1.

During embryological development certain cells has been induced to undergo

programmed cell death. In the course of this developmental process an
apoptosome forms within those cells.
Which of the following is required for this process?
(A) Energy in the form of ATP
(B) Fas death receptor signaling
(C) Loss of mitochondria from cells
(D) Plasma membrane rupture
(E) Release of enzymes from cells

2.
A forensic pathologist investigating a homicide is wants to rule out cellular
necrosis from programmed cell death. A population of cells is being grown in the
laboratory and the total number of viable cells is observed to decrease. Analysis
of Bax protein reveals an increase in its expression.
Which of the following findings may be used to confirm that apoptosis
is occurring in this cell population not cellular necrosis?
(C) Phosphatidylserine on the outer membrane leaflet
(A) Increased expression of Bcl-2 protein
(B) Intracellular enzymes in the culture medium
(D) Release of mitochondria from the dying cells
(E) Visualization of ruptured plasma membranes

3.
A research student is studying the various proteins and enzymes involved in
prokaryotic DNA replication. The investigator studies cultured E. Coli to better
understand it’s replication processes. He notes E. Coli’s replication is bi-
directional and originates at a single origin of replication and consists of three
steps: Initiation, elongation, and termination.
Which of the following enzymes that participate in prokaryotic
replication is listed in the correct order?
(E) Primase, Polymerase III, Polymerase I (5′→3′ exonuclease activity),
Polymerase I (5′→3′ polymerase activity), Polymerase I (3′→5′ exonuclease
activity), and Ligase
(A) Ligase, Primase, Polymerase III, Polymerase I (5′→3′ exonuclease activity),
Polymerase I (5′→3′ polymerase activity), and Polymerase I (3′→5′ exonuclease
activity)
(B) Polymerase I (3′→5′ exonuclease activity), Primase, Polymerase III,
Polymerase I (5′→3′ exonuclease activity), Polymerase I (5′→3′ polymerase
activity), and Ligase
(C) Polymerase I (5′→3′ polymerase activity), Primase, Polymerase III,
Polymerase I (5′→3′ exonuclease activity), Polymerase I (3′→5′ exonuclease
activity), and Ligase
(D) Polymerase III, Primase, Polymerase I (5′→3′ exonuclease activity),
Polymerase I (5′→3′ polymerase activity), Polymerase I (3′→5′ exonuclease
activity), and Ligase

4.
A baby is born with two congenital disorders, tetrology of fallot and pulmonary
atresia, which cause severe cardiac and respiratory complications and require
major surgeries to correct them. In this baby, complication are so severe the
prognosis of survival is low despite the surgery. The parents are willing to move
forward with aggressive treatment as they will do anything for their baby’s
survival. The surgical procedures discussed may extend survival but come with
significant morbidity and are unlikely to improve the baby’s quality of life.
Which of the following describes the best way for a physician to
proceed in this case?
(C) The physicians should proceed with the course of action that will cause the
least pain and suffering to the baby
(B) The physicians should proceed with a course of action in the interest of the
baby to extend life
(A) The physicians should advise the parents of the prognosis of the baby with
surgical intervention
(D) The physicians should respect and follow through with the wishes of the
baby as represented by her parents

5.
A 15-year-old female presents to her endocrinologist for her regular check-up
and to refill a prescription insulin. She has been seen by her doctor from a
young age after being diagnosed with type I diabetes mellitus, a disease
characterized by a gradual destruction of pancreatic islet cells leading to little or
no insulin production. Insulin is an essential hormone in the body structurally
rich in disulfide bonds, known to stabilize the amount of sugar in your
bloodstream.
Which of the following amino acids is necessary in the formation of
these disulfide bonds?
(B) Cysteine
(A) Arginine
(C) Leucine
(D) Threonine
(E) Tryptophan
6.
A 2-year-old boy is admitted to the hospital with pain and hearing defect. An MRI
examination reveals that he has developmental defects in the auditory tube and
middle ear cavity.
Which of the following pharyngeal pouches is most likely developed
abnormally?
(B) First pouch
(A) First pharyngeal cleft
(C) Fourth pouch
(D) Second pouch
(E) Third pouch

7.
A 4-year-old boy is admitted to the hospital with pain and hearing defect. An MRI
examination reveals that he has developmental defects in the external auditory
meatus.
Which of the following pharyngeal derivatives is most likely developed
abnormally?
(A) First pharyngeal cleft
(B) First pharyngeal pouch
(C) Fourth pharyngeal pouch
(D) Second pharyngeal pouch
(E) Third pharyngeal pouch

8.
A newborn baby boy presents with maxillofacial malformations including cleft
palate, glossoptosis, and micrognathia. These findings clearly suggest that the
cartilage and muscles arising from the pharyngeal arch failed to develop
correctly.
The medial and lateral pterygoid muscles originate embryologically
from which of the following?
(A) Pharyngeal arch 1
(B) Pharyngeal arch 2
(C) Pharyngeal arch 3
(D) Pharyngeal arch 4
(E) Pharyngeal arch 6

9.
A newborn is seen by the pediatrician for a general checkup. Upon the
examination of the eyes, ears, and throat the physician notices the
maldevelopment of the first pharyngeal pouch.
The first pharyngeal pouch during embryonic weeks 4 to 5 is most
likely to result in a congenital disorder of which of the following
structures?
(E) Tympanic cavity
(A) Facial muscles
(B) Parathyroid glands
(C) Thymus gland
(D) Thyroid gland

10.
A 45-year-old women presents with a 4-week history of severely painful toes on
her right foot. She denies any trauma; she also denies any fever or chills. She
has a past medical history of moderate psoriasis on her elbows and knees
bilaterally, which has responded to topical corticosteroids and calcipotriene. She
also has a history of irritable bowel disease, for which she is on fiber
supplements. On physical exam, her 2nd and 3rd digits of the right foot are
swollen and tender to palpation throughout. Erythema and swelling are noted
over the length of the two toes, each resembling a sausage. Range of motion of
the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints in the
right foot 2nd and 3rd digits is greatly reduced. Additionally, it is noted that her
vital signs are normal and that there is evidence of minimal hyperkeratosis on
her bilateral elbows and knees. The physician tells her that she most likely has
psoriatic arthritis, but he wants to run some more tests to confirm. He explains
that in psoriatic arthritis there is periarticular erosions of cortical bones and/or
“pencil-in-cup” deformities due to erosion at the end of the bone.
If the physician wanted imaging done to see these erosions, which of
the following imaging modalities would be best to use?
(E) X-Ray
(A) CT scan
(B) MRI
(C) PET scan
(D) Ultrasound

11.
A 16-year-old female presents to the pediatrics clinic for evaluation for possible
scoliosis. She has no symptoms that she has noticed, but came to the clinic
after a scoliosis screening at her high school was abnormal. She is otherwise
healthy with no significant medical issues. Physical exam shows slightly
unequal height of shoulders when standing upright and a noticeable lateral
curvature of the spine when observing her spine when she bends forward. After
obtaining a spinal x-ray, the patient is determined to have a curvature of 15° in
her lumbar spine.
Which of the following is the most likely first-line treatment for this
patient’s scoliosis?
(B) Observation
(D) Physical therapy
(A) Bracing
(C) Orthopedic referral
(E) Surgical intervention

12.
A 78-year-old elderly man at a nursing home has been having progressive
cognitive decline within the past few weeks. The patient is confused and
agitative with staff and visiting family members. The attending physician
suspects encephalopathy.
Cerebrospinal fluid is withdrawn by lumbar puncture for further
examination, which of the following structures is most likely
penetrated by the needle?
(C) Ligamentum flavum
(A) Annulus fibrosus
(B) Filum terminale externum
(D) Pia mater
(E) Posterior longitudinal ligament

13.
A 45-year-old male presents with a recent history of low back pain for one week.
He works as a construction worker, but does not remember any trauma. He just
noted the pain upon awakening one morning. He denies any fever, chills, or
neurologic changes.
Which of the following is the best recommendation for the patient?
(A) Activity as tolerated
(B) Chiropractic manipulation
(C) Massage therapy
(D) Physical therapy
(E) Strict bed rest

14.
A 56-year-old man presents to the emergency room complaining of severe back
pain after he was jumping on a trampoline with his grandson. On exam he
appears in moderate distress, has a pulse of 104/min, and a blood pressure of
146/84 mm Hg. He is unable to stand up without pain and prefers to lie down in
a knee-chest position. He demonstrates weakness of extension of his great toe
with associated numbness on top of his foot and the first web space. An MRI of
his back indicates he has a bulging disc at the L4-5 lumbar vertebrae.
Which of the following statements most accurately describes his
condition?
(A) It is associated with a posteriorly displaced nucleus pulposus
(B) It is associated with abnormal rib facets on the lumbar bodies
(C) It is associated with an abnormal disc in the atlanto-axial joint
(D) It is associated with an increase in water content within the nucleus
pulposus
(E) It is associated with the subsequent development of a hemivertebrae

15.
A 30-year-old woman presents with a history of periodic pain and muscle
spasms in her left upper limb. There is an associated history of loss of sensation
on the radial side of the left upper limb. Physical examination reveal marked
tenderness in the neck region. MRI of the cervical spine reveals posterolateral
herniation of the C5-6 intervertebral disc with spinal nerve roots compression.
Which of the following structures is this herniation likely impinging?
(D) C6 spinal nerve roots
(A) C3 spinal nerve roots
(B) C4 spinal nerve roots
(C) C5 spinal nerve roots
(E) C7 spinal nerve roots

16.
After a jarring blow to the left anterior shoulder region, a young female field
hockey player was told by an examining physician that she had torn a muscle.
The physician told her it was caused by the superolateral displacement of a
fractured coracoid process.
Which muscle was torn?
(C) Pectoralis minor
(A) Deltoid
(B) Pectoralis major
(D) Serratus anterior
(E) Subclavius
17.
A 19-year-old man goes to his primary care physician complaining of soreness in
his left wrist after falling on an outstretched hand during a baseball game two
days ago. He is unable to use his left wrist and indicates that the pain worsens
with movement but when it’s stabilized there is no pain. Physical examination
reveals no loss of feeling in his hand, nor does he have trouble grasping or
holding objects. The physician palpates the wrist by applying pressure to the
base of the thumb in the anatomical snuffbox eliciting a painful response.
Which of the following carpal bones would the radiographic imaging
confirm a break in?
(D) Scaphoid
(A) Capitate
(B) Hamate
(C) Pisiform
(E) Trapezium

18.
A 74-year-old man comes to the emergency room after a hard fall onto the
lateral aspect of his right shoulder during a brisk walk to his mailbox. He
complains of generalized pain during shoulder motion. On physical examination,
the distal end of the clavicle is prominent and distinctly palpable. Imaging of the
affected area confirm the diagnosis of a severe shoulder separation.
Which of the following features is a component of this condition?
(E) Torn coracoclavicular ligament
(A) Dislocated head of the humerus
(B) Dislocated sternal end of the clavicle
(C) Fractured clavicle
(D) Torn anterior glenohumeral ligament

19.
A 15-year-old male arrives at his campus health clinic complaining of pain in his
left wrist. He explains he landed on an outstretched hand when he was tripped
in a soccer game. He indicates that the pain worsens with movement and is
minimized by stabilization of the wrist. Physical examination reveals no loss of
feeling in his hand, nor does he have trouble grasping or holding objects. The
physician palpates the wrist by applying pressure to the anatomic snuffbox
between the extensor pollicis brevis and extensor pollicis longus tendons which
does not elicit a painful response by the patient. Radiographic studies show no
fractures but reveal an anterior dislocation of a bone in the proximal row of
carpal bones.
Which of the following carpal bones is most likely dislocated in this
patient?
(B) Lunate
(C) Scaphoid
(A) Capitate
(D) Trapezium
(E) Triquetrum

20.
A graduate student is studying two types of muscle tissue to better understand
the mechanisms of muscle contraction. He examines both smooth and striated
muscle tissues under laboratory conditions inducing contraction in both
samples.
Which of the following contractile mechanisms is required in striated
muscle only?
(A) Calcium-Troponin C binding
(B) Cyclic guanosine monophosphate (cGMP)
(C) Myosin light chain phosphorylation
(D) Myosin light-chain phosphatase activation
(E) Presence of intracellular calcium