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1. A 6-year-old boy who has a history of self-mutilating behavior is now exhibiting aggressive behavior to other kids in his school.

Which of the following symptoms is he also prone to develop? op of !orm

"orneal clouding

#uscle weakness

$eophrolithiasis

%iarrhea

&ypersexuality 'ottom of !orm

(. A 1)-year-old female presents after a motor vehicle accident. *he is unconscious+ her heart rate is elevated+ and her blood pressure is low. *he has orthostatic changes as well. A foley catheter was inserted ,- minutes ago by the paramedics. urine output is extremely low. here is no exterior source of bleeding+ but given her falling blood pressure you suspect internal bleeding and hypovolemic shock. he most appropriate medication is op of !orm

dobutamine

norepinephrine

dopamine

nitroprusside

isoproterenol 'ottom of !orm

,. A /(-year-old woman presents at her family doctor0s office complaining of 1hot flashes1 and 1irregular periods1. 2ast medical history and family history are unremarkable. 2hysical exam is normal. 3ab values reveal elevated !*& and 3&. 4ou believe that she is menopausal and suggest hormone replacement. he patient voices some concerns about endometrial carcinoma+ which has been in the headlines lately. Which of the following hormonal regimens is best suited in this patient? op of !orm

5strogen only

5strogen and progesterone

2rogesterone only

estosterone

"lomiphene 'ottom of !orm

6. An 17-year-old female presents for a routine checkup. 8n examination+ she is found to have low blood pressure 9)-:6-; and poorer dentition than would be expected given her otherwise wellkept appearance. *he is thin+ but not substantially so. *he denies significantly restricting her intake+ saying she eats three large meals a day plus two small snacks. Which of the following metabolic disorders is she most likely to have? op of !orm

&yperkalemia

Alkalemia

&yponatremia

&ypoalbuminemia

&yperglycemia 'ottom of !orm /. A 6--year-old woman presents to her primary care physician with complaints of shortness of breath and a chronic cough. *he has suffered idiopathic pulmonary fibrosis for several years+ but now her symptoms are more prominent. *he has coarse rales throughout both lung fields and a prominent+ widely-split second heart sound. Which of the following is an accurate description of the second heart sound? op of !orm

Aortic then pulmonic valve closure

Aortic then pulmonic valve opening

#itral then tricuspid valve closure

#itral then tricuspid valve opening

2ulmonic then aortic valve opening

ricuspid then mitral valve closure

ricuspid then mitral valve opening 'ottom of !orm

6. A 6/-year-old patient is wheeled into the operating room to receive general anesthesia. After administration of one of the agents+ the patient briefly twitches and appears to have myoclonus+ but over a minute this passes and the patient becomes flaccid. he heart rate also falls slightly. he agent most likely to have done this is op of !orm

tubocurarine

enflurane

nitric oxide

succhinylcholine

propofol 'ottom of !orm

<. A ,--year-old sickle cell anemia patient known to the infectious disease clinic arrives for her regular pneumococcal vaccine. *ickle cell anemia patients are at particular risk of infection with which of the following microorganisms? op of !orm

*taphylococcus Aureus

&emophilus =nfluen>a

"hlamydia 2sittaci

#ycoplasma 2neumoniae

2neumocystis "arinii 'ottom of !orm

7. A (6-year-old pole-vaulter is training for the summer 8lympics. %uring practice+ he sustains a fracture of the surgical neck of the humerus. Which muscle0s nerve supply is most likely to be compromised? op of !orm

*upraspinatus

=nfraspinatus

eres ma?or

rape>ius

%eltoid 'ottom of !orm

). A /6-year-old male presents to his primary care physician complaining of pain in his left eye for the last several hours. &e did not sustain any ocular trauma. he left eye is inflamed. &e has marked photophobia in his left eye. &is intraocular pressure is measured and is markedly elevated in his left eye. Which of the following lesions most likely accounts for his symptoms? op of !orm

"orneal abrasion

=nflammation of the iris

=nflammation of the uvea

8bstruction at the canal of *chlemm

@etinal detachment 'ottom of !orm 1-. A (<-year-old medical student complains of lower back pain that is worse at night. 2hysical examination reveals a tender sacroiliac ?oint with decreased lumbar vertebra movement. A @ays of the lumbar-sacral spine are shown. he most likely diagnosis in this man is op of !orm

Ankylosing *pondylitis

spina bifida occulta

rheumatoid arthritis

@eiter0s syndrome

osteoid osteoma 'ottom of !orm 11. A 6/-year-old man with hypertension is given antihypertensive medication. &is blood pressure is normali>ed and stable for over a year. 8n a follow-up visit over a year later+ the patient is observed to have mild breast enlargement+ complaints of impotence and delayed e?aculation+ and decreased body hair. &is sodium is normal+ but potassium is mildly elevated. he most likely cause of these findings is op of !orm

hydrochlorothia>ide

spironolactone

enalapril

pra>osin

nifedipine 'ottom of !orm

1(. An infant is born with microcephaly and low A2BA@ scores. " scan reveals hydrocephalus and calcifications. he baby has several sei>ures within his first few weeks of life. by six months he has failed to reach any significant developmental milestones. &e may have experienced in-utero infection with which of the following agents? op of !orm

*almonella typhi

Adenovirus

Alphaviridae

oxoplasma gondii

*taphylococcus saprophyticus 'ottom of !orm

1,. A young couple visits a genetic counselor after finding out that the wife is pregnant. Cpon drawing out a family tree+ it becomes obvious that several family members have similar symptoms of failure to thrive+ freDuent respiratory infections+ and pancreatic insufficiency. $either of the couple have these symptoms+ but the woman0s mother and the father0s mother both had these symptoms+ as did the woman0s two brothers. he father is an only child. What is the risk that their fetus will suffer from this disease? op of !orm

-E

1(./E

(/E

/-E

</E 'ottom of !orm 16. A /--year-old man with a history of melancholic depression characteri>ed by lethargy+ hypersomnia+ decreased energy+ and decreased motivation is found to have chronic hypertension. he

decision is made to place him on a beta blocker. Which of the following is least likely to exacerbate his depression? op of !orm

Atenolol

2ropanolol

#etoprolol

$adolol

imolol 'ottom of !orm

1/. A 66-year-old librarian complains of right-sided headache+ particularly when chewing food. 2hysical examination reveals temporal tenderness. 3aboratory analysis reveals $a 161+ "l 1--+ F ,.)+ &"8, ((+ urea 11 mg:d3+ creatinine 1.- mg:d3+ hemoglobin 16g:d3+ leukocyte count 11./+ erythrocyte sedimentation rate 95*@; 61 mm:h. What is a possible complication of this disease? op of !orm

'ilateral neural deafness

2arotid gland stones

@ight eye blindness

rigeminal neuralgia

@enal failure 'ottom of !orm

16. A 6/-year-old woman presents to her family physician complaining of weight gain+ weakness+ increased urination+ excessive thirst+ and facial hair growth. 2hysical examination reveals moon facies+ buffalo hump+ and extensive purple striae on her lower abdomen. 'lood tests reveal a serum glucose of (,mg:d3. Crine cortisol test reveals a level of (-- mcg:(6 hr. *erum A" & level is -.< pg:m3. he patient denies use of any exogenous steroids. Which of the following is the most likely etiology of this patient0s disease? op of !orm

Adrenal tumor

2ituitary tumor

2ancreatic tumor

hymus tumor

Fidney tumor 'ottom of !orm 1<. A /6-year-old man complains of shortness of breath over the last few months with some episodes of whee>ing. *pirometry reveals flow rates similar to those for asthma+ although this patient has no previous history of asthma and doesn0t smoke. 3aboratory results are significant for a peripheral eosinophilia. What is the most likely diagnosis in this patient? op of !orm

Wegener0s granulomatosis

2olyarteritis nodosa

'uerger0s disease

&ypersensitivity angiitis

"hurg-*trauss syndrome 'ottom of !orm 17. A 6(-year-old surgeon presents to your office complaining of fatigue. 3aboratory analysis reveals $a 16/+ "l ))+ F 6.1+ &"8, (,+ hemoglobin 11.( g:d3+ leukocyte count 1-.1+ #"G <-+ #"& (6.1+ platelets ,--+---:mm. 2eripheral smear is significant for a microcytosis and hypochromia. 4our next step would be to proceed to op of !orm

colonoscopy

stool occult blood testing

oral iron therapy

vitamin '1( therapy

folate therapy

'ottom of !orm

1). A ,-month-old girl is brought in for evaluation of poor feeding. he girl has only gained one kilogram since birth. he mother states that the baby does not take the bottle that often+ and she is often irritable. %uring the examination+ the baby wets her diaper. 5valuation of the diaper elicits a strong+ sweetsmelling odor. Which of the following compounds is affected by this disease? op of !orm

Alanine

Galine

yrosine

&omogentisic acid

&omocysteine 'ottom of !orm

(-. A ,1-year-old woman presents to her primary care physician with complaints of diarrhea and freDuent itching that has been

going on for the last , months. affected by this disease? op of !orm

Which of the following en>ymes is

*uccinate dehydrogenase

#alate dehydrogenase

2yruvate kinase

Blucokinase

Blycogen synthase 'ottom of !orm

(1. A 6(-year-old man is referred to a gastroenterologist for persistent epigastric pain+ dyspepsia+ and nausea. &e reports that the pain is relieved by food+ especially milk and bread. Cpper gastrointestinal endoscopy reveals a 1./ cm ulcer of the duodenal bulb. &is condition could have been caused by elevation of op of !orm

pepsin

somatostatin

gastrin

secretin

cholecystokinin 'ottom of !orm

((. What is the most powerful flexor of the thigh? op of !orm

Adductor magnus

=liopsoas

@ectus femoris

*artorius

ensor fascia lata

Gastus lateralis

Gastus medialis 'ottom of !orm

(,. A 16-year-old male complains to his mother that he is having difficulty on the swim team that he recently ?oined at his high school. &e is able to sprint a few laps more Duickly than anyone on the team+ but when asked to swim longer distances+ he is disabled by painful muscle cramps. Which of the following is the most likely en>yme deficiency? op of !orm

a - 1+6 - glucosidase

'ranching en>yme

%ebranching en>yme

3iver phosphorylase

#uscle phosphorylase 'ottom of !orm

(6. A /6-year-old ype ( diabetic on metformin presents for his annual ophthalmologic exam. !undoscopy reveals a marked progression of diabetic retinopathy since the last examination. Which of the following tests is most useful to determine this man0s long-term blood glucose control? op of !orm

&emoglobin A1c

!asting blood glucose

8ral glucose tolerance test

Crine ketones

Crine glucose 'ottom of !orm

(/. A 66-year-old female is hospitali>ed for severe pneumonia. *he reDuires several days of mechanical ventilation in the intensive care unit. After she is extubated and able to speak+ she appears to be speaking to people who are not there. When asked to whom she is speaking+ she says she is speaking to her husband. here is no one in the room except the patient during these episodes. Which of the following is the best description of this patient0s behavior? op of !orm

%elusion

&allucination

2revarication

2ro?ection

*plitting 'ottom of !orm

(6. A (/-year-old office worker complains of vulvar burning and pruritis and a foul-smelling greenish vaginal discharge. *he admits to having multiple sexual partners over the last month. 2elvic examination is significant for multiple vulvar excoriations and the above-mentioned discharge. "ervical appearance is normal. A wet mount preparation reveals an oval motile proto>oan and an abundant inflammatory infiltrate. he best line of treatment is op of !orm

oral metronida>ole

topical nystatin

oral erythromycin

oral tetracycline

intramuscular ben>athene penicillin 'ottom of !orm

(<. A 6,-year-old 2uerto @ican male presents to his primary care physician with complaints of fever+ chills+ night sweats+ and a 6 kg 91- lb; weight loss in the last , months. &e also has a cough productive of yellow sputum. &e has a history of &=G infection 9last "%6H count I /-- : mm,;. *putum smear stained with the Jiehl-$eelsen method demonstrates acid-fast bacilli. 2ending

culture results+ the patient is prescribed 6 medications. Why is treatment with multiple medications necessary? op of !orm

Anticipated noncompliance with treatment

%ue to the patient0s &=G status

5xtreme virulence of the isolate

&igh freDuency of mutational resistance

&igh rate of medication side effects 'ottom of !orm

(7. A <(-year-old white female is admitted to the hospital with fever and hypotension. *everal days prior to admission+ she began to have urinary burning and freDuency+ but did not seek medical attention. 'lood cultures are obtained on admission and yield 5scherichia coli. %espite appropriate antibiotic treatment+ she remains hypotensive and develops disseminated intravascular coagulation. 5ndotoxin is implicated. Which of the following is the most likely component of endotoxin to be mediating these effects? op of !orm

A. A subunit

'. 3ipid A

". 8-polysaccharide side chain

%. 2eptidoglycan

5. 2olysaccharide core 'ottom of !orm

(). A 6/-year-old man with ventricular tachyarrhythmia is treated effectively with a medication that blocks sodium channels and therefore inhibits depolari>ation+ but does not affect the duration of the action potential itself. he medication most likely to do this is op of !orm

diltia>em

lidocaine

bretylium

Duinidine

procainimide 'ottom of !orm

,-. A (6-year-old salesman complains of yellow skin and eyes and fatigue 1ever since = can remember1. he peripheral blood smear is shown. What is the next line of treatment? op of !orm

=ron therapy

Gitamin '1( therapy

!olate therapy

*plenectomy

2hlebotomy 'ottom of !orm

,1. A 6(-year-old woman complains of freDuent urination+ often at night+ as well as excessive water drinking. *he has a 1--year history of bipolar disorder treated with 3ithium and under control. 3ab results areK $a 1/6+ "l 11(+ F 6.)+ &"8, (<+ urea (( mg:d3+ creatinine .7 mg:d3+ serum glucose )- mg:d3. Crine osmolarity is (- m8smol:kg. *he likely has a disorder involving end-organ resistance to op of !orm

glucose

anti-diuretic hormone

insulin

3ithium

aldosterone 'ottom of !orm

,(. A 16-year-old girl who is otherwise healthy complains of bilateral anterior knee pain that is most pronounced when walking up stairs. 2hysical exam demonstrates knee pain with forced Duadriceps contraction against a fixed patella. here is no other abnormality on physical exam. A @ays appear normal. he most likely diagnosis is op of !orm

meniscal tear

patellar fracture

tibial plateau fracture

chondromalacia patella

anterior cruciate ligament tear 'ottom of !orm

,,. A 6-month-old boy has severe cardiomegaly+ hypotonia+ failure to thrive+ and hepatomegaly. *erum glucose is normal. Which of the following diseases is the most likely diagnosis?

op of !orm

Gon Bierke0s disease

2ompe0s disease

"ori0s disease

Andersen0s disease

#cArdle0s disease 'ottom of !orm

,6. A <(-year-old white male presents to his primary care physician with complaints of fatigue worsening over the last several months. &e has splenomegaly. &is peripheral blood smear demonstrates typical cells of hairy-cell leukemia. Which of the following is a marker for hairy-cell leukemia? op of !orm

Alpha-fetoprotein

'eta( - microglobulin

"A-1(/

"% (/

"arcinoembryonic antigen 9"5A;

3actate dehydrogenase 93%&;

2rostate specific antigen 92*A; 'ottom of !orm

,/. A 6/-year-old man has 'retylium is ordered+ but available. he next best refractory period similar op of !orm

refractory ventricular fibrillation. beyond all comprehension+ there is none alternative+ because it prolongs the to bretylium+ is

procainimide

Duinidine

sotalol

flecainide

diltia>em 'ottom of !orm

,6. A ,7-year-old obese woman takes a long plane trip to visit her sister. Cpon deplaning+ she suddenly becomes short of breath and falls on the airport tarmac unconscious. *he is rushed to the nearest hospital where physicians note elevated ?ugular venous pulses+ *a8( 77E+ '2 <-://+ &@ 166. Cnfortunately+ resuscitative efforts are futile. Which of the following underlying conditions is most likely given this clinical scenario? op of !orm

"ardiac arrythmia

Abdominal aortic aneurysm

!at embolism

Air embolism

%eep venous thrombosis 'ottom of !orm

,<. A 1/-year-old female is brought by her mother to her family physician. the mother is concerned that the daughter is short and hasn0t begun her menstruations yet. 2hysical exam reveals that the young woman is / feet tall with absent breast development+ and webbing of the neck. Which congenital heart malformation is most likely in this patient? op of !orm

"oarctation of the aorta

etralogy of !allot

ransposition of the great arteries

%extrocardia

Anomalous pulmonary venous return 'ottom of !orm

,7. A ,)-year-old woman hospitali>ed for wound infection after a caesarian section receives oral amoxicillin and =G gentamycin. After a week she develops freDuent watery diarrhea+ with up to 17 liDuid bowel movements a day. "olonoscopy reveals pseudomembrane formation. he causative agent in this case is op of !orm

"lostridium perfringens

"lostridium difficile

"lostridium botulinum

&elicobacter pylori

5ntamoeba histolytica 'ottom of !orm

,). A (--year-old woman wants to find out who the father for her (-month-old baby is. *he has a blood type of A. &er baby has

blood type 8. here are five men+ numbered 1-/+ and their respective blood types are A+ '+ A'+ 8+ and '. 8n @!32 analysis+ the mom has two bandsK (6kb and 66kb. he baby has three bandsK (6kb+ /-kb+ and //kb. #an L1 has (6kb and /-kb. #an L( has /kb+ /-kb+ and //kb. #an L, has (6kb+ /-kb+ and //kb. #an L6 has (6kb and //kb. #an L/ has /kb and //kb. 'ased on the above information+ who is the father? op of !orm

#an L1

#an L(

#an L,

#an L6

#an L/ 'ottom of !orm

6-. A 1)-year-old college student is seen less and less by his friends. &is appearance has become disheveled and unkempt over the last several months. &e seems to have lost all interest in his studies. 3ately+ he has been mumbling about aliens and an invasion. &is roommate has found him talking to the television. Which of the following neurotransmitter disturbances is hypothesi>ed to cause this psychiatric illness?

op of !orm

%epletion of acetylcholine

%epletion of dopamine

%epletion of ? - aminobutyric acid

5xcessive production of acetylcholine

5xcessive production of dopamine

5xcessive production of ? - aminobutyric acid

5xcessive production of norepinephrine 'ottom of !orm

61. A <--year-old man is given an antiarrhythmic medication. *ubseDuently+ it is noted that his M interval is mildly decreased+ rather than increased. he most likely medication administered was

op of !orm

Duinidine

lidocaine

sotalol

procainimide

flecainide 'ottom of !orm 6(. A 6)-year-old man with chronic atrial fibrillation is put on Warfarin therapy to prevent mural thrombosis. he most short-lived of the vitamin F dependent clotting factors is op of !orm

factor ==

factor G==

factor =A

protein "

antithrombin === 'ottom of !orm 6,. A /--year-old man complains that he has become 1much uglier over the last two years1. &e brings a picture with him and+ indeed+ he appears much more coarse-featured. Cpon further Duestioning+ you find out that he has had to buy new gardening gloves and a gardening hat every few months+ because the old ones became too tight. 2hysical examination reveals a well-dressed man 6 feet tall with normal gait. #ental status and cerebellar testing are normal. #otor strength is also normal+ with normal reflexes bilaterally. Gisual field testing is performed and you notice a marked abnormality. his abnormality is most likely to be op of !orm

homonymous hemianopsia

bitemporal hemianopsia

Duadrantopsia

monocular blindness

monocular nasal hemianopsia 'ottom of !orm

66. A ,(-year-old male presents because of recurrent depressive periods. 8n history+ he states that he has had at least three periods of mild depressions+ where he felt unmotivated+ blue+ and anhedonic+ though he still was able to go to work and function effectively. &e has never been suicidal. &e also described+ incidentally+ periods of a month or more when he felt relatively energetic. &e slept somewhat less+ worked longer hours without becoming tired+ and was substantially more social and outgoing. &e recogni>es both periods as abnormal for him+ though he wishes to be consistently more 1up1. hese symptoms are most consistent with op of !orm

cyclothymia

bipolar disorder type ==

ma?or depression+ recurrent

dysthymia

bipolar disorder+ type = 'ottom of !orm

6/. Which of the following is the molecular defect in globin that results in sickle cell anemia? op of !orm

%eletion of arginine at position 6 of the beta chain

%eletion of glutamate at position 6 of the beta chain

%eletion of valine at position 6 of the alpha chain

*ubstitution of glutamate for valine at position 6 of the alpha chain

*ubstitution of valine for glutamate at position 6 of the beta chain 'ottom of !orm

66. A ,6-year-old male is visiting Gene>uela on a photography tour. After several days shooting photos at the edge of a brackish swamp+ he is struck with massive watery diarrhea. &e is air-lifted to a hospital for intravenous hydration and he recovers fully. Which of the following en>ymatic mechanisms does the toxin that caused this patient0s diarrhea exploit? op of !orm

Activation of cB#2 phosphodiesterase

=rreversible deactivation of adenylate cyclase

=rreversible deactivation of phospholipase "

2ersistent activation of adenylate cyclase

2ersistent activation of a phospholipase " 'ottom of !orm

6<. A patient with schi>ophrenia presents for a routine visit. &e begins to tell you about some of the side effects he has had+ and+ suddenly+ without any connection+ begins to tell you about a dog he saw in the street. his is most appropriately characteri>ed as

op of !orm

derailment

flight of ideas

circumstantiality

thought blocking

thought withdrawal 'ottom of !orm 67. A (7-year-old woman presents to her family physician with complaints of vulvar itchiness and burning. !urther Duestioning reveals an unprotected sexual encounter a week ago. 2hysical examination is significant for several vulvar fluid-filled vesicles. he most likely diagnosis is op of !orm

2aget0s disease of the vulva

vulvar carcinoma

&uman 2apilloma Girus 9&2G;

herpes simplex type ==

herpes simplex type = 'ottom of !orm 6). A 6(-year-old Gietnamese woman complains of preprandial epigastric pain radiating to the back and some vomitus of coffee grounds-like stomach contents. *he is diagnosed with peptic ulcer disease. triple therapy with Ampicillin+ 'ismuth *ulfate+ and #etronida>ole is initiated. and+ the patient is placed on 8mepra>ole. wo months later+ the patient has lost 1( pounds+ the pain is persistent+ and gastroscopy reveals a lesion of the antrum of the stomach. his lesion is most likely to be op of !orm

gastric carcinoma

recurrent gastric ulcer

Jollinger-5llison syndrome

gastritis

gastric leiomyoma 'ottom of !orm

/-. A ,-year-old boy has freDuent 1cyanotic spells1 and is often short of breath+ which he seems to compensate for by sDuatting. &e was the product of a full-term uncomplicated pregnancy+ and has normal motor and neurologic development thus far. here is no family history of any disorder similar to this. What is this boy0s most likely diagnosis? op of !orm

"oarctation of the aorta

ransposition of the great arteries

=diopathic &ypertrophic *ub-aortic *tenosis 9=&**;

etralogy of !allot

2atent ductus arteriosus

'ottom of !orm