(© National Board of Medical Examiners = Maria Firefox. - a i a a A a ee (ain (CUBES tip /ronn startet com/ op 1 DITDSert yp2SUC=2eceaTo? 26 -o33-bSbd-I 2582 Daas Com oe 11. A24-year-old man comes to the physician because of a 3-month history of inability to obtain an erection and occasional penile pain. He also has had mild chronic back pain {or 2 years and hemorthoids that bleed on occasion. He is married and has a 2-year-cold son. He enjays his job, and he and his wife have a good relationship. He ifs weights regularly and trains on his bicycle. He usually ndes for 2 hours daily dunng the week and 5 to 6 hours daily on the weekend. On questioning, he does not recall having ‘spontaneous nocturnal erections. Physical examination shows no abnormalities except for back tenderness and extemal hemorrhoids. Which of the following is the most likely cause of this patient's erectile dysfunction? A) Compromised blood flow from the pampiniform plexus 'B) Damaged blood and nerve supply to the erectile tissue ©) Lumbosacral strain © D) Obturatornerve compression © E) Pressure of hemormhoids on the erectile tissue @ fee—————EE~ EEE (CUBES tip /ronn startet com/ op 1 DITDSert yp2SUC=2eceaTo? 26 -o33-bSbd-I 2582 tical Examin oe 12. A28-year-old woman undergoes PPD skin testing to determine previous infection with Mycobacterium tuberculosis. Results show a 25-mm, firm area of induration at 48 hours. Analysis ofthis patents lesion is most ikely to show a predominance of which ofthe folowing celltypes? © A)B lymphocytes © B) Cytotoxic T lymphocytes ©) Eosinophils D) Macrophages E) Mast cells F) Neutrophils—————EE~ EEE (CES pr stentest.com/ap/S2.1OTD Start epe2SVC=2eceaT2-426-4a53-bSbd-eI 5250820 Caan oe 13. A 45-year-old man has a partial colectomy for carcinoma. Which ofthe following scenarios indicates the highest likelihood for survival for 5 years after resection of the lesion? © A) Moderately differentiated carcinoma invading the muscularis © B)Mucin-producing carcinoma invasive to the serosal surface © C)Mucin-producing carcinoma metastatic to two regional lymph nodes © D) Poorly differenbated carcinoma confined to the mucosa © E) Wel-diferentiated carcinoma with hepatic metastasis i G vious fee—————EE~ EEE (CES pr stentest.com/ap/S2.1OTD Start epe2SVC=2eceaT2-426-4a53-bSbd-eI 5250820 Taras oe 14. A23-year-old primigravid woman at 18 weeks’ gestation comes to the physician because she has felt minimal fetal movement during the past 2 weeks. There is no family history of congenital anomalies. Physical examination shows a uterus consistent in size with an 18-week gestation. Utrasonography shows decreased amniotic fuid and znormal-sized fetal kidneys, but the fetal bladder and ureters bilaterally appear markedly distended. The fetus appears to be male. Which of the following abnormalities best, ‘explains these findings? © A)Perile hypospadias © B) Placental insufficiency © ©) Polycystic kidney disease D) Posterior urethral valves © E) Prostatic nodular hyperplasia, @ fee(@ National Board of Medical Examiners - Mozilla Firefox (CUBES tip /ronn startet com/ op 1 DITDSert yp2SUC=2eceaTo? 26 -o33-bSbd-I 2582 Cee aon dical Examin Com oe 15. Astudy is conducted to assess the accuracy of a new rapid test to detect a virulent bacterial infection. This infection has an 80% mortality rate if tis not identified early in its ‘course; however, prompt administration of antibiotics decreases the mortality rate to less than 5%. The risks of this antibiotic therapy are minimal. A total of 10,000 participants are enrolled and undergo assessment with the new test. The craph shows the distribution of infected and noninfected participants according to the resuts of the test. Which ofthe following labeled poinis is most appropriate for use as the optimal diagnostic cut point for results ofthis test? Not infected Number of participants ©A OB) OC) OD) CE @ fee—————EE~ EEE (CES pr stentest.com/ap/S2.1OTD Start epe2SVC=2eceaT2-426-4a53-bSbd-eI 5250820 arenas 16. A37-year-old man comes to the emergency department because of a 10-day history of yellow skin, vague abdominal discomfort, and fatigue. His vital signs are within normal limits Physical examination shows generalized icterus. Serum studies show: AST 320 U/L AUT 340 U/L Hepatitis B surface antigen (HBsAg) Positive ‘IgM anti-hepatitis B core antgen (HBcAg) positive Aaichepaiilis D vines negative Direct damage to infected hepatocytes in tis patient is most likely mediated predominantly by which of the following? © A) Antibody against HBCAg © B) Antibody against HBSAg C) Complement via the alternate pathway 1D) Cytotoxic T lymohocytes © E) Viral cytopathic effect i G fee(Bb National oard of Medical Eupmigers - Mczila Fireton a, (CESSES https formas starttest.com/ api/5.1.1.0/1TDStartspr2SVC=2eceaTb?-4706-4a53-bSb4-e1825O1cO2d en oe 17. A3-year-old boy is brought to the physician by his parents because of concerns about his ability o heal from injuries. They report that he develops bruises and scars with even mild trauma, particularly in comparison to their S-year-old daughter. He was born at 35 weeks’ gestation without complications. He has otherwise been healthy ‘and has developed normally. Physical examination shows extensible skin, and the joints are freely mobile, there. are thin, atrophic scars on both knees. A photograph of his hands is shown. Which of the following is the most likely cause of this patient's condition? © A) Aberrant production of elastin © B) Abnormal synthesis of extracellular gycoprotein © C) Detect inthe synthesis of fibrillar collagen, 'D) Dysfunctional cellular transport protein © E) Normal age-related skin and joint development oO G a fee[ib Mational Roars of Medical Eapmipers - Mozila Firetow a, (CES pr stentest.com/ap/S2.1OTD Start epe2SVC=2eceaT2-426-4a53-bSbd-eI 5250820 oe aces 18. A23-year-old woman comes to the physician for prenatal care. On examination, she appears euthyroid and the thyroid gland is not palpable. Uterine size is consistent with ‘dates, and fetal puise is normal. Serum thyroid tests show: Thyroxine (T,) 14 ugidL. Thyfoid-stimulating hormone 2 yUimL ‘Changes in which ofthe folowing hormones during pregnancy is primarily responsible for the thyroid test results? © Ay Androgens © B) Corticosteroids © C)Estrogens © D) Progesterones © E) Proiactins ro @ vious fee—————EE~ EEE (CES pr stentest.com/ap/S2.1OTD Start epe2SVC=2eceaT2-426-4a53-bSbd-eI 5250820 Dacia oe 19. One day after a total abdominal hysterectomy with salpingo-oophorectomy for stage Ill cervical cancer, a 42-year-old woman has abdominal distention. She has passed only. 200 mi of urine since the operation. Utrasonography shows an accumulation of fd inthe abdominal cavity, te physician suspects tha he fui urine. This patient most likely sustained injury to the ureter during intraoperative gation of which of the following arteries? © AYinternaliliac artery © B) Ovarian artery © C)Pudendal artery © D) Superior vesicle artentes © E)Uretenc branches ofthe renal artery @ fee—————EE~ EEE (CUBES tip /ronn startet com/ op 1 DITDSert yp2SUC=2eceaTo? 26 -o33-bSbd-I 2582 dical Examin aca oe 2. 45-year-old man with recently diagnosed early-onset Parkinson disease comes to the physician fora follow-up examination. He has a long history of major depressive disorder successfull treated with fluoxetine. Treatment with which of the following anfiparkinsonian drugs is contraindicated in this patient? © A)Amantadine © B)Beratropine 6) Levodopa © D) Ropinitole © E)Seleaiine—————EE~ EEE (CES pr stentest.com/ap/S2.1OTD Start epe2SVC=2eceaT2-426-4a53-bSbd-eI 5250820 fac Cee c oe 20. Aheaithy 28-year-old woman delivers a female newborn at term with a crarial matformation, There is no family history of similar findings. Physical examination of the newbom ‘shows a large defect in the calvaria and meninges with a primitive brain. The newborn dies 2 days later In this patient's future pregnancies, an increased matemal serum ‘concentration of which of the following during the second inmester wil most Ikely indicate the same malformation? © AyaFetoprotein © B) Free B-human chorionic. gonadotropin © ©) inhibin A © D) Pregnancy-associated plasma protein A © E) Unconjugated estnol @ fee—————EE~ EEE (CES pr stentest.com/ap/S2.1OTD Start epe2SVC=2eceaT2-426-4a53-bSbd-eI 5250820 fac oe 21. A40-year-old woman with chronic paraplegia caused by multiple sclerosis is brought to the physician because of severe, debilitating muscle cramps for the past 3 weeks. Treatment wth baclofen resolves her muscie cramps. Which of the folowing receptors most ikely decreased tne muscle spasticity in this patient? © A)a-Adrenoreceptor © B)ByAdrenoreceptor ©) y-Aminobutync acid receptor © D) Calcium-sensing receptor © E)Ryanodine receptor i G tat Ves—————EE~ EEE (CES pr stentest.com/ap/S2.1OTD Start epe2SVC=2eceaT2-426-4a53-bSbd-eI 5250820 fac oe 22. Osteogenesis imperfecta (Ol) is an autosomal dominant disorder characterized clinically by a remarkably wide variety of manifestations that includes fragile bones that fracture easily, blue sclerae, hearing loss, hyperestensible joints, and enamel dysplasia. Which ofthe folowing isthe most lkely explanation for the pleiotropic effects of the Ol gene? © A)Contiguous gene deletion ©. B) Expression ofa defective gene in mutiple tissues © C)Loss of imprinting at mutipie loci © D) Somatic oss of heterozygosity in aleles © E) Variable tinucleotide expansion @ fee—————EE~ EEE (CES pr stentest.com/ap/S2.1OTD Start epe2SVC=2eceaT2-426-4a53-bSbd-eI 5250820 Tacit oe 23. An 18.month-old gil is brought to the physician by her parents because of physical and mental regression. Pregnancy and delivery were normal. One month after birth, the ‘mother noticed a marked startle reaction to noise. At the age of 1 year, she was not able to sit ar stand. Physical examination shows macrocephaly. Ophinalmalogic ‘examination shows a cherry-red spot in the macula. Laboratory studies in blood leukocytes show a deficiency of f hexosaminidase A achity. An excessive amount of which of the following metabolites is most likely present inthis patients tissues and organs? © A) Cholesterol © B) Dermatan sulfate © ©) Glycogen D) GM, ganglioside © E)Sphingomyetin @ fee(© National Board of Medical Examiners = Maria Firefox. - a i a a A a ee (ain (CUBES tip /ronn startet com/ op 1 DITDSert yp2SUC=2eceaTo? 26 -o33-bSbd-I 2582 ac oe 24. 49-year-old woman comes to the emergency department because of a 3-day history of fever, shortness of breath, and confusion. She isa postal worker. Her temperature is 38.4°C (101 .2°F), respirations are 28/min, and blood pressure is 100/60 mm Hg. Ptysical examination shows nuchal rigidity. Breath sounds are decreased on the right side ofthe chest. A lumbar puncture is done. Analysis of cerebrospinal uid (CSF) shows: Ghicose 18 mg/d. ‘otal protein 138 mg/dL Leukocyte count 838/mm? Segmented neutrophis 87% Monocytes 13% RBC 2300!mm? AGram stain of CSF shows large, gram-positive, spore forming bacili. A chest xray shows marked widening of the mediastinum. Which ofthe following extracellular virulence factors most ely enables the causal organism to evade phagocytosis? © A) Alginate © B)Glucuronoxylomannan © C) Hyaluronic acid © D) Polygiutamic acid © E)Polynbitol phosphate @ fee—————EE~ EEE (CES pr stentest.com/ap/S2.1OTD Start epe2SVC=2eceaT2-426-4a53-bSbd-eI 5250820 aca oe 25. A80-year-old man comes to the physician because of a 6-month history of decreased libido and inability to sustain an erection. He also has had decreased energy during this period and has been faliing asieep by 7 pm each evening, He has not had chranic pain, feelings of depression, or recent psychosocial stressors. He has had a 2.54.cm (Lin) loss in height and a 7.62-cm (3.n) increase in waist circumference since his last visit 6 months ago. Physical examination shows mild gynecomastia and decreased ‘muscle mass throughout. Which of the folowing isthe most appropriate pharmacotherapy for ths patient? © A)Epoetin alfa © B) Human growth hormone © C) Modafinil ) Sildenafil © E) Testosterone i G tat Ves—————EE~ EEE (CES pr stentest.com/ap/S2.1OTD Start epe2SVC=2eceaT2-426-4a53-bSbd-eI 5250820 Tac 28. A'55-year-old woman undergoing chemotherapy for melanoma develops a temperature of 39°C (102.2°F) and neutropenia. Her absolute segmented neutrophil count is ‘500/mm? In addition to antibiotics, which of the following substances is most appropriate to administer to this patient? © A) Granulocyte-macrophage colony-stimulating factor © B)Interteukin-6 (IL-8) oyIL10 © D) Macrophage colony stimulating factor © E) Stem cel factor (C-kit igand) @ fee ea—————EE~ EEE (CES pr stentest.com/ap/S2.1OTD Start epe2SVC=2eceaT2-426-4a53-bSbd-eI 5250820 ment Tacit arene 27. A46-year-old man is brought to the emergency department 2 hours after he fell heagfirst into the water while attempting to water ski. He says that he has pain when he tries to ‘move hs left arr. Physical examination shows that the patent is unable to abduct the left upper extremity due to pain. Which ofthe folowing muscles is mast ikly ined in this patient? © A)Infraspinatus © B) Subscapularis. © ©) Supraspinatus © D) Teres major © E)Teres minor @ fee—————EE~ EEE (CES pr stentest.com/ap/S2.1OTD Start epe2SVC=2eceaT2-426-4a53-bSbd-eI 5250820 oe 28. 40-year-old man with alcoholism is admitted to the hospital because of a 2-day history of confusion. Serum studies show a sodium concentration of 99 mEq/L. He is treated vith 0 9% saline. Four days later, he develops slurred speech Physical examination shows mild-to-moderate muscle weakness of all extremities and dysarthria. Sensation is Intact. Babinski sign is present bilateraly. These findings are most lkely caused by a lesion in which ofthe foliowang locations? © A) Bilateral cerebral hemispheres © B) Brainstem © C)Medial diencephalon © D) Muscle © E) Neuromuscular junction F) Peripheral nerve @ fee—————EE~ EEE (CES pr stentest.com/ap/S2.1OTD Start epe2SVC=2eceaT2-426-4a53-bSbd-eI 5250820 ace) Cee C arene 29. A‘-year-old git is brought to the emergency department because of a 5-day history of vomiting, copious diarthea, and markedly decreased urinary frequency. Several other children at the day-care center that she attends have had a similar ilness during the past week She appears Iistless. Physical examination shows decreased skin turgor, cctacked lips, and a dry mouth. The virus identified by ELISA testing of the stool is resistant to treatment with ether and contains a double-stranded, segmented RNA genome. ‘Which of the following is the most likely causal virus? © A) Adenovirus © B)Cytomegalovius © C)Hepattis Avirus 1D) Herpes simplex virus 4 © E)Infuenca virus © F)Rotawrus: @ fee(© National Board of Meccal Examiner = Maria Fico, je i i ee a (CES pr stentest.com/ap/S2.1OTD Start epe2SVC=2eceaT2-426-4a53-bSbd-eI 5250820 . oe Tare) 3. randomized cohort study of drug X administered to subjects after a myocardial infarction found that overall there was no decrease in morality compared with administration ‘of a placebo after a myocardial infarction. However, on review of the data, there were statisticaly fewer deaths amang drug X subjects in the subgroup with nontransmural ‘myocardial infarction than in the placebo group. A retrospective assessment of the database available for drug X supported the observation. Which of the following is the most appropriate next step? © A) Cross sectional population study of administration of drug X vs. placebo after nontransmural myocardial infarction © B) Prospective, randomized, controlled study of administration of drug X vs. placebo after nontransmural myocardial infarction © C) Treatment of all patients with drug X after myocardial infarchon D) Treatment of only patien's with nontransmural myocardial infarction with drug X © E) Treatment of only patients with transmural myocardial infection with drug X @ fee—————EE~ EEE (CUBES tip /ronn startet com/ op 1 DITDSert yp2SUC=2eceaTo? 26 -o33-bSbd-I 2582 Cee ee 7 acid 80. 55-year-old woman with congestive heart failure has progressive shortness of breath and chest pain. An x-ray of the chest shows bilateral pleural effusions. Laboratory ‘studies done on pleural ud and serum show: PleuralFluid Serum Glucose 80 mg/dL. 100 mgia_ Protein 2aldL Zaid Lactate dehydrogenase 25 U/L 50 UIL Total nucleated cell count 500/mm? ‘Which ofthe following is the most ikely cause of the pleural effusion? © A) Decreased lymphatic drainage © B) Decreased oncotic pressure © C) Decreased serum protein concentration © D) Increased hydrostatic pressure © B)Increased vascular permeability ® res(© National Board of Medical Examiners = Maria Firefox. - a i a a A a ee (ain (CUBES tip /ronn startet com/ op 1 DITDSert yp2SUC=2eceaTo? 26 -o33-bSbd-I 2582 ‘31. 56-year-old woman has recently diagnosed carcinoma of the breast. An x-ray ofthe chest shows a tumor next fo the right side of the heart. An enhanced CT scan with the tumor invading the pericardium is shown, ‘Which ofthe following structures is most likely involved? A) Coronary sinus, © B) Greater splanchnic vein © C) Right phrenic neve > D) Right vagus nerve E) Thoracic duct ero—————EE~ EEE (CES pr stentest.com/ap/S2.1OTD Start epe2SVC=2eceaT2-426-4a53-bSbd-eI 5250820 acm 32. A62-year-old man is brought to the physician by his wife because of increasing confusion during the past 6 months. His wife says that he has become lost twice in the past ‘month when going to work, even though he has been going to the same office for 12 years. She adds that he often has difficulty finding objects such as his glasses and keys, ‘sometimes cannot recall his grandchildren's names, and has become very cntical of her cooking, which he used to enjoy. When asked, he can name only the current president ‘and none of the candidates for an upcoming presidential election, although he and his wife watch the television news together each night Neurologic examination shows no ‘motor or sensory abnormaities. His Mini-Mental State Examination score is 19/30. Treatment with a cholinesterase inhibitor is most ikely to improve this patient's memory because of its ability o target synaptic connections between which of the following structures? © A) The basal forebrain and neurons in the cerebral cortex B) The dentate nucleus and the thalamus, © ©) The fomix and neurons in the mammillary bodies © D) The substantia nigra and the neurons of the globus pallidus © E) The thalamus and neurons in ayer 4 of the cerebral cortex ® ero—————EE~ EEE (CUBES tip /ronn startet com/ op 1 DITDSert yp2SUC=2eceaTo? 26 -o33-bSbd-I 2582 ac 83. A72-year-old man has had moderate progressive dementia for the past 3 years, He has a 25-year history of hypertension. He has a 5-year history of episodic dysarthria and ‘weakness of the right upper extremity. He has no family history of a similar disorder. Which of the following is the most likely diagnosis? © A)AIDS dementia © B) Dementia, Alzheimer type ©) Huntington disease © D) Mult-infarct (vascular) dementia © E)Pariansonism ® ero—————EE~ EEE (CUBES tip /ronn startet com/ op 1 DITDSert yp2SUC=2eceaTo? 26 -o33-bSbd-I 2582 Danes ‘34. A32.year-old woman comes to the physician because of intermittent abdominal cramps and diarthea, altemiating with constipation. The stools are loose and brown, there is rno blood or mucus. She has had these symptoms for 75 years, but they have become more frequent during the past 3 months. She has not had fever or weight loss. Colonoscopy 3 years ago showed no abnormalities. She recently was promoted to a management position at her company. She is 160 cm (S ft 3 in) tall and weighs 75 ka (165 Ib), BMI is 29 kgim2 Her temperature is 37°C (98 6°F), pulse is 72!min, respirations are 16/min, and blood pressure is 130/76 mm Hg. Examination shows no ~abnormaities. Test ofthe stool for occut blood is negative. Which of the folowing is the most ikely diagnosis? A)Colon cancer B) Inflammatory bowel disease ©)Inritable bowel syndrome © D) Pancreatic insufficiency © E)Peptic ulcer disease ® 2 a sem—————EE~ EEE (CUBES tip /ronn startet com/ op 1 DITDSert yp2SUC=2eceaTo? 26 -o33-bSbd-I 2582 ann 35. A63-year-old man comes to the physician because of weakness and fatigue for 8 months. Physical examination shows massive splenomegaly. Laboratory studies show: Hemagiobin 82 g/dL Hematocrit 23% Leukocyte count. = 6000/mm? Platelet count 60,000!mm= peripheral biood smear shows the presence of myelocytes, metamyelocytes, nucleated enthrocytes, and teardrop erythrocytes. A bone marrow specimen shows markedly thickened trabeculae with replacement of the marrow by celluar fibrous tissue with admixed marrow elements. Which of the following is the most Ikely diagnosis? © A) Acute myelogenous leukemia B) Aplastic anemia © C)Immune thrombocytopenic purpura © D)Megaloblastic anemia © E)Myelotibrosis ® 2 a base—————EE~ EEE (CUBES tip /ronn startet com/ op 1 DITDSert yp2SUC=2eceaTo? 26 -o33-bSbd-I 2582 ann 36. An investigator is planning to create gene therapy for Leigh syndrome, which is caused by an A-»G mutation in the mitochondrial tRNA‘ gene, Which of the following is the ‘most Ikely reason why mitochondria encode their awn tRNA? © A) Mitochondria cannot import proteins or RNA © B) Mitochondria produce large amounts of reactive oxygen species: (C) Mitochondna use a non-standard genetic code © D) The unusually high mitochondrial pH denatures nuclear-encoded {RNA © E) The unusually low mitochondrial pH hydrolyzes nuclear-encoded tRNA. ® 2 a base—————EE~ EEE (CUBES tip /ronn startet com/ op 1 DITDSert yp2SUC=2eceaTo? 26 -o33-bSbd-I 2582 Dae ed ‘37. A4-year-old boy is brought to the physician because of a 1-day history of restlessness, initabilty, and intense perirectal itching. He altends a large day-care facility. Examination of the perirectal region shows small worms visualized under bright light. Celophane tape test results for Enterobius vermiculans are positive. Which of the following is the most appropriate pharmacotherapy? © A)Aaithromycin B) Mebendazole © C) Metronidazole 1D) Pentamicine © E) Tetracycline ® 2 a base—————EE~ EEE (CUBES tip /ronn startet com/ op 1 DITDSert yp2SUC=2eceaTo? 26 -o33-bSbd-I 2582 Caries 38. A40-year-old woman comes to the physician because of a 2-month history of increasing redness around her nose and cheeks, and pimples around her mouth. She appears very upset and tells the physician, "Ilook like a teenaged Santa Claus.” Which ofthe folowing initial responses by the physician is most appropriate? © A)"Can you tell me how offen you go out in the sun and what kind of protection you use?" © B)"Dontt worry. Let me assure you this is not a serous condition.” G)""es upsetting when you have a skin problem on your face.” © D)"Maybe a litle. At least you are Keeping your sense of humor about the situation" © E)"You realy do look rather oda. I can understand why you are so upset.” ® 2 a base(@ National Board of Medical Examiners - Mozilla Firefox (CUBES tip /ronn startet com/ op 1 DITDSert yp2SUC=2eceaTo? 26 -o33-bSbd-I 2582 Cee eed acta 39. 23-year-old woman at 32 weeks’ gestation comes to the emergency department because of a 1-day history of left lank pain ‘and fever. Her temperature is 391°C (102.3°F), puise is 104imin, respirations are 14imin, and blood pressure is 120/72 mm Ho. Physical examination shows prominent tenderness over the left costovertebral angle. A photomicrograph of a renal biopsy ‘specimen from a similar patient is shown. Which of the following is the most ikely diagnosis? © A) Acute pyelonepns © B) Acute renal infarction C) Acute tubulointerstifal nephritis © D) Crescentic glomenuionephritis © E) Hemottic uremic syndrome ® 2 a base(© National Board of Medical Examiners = Maria Firefox. - a i a a A a ee (ain (CUBES tip /ronn startet com/ op 1 DITDSert yp2SUC=2eceaTo? 26 -o33-bSbd-I 2582 Coo Taner 4, A22-year-old man comes to the physician 1 week after he noticed a painless ulcer on his penis. Tree weeks ‘ago, he had sexual intercourse with a new male partner Physical examination shows regional lymphadenopathy. A photograph of the penis is shown. Dark field microscopy of exudate from the ulcer shows 4 spiral shaped organism, Which of the following is the most appropriate pharmacotherapy for this patient? © Ay Cetazoun © B) Ciprofioxacin ©) Erythromycin 1D) Penicitin © E) Timethopnm sutfamethoxazole i G tat Ves coExam Section 4: Item 40 of 0 a” eteae ic alas seme ae 40. A.56-year-old man is brought to the emergency department 1 hour after the sudden onset of left-sided weakness. Neurologic examination shows weakness ofthe lower two thirds of tne face on the left, marked weakness of te left upper extremity, and moderate weakness of the left lower extremity. Deep tendan reflexes are hyperactive in both the upper and lower extremities on the left, but they are more active in the upper extremity. Nomal results of MR anglooraphy are shown. This patient most likely has an ‘occlusion of which of the following labeled arteries?—————EE~ EEE (CUBES tip /ronn startet com/ op 1 DITDSert yp2SUC=2eceaTo? 26 -o33-bSbd-I 2582 41. AG-year-old gil is brought tothe physician by her mother because of a 2-week history of increased thirst and a 3-kg (6 6-1) weight loss. Her mother says that the patient is, ‘constanty drinking water. She is at he 75th percentile for height and 50th percentile for weight. Physical examination shows tachypnea and dehydration, Laboratory studies show hyperalycemva, metabolic acidosis, and ketonemia. Ita biopsy specimen were obtained from tis patient's pancreas, which ofthe folowing findings in islet cels woukd ‘now be most likely? © A)Basement membrane thickening of capillaries © B) Celular necrosis and lymphocytic infitration © ©) Decrease in mass and deposition of amyloid D) Large 6 cels and nuclei © E) Marked atrophy and fibrosis ® 2h a sacpm(©) National Boar of Mecical Eraminers = Moria Fiefoe (COEEIEEE tip /rorn startet com/ op TDS yp2SUC-=2eceaTo? A26-o33-bSbd-I D582 42. An 18-year-old woman sustains second-degree bums over her right thigh and lower leg after spilling hot grease while working at a fast-food restaurant. Six weeks later, the ‘surface area ofthe wound has markedly decreased. Which of the following processes best explains the wound contracture in this patient? © A) Cross-linking of type I collagen fibers © B)Inhibition of stromeiysin-+ (matrix metalloproteinase-3) ©) Myotibrobiast activity © D)P-selectin activity © E) Respiratory burst in macrophages. ® eo(Binational Road of Medical Examiners - Mozilla Firefox a i. lt i. ia -_- = (COESEEEES hp rr stntest.com/op/S1.1OTDStart rpe2SVC=2eceaT2-426-4a53-bSbd- eI 5750820 43, 17-year-old gil is brought to the physician because she has not had a menstrual period for 15 months. Menarche occurred at the age of 12 years. Menses had occurred at tall and weighs 45 kg (100 Ib), BM is 17 kgim? She says that she regular 28-day intervals unfil she began a weight-loss regimen 18 months ago. She is 165 cm (5 ft ‘eats only 800 calories daily and exercises for more than 3 hours daily. Which of the following serum findings is most likely in this patent?” © A) Decreased circadian variability of free thyroxine concentration © B) Decreased gonadotropin-releasing hormone pulsatility © ©)Increased adrenacorticotropic hormone pulse frequency © D)Increased diurnal vanabilty of folicle-stmulating hormone concentration © E) Reversal of diurnal variability of growth hormone concentration ® Pd—————EE~ EEE (CUBES tip /ronn startet com/ op 1 DITDSert yp2SUC=2eceaTo? 26 -o33-bSbd-I 2582 44, 42-year-old woman comes to the physician because of numbness of her Feet and poor balance for 3 months. She folows a vegan diet. She says," cart eat animal ‘products, but! do try to keep my proteins and carbonydretes balanced." Pnysical examination shows absent ankle reflexes. Proprioception and sensafion to vibration are ‘decreased in both feet. Laboratory studies show a hemoglobin concertration of 11 g/dL and mean corpuscular volume of 110 pm®. This patient mostlikely has a dietary deficiency of which of the folowing? © A)Folc acid © B)lron © ©) Vitamin B (pyridoxine) D) Vitamin B ,2 (cobalamin) © E) Vitamin G © F)VitaminE ® 2 sre—————EE~ EEE (CUBES tip /ronn startet com/ op 1 DITDSert yp2SUC=2eceaTo? 26 -o33-bSbd-I 2582 Cee 45, During an experiment, an investigator wishes to evaluate the serum cholesterol concentrations of all patients over the age of 50 years on the day of admission to the hospital Both the mean and the median are the same. It's decided to use the mean as the measure of central tendency. Which of the following is the most appropriate measure of dispersion to analyze the data for this experiment? © A) Coefficient of vanation © B) interquartile range © ©)Percentile © D)Range © E) Standard deviation ® 2 sre(© National Board of Medical Examiners = Maria Firefox. - a i a a A a ee (ain (CUBES tip /ronn startet com/ op 1 DITDSert yp2SUC=2eceaTo? 26 -o33-bSbd-I 2582 48. During an experiment using adult rats, bone formation and resorption are studied. The addition of compound X causes a decrease in bone resorplion. Compound X is most, likely which of the following? © A)Calcitonin © B) Parathyroid hormone C) Prednisone © D)Trytoxine (7) (© E) Tumor necrosis factor ® 2 sre—————EE~ EEE (CES pr stentest.com/ap/S2.1OTD Start epe2SVC=2eceaT2-426-4a53-bSbd-eI 5250820 47. An 80-year-old woman is brought to the emergency department by police 30 minutes afler she was found wandering in the street, confused and disoriented, She says that ‘she has no medical conditions and takes no medications. During histary taking, she becomas annoyed and agitated, saying, "Stop being so nosey! There's nathing wrong vith me! | fee! fine and | just want to go home.” She appears frail but alert. Her vital signs are within normal mts. Physical examination shows mildly dry mucous membranes. There is no evidence of trauma. She is oriented to person but not to place or time. She is able to provide her home address. Which of the folowing is the most appropriate action by the physician? © A)Attempt to contact the patient's family to ind out more information B) Arrange for transportation to take the patient home ©) Arrange for the patient to be transferred to a skilled nursing care facility © D) Administer a sedative-hypnotic medication © E) Admit the patient to a psychiatric inpatient faciity ® 2 sre—————EE~ EEE (CUBES tip /ronn startet com/ op 1 DITDSert yp2SUC=2eceaTo? 26 -o33-bSbd-I 2582 48. Adefect in enzyme activity in amino acid metabolism s induced in an experimental animal. Resulls show an increased serum concentration of phenyjalanine and decreased ‘concentrations of dopamine and serotonin in the brain. A deficiency of which ofthe following is the mast likely cause of the findings in this animal? © A)Biotin © B) Glutamate NADH © D) Tetranydrobiopterin © E) Vitamin B 2 (cobalamin) ® 2h a susp—————EE~ EEE (CUBES tip /ronn startet com/ op 1 DITDSert yp2SUC=2eceaTo? 26 -o33-bSbd-I 2582 49. 25-year-old man has acute lymphocytic leukemia that improves after the administration of chemotherapy including methotrexate. The beneficial effect ofthis drug is most likely the resuit of inhibition of which ofthe folowing enzyme activities? © A) Adenosine deaminase © B)DNApoymerase C) Hypoxanthine-guanine phosphonbesytransterase © B) Thymidylate synthase: © E) Xanthine oxidase: ® 2h a susp[ib Mational Roars of Medical Eapmipers - Mozila Firetow a, (CES pr stentest.com/ap/S2.1OTD Start epe2SVC=2eceaT2-426-4a53-bSbd-eI 5250820 Caines oe 5, Nitrogen dioxide inhalation in humans causes loss of type | pneumocyles in those aiveok exposed to high concentrations of the gas. Within 2 weeks, the affected aiveol are te-epitheliaized with type | pneumacytes. Which of the following is the mast likely immediate precursor of the new type | pneumacytes? © A)ANeolar macrophages © B) Capillary endothelial ces ©)intersttal celts © D) Type | pneumacytes © E) Type ll pneumocytes ro @ fee—————EE~ EEE (CUBES tip /ronn startet com/ op 1 DITDSert yp2SUC=2eceaTo? 26 -o33-bSbd-I 2582 ‘50. An 88-year-old man loses consciousness when his neck is palpated during a routine health maintenance examination, He has a 40-year history of hypertension that has been well controled with hydrochlorothiazide and a 20-year histary of degenerative osteoarthritis, for which he occasionally takes anti-inlammatory drugs. Which of the following is, the most likely cause of the syncope? © A)Complete heart block © B)Laryngospasm © ©)Peripheral arteriole constriction © D)Penpheral artenole dilation © E) Sinus bradyarthythmia F) Ventricular tacyanrhythnia ® 2h a susptional Board of Medical Eypmipers - Moxie Firetow (CUBES tip /ronn startet com/ op 1 DITDSert yp2SUC=2eceaTo? 26 -o33-bSbd-I 2582 6. A1-year-old boy is brought to the physician for a well-child examination. Physical examination shows pallor Laboratory studies show: Hemoglobin Hematocrit Enythrocyte count Mean corpuscular volume Reficulocyte count Leukocyte count Platelet count ‘Aperipheral blood smear is shown in the photomicrograph. Which ofthe following is the most likely diagnosis? © A) Acate lymphoblastic leukemia © B) Folic acid deficiency © G) iron deficiency anemia © D) Sickie cell disease © E) Vitamin B ,2 (cobalamin) deficiency 3299 On9' 6) 2 a5 4 08 oS 40 a 46 85 gil 26% - 2.4 milionmm? 65 um? (N=70-86) 05% “ 8000imm? with a nomal differential -480,000imm? 60 0 .3'(© National Board of Medical Examiners = Moria Ficiox ss is ce a ea (CES pr stentest.com/ap/S2.1OTD Start epe2SVC=2eceaT2-426-4a53-bSbd-eI 5250820 . oe Pana 7. 30-year-old woman comes to the physician for a follow-up examination because of a 10-year history of recurrent renal calcul. The calcul have primarily been composed of ‘calcium oxalate. Physical examination shows no abnormalities. Serum calcium and phosphorus concentrations are within the reference ranges. A 24-hour urine collection ‘shows an increased calcium concentration. The physician recommends that the patient increase her consumption of water and decrease her consumption of sodium and protein. The physician also recommends pharmacotherapy with a drug that decreases urinary calcium concentrations. Which of the following is the most fkely mechanism of action of this drug? © A) Decreases 1,25-dihydroxycholecalciferol synthesis B) Decreases H+ secretion in the distal tubule ©) Decreases magnesium reabsorption in the thick ascending limb of the loop of Henle. © D)Increases calcium reabsorption in the distal tubule © E)Incteases HCO; secretion in the proximal tubule © F)Incteases phosphate reabsorption in the proximal tubule G) Inbibits parathyroid hormone secretion @ fee—————EE~ EEE (CSR htps://onanwstarttest.com/api/5.1.1.0/ITDStart aspr2SVC=2eceaTb2-4206-4033-bSb4-e1 R2ScOfd02d_ Pana oe 8. A2-month-old boy is brought to the physician for a follow-up examination. He was delivered at term to a 27-year-old woman with myasthenia gravis. Immediately after delivery, he developed respiratory distress that lasted for 2 weeks. Physical examination today shows no abnormalities. The most likely cause of this patient's transient disease is transplacental transfer of which ofthe following antibody types? © A)lGA © B)lgD © ©)IgE © Dyas © E)lgM @ fee1D Natera Boar of Mecca Exarinets- Moria Fret = a Sc A A AR (CES pr stentest.com/ap/S2.1OTD Start epe2SVC=2eceaT2-426-4a53-bSbd-eI 5250820 = Com aren zer Taner t 9. A25-year-old man comes to the emergency department 5 hours aller developing shortness of breath and chest pain during exercise, he has had no cough or bloody mucus. He has asthma and major depressive disorder. Current medications include fluticasone inhaler and albuterol His temperature is 37 1°C (98 8°F), pulse is 110imin, respirations are 30Imin, and blood pressure is 90/60 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 93%. Cardiac examination shows a normal, and Sp with no murmurs and no increase in jugular venous pressure. Laboratory studies show. Hemoglobin 139d, 39% @[ib National oer of Medical Eepmipers - Mezile. Firetow ay (CESSES https formas starttest.com/ api/5.1.1.0/1TDStartspr2SVC=2eceaTb?-4706-4a53-bSb4-e1825O1cO2d w) Com oe Tanned 9 A25-year-old man comes to the emergency department 5 hours afler developing shortness of breath and chest pain during exercise, he has had no cough or bloody mucus. He has asthma and major depressive disorder. Current medications include futicasone inhaler and albuterol His temperature is 37 1°C (28 8°F), pulse is 110imin, respirations are 30/min, and blood pressure is 90/60 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 93%. Cardiac examination shows a normal S., and ‘SpWwith no murmurs and no increase in jugular venous pressure. Laboratory studies show Hemoglobin 13.g/L Hematocrit 39% Atterial blood gas analysis on room air: pH 7.46 Pco, 26 mm Ho. Po.) 60. mmHg J Achest xray is shown, Which of the folowing puimonary findings are most likely in this patient? © A)Crackles on the left ung base and apex © B) Crackies on the nght lung base © C) Decreased breath sounds on the left D) Increased wheezes on the lett © E)Rhonchi on the right @ fee—————EE~ EEE (COE ovr statist com/ pi 1.1 DTDStat np ?SVC=eceaTb2-4206-Ua33-bSbd-c1BIScOFO2A dical Examin oe Carats 1. A28 year-old woman, gravida 4, para 0, aborta 3, with systemic lypus erythematosus comes to the physician at 12 weeks! gestation for an intial prenatal examination. She is, concemed that she will not be able to carry her current pregnancy to term. The presence of which of the following is most likely increasing the risk for complications during pregnancy in this patient? © A)Antimitochondral antibodies © B) Antineussophil cytoplasmic antibodies © C) Antiphospholipid antibodies © D) Artistreptolysin O antibodies © E) Rheumatoid factor—————EE~ EEE (CES pr stentest.com/ap/S2.1OTD Start epe2SVC=2eceaT2-426-4a53-bSbd-eI 5250820 oe 10. A 14-year-old boy collapses while running sprints during high school basketball tryouts and dies within several minules. He was considered healthy and had no abnormal findings on prior physical examinations. His father died at the age of 38 years. At autopsy, the heart weighs 50% more than expected and has marked thickening of the left ventsicular wall and the interventricular septum, There are no other gross abnormalities. Which of the following findings is also expected? © A) Diffuse myocardial necrosis © B) Disorganized hypertrophic cardiac myocytes: © ©) Increased numbers of cardiac myocytes © D) Interstitial infitration of lymphocytes © E) Premature coronary atherosclerosis @ fee