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1.Anincreaseinwhichofthefollowingbestexplainsthemechanism
bywhichthecardiacoutputincreasesinsevereanemia?
A.
Arteriolardiameter
B.
Bloodviscosity
C.
Peripheralvascularresistance
D.
Splanchnicbloodflow
E.
Tissueoxygentension
Answer
2.A2yearoldretardedchildisevaluatedbyametabolic
specialist.Thechild'shistoryissignificantforfailureto
thriveandprogressiveneurologicdeterioration,includingdeafness
andblindness.Physicalexaminationisremarkableforhepatosplenomegaly
,aswellasacherryredspotonfunduscopicexamination.Thesesymptoms
areconsistentwithadiagnosisof
A.
Huntersyndrome
B.
NiemannPickdisease
C.
Pompe'sdisease
D.
tyrosinosis
E.
vonGierke'sdisease
Answer
3.An8montholdfemalechildisbroughttomedica
lattentionbecauseherfirstfourteethshowseveraldiscrete,
discolored,circumferentialbandsthatshowverylittleenamel.
Excessivelevelsofwhichofthefollowingmayhaveproducedthisdefect?
A.
Bilirubin
B.
Fluoride
C.
Parathormone
D.
Thyroidhormone
E.
VitaminC
Answer
4.Whichofthefollowingcomplicationsiscurrentlythemajo
rlimitationtothelongtermsuccessofcardiactransplantation?
A.
Allograftrejection
B.
Graftarteriosclerosis
C.
Graftatherosclerosis
D.
Opportunisticinfections
E.
Lymphoma
Answer
5>.Achilddevelopsatumorofthecerebellum.Biopsyreveals
evidenceofbothneuronalandglialdifferentiation.Whichofthe
followingisthemostlikelydiagnosis?
A.
Astrocytoma
B.
Glioblastomamultiforme
C.
Medulloblastoma
D.
Meningioma
E.
Oligodendroglioma
Answer
6>.A56yearoldmanvisitshisphysicianwithcomplaintsof
completeexhaustionaftermowingthelawninhissmallfront
yard.Healsocomplainsofdizziness,irritability,difficulty
sleeping,andlossoflibido.Onphysicalexamination,theman's
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skin,conjunctiva,andoralmucosaarepale.Abloodtestindicates
theman'shemoglobinis7g/dL.Whichofthefollowingfindingsis
alsolikelytobepresentinthisman?
A.
Bradycardia
B.
Cyanosis
C.
Lowstrokevolume
D.
Warmhands
E.
Widepulsepressure
Answer
7>.A55yearoldmanhadbeeningoodhealthsincereceivingaheart
transplantforsevereatheroscleroticdisease.Fiveyearsafter
transplantation,thepatientdiedsuddenly,withoutanypremonitory
symptoms,whileworkinginhisgarden.Hehadbeenmaintainedon
cyclosporinsincehistransplant.Whichofthefollowingcomplications
wouldmostlikelybefoundatautopsyinthetransplantedheart?
A.
Allograftrejection
B.
Atherosclerosisofcoronaryarteries
C.
Graftvasculardisease
D.
Hyalinearteriolosclerosis
E.
Hyperplasticarteriolosclerosis
Answer
8.Anelderlyladyisbroughttotheemergencyroomafterdrinking
insecticidethatshethoughtwastea.Afterherstomachispumped,
hersenseofsmellistestedanditisfoundthatshecannotdistinguish
commonsmells(e.g.,anorange,coffee).CTscanoftheheaddemonstrates
amassintheolfactorygroovearea.Theaxonslikelycompressedbythis
massprojecttowhichofthefollowingstructures?
A.
Insula
B.
Nucleusambiguus
C.
Postcentralgyrus
D.
Precentralgyrus
E.
Pyriformcortex
Answer
9.A27yearoldmandevelopsbilateralparotidglandswellingand
orchitis,andisgenerallyillwithfeverof102F.Whichofthe
followingsubstancesismostlikelytobesignificantlyelevatedin
thepatient'sserum?
A.
Alanineaminotransferase(ALT)
B.
Amylase
C.
Aspartateaminotransferase(AST)
D.
Ceruloplasmin
E.
Creatinephosphokinase,MBisoenzyme(CPKMB)
Answer
10.A55yearoldmanpresentstotheemergencyroomwithcrushing
substernalpainandleftshoulderpainof2hoursduration.Thepain
isnotrelievedbysublingualnitroglycerin,andtheelectrocardiogram
showsSTelevationinseveralleads.Aspirinandstreptokinasetherapy
areinitiated,andthepatientisadmittedtotheintensivecareunit.
Thenextmorning,serumcardiacenzymesareelevatedto4timestheupper
limitofnormal,andtheelectrocardiographicchangesarestillpresent.
Whichofthefollowingisthemostlikelydiagnosis?
A.
Prinzmetal'sangina
B.
Stableangina
C.
Subendocardialinfarction
D.
Transmuralinfarction
E.
Unstableangina
Answer
11Whichofthefollowingaminoacidsisposttranslationally
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hydroxylatedinthecytoplasmoffibroblasts?
A.
Cysteine
B.
Glycine
C.
Proline
D.
Serine
E.
Tyrosine
Answer
12.Microscopicexaminationofacancercellrevealsacell
inanabnormaltelophaseinwhichthreeclustersofchromosomes
areseen.Anabnormalityofwhichofthefollowingwouldbemost
likelytoproducethisalteration?
A.
Chiasma
B.
Mitoticspindle
C.
Mosaicism
D.
Polarbody
E.
Synapsis
Answer
13.A58yearoldmanwithfaintingspellsandexerciseintolerance
isfoundtohaveabicuspidaorticvalvewithmarkedaorticstenosis.
Whichofthefollowingphysicalfindingswouldbeprominentinthispatient?
A.
Diastolicmurmur
B.
Heaveatleftparasternalborder
C.
LoudS2heartsound
D.
LoudS3heartsound
E.
Weakperipheralpulse
Answer
14.A57yearoldfemaleisfoundunconsciousonherkitchenfloorafter
havingsufferedamyocardialinfarction.Shehaspulmonaryedemaand
distendedjugularandperipheralveins.Amidsystolicgallopisheard
uponchestauscultation.EKGshowsprominentQwavesinleadsII,III,
andaVF.Whichofthefollowingismostconsistentwiththepatient's
condition?
Preload
CardiacoutputPAWP CVP
Vascularresistance
Mixedvenousoxygen
A.
Increased
Decreased
Decreased
Increased
Increased
Decreased
B.
Increased
Increased
Decreased
Decreased
Decreased
Increased
C.
Increased
Decreased
Increased
Increased
Increased
Decreased
D.
Increased
Increased
Increased
Increased
Decreased
Decreased
E.
Decreased
Decreased
Increased
Decreased
Increased
Decreased
F.
Decreased
Increased
Decreased
Increased
Decreased
Increased
G.
Decreased
Decreased
Increased
Decreased
Decreased
Decreased
Answer
15.A48yearoldmancomplainingofchestpainisbroughttothe
emergencyroom.Physicalexaminationfollowedbyechocardiography
demonstratesaorticstenosis.Hiscoronarybloodflowisincreased.
Whichofthefollowingisthemostlikelyexplanationfortheincreased
coronarybloodflowinthisindividual?
A.
Decreasedleftventricularoxygenconsumption
B.
Decreasedleftventricularpressure
C.
Decreasedleftventricularwork
D.
Increasedcardiactissueadenosineconcentration
E.
Increasedcardiactissueoxygenconcentration
Answer
16.A45yearoldmanpresentstotheemergencydepartmentwithsevere
headacheandvomiting.ACTscanshowsawellcircumscribedcysticlesion
withinthe3rdventricle;thereisnocalciumdeposition.Thecystis
surgicallyremoved.Onhistologicexamination,thewallofthecyst
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consistsofasinglelayerofmucinproducingcolumnarepitheliumwith
aciliatedapicalsurface.Whichofthefollowingisthemostlikely
diagnosis?
A.
Colloidcyst
B.
Craniopharyngioma
C.
Cysticercosis
D.
Echinococcuscyst
E.
Pilocyticastrocytoma
Answer
17.A36yearoldfemaleisbroughttotheemergencyroombyher
husbandwhosaysthatshe"complainedofasevereheadachethenlost
consciousness."Shehasahistoryofhypertensionandhadbeenonseveral
differentmedications.Theexaminingphysiciannotesthatsheisunable
tomoveherarmsandlegs,butcanblinkhereyes.Whenthephysicianasks
hertoblinktwiceifshecanhearhim,shepromptlydoesso.Inwhichof
thefollowingstructuresisthiswoman'slesionmostlikelylocated?
A.
Cervicalspinalcord
B.
Medullaoblongata
C.
Midbrain
D.
Pons
E.
Thalamus
Answer
18.A71yearoldmanhasbeeninexcellenthealth,andpracticing
competentlyasanattorney.Heisbroughttotheemergencyroom
followingamotorvehicleaccident.Aworkup,includingimagingof
thespine,thorax,andhead,isnegative,butthepatientisadmitted
forovernightobservation.Hisinjuriesincludeseverallacerationsto
thefaceandextremitiesaswellasseveralcontusionstothethorax.
Threeweekslater,heisadmittedtothehospitalforconfusion.
Aneurologicexamisnormalexceptthatheisnotorientedtotime
orplace,andcanrecallonly1outof6objectsafter3minutes.
Whichofthefollowingisthemostlikelydiagnosis?
A.
Alzheimer'sdisease
B.
Brainmetastases
C.
Epiduralhematoma
D.
Normalpressurehydrocephalus
E.
Subduralhematoma
Answer
19.Aworkdiagramshowingchangesinleftventricularvolumeand
pressureduringonecardiaccycleisshownaboveforanormalheart
(diagramA)andfollowingaorticvalvulardisease(diagramB).DiagramB
showswhichofthefollowingcomparedtodiagramA?
A.
Decreasedworkforagreaterstrokevolume
B.
Decreasedworkforalowerstrokevolume
C.
Decreasedworkforthesamestrokevolume
D.
Increasedworkforagreaterstrokevolume
E.
Increasedworkforalowerstrokevolume
F.
Increasedworkforthesamestrokevolume
Answer
20.An80yearoldwomandiesafteralonghistoryofprogressivememoryloss,
apraxia,andrecurrentepisodesofconfusion.Inthelastmonthsoflifeshe
wasbedriddenandunabletorecognizefamiliarfacesandobjects.The
pathologistidentifiesnumerousflameshapedintracytoplasmicinclusions
inneuronsoftheneocortexandhippocampus.Theseconsistofpaired
helicalfilaments(PHFs)onelectronmicroscopy.Whichofthefollowing
biochemicalchangesmostlikelyaccountsforthedevelopmentofPHFsin
thiscondition?
A.
Abnormaldegradationofamyloidprecursorprotein(APP)
B.
Abnormalphosphorylationoftau
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Answer
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C.
D.
E.
Accumulationofadvancedglycosylationend(AGE)products
IncreasedexpressionofAPP
Precipitationofinsolubleatubulin
21.Theactivityofwhichofthefollowingenzymesisdirectlyaffected
bycitrate?
A.
Fructose2,6bisphosphatase
B.
Isocitratedehydrogenase
C.
PhosphofructokinaseI
D.
Pyruvatecarboxylase
E.
6phosphogluconatedehydrogenase
Answer
22.WhichofthefollowingstructuresisfoundonlyinGramnegative
microorganisms?
A.
Cellenvelope
B.
Exotoxin
C.
Peptidoglycan
D.
Periplasmicspace
E.
Teichoicacids
23.Ascientistwishestostudyfreeradicalproductionunderischemic
conditions.Hedecidestoproducecerebralischemiabytyingoffanartery
ofthebrain.Ligationofwhichofthefollowingarterieswouldbemost
likelytoproducesignificantischemicdamage?
A.Anteriorcerebralarteryatitsoriginfromtheinternalcarotidartery
B.Anteriorcommunicatingartery
C.Middlecerebralarteryatitsoriginfromtheinternalcarotidartery
D.Posteriorcerebralarteryatitsoriginfromthebasilarartery
E.
Posteriorcommunicatingartery
Answer
24.A52yearoldwomanhaslongstandingrheumatoidarthritis(RA)and
isbeingtreatedwithcorticosteroidsandnonsteroidalantiinflammatory
drugs(NSAIDs).Whichofthefollowingcardiaccomplicationsmayarisein
thisclinicalsetting?
A.
Constrictivepericarditis
B.
Dilatedcardiomyopathy
C.
Hypersensitivitymyocarditis
D.
Hypertrophiccardiomyopathy
E.
Restrictivecardiomyopathy
Answer
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