or Pies [A 66.yeat-old man comes to the physician because of severe back pain. He dies of the dsease 4 year later. A portion of the man's vertebcal colurn ebtaines at autopsy is shown. Which of he folowing isthe most ikely dagnosis? OA Couty arnt OB. Muple myeloma Oc.Paget disease © D.Pyogenic osteomyelitis © E.Sketeta syonits FSBRBSBREEREBEESSESERESee~araunLcd = pCa Pies ‘A 26-year-old woman comes to tne physician because of recent fatigue and pallor. She says that her sister and older brother ‘nave been clagnosed wit hemolytic anemia but that two younger brothers are asymptomatic. The patient's mother and father ‘are second cousins. Deficiency of which ofthe following enzymes 's most Ikely to cause this disorder? OA.Dedranching enzyme OB clucose-sphospnatase (0 . muscle phosphoryiase OD. Pyruvate carbowyiase O .Pyruvate kinase sueMir BUSRERRE Boe Lama 1140 ©kapin 2010 rSBRNSERERE SEpC Pies ‘A 65-year-old man comes to me physician because of abdominal pan, jntaly te pain was epigastne, but is moming has localizes to the right lower quadrant. His temperature is 38.0°C (100.5%). Physical examination shows abdomenal tenderness. ‘Whict of the folowing fs the most ikely diagnosis? OA Acute appendicitis OB divertcuims Oc calstones OD. Pancreatitis O E.Pyelonepnntis sueMir BSSREEREB Co vas 0140 ©kapen 2010 rSBRNSERERE SELcd = pC Pies ‘A 28-year-old man who recently emigrated trom Nexieo comes fo the physician because of a gradual loss of sensation In his ‘ingertips over tne last year Physical examination shows several nodular lesions on the ears, nose, and fingers. Histologt: ‘examination of a lesion shows acid-fast bacili and multinucleated giant cells. Which ofthe folowing cells produce the intecteron-gamma that mediates the transformation of macrophages into epithelioid cel’ in ths type of lesion?” OA.Cytotaxc T lymphocytes (OB. Mulinucleated giant cet OG. Natura killer cots OD.THT subset of Tnelper lymphocytes OE. THe subset of T-nelper lymphocytes suBMIT BESSEEERE Sea +oa 1200 © kapin 2010 PSBRBNRRRERESLcd = Ce Pies ‘A 58-year-old man wi a nistory of colorectal eancer has nad Talgue, weight loss, and myalgias for several weeks. He nas @ ‘temperature of 38.0°C (100 4°F). Physical examination shows punctate Nemorrhages under the figernalls and a muITU 1S heard on auscultation of tie chest. Whici of the folowing organisms 's most Ikely responsible forthe development ofthese ‘symptoms in ths patent? OA Steptococeus agalactiae 0B. Steptococeus bovis 0.6. streptococcus mutans ©, sreptococous pneumoniae OE. streptococcus pyogenes OF. Streptocacous senguis BSSREEREB Cove SUBMIT 1200963 © Kapa 210 rSBRNSERERE SELcd = pe Pies ‘A 62-year-old man Is Brought fo the emergency epartment DecaUlse ofthe acute onset of severe ocular pain and Diurred vision {hat is associated wih halos around ights. Ophialmologic examination shows redness of the lef eye. The eye Is Nard 10 palpation, and the cornea appears hazy, with mydriasis. Which ofthe following drugs is most appropriate for this patient? OA.Acetazolamiae (wv) © B.Dorlamice topical) OG.Epmnepnnine (vy (OD Latanoprost (topical) (© ,Timolo! topical) sueMir BSSREEREB CoS (01288 © kapin 2010 rSBRNSERERE SELcd = BE Pies ‘A 61-year-old man Is acmified to the hospital Decaulse of pneumonia. After Tour days, Re nas worsening shortness of Breath. A ‘chest xray shows a large right-sided pleural eMusion. Thoracentesis yields 260 mL of fuld wih a pleural ful proteinrserum protein rao of 0.7, and a lactate dehydrogenase level of 240 UL. Which ofthe folowing is the most likely diagnosis? (OA Bacterial pleuis OB.cinnosis ortne wer O6.congestive neart tature OD. Nephrote syndrome (0 E. Protein-losing enteropathy sueMir BSSRSEREB Co igor © Kap 20109 rSBRNSERERE SELcd = pe Pies ‘A 82-year-old Caucasian man comes to tne physician because of a bioocy nasal alscharge and nasal pan. Physical examination ‘shows ulceration of ihe nasal mucosa. Urinalysis shows protelnuria, Nematuria, and red blood call casts. biopsy of he upper airway tssue reveals granulomatous inflammation wth necrosis. Antineutrophil cytoplasmic antibodies (c-ANCA) are present. ‘Which of the folowing isthe most likely diagnosis? OAAlerac ancitis © B. Goodpasture syndrome © .Nonsntectous granulomatous aisease ©. Tumors oftne upper away © E. Wegener granulomatosis, suBMIT BSSRSEREBS Lim © Kap 2010 rSBRNSERERE SELcd = pe Pies “The current recammendea seneduie for administration of the clpntnera torolo, acellular pertussis produets, and tetanus toxoid (DTaP) vaccine includes fve Immunvations, The frst dose is administered at 2 mons of age and ts Followed by boosters at 4, and 15-18 months of age. A final immunization is given at 4 to 6 years of ave, and thereafter, boosters of tetanus and Ciphtnena toxoids are administered at 10-year intervals. Which of the folowing best describes the type of mmunization? OAAvtineal active OB Avticia! passive O-6.natural active (OD. Natural passive SUBMIT BSSRSERES L147 ©kapin 2010 rSBRNSERERE SELcd = BCL Pies ‘A 50-year-old woman presents wih myinmic involuntary snaking of Doth nands that nad nen gracualy worsening for ten years, ‘The shaking is Worse when she Is nervous oF upset. On examination, she has @ moderate amplitude & He tremor of the upper ‘extremities that particulary involves Nexion and extension at the wrists and fingers. The tremor is mildly accentuated when her arms are outstretched and when she performs the finger-nose-finger maneuver. She also has a very ow amplitude, sirilar ‘requeney tremor of ner nead and voice. The remainder of her neurologic examination ts normal. Which ofthe folowing agents, ‘woud most likely Nelp relieve this woman's symptoms? (OA Agonist at copaminergie receptors (OB Agonist at glutamatergic receptors (0 G.Antagonist of beta-adrenergic receptors OD. Antagonist of GABAA receptors © E.Antagonist of muscarinic cholinergic receptors SESSEEERE sueMiT 1200209 © Kapa 200 PSBRBNRRRERESBESRREER ES ee voosunn PSBRBNRRRERES Lcd = SCS Pies ‘A 57-year-old worian with a history of leukemia who nas undergone multple courses of cnemotnerapy is brought to tne ‘emergency departinent wit fever and severe headactie. She fs oblunded., and unable to respond to questions. Lumbar puncture shows elevated protein, normal glucose, and a mononuclear pleocytosis. CSF cultures are pending. Which of the, ‘ollomng findings on CT scan would contiem the diagnosis of herpes encephalitis? A, Generalized volume loss © B.Volume loss selectively in the basal gang © 6.Volume foss selectively the brainstem 0D. Volume foss selectively tne eerebetium OE. Volume loss selectively inthe temporal and frontal lobes suBMIT 01140 © apn 2010BSBREBBES Covonsene rSBRNSERERE SE Lcd = BC Pies ‘A 49-year-old man comes to tne emergency department because of dizziness. His blood pressure Is 178/108 mm Hg. He has a tong history of hypertension and alcoho! abuse. He says that he Nas not been taking the antihypertensives that were prescribed {or him. Which of the folowing fs most kely to be increased in his skeletal muscles during resting conditions? OA Atteroiar censity © B.Capitary density 0 .Arertoiar watttosumen ratio OD. Capiary wal-to-umen ratio (OE Total cross-sectional area of arterioles, OF. Total cross-sectional area of capilaries sueMiT c1sst ©kapen 2010Lcd = BCT Pies ‘A 25-year-old man win a recent iver transplant comes to te pnysician fora folou-up examination. Treatment with a corticosteroid is begun to prevent ejection of the transplant. Additionally, a drug that reduces the activation of cytotoxle T Iymphocytes by inhibiting interleukin (IL)-2 production is administered. Which of the folowing fs the most ikely drug administered to this patient? OA eathioprine © B.cyclophosphamice | ©.6.8-Nereaptopurine ©0.sroimus OE Tacrotmus suBMIT BSBEEBRES cov onsen 200150 © Kapen 2010 rSBRNSERERE SEERE Bee voocsenn SESEE PSBRBNRRRERES Lcd = BG Pies t t of t conto Bagi Relapse rug x Drugs are added fo an isolated ulerus preparation and the effects on contraction sirenati in response to an electrical simulus are recorded. In this experiment, the uterus is stimulated four tmes. The controls an isolated electrical stimulus. An unknown ‘rug X's ance to tne Isolates uterus, ana the effects on contraction sfengin in response to the electncal stimulus are recorded. Assume that drug X has been washed out prior To the adaition of the antagonist. Drug X's addea again in the presence of a recepior antagonist and the contractions are recorded again. Which of the following are tie most ikely identities ‘of crug X and the antagonist? Drug Xx ‘Antagonist ach Atropine Propranoiol Atenolot Epinepinrine ‘soprotereno| Phentolamine Norepinepnrine 1200493 © kaplan 210BG Pies t of t ono rug X Antagonist rug x Drugs are adced to an solatec uterus preparation and ine elects on contraction strengin In response to an electncal stimulus are recorded. In this experiment, the uferus is stimulated four tines. The contol isan Isolated electrical stimulus. An unknown rug Xis added to the isolated uterus, and the effects on contraction strength in response to the electrical stimulus are recorded. Assume that drug X has been washed out prior to the addition ofthe antagonst. Drug X's adcec again in the presence of a receptor antagonist ana the contractions are recorded again. Which ofthe following are me most ikely Iaentiies or rug X and tne antagonist? ERE Bee voocsenn Drug x Antagonist ach Atropine Epinepanne Propranoio! Isoprotereno! Atenolol SESEE Norepinepine ——_Phentolamine Phenylephrine Phentolamine 1200493 © kaplan 210 PSBRBNRRRERESLcd = BCC Pies ‘A normal pinivelght, term, male newborn with APGAR scores of 8 at 1 minute and 9 at 5 minutes tals to pass meconium wrtnin 26 hours of bith. The newbom also has @ aistended abdomen, and has been vomiting and feeding poorly Digital rectal ‘examination temporarily relieves the obstruction, but ihe baby fas to pass stool thereafler. Barium enema examination ‘cemonstrates a segment of narrowed bowel. \Vnich ofthe folowing regions of the bowel is most ikely affected”? © A.Long segment extending from the splenic fesure into the rectum © B.Long segment involving the descending colon (©-€. snort segment involving the descending colon OD. snort segment invowving tne Heoveeal valve (O-€ Snort segment invowng tne reetum suBMIT BSSRSERE Beer aaronn 1200257 © Kapa 210 bSBRBNRRREREBSBEEBE Boe voasune PSBRBNBREEREBEES Lcd = BCG Pies ‘A a6-year-old woman comes to ie physician because ofa teeing that she has “san ln ner eyes" and amieuty swallowing tooo. ‘such as crackers and toast. Examination of tissue obtained on biopsy ofan eniarged salivary gland shows lymphocytic infitration. Which ofthe Following tests wil mostIkely yield positive results inthis patient? © A.Anticentromere antioogy © B.Anti-coubie stranded DNA antibody © .Antiglomeruiar basement membrane antnocy OD. AntiSet-70 antibody O E.Ant.88-A antivocy sueMir 1221 © kapen 2010Lcd = BAC . ‘An 18-year-old colege student is brought to the emergency department by nis roommate who found him compkaining of ‘epigastric pain and nausea. The roommate had noticed an emply bottle of aspirin near te patient. Upon questioning, the patient admits to ingesting the contents ofthe botte half an hour ago. Which ofthe fllowing letters on the Davenport diagram accurately describes the status of this patient with acute salicylate poisoning? 1200294 © kaplan 200 ISBBNRREEREBSERSREEKREB Cov ao eenSBRREERE BS cevonsenn rSBRNSERERESE Lcd = BCC Pies ‘A a6-year-old woman presents wih a 100 weight gain in tne past 6 months. She also complains of falgue and some memory problems. Examination reveais blood pressure of 90/60 mm Hg. heart rate of 55/min, and temperature of 35°C (85 O°F). The. {thyroid is enlarged but nontencer on palpation. Serum T# is 6.5 ug/dL and serum TSH is 8 wWimL. Antimicrosomeal antibodies are present. Wnich ofthe follonng isthe most likely diagnosis? OA Graves disease OB Hashimoto thyroiditis ©-6. Secondary nypotnyroictsm OD. Tertiary nypotnyroiaism OE Toe acenoma suBMIT 1808 © kapin 2010Lcd = pC Pies ‘A 24-year-old man is brought tothe emergency cepartment because of loss of consciousness. Physical examination suggests ‘dehydration. His clothing is soled wih watery feces. Laboratory studies are shown ‘AneralCO, — 28mmHg Aner 732 Prsmaci” 16 mEq PlasmaHco ,” mEq. Plasma Na 140 met mien of me folowing is tne best interpretation of tne anion gap inthis patent? © A.Contraction alalosts OB ketoacidosis OC .Lactc acidosis ©°D. Loss of bicarbonate in feces BSSREEREB Ce vaosene © E.Uremic acidosis © F.Vomiting-induced alkalosis SUBMIT (01200m © Kap 210 TSBRNSERERRSBESHSREERE Bee vooeenn fSBRNSERERE Lcd = BEL Pies ‘An auopsy Is performed on a 12-32-04 Boy wno, cuiing hls Me, required frequent blood transfusions. On autopsy, Re found {0 have Nepatospienomegaly and expansion of the calvarlum. Histologic examination shows abundant brown pigment in ‘macrophages of te liver, spleen, and lymph nodes, as well a in parenchymal cels of tie heat, ver, and endocrine organs. “The pigment seen histologically inthis patient's most bkely which ofthe folowing? OA Bilubin OB.Carbon particles O¢.Hemosiaerin ©. Homogentisc acta OE. Liporuscin O F.Melanin SUBMIT oL1916n © Kapa 210Lcd = BCE Pies ‘A 24-year-old woman 's admit to the Intensive care unt because of third degree Burns aver 35% of her Body Dung her say, ‘she develops a fever ang ciicuty breathing, requiring mechanical vention. Blood cultures grow gram-negative rods. Bronchoscopy wih biopsy shows hyaline membranes vthin the alveolar walls, alveolar septal thickening, and neutrophilic infitrate, but no hemosicerin deposits. Which ofthe folowing is the most likely mechanism of injury? OA Asthma. (OB Bacterial pneumonia © 6. Desquamative intersitial pneumonitis (O1P) OD. pimuse alveotar damage OE. Hemodynamic pulmonary edema suBMIT (01609 © kapin 2010 ISBBNBRRERBSSESSREEKREB Cov ao seneBE Pies During an accident in wood shop, an individual sustains 2 ceep cul that severs ihe mecian nerve at the wnt The nerve is. prompty surgially reconnected. Under optimal circumstances the nerve can regenerate at whic of he folowing rates? Oat mmaay 0B.5 mmaay OC.2mmiveck 0.4 mnimonth (0 E.5 mmmonth sueMiT BESBREERE Bee vooeenn (0.1265 © kapin 2010Lcd = BET Pies ‘A 13-year-old poy 's brought to a rural cine because of poor sehoo! performance. His parents state that ne ald not begin taking ‘unt after 3 years of age and that he does not use language effectNely_ A careful family nistory reveals that a maternal ‘oranafather was mildly retarded. The mother admits thal she did not do wel in school, and dropped out atthe age of 16 Physical examination of the chid reveals large ears; a long, narrow face; and large testes. Which of the following genetic mechanisms most ikely accounts for me rinalags observes in te son? OA Expanded tnnucieotie repeat ©B. Genomic imprinting © C. Robertsonian translocation ©D.Trisomy 13 OE. Trisomy 18 SUBMIT BESBREERE Bee vooeenn BEB 179s ©kapen 2010‘A 62-year-old man undergoes a renal Diopsy for evaluation of renal insutTelency. The blopsy inicentaly samples one of the arcuate arteries, which shows redupication ofthe elastic lamina and fibrosis of te media. Which of the following fs the most Tely underiying cause of these findings? OA Diabetic nephropathy © B.Esonerionia cow enterotoxn OG Hypertension OD. Lipoid nephrosis OE Sicke-cel disease sueMir BESBREERE Bee vooeenn tei © Kapa 2010 rSBRNSSRORESCECT Pies Lcd = ‘A 20-year-old woman comes to me physician Decaulse of progressive vaginal pruntus for the past 3 days. She recently nad a ‘urinary tract infection and she was treated wt trimethoprinysulfamethoxazole. Physical examination shows no abnormaiies ‘excepl for mild eryhiema of the vulvar area, and a while vaginal discharge. A swab of the vaginal discharge is taken and inoculated into animal serum. Which ofthe following is most likely to be seen n tis medium after 2-3 nours? OA Attiroconiais OB Encapsulated yeasts (© 6. Hyphae with rosettes of microconiaia OD. Macroconiaia 0 €.Pseudonypnae suBMIT BESBREERE Bee vooeenn BEB iactm © Kapa 200Lcd = BET Pies ‘A 1e-year-old man comes to tne physilan for 2 routine physical examination. He nas a history ofa small retinal detachment 2 ‘years ago. His neight Is 6 4In ana nis BMI is 21 kgim?_ Vital signs are normal. Examination shows pectus excavatum and a ‘systolic murmur wih mi-sysiolic cick. The patient has long arms and long fingers. Which of the folowing gene products is most likely abnormal inthis patient? OA.collagen OB dystrophin Oc.elestin OD. Fipnin OE Myosin p-chain SUBMIT BESBREERE Bee vooeenn BEB (1 1ssam © Kapa 2010BESBREERE Bee vooeenn Lcd = pCa Pies ‘Anigh poteney typical antpsycrotic agent is stucled in neurons in vio ina batn tnat contains acetyicholine, dopamine, orepinephrine, and serotonin. The receptor thats being studied is he same one that is responsible forthe therapeull eMMcacy ofthis agent in schizophrenic patients. Which ofthe following effects would most Fkely occur intracelluarly after adlton of this agent tothe bath? OA, Decreased cAMP OB, Decreased inositol triphosphate (IP .) OC decreased Na * 0D increased cAMP © E:increasedinosteltiphosphate (P 5) © Frincreased Na* sueMIT 120008 © Kapa 2010Lcd = ‘A.37-year-old woman sustains 2 closea head injury in @ motor venice accisent. She does nat immediately seek medical altention, but presents 2 hours later On physical examination, tnere Is mydriasis and 1oss ofthe pupillary ight refiex. Several hours jae, she is unable to folow a fashiight with her eyes. Which ofthe folowing types of hemiation fs most kely occurring in this patient? OA.Cingutate hemiation © B.Meduila herniation ©.6.Tonsitarnetnation into the foramen magnum ©D.uncal nemiation (© Upward nemiaton of te eerebetium suBMIT BSSREEREB Ce vaaosene RRRREREBE 127s © kapen 2010BSSREEREB Ce vaaosene Lcd = BEG Pies ‘A 22-year-old woman who Is a college student comes to te physician decause of a fever, tatigue, ana aimcuity swallomng Physical examination shows exudative tonsils and cervical iympnadenopathy. A peripheral blood smear shows mid anemia and Iymphocytosis, with about 20% ofthe lymphocytes exhibiting alypical features, and mild thrombocytopenia. A serum sample ‘causes the agglutination of red blood ceils. Wnich ofthe folounng is most likely fo be found in tis patent? © A.Cold zogitins © B.Douey eels © ¢.kotocyes © .negr podies © E.owrs-2ye lncusions suBMIT LAs © Kap 2010Lcd = pCO Pies ‘A d-month-ola boy who appeared healtny at bit 's brought fo tne physician because of poor grown an He has faled to achieve major developmentai mestones, and fs now inthe 5 percentie for lengtn hous itlessniess, and malted, sparse, and very pale hair \Which ofthe following enzymes most likely has abnormally lon ‘acuity in this chile? @ Dormioad This Video] * © OA.cytochrome b ¢ reductase OB Glutainjone reauctase OG. Lysy! onaase (OD. N-acetyiglucosamine-1-phosphotransferase 0 E- Phenylalanine nycroyiase suemir BSSREEREB Ce vaaosene 001082 © Kap 2010 BRENBRESREBSELcd = pT Pies ‘A G-year-old ay I brought fo the paysiclan necause of ihe onset of fainting spells. ARear murmur Is nears on auscultaton of {the heart. An echocardiogram snows an ostium primum type of alia septal Gefect Failure of which of the folowing processes IS the most Ikely cause of these findings inthis patient? (©-A.Cstum primum formation within the septum primum © ostium secundum formation wihin tne septum primum OG septum pamum tuston with tne endocardia\cushions OD. Septum primum fusion with the septum secundum E Septum secundum fusion with the endocarcial cushions sueMir BSSREEREB Ce vaaosene 1286 © Kap 2010 SBRNRRREREBSBESBREERE Bee vooeenn PSBRBNRRRERES Lcd = BT Pies ‘A a0-year-old man comes to me physician because of a" Podule on the et sie. The nodule does not ennance during [ Te] pertechnetate imaging, Laboratory stuales of serum show ‘pormal T3, T4, and TSH, but serum calcitonin is elevated. Examination ofa biopsy specimen of the nodule wil most likely show neoplastic cells that are most closely related to whieh ofthe folaring normal cell types Imp i hs neck" Prysical examination shows a soltary, tm tayroid OA Hurthie cats © B Parathyroid chief ceils (0.¢ Parathyroid orypnilceits OD. Mmyrola c ees (OE. Thyroid glandular epthetia| cells SUBMIT 0122s © kepen 2010BSSREEREB Ce vaaosene rSBRNSERERE SE Lcd = SCG Pies ‘A 24-year-old woman 's Drought to the emergency cepariment arer ingesting an unknown quantly of a arug that has anxioyte, muscle rtaxant, anticonvulsant, and amnestc effects. The patient's roommate says that the patient had been very depressed ‘afer breaking up ui her boyiriend of 2 years. Which ofthe following érugs is most appropriate fortis patient? OAAcetyicysieine OB.Atropine Oc Bicarbonate OD. Cava ,EDTA chetaton OE Deteroxamine © Feethano! 0G. Fumazent OW. Physostigmine © |. Pratigoxime 0 4. Protamine SUBMIT (01025 ©kapin 2010BESBREERE Bee vooeenn PSBRBNRRRERES Lcd = ‘A.72-year-old woman comes to the pysician wih generalized fatgue and swolen ankles. To view me physical examination, cick the "Play Mecia” bution. The physical examination nding shoun best correlates with which of the folowing cardiovascular indices? OA.Central venous pressure OB.Right atrial volume O-c.stroke voume (OD. sympatnetic stmuiaton of the heart 0 € Total blood votume SUBMIT 100011 © Kapa 2010BCT Pies ‘A 54-year-old man presents wih gnawing epigastric pain that occurs af regular inlerva's daly. The pain is partially relieved by antacids and food. Upper endoscopic studies reveal 2 duodenal lesion similar to that shoum in the gross specimen Spiralshaped, motile, oxiase-postive, and catalase-positve rocs uith multiple fagella at one pole are cultured fram the lesion whieh of he following would be the most effectve pharmacotherapy? ©-A.Aluminum- oF magnesium-containing antacid OBA, -eceptor blocking agent (0.6 Prostaclandin analog (OD. Proton-pump inhibitor plus anbbiotics OF Sucraliate TSBRBSRBREERREBERESSRESE RES oe~ moe eneRSSBNBREBRESSESSREE EES oov~ousune Lcd = ‘An f-mont-ola boy is admiied to te peclatne Itenaive care unit aecause oF resplratory distress. Laboratory studies show an ‘acidosis with a very high serum concentration of lactate. Treatment wih intravenous hydration and thiamine fs begun. The rationale inthis case for thiamine administration is that thiamine is converted to @ coenzyme used by which of the foloning ‘enaymes? OA Lactate dehydrogenase OB Pyruvate carboryiase © 6. Pyruvate denyerogenase OD. Pyruvate kinase OE. Transketoiase suBMIT (1022 ©kapin 2010BESBSENSSESSREBEESSEEEEEESecereaeur BCA Lcd = ae ‘A S-monih-old gts brought tothe emergency department by her parents because of seizures. The moter did not have any prenatal care. The ciagram shous the pecigree of the couple and their fo children. Physical examination shows hepatomegaly Ane growin retarcation Laboratory studies show severe nypogiyeemia and nyperipicema. A cetect invoiving wich of me ‘ollowing enzymes is most Ikely responsible for this patents iness? O-A.Aipha-L-iduronigase 0B seta-guucocerebrosiaase (0.6 Glucose-6:phosphatase OD. Hesosaminidase A (© E. Muscle phosphorylase 197m © kapsn 2010BEESIBSBSRERESSESSRESBES core uHs Lcd = ‘Alocal chureh sponsors 2 family trom Somalia who wants to immigrate to tne United States. Upon arrval nthe U.S., the tary is ‘taken tothe physician. Physica examination shows tnat the chien are thin and have very protuberant abdomens with age palpable vers. These chicren would most likely have the oreatest defciency of which of the folloning amino acids? OAAsnine OB.GIeine OcLeveine OD.Proine OE Senne sueMir (1975 ©kapen 2010ESSESISNBRESRESSES SRE BEES oH +O: Lcd = BOG Pies ‘A 12-year-old noy 's brought to the physician fora routine well-chid examination. A review of his records shows tnat four of ie ‘six members of his family nave displayed increased susceptibiy to extracelular bacteria and elevated serum levels of gM and IgG. Laboratory stucies of serum complement protein levels show near absence of component C4. This deficiency wil most Ikely inhibi which ofthe tollomng complement acbvites? © A. Completion ofthe classical pathway upto the soiling of C8 © B.Fonmation of €3b for opsonization © 6.Fonmation of 8 convertase via tne alternative pathray ©. Formation of G&a for chemotactle attraction of neutrophils (© Formation of ine membrane attack complex suBMIT L181 ©kapin 2010REERESBBSBREBRESSESSEESEESewHrao Lcd = BOL Pies “There are moce tan 200 mutations for beta-tnalassemia, Some involve globin gene deietions, promoter region mutations, termination mutations, and spice site mutations. With spice ste mutations. there Is interference with the proper splicing of beta-globin messenger RNA (mRNA). Which ofthe following represents the fist post-transcriptonal event that might be affected 2 resutt ofthe splicing mutation? © A.Adsiton ofa polyadenyiat tai tomRNA ©B.Capping the 5 prime end of mRNA with 7-methylguanosine triphosphate © 6. Degradation oftanat stuctures ©.D. Removal of introns as lala structures (© €. Transportation of mature mRNA to he eytopiasm suBMIT 1200088 © Kapa 210BRESSESBBNSBREBRESSESSRESEES oo~s Lcd = Be OG Pies ‘A 46-year-old woman 's Drought to the physician because of 2-month history of amcuty walking and memory loss, According to her husband, she is having trouble remembering people's names and becomes confused easly. She also Nas had trouble ‘walking, and has been unable to wak without assisiance for the past week. She has no history of major medica ness. On ‘neurologic examination, she is alert and oriented and follows simple commands. However, she remembers only ane out of three lems ater minutes. Sne also nas trouble walkng ina straight ine and snows suatie dysmetna wnen asked to point rom finger {to nose. Muscle strength and reflexes are normal throughout. Which ofthe following is most Ikely associated with this woman's ‘condition? OA infectious prions OB.Lewy bodes 0-6. mumnple cerepralintarets OD. Tanucleotise expansion (0 E.Verteal gaze impairment sueMir 1200964 © kaplan 200RSGSSSESIBNBRESRRSSESSHESBES oe - Lcd = pO Pies ‘A 66-year-old woman wih a history of osteearthat's & brought to te pysiclan Because of ammcuty walking after belng bed-bound for an extended period of tine. Physical examination shows an inabilly to dorsiex the right foot against resistance: but shoms normal stenath during plantar flexion. At rest, the right foot is maintained in an inverted position. There is reduced ‘sensation on the dorsum of the right foot but normal sensation on the sole of the foot. Which of the folomng nerves is most IMely njurea? (© A.Right common peroneal nerve © B.Right femoral nerve © G.Right obturator nerve OD. Right sciatic nerve © E-Rignt tial nerve SUBMIT 01712 ©kapin 2010BYSREERESBBSBERERESSESSRESKES © Lcd = CG Pies ‘A 20-year-old man is found fo nave 2 mass in nis lef anterior neck. Chest x-ray flms are normal. A CT sean of the thorax and abdomen shows a hemorthagic ight adrenal mass. Serum electrolytes are remarkable for decreased calcium levels. Wich of {the folowing neoplasms is most ikely responsive for the depression of calcium levels inthis patient? OA Foticularthyroic carcinoma OB. Hurtie cal carcinoma, O-.Meauiary tnyrovs eareinoma OD. Parathyroid carcinoma (0 €.Pheoehromocytoma sueMir (01509 © kapen 2010BEYSRESRSESSRYBRESRESSESSREGKES « Lcd = ‘A 29-year-old man comes to tne physician because of abdominal pain and acid reflux. He has no history of any major medical liness and takes no medications. Further evalvation does not show the presence of H.pyior’. Treatment with H » blockers 1S begun but his symotoms do not remit. Laboratory studies show basal gastic acid hypersecretion and high levels of blood ‘gastrin, Which of the folowing Is most ikely to be seen inthis patient? © A.A tunctional neopiasm inthe stomach antrum © B.Atrophy of fundal gastric epithelium © C.High blood leves or secretin (©D. Reduced secretion of somatastatn trom the gasre epthetum OE Steatormea cue to ine presence of excess fecal tay aries and f-monogyeenides suBMIT 1220706 © Kapa 2010ESELSRLERESBBSBRESRESSESSHESKEE Lcd = BOG Pies 'A.20-year-old man comes to tne physician because of a swollen and painful upper arm after taling nie playing nasketoall Over {he next several weeks, the involved area becomes more circumscribed and fim, and then later evolves to 2 painiess. nara well demarcated mass. Which ofthe following is most likely to be seen on x-ray of te arm? OA Benign-appearing bony outgrowths from the humerus OB Distocation of ne shoulder OG Fioeeuient radiodensties surrounding a radiolucent center OD. Healing fracture E.Malgnant-appearing bony outgrow from the humerus. sueMir Loe ©kapin 2010FSSBLSRESRESBRBSBRESRBESSESSREGKE BCG Pies ‘A 25-year-old woman 's despondent that ner husband lef ner for another woman. She attempts suicide by ingesting 25 tapiets of extva-strength acetaminophen, Her mother finds her and the empty bottle 2 couple of hours later anc immediately rushes her {o the emergency room. Which of the following drugs wil most tkely be given to this patient? OAAcetyicysieine OB.Atropine OG Penicitamine OD. Praldoxime OE Protamine sueMir (01077 ©kapin 2010SESSRESSRERSRESBSNBRESRRSSESSREDE Lcd = pCa Pies 'A 22-year-old man s brought fo the emergency cepartment afer being involved ln a near-fatal re. Over the next several days, he develops prieumonia and progressive shortness of breath and is intubated. Gram stain of the sputum shows a ‘gram-negative, encapsulated, oxidase-poslive aerobic rod. Which ofthe following mechanisms allows the most ikely causal organism to be resistant to many ciferent antioioes? © A Mutation of a penctin-binding protein © B.Nutation ofa porin protein © 6. Mutation ofa topoisomerase ©. Piasinic-mediated acetyiransterase production O €. Piasmic-mediates netalactamase procucton suBMIT 1200118 © kapan 210SESSSLSHSBSESSBNLBRESRESSES SHEL is A Tesjearod man comes tome phystan Deca o progressvey worsening pan i ons anc ne Tore past @ monn He says ha he pans worse when ne otates hs nead om ede to side. Physkal examinalon stows motor weakness inthe {rms and legs i saa and sight ophihamoplegia. Which ofthe folowing best explains he things seen ints patient? © A Compression of spina nerve by osteoatnise ostophytes © B.compression ore vertebral avery by otecartheoseophyes ©.6.Hemion ata nucleus pulposus or acer ase OD. nstabity ofthe occiptoatianta joint (OE, Rupture of tne anulus fbrosus of a cervical aise sueMir 1200247 © kaplan 200