fo folowing best explains tne fangs ints pationt? A) Recurrent ceva carcinoma 8) Retroperitoneal fess ©) Uretral condyioma D) Uretral ransitona cel papiloma £) Urotela carcinoma e Or‘researchers asked to prospectively investigate the prevalence and incidence of decubitus ulcers in 100 residents of a nursing care facity during a 2-year period. At the binning ofthe study, 10 resents are found fo have decubius ucers. During the fst yea. fve addtional residents develop decubius ulcers. and another 10 residents develo ecubisucers during the second year Three ofthe previously noted ulcers have compelaly healed by ts endo te 2year prod. National standards fr nursing care faci ‘mandate tha the prevalonce of dacubtus Ucers should bo loss than 20% o the total residents nthe fay, andthe incidence of now decubeus ulcers shouldbe less than. 50 per 1000 panent years Wich of te followings tre most appropriate concusion regarding te prevalence and incidence of decubus ulcers this population athe end oft 2.yesr period? Prevalence Incidence a ‘Above the standard above the standard 5) ‘Above the siandard below the stanaara °) ‘Below the standard above he standard D) Below tho standard below the standard e Or‘A S5.year-ld man who hes @ 10-year history of type 2clabetes melts comes tothe physician because of fecal incontnence. Which af the folowing addtional symptoms is ma Tey in hs patient? A) Dysuia 8) Impotence ©) Inabity to cmp stars D) Nighttime leg cramps E) Sciatica e Or r Prec