N ationa: Board o f M ed ica l Examiners - G o o g le C hrom e

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Exam Section 1: Item 1 o f 50 ■ M ark

N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment

T im e R em aining: 4 hr 19 m in 0 sec

1. A 64-year-old woman comes to the physician because of a 6-month history of heartburn and difficulty swallowing solid food and liquid. She has not had nausea or vomiting. She also has a 2-year history of pain and swelling of her wrists and hands. She has not seen a physician in 5 years. She takes no medications. She does not smoke. Physical examination shows no wrinkles on the face and neck. Her vital signs are within normal limits. There is synovial thickening of the wrists bilaterally. A photograph of the left hand is shown. Abdominal examination shows no abnormalities. Which of the following sets of findings is most likely on esophageal manometry?

Esophageal Peristalsis
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Lower Esophageal Sphincter Tone
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Exam Section 1: Item 2 o f 50 I Mark

N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment

T im e R em aining: 4 hr 16 m in 41 sec

2. A 31-year-old woman is evaluated because of a 1-year history of infertility. Her hysterosalpingogram is shown. The most likely cause of these findings is malformation of which of the following embryonic tissues? © A) Germ cells B) Gonadal ridges C) Mesonephric (wolffian) ducts D) Paramesonephric (mullerian) ducts © E) Urogenital folds F) Urogenital sinus "S T s T -

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Exam Section 1: Item 3 o f 50 I Mark

N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment

T im e R em aining: 4 hr 16 m in 4 sec

3. A 52-year-old man with a family history of renal failure comes to the physician because of abdominal pain over the past 6 months. He has been treated in the past for renal calculi and hypertension. Physical examination shows bilateral palpable masses in the upper abdomen. Urinalysis shows crenated erythrocytes and mild proteinuria. A CT scan of the abdomen identifies the cause of the patient's problem. Which of the following is the most likely diagnosis? A) Adrenal adenoma B) Glomerulonephritis O C) Henoch-Schonlein purpura O D) Polycystic kidney disease E) Renal cell adenoma

N ationa: Board o f M ed ica l Examiners - G o o g le C hrom e

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Exam Section 1: Item 4 o f 50 ■ M ark

N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment

T im e R em aining: 4 hr 13 m in 31 sec

4. A 55-year-old man comes to the physician because of two episodes of painless, blood-tinged urine during the past week. His last episode was 2 days ago. He has smoked 1 pack of cigarettes daily for 35 years. Vital signs are within normal limits. Physical examination shows no abnormalities. Urinalysis shows normal findings except for microscopic blood. Which of the following is the most likely diagnosis? O A) Bladder cancer B) Bladder diverticulum C) Interstitial cystitis D) Nephrolithiasis O E) Urinary tract infection

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10:52 AM 28/08/2012

formation of tumor nodules in the liver is prevented.eom /api/5. A clone of the B-16 melanoma cells is injected intravenously into the tail vein of mice.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 1: Item 5 o f 50 ■ M ark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 12 m in 14 sec 5.l. and 3 weeks later tumor nodules are found in the lungs. A mouse melanoma.starttest. is highly metastatic. In vitro studies do not show any cytotoxic effect of the antibody on B-16 or hepatic cells.0/ITDStart. When an antibody to a liver cell surface antigen is injected 1 hour prior to injection of the B-16 melanoma cells. liver. and ovaries.5 10:53 AM 28/08/2012 . Which of the following processes is most likely to be affected by the antibody? O A) Homing B) Initiation O C) Invasion O D) Motility O E) Progression O F) Promotion o o 31l ? « $ Tpr F Previous Next Lab Values @ Review © Help Pause C l ■ il m Hu ^4 ^ 1. B-16.1.G o o g le C hrom e [ o | 0 Q h ttps://w vvw . but tumor nodules develop in the ovaries and lungs.N ationa: Board o f M ed ica l Examiners .

The annual incidence of this condition is 15 per 100.000 people. which of the following represents the annual mortality rate for subarachnoid hemorrhage per 100. Based on these data.com/api/5.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 ^ Exam Section 1: Item 6 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 6 m in 13 sec 6.000 © C) 0.1.6 x 15 © D) 0. A retrospective study is conducted to assess the incidence and outcome of subarachnoid hemorrhage in a midwestern state. and the case fatality rate is 40%.4 x 100.4 x 15 © B) 0.starttest.1.000 people in this state? © A) 0.r -■' National Board o f Medical Examiners .6 x 100.000 .0/TTDStart.Google Chrome https://www.

com/api/5. Microscopic examination of the removed specimen shows scattered mesenchymal cells in an abundant extracellular matrix.0/ITDStart.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 ^ Exam Section 1: Item 7 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 51 m in 22 sec 7.1. Angiography of the left lower extremity shows complete obstruction of the distal left femoral artery by what appears to be a thrombus. The occlusion is removed using a catheter.r -■' National Board o f Medical Examiners . Examination of the left lower extremity shows only a markedly decreased pulse in the left lower extremity. Echocardiography confirms a diagnosis of cardiac tumor.Google Chrome https://www. A 24-year-old woman comes to the physician because of a 1-day history of pain in her left leg while walking. Her temperature is 37°C (98. pulse is 84/min.6°F).starttest. This patient most likely has which of the following types of cardiac tumors? O A) Fibroelastoma O B) Fibroma C) Hamartoma O D) Hemangioma O E) Myxoma .1. and blood pressure is 135/78 mm Hg. An intermittent faint diastolic heart murmur is heard at the apex.

N a tio n a i Board o f M ed ica l Examiners .aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 1: Item 8 o f 50 ■ M ark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 49 m in 1 sec 8. Two years ago. and generalized weakness.e o m /a p i/5 . She has a lifelong history of chronic diarrhea. Laboratory studies show erythrocytes with spiny projections and a serum total cholesterol concentration of 40 mg/dL. There is ataxia and loss of deep tendon reflexes.0/TTDStart.sta rtte st. Which of the following apolipoproteins is most likely deficient in this patient? © A) Apo A-l © B) Apo A-ll © C) Apo B © D) Apo C © E) Apo E o Previous o Next $ @ Lab Values © Review Help Pause ? « T p r F 3 1 l m H u . V 11:16 AM 28/08/2012 . An 18-year-old woman with mild mental retardation is brought to the physician because of a 3-day history of decreased ability to see in reduced light.l. she developed a lack of muscle control of her arms and legs. Ophthalmologic examination shows bilateral retinitis pigmentosa.1. Her 16-year-old brother has had similar symptoms.G o o g le C hrom e [ o | 0 Q h ttp s://w w w .

starttest.com/api/5. The patient asks the physician for extra pain medication to "kill me because I can't take it anymore. he was admitted to the hospital each time for treatment of the pain.1.r -■' National Board o f Medical Examiners ." Which of the following initial actions by the physician regarding the patient's request is most appropriate? A) Contact the hospital ethics committee B) Restrain the patient C) Reevaluate the patient after his pain has been controlled D) Administer general anesthesia for sedation O E) Comply with the patient's request . A 21 -year-old African American man with sickle cell disease is brought to the emergency department 2 hours after the sudden onset of severe pain in his abdomen and knees. He has had six similar episodes within the past 4 years.Google Chrome https://www.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 ^ Exam Section 1: Item 9 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 47 m in 43 sec 9. His course has been complicated by two episodes of pneumonia and a small cerebral infarction in the past 2 years.1.0/TTDStart.

She says that she has not sought treatment because her symptoms are not severe. A 40-year-old woman comes to the physician for genetic counseling because of a family history of muscle weakness. Sequence analysis of mitochondrial DNA shows a mutation in 50% of the mother's mitochondrial DNA and in 100% of each of her children's mitochondrial DNA.r -■' National Board o f Medical Examiners .0/ITDStart.Google Chrome https://www.1.1.starttest. but her children have profound muscle weakness and fatigue.5 11:25 AM 28/08/2012 . Which of the following genetic principles best explains the findings in this family? A) Anticipation O B) Genetic drift O C) Heteroplasmy D) Imprinting E) Pseudodominant inheritance f i l l 1 2 3 100% 100% 100% 4 100% O □ # ■ U naffected fem ale Unaffected male A ffected fem ale A ffected m ale o Previous o Next $ @ Lab Values © Review Help Pause -a ■ ^ il ? « T p r F 3 1 l m H u 4 1.com/api/5.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 ^ Exam Section 1: Item 10 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 40 m in 18 sec 10. A pedigree is shown.

0/TTDStart.1.l.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 '0 !» ■ & ■ ! Exam Section 1: Item 11 o f 50 H Mark National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment Tim e Remaining: 3 hr 37 min 44 sec 11. The concentration of which of the following substances will most likely be higher in the effluent from the left renal vein than that from the right renal vein? O A )A D H (vasopressin) O B) Aldosterone 0 C) Endothelin 0 D) Epinephrine o E) Renin Previous Lab Values ® Review Help Pause O * .. a cuff occluder is placed on the left renal artery of a normal rat and inflated to cause a 90% decrease in the cross-sectional area of the artery.Google Chrome Q h ttps://w w w .ill ><> s fTi 11:28 AM 28/08/2012 .eom /a p i/5 .N ational Board o f Medical Examiners . During an experiment.sta rttest. A catheter is placed in the left and right renal veins to sample the effluent.

He is a painter and says that yesterday he cleaned up a spilled bottle of paint thinner.1.r- N a tio n a l Board o f M ed ica l Examiners .l.e o m /a p i/5 . The most appropriate pharmacotherapy for this patient is most likely to inhibit the activity of which of the following? A) Alcohol dehydrogenase B) Aldehyde dehydrogenase C) Formaldehyde dehydrogenase D) Lactate dehydrogenase O E) Pyruvate dehydrogenase . vomiting.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 1: Item 12 o f 50 ■ Mark National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment Tim e Remaining: 3 hr 37 min 35 sec 12.G o o g le C hrom e [ a j (P Q h ttp s://w w w . confusion. Ophthalmologic examination shows dilated pupils with hyperemia of the optic disc and retinal edema. Serum studies show an anion gap metabolic acidosis.0/TTDStart.sta rtte st. Physical examination shows tachypnea. and difficulty walking. A previously healthy 32-year-old man is brought to the emergency department because of a 1-day history of intermittent flashing spots and blurred vision.

Which of the following best describes the process in this patient? A) Blockade of inhibitory neurotransmitter release B) Cell death in central nervous system neurons C) Cell death in muscles D) Cell death in peripheral nervous system neurons O E) Demyelinization .aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 ^ Exam Section 1: Item 13 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 35 m in 50 sec 13.starttest. He has received no medical care for 30 years.1.com/api/5. Physical examination shows trismus and opisthotonos.r -■' National Board o f Medical Examiners . He sustained a puncture wound to his arm 1 week ago. shoulders. A 48-year-old man is brought to the emergency department because of difficulty opening his mouth and stiffness of his neck. and back for 4 hours.Google Chrome https://www.1.0/TTDStart.

Ophthalmologic examination shows hemianopia and a tendency to gaze to the right. Neurologic examination shows left-sided numbness and paralysis that are more severe in the face and upper extremity than in the lower extremity.1.0/TTDStart.1.r -■' National Board o f Medical Examiners . She has a 2-year history of atrial fibrillation.Google Chrome https://www. She has difficulty understanding and answering questions. slurred speech. and confusion.starttest. A 76-year-old woman is brought to the emergency department because of a 3-hour history of severe headache.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 ^ Exam Section 1: Item 14 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 35 m in 34 sec 14. but she is cooperative.com/api/5. Which of the following arteries is most likely involved in this patient's condition? O A) Anterior cerebral O B) Anterior spinal O C) Middle cerebral O D) Posterior cerebral O E) Vertebral . The pupils are normal sized and reactive to light.

com/api/5. Physical examination shows point tenderness over the T6 vertebra. Serum studies show a calcium concentration of 13.0/ITDStart.1.1.starttest. urinalysis shows Bence Jones proteins.r -■' National Board o f Medical Examiners .25-dihydroxycholecalciferol production . Which of the following is the most likely cause of this patient's hypercalcemia? A) Excessive parathyroid hormone production B) Excessive parathyroid hormone-related protein production C) Increased fractional calcium gastrointestinal absorption O D) Local interleukin-1 (IL-1) and tumor necrosis factor effects E) Unregulated 1.4 mg/dl_.Google Chrome https://www.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 ^ Exam Section 1: Item 15 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 34 m in 19 sec 15. A 54-year-old woman comes to the physician because of a 5-day history of severe mid-back pain.

com/api/5. Twelve-hours later. he begins sucking frantically and crying inconsolably. A male newborn is delivered at 38 weeks' gestation following an uncomplicated pregnancy. The most likely explanation for these symptoms is maternal use of which of the following substances during pregnancy? O A) Alcohol 0 B) Heroin © C) LSD D) 0 Marijuana E) Psilocybin .Google Chrome https://www.0/ITDStart.starttest. The symptoms slowly resolve over the next 2 to 3 weeks. He overreacts to stimuli around him and has a marked startle response.r -■' National Board o f Medical Examiners .1.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 ^ Exam Section 1: Item 16 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 31 m in 41 sec 16.1.

r -■' National Board o f Medical Examiners . she also has had four episodes of urinary incontinence. nonspecific white-matter plaques.com/api/5. A 27-year-old woman comes to the physician because of a 2-year history of sporadic double vision and a 1-year history of intermittent numbness and tingling in her arms.starttest. On mental status examination.0/ITDStart.1.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 ^ Exam Section 1: Item 17 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 28 m in 23 sec 17. scattered. The symptoms became more severe 5 days ago after a 4-day visit from her husband's parents.1. MRI of the brain shows a few small.Google Chrome https://www. Which of the following is the most likely diagnosis? A) Complex partial seizure disorder O B) Conversion disorder O C) Huntington disease o D) Multiple sclerosis E) Panic disorder without agoraphobia . During the past year. she has a mildly worried mood and a reactive affect. Physical examination shows mild dysarthria.

0/TTDStart.N ationa: Board o f M ed ica l Examiners .T|[ ^4 ^ 1. Examination of the uterus shows fragments of placenta adherent to the uterine wall. and the patient undergoes an emergency hysterectomy to control the bleeding. para 2.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 1: Item 18 o f 50 ■ M ark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 28 m in 14 sec 18.sta rtte st.5 11:37 AM 28/08/2012 .1. There is absence of the decidua basalis.G o o g le C hrom e [ o | 0 Q h ttp s://w w w . The hemorrhage continues during the next hour. Which of the following is the most likely diagnosis? O A) Abruptio placentae O B) Chronic villitis C) Circumvallate placenta D) Placenta accreta O E) Succenturiate lobe o o 31l ? « $ Tpr F Previous Next Lab Values @ Review © Help Pause C l ■ il m r[^ .l. develops severe vaginal bleeding immediately after vaginal delivery of a male newborn at term.e o m /a p i/5 . gravida 2. A 30-year-old woman.

He has a history of cirrhosis of the liver caused by hepatitis C.1.starttest. Administration of which of the following drugs is most likely to improve this patient's mental status? O A) Bisacodyl O B) Docusate © C) Lactulose 0 D) Octreotide 0. His temperature is 37°C (98. Test of the stool for occult blood is negative. Physical examination shows scleral icterus. He is easily arousable despite the lethargy. asterixis.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 ^ Exam Section 1: Item 19 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 27 m in 45 sec 19. E) Omeprazole 0 F) Sucralfate 0 G) Ursodiol o Previous o Next $ @ Lab Values © Review Help Pause ^ ■ ^ il ? « T p r F 3 1 l m H u 4 1.r -■' National Board o f Medical Examiners . a protuberant abdomen.1.0/TTDStart. A 55-year-old man with hepatic encephalopathy is brought to the physician because of confusion and increased lethargy during the past 24 hours.5 11:38 AM 28/08/2012 . and ascites.6°F).com/api/5.Google Chrome https://www.

The physician plans to initiate treatment. A 76-year-old man is admitted to the hospital because of a 2-week history of a persistent urinary tract infection.35 L/kg. BMI is 20 kg/m2.1.starttest. A component of the initial treatment includes an intravenous bolus dose of an antibiotic to attain an initial peak serum concentration of 8 mg/L. Laboratory studies show a 24-hour urine creatinine clearance within the reference range.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 ^ Exam Section 1: Item 20 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 27 m in 17 sec 20. The volume of distribution of the antibiotic is 0.com/api/5.0/ITDStart. He is 165 cm (5 ft 5 in) and weighs 55 kg (121 lb).Google Chrome https://www. Which of the following is the most appropriate loading dose of this drug for this patient (in mg)? © A) 25 © B) 50 © C) 100 © D ) 150 © E )200 p 1 Previous Lab Values Review Pause 11:38 AM 28/08/2012 .1.r -■' National Board o f Medical Examiners .

his heart rate increases.r National Board o f Medical Examiners . A healthy 22-year-old man is a subject in a study investigating the regulation of heart rate during exercise.com/api/5.0/TTDStart.1.1. He is sitting on a stationary bicycle and is instructed to begin pedaling in 5 minutes. One minute before he begins to pedal.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 1: Item 21 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 17 m in 39 sec 21.Google Chrome Q https:/?www. An increase in which of the following transmitters acting at the indicated receptor best explains the increase in heart rate in this man? Transmitter © © © © © A) B) C) D) E) Acetylcholine Acetylcholine Norepinephrine Norepinephrine Norepinephrine Receptor muscarinic nicotinic a pi P2 .starttest.

Google Chrome Q https:/?www.0/TTDStart.1.1.r National Board o f Medical Examiners .starttest. A 15-year-old boy has intracranial neoplasms. mental retardation. Which of the following best explains the findings in the boy and his mother? A) Alternate paternity B) Anticipation C) Parental germline mosaicism O D) Reduced penetrance E) Variable expressivity . His 41-year-old mother is healthy but has angiofibromas.com/api/5. and seizures associated with tuberous sclerosis complex. which are benign skin lesions characteristic of tuberous sclerosis complex. an autosomal dominant disorder.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 1: Item 22 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 16 m in 12 sec 22.

*V 11:51 AM 28/08/2012 . A photograph of a coronal section of the brain obtained at autopsy is shown. She had a 25-year history of a wellcontrolled seizure disorder. Despite appropriate treatment. *" .1. A 40-year-old woman is brought to the emergency department 30 minutes after sustaining severe chest injuries in a motor vehicle collision.com/api/5. Which of the following is the most likely cause of this patient's seizure disorder? A) Glioblastoma multiforme B) Herpes simplex encephalitis C) Mesial temporal sclerosis D) Neonatal ischemic stroke E) Vascular malformation o o re*reii ? « Previous Next Lab Values @ Review © © Help Pause q b T iri.Google Chrome Q https:/?www.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 1: Item 23 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 14 m in 45 sec 23.starttest.r National Board o f Medical Examiners .0/TTDStart.1. she dies 1 hour later.

there are no crackles. Wheezes are heard over the right upper lobe anteriorly. Laboratory studies show: Serum Na+ K+ c i3 Urea nitrogen Creatinine Osmolality hco Urine osmolality 125 mEq/L 3.starttest.6-lb) weight loss during the past month.4 x 1. He has hypertension treated with metoprolol.Google Chrome Q https://w vvw .9 mEq/L 85 mEq/L 25 mEq/L 8 mg/dL 0.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 1: Item 24 o f 50 H Mark National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment Tim e Remaining: 3 hr 12 min 3 sec 24. spiculated noncalcified mass in the right upper lobe eroding into the right bronchus.0/TTDStart. He has smoked 2 packs of cigarettes daily for 32 years.1. He also has had a 3-kg (6.2-cm. This patient's laboratory findings are most likely caused by an excess of which of the following hormones? O A) ADH (vasopressin) O B) Adrenocorticotropic hormone O C) Brain natriuretic peptide © D) Cortisol O E) Thyroxine (T4) Previous O Next o Lab Values @ Review © Help Pause ? « $ Tpr F31l 1 PS l^ ip r .eom /api/5.4 mg/dL 262 mOsmol/kg 564 mOsmol/kg A CT scan of the chest shows a 2. Hu ■ il ^ ^ 4 1.5 11:54 AM 28/08/2012 . A 51-year-old man comes to the physician because of a 2-week history of cough productive of blood. Physical examination shows clubbing of the fingernails.r National Board o f Medical Examiners .l.

His diet consists of a healthy balance of fruits.1.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 1: Item 25 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 10 m in 48 sec 25. He has a 10-year history of chronic autoimmune (Hashimoto) thyroiditis treated with thyroxine.Google Chrome Q https:/?www.com/api/5.0/TTDStart. Serum studies show increased concentrations of methylmalonic acid and total homocysteine.starttest.r National Board o f Medical Examiners . A 60-year-old man comes to the physician because of weakness and light-headedness for 3 months. Physical examination shows pallor. and lean chicken and fish. A peripheral blood smear shows megaloblastic anemia. Which of the following is the most likely cause of the findings in this patient? A) Cystathionine 3-synthase deficiency O B) Failure of intrinsic factor production © C) Folic acid deficiency D) Helicobacter pylori gastritis E) Methylmalonyl-CoA mutase deficiency .1. vegetables. whole grains.

sta rtte st. During the procedure.l.5 11:56 AM 28/08/2012 .r National Board o f Medical Examiners .1. Identification and incision of which of the following structures that attaches to the cervical region and extends posteriorly is most appropriate in this patient? C A) Mesometrium B) D) Mesosalpinx Ovarian ligament C C) Mesovarium C E) Round ligament of the uterus F) Uterosacral ligament Previous O ? o « $ Tpr F31l Next Lab Values @ Review © Help Pause m r[^ .e o m /a p i/5 .T|[ ■ il ^4 ^ 1.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 1: Item 26 o f 50 H Mark National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment Tim e Remaining: 3 hr 9 min 28 sec 26. the uterus must be separated from all surrounding pelvic structures.0/TTDStart.Google Chrome Q h ttp s://w w w . A 55-year-old woman is scheduled to undergo transvaginal hysterectomy and oophorectomy for dysfunctional uterine bleeding.

A 33-year-old woman comes to the physician because of a 16-kg (35-lb) weight gain during the past 6 months despite dieting.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 1: Item 27 o f 50 H Mark National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment Tim e Remaining: 3 hr 8 min 51 sec 27. and purple striae over the abdomen.r National Board o f Medical Examiners . An MRI shows a mass in the pituitary gland. She is 168 cm (5 ft 6 in) tall and now weighs 104 kg (230 lb). A CT scan of the abdomen shows enlarged adrenal glands.sta rtte st. Her blood pressure is 156/96 mm Hg.e o m /a p i/5 . Which of the following histologic changes would be expected in this patient's adrenal glands? A) Cortical hyperplasia C B) Cortical hypertrophy C) Cortical metaplasia D) Medullary hyperplasia E) Medullary hypertrophy F) Medullary metaplasia O o 31 ? « $ Tpr F Previous Next l Lab Values @ Review © Help Pause © ■ il m Hu ^4 -a 1. excess weight predominantly in the shoulders and abdomen.l.5 11:57 AM 28/08/2012 . BMI is 37 kg/m2.Google Chrome Q h ttp s://w w w . ruddy face with hirsutism.0/TTDStart. Physical examination shows a round.1.

com/api/5. Laboratory studies show a platelet count of 250. The findings in this patient are most consistent with which of the following conditions? A) C) Antiphospholipid antibody syndrome Increased factor VIII (antihemophilic factor) concentration O B) Factor V Leiden mutation © D) Protein C deficiency © E) Prothrombin G20210A mutation .r National Board o f Medical Examiners .000/mm3.starttest. One year ago.Google Chrome Q https:/?www. a prothrombin time within the reference range. Two years ago. she delivered a female stillborn at 23 weeks' gestation.0/TTDStart.1. Physical examination today shows no abnormalities.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 1: Item 28 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 6 m in 43 sec 28. she was diagnosed with a pulmonary embolism.1. A 22-year-old woman comes to the physician for a follow-up examination. and an increased partial thromboplastin time.

A 54-year-old man comes to the physician because of a 2-week history of burning epigastric pain.starttest.1.r National Board o f Medical Examiners . A peptic ulcer is suspected. He is recently divorced.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 1: Item 29 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 5 m in 17 sec 29.0/TTDStart.1.Google Chrome Q https:/?www.com/api/5. He was treated for Helicobacter pylori infection 1 year ago. Abdominal examination shows tenderness to deep palpation of the epigastric area. He uses high doses (600 mg daily) of over-the-counter ibuprofen for chronic joint pain. He smokes cigars and drinks one to two 12-ounce cans of beer on the weekends. Which of the following is the strongest predisposing risk factor for this patient's condition? O A) High-fat diet O B) Ibuprofen use O C) Ingestion of alcohol D) Recent psychosocial stressor O E) Smoking cigars . His diet mainly consists of fast food.

BMI is 32 kg/m2.r National Board o f Medical Examiners . a bimanual examination is limited by the patient's obesity. She is 165 cm (5 ft 5 in) tall and weighs 88 kg (195 lb). pulse is 88/min.2°F).com/api/5.starttest. Which of the following is the most likely cause of this patient's infertility? A) Hypothyroidism B) Klinefelter syndrome C) Pituitary adenoma D) Polycystic ovarian syndrome E) Primary ovarian failure .8°C (98.Google Chrome Q https:/?www. and blood pressure is 140/90 mm Hg. respirations are 14/min. Pelvic examination shows no abnormalities of the exterior genitalia. She has had irregular menses since menarche at the age of 13 years.1. Physical examination shows moderate hirsutism and mild acne over the face and back. A 22-year-old nulligravid woman comes to the physician because she has been unable to conceive for 18 months. Her temperature is 36.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 1: Item 30 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 4 m in 11 sec 30.0/TTDStart.1.

0/TTDStart. Physical examination shows pain on movement of the right shoulder and a tender right clavicle. Which of the following structures of the clavicle will most likely assist in producing new bone to heal this fracture? O A) Epiphysis B) Haversian canal © C) Lamella © D) Periosteum E) Volkmann canal .aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 1: Item 31 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 3 m in 14 sec 31. An x-ray of the shoulder shows a nondisplaced fracture of the right clavicle.1.com/api/5. A 9-year-old girl is brought to the emergency department by her father because of severe pain in her right shoulder after a fall 1 hour ago.starttest.Google Chrome Q https:/?www.1.r National Board o f Medical Examiners .

0/TTDStart.l.Google Chrome Q h ttp s://w w w .1. A 2-month-old boy dies of meningitis despite appropriate antibiotic therapy. Which of the following immunodeficiencies most likely explains this familial history? C A) Complement deficiency C B) Interferon-Y receptor deficiency C C) Leukocyte adhesion deficiency D)X-linked agammaglobulinemia Mycobacterium tuberculosis.e o m /a p i/5 .aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 1: Item 32 o f 50 H Mark National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment Tim e Remaining: 3 hr 1 min 30 sec 32.sta rtte st. Two of his brothers died of atypical Previous O p 1 Lab Values Review © Pause C l 12:04 PM 28/08/2012 .r National Board o f Medical Examiners . Culture of his cerebrospinal fluid grows mycobacterial infections.

An openlung biopsy specimen is obtained and shows a pattern of acute lung injury. The presence of which of the following in the biopsy specimen most clearly suggests diffuse alveolar damage rather than bronchiolitis obliterans-organizing pneumonia in this patient? A) Alveolar hyaline membrane B) Foamy macrophages C) Interstitial collagen deposition O D) Masson bodies E) Uniform fibroblastic proliferation .1.starttest.0/ITDStart.Google Chrome Q https:/7www.1.r National Board o f Medical Examiners . A previously healthy 25-year-old man is admitted to the hospital for treatment of viral pneumonia.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 1: Item 33 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 1 m in 15 sec 33. He is mechanically ventilated because of respiratoryfailure due to hypoxemia.com/api/5.

1.0/ITDStart.r National Board o f Medical Examiners .starttest.com/api/5.1.Google Chrome Q https:/7www. unrelated donor. the transplant is rejected after 6 months. Which of the following is the most likely cause of rejection of the transplant in this patient? O A) Antibody synthesis O B) Complement activation O C) Direct cytotoxicity D) Histamine release O E) Nitric oxide production . A 39-year-old woman with end-stage renal disease caused by systemic lupus erythematosus undergoes kidney transplantation from a living. Analysis of a biopsy specimen of the transplant shows numerous infiltrating CD8+ T lymphocytes.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 1: Item 34 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 2 hr 59 m in 45 sec 34. Despite aggressive immunosuppressive therapy.

Google Chrome Q https:/?www. She refuses to sleep alone and recently would not attend her friend's birthday slumber party. Her father recalls that he behaved the same way when he was her age.1.r National Board o f Medical Examiners .1. She calls to her mother if she is in another room of the house.com/api/5. Her mother recently returned to work full-time and says that she is quite angry that her daughter is behaving in such a defiant way. A 7-year-old girl is brought to the physician by her parents because of a 3-year history of temper tantrums when her parents leave her.starttest. Which of the following is the most likely explanation for this patient's behavior? O A) Conduct disorder B) Oppositional defiant disorder C) Post-traumatic stress disorder D) Separation anxiety disorder O E) Normal behavior . Each morning.0/TTDStart. the patient's teacher has to carry her into school crying.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 1: Item 35 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 2 hr 58 m in 11 sec 35.

r National Board o f Medical Examiners . A 49-year-old man with pancreatic cancer undergoes a Whipple procedure to resect the distal stomach. Which of the following nerve structures can be cut to decrease stomach acid output and decrease the likelihood of ulcers forming in the jejunum at the site of junction with the stomach? O A) Celiac plexus B) Iliohypogastric nerves © C) Phrenic nerves O D) Subcostal nerves O E) Sympathetic chain O F) Vagal trunks . and head of the pancreas.1.1.com/api/5. the cut end of the remaining stomach is joined to the side of the jejunum (gastrojejunostomy).0/TTDStart.Google Chrome Q https:/?www. duodenum.starttest.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 1: Item 36 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 2 hr 56 m in 25 sec 36. During the procedure.

starttest.Google Chrome Q https:/?www. Which of the following best explains the longevity of the herpes simplex virus? A) Continual replication in dendritic cells B) Continual replication in epithelial cells of the skin C) Continual replication in sacral root ganglia D) Continual replication in T lymphocytes E) Establishment of a latent infection in B lymphocytes F) Establishment of a latent infection in circulating immune cells G) Establishment of a latent infection in epithelial cells of the skin H) Establishment of a latent infection in sensory nerve cells .aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 1: Item 37 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 2 hr 56 m in 9 sec 37. "I've been taking the medication. He says.0/TTDStart. He has a 5-year history of recurrent episodes of genital herpes treated with acyclovir. When will I be cured?" The physician informs him that herpes simplex is a lifelong infection.1.r National Board o f Medical Examiners .com/api/5. but I still occasionally get lesions. with no cure at the present time. A 35-year-old man comes to the physician for a routine examination.1.

A 3-year-old boy is brought to the emergency department because of multiple ecchymoses.r National Board o f Medical Examiners .Google Chrome Q https:/?www.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 1: Item 38 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 2 hr 52 m in 57 sec 38.1. and bloody diarrhea 48 hours after ingesting an unknown quantity of warfarin that he took from his grandmother's purse. bleeding into the joints.com/api/5.1. parenterally . Prothrombin time is 80 sec (INR=20).0/TTDStart.starttest. Which of the following is the most appropriate initial therapy? A) C) Factor IX (plasma thromboplastin component) concentrate Fresh frozen plasma O B) Fibrinogen concentrate O D) Platelet concentrates E) Vitamin B 12(cyanocobalamin).

com/api/5.1. suggestive of a tear. An 18-year-old man comes to the physician 6 hours after he twisted his ankle while playing football.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 1: Item 39 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 2 hr 52 m in 4 sec 39.r National Board o f Medical Examiners .0/TTDStart. Lack of which of the following components in the ligament will most likely limit healing of this injury? O A) Blood vessels O B) Collagen fibers O C) Elastic fibers O D) Lymphatic vessels © E) Nerves .1.starttest. Physical examination shows looseness of the lateral collateral ligament.Google Chrome Q https:/?www.

Examination shows no abnormalities of the skin. and vomiting that began 4 hours after attending a friend's birthday party.0/TTDStart.r National Board o f Medical Examiners .starttest.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 1: Item 40 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 2 hr 51 m in 17 sec 40. She appears acutely ill and mildly dehydrated. Which of the following is the most likely cause of these findings? O A) Bacteremia B) Enterotoxin ingestion C) Intestinal mucosa inflammation O D) Lead toxicity E) Villus atrophy © F)Virem ia . and blood pressure is 96/60 mm Hg. Her temperature is 37°C (98. respirations are 20/min.1.6°F). A previously healthy 6-year-old girl is brought to the emergency department because of severe abdominal pain.Google Chrome Q https:/?www.1. Cake and other pastries were served at the party. pulse is 104/min. Bowel sounds are hyperactive. nausea.com/api/5.

She says she wants to go out with friends. preferring individual activities such as hiking.5 12:16 PM 28/08/2012 . She says he seems indifferent to sexual intimacy and neither shows much emotion nor understands her feelings at all.0/TTDStart.Google Chrome Q https://w vvw .l.starttest.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 1: Item 41 o f 50 H Mark National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment Tim e Remaining: 2 hr 50 min 2 sec 41. but he does not enjoy being with people. During the interview. Which of the following personality styles best explains the husband's behavior? © A) Avoidant C B) Narcissistic © C) Paranoid D) Schizoid C E) Schizotypal O o 31 ? « $ Tpr F Previous Next l Lab Values @ Review © Help Pause m Hu ■ il ^4 ^ 1.1. A 28-year-old woman comes to the physician for a health maintenance examination.r National Board o f Medical Examiners . she tearfully tells the physician that she and her new husband are having problems.eom /api/5.

l.startte st.. A 23-year-old woman is treated with acetazolamide to prevent acute altitude sickness 3 days before going on a mountain-climbing expedition.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 I <=> I © ■ £3— *| — Exam Section 1: Item 42 o f 50 H Mark National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment Tim e Remaining: 2 hr 48 min 16 sec 42. Acetazolamide acts predominately in which of the following areas of the kidney in this patient? O A) Ascending loop of Henle O B) Collecting ducts O C) Descending loop of Henle © D) Distal tubule © E) Proximal tubule Previous Lab Values ® Review Help Pause O * .^ National Beard of Medical Examiners .1.e om /a p i/5 .ill ><> s fTi 12:18 PM 28/08/2012 .Google Chrome Q h ttps://w w w .0/TTDStart.

A study is conducted to assess the effectiveness of vitamin C in preventing common colds in children.1.1.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 1: Item 43 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 2 hr 47 m in 47 sec 43. Outcome events (common cold) are reported by the parents on a monthly basis for 1 year.Google Chrome Q https:/?www.0/TTDStart.05).com/api/5.r National Board o f Medical Examiners . Which of the following raises the most concern about the validity of the conclusion that vitamin C supplements prevent the common cold? A) Inadequate statistical power O B) Nonrandomization O C) Selection bias D) Variability in outcome assessment . Results show that those taking vitamin C have fewer colds compared with those who received no intervention (p<0. Patients are randomly assigned to receive either vitamin C or no intervention.starttest.

Google Chrome Q h ttps://w w w .aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 I <=> I © ■ £3— *| — Exam Section 1: Item 44 o f 50 H Mark National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment Tim e Remaining: 2 hr 45 min 36 sec 44.startte st.1. A healthy 21-year-old man dies suddenly of cardiac arrest after snorting cocaine.0/TTDStart.^ National Beard of Medical Examiners .e om /a p i/5 .l. Cocaine-induced inhibition of which of the following is the most likely explanation for the cardiac arrest? A) Acetylcholinesterase O B) a2 -Adrenergic receptors O C) (32 -Adrenergic receptors O D) Monoamine oxidase O E) Muscarinic receptors O F) Norepinephrine reuptake Previous Lab Values ® Review Help Pause O 12:21 PM 28/08/2012 s fTi .

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Exam Section 1: Item 45 o f 50 I Mark

N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment

T im e R em aining: 2 hr 44 m in 48 sec

45. A 62-year-old man is brought to the emergency department because of a 3-hour history of progressive difficulty breathing and mild left shoulder pain. His symptoms began after he ran up several flights of stairs. He has poorly controlled hypertension and mild angina pectoris. He has smoked one-half pack of cigarettes daily for 40 years. He appears uncomfortable and has labored breathing. Diffuse crackles, rhonchi, and scattered wheezing are heard on auscultation of the posterior lung fields. His arterial Po2 is 58 mm Hg. Which of the following is the most likely diagnosis? A) Cardiac tamponade

O B) Pneumonitis O C) Pneumothorax O D) Pulmonary edema O E) Pulmonary embolism

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Exam Section 1: Item 46 o f 50 I Mark

N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment

T im e R em aining: 2 hr 43 m in 19 sec

46. A 22-year-old woman is admitted to the hospital because of a 10-day history of polydipsia and polyuria. She says that the urge to urinate often awakens her at night. She has been taking lithium carbonate for 2 years for bipolar disorder; her dosage was increased 6 months ago because of recurrent severe manic episodes. Her vital signs are within normal limits. Physical examination shows no abnormalities. Over the next 24 hours, urine excretion totals 6.5 L. Laboratory studies at this time show a serum sodium concentration of 148 mEq/L, serum osmolality of 315 mOsmol/kg, and urine osmolality of 75 mOsmol/kg. After administration of desmopressin, urine output and osmolality do not change. Which of the following findings in the nephron best describes the tubular osmolality, compared with serum, in this patient?

Proximal Tubule
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Medullary Collecting Duct
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Exam Section 1: Item 47 o f 50 I Mark

N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment

T im e R em aining: 2 hr 40 m in 22 sec

47. An 82-year-old woman is admitted to the hospital for treatment of a smallright pleural effusion.Physical examination showsdullness to percussion at thelevel of the 7th rib and below on the right. A thoracentesis is done. The patient is sitting up, supportedby leaning against abedside table. After preparing the skin and deliveringa local anesthetic,into which of the following locations on the right is it most appropriate to insert the catheter? O A) Above the 5th rib in the midscapular line B) Above the 5th rib just to the right of the sternum C) Above the 7th rib in the paravertebral region D) Above the 9th rib in the midscapular line O E) Below the 5th rib in the midaxillary line F) Below the 5th rib in the midclavicular line G) Below the 9th rib in the midscapular line

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Exam Section 1: Item 48 o f 50 I Mark

N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment

T im e R em aining: 2 hr 38 m in 5 sec

48. A 72-year-old woman is admitted to the intensive care unit after undergoing immediate operative repair of a ruptured colonic diverticulum. During the next 2 weeks, she develops recurrent fevers. After a blood culture grows yeast, micafungin therapy is initiated. This drug most likely targets which of the following cellular structures? © A) Cell wall © B) Endospore C) Kinetoplast © D) Ribosome O E) Transcription complex

Her temperature is 38.Google Chrome Q https:/?www. The production of which of the following by the bacterium aids in the virulence of the causal organism in this patient? O A)Adhesins B) Anti hemolytic factors O C) Pyrogenic exotoxin O D) Teichoic acid in the cell wall O E) Thick peptidoglycan layer . A urine sample grows pink colonies on lactose-MacConkey agar. and vomiting.r National Board o f Medical Examiners . and blood pressure is 96/60 mm Hg. Urinalysis shows 25 WBC/hpf. and is indole positive. pulse is 125/min.com/api/5.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 1: Item 49 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 2 hr 37 m in 0 sec 49.starttest.1. Physical examination shows right costovertebral angle tenderness. and pain with urination.1.0/TTDStart. A 23-year-old woman comes to the physician because of a 1-day history of chills. nausea. She also has a 4-day history of flank pain. urinary frequency and urgency. produces a characteristic green sheen on eosin-methylene blue agar.9°C (102°F).

eom /a p i/5 . vomiting.l. She appears acutely ill.0/TTDStart. A 38-year-old woman at 32 weeks' gestation is brought to the physician because of a 2-day history of fever. nausea. Which of the following is the most likely causal organism? O Corynebacterium urealyticum B) Gardnerella vaginalis C) Listeria monocytogenes D ) Rhodococcus equi E) Staphylococcus aureus A) \ . Her temperature is 39°C (102.1.2°F). and respirations are 20/min.sta rttest. pulse is 120/min. A photomicrograph of a Gram stain of an organism recovered from a blood culture is shown.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 1: Item 50 o f 50 H Mark National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment Tim e Remaining: 50.r National Board o f Medical Examiners .Google Chrome Q h ttps://w w w . and muscle aches.

A 21-year-old woman who is a medical student comes to the physician for evaluation of recurrent throbbing headache associated with sensitivity to light and sound.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 0 Exam Section 2: Item 1 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 19 m in 55 sec 1.starttest.com/api/5.1.Google Chrome https://www.r -■' National Board o f Medical Examiners .1.0/ITDStart. Neurologic examination shows no abnormalities. This drug is most appropriate for this patient because of its ability to activate which of the following types of receptors? O A) Acetylcholine B) Y-Aminobutyric acid O C) Dopamine O D) Neurotensin 0 E) Serotonin . Sumatriptan is initiated for suspected migraine.

1. and dull pain in the right upper quadrant of the abdomen. Her height and weight are below the 25th percentile. the amount of mRNAfor (3-globin is decreased to 10% of normal.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 0 Exam Section 2: Item 2 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 19 m in 23 sec 2. Sequencing of the (3-globin gene shows a point mutation in a sequence 3' to the coding region in which AATAAA is converted to AACAAA. Which of the following functions in mRNA synthesis and processing is most likely encoded by the sequence AATAAA? © A) Capping with GTP B) D) Cleavage and polyadenylation Splicing of the initial mRNA transcript in the nucleus © C) Silencing of the promoter © E) Transport of the mRNA out of the nucleus o Previous o Next m Lab Values © Review Help to Pause -a ■ ^ il ? « ~ m H I S s h § ' V i r g r © r i j 4 1.1. Laboratory findings indicate that the content of her (3-globin chain is 15% to 20% of normal. fatigue.starttest.Google Chrome https://www.0/ITDStart. A 5-year-old girl is brought to the physician because of listlessness.com/api/5.5 12:50 PM 28/08/2012 .r -■' National Board o f Medical Examiners . Consequently.

5 12:50 PM 28/08/2012 .starttest.0/ITDStart.Google Chrome https://www. An investigator breeds a transgenic strain of mice that develops severe fasting hypoglycemia.1.r -■' National Board o f Medical Examiners . but administration of epinephrine results in an increase in the serum glucose concentration.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 0 Exam Section 2: Item 3 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 18 m in 54 sec 3. Which of the following proteins is most likely defective in this mouse strain? O A) Adenylyl cyclase O B) Glucagon receptor C) E) Glycogen phosphorylase Phosphorylase kinase O D) Heterotrimeric G protein © F) Protein kinase A o Previous o Next m Lab Values © Review * * Help to Pause -a ■ ^ il ? « ~ m H I S s h § ' V i r g r © r i j 4 1.1.com/api/5. Administration of glucagon does not correct the hypoglycemia.

Google Chrome https://www. He drinks two beers daily during the workweek and approximately six beers daily on weekends. Sensory examination is normal. He works as a carpenter and has had difficulty handling his tools. There is decreased strength (4/5) in the upper and lower extremities and atrophy of the muscles of the hands. which of the following findings is most likely? O A) Dementia o B) Difficulty swallowing O C) Loss of facial sensation D) Loss of peripheral vibratory sensation O E) Nystagmus o Previous o Next m Lab Values © Review p Help to Pause -a ■ ^ il 4 1. Fasciculations are noticed on the muscles of the hands and upper extremities. Over the course of this disease.1. He has diffuse hyperreflexia. Physical examination shows no lymphadenopathy.0/ITDStart. A 60-year-old man comes to the physician because of progressive weakness of his hands during the past 6 months.starttest.5 ? « ~ m H I S r "5 ' V l l ' Z J r @ ^ 12:51 PM 28/08/2012 .aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 0 Exam Section 2: Item 4 o f 50 0 M ark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 17 m in 35 sec 4. He has smoked 1 pack of cigarettes daily for 45 years.1.r -■' National Board o f Medical Examiners .com/api/5.

An x-ray of the chest shows a mass in the mediastinum.com/api/5. he has had drooping of the eyelids and double vision. Which of the following laboratory assays is most likely to be positive? O A) Acetylcholine receptor antibody B) D) Botulinum toxin Rapid plasma reagin © C) C-reactive protein © E) Rheumatoid factor o Previous o Next m Lab Values © Review Help to Pause -a ■ ^ il ? « ~ m H I S s h § ' V i r g r © r i j 4 1.1.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 ^ Exam Section 2: Item 5 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 17 m in 27 sec 5.0/ITDStart.Google Chrome https://www.1. A 60-year-old man has had episodes of fluctuating weakness for the past 2 years. Recently. On physical examination. At times. he has had difficulty climbing stairs and regurgitation of liquids into his nose.starttest. The weakness was first noticed when he had difficulty lifting books.r -■' National Board o f Medical Examiners .5 12:52 PM 28/08/2012 . the weakness increases with repeated exercise.

1. Physical examination shows no abnormalities.N ationa: Board o f M ed ica l Examiners .l.sta rtte st.0/TTDStart. The mother tells the physician that the child consumed approximately 25 metformin tablets.e o m /a p i/5 .aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 2: Item 6 o f 50 ■ M ark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 16 m in 33 sec 6. A 3-year-old girl is brought to the emergency department by her mother 1 hour after she was found with a half-empty bottle of her grandmother's diabetes medication.G o o g le C hrom e [ o | 0 Q h ttp s://w w w .5 12:53 PM 28/08/2012 . This patient is at greatest risk for which of the following serum abnormalities? A) Decreased calcium concentration B) Decreased glucose concentration C) Decreased sodium concentration O D) Increased AST and ALT activities E) Increased creatinine concentration F) Increased lactic acid concentration o Previous o Next m Lab Values © Review Help to Pause -a ■ ^ il ? « ~ m H I S s h § ' V i r g r © r i j 4 1.

com/api/5.r -■' National Board o f Medical Examiners .Google Chrome https://www. A 65-year-old woman with diabetic ketoacidosis has had a fever and proptosis of the left eye over the past 3 days.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 0 Exam Section 2: Item 7 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 16 m in 8 sec 7. Which of the following is the most likely diagnosis? A) Aspergillosis B) Candidiasis O C) Coccidioidomycosis O D) Cryptococcosis E) Histoplasmosis O F) Mucormycosis o Previous o Next m Lab Values © Review ^ Help to Pause -a ■ ^ il ? « ~ m H I S s h § ' V i r g r © r i j 4 1.0/ITDStart.5 12:53 PM 28/08/2012 .1. A black eschar is present on the nasal mucosa.1.starttest. She is unable to move the left eye.

1.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 ^ Exam Section 2: Item 8 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 15 m in 40 sec 8. This patient's myalgia is most likely related to which of the following effects of gemfibrozil on simvastatin? A) Decreased bioavailability B) Increased absorption O C) Inhibition of cytochrome P450 metabolism D) Inhibition of hepatic glycosylation E) Inhibition of hepatic sulfation o Previous o Next m Lab Values © Review Help to Pause -a ■ ^ il ? « ~ m H I S s h § ' V i r g r © r i j 4 1. gemfibrozil was added to his regimen to decrease his triglyceride concentration.0/ITDStart. A 42-year-old man comes to the physician because of a 4-week history of muscle cramping and pain. but serum triglyceride concentration remained increased.com/api/5. he began treatment with simvastatin (80 mg daily) for hypercholesterolemia. After 1 month. marked improvement was noted in his serum LDL-cholesterol concentration.r -■' National Board o f Medical Examiners .1. At that time. Physical examination today shows no abnormalities.Google Chrome https://www.5 12:54 PM 28/08/2012 . Two months ago.starttest.

010 2+ 25 mEq/L brown granular Histologic examination of this patient's kidneys would most likely show necrotic cells in which of the following components of the nephron? C A) Bowman capsule 0 B) Collecting tubule C) Glomerular basement membrane D) Mesangium 0 E) Proximal tubule O Previous o Next m Lab Values © Review * * Help to Pause ^ ■ ^ il 4 1. Laboratory studies show: Serum Urea nitrogen Creatinine Urine Specific gravity Protein Na+ Casts 35 mg/dL 2.G o o g le C hrom e [ o | 0 Q h ttps://w vvw .starttest. A 25-year-old woman comes to the physician because of a 2-day history of decreasing urine output despite ample fluid intake.0/ITDStart.eom /api/5.l. She underwent operative removal of a perforated appendix 3 weeks ago.5 ? « ~ m H I S s h § ' V i r g r © r i j 12:57 PM 28/08/2012 .1. She received intravenous gentamicin for 2 weeks.9 mg/dL 1.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 2: Item 9 o f 50 | National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment Tim e Remaining: 4 hr 12 min 32 sec 9. Physical examination shows no abnormalities.N ationa: Board o f M ed ica l Examiners .

A 48-year-old man comes to the physician because he is concerned about his weight. Laboratory studies show fasting serum glucose and insulin concentrations that are increased and remain increased 2 hours after the patient receives 75 g of oral glucose.Google Chrome https://www. His waist circumference is 103 cm (41 in).r -■' National Board o f Medical Examiners .0/ITDStart.starttest.1.1. BMI is 29 kg/m2. His blood pressure is 140/90 mm Hg.com/api/5.5 12:59 PM 28/08/2012 . Physical examination shows a protuberant abdomen.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 0 Exam Section 2: Item 10 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 9 m in 48 sec 10. He is 178 cm (5 ft 10 in) tall and weighs 91 kg (200 lb). Which of the following sets of additional laboratory findings in serum is most likely in this patient? Triglycerides © © © © © © A) B) C) D) E) F) * * * HDL-cholesterol Free Fatty Acids i i i i + i i i + i + i O Previous o Next m Lab Values © Review Help to Pause -a ■ ^ il ? « ~ m H I S s h § ' V i r g r © r i j 4 1.

His temperature is 38.0/TTDStart. A 47-year-old man is brought to the emergency department 3 hours after the sudden onset of sharp left flank pain and fever. A nephrectomy is done.G o o g le C hrom e [ o | 0 Q h ttp s://w w w .1.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 2: Item 11 o f 50 | l^ ark National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment Tim e Remaining: 4 hr 7 min 35 sec 11.3°C (100. Laboratory studies show: Hemoglobin Hematocrit Leukocyte count Segmented neutrophils Bands Lymphocytes Monocytes Urine leukocytes 16 g/dL 48% 18.l.9°F).N ationa: Board o f M ed ica l Examiners . Abdominal examination shows exquisite tenderness in the left costovertebral region. He has had similar episodes during the past 5 years.e o m /a p i/5 . Culture of a urine sample is most likely to grow which of the following organisms? C A) Escherichia coli B) Proteus mirabilis C) Pseudomonas aeruginosa D) Serratia marcescens E) Staphylococcus aureus .sta rtte st.000/mm3 85% 5% 8% 2% 2500/mm3 Imaging studies show hydronephrosis of the left kidney and a staghorn calculus. the calculus is composed of magnesium ammonium phosphate (struvite).

Google Chrome https://www. "My older brother just got diagnosed with diabetes.com/api/5.1.r -■' National Board o f Medical Examiners .1. What should I do?" Which of the following diets is most likely to be effective in decreasing this patient's risk for type 2 diabetes mellitus? 0 0 0 0 0 A) Low-calorie B) Low-carbohydrate C) Low-cholesterol D) Low-protein E) Low-sodium .0/TTDStart.starttest. A 43-year-old man comes to the physician for a routine health maintenance examination. Physical examination and laboratory studies show no other abnormalities. BMI is 30 kg/m2.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 0 Exam Section 2: Item 12 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 7 m in 2 sec 12. He is 170 cm (5 ft 7 in) tall and weighs 86 kg (188 lb). I don't want that to happen to me. He tells the physician.

The most likely cause of her condition is proliferation of which of the following? O A) Allantois O B) Blastocysts C) Decidua basalis D) Decidua capsularis O E) Trophoblastic tissue o Previous o Next m Lab Values © Review Help to Pause ? « ~ m H I S s h § ' V i r g r © r i j *" * . Her serum (3-human chorionic gonadotropin concentration is markedly increased.1. An 18-year-old primigravid woman at approximately 16 weeks' gestation comes to the physician because of a 3-month history of nausea and vomiting. Ultrasonography of the abdomen shows echogenic material within the endometrial cavity but no fetus. Urinalysis shows 4+ protein.0/ITDStart.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 0 Exam Section 2: Item 13 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 6 m in 30 sec 13. V 1:03 PM 28/08/2012 .com/api/5. She has not had any prenatal care.starttest.Google Chrome https://www. Physical examination shows a uterus consistent in size with a 20-week gestation.r -■' National Board o f Medical Examiners .1.

aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Q Exam Section 2: Item 14 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 5 m in 34 sec 14. Which of the following is the most likely cause of his orthostatic hypotension? O A) High-altitude sickness O B) Hypovolemia O C) Hypoxia D) Impaired sympathetic nerve activity E) Respiratory alkalosis .starttest.Google Chrome https:/?www. His blood pressure is 110/60 mm Hg while sitting and 95/50 mm Hg while standing. His symptom began after skiing at a resort at an altitude of 2743 m (9000 ft). Physical examination shows no other abnormalities.r~' National Board o f Medical Examiners .com/api/5.0/ITDStart. He has been taking a carbonic anhydrase inhibitor since 2 days before arrival at the resort.1. A previously healthy 54-year-old man comes to the clinic because of light-headedness for 6 hours.1.

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Exam Section 2: Item 15 o f 50 I Mark

N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment

T im e R em aining: 4 hr 5 m in 28 sec

15. A 55-year-old man comes to the physician because of a 3-day history of fever and shaking chills. He has end-stage renal disease treated with hemodialysis. His temperature is 39.2°C (102.6°F), pulse is 110/min, and blood pressure is 156/92 mm Hg. Physical examination shows a tunneled central venous catheter entering the right side of the chest below the clavicle; the area surrounding the catheter is not tender. Echocardiography shows a 3-cm vegetation on the tricuspid valve. Which of the following is the most likely causal organism? O A)

Escherichia coli B) Klebsiella pneumoniae C) Staphylococcus aureus D) Streptococcus pyogenes (group A)

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Exam Section 2: Item 16 o f 50 H Mark

National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment

Tim e Remaining: 4 hr 5 min 25 sec

16. A 42-year-old woman comes to the physician because of a 3-week history of numbness of the fingers on the left hand. Neurologic examination shows loss of touch graphesthesia and loss of two-point discrimination in the left hand. This patient most likely has a lesion in which of the following locations of the hemispheres shown?

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Exam Section 2: Item 17 o f 50 ■ M ark

N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment

T im e R em aining: 4 hr 5 m in 21 sec

17. A 60-year-old woman with a 1-year history of diabetes mellitus has had decreasing vision over the past year. Examination of the eyes shows milky opacity of both lenses. Which of the following aberrant metabolites of glucose is most likely responsible for the formation of this abnormality? 0 A) Fructose O B) Glycogen
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Exam Section 2: Item 18 o f 50 I Mark

N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment

T im e R em aining: 4 hr 5 m in 19 sec

18. A 22-year-old woman comes to the physician 3 months after she noticed a painless, slowly enlarging mass on the left side of her neck. Physical examination shows a freely mobile, soft, cystic mass with a cutaneous surface opening. The physician explains that it is from incomplete fusion during embryonic development. Which of the following is the most likely location of the opening of the duct leading to the mass in this patient? A) C)
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Google Chrome https://www. In a healthy person.1.0/TTDStart. the thyroid gland produces and secretes thyroxine (T4).r -■' National Board o f Medical Examiners .com/api/5.1. Which of the following best describes the T4 -binding substance in the blood and the type of cellular receptor for T 4 in the peripheral tissues? T4-binding Substance in the Blood © © © © © © A) B) C) D) E) F) Globulin Globulin Globulin Lipid Lipid Lipid Receptor That Interacts With T4in the Peripheral Tissues cell membrane receptor mitochondrial nuclear cell membrane receptor mitochondrial nuclear O Previous o Next m Lab Values © Review Help to Pause -a ■ ^ il ? « ~ m H I S s h § ' V i r g r © r i j 4 1.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 0 Exam Section 2: Item 19 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 5 m in 15 sec 19. maintaining metabolism.starttest.5 1:04 PM 28/08/2012 .

1. Which of the following is the most likely diagnosis? A) Multiple sclerosis B) Myasthenia gravis o Previous o Next <P Lab Values © Review O Help to Pause -a ■ ^ il ? « ~ m H I S s h § ' V i r g r © r i j 4 1. A 42-year-old man has an autoimmune disorder resulting in proximal muscle weakness of the lower extremities.^ —«J Q h ttp s://w w w .G o o g le C hrom e 1° I0 |i—.N a tio n a l Board o f M ed ica l Examiners .e o m /a p i/5 .aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 2: Item 20 o f 50 ■ Mark National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment Tim e Remaining: 4 hr 5 min 3 sec 20.5 1:04 PM 28/08/2012 .0/TTDStart.l. Arrows in the photomicrograph shown indicate membranes that contain high concentrations of channels that are targeted by this condition.sta rtte st.

5 1:05 PM 28/08/2012 . A 42-year-old man has an autoimmune disorder resulting in proximal muscle weakness of the lower extremities. Which of the following is the most likely diagnosis? A) Multiple sclerosis B) Myasthenia gravis C) Myasthenic (Lambert-Eaton) syndrome D) Periodic paralysis © E) Tetany o o ~m H I S s h§ 'V ir g r© r i j ? « Previous Next Lab Values ® Review © © Help Pause © ■ il ^4 ^ 1.1.r -■' National Board o f Medical Examiners .com/api/5.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 I1t= I IB I—25—1 » ^ Exam Section 2: Item 20 o f 50 ■ Mark National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment Tim e Remaining: 4 hr 4 min 55 sec 20.0/ITDStart.1.Google Chrome https://www.starttest. Arrows in the photomicrograph shown indicate membranes that contain high concentrations of channels that are targeted by this condition.

Google Chrome https://www.starttest.1. I always have to wait forever to be seen.1. He never returns my phone calls. the patient says. A 43-year-old man comes to the emergency department because of a 1-year history of low back pain. and he can never tell me what is causing my back pain or how to treat it.r -■' National Board o f Medical Examiners .com/api/5. "My physician is arrogant and insensitive.5 1:05 PM 28/08/2012 ." Which of the following is the most appropriate response by the emergency department physician about this patient's complaints? A) Reassure the patient that his physician's behavior is not unusual and that low back pain can be difficult to assess B) Encourage the patient to make an appointment with his physician to communicate his concerns C) Explain to the patient how he may register a complaint against his physician with the state medical licensing board D) Provide the patient with a copy of the Patients' Bill of Rights E) Telephone the patient's physician to make him aware that the patient is very dissatisfied with treatment o Previous o Next m Lab Values © Review Help to Pause -a ■ ^ il ? « ~ m H I S s h § ' V i r g r © r i j 4 1. the tests he orders are painful and unnecessary.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 ^ Exam Section 2: Item 21 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 4 m in 49 sec 21. Before the examination.0/ITDStart.

r -■' National Board o f Medical Examiners . He is at increased risk for which of the following psychiatric disorders? A) Agoraphobia B) Major depressive disorder C) Obsessive-compulsive disorder D) Post-traumatic stress disorder E) Social phobia o Previous o Next m Lab Values © Review * * Help to Pause -a ■ ^ il ? « ~ m H I S s h § ' V i r g r © r i j 4 1.1.starttest.com/api/5.5 1:05 PM 28/08/2012 .aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 ^ Exam Section 2: Item 22 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 4 m in 46 sec 22.Google Chrome https://www.1. He lives alone. A 55-year-old man recovered from a stroke 2 months ago.0/ITDStart.

com/api/5.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 ^ Exam Section 2: Item 23 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 4 m in 41 sec 23. Cardiac examination shows an S 4. An ECG shows ST-segment depression in the precordial leads.0/ITDStart. This antibody will most likely prevent binding of which of the following substances to platelets? O A) Adenosine © B) ADP © C) Fibrinogen © D) Serotonin © E) Thrombin © F) Thromboxane A 2 o Previous o Next m Lab Values © Review Help to Pause -a ■ ^ il ? « ~ m H I S s h § ' V i r g r © r i j 4 1. heparin. which required treatment with increasing doses of nitroglycerin to resolve. he is given a dose of a monoclonal antibody against the platelet llb/llla receptor. pulse is 105/min.Google Chrome https://www.5 1:05 PM 28/08/2012 .r -■' National Board o f Medical Examiners . and nitroglycerin. A 44-year-old man with a 1-year history of angina pectoris comes to the emergency department because of increasingly severe chest pain during the past 2 days. and blood pressure is 150/90 mm Hg.6°F). In addition to aspirin. respirations are 16/min. His temperature is 37°C (98.1.1. He has had five previous similar episodes.starttest.

.1. Which of the following is the most likely site of a primary neoplasm in this patient? A) Adrenal gland © B) Bone marrow © C) Kidney © D) Ovary © E) Small intestine Previous Lab Values ® Review © P1 Help * Pause O .0/ITDStart.r% IPX f 1:05 PM 28/08/2012 .ill ><> 'RH m "s .starttest. A 45-year-old woman has a 2-week history of a heart murmur and hepatomegaly.Google Chrome Q https:/?www. She has a 3-month history of flushing with hypotension and crampy diarrhea.com/api/5.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 2: Item 24 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 4 m in 35 sec 24.N ational Board o f Medical Examiners .1.

e o m /a p i/5 . The process shown is most likely associated with an increase in which of the following? O A) Calcium O B) Estrogen O C) Interleukin-1 (IL-1) D) Monoclonal immunoglobulin O E) Vitamin D ? T Previous O Next o Lab Values (S' Review © Help © s. . is shown in the photograph.l.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 I o I@ Exam Section 2: Item 25 o f 50 H Mark National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment Tim e Remaining: 4 hr 4 min 19 sec 25.Google Chrome Q h ttp s://w w w .1. obtained at autopsy. Her vertebral column.sta rtte st.0/TTDStart. A 77-year-old woman dies in the hospital after a long illness.o jd jia i Pause .National Beard of Medical Examiners .

Google Chrome https://www.starttest.1.r -■' National Board o f Medical Examiners . Two clinical trials.com/api/5. The two studies are identical.5 1:18 PM 28/08/2012 .8 in Study X. and 0. except the statistical power is 0. Trial X and Trial Y.9 in Study Y.0/ITDStart.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 ^ Exam Section 2: Item 26 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 52 m in 22 sec 26.1. are conducted to assess the potential therapeutic efficacy of a new experimental antibiotic compared to the currently used antibiotic for treatment of urinary tract infections. Which of the following is the most accurate conclusion regarding the likelihood of a type II error? O A) Greater in Trial X than in Trial Y O B) Greater in Trial Y than in Trial X © C) The same in Trial X and in Trial Y D) Cannot be calculated from the data given o Previous o Next m Lab Values © Review Help to Pause -a ■ ^ il ? « ~ m H I S s h § ' V i r g r © r i j 4 1.

r -■' National Board o f Medical Examiners .5 1:18 PM 28/08/2012 .1. lack of perspiration.1.0/ITDStart.Google Chrome https://www.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 ^ Exam Section 2: Item 27 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 52 m in 12 sec 27. A 3-year-old boy with a history of unexplained fever. and self-mutilating behavioris diagnosed withcongenital insensitivity to pain with anhidrosis. Assuming this is theonly signaling defectin this patient. absence of response to noxious stimuli. Genetic analysis shows a missense mutation of the tyrosine kinasedomain of the TrkA gene.com/api/5. which of the following processes has most likely been disrupted? O A) Binding of nerve growth factor to its receptor B) Formation of TrkA homodimer in response to nerve growth factor C) Phosphorylation of downstream molecules in response to nerve growth factor D) Retrograde transport of nerve growth factor from nerve terminals O E) Synthesis of nerve growth factor o Previous o Next m Lab Values © Review Help to Pause -a ■ ^ il ? « ~ m H I S s h § ' V i r g r © r i j 4 1.starttest.

5 1:25 PM 28/08/2012 ? « h i s s r "5 ' v i r g r @ ^ . A 4-year-old boy is brought to the emergency department because of a 1-hour history of headache.1.0/ITDStart. carboxyhemoglobin saturation is 30% (reference range < 5%). Physical examination shows severe lethargy.starttest. 4 ■ ^ il 1. n -t B Flavin mononucleotide © A) © B) © C) © D) © E) o Previous o Next <P Lab Values © Review P Help to Pause i-u.com/api/5.r -■' National Board o f Medical Examiners . His venous blood is bright red.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 ^ Exam Section 2: Item 28 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 45 m in 8 sec 28. and dizziness. Which of the following steps in the electron transport pathway is primarily affected in this patient? A Reduced substrate .1. nausea and vomiting.Google Chrome https://www.

5 1:26 PM 28/08/2012 . swelling.0/TTDStart.G o o g le C hrom e [ o | 0 Q h ttp s://w w w .sta rtte st. Examination shows painless nodules on the extensor surfaces of the arms and tenderness and swelling of the metacarpophalangeal and proximal interphalangeal joints.e o m /a p i/5 . The pain and stiffness are worst in the mornings.N ationa: Board o f M ed ica l Examiners . and stiffness in both hands over the past 6 months.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 2: Item 29 o f 50 ■ M ark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 44 m in 25 sec 29. Which of the following is involved in the pathologic process affecting her joints? A) Bacterial invasion B) Caseating necrosis C) Crystal deposition D) Necrotizing vasculitis O E) Pannus formation o Previous o Next m Lab Values © Review Help to Pause -a ■ ^ il ? « ~ m H I S s h § ' V i r g r © r i j 4 1.1. A 44-year-old woman has had pain. but symptoms improve with activity.l.

Google Chrome Q h ttp s://w w w . Their 6-month-old son was recently diagnosed with this disease.1.e o m /a p i/5 . There is a history of this disease in both the woman's and the man's families.0/TTDStart.5 1:28 PM 28/08/2012 .l. Which of the following best represents the risk for this couple's next child to have Tay-Sachs disease? © A) <1% © B) 10% © C) 25% © D) 50% © E) 100% o Previous o Next m Lab Values © Review Help to Pause -a ■ ^ il ? « ~ m H I S s h § ' V i r g r © r i j 4 1.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 2: Item 30 o f 50 H Mark National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment Tim e Remaining: 3 hr 42 min 58 sec 30. A 30-year-old woman and her 25-year-old husband come to the physician for advice about their risk for having another child with Tay-Sachs disease.r National Board o f Medical Examiners .sta rtte st.

1.r National Board o f Medical Examiners .1. We'll have to do more tests to be sure.starttest. even birth control pills." B) "Some teenagers experiment with their parents' prescription drugs. A 15-year-old boy is brought to the physician because of painless swelling in his left breast for 1 month. Hisgenitalia are Tanner stage 3. He is at the 65th percentile for height and 70th percentile for weight. thickeningof mustache hairon the face." O D) "This may be a sign of a chromosomal problem." . The left breast appears mildly enlarged with a palpable breast bud.0/TTDStart. There is no adenopathy. the right breast is normal with nogynecomastia.com/api/5.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 2: Item 31 o f 50 I Mark National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment Tim e Remaining: 3 hr 37 min 57 sec 31. There is no family history of breast cancer. His pulse is 65/min.Google Chrome Q https:/?www. and the presence of axillary hair. Physical examination shows mild facial acne. We need to do some genetic testing. Which of the following is the most appropriate initial statement by the physician regarding this patient's breast finding? A) "Have you tried smoking marijuana recently? That has been known to cause breast enlargement." O E) "This may be a sign of a more serious condition. and blood pressure is 118/76 mm Hg. Are you?" O C) "This is a common condition for teenage boys and should resolve in time.

aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 2: Item 32 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 37 m in 29 sec 32. His vital signs are normal. The pain is exacerbated following meals.starttest. Physical examination shows no abnormalities.5 1:33 PM 28/08/2012 ? « r m E i i w ■ r § ~ ^ j r z j ' ® .0/TTDStart. He went on a camping trip in upstate New York 3 weeks ago.r National Board o f Medical Examiners . swimming in the nearby lakes and hiking in the mountains.1.5-kg (10-lb) weight loss during this period. he has had a 4.1. A 20-year-old man comes to the physician because of cramping abdominal pain and diarrhea during the past 3 weeks. Which of the following diagnostic tests is most likely to identify the causal organism of this patient's condition? A) Culture of the stool for enteric bacterial pathogens B) Electron microscopy of the stool for small round viruses C) Microscopic examination of the stool for ova and parasites D) Polymerase chain reaction test of the stool for Shiga toxin E) Proctoscopy and rectal biopsy o Previous o Next <P Lab Values © Review * * Help to Pause i-u.com/api/5. 4 ■ ^ il 1.Google Chrome Q https:/?www.

1. Which of the following is the most likely underlying cause of this patient's symptoms? A) Abnormal folding of the hemoglobin molecule caused by increased Pco2 B) Abnormal hydrogen bonding in the hemoglobin caused by amino acid substitution on the a chain C) Decreased oxygen affinity caused by an amino acid substitution in the hemoglobin a chain D) Erythrocyte fragility caused by an amino acid substitution in glycoproteins on the cell surface E) Polymerization of hemoglobin with hypoxic conditions due to amino acid substitution in the (3 chain . A peripheral blood smear is shown in the photomicrograph.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 1□> X Exam Section 2: Item 33 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 36 m in 41 sec 33.starttest.Google Chrome Q https:/?www.com/api/5.0/TTDStart. A 12-year-old African American girl is brought to the emergency department by her mother because of a6-hour history of fever and severe rib pain. Abdominal examination shows tenderness to palpation.2°F). She has had numerous episodes in the past. The lungs are clear to auscultation.1. Her paternal aunt and uncle have had similar symptoms since youth.Her temperature is 39°C (102.r National Board o f Medical Examiners .

r National Board o f Medical Examiners .com/api/5.starttest. Serum studies show an increased lactate concentration. A 5-year-old boy is brought to the physician by his mother because of a 3-month history of headache.1. Physical examination shows weakness of the left lower extremity. Ophthalmologic examination shows ptosis of the left eye and bilateral external ophthalmoplegia. His mother says that he often falls while running.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 2: Item 34 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 36 m in 21 sec 34.0/TTDStart.Google Chrome Q https:/?www. clumsiness.1. and fatigue. He had a generalized tonic-clonic seizure 1 month ago. Analysis of a calf muscle biopsy specimen obtained from the left lower extremity shows ragged red fibers. Which of the following metabolic processes is most likely impaired in this patient? A) Fatty acid oxidation O B) Gluconeogenesis O C) Glycolysis D) Oxidative phosphorylation E) Pentose phosphate pathway .

r National Board o f Medical Examiners . A 48-year-old woman comes to the emergency department because of a 3-hour history of nausea and acute.0/TTDStart. Physical examination shows an enlarged right ovary.com/api/5. She says the pain started 30 minutes into her aerobics class and has increased in severity since then. Ultrasonography of the pelvis confirms the presence of an enlarged ovary.starttest. The result of a urine pregnancy test is negative. right-sided lower abdominal pain that radiates to her back. and Doppler ultrasonography shows decreased adnexal flow.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 2: Item 35 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 34 m in 9 sec 35. sharp.Google Chrome Q https:/?www. Which of the following structures is most likely affected in this patient? O A) Mesometrium O B) Oviduct O C) Round ligament of the uterus D) Suspensory ligament E) Transverse cervical ligament .1.1.

aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 2: Item 36 o f 50 I Mark National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment Tim e Remaining: 3 hr 29 min 12 sec 36.1.l. A 60-year-old man comes to the physician because of skin blistering for 1 week.starttest. Direct immunofluorescence microscopy of intact skin shows deposits of IgG on keratinocytes. Physical examination shows scattered blisters over the upper and lower extremities and trunk intermingled with crusted denuded areas. Six months ago.0/TTDStart.Google Chrome Q h ttps://w w w . A biopsy specimen of an early lesion shows intraepidermal vesicle formation.National Board o f Medical Examiners . Which of the following structures is most likely involved in the skin disorder in this patient? A) Adherens junctions (zonulae adherentes) B) Desmosomes (maculae adherentes) O C) Gap junctions O D) Hemidesmosomes E) Tight junctions (zonulae occludentes) . he had blisters in his mouth that easily ruptured.eo m /a p i/5 .

000/mm3with 90% neutrophils.sta rtte st.0/ITDStart.National Board o f Medical Examiners . His temperature is 40°C (104°F). After several hours. the pain shifts to the right lower quadrant and becomes constant. Which of the following mediators is most likely causing this patient's fever and leukocytosis? O A) Interleukin-1 (IL-1) O B) lnterleukin-2 (IL-2) © C) Leukotriene B4 © D) Leukotriene C 4 E) Prostaglandin D2 © Previous Next o Lab Values < P © Review & Help to Pause ^ * ? « rm E iiw ■ r § ~ ^ jr z j 1 ® *" .1. A 20-year-old man has cramping periumbilical pain.e o m /a p i/5 . and his leukocyte count is 20. V 1:43 PM 28/08/2012 .Google Chrome Q h ttp s://w w w .l.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 2: Item 37 o f 50 I Mark National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment Tim e Remaining: 3 hr 28 min 12 sec 37.

The test is then used to screen a second population in which the prevalence of prostate cancer is different.Google Chrome Q h ttp s://w w w . A screening test is used to detect prostate cancer in a population of 100.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 2: Item 38 o f 50 H Mark National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment Tim e Remaining: 3 hr 27 min 4 sec 38. The test has a sensitivity of 70% and a specificity of 90%.l.N ational Board o f Medical Examiners .e o m /a p i/5 .1.0/TTDStart.sta rtte st.000 men. Which of the following is the most likely effect on the positive predictive value of this test? A) Decreases as prevalence increases B) Increases as prevalence decreases C) Increases as prevalence increases D) No change as prevalence changes Previous O p 1 Lab Values Review © Pause C l 1:44 PM 28/08/2012 .

starttest.com/api/5.1.1.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 2: Item 39 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 23 m in 50 sec 39. An investigator is studying the human immune response to tumor cell antigens in malignancies.Google Chrome Q https:/?www.r National Board o f Medical Examiners . Which of the following sets of cancer types and tumor antigens is most likely to produce the highest antibody titer? Cancer Type © © © © © A) B) C) D) E) B-cell lymphoma Breast cancer Cervical cancer Melanoma Prostate cancer Tumor Antigen CD19 HER2/neu human papillomavirus type 16 E6 protein tyrosinase prostatic acid phosphatase .0/TTDStart.

His vital signs are within normal limits.com/api/5. Physical examination shows a typical male-pattern distribution of hair.r National Board o f Medical Examiners . Serum studies show a thyroid-stimulating hormone concentration of 2 pU/mL.1.1. He takes no medications. Semen analysis shows a markedly decreased sperm count with impaired motility. He does not smoke or drink alcohol. Genital examination shows no abnormalities.0/TTDStart. BMI is 23 kg/m2.starttest. Puberty began at the age of 12 years.Google Chrome Q https:/?www. Administration of which of the following is the most appropriate treatment for this patient? O A) Bromocriptine B) Gonadotropin-releasing hormone O C) Human chorionic gonadotropin O D) Sildenafil O E) Testosterone O F) Thyroxine . prolactin concentration of 120 ng/ml_. and total testosterone concentration of 25 nmol/L (N=10-35). A previously healthy 35-year-old man comes to the physician because of a 2-year history of gradually decreasing libido and intermittent inability to achieve erection or orgasm. An MRI of the brain shows a 1-cm lesion in the pituitary gland. he also has had decreased growth of facial hair during this period.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 2: Item 40 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 23 m in 22 sec 40. He is 180 cm (5 ft 11 in) tall and weighs 75 kg (165 lb).

0/TTDStart.r National Board o f Medical Examiners .l.sta rtte st.e o m /a p i/5 .aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 2: Item 41 o f 50 H Mark National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment Tim e Remaining: 3 hr 21 min 0 sec 41. Which of the following defects is most likely in this patient? A) Aortic regurgitation B) Aortic stenosis C) Atrial septal defect D) Coarctation of the aorta E) Mitral regurgitation F) Mitral stenosis G) Patent ductus arteriosus H) Pulmonic stenosis I) Tricuspid regurgitation J) Ventricular septal defect Previous O p 1 Lab Values Review © Pause C l 1:50 PM 28/08/2012 . A 3-year-old girl is found to have a grade 4/6. loud.1. high-pitched holosystolic murmur that radiates over the precordium and a palpable thrill at the left sternal border.Google Chrome Q h ttp s://w w w . harsh.

starttest.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 2: Item 42 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 17 m in 28 sec 42.0/TTDStart.1.com/api/5. The ability to administer this agent despite it being a foreign protein is most likely a result of which of the following? A) The agent being a humanized antibody B) The agent containing the variable region of a murine antibody molecule directed against vascular endothelial growth factor O C) B-cell dysfunction D) The immunosuppressive effect of previously administered chemotherapy © E)T-cell dysfunction .1. A 43-year-old woman with metastatic colon cancer has maintained remission by taking bevacizumab as a single agent.r National Board o f Medical Examiners .Google Chrome Q https:/?www.

3 mg/dL 30 U/L 12 U/L 10 U/L .sta rtte st. tattoos. use of intravenous drugs. He has not had clay-colored stools or dark urine. and muscle aches for 1 week. nasal congestion.e o m /a p i/5 . Physical examination shows mild scleral icterus but no subungual icterus. BMI is 23 kg/m2.l. He is 183 cm (6 ft) tall and weighs 77 kg (170 lb).Google Chrome Q h ttp s://w w w .1.6 mg/dL 0. The remainder of the examination shows no abnormalities. or exposure to blood products. He has no recent history of foreign travel. His only medication is ibuprofen. A 23-year-old man comes to the physician because of a low-grade fever. Serum studies show: Bilirubin. total Direct Alkaline phosphatase AST ALT Which of the following is the most likely diagnosis? A) Gilbert syndrome B) Hepatitis D C) Hereditary spherocytosis D) Idiopathic cirrhosis E) Steatohepatitis 2. He states that his girlfriend recently told him that his eyes appeared yellow.r National Board o f Medical Examiners .aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 2: Item 43 o f 50 H Mark National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment Tim e Remaining: 3 hr 17 min 7 sec 43.0/TTDStart.

Breath sounds are normal on auscultation of the chest. deep breath.33 70 mm Hg 65 mm Hg Pulmonary function testing shows a decreased vital capacity. but the patient has difficulty taking a long.1. tidal volume. BMI is 24 kg/m2. Which of the following is the most likely underlying cause of this patient's condition? O A) a ^Antitrypsin deficiency B) Central nervous system neoplasm O C) Chronic bronchitis O D) Chronic opiate use E) Myasthenia gravis © F) Obesity .r National Board o f Medical Examiners . She is 170 cm (5 ft 7 in) tall and weighs 70 kg (155 lb). A 32-year-old woman comes to the physician because of a 1-month history of progressive shortness of breath and anxiety.sta rtte st. Her residual volume is within the reference range. Arterial blood gas analysis on room air shows: pH Pco2 Po2 7.0/ITDStart.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 2: Item 44 o f 50 H Mark National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment Tim e Remaining: 3 hr 16 min 45 sec 44. and expiratory reserve volume.Google Chrome Q h ttp s://w w w . She says that her symptoms become much more pronounced as the day progresses.e o m /a p i/5 .l.

An 18-year-old man has had temperatures to 38.starttest.0/TTDStart.Google Chrome Q https:/?www. A latex agglutination test result for Epstein-Barr virus antibody is positive.r National Board o f Medical Examiners . a sore throat.com/api/5.3°C (101°F). and cervical lymph node enlargement for 8 days.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 2: Item 45 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 14 m in 45 sec 45.1.1. Atypical cells with abundant lacey cytoplasm in the peripheral blood smear are most likely derived from which of the following types of cells? O A) B lymphocytes O B) Basophils O C) Neutrophils O D) Plasma cells O E) T lymphocytes .

starttest.Google Chrome Q https:/?www. and joint stiffness. Physical examination shows coarse facial features. An 18-month-old boy is brought to the physician because of progressive facial abnormalities and slow growth during the past 6 months. hepatosplenomegaly.1. A deficiency of which of the following enzyme activities is the most likely cause of the findings in this patient? A) Galactosidase O B) Glycosylase C) Hexosaminidase A D) Iduronate sulfatase O E) Lipoxygenase .aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 2: Item 46 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 13 m in 11 sec 46. He has an older brother with similar abnormalities who also has mental retardation.0/TTDStart. His urine concentrations of dermatan sulfate and heparan sulfate are increased.1.com/api/5.r National Board o f Medical Examiners . The patient is below the 3rd percentile for length and at the 10th percentile for weight.

aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 2: Item 47 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 10 m in 24 sec 47. A throat culture grows group A Streptococcus.starttest. A 6-year-old boy is brought to the physician by his mother because of a 2-day history of fever. sore throat.1.0/TTDStart.1. His temperature is 39°C (102.r National Board o f Medical Examiners . The anterior cervical glands are enlarged and tender.2°F). The effectiveness of this antibiotic is most likely due to which of the following actions in protein synthesis? A) Causes misreading of mRNA information B) Functions as an analog of aminoacyl-tRNA C) Inactivates elongation factor-2 D) Interferes in aminoacyl-tRNA binding E) Interferes with translocation . and occasional vomiting. His condition improves during the next 2 days.Google Chrome Q https:/?www.com/api/5. Physical examination shows erythema and purulent exudate over the posterior pharyngeal wall and tonsils. treatment with erythromycin is begun. Because he is allergic to penicillin.

raised.starttest.com/api/5. A male newborn at 34 weeks' gestation is delivered vaginally. a benign growth. His mother is concerned.1. red area on the anterior section of the neck. This neoplasm most likely originated in which of the following tissues? O A) Ectoderm B) D) Endothelium Notochord O C) Neural crest cells © E) Yolk sac .aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 2: Item 48 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 9 m in 26 sec 48.r National Board o f Medical Examiners .1.0/TTDStart. Physical examination shows no abnormalities except for a 1-cm.Google Chrome Q https:/?www. and the physician explains that the lesion is a hemangioma.

aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 2: Item 49 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 8 m in 11 sec 49.0/TTDStart.1.r National Board o f Medical Examiners . A researcher in a pharmaceutical company designs a new protease inhibitor that inhibits replication of HIV in T lymphocytes in culture.com/api/5.1. which of the following findings is most likely to indicate that the compound is workingspecifically as a protease inhibitor? A) The drug prevents integration of proviral DNA into the host genome B) The RNA is partially reverse transcribed into proviral DNA © C) There is a lack of a mature core © © D) Transcription from the HIV promoter is blocked E) The virus does not bind to CD4 in the presence of the drug o Previous o Next <P Lab Values # Review O Help to Pause -a ■ ^ il 4 ^ ? « r m E i i w ■ r § ~ ^ j r z j ' ® 2:03 PM 28/08/2012 .starttest.Google Chrome Q https:/?www. In subsequent assays.

Which of the following is the most likely diagnosis? O A)Asbestosis B) Idiopathic pulmonary fibrosis C) Pneumocystis jiroveci (formerly P. or silver stain. acid-fast stain.1. and fatigue. carinii) pneumonia O D) Sarcoidosis O E) Tuberculosis .starttest. weight loss. An x-ray of the chest shows enlargement of the hilar lymph nodes and nodular infiltrates in both lungs. A PPD skin test is negative.r National Board o f Medical Examiners . Examination of lung tissue obtained on biopsy shows multiple noncaseating granulomas with many giant cells.0/TTDStart.1.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 2: Item 50 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 7 m in 30 sec 50.com/api/5.Google Chrome Q https:/?www. No organisms are seen on sections stained with hematoxylin and eosin. night sweats. A 42-year-old man seeks medical attention because of the gradual onset of shortness of breath.

e o m /a p i/5 .sta rtte st.1.r National Board o f Medical Examiners . A 65-year-old man dies 4 days after complete occlusion of the left coronary artery. The left ventricle contains a large irregular area that is soft and pale.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 1 o f 50 H Mark National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment Tim e Remaining: 4 hr 19 min 29 sec 1.l.0/TTDStart. Which of the following processes is most likely responsible? A) Caseation necrosis B) Coagulation necrosis C) Dystrophic calcification © D) Fat necrosis E) Gangrenous necrosis O F) Liquefaction necrosis G) Metastatic calcification p 1 Lab Values Review © Pause 2:18 PM 28/08/2012 Cl .Google Chrome Q h ttp s://w w w .

aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 2 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 18 m in 38 sec 2. A 23-year-old woman comes to the physician because of a 3-week history of persistent cough that is worsened by the cold air in her drafty apartment. Short-term cough suppressant treatment is initiated with a drug that does not cause constipation and has a low potential for substance abuse. Physical examination shows no abnormalities.com/api/5.r National Board o f Medical Examiners . This drug is most likely which of the following? © A) Codeine B) Dextromethorphan © C) Hydromorphone © D) Oxycodone © E) Tramadol . takes no medications.0/TTDStart.1.1.starttest. She does not smoke. and has no history of asthma or chronic pulmonary disease.Google Chrome Q https:/?www.

She also complains of increased difficulties with concentration and memory for the past month.1.5-kg (30-lb) weight gain.1. and decreased muscle stretch reflexes at the ankles.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 3 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 17 m in 35 sec 3. and serum potassium concentration is 4. dry skin.r National Board o f Medical Examiners .0/TTDStart. A 26-year-old woman comes to the physician's office because of a 13.com/api/5. irregular menstrual periods.0 mEq/L. Determination of which of the following serum concentrations is most likely to confirm the diagnosis? © A) Cortisol B) Dehydroepiandrosterone © C) Hemoglobin A 1c © D) Luteinizing hormone © E) Prolactin © F) Testosterone G) Thyroid-stimulating hormone . Physical examination shows a blood pressure of 145/84 mm Hg. Serum cholesterol concentration is 310 mg/dL.starttest. constipation.Google Chrome Q https:/?www. and fatigue for the past 6 months.

and spoon-shaped nails. Physical examination shows a red.1. angular stomatitis.1.starttest. Hemoglobin and mean corpuscular volume are decreased. A 38-year-old woman is brought to the emergency department after being found lying on the sidewalk. Which of the following is the most likely diagnosis? A) Vitamin B 12 (cobalamin) deficiency © B) Folic acid deficiency O C) Iron deficiency © D) Sickle cell disease © E) Vitamin B 1 (thiamine) deficiency . swollen.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 4 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 16 m in 1 sec 4.Google Chrome Q https:/?www. She is conscious but says she is too weak to stand.com/api/5. tender tongue.0/TTDStart.r National Board o f Medical Examiners .

This physician has violated which of the following ethical principles? O A) Beneficence O B) Informed consent © C) Justice © D) Nonmaleficence © E) Veracity . and he has fatigue with minimal exertion. The physician presents the benefits of the pacemaker fully.1. the patient has expressed a desire to forego all invasive procedures.Google Chrome Q https:/?www. however. and his symptoms resolve over the next 3 days. The patient consents to the procedure. Diuretic therapy is initiated. A 92-year-old man is brought to the emergency department because of a 6-hour history of chest pain and shortness of breath.0/TTDStart. However.starttest.com/api/5. A diagnosis of congestive heart failure is made.1.r National Board o f Medical Examiners .aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 5 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 15 m in 21 sec 5. his pulse remains at 44/min. but he describes the risks and follow-up in a cursory manner. His physician believes that he should receive a pacemaker.

A 46-year-old man receives the diagnosis of squamous cell carcinoma of the esophagus.Google Chrome Exam Section 3: Item 6 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 10 m in 44 sec 6. A barium swallow is shown.r National Board o f Medical Examiners . Esophagectomy at the region indicated by the arrows is most likely to involve ligation of arterial branches of which of the following vessels? O A) Aorta B) Internal thoracic arteries C) Pulmonary arteries O D) Superior mesenteric artery E) Thyrocervical trunk .

Google Chrome Q https:/?www.1. An MRI of the brain shows an aneurysm of the left posterior communicating artery.r National Board o f Medical Examiners . Her husband has told her that the eye appears to be "looking sideways.com/api/5.starttest.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 7 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 9 m in 36 sec 7. intermittent pain of her left eye. A 63-year-old woman comes to the physician because of a 2-month history of a drooping left eyelid. The function of which of the following muscles is most likely to remain intact in this patient? O A) Ciliary O B) Inferior oblique O C) Inferior rectus O D) Pupillary constrictor O E) Superior oblique © F) Superior rectus . and mydriasis of the left eye.1. lateral strabismus. and an unusually large pupil." Ophthalmologic examination shows ptosis.0/TTDStart.

starttest. A 30-year-old woman is brought to the emergency department 6 hours after the onset of severe abdominal pain and confusion. Her pulse is 120/min. Two weeks ago. There is no abdominal tenderness.0/TTDStart. Urine studies show an increased porphobilinogen concentration. excess sweating.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 8 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 8 m in 14 sec 8. and paternal grandmother had similar problems. she began a low-calorie diet. Her brother. and tremors. Which of the following is the most likely pattern of inheritance causing this patient's condition? O A) Autosomal dominant O B) Autosomal recessive O C) Mitochondrial DNA mutation D) Mutifactorial O E)X-linked dominant © F)X-linked recessive .1.com/api/5.r National Board o f Medical Examiners . father.1.Google Chrome Q https:/?www. and blood pressure is 160/110 mm Hg. Physical examination shows restlessness.

trunk.r National Board o f Medical Examiners .1. and back. Fifteen minutes after his symptoms first begin. Which of the following describes the most likely underlying mechanism of the rash in this patient? A) Type I (immediate) hypersensitivity B) Type II (complement-mediated cytotoxic) hypersensitivity C) Type III (immune complex-mediated) hypersensitivity D) Type IV (delayed) hypersensitivity . pruritic.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 9 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 4 m in 32 sec 9. A 15-year-old boy is brought to the physician by his mother because of a 2-month history of sneezing.com/api/5. soft.0/TTDStart. erythematous lesions with wheal and flare eruptions over the face. he develops a red rash containing areas that are soft to the touch.Google Chrome Q https:/?www. raised. coughing. Physical examination shows boggy.starttest.1. and watery eyes immediately after he mows the lawn.

starttest. therefore decreasing the duration of this patient's symptoms? A) Nucleocapsid-matrix protein interactions B) Release of virus from infected epithelial cells O C) Replication of genomic RNA D) Synthesis of surface glycoproteins O E) Transcription of mRNA . This drug most likely will inhibit which of the following processes. Several other residents have similar symptoms.Google Chrome Q https:/?www. headache. Physical examination shows no other abnormalities. Treatment with a neuraminidase inhibitor is begun. cough.r National Board o f Medical Examiners .com/api/5. A 95-year-old man who is a resident of a skilled nursing care facility is brought to the emergency department because of a 1-day history of temperatures to 39.9°F).1.4°C (102.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 10 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 3 m in 32 sec 10.1. and muscle aches.0/TTDStart.

r National Board o f Medical Examiners .Google Chrome Q https:/?www.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 11 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 2 m in 51 sec 11.0/TTDStart.2-kg (7-lb) weight loss. A 32-year-old man comes to the physician because of back pain and joint stiffness for 3 months. Hissymptoms improve aftermild exercise.com/api/5.he alsohas had fatigue and a 3. Physical examination and x-rays of the sacroiliac joints confirm a diagnosis of ankylosing spondylitis. Which of the followinglaboratory tests would be most appropriate for the patient's two children to evaluate their susceptibility to this disease? A) Analysis of class I MHC allele expression B) Measurement of B-lymphocyte mitogen responses to pokeweed mitogen C) Measurement of T-lymphocyte mitogen responses to phytohemagglutinin D) Polymerase chain reaction assay for bcl-2 gene expression E) Polymerase chain reaction assay for tyrosine kinase gene expression .1.1.starttest.During thisillness.

com/api/5. A 47-year-old woman comes to the physician because she wants to "do something about my wrinkles. Treatment with tretinoin is started.1.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 12 o f 50 0 M ark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 1 m in 20 sec 12.1.starttest.Google Chrome Q https:/?www.r National Board o f Medical Examiners .0/TTDStart. Collagen synthesis will most likely be increased in this patient by which of the following mechanisms? A) C) Activation of nuclear gene transcription Displaced vitamin A from cellular stores O B) Decreased cAMP production O D) Increased sebum production E) Protection of keratinocytes from UVB irradiation ." Physical examination shows fine wrinkles in photodamaged skin on the face.

A 25-year-old man receives a bupivacaine injection for median nerve block as treatment of carpal tunnel syndrome.r National Board o f Medical Examiners .Google Chrome Q https:/?www.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 13 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 59 m in 18 sec 13.0/TTDStart.starttest.1. Which of the following is the mechanism of action of this drug on the membrane? O A) Activation of the Na+-K+ATPase B) Decreased permeability to C a2+ C) Decreased permeability to Na+ D) Increased reuptake glutamate E) Inhibition of the Na+ a2+antiporter /C .com/api/5.1.

ill ><> ■ 2:40 PM 28/08/2012 . An experimental model of treatment for sickle cell disease involves reactivating the genes that code for the (3 chains of fetal hemoglobin.e o m /a p i/5 .l. This treatment is most likely to increase the affinity of hemoglobin for which of the following? A) 2..aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 I° |0 Exam Section 3: Item 14 o f 50 H Mark National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment Tim e Remaining: 3 hr 58 min 6 sec 14.3-Bisphosphoglycerate O B) Carbon dioxide 0 C) Chloride ions D) 0 Oxygen E) Protons Previous < *• m « Lab Values ® Review Help Pause O * .Google Chrome Q h ttp s://w w w .sta rtte st.National Beard of Medical Examiners .1.0/TTDStart.

1. Her blood pressure is 130/80 mm Hg. BMI is 27 kg/m2.0/TTDStart.e o m /a p i/5 . fatty bowel movements since starting a drug 1 month ago to aid in weight loss. The results of serum lipid studies done 1 month ago and at this visit are shown.r National Board o f Medical Examiners .Google Chrome Q h ttp s://w w w . total (mg/dL) HDL-cholesterol (mg/dL) LDL-cholesterol (mg/dL) Triglycerides (mg/dL) 285 25 250 300 This Visit 225 28 150 200 Which of the following drugs is the most likely cause of the steatorrhea and changes in lipid serum studies in this patient? A) C) Atorvastatin Orlistat O B) Bupropion O D) Phentermine O E) Sibutramine . She is 157 cm (5 ft 2 in) tall and now weighs 66 kg (145 lb).sta rtte st.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 15 o f 50 H Mark National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment Tim e Remaining: 3 hr 56 min 21 sec 15. Visit 1 Month Ago Cholesterol. Physical examination shows no other abnormalities. it was 140/85 mm Hg at her last visit 1 month ago.l. She has had a 5-kg (11 -lb) weight loss during this period. A 25-year-old woman with obstructive sleep apnea comes to the physician because of oily.

and 40 people ate lettuce.2 © D) 0.1 © C) 0. An epidemiologist is investigating an outbreak of diarrhea among a total of 1000 consumers of vegetables.4 © E) 0.1.1.r 0 National Board o f Medical Examiners . Which of the following indicates the probability of diarrhea having developed in people who consumed lettuce? © A) 0. 800 people ate tomatoes and 200 people ate lettuce.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 16 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 52 m in 25 sec 16.5 .Google Chrome https://www.08 © B) 0. A total of 400 people became ill. Of those consumers. 80 of these people ate tomatoes.starttest.com/api/5.0/TTDStart.

Google Chrome https://www.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 17 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 46 m in 14 sec 17.1.r 0 National Board o f Medical Examiners . A 25-year-old medical student whose father had alcoholism and died of cirrhosis initially gets angry at patients with alcoholism. Over the course of training. he continues to recognize that working with these types of patients is distressing to him.com/api/5. but he learns methods of dealing more effectively with them.1. Which of the following mental mechanisms best describes his ability to effectively control his emotions? 0 A) Denial O B) Projection O C) Reaction formation O D) Repression O E) Suppression .starttest.0/TTDStart.

The organism causing this patient's symptoms most likely produces which of the following virulence factors? O A) Elementary bodies O B) Exotoxins O C) Free radicals O D) Pili 0 E) Spores .aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 18 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 45 m in 38 sec 18.starttest.Google Chrome https://www. Urinalysis shows 2+ protein.0/TTDStart.r 0 National Board o f Medical Examiners .com/api/5.1. cultures grow on chocolate agar. A Gram stain shows gram-negative diplococci. He is sexually active and has several female partners.1.6°F). he does not use condoms. His temperature is 37°C (98. A 25-year-old man comes to the physician because of a 4-day history of pain and burning with urination and frequent urinary urgency.

Ultrasonography of the abdomen shows a large calculus filling the entire right renal pelvis. A 60-year-old woman comes to the physician because of a 2-day history of flank pain and pain with urination. and few bacteria.1 Exam Section 3: Item 19 o f 50 ■ M ark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 44 m in 11 sec 19. 1+ leukocytes. I IB 1 ^ 3 . and blood pressure is 152/92 mm Hg. Physical examination shows no other abnormalities. Urinalysis shows 3+ blood.r National Board o f Medical Examiners . The renal calculus in this patient is most likely composed of which of the following substances? A) Calcium oxalate O B) Cystine O C) Struvite O D) Uric acid . Her temperature is 37°C (98.l. She has hypertension.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 1 cz. recurrent urinary tract infections.6°F).0/TTDStart. and hypothyroidism. pulse is 96/min.1.Google Chrome Q h ttp s://w w w .sta rtte st.e o m /a p i/5 .

Google Chrome https://www.r 0 National Board o f Medical Examiners . which of the following is the most appropriate therapy? O A) Desflurane O B) Hyperbaric oxygen O C) Nitric oxide 0 D) Nitrous oxide E) Oxygen diluted with helium .com/api/5.starttest. The diagnosis of persistent pulmonary hypertension is made.0/TTDStart.1.1.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 20 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 43 m in 14 sec 20. Considering that the newborn can be carefully monitored for methemoglobinemia. A female newborn is delivered at 34 weeks' gestation in an advanced-care setting where special delivery systems are available.

sta rtte st. Based on this pathology.^ National Beard of Medical Examiners .e o m /a p i/5 .l. which of the following findings was most likely present on neurologic examination of the patient prior to his death? A) Dysdiadochokinesia B) Dysmetria on finger-nose testing C) Essential tremor D) Gait ataxia O E) Present Romberg sign . A photograph of a sagittal section of the brain is shown.Google Chrome [a [p | Q h ttp s://w w w .0/TTDStart.1. An autopsy is done on a 50-year-old man who died of pneumonia despite 5 days of antibiotic therapy in the intensive care unit.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 21 o f 50 H Mark National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment Tim e Remaining: 3 hr 37 min 42 sec 21. He had a 15-year history of alcoholism.

1. A healthy 56-year-old man comes to the physician for a pre-employment physical.r 0 National Board o f Medical Examiners . and ceases before S 2.1.starttest. Which of the f following is the most likely cause of the murmur? O A) Aortic stenosis B) Atrial septal defect C) Mitral regurgitation O D) Pulmonary regurgitation O E) Tricuspid stenosis . The murmur begins immediately after S 1 rises in crescendo before falling in pitch.com/api/5.Google Chrome https://www.0/ITDStart.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 22 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 36 m in 26 sec 22. Cardiac examination shows a systolic heart murmur that is best heard in the second interspace at the right sternal border and is transmitted to the carotid arteries.

Google Chrome https://www.0/TTDStart.starttest.1.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 23 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 35 m in 21 sec 23. Examination of tissue obtained on biopsy of the lesion is most likely to show which of the following? O A) Adenocarcinoma 0 B) Reactive nodule C) Squamous cell carcinoma D) Squamous papilloma E) Undifferentiated carcinoma . A 59-year-old man who has smoked 2 packs of cigarettes daily for 40 years develops an ulcerated laryngeal neoplasm.com/api/5.r 0 National Board o f Medical Examiners .1.

l. the patient has a chronic pruritic rash shown in the photograph of his elbow. greasy.Google Chrome Q h ttp s://w w w .aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 1 cz. I IB 1 ^ 3 .1 Exam Section 3: Item 24 o f 50 ■ M ark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 34 m in 40 sec 24. He had similar symptoms as an adolescent. barley. His mother has a similar illness that is controlled by restricting wheat. chronic abdominal pain.e o m /a p i/5 . A 35-year-old man has a 6-year history of weight loss. In addition to the gastrointestinal symptoms. and frequent voluminous. but they resolved spontaneously within 2 years. and rye in her diet. bloating.0/TTDStart.1. Which of the following is the most likely diagnosis of this patient's skin condition? A) Bullous pemphigoid B) Dermatitis herpetiformis C) Epidermolysis bullosa O D) Erythema nodosum O E) Pemphigus vulgaris . malodorous stools.r National Board o f Medical Examiners .sta rtte st.

This patient's disorder is most likely due to which of the following pathogenetic mechanisms? O A) Bone marrow suppression 0 B) Defect in leukocyte adhesion C) Defect in phagolysosome function D) Myeloperoxidase deficiency 0 E) NAD PH oxidase deficiency . and prominent red pupils. blue irises. A 1-year-old girl is brought to the physician because of multiple bacterial infections since birth.1.1. A complete blood count shows neutropenia. She is at the 40th percentile for length and 40th percentile for weight.Google Chrome https://www.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 25 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 33 m in 36 sec 25.com/api/5. A peripheral smear shows giant granules in the neutrophils. pale skin.starttest.0/TTDStart.r 0 National Board o f Medical Examiners . She has white hair.

Which of the following is the most likely causal organism? p 1 Previous Lab Values Review Pause 3:07 PM 28/08/2012 .r N ational Board o f Medical Examiners . Silver stain of a lung biopsy specimen is shown.sta rtte st.0/TTDStart. An x-ray of the chest shows a diffuse interstitial infiltrate.l.Google Chrome Q h ttp s://w w w .aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 26 o f 50 I Mark National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment Tim e Remaining: 3 hr 32 min 13 sec 26.e o m /a p i/5 . A 36-year-old man who is seropositive for HIV has had a nonproductive cough for 2 weeks.1.

r 0 National Board o f Medical Examiners .Google Chrome https://www.0/ITDStart. carinii) . An x-ray of the chest shows a diffuse interstitial infiltrate.starttest.1.1.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 26 o f 50 I Mark National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment Tim e Remaining: 3 hr 32 min 6 sec A 26.com/api/5. Which of the following is the most likely causal organism? O Candida tropicalis B) Coccidioides immitis C) Cryptococcus neoformans A) D) Cytomegalovirus E) Mycobacterium tuberculosis O F) Pneumocystis jiroveci (formerly P. Silver stain of a lung biopsy specimen is shown. A 36-year-old man who is seropositive for HIV has had a nonproductive cough for 2 weeks.

Sequencing of mitochondrial DNA shows a G-to-A transition. Physical examination shows jugular venous distention and ankle edema. An atrial endocardial biopsy specimen shows abnormal sarcomeres with paracrystalline inclusions in mitochondria.Google Chrome https://www. Which of the following is the most likely effect of this mutation on mitochondrial function? A) Decreased mRNA stability B) Decreased protein synthesis C) Decreased replication D) Increased mRNA stability E) Increased protein synthesis O F) Increased replication . Inspiratory crackles are heard over both lung bases.1.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 27 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 31 m in 24 sec 27. His mother died of dilated cardiomyopathy.starttest.r 0 National Board o f Medical Examiners . thus shortening the C loop.0/TTDStart. A 60-year-old man comes to the physician because of a 2-year history of progressive shortness of breath with exertion.com/api/5. There is hepatomegaly. This results in an added A:T base pair to the 3' end of the tRNA.1. angiography confirms dilated cardiomyopathy. His two younger siblings have had similar symptoms. A chest x-ray shows cardiomegaly and pulmonary congestion.

aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 28 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 28 m in 48 sec 28. He says that he has approximately two episodes weekly during which he develops burning pain between his chest and abdomen when he lies down for a nap after dinner.0/TTDStart. A 55-year-old man comes to the physician because of intermittent heartburn during the past 3 months. In addition to weight loss and decreased alcohol consumption. He often has an alcoholic drink before dinner and several glasses of wine with the meal. which of the following drugs is most appropriate for this patient? C A) Loperamide B) Misoprostol C C) Omeprazole C D) Prochlorperazine C E) Sucralfate .Google Chrome https://www. BMI is 36 kg/m2.1.starttest.1. He is 178 cm (5 ft 10 in) tall and weighs 113 kg (250 lb). A bitter taste sometimes accompanies the pain.r 0 National Board o f Medical Examiners .com/api/5. Physical examination shows no other abnormalities.

1.com/api/5.1." O D) "I'll prescribe some nicotine patches for you." He has smoked 2 packs of cigarettes daily for 15 years. which of the following responses is most appropriate to encourage this patient to quit smoking? A) "Have you ever considered changing to chewing tobacco?" B) "Have you ever thought about quitting smoking?" C) "I'd like to refer you to a hypnotist to help you quit smoking. That will decrease your chances of getting lung cancer. After the physician informs the patient of the findings.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 29 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 27 m in 59 sec 29.Google Chrome https://www. He says.0/ITDStart. That will help you cut down on your smoking.starttest." E) "Try changing to low-nicotine cigarettes for a while. "I worry I may have lung cancer like my dad. or you will most likely get lung cancer someday like your father.r 0 National Board o f Medical Examiners . Physical examination and an x-ray of the chest show no abnormalities." ." F) "You must stop smoking immediately. A 35-year-old man comes to the physician because of a chronic cough for 5 months.

1.com/api/5.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 30 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 27 m in 10 sec 30.r 0 National Board o f Medical Examiners . A 22-year-old man comes to the physician because of a 2-year history of episodes of shortness of breath and wheezing. This patient's symptoms are most likely caused by excessive production of which of the following substances? O A) Cyclooxygenase B) Hydroxyeicosatetraenoic acid O C) Leukotrienes O D) Prostacyclin (PGI2) E) Prostaglandins © F) Thromboxane A 2 . Laboratory studies show a serum IgE concentration within the reference range and no eosinophilia. Physical examination shows no abnormalities.0/TTDStart.starttest.1.Google Chrome https://www. It is found that the symptoms occur after he takes certain over-the-counter medications containing aspirin. His respirations are 12/min.

Neurologic examination shows normal strength and sensation. and memory.1. Which of the following is the most likely diagnosis? A) Atherosclerosis of the carotid artery O B) Dementia. A CT scan of the head shows marked enlargement of the ventricles. She also has had a 3-month history of difficulties with walking.com/api/5. Alzheimer type O C) Huntington disease o D) Normal-pressure hydrocephalus E) Parkinson disease F) Small vessel disease .1. She walks with a wide-based. shuffling gait.Google Chrome https://www. A 73-year-old woman is brought to the physician because of a 1-month history of urinary frequency and urgency.0/TTDStart. Her Mini-Mental State Examination score is 21/30.starttest. conversation.r 0 National Board o f Medical Examiners .aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 31 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 25 m in 32 sec 31.

Google Chrome https://www.starttest. persons aged 30 years and older are studied in a community. Which of the following best describes this type of study? O A) Case-control study O B) Case series study C) Cross-sectional study O D) Ecologic study E) Observational cohort study F) Randomized clinical trial .1. blood pressure.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 32 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 25 m in 22 sec 32. Persons with increased blood pressure are compared with those who have normal blood pressure to determine which group has greater mortality from coronary artery disease.com/api/5. Every 2 years for a total of 10 years.0/ITDStart. and smoking status are assessed along with deaths from CAD.1. In order to determine risk factors for death from coronary artery disease (CAD). serum cholesterol concentration.r 0 National Board o f Medical Examiners .

5-cm.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 33 o f 50 H Mark National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment Tim e Remaining: 3 hr 23 min 28 sec 33. A 33-year-old woman comes to the physician 3 days after she found a mass in her right breast on self-examination. hard mass in the upper outer quadrant of the right breast.starttest.0/ITDStart. Which of the following characteristics of the lesion best predicts this patient's prognosis? A) Degree of differentiation of the cells comprising the lesion B) DNA content of the cells comprising the lesion C) Lymph node involvement by cells originating in the lesion D) Presence or absence of hormone receptors within the lesion © E) Size of the lesion Previous O p 1 Lab Values Review © Pause 3:16 PM 28/08/2012 Cl . Examination of the right breast shows a 2.v---------.com/api/5. A photograph of the resected mass is shown.1.1.1----------l------------------' - 0 https:/7www.

1.starttest.1. He regained consciousness 1 minute after fainting.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 34 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 21 m in 5 sec 34.com/api/5.0/TTDStart. and intravenous fluid replacement is started.Google Chrome https://www.r 0 National Board o f Medical Examiners .5 L. Which of the following is the most likely cause of this patient's diarrhea? © A) Bacterial overgrowth © B) Cholera C) Inactivation of lipase © D) Lactose intolerance E) Vasoactive intestinal polypeptide secretion . His blood pressure is 90/60 mm Hg. Physical examination shows a flushed face and dehydration. A 49-year-old man is brought to the emergency department 30 minutes after fainting in the street. He says that he has had watery diarrhea during the past 5 days. He is admitted to the hospital. He has not changed his diet or travelled overseas recently. he passes a stool with a volume of 3. Over the next day. which has not improved with fasting. Serum studies show a potassium concentration of 2 mEq/L and glucose concentration of 150 mg/dL.

moist crackles are heard over both lungs.1. and he has had to use two pillows to sleep during this period.1.com/api/5.0/ITDStart. There is pitting edema above the ankles.starttest. He has had frequent nausea.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 35 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 20 m in 52 sec 35. Which of the following best describes the function of the product secreted by the atrial myocytes in this patient? A) Decreased glomerular filtration rate B) Increased sodium reabsorption O C) Induction of vasoconstriction O D) Inhibition of renin release E) Stimulation of aldosterone release .r 0 National Board o f Medical Examiners .Google Chrome https://www. Diffuse. A 76-year-old man with congestive heart failure comes to the physician because of a 1-month history of shortness of breath after walking up a flight of stairs.

com/api/5.Google Chrome https://www.r 0 National Board o f Medical Examiners .aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 36 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 19 m in 38 sec 36. Which of the following is the most likely cause of the hip abnormality? A) Ankylosing spondylitis O B) Aseptic necrosis O C) Gouty arthritis D) Multiple myeloma O E) Septic arthritis . The left hip appears normal.starttest. She has a 4-year history of refractory inflammatory bowel disease with arthritis in the hands treated with corticosteroids for the past 2 years. A 19-year-old woman comes to the physician because of increasingly severe pain in the right hip during the past month.1. An x-ray of the pelvis shows collapse of the superior half of the right femoral head with preservation of the articular cartilage.1.0/TTDStart.

The deceased woman was a philanthropist who was active in addressing disparities in health care.1.1.com/api/5. The most appropriate use of this money would be a program addressing which of the following diseases? O A) Breast cancer B) Cardiovascular disease C) Cerebral infarction © D) Cervical cancer © E) Ovarian cancer .aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 37 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 17 m in 16 sec 37.Google Chrome https://www.0/TTDStart. An executor of an estate consults with a physician concerning the terms of a will. She designated that a large sum of her money be used to educate the public about the leading cause of death in women.starttest.r 0 National Board o f Medical Examiners .

3°F). and uninterested in eating. and the exudate can be lifted with a tongue blade. Physical examination shows a dull red throat. She was recently adopted from a developing country. A gray exudate is present on the tonsils. There is marked cervical lymphadenopathy.0/ITDStart.com/api/5. listless.r 0 National Board o f Medical Examiners . She has difficulty swallowing and has become irritable.1. and respirations are 40/min.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 38 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 14 m in 50 sec 38.starttest. pharynx. pulse is 150/min.1. and her immunization history is unknown. and tongue. uvula.Google Chrome https://www.5°C (101. A 2-year-old girl is brought to the physician by her mother because of fever and a sore throat for 3 days. Her temperature is 38. The most likely causal organism produces a toxin that causes ADP-ribosylation of which of the following targets? A) Acetylcholinesterase C B) Adenylyl cyclase C C) Elongation factor-2 © D) GTPase Gs subunit C E) Guanylyl cyclase O F) Ribosomal protein S1 .

A 70-year-old woman comes to the physician because of several episodes of burning pain with urination during the past year. This patient is at greatest risk for which of the following? O A) Cervical carcinoma B) Pyelonephritis C) Renal cell carcinoma D) Ureterolithiasis E) Urothelial carcinoma .1. Ultrasonography of the abdomen shows bilateral dilation of the renal collecting system.Google Chrome https://www. Urinalysis shows a mild increase in leukocytes.0/TTDStart.starttest.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 39 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 13 m in 34 sec 39. Physical examination shows uterine prolapse.r 0 National Board o f Medical Examiners .1.com/api/5.

l.1 Exam Section 3: Item 40 o f 50 ■ M ark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 12 m in 15 sec 40.0/TTDStart.Google Chrome Q h ttp s://w w w . Which of the following is the most likely mechanism of this condition? A) Aganglionosis of the large bowel B) Congenital atresia of the bile ducts C) Congenital defect in the diaphragm O D) Hypertrophy of the pyloric sphincter O E) Intestinal obstruction by meconium .r National Board o f Medical Examiners .1. Laboratory findings are indicative of a metabolic alkalosis. Physical examination shows prominent peristalsis.sta rtte st.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 1 cz.e o m /a p i/5 . A 6-week-old male newborn has persistent nonbilious projectile vomiting. I IB 1 ^ 3 .

aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 41 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 12 m in 13 sec 41.com/api/5.1.0/ITDStart.1. Physical examination and CT scan of the head show no abnormalities. Which of the following additional findings in this patient is consistent with a diagnosis of hypochondriasis rather than undifferentiated somatoform disorder? A) Disproportionate fear of serious disease B) Frequent health care visits C) Past history of unexplained symptoms D) Persistence of symptoms longer than 6 months O E) Presence of depressive symptoms . A 32-year-old man has had generalized band-like headaches and dizziness almost every day for the past 6 months.starttest.r 0 National Board o f Medical Examiners .Google Chrome https://www.

1. Menses occur at regular 28-day intervals. Physical examination shows mild right flank tenderness.starttest. The most likely cause of this patient's pain is the accidental ligation of which of the following structures on the right? A) Ovarian artery © B) Ovarian vein O C) Renal artery © D) Renal vein © E) Ureter © F) Uterine ligament . A 22-year-old nulligravid woman develops right flank pain 3 days after undergoing an appendectomy and right ovarian resection because of an appendiceal abscess.1.Google Chrome https://www. Vital signs are within normal limits.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 42 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 12 m in 10 sec 42.0/TTDStart.com/api/5.r 0 National Board o f Medical Examiners .

Physical examination shows hypertrophy of the calf muscles. He is alert.1.r 0 National Board o f Medical Examiners . He was delivered at term after an uncomplicated pregnancy.0/TTDStart.com/api/5. He has difficulty rising from the chair. He says that his legs are tired. he uses his arms to push himself into a standing position. This patient most likely has weak hip adduction as a result of dysfunction of the muscle inserting onto the femur from which of the following locations? © A) Anterior sacrum © B) Iliac crest O C) Iliac spine © D) Ischium © E) Lateral ilium . He is unable to jump with both feet together.starttest. A 5-year-old boy is brought to the physician by his mother because of progressive clumsiness and fatigue during the past 6 months.1.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 43 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 12 m in 7 sec 43. He has met all developmental milestones. although there was some delay compared with other children his age.Google Chrome https://www.

Temperature is 36°C (96. A 35-year-old man who is a farmer is brought to the hospital by his wife because of difficulty breathing.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 44 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 12 m in 4 sec 44.8°F).1. respirations are 22/min. sweating. excess salivation.starttest.0/ITDStart. and diarrhea for the past 2 hours. His wife says that the symptoms started when he was applying a new insecticide to his crops. Which of the following is the most appropriate treatment? O A) Atropine B) Ipratropium C) Mecamylamine D) Neostigmine O E) Propantheline . pulse is 50/min.r 0 National Board o f Medical Examiners . and blood pressure is 90/60 mm Hg.1.Google Chrome https://www.com/api/5.

com/api/5.starttest. A 59-year-old woman with metastatic renal carcinoma is receiving cyclophosphamide. and interleukin-2 (IL-2).0/TTDStart.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 45 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 12 m in 1 sec 45.1. paclitaxel.r 0 National Board o f Medical Examiners .Google Chrome https://www. Which of the following is the reason for including IL-2 in the regimen? A) Decreasing bone marrow suppression B) Decreasing the likelihood of hemorrhagic cystitis C) Decreasing the likelihood of peripheral neuropathy D) Decreasing nausea and vomiting O E)Stim ulating!lym phocytes .1.

1. epinephrine is injected intramuscularly into each animal. During the experiment. Which of the following physiologic effects is most likely to be observed in these animals? A) Increased myocardial contractility B) Internal urethral sphincter contraction © C) Lipolysis © D) Pilomotor contraction © E) Pupillary dilation © F) Uterine relaxation .aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 46 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 11 m in 58 sec 46. and the effects on (32 adrenoreceptors are then observed.starttest.1.r 0 National Board o f Medical Examiners .0/TTDStart.Google Chrome https://www.com/api/5. An investigator is studying (32-adrenoreceptors in female experimental animals.

starttest. cystic structure. A CT scan of the neck shows a 4-cm. Physical examination shows macroglossia and enlargement of the anterior neck at the midline.0/ITDStart.1.com/api/5. A 5-month-old boy is brought to the physician because of a 5-day history of difficulty feeding.r 0 National Board o f Medical Examiners .Google Chrome https://www. well-defined.1. A remnant of which of the following is the most likely cause of this patient's condition? O A) Cervical sinus O B) First pharyngeal pouch O C) Fourth pharyngeal pouch O D) Occipital myotome O E) Thyroglossal duct .aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 47 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 11 m in 55 sec 47.

aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 48 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 11 m in 52 sec 48.1. Physical examination shows spasticity.starttest.r 0 National Board o f Medical Examiners .com/api/5. His male cousin has similar symptoms.0/TTDStart.Google Chrome https://www.1. and mutilation of the digits. An 8-year-old boy with severe mental retardation is brought to the physician because of a 1-year history of self-mutilating behavior. chorea. including biting his fingers. Laboratory studies are most likely to show which of the following abnormalities? O A) Hypercalcemia O B) Hypercalciuria O C) Hyperuricemia D) Hypokalemia O E) Hyponatremia F)Hypophosphatemia .

Treatment with ciprofloxacin is begun.r 0 National Board o f Medical Examiners . she is admitted to the hospital because of a progressive cough and a temperature of 39°C (102. Culture of sputum at this time grows Streptococcus pneumoniae.0/TTDStart.1.starttest. Two days later.5°C (101. A 76-year-old woman who is a resident of a skilled nursing care facility is brought to the physician because of a 2-day history of fever and cough.1. A mutation in genes encoding which of the following enzymes is the most likely cause of the organism's resistance to ciprofloxacin? A) Acetyltransferase O B) DNA gyrase O C) 3-Lactamase D) Tetrahydrofolate reductase E) Transpeptidase .aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 3: Item 49 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 11 m in 48 sec 49.3°F).Google Chrome https://www. Her temperature is 38.2°F).com/api/5.

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Exam Section 3: Item 50 o f 50 H Mark

National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment

Tim e Remaining: 3 hr 11 min 38 sec

50. A 54-year-old man has a squamous cell carcinoma of the right lung. Analysis of his germline DNA shows two alleles, m and n, at the microsatellite locus Z tightly linked to the p53 gene. Similar analysis of the neoplastic cells shows the presence of the m allele only. These findings are most likely due to which of the following processes? O A) Germline mosaicism O B) Loss of heterozygosity C) p53 Gene amplification O D) Pericentric inversion involving p53 and locus Z O E) Point mutation of allele n

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Exam Section 4: Item 1 o f 50 I Mark

N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment

T im e R em aining: 4 hr 19 m in 19 sec

1. A 70-year-old man comes to the emergency department 30 minutes after the onset of weakness, nausea, and lower abdominal and back pain that radiates to the lower extremities. He appears pale and has a cold sweat. Pulse is 110/min and blood pressure is 90/60 mm Hg. Pulses in the lower extremities are weak. A faint bruit is heard in the lower abdomen. Muscle stretch reflexes are normal in both lower extremities. Which of the following is the most likely diagnosis? A)
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Exam Section 4: Item 2 o f 50 I Mark

N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment

T im e R em aining: 4 hr 19 m in 10 sec

2. A 45-year-old man is brought to the emergency department because of a 6-hour history of severe headache and confusion. He says that it is the worst headache he has ever had. He appears lethargic. His blood pressure is 130/80 mm Hg. Physical examination shows nuchal rigidity. A CT scan of the head without contrast is shown. Which of the following is the most likely cause of this patient's condition? A) Diffuse cerebral edema

O B) Hydrocephalus O C) Large mass in the posterior fossa D) Subarachnoid hemorrhage E) Subdural hematoma

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Exam Section 4: Item 3 o f 50 I Mark

N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment

T im e R em aining: 4 hr 18 m in 55 sec

3. An otherwise healthy 23-year-old woman comes to the physician because she has not had a menstrual period for 2 months. Menarche occurred at the age of 14 years, and menses had occurred at regular 28-day intervals. Pelvic examination shows blue-tinged vaginal mucosa. The uterus is somewhat soft in the lower segment and is about the size of an orange. The adnexa are nontender with normal-sized ovaries. Which of the following is the most appropriate next step to establish the diagnosis? A) Measurement of serum follicle-stimulating hormone concentration B) Measurement of serum thyroid-stimulating hormone concentration C) Measurement of urine 3-human chorionic gonadotropin concentration D) Ultrasonography of the pelvis O E) Endometrial biopsy

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Exam Section 4: Item 4 o f 50 I Mark

N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment

T im e R em aining: 4 hr 18 m in 53 sec

4. A 25-year-old man is diagnosed with advanced testicular cancer. Combination chemotherapy is being considered. Cisplatin is included in the regimen because of its effect on which of the following? A) Dihydrofolate reductase

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Exam Section 4: Item 5 o f 50 I Mark

N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment

T im e R em aining: 4 hr 18 m in 34 sec

5. A 72-year-old man is brought to the emergency department because of a 1-week history of increasingly severe abdominal pain, diarrhea, and loss of appetite. He has had a fever for 2 days. His temperature is 38.3°C (101 °F), and pulse is 106/min. Abdominal examination shows distention and rebound tenderness localized to the left lower quadrant. His leukocyte count is 18,000/mm3 (80% segmented neutrophils, 10% bands, and 10% lymphocytes). An abdominal CT scan with contrast shows a 7-mm, thickened colonic wall, and pericolic fat inflammation; there is a collection of contrast in this region. Which of the following is the most likely diagnosis? O A) Amebiasis O B) Collagenous colitis © C) Colon cancer © D) Diverticulitis © E) Ulcerative colitis

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Exam Section 4: Item 6 o f 50 I Mark

N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment

T im e R em aining: 4 hr 18 m in 31 sec

6. A 6-year-old boy is found to have almond-shaped eyes, temperature instability, mental retardation, hyperphagia, and obesity. Cytogenetic analysis shows a balanced translocation involving chromosome 15q11-q13. His father and paternal aunt are found to have an identical balanced translocation. His aunt's 5-year-old daughter has a history of inappropriate laughter, abnormal gait, and mental retardation. Which of the following genetic principles best explains the findings in this family? O A) Anticipation 0 B) Genetic drift

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Exam Section 4: Item 7 o f 50 I Mark

N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment

T im e R em aining: 4 hr 18 m in 28 sec

7. A 31 -year-old woman is brought to the emergency department by her husband because of difficulty breathing and severe muscle weakness for 10 minutes. She has a 3-year history of myasthenia gravis treated with neostigmine. The husband reports that she doubled her dosage 2 days ago because she was feeling extraordinarily weak, but her weakness has increased since then. Which of the following events is the most likely cause of the increased muscle weakness in this patient? O A) Autoimmune hyperactivation of nicotinic receptors B) Autoimmune inactivation of muscarinic receptors C) Desensitization of nicotinic receptors D) Excessive degradation of acetylcholine E) Hypersensitization of muscarinic receptors F) Insufficient release of acetylcholine

Google Chrome https://www.1.0/ITDStart. Which of the following is the mechanism of action of this antibiotic in this . A 2-year-old girl takes oral cephalexin for treatment of impetigo caused by group A (3-hemolytic patient? A) Binding to bacterial 30S ribosomal subunits B) Binding to bacterial 50S ribosomal subunits C) Inhibition of bacterial dihydrofolate reductase D) Interference with bacterial cell wall synthesis E) Production of 3-lactamase Streptococcus.com/api/5.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 4: Item 8 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 18 m in 25 sec 8.starttest.r 0 National Board o f Medical Examiners .1.

She uses high-dose acetaminophen daily for headaches. BMI is 21 kg/m2. She is responsive to painful stimuli. vomiting. Initial laboratory studies show increased hepatic aminotransferase.r 0 National Board o f Medical Examiners .Google Chrome https://www. Which of the following effects of alcohol most likely contributed to this patient's condition? A) Decreased generation of/V-acetyl-p-benzoquinoneimine B) Increased glucuronidation C) Increased hepatic glutathione stores D) Increased sulfation O E) Induction of cytochrome P450 . She does not use illicit drugs. She is 155 cm (5 ft 1 in) tall and weighs 50 kg (110 lb).starttest.0/TTDStart.com/api/5.1. A previously healthy 42-year-old Asian woman is brought to the emergency department because of a 24-hour history of nausea. She has smoked 1 pack of cigarettes daily for 25 years and drinks four glasses of wine daily.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 4: Item 9 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 18 m in 22 sec 9. and progressive lethargy.1.

starttest.1-0.1.Google Chrome https://www.aspx?SVC=f3fd94ad-4a91-4962-b764-2d4caccal061 Exam Section 4: Item 10 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 18 m in 19 sec 10.8). Which of the following is the most appropriate interpretation of this finding? A) Selenium causes gastric cancer B) Selenium exposure is unrelated to gastric cancer C) Selenium is associated with a higher risk of gastric cancer D) Selenium is associated with a lower risk of gastric cancer E) Selenium is positively correlated with gastric cancer .com/api/5.3 in individuals with a high-selenium diet (95% confidence interval 0.0/TTDStart. A prospective study examined the relationship between the development of gastric cancer and exposure to a diet rich in selenium.1. The investigators estimated the relative risk of gastric cancer to be 0.r 0 National Board o f Medical Examiners .

and is no longer relieved by aspirin. There has been no trauma to the area.starttest. and blood pressure is 160/100 mm Hg.aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 I1a \ < @ | Q Exam Section 4: Item 11 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 18 m in 1 sec 11. there are no skin lesions. The pain occurs mostly at night. Physical examination shows point tenderness over the L4-5 area. is exacerbated by movement. He appears chronically ill. Which of the following is the most likely diagnosis? A) Hyperparathyroidism B) Metastatic bone disease C) Multiple myeloma D) Osteitis deformans (Paget disease) E) Waldenstrom macroglobulinemia .0/ITDStart. A 78-year-old man comes to the physician because of a 3-month history of increasingly severe back pain.1. A photomicrograph of findings from bone marrow aspiration are shown. His pulse is 100/min. Urinalysis shows 4+ protein.1.r~' National Board o f Medical Examiners . He has had a 5.Google Chrome https:/?www.4-kg (12-lb) weight loss during this period.com/api/5.

1. A 32-year-old woman comes to the physician because she has not been able to conceive for 5 years.r~' National Board o f Medical Examiners .0/ITDStart.Google Chrome https:/7www. Which of the following is the most appropriate pharmacotherapy for this patient's infertility? O A) Bromocriptine O B)Clomiphene C) DiethylstiIbestrol D) Ethinyl estradiol E) Medroxyprogesterone .aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 F z* m Q Exam Section 4: Item 12 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 17 m in 59 sec 12.com/api/5. Hysterosalpingography shows normal findings. Menses occur at regular 28-day intervals.1. Previous fertility examinations of her husband showed no abnormalities. Physical and pelvic examinations show no abnormalities.starttest. Her serum hormone concentrations are within the reference range. Her blood pressure is 110/70 mm Hg.

A 70-year-old man comes to the physician because of a rash for 7 days. type IV O D) Hemidesmosomal proteins E) Intracellular adhesion molecule-1 . Serologic studies are most likely to show an autoantibody directed against which of the following? A) C) Anchoring filaments Desmosomal proteins O B) Collagen.aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 F z* m Q Exam Section 4: Item 13 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 17 m in 57 sec 13. lower abdomen.1.0/ITDStart.starttest. Physical examination shows multiple 4. groin. and thighs.Google Chrome https:/7www.1.to 6-cm tense bullae filled with clear fluid over the inner aspects of the forearms.r~' National Board o f Medical Examiners . Examination of a skin biopsy specimen shows a non-acantholytic blister with separation of the epidermis from the basement membrane.com/api/5.

A 20-year-old man has had hemoptysis.r~' National Board o f Medical Examiners . Laboratory studies show a hypochromic microcytic anemia. hematuria.0/ITDStart.1.1.com/api/5. and a 10-kg (22-lb) weight loss over the past 3 months.starttest.aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 F z* m Q Exam Section 4: Item 14 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 17 m in 53 sec 14. Which of the following sets of microscopic findings is most likely in tissue obtained on biopsy of his kidney? Light Microscopy © © © © A) B) C) D) Diffusely hypercellular glomeruli Glomerular crescents Normal glomerular cellularity Normal glomerular cellularity Deposition in Glomerular Basement Membrane granular IgG and C3 linear IgG and C3 granular IgG and C3 negative Electron Microscopy subepithelial humps no deposits subepithelial deposits loss of foot processes .Google Chrome https:/7www.

com/api/5.r~' National Board o f Medical Examiners .1.starttest.aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 F z* m Q Exam Section 4: Item 15 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 17 m in 49 sec 15. Which of the following is the most likely cause of the increased susceptibility to infections in this patient? A) Decreased oxygen consumption after phagocytosis B) Defective neutrophil degranulation C) Defective production of prostaglandins D) Inability to produce hydrogen peroxide E) Inability to produce hydroxy-halide radicals .Google Chrome https:/?www. A 23-year-old woman with type 1 diabetes mellitus is brought to the physician for a follow-up examination.1.0/ITDStart. She has a 2-year history of recurrent yeast infections. Genetic analysis shows a deficiency of myeloperoxidase.

starttest. Decreased serum concentrations of which of the following is the most likely cause of this patient's erectile dysfunction? O A) Estradiol 0 0 0 0 0 B) Estrone C) Follicle-stimulating hormone D) Human chorionic gonadotropin E) Luteinizing hormone F) Testosterone . His pulse is 88/min.aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 F z* m Q Exam Section 4: Item 16 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 4 hr 0 m in 50 sec 16.1. The spleen tip is palpated 5 to 6 cm below the left costal margin.0/ITDStart.r~' National Board o f Medical Examiners .Google Chrome https:/7www. The liver span is 5 to 6 cm in the midclavicular line.1. A 40-year-old man comes to the physician because of a 6-month history of difficulty maintaining an erection during sexual intercourse. Examination shows scleral icterus and spider angiomata over the trunk. He has consumed 1 L of bourbon daily for /4 15 years. and blood pressure is 130/80 mm Hg.com/api/5.

r~' National Board o f Medical Examiners .com/api/5. Drug X is administered to treat trematode and cestode infestations. dislodgement. Drug X most closely resembles which of the following? O A) Albendazole O B) Bithionol C) Diethylcarbamazine O D) Niclosamide O E) Praziquantel . causing paralysis.1. and death of the parasite.0/ITDStart. During an experiment.1.Google Chrome https:/7www.aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 F z* m Q Exam Section 4: Item 17 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 59 m in 43 sec 17.starttest. Results show that Drug X increases the permeability of the cell membranes to calcium.

1.aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 F z* m Q Exam Section 4: Item 18 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 59 m in 24 sec 18. she develops painful edema of the left upper extremity.Google Chrome https:/?www.1. Which of the following therapies is most likely to decrease the swelling in this patient? O A) Application of heat O B) Compression sleeve O C) Diuretic therapy O D) Exercise therapy O E) Passive movement .starttest.r~' National Board o f Medical Examiners . A 25-year-old woman undergoes a radical mastectomy with removal of the axillary lymph nodes on the left side.com/api/5.0/ITDStart. After the operation.

A semen analysis shows: Quality Quantity Color Fructose normal range normal range white 5% of normal content The most likely cause of this couple's infertility is deficient activity of which of the following in the man? A) Adenohypophysis B) Bulbourethral glands © C) Prostate D) Seminal vesicles © E) Testes . A young adult couple has been unable to conceive for the past 2 years.0/ITDStart. The woman has regular menstrual cycles and takes no contraceptives.aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 F z* m Q Exam Section 4: Item 19 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 59 m in 15 sec 19.r~' National Board o f Medical Examiners .1.1.com/api/5.starttest.Google Chrome https:/7www.

aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 Exam Section 4: Item 20 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 56 m in 21 sec 20.starttest.0/ITDStart.'www. Each patient in the ICU is in a private. enclosed room.1. Which of the following infection control measures is most likely to decrease the spread of this organism to other patients in the ICU and elsewhere in the hospital? A) Place infected patients in rooms with at least six air exchanges per hour B) Place infected patients in rooms with negative air pressure C) Place infected patients in rooms with positive air pressure D) Promote thorough hand cleansing before and after medical personnel visit each patient E) Require medical personnel to wear masks when visiting infected patients .Google Chrome https:/..r 0 National Board o f Medical Examiners .1.com/api/5. A cluster of three cases of nosocomial pneumonia caused by a highly resistant strain of Klebsiella pneumoniae occurs in a 13-bed intensive care unit (ICU).

starttest.com/api/5. During the pain. stabbing pain behind his left eye for 5 nights.Google Chrome Q https:/?www.0/TTDStart. He had a similar series of nightly headaches for 6 weeks several years ago. The headaches generally begin 1 hour after he goes to bed and last for about 1 hour..1.r National Board o f Medical Examiners . Which of the following is the most likely diagnosis? o A) Cluster headache O B) Factitious disorder C) Generalized anxiety disorder O D) Sinusitis O E) Temporal arteritis O F) Tension-type headache Previous Lab Values ® Review Help Pause O 4:21 PM * .aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 Exam Section 4: Item 21 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 53 m in 55 sec 21. he has left-sided nasal stuffiness and tearing from his left eye. A 39-year-old man comes to the physician because he has had an intense.1.ill ><> I) & ® rSTEaI rfcjrxy'® r^i 28/08/2012 .

ill ><> I) & ® rSTEaI rfcjrxy'® r^i 28/08/2012 . she has winging of the scapula when she presses her outstretched arms against a wall.r National Board o f Medical Examiners .Google Chrome Q https:/?www.com/api/5.aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 Exam Section 4: Item 22 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 53 m in 13 sec 22..1. A 48-year-old woman with ductal carcinoma of the right breast has a modified radical mastectomy.1. Which of the following nerves is most likely injured? O A) Axillary o B) Long thoracic 0 C) Lower subscapular D) Suprascapular E) Thoracodorsal 0 Previous Lab Values ® Review © & Help * Pause O 4:22 PM .0/TTDStart. After the operation.starttest.

Laboratory studies show: Hemoglobin Hematocrit Mean corpuscular hemoglobin Mean corpuscular hemoglobin concentration Mean corpuscular volume Leukocyte count Platelet count Serum Urea nitrogen Creatinine Total bilirubin Which of the following is the most appropriate pharmacotherapy for this patient? O A) Cyclosporine O B) Deferoxamine O C) Erythropoietin D) 0 0 8 g/dL 24% 30 pg/cell 33% Hb/cell 85 pm3 8000/mm3 200. pulse is 95/min. Physical examination shows pallor.1 Exam Section 4: Item 23 o f 50 ■ M ark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 53 m in 10 sec 23.0/TTDStart. A 50-year-old man with a long-standing history of type 2 diabetes mellitus comes to the physician because of several fainting episodes and fatigue during the past month.e o m /a p i/5 .9 mg/dL Filgrastim E) Folic acid F)Oprelvekin G) Vitamin B 12(cyanocobalamin) . He appears chronically ill. I IB 1 ^ 3 .1. and blood pressure is 155/95 mm Hg. His temperature is 37°C (98.r National Board o f Medical Examiners .6°F).aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 1 cz.000/mm3 60 mg/dL 6 mg/dL 0.sta rtte st. respirations are 17/min.l.Google Chrome Q h ttp s://w w w .

One of these monoclonal antibodies is found to inhibit the ribosome peptidyl transferase.r 0 National Board o f Medical Examiners .0/ITDStart.1.com/api/5. An investigator studying the molecular events in the underlying causes of an autoimmune disease develops a collection of monoclonal antibodies to ribosomal proteins.Google Chrome https:/.1.starttest.aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 Exam Section 4: Item 24 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 51 m in 55 sec 24.'www. Which of the following is most likely affected in the presence of this antibody? A) Assembly of 80S ribosomal subunits B) Attachment of amino acids to tRNA C) Dissociation of 80S ribosomes into 60S and 40S subunits D) Establishment of covalent bonding between amino acids O E) Release of the mRNA from ribosomes .

starttest. and his thought process is confused. his affect is agitated.aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 Exam Section 4: Item 25 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 46 m in 34 sec 25. On mental status examination.Google Chrome https:/.0/ITDStart. A 15-year-old boy is brought to the physician by his father because of behavioral changes during the past month.com/api/5.'www." His pulse is 110/min. Intoxication with which of the following substances is the most likely cause of this patient's symptoms? O A) Alcohol B) 0 Amphetamine Cannabis C) Amyl nitrate D) E) Heroin 0 .1. Physical examination shows pupillary dilation and diaphoresis.r 0 National Board o f Medical Examiners . and blood pressure is 140/85 mm Hg. and that the local teenagers are "all drug addicts and criminals.1. respirations are 24/min. He has been failing his classes at school and staying out late at night. His father reports that the family moved to a new neighborhood 2 months ago.

Homologous pairing of chromosomes in prophase I is essential for which of the following normal processes? O A) Centromere division O B) Chromosome uncoiling O C) Crossing over O D) DNA replication Previous Lab Values ® Review Help Pause O 4:30 PM * .com/api/5.ill ><> I) & ® rSTEaI rfcjrxy'® r^i 28/08/2012 ..1.Google Chrome Q https:/?www.starttest.0/TTDStart.aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 Exam Section 4: Item 26 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 45 m in 8 sec 26.1.r National Board o f Medical Examiners .

A 9-year-old boy is brought to the emergency department because of fever. hips. His temperature is 39°C (102. Four weeks ago.'www. The greatest risk for death at this time is from which of the following? O A) Aortic stenosis O B) Embolism C) Mitral insufficiency O D) Myocarditis © E) Septic shock . A pericardial friction rub and quiet heart sounds are heard. and knees for 2 days.1. and migratory joint pain of his shoulders. Throat cultures do not grow any pathogens.2°F). Laboratory testing shows increased antibody titers to streptolysin 0 . The lungs are clear to auscultation.0/ITDStart.aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 Exam Section 4: Item 27 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 45 m in 3 sec 27. chest pain.r 0 National Board o f Medical Examiners .Google Chrome https:/.1. which resolved 2 weeks later without treatment.starttest.com/api/5. he had a febrile pharyngitis.

1. He is found to have ruptured the left Achilles tendon and undergoes operative repair and long leg cast immobilization.Google Chrome https:/. Which of the following is the most likely cause of this decrease? A) Decreased glycogen synthesis B) Decreased myosin light chain phosphatase activity C) Increased phosphatidyl degradation D) Increased protein degradation E) Mitochondria damage O F) Necrosis of muscle fibers .r 0 National Board o f Medical Examiners .0/ITDStart.'www.1.com/api/5.starttest. Six months later. the left calf shows a 2-cm decrease in circumference compared with the right calf. A previously healthy 40-year-old man is brought to the emergency department 1 hour after the sudden onset of severe pain in his left leg while playing tennis.aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 Exam Section 4: Item 28 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 44 m in 13 sec 28.

Physical examination shows epigastric tenderness. A 52-year-old man comes to the physician because of a 3-month history of epigastric abdominal pain.'www. He immigrated to the USA from Japan 6 months ago.0/ITDStart. He has osteoarthritis treated with naproxen as needed.com/api/5.Google Chrome https:/.r 0 National Board o f Medical Examiners . He has smoked 2 packs of cigarettes daily for 30 years and drinks three to four glasses of wine daily.8-kg (15-lb) weight loss during this period.1. Examination of a biopsy specimen of the lesion confirms adenocarcinoma.starttest. He is 170 cm (5 ft 7 in) tall and now weighs 82 kg (180 lb).1. BMI is 28 kg/m2.aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 Exam Section 4: Item 29 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 42 m in 49 sec 29.. he also has had an unintentional 6. Which of the following is the strongest predisposing risk factor for this patient's condition? © A) Alcohol use o B) Diet O C) Ethnicity © D) Naproxen use © E) Tobacco use . Upper gastrointestinal endoscopy shows a 4-cm ulcer in the stomach. He eats mostly traditional Japanese food prepared by his wife.

1.r National Board o f Medical Examiners . At autopsy.aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 Exam Section 4: Item 30 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 42 m in 43 sec 30. examination of lung tissue shows alveoli containing epithelial cells that are cuboidal in shape with electron dense lamellar bodies 1— m in diameter. These cells most likely produce which of the following? 2 O A) Collagen.0/TTDStart.com/api/5.Google Chrome Q https:/?www.1. A 57-year-old man dies of a myocardial infarction. type I B) Epinephrine O C) Histamine O D)lgG O E) Surfactant Previous Lab Values ® Review © & Help Pause O 4:32 PM 28/08/2012 I) & ® rSTEaI rfcjrxy'® r^i .starttest.

and respirations are 32/min.Google Chrome https:/. He does not smoke cigarettes.r 0 National Board o f Medical Examiners .'www.0/ITDStart. His pulse is 110/min.com/api/5.1. The lungs are clear to auscultation. A 63-year-old man comes to the emergency department 30 minutes after the sudden onset of right-sided chest pain and shortness of breath that began after a 10-hour drive in his truck.1.aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 Exam Section 4: Item 31 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 42 m in 21 sec 31.starttest. The pain is more severe with inspiration. Which of the following findings is most likely on ventilation-perfusion lung scans? A) Absence of perfusion in some areas that are ventilated B) Absence of ventilation in some areas that are perfused C) Absence of ventilation-perfusion mismatching D) Decreased perfusion gradient from the apices to the bases of the lungs E) Increased ventilation-perfusion ratios at lung bases compared with those at the apices .

which is surgically repaired.Google Chrome https:/. and blood pressure is 80/45 mm Hg.0/ITDStart. hematocrit is 24%.1. respirations are 16/min.com/api/5. Histologic examination of a renal biopsy specimen is most likely to show which of the following at this time? A) Coagulation necrosis B) Collagen scar C) Granulation tissue D) Lymphocytic infiltrate and fibrogenesis E) Regenerating tubular epithelial cells . His hemoglobin concentration is 8 g/dL. Physical examination shows no other abnormalities. laboratory studies show: Hemoglobin Hematocrit Serum Urea nitrogen Creatinine Urine Blood Sediment Volume Total protein Sodium Fractional excretion of sodium Osmolality 10 g/dL 30% 70 mg/dL 3 mg/dL absent granular casts 100 ml_/24 h 100 mg/24 h 50 mEq/L 2.starttest.. Two days later.'www. A 55-year-old man is brought to the emergency department 45 minutes after he collapsed at home. His pulse is 120/min.aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 Exam Section 4: Item 32 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 40 m in 38 sec 32. and platelet count is 240.000/mm3 Endoscopy shows a bleeding .r 0 National Board o f Medical Examiners .5% 300 mOsmol/kg H20 Two weeks later.1. the urine sediment is clear and renal function is normal. duodenal ulcer. He receives 4 units of packed red blood cells.

Google Chrome https:/.1.r 0 National Board o f Medical Examiners .starttest.0/ITDStart.aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 Exam Section 4: Item 33 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 38 m in 42 sec 33. higher-pressure system .com/api/5. The pulmonary circulation of these subjects most likely has which of the following characteristics compared with their bronchial circulation? A) Greater number of branches supplying the visceral pleura B) Larger number of anastomoses with the intercostal arteries C) Larger percentage of cardiac output D) Larger volume of nutrient blood to the conducting airways O E) Lower-volume.1.'www. Twenty subjects participate in a study of cardiopulmonary physiology.

r 0 National Board o f Medical Examiners .1.aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 Exam Section 4: Item 34 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 36 m in 46 sec 34.1. chills. He is pronounced dead on arrival. headache.com/api/5. Which of the following processes is most likely occurring in the hepatocytes described? O A)Apoptosis O B) Atrophy O C) Caseous necrosis D) Coagulation necrosis E) Dysplasia © F) Fatty change G) Heterophagy © H) Liquefaction necrosis I) Metaplasia .starttest. Small shrunken hepatocytes with intense eosinophilic cytoplasm. histologic examination of a liver section shows disruption of the normal hepatic lobule.0/ITDStart. During autopsy. fragmented nuclear chromatin. A 40-year-old man is brought to the emergency department after being involved in a motor vehicle collision. He had a history of fever.Google Chrome https:/.'www. and cytoplasmic bleb formations are noted. and pain in the right upper quadrant of the abdomen 5 days ago.

1. I IB 1 ^ 3 .Google Chrome Q h ttp s://w w w .aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 1 cz. The tracing shows contractile responses of a skeletal muscle preparation to electrical stimulation at five different frequencies. The amount of calcium sequestration in sarcoplasmic reticulum is highest during which of the following labeled responses? ©A) © B) © C) © D) © E) .sta rtte st.1 Exam Section 4: Item 35 o f 50 ■ M ark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 36 m in 1 sec 35.0/TTDStart.e o m /a p i/5 .r National Board o f Medical Examiners .l.

the newborn appears progressively lethargic. This isotype is most likely which of the following? © A) IgA C B)lgD © C) IgE C D)lgG © E)lgM Previous Lab Values Review Pause 4:40 PM 28/08/2012 . serotype III. Cerebrospinal fluid and blood cultures grow S.com/api/5. during a clinical trial.1. she received a vaccine. serotype III.'www. It is suspected that the mother produced only one antibody isotype in response to the vaccine.2°C (100. Eight hours after delivery.Google Chrome https:/.8°F). Streptococcus agalactiae (group B). A 26-year-old primigravid woman delivers a 2948-g (6-lb 8-oz) male newborn at term.0/ITDStart. agalactiae (group B). This antibody was detected in her serum immediately prior to the onset of labor. Screening indicated that she had generated an antibody response to this polysaccharide antigen within 1 month of the vaccination. and his temperature is 38.r 0 National Board o f Medical Examiners . Six months ago.1.aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 Exam Section 4: Item 36 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 35 m in 25 sec 36.starttest.

r 0 National Board o f Medical Examiners . Urinalysis shows no red or white blood cells or casts.com/api/5.1. A urine dipstick test shows 3+ protein.aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 Exam Section 4: Item 37 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 34 m in 46 sec 37. A 4-year-old girl has had "puffy" eyes for the past 3 days. She has had an upper respiratory tract infection for the past week. Which of the following mechanisms is the most likely cause of this patient's condition? A) Attack by antiglomerular basement membrane antibodies O B) Damage to the loop of Henle C) Damage to the proximal renal tubule D) Loss of negative glomerular charge O E) Presence of a posterior urethral valve .'www.Google Chrome https:/.0/ITDStart.1.starttest.

Treatment with multiple appropriate antibiotics has not led to eradication of the causal organism. cough. The organism does not ferment lactose.4°F). Bilateral crackles and rhonchi are heard on auscultation of the chest.r 0 National Board o f Medical Examiners .1.0/ITDStart..1. Which of the following is the most likely explanation for the persistent colonization of this patient by this organism? A) Bacteriophage superinfection B) Biofilm formation in the lower respiratory tract C) Overgrowth of acapsular strains O D) Pyocyanin synthesis O E) Synthesis of exotoxin A . gram-negative rod that forms slimy colonies and produces pyocyanin.'www. and progressive shortness of breath. oxidase-positive.Google Chrome https:/. A nutrient agar plate seeded with bronchial secretions grows an aerobic.com/api/5.aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 Exam Section 4: Item 38 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 34 m in 15 sec 38. A 25-year-old man with cystic fibrosis comes to the physician because of a 3-day history of fever. and respirations are 32/min.starttest. His temperature is 38°C (100.

starttest.Google Chrome https:/.r 0 National Board o f Medical Examiners . Which of the following is the most likely cause of this patient's hyperglycemia? A) Activation of hepatic adenylyl cyclase B) Activation of muscle glycogen synthase C) Activation of muscle phosphorylase D) Activation of muscle protein phosphatase O E) Inhibition of hepatic protein kinase A .'www.0/ITDStart.com/api/5. One hour after his morning dose of insulin.1. His blood glucose concentration is now increased. his symptoms resolve. he becomes tremulous and diaphoretic and has tachycardia. Several hours later.1. A 10-year-old boy who has had type 1 diabetes mellitus for 1 year is receiving insulin.aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 Exam Section 4: Item 39 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 32 m in 10 sec 39.

Would you like me to arrange some training for you by our nurses?" C) "It's been my experience that most poorly controlled diabetics have trouble giving themselves insulin. How often has this happened?" .'www.r 0 National Board o f Medical Examiners . His blood glucose control has been poor recently.1. Which of the following questions is most appropriate to broach this issue with the patient? A) "Giving yourself insulin injections can be difficult.1.Google Chrome https:/. which the physician suspects may be related to the patient's reluctance to self-administer insulin. Would you like to arrange for a family member to give you your shots?" O E) "You seem to have missed your shots. A 16-year-old boy has a 6-month history of type 1 diabetes mellitus and requires daily insulin injections. Do you have this problem?" D) "You are clearly having difficulty with insulin injections. What's it like for you?" B) "I get the feeling you have not been taking your insulin regularly.aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 Exam Section 4: Item 40 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 29 m in 46 sec 40.starttest.com/api/5.0/ITDStart.

Physical examination shows bronze-colored skin.1. changes in skin color.aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 Exam Section 4: Item 41 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 28 m in 51 sec 41. A 50-year-old man comes to the physician because of a 2-month history of pain of his wrists. and progressive fatigue.0/ITDStart. Serum studies show: AST ALT Ferritin Total iron-binding capacity Transferrin saturation 100 U/L 110 U/L 1200ng/mL 200 pg/dL (N=250-400) 80% (N=20-50) Analysis of a liver biopsy specimen shows a markedly increased iron concentration and cirrhosis. Which of the following is the most likely cause of the findings in this patient? O A) Increased erythropoietin action B) Increased intestinal iron absorption C) Increased oral iron intake O D) Decreased erythropoiesis O E) Decreased iron excretion F) Decreased serum transferrin concentration .starttest. tenderness of the metacarpophalangeal joints in both hands.r 0 National Board o f Medical Examiners .com/api/5.. and hepatosplenomegaly.Google Chrome https:/. His brother has type 2 diabetes mellitus and cirrhosis.'www.1.

An autopsy is done on a 46-year-old woman who died of adenocarcinoma of the colon. 1 . chromogranin and neuron-specific enolase.aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 Exam Section 4: Item 42 o f 50 H Mark National Board o f Medical Examiners Comprehensive Basic Science Self-Assessment Tim e Remaining: 3 hr 28 min 11 sec 42.r National Board o f Medical Examiners . Examination of the adrenal glands shows no masses.0/TTDStart. Immunohistochemistry of the section is positive for synaptophysin.1.l. A section of the mass is shown in the photomicrograph. Which of the following is the most likely diagnosis? A) Metastatic colonic adenocarcinoma B) Metastatic squamous cell carcinoma of the larynx C) Papillary carcinoma of the thyroid gland D) Paraganglioma E) Parathyroid adenoma 'V ill ft 7.e o m /a p i/5 .Google Chrome Q h ttp s://w w w .sta rtte st. Electron microscopy shows numerous electron-dense. membrane-bound neurosecretory granules. Examination of the neck shows a 5-cm. rounded mass next to the bifurcation of the carotid artery.

3°C (100. The mother states that her son has a 6-month history of large. A 29-month-old boy is brought to the physician by his mother because of a 2-week history of a green nasal discharge and cough.0/ITDStart. Abdominal examination shows distention.com/api/5.1.Google Chrome https:/.r 0 National Board o f Medical Examiners .'www. Which of the following types of modification is required prior to destruction of misfolded proteins in this patient's proteasomes? O A) Dimerization B) Glycosylation O C) Phosphorylation O D) Sulfation O E) Ubiquitination . His temperature is 38. foul-smelling stools and a salty taste when she kisses him.1. He has a past history of frequent respiratory tract illnesses and pneumonia.9°F). He is at the 5th percentile for height and below the 3rd percentile for weight. There is no family history of a similar condition.starttest.aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 Exam Section 4: Item 43 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 26 m in 23 sec 43. Genetic testing shows a mutation in the Phe residue at position 508 in the cystic fibrosis transmembrane conductance regulator gene.

Which of the following mechanisms of action of pindolol best explains its effect on this patient's heart rate? O A) Competitive agonism B) Competitive antagonism O C) Inverse agonism o D) Partial agonism . His pulse is 56/min..Google Chrome https:/. he was diagnosed with stage I hypertension and began treatment with propranolol.1.1.starttest.com/api/5. compared with 72/min 1 month ago.'www. His symptoms resolve within 1 month.aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 Exam Section 4: Item 44 o f 50 0 M ark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 25 m in 17 sec 44. His treatment is switched to pindolol. A 60-year-old man comes to the physician because of a 2-week history of fatigue and exercise intolerance. and his pulse is 68/min. One month ago.0/ITDStart.r 0 National Board o f Medical Examiners .

'www.0/ITDStart. and the test results were normal.starttest.Google Chrome https:/.1.r 0 National Board o f Medical Examiners .aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 Exam Section 4: Item 45 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 24 m in 59 sec 45. A 24-year-old man comes to the physician with his 25-year-old wife because they have been unable to conceive for 3 years. this man is most likely to have which of the following associated conditions? A) Cholelithiasis B) Coronary artery disease C) Fat malabsorption D) Glomerulonephritis O E) Sinusitis . Analysis of the man’s semen shows normal numbers of living sperm but they are immotile. The wife has been evaluated for infertility. In addition to infertility.1.com/api/5.

0/ITDStart.'www..r 0 National Board o f Medical Examiners .Google Chrome https:/. Examination shows watery stool with red blood. Which of the following is the most likely diagnosis? © A) Celiac sprue B) D) Irritable bowel syndrome Pancreatic insufficiency O C) Ischemic colitis © E) Regional enteritis © F) Ulcerative colitis .1.com/api/5. A 72-year-old woman comes to the emergency department because of bloody diarrhea for the past 12 hours and diffuse abdominal pain for the past 4 days.starttest.1. Colonoscopy shows patchy ulceration at the area near the splenic flexure. History includes a cerebral infarction 3 years ago from which she recovered completely.aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 Exam Section 4: Item 46 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 23 m in 51 sec 46.

Physical examination shows cyanosis and lower rib retractions with respiration. His respirations are 40/min.starttest.0/ITDStart.Google Chrome https:/. Which of the following is the most likely cause of these findings? A) Erythroblastosis fetalis B) Extralobar sequestration C) Intracranial hemorrhage D) Pulmonary surfactant deficiency O E) Situs inversus .1.aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 Exam Section 4: Item 47 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 23 m in 15 sec 47.'www.com/api/5.1. A male newborn delivered at 34 weeks’ gestation by an uncomplicated spontaneous vaginal delivery develops respiratory distress 30 minutes later.r 0 National Board o f Medical Examiners . Chest x-rays show fine densities with a reticulogranular appearance bilaterally.

com/api/5. she is unable to flex the elbow against gravity.starttest. Immediately after reduction of the glenohumeral joint. There is an area of tenderness and absent sensation over the lateral aspect of the forearm.Google Chrome https:/.0/ITDStart.1. The patient is holding her right arm in external rotation. Which of the following structures is most likely injured in this patient? O A) Axillary nerve B) Musculocutaneous nerve C) Posterior cord of the brachial plexus O D) Radial nerve O E) Thoracodorsal nerve .aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 Exam Section 4: Item 48 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 22 m in 42 sec 48. A 23-year-old woman is brought to the emergency department 45 minutes after sustaining an injury to her right shoulder when she was forcefully thrown into a swimming pool.r 0 National Board o f Medical Examiners .1.'www.

Sensation to vibration and joint position is decreased in the fingers and toes.Google Chrome https:/. peroneal.0/ITDStart.com/api/5..starttest. A 33-year-old woman who is right-handed is brought to the physician because of a 3-day history of progressive weakness and numbness of her arms and legs. ulnar. These electrophysiologic findings most likely indicate impaired function of which of the following ion channels? A) Neurotransmitter-gated Ca2+ channels B) Neurotransmitter-gated K +channels C) Neurotransmitter-gated Na+channels D) Voltage-gated C a2+ channels E) Voltage-gated K +channels F) Voltage-gated Na+channels . and tibial nerves.1. Neurologic examination shows proximal and distal weakness of the upper and lower extremities. Nerve conduction studies show a slow conduction velocity in the median. There is areflexia.r 0 National Board o f Medical Examiners .'www.aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 Exam Section 4: Item 49 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 21 m in 25 sec 49.1.

A study is conducted to evaluate the onset and course of cardiovascular disease in African American men and women in the USA.Google Chrome https:/. Which of the following best describes this sampling technique? A) Blocked randomization O B) Population-based O C) Sample of convenience O D) Self-selection O E) Sequential . A series of factors including family income and years of education is defined.com/api/5.1.1.starttest.r 0 National Board o f Medical Examiners .aspx?SVC=a2401610-d3a2-45ec-83a7-b56dlda82cf6 Exam Section 4: Item 50 o f 50 I Mark N ational Board o f M edical E xam iners C om prehensive Basic Science Self-Assessment T im e R em aining: 3 hr 18 m in 27 sec 50.'www. Census tracts most representative of the national census data for the factors selected are used for sampling.0/ITDStart. Census data from the year 2000 are used to select the study sample.

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