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Exam Section 1: Item 1 of 50 National Board of Medical Examiners Time Remaining:

~ Mark Comprehensive Basic Science Self-Assessment 4 hr 15 min 49 sec
1. A 28-year-old woman comes to the physician for~.111.a .e . · ·

During the interview, she tearfully tells the physician that she and her new husband are havin pro~
She sa s she wants to o out with friends, but h does not enjoy being with people, referring individual activities such as hiking. She says eems j ndifferp(')Ug_§exual in imacy: n "~
show muc emotion nor understands her feelings a a . 1c o e o owing personality styles best explains the husband's behavior?
0 A) Avoidant
O B) Narcissistic
C Paranoid
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~ Mark Comprehensive Basic Science Self-Assessment 4 hr 15 min 46 sec
[ DA 55-year-old woman is scheduled to undergo transvaginal hysterectomy and oophorectomy for dysfunctional uterine bleeding. During the procedure, the uterus must be separated from all
surrounding pelvic structures. Identification and incision of which of the following structures that attaches to the cervical region and extends posteriorly is most appropriate in this patient?
O A) Mesometrium
O B) Mesosalpinx
O C) Mesovarium
0 D) Ovarian ligament
O E) Round ligament of the uterus
O F) Uterosacral ligament
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■ Mark Comprehensive Basic Science Self-Assessment
3. A 27-year-old woman comes to the physician because of a 2-year history of sporadic double · ·
more severe 5 days ago after a 4-day vis· _ _ _ ast year, he also has had four e isodes of urina -incontinence. Ptiysical examination shows ild dysarthria.
On mental status examination, she has mildly worried mood and a reactive affec . MRI of the-brain shows afew small, s-catterea, nonspeciffc whife-matter plagues. Which of the owing 1st e~
f •
most likely diagnosis?
O A) Complex partial seizure disorder

O B) Conversion disorder
e
C D) Multiple sclerosis
O E)Panic disorder without agoraphobia
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■ Mark Comprehensive Basic Science Self-Assessment 4 hr 15 min 32 sec
4. _ ysician because of 5-day history of severe mid-back pain Physical examination show point tenderness over the T6 vertebra Serum studies show a
calcium concentration of 13.4 mg/dl; urinalysis shows Bence ci-n-es pro e1ns. 1c -o - e o owing is the most likely cause o - 1s pa 1en!!f yperca cem1a.
O A) Excessive parathyroid hormone production

O B) Excessive parathyroid hormone-related protein production
O C) Increased fractional calcium gastrointestinal absorption
O oli
Local ir.),terleukin-1 (IL-1 ) and tumor necrosis factor effects]
O E) Unregulated 1,25-dihydroxycholecalciferol production
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0 0 0 National Board of Medical Examine(s
Exam Section 1: Item S of SO National Board of Medical Examiners Time Remaining:

5. During an experiment, a cuff occluder is placed on the left renal artery of a normal rat and inflated to cause a 90%, decrease in the cross-sectional area of the artery. A catheter is placed in the left
and right renal veins to sample the effluent. The concentration of which of the following substances will most likely be higher in the effluent from the left renal vein than that from the right renal
vein?
O A) ADH (vasopressin)
O B)Aldosterone
0 C) Endothelin
O D) Epinephrine
0 E)Renin
Exam Section 1: Item 6 of SO National Board of Medical Examiners Time Remaining:

6. A healthy 21-year-old man dies suddenly of cardiac arrest after snorting E

caine) Cocaine-induced inhibition of which of the following is the most likely explanation for the cardiac arrest?
O A) Acetylcholinesterase
O B) a 2-Adrenergic receptors
0 C) 132-Adrenergic receptors
O D) Monoamine oxidase
"") I=\ .
DF) Norepinephrine reuptake

National Board of Medical Examine,s

7. A 30-year-old woman, gravida 2, para 2, develop~ severe vaginal bleeding immediately after vaginal delivery of a male newborn at term! The hemorrhage continues durina the next hour and the
patient undergoes an emergency hysterectomy to control !tiebleeclirig. Examination of the uterus sliows fragments of placenta acllierent to the uterine wall. There is absence of the decidua
basal is. Which of the following is the most likely diagnosis?
O A) Abruptio placentae
O B) Chronic villitis
OC Circumvallate lacenta
D) Placenta accreta
E) Succenturiate lobe

■ Mark Comprehensive Basic Science Self-Assessment 4 hr 7 min O sec
8. A healthy 22-year-old man is a subject in a study investigating the regulation of heart rate during exercise. He is sitting on a stationary bicycle and is instructed to begin pedaling in 5 minutes.
One minute before he begins to pedal, his heart rate increases. An increase in which of the following transmitters acting at the indicated receptor best explains the increase in heart rate in this
man?
Transmitter Receptor
O A) Acetylcholine muscarinic
O B) Acetylcholine nicotinic
O C) Norepinephrine a
O D) Norepinephrine '31
O E) Norepinephrine '32

9. An 18-year-old woman with mild mental retardation is brought to the physician because of a 3-day history of decreased ability to see in reduced light. She has a lifelong history of chronic
diarrhea. Two years ago, she developed a lack of muscle control of her arms and legs, and generalized weakness. Her 16-year-old brother has had similar symptoms. Ophthalmologic
examination shows bilateral retinitis pigmentosa. There is ataxia and loss of deep tendon reflexes. Laboratory studies show erythrocytes with spiny projections and a serum total cholesterol
concentration of 40 mg/dL. Which of the following apolipoproteins is most likely deficient in this patient?
O A)ApoA-1
0 B)ApoA-11
O C)Apo B
O D)Apo C
0 E)Apo E

10. A previously healthy 32-year-old man is brought to the emergency department because of a 1-day history of intermittent flashing spots and blurred vision, vomiting, confusion, and difficulty
walking. He is a painter and says that yesterday he cleaned up a spilled bottle of paint thinner. Ophthalmologic examination shows dilated pupils with hyperemia of the optic disc and retinal
edema. Physical examination shows tachypnea. Serum studies show an anion gap metabolic acidosis. The most appropriate pharmacotherapy for this patient is most likely to inhibit the activity
of which of the following?
O A) Alcohol dehydrogenase
O B)Aldehyde dehydrogenase
O C) Formaldehyde dehydrogenase
O D) Lactate dehydrogenase
O E) Pyruvate dehydrogenase

11. A 49-year-old man with pancreatic cancer undergoes a Whipple procedure to resect the distal stomach, duodenum, and head of the pancreas. During the procedure, the cut end of the
remaining stomach is joined to the side of the jejunum (gastrojejunostomy). Which of the following nerve structures can be cut to decrease stomach acid output and decrease the likelihood of
ulcers forming in the jejunum at the site of junction with the stomach?
O A) Celiac plexus
O B) lliohypogastric nerves
O C) Phrenic nerves
O D) Subcostal nerves
O E) Sympathetic chain
O F) Vagal trunks

12. A 40-year-old woman comes to the physician for genetic counseling because of a family history of muscle weakness. She says that she has not sought
treatment because her symptoms are not severe, but her children have profound muscle weakness and fatigue. Sequence analysis of mitochondrial DNA I
shows a mutation in 50°/c, of the mother's mitochondrial DNA and in 100°/c, of each of her children's mitochondrial DNA. A pedigree is shown. Which of the
following genetic principles best explains the findings in this family? 11
1 2
50%
0 A) Anticipation
O B) Genetic drift
111
O C) Heteroplasmy 1 2 3 4
100% 100% 100% 100%
0 D) Imprinting
O E) Pseudodominant inheritance 0 Unaffected female
D Unaffected male
• Affected female
■ Affected male

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

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

15. A previously healthy 6-year-old girl is brought to the emergency department because of severe abdominal pain, nausea, and vomiting that began 4 hours after attending a friend's birthday party.
Cake and other pastries were served at the party. She appears acutely ill and mildly dehydrated. Her temperature is 37•c (98.6.F), pulse is 104/min, respirations are 20/min, and blood pressure
is 96/60 mm Hg. Examination shows no abnormalities of the skin. Bowel sounds are hyperactive. Which of the following is the most likely cause of these findings?
O A) Bacteremia
O B) Enterotoxin ingestion
O C) Intestinal mucosa inflammation
O D) Lead toxicity
O E) Villus atrophy
0 F)Viremia

16. A 39-year-old woman with end-stage renal disease caused by systemic lupus erythematosus undergoes kidney transplantation from a living, unrelated donor. Despite aggressive
immunosuppressive therapy, the transplant is rejected after 6 months. Analysis of a biopsy specimen of the transplant shows numerous infiltrating COB+ T lymphocytes. Which of the following
is the most likely cause of rejection of the transplant in this patient?
O A) Antibody synthesis
O B) Complement activation
O C) Direct cytotoxicity
O D) Histamine release
O E) Nitric oxide production

17. A male newborn is delivered at 38 weeks' gestation following an uncomplicated pregnancy. Twelve-hours later, he begins sucking frantically and crying inconsolably. He overreacts to stimuli
around him and has a marked startle response. The symptoms slowly resolve over the next 2 to 3 weeks. The most likely explanation for these symptoms is maternal use of which of the
following substances during pregnancy?
O A)Alcohol
0 B)Heroin
O C)LSD
0 D) Marijuana
O E) Psilocybin

18. A 22-year-old woman comes to the physician for a follow-up examination. One year ago, she was diagnosed with a pulmonary embolism. Two years ago, she delivered a female stillborn at
23 weeks' gestation. Physical examination today shows no abnormalities. Laboratory studies show a platelet count of 250,000/mm 3, a prothrombin time within the reference range, and an
increased partial thromboplastin time. The findings in this patient are most consistent with which of the following conditions?
O A) Antiphospholipid antibody syndrome

O B) Factor V Leiden mutation
O C) Increased factor VIII (antihemophilic factor) concentration
O D) Protein C deficiency
O E) Prothrombin G2021 OA mutation

19. A 2-month-old boy dies of meningitis despite appropriate antibiotic therapy. Culture of his cerebrospinal fluid grows Mycobacterium tuberculosis. Two of his brothers died of atypical
mycobacterial infections. Which of the following immunodeficiencies most likely explains this familial history?
O A) Complement deficiency
O B) lnterferon-y receptor deficiency
O C) Leukocyte adhesion deficiency
O D) X-linked agammaglobulinemia

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

22. A 35-year-old man comes to the physician for a routine examination. He has a 5-year history of recurrent episodes of genital herpes treated with acyclovir. He says, "I've been taking the
medication, but I still occasionally get lesions. When will I be cured?" The physician informs him that herpes simplex is a lifelong infection, with no cure at the present time. Which of the
following best explains the longevity of the herpes simplex virus?
O A) Continual replication in dendritic cells

O B) Continual replication in epithelial cells of the skin
O C) Continual replication in sacral root ganglia
O D) Continual replication in T lymphocytes
O E) Establishment of a latent infection in B lymphocytes
O F) Establishment of a latent infection in circulating immune cells
O G) Establishment of a latent infection in epithelial cells of the skin
O H) Establishment of a latent infection in sensory nerve cells

23. A 24-year-old woman comes to the physician because of a 1-day history of pain in her left leg while walking. Her temperature is 37°C (98.6°F), pulse is 84/min, and blood pressure is
135/78 mm Hg. Examination of the left lower extremity shows only a markedly decreased pulse in the left lower extremity. An intermittent faint diastolic heart murmur is heard at the apex.
Angiography of the left lower extremity shows complete obstruction of the distal left femoral artery by what appears to be a thrombus. The occlusion is removed using a catheter. Microscopic
examination of the removed specimen shows scattered mesenchymal cells in an abundant extracellular matrix. Echocardiography confirms a diagnosis of cardiac tumor. This patient most likely
has which of the following types of cardiac tumors?
O A) Fibroelastoma
0 B) Fibroma
O C) Hamartoma
O D) Hemangioma
0 E) Myxoma

24. A 48-year-old man is brought to the emergency department because of difficulty opening his mouth and stiffness of his neck, shoulders, and back for 4 hours. He sustained a puncture wound to
his arm 1 week ago. He has received no medical care for 30 years. Physical examination shows trismus and opisthotonos. Which of the following best describes the process in this patient?
O A) Blockade of inhibitory neurotransmitter release

O B) Cell death in central nervous system neurons
O C) Cell death in muscles
O D) Cell death in peripheral nervous system neurons
O E) Demyelinization

25. A 33-year-old woman comes to the physician because of a 16-kg (35-lb) weight gain during the past 6 months despite dieting. She is 168 cm (5 ft 6 in) tall and now weighs 104 kg (230 lb}; BMI
is 37 kg/m 2. Her blood pressure is 156/96 mm Hg. Physical examination shows a round, ruddy face with hirsutism, excess weight predominantly in the shoulders and abdomen, and purple
striae over the abdomen. An MRI shows a mass in the pituitary gland. A CT scan of the abdomen shows enlarged adrenal glands. Which of the following histologic changes would be expected
in this patient's adrenal glands?
O A) Cortical hyperplasia
O B) Cortical hypertrophy
O C) Cortical metaplasia
O D) Medullary hyperplasia
0 E) Medullary hypertrophy
O F) Medullary metaplasia

26. A mouse melanoma, B-16, is highly metastatic. A clone of the B-16 melanoma cells is injected intravenously into the tail vein of mice, and 3 weeks later tumor nodules are found in the lungs,
liver, and ovaries. When an antibody to a liver cell surface antigen is injected 1 hour prior to injection of the B-16 melanoma cells, formation of tumor nodules in the liver is prevented, but tumor
nodules develop in the ovaries and lungs. In vitro studies do not show any cytotoxic effect of the antibody on B-16 or hepatic cells. Which of the following processes is most likely to be affected
by the antibody?
0 A)Homing
O B) Initiation
0 C) Invasion
0 D) Motility
O E) Progression
O F) Promotion

27. A study is conducted to assess the effectiveness of vitamin C in preventing common colds in children. Patients are randomly assigned to receive either vitamin C or no intervention. Outcome
events (common cold) are reported by the parents on a monthly basis for 1 year. Results show that those taking vitamin C have fewer colds compared with those who received no intervention
(p<0.05). Which of the following raises the most concern about the validity of the conclusion that vitamin C supplements prevent the common cold?
O A) Inadequate statistical power

O B) Nonrandomization
O C) Selection bias
O D) Variability in outcome assessment

28. A 21-year-old African American man with sickle cell disease is brought to the emergency department 2 hours after the sudden onset of severe pain in his abdomen and knees. He has had six
similar episodes within the past 4 years; he was admitted to the hospital each time for treatment of the pain. His course has been complicated by two episodes of pneumonia and a small
cerebral infarction in the past 2 years. The patient asks the physician for extra pain medication to "kill me because I can't take it anymore." Which of the following initial actions by the physician
regarding the patient's request is most appropriate?
O A) Contact the hospital ethics committee

O B) Restrain the patient
O C) Reevaluate the patient after his pain has been controlled
O D) Administer general anesthesia for sedation
O E) Comply with the patient's request

29. A 7-year-old girl is brought to the physician by her parents because of a 3-year history of temper tantrums when her parents leave her. She refuses to sleep alone and recently would not attend
her friend's birthday slumber party. She calls to her mother if she is in another room of the house. Each morning, the patient's teacher has to carry her into school crying. Her mother recently
returned to work full-time and says that she is quite angry that her daughter is behaving in such a defiant way. Her father recalls that he behaved the same way when he was her age. Which of
the following is the most likely explanation for this patient's behavior?
O A) Conduct disorder
O B) Oppositional defiant disorder
O C) Post-traumatic stress disorder
O D) Separation anxiety disorder
O E) Normal behavior

30. A 15-year-old boy has intracranial neoplasms, mental retardation, and seizures associated with tuberous sclerosis complex, an autosomal dominant disorder. His 41 -year-old mother is healthy
but has angiofibromas, which are benign skin lesions characteristic of tuberous sclerosis complex. Which of the following best explains the findings in the boy and his mother?
O A) Alternate paternity
O B) Anticipation
O C) Parental germline mosaicism
O D) Reduced penetrance
O E) Variable expressivity

31. A 23-year-old woman is treated with acetazolamide to prevent acute altitude sickness 3 days before going on a mountain-climbing expedition. Acetazolamide acts predominately in which of the
following areas of the kidney in this patient?
O A) Ascending loop of Henle

O B) Collecting ducts
O C) Descending loop of Henle
O D) Distal tubule
O E) Proximal tubule
Exam Section 1: Item 31 of 50 National Board of Medical Examiners

■ Mark Comprehensive Basic Science Self-Assessment (!Itease Wait
32. A 40-year-old woman is brought to the emergency department 30 minutes after sustaining severe chest injuries in a motor
vehicle collision. Despite appropriate treatment, she dies 1 hour later. She had a 25-year history of a well-controlled seizure
disorder. A photograph of a coronal section of the brain obtained at autopsy is shown. Which of the following is the most likely
cause of this patient's seizure disorder?
O A) Glioblastoma multiforme •
O B) Herpes simplex encephalitis •
O C) Mesial temporal sclerosis
O
O
D) Neonatal ischemic stroke
E) Vascular malformation
·•

33. A 22-year-old nulligravid woman comes to the physician because she has been unable to conceive for 18 months. She has had irregular menses since menarche at the age of 13 years. She is
165 cm (5 ft 5 in) tall and weighs 88 kg (1 95 lb}; BMI is 32 kg/m 2• Her temperature is 36.8°C (98.2°F), pulse is 88/min, respirations are 14/min, and blood pressure is 140/90 mm Hg. Physical
examination shows moderate hirsutism and mild acne over the face and back. Pelvic examination shows no abnormalities of the exterior genitalia; a bimanual examination is limited by the
patient's obesity. Which of the following is the most likely cause of this patient's infertility?
O A) Hypothyroidism
O B) Klinefelter syndrome
O C) Pituitary adenoma
O D) Polycystic ovarian syndrome
O E) Primary ovarian failure

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

35. A 60-year-old man comes to the physician because of weakness and light-headedness for 3 months. His diet consists of a healthy balance of fruits, vegetables, whole grains, and lean chicken
and fish. He has a 10-year history of chronic autoimmune (Hashimoto) thyroiditis treated with thyroxine. Physical examination shows pallor. Serum studies show increased concentrations of
methylmalonic acid and total homocysteine. A peripheral blood smear shows megaloblastic anemia. Which of the following is the most likely cause of the findings in this patient?
O A) Cystathionine '3-synthase deficiency

O B) Failure of intrinsic factor production
O C) Folic acid deficiency
O D) Helicobacter pylori gastritis
O E) Methylmalonyl-CoA mutase deficiency
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36. An 18-year-old man comes to the physician 6 hours after e twisted his ankle while playing football. Physical examination shows looseness of the lateral collateral ligament, suggestive of a
tear. Lack of which of the following components in the ligament will most likely limit healing of this injury?
O A) Blood vessels
O B) Collagen fibers
O C) Elastic fibers
O D) Lymphatic vessels
0 E) Nerves

38. A 62-year-old man is brought to the emergency department because of a 3-hour history of progressive difficulty breathing and mild left shoulder pain. His symptoms began after he ran up
several flights of stairs. He has poorly controlled hypertension and mild angina pectoris. He has smoked one-half pack of cigarettes daily for 40 years. He appears uncomfortable and has
labored breathing. Diffuse crackles, rhonchi, and scattered wheezing are heard on auscultation of the posterior lung fields. His arterial Po 2 is 58 mm Hg. Which of the following is the most likely
diagnosis?
O A) Cardiac tamponade
O B) Pneumonitis
O C) Pneumothorax
O D) Pulmonary edema
O E) Pulmonary embolism

39. A previously healthy 25-year-old man is admitted to the hospital for treatment of viral pneumonia. He is mechanically ventilated because of respiratory failure due to hypoxemia. An open-lung
biopsy specimen is obtained and shows a pattern of acute lung injury. The presence of which of the following in the biopsy specimen most clearly suggests diffuse alveolar damage rather than
bronchiolitis obliterans-organizing pneumonia in this patient?
O A) Alveolar hyaline membrane

O B) Foamy macrophages
O C) Interstitial collagen deposition
O D) Masson bodies
O E) Uniform fibroblastic proliferation
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40. A 31-year-old woman is evaluated because of a 1-year history of infertility. Her hysterosalpingogram is shown. The most likely
cause of these findings is malformation of which of the following embryonic tissues?
O A) Germ cells
O B) Gonadal ridges
O C) Mesonephric (wolffian) ducts
O D) Paramesonephric (mullerian) ducts
O E) Urogenital folds
O F) Urogenital sinus
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41 . A 51-year-old man comes to the physician because of a 2-week history of cough productive of blood. He also has had a 3-kg (6.6-lb} weight loss during the past month. He has smoked 2 packs
of cigarettes daily for 32 years. He has hypertension treated with metoprolol. Physical examination shows clubbing of the fingernails. Wheezes are heard over the right upper lobe anteriorly;
there are no crackles. Laboratory studies show:
Serum
Na• 125 mEq/L
K• 3.9 mEq/L
c1- 85 mEq/L
Hco3- 25 mEq/L
Urea nitrogen 8 mg/dl
Creatinine 0.4 mg/dl
Osmolality 262
mOsmol/kg
Urine osmolality 564
mOsmol/kg
A CT scan of the chest shows a 2.4 x 1.2-cm, spiculated noncalcified mass in the right upper lobe eroding into the right bronchus. This patient's laboratory findings are most likely caused by an
excess of which of the following hormones?
O A) ADH (vasopressin)
O B) Adrenocorticotropic hormone
O C) Brain natriuretic peptide
0 D) Cortisol
0 E) Thyroxine (T.J

42. A 3-year-old boy is brought to the emergency department because of multiple ecchymoses, bleeding into t.!le joints, and bloody diarrhea 48 hours after ingesting an unknown quantity of
warfari that he took from his grandmother's purse. Prothrombin time is 80 sec (INR=20). Which of the following is the most appropriate initial therapy?
O A) Factor IX (plasma thromboplastin component) concentrate

O B) Fibrinogen concentrate
0 C) Fresh frozen plasma
O D) Platelet concentrates
O E) Vitamin B12 (cyanocobalamin), parenterally

43. A 38-year-old woman at 32 weeks' gestation is brought to the physician because of a 2-day history of fever, nausea, vomiting, and muscle aches. She
appears acutely ill. Her temperature is 39°C (102.2°F), pulse is 120/min, and respirations are 20/min. A photomicrograph of a Gram stain of an ' I
organism recovered from a blood culture is shown. Which of the following is the most likely causal organism?
O A) Corynebacterium urealyticum (
O B) Gardnerel/a vagina/is • \
O C) Listeria monocytogenes ,
O D) Rhodococcus equi • \
O E) Staphylococcus aureus ' ((., •
•
• •
•
• •
, \ •

44. A 76-year-old woman is brought to the emergency department because of a 3-hour history of severe headache, slurred speech, and confusion. She has a 2-year history of atrial fibrillation. She
has difficulty understanding and answering questions, but she is cooperative. Ophthalmologic examination shows hemianopia and a tendency to gaze to the right. The pupils are normal sized
and reactive to light. Neurologic examination shows left-sided numbness and paralysis that are more severe in the face and upper extremity than in the lower extremity. Which of the following
arteries is most likely involved in this patient's condition?
O A) Anterior cerebral
O B) Anterior spinal
O C) Middle cerebral
O D) Posterior cerebral
O E) Vertebral
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45. An 82-year-old woman is admitted to the hospital for treatment of a small right pleural effusion. Physical examination shows dullness to percussion at the level of the 7th rib and below on the
right. A thoracentesis is done. The patient is sitting up, supported by leaning against a bedside table. After preparing the skin and delivering a local anesthetic, into which of the following
locations on the right is it most appropriate to insert the catheter?
O A) Above the 5th rib in the midscapular line

O B) Above the 5th rib just to the right of the sternum
O C) Above the 7th rib in the paravertebral region
O D) Above the 9th rib in the midscapular line
O E) Below the 5th rib in the midaxillary line
O F) Below the 5th rib in the midclavicular line
O G) Below the 9th rib in the midscapular line

46. A 23-year-old woman comes to the physician because of a 1-day history of chills, nausea. and vomiting She also has a 4-day history of flank pain, urinary frequency ancl urgency, ancl pain wi
urination. Her temperature is 38.9°C (102°F), pulse is 125/min, and blood pressure is 96/60 mm Hg. Physical examination shows right costovertebral angle tenderness. Urinalysis shows
25 WBC/hpf. A urine sam111e grows pink colonies on lactose-MacConkey agar, i:,roduces a characteris ic g_reen. sbeen, pp_eosi -methylene blue agar, and ·s indole positive. The production of
which of the following by the bacterium aids in the virulence of the causal organism in this patient?
0 A) Adhesins
O B) Anti hemolytic factors
O C) Pyrogenic exotoxin
0 D) Teichoic acid in the cell wall
O E) Thick peptidoglycan layer

47. A 76-year-old man is admitted to the hospital because of a 2-week history of a persistent urinary tract infection. He is 165 cm (5 ft 5 in) an weighs 55 kg (121 lb}; BMI is 20 g/m-\ The physician
plans to initiate treatment. A component of the initial treatment includes an intravenous bolus dose of an antibiotic to attain an initial peak serum concentration of 8 mg/L. The volume of
distribution of the antibiotic is 0.35 L/kg. Laboratory studies show a 24-hour urine creatinine clearance within the reference range. Which of the following is the most appropriate loading dose of
this drug for this patient (in mg)?
0 A)25
0 6)50
O C) 100
0 0)150
0 E)200

48. A 55-year-old man with hepatic encephalo11athy is brought to the physician because of confusion and increasecl letharg~ cluring e past 2 ours. He has a history of cimiosis o e. liver
caused by hepatitis He is easily arousable despite the lethargy. His temperature is 37°C (98.6°F). Physical examination shows scleral icterus, asterixis, a protuberant abdomen, and ascites.
Test of the stool for occult blood is negative. Administration of which of the following drugs is most likely to improve this patient's mental status?
O A) Bisacodyl
0 B) Docusate
0 C) Lactulose
O D) Octreotide
O E) Omeprazole
0 F) Sucralfate
0 G) Ursodiol
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■ Mark Comprehensive Basic Science Self-Assessment 2 hr46mln 4sec
50. A 22-year-old woman is admitted to the hospital because of a 10-day history of polydipsia and i:1olyuria. She says that the urge to urinate often awakens her at night. She has been taking lithium
carbonate for 2 years for bipolar disorder; her dosage was increased 6 months ago because of recurrent severe manic episodes. Her vital signs are within normal limits. Physical examination
shows no abnormalities. Over the next 24 hours, urine excretion totals §.:5 L. Laboratory studies at this time show a serum sodium concentration of 148 mEq/L, serum osmolality of
315 mOsmol/kg, and urine osmolality of 75 mOsmol/kg. After administration of desmopressin, urine output and osmolality do not change. Which of the following findings in the nephron best
describes the tubular osmolality, compared with serum, in this patient?
Proximal Tubule Juxtaglomerular Apparatus Medullary Collecting Duct
O A) Hypertonic hypertonic hypertonic
O B) Hypertonic hypertonic hypotonic
O C) Hypertonic hypotonic hypotonic
O D) Isotonic isotonic isotonic
0 E) Isotonic hypotonic hypertonic
0 F) Isotonic hypotonic hypotonic
O G) Hypotonic hypertonic hypertonic
O H) Hypotonic hypotonic hypertonic
0 I) Hypotonic hypotonic hypotonic

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0 0 0 National Board of Medical Examiners

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1. A 28-year-old woman comes to the physician for~.111.a .e . · ·

O A) Complex partial seizure disorder

O A) Excessive parathyroid hormone production

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6. A healthy 21-year-old man dies suddenly of cardiac arrest after snorting E

DF) Norepinephrine reuptake

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O A) Antiphospholipid antibody syndrome

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O A) Continual replication in dendritic cells

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O A) Blockade of inhibitory neurotransmitter release

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O A) Inadequate statistical power

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O A) Contact the hospital ethics committee

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O A) Ascending loop of Henle

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O A) Cystathionine '3-synthase deficiency

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O A) Alveolar hyaline membrane

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O A) Factor IX (plasma thromboplastin component) concentrate

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O A) Above the 5th rib in the midscapular line

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