1. A 75-year-old man develops a burnings ensationo ver his right flank.

One day later, he

developsa n eruptiono f clusteredv esicles on erythematousb ases in the same area.
Pain associated with the rash is sharp, stabbing, and severe. A drug that inhibits which of the
following actions is most appropriate?
<!:) A) Cell wall synthesis
@ B) DNA replication
<!:) C) DNA topoisomerase activity
<!:) D) Ergosterol synthesis

o E) Protease activity
<!:) F) Reverse transcriptase activity
<!:) G) Ribosomal protein synthesis

2. Duringd evelopment,n euralp recursorsm igratef rom the bowel into organst hat developf rom
the primordialg ut.A s a result,w hich of the followingo rgans is most likelyt o
contain ganglia innervated by enteric neurons?
@ A) Adrenal gland
<!:) B) Kidney
<!:) C) Pancreas
<!:) D) Spleen
<!:) E) Ureter

3. The bar graph shows the results of an experiment in which levodopa was administered orally
alone and in the presence of drug X. Drug Xis most likely which of the
following?
e> A) Benztropine
e> B) Bromocriptine
@ C) Carbidopa
e> D) Dopamine
e> E) a-Methyldopa
e> F) Pergoli de
e> G) Selegiline
4. A 43-year-oldw oman has hypertensionth at has been unresponsiveto diuretics,a ngiotensin-
convertinegn zymei nhibitors,a nd calciumc hannelb locking agents.A drug that
mimics the autoinhibitorye ffects of norepinephrineis started.T his drug acts at whicho f the
followingl ettereds ites on the schematico f adrenergica nd cholinergicn erves
innervating an organ?
Tyrosine

l
DOPA

l
Astorage{I)
granulel
Reuptake carrier
O A) @ B) O C) O D) O E) e F)

5. A healthy 28-year-old single mother of three healthy children recently started employment as
a secretary at a local corporation. She has a variety of health care plans from
which to choose. Which of the following types of plans is most likely to have the lowest out-of-
pocket cost for this patient and her family?
<!:) A) Fee-for-service
<!:) B) Health maintenance organization
<!:) C) Personal tax-exempt health care account
<!:) D) Point-of-service
@ E) Preferred provider organization

6. A 31-year-oldm an with AIDS is receivingh ighlya ctive antiretroviratlh erapy( HAART).L

aboratorys tudies show significantm yelosuppressiona nd a decreased plasma HIVmRNA
burden.T o counteract his toxicity (rathert han modify his antiretrovria l therapy),h e begins
treatmentw ith a hematopoei tic growthf actor. Thirtym inutesl ater, he
develops dyspnea, severe muscle pain, vomiting, and sinus tachycardia; his blood pressure is
80/40 mm Hg. Which of the following hematopoietic growth factors most likely
caused these new findings?
<!:) A) Erythropoietin
@ B) Filgrastim (G-CSF)
<!:) C) Platelet-derivedg rowthf actor
<!:) D) Sargramostim (GM-CSF)
<!:) E) Thrombopoietin

7. A newborn is born with a hypoplastic mandible. Which of the following structures is also
likely to be affected?
e> A) Cri coi d cartilage
e> B) Greater cornu of the hyoid bone
@ C) Malleus
ro D) Stapes
e> E) Thyroid cartilage
8. The diagram representst he distributiono f plasma concentrationsfo r isoniazid 6 hoursa fter
oral administrationt o a large group of subjects.T he bimodal distributioni s due to
genetic variability in which of the following?
e, A) Gastrointestinapl H and motility
@ B) Hepatic acetyltransferasea ctivity
e, C) Hydroxylasep olymorphism
e, D) Plasma cholinesterase activity
e, E) Plasma protein structure
9. A 62-year-old man with a history of alcohol dependence is admitted to the hospital
fortransurethral resection of the prostate. The following morning, while being transported
to the operating room, he has two generalized tonic-clonic seizures within 5 minutes. Neurologic
examination following the second seizure shows no focal abnormalities.
Which of the following is the most likely diagnosis?
@ A) Alcohol withdrawal
e> B) Hyponatremia
e> C) Korsakoff syndrome
e>D ) Partial complex( psychomotor)s eizure
e> E) Wernicke encephalopathy
10. A 15-year-oldg irl has virilizinga drenalh yperplasia.I ncreaseds erum concentrationso f 11-
deoxycorticosteronhea ve resultedi n hypernatremiah, ypokalemia,a nd
hypervolemiaS. erumA CTH concentrationis increased,b ut serum aldosteronec oncentrationis
decreased.A dministrationo f dexamethasonen ormalizest he ACTH, 11-
deoxycorticosteronea, ldosterone,a nd androgenc oncentrationsW. hich of the followingl abeled
enzymesi s most likelyt o be defectivei n this patient?

11. A 45-year-old man with an acute inferior wall myocardial infarct has hypotension secondary
to sinus bradycardia. Which of the following drugs is most appropriate for this
patient?
<!:) A) Acetylcholine
@ B) Atropine
<!:) C) Methacholine
<!:) D) Pilocarpi ne

o E) Pyri dosti gmi ne

12. A 35-year-old woman comes to the physician because of a 2-week history of fever and
headaches that seem to occur every other day. She recently returned from a 1-month
camping expeditioni n Cambodia. Her temperaturei s 40.6°C (105.1° F). Physicale xaminations
hows diaphoresisa nd splenomegalyA. peripheralb lood smear shows
Plasmodium vivax, and treatmentw ith chloroquinei s started and followed with a course of
primaquine.W hich of the followingi s the best explanationf or the inclusiono f
primaquine in this patient's medication regimen?
o A) Cerebral involvement
@ B) Hemolysis

o C) High parasite load on the blood smear

o D) Minimal toxicity
o E) Prevention of recurrence of malaria
13. A 45-year-oldm an with poorlyc ontrolledd iabetes mellitusd evelopsf ever, shakingc hills,h
ypotensiona, nd generalizedm alaise shortlya fter infusiono f an antifungala gent
for a large necrotic lesion on the upper palate. Which of the following antifungal agents is most
likely responsible?
@ A) Amphotericin
<!:) B) Fluconazole
<!:) C) Flucytosine
<!:) D) ltraconazole

o E) T erbi nafi ne
14. Which of the following is the major disadvantage of naloxone as a treatment for opioid
overdose?
e> A) As a partial agonist, it may produce depression of the central nervous system
e> B) It does not antagonize the effects of heroin
e> C) It has a low therapeutic index
@ D) It has a shorter duration of action than most opioids
e> E) Tolerance develops to its antagonistic effect
15. A 14-year-old girl is brought to the physician because of fever and pain in the lower
extremities for the past week. She had a sore throat that resolved without treatment 3
weeks ago. Her temperature is 38.9°C (102°F). Examination shows swelling and tenderness of
the knees and ankles, three 1-cm nodules on the right elbow, and a new
grade 3/6 crescendo-decrescendos ystolicm urmur.W hich of the followinga ntimicrobiala gents
is most appropriatet o preventr ecurrenceo f this disorder?
ro A) Acyclovir
e> B) Doxycycline
ro C) Fluconazole
e> D) lsoniazid
@ E) Penicillin
e> F) Trimethoprim-sulfamethoxazole
16. A 55-year-old man comes to the physicianb ecause he has had a 3.6-kg (8-lb)w eight loss
duringt he past 3 months.H e is a constructionw orker. He has smoked 2 packs of
cigarettes daily for 35 years. He has no history of medical illnesses. Vital signs are normal.
Physical examination shows suprapubic tenderness. Urinalysis shows 3
RBC/hpf, 0 WBC/hpf, and no bacteria. Urine cytology shows malignant cells. Which of the
following is the strongest predisposing risk factor for this patient's condition?
ro A) Age
@ B) Cigarette smoking
ro C) Gender
ro D) Heredity
ro E) Occupation

17. A 13-year-old boy is brought to the physician by his parents for a routine well-child
examination. When alone with the physician during the interview, the patient says that he
occasionally smokes cigarettes after school with his friends. He says that he smokes fewer than
10 cigarettes weekly. When the physician initiates a discussion about
smoking cessation, the patient says, "Smoking isn't a problem for me." Which of the following
responses by the physician is most appropriate?
ro A) "At what point would smoking become a problem for you?"
@ B) "Did you know that smoking has many long-term health consequences?"
ro C) "Do you want me to tell your parents about your smoking?"
ro D) "How did a nice kid like you get started smoking?"
ro E) "Why don't you just quit now before it gets to be a bigger problem."

18. A 52-year-old woman comes to the physicianb ecause of pain in her right knee.T he knee is
red, warm, and swollen.S erum uric acid concentrationis 11.4 mg/dl. Joint fluid
aspirate shows negativelyb irefringentc rystals.l ndomethacinth erapyi s started and she begins a
purine-restrictedd iet. One week later, her 24-houru rinaryu ric acid
excretioni s 800 mg/day( N = 300-600 mg/day).W hich of the followingd rugs is most
appropriatet o decreaset he serum uric acid concentrationin this patient?
@ A) Allopurinol
e> B) Aspirin
e> C) Colchicine
e> D) Probenecid
e> E) Sulfi npyrazone
19. After 6 days of therapy with a psychotropicd rug, a 35-year-oldm an initiates movements
lowlya nd has a shufflingg ait. Musclet one is increaseds ymmetricallyin all
extremities. Which of the following drugs is the most likely cause?
<!:) A) Amitriptyline
@ B) Chlorpromazine

o C) Diazepam
<!:) D) Fluoxetni e
<!:) E) Phenelzine

20. A 76-year-old man with a 15-year history of type 2 diabetes mellitus and hypertension has
had dry skin, marked cold intolerance, and constipation for 8 months. He is 178
cm (5 ft 10 in) tall and weighs 85 kg (187 lb); BMI is 27 kg/m2. Treatment is started with a full-
replacement dose of thyroxine (T4
). This patient is at increased risk for
developing which of the following during the first month of therapy?
<!:) A) Angina pectoris

o B) Asthma
<!:) C) Exophthalmos
@ D) Goiter
<!:) E) Jaundice

21. A 19-year-oldw oman comes to the physicianr equestinga n oral contraceptive.S he is

sexuallya ctivew ith one partner.S he underwenta splenectomy3 years ago after
sustaining a blunt trauma injury to the abdomen. Her vital signs are within normal limits.
Physical examination shows a well-healed, midline abdominal scar. Laboratory
studies showt he presenceo f Howell-Jollyb odies in the erythrocytesT. his patient is at greatestr
isk for mortalityi f she developsa n infectionw ith which of the following
causal organisms?
<!:) A) Candida albicans
<!:) B) Moraxella catarrhalis
<!:) C) Mycoplasma pneumoniae
@ D) Neisseria gonorrhoeae
<!:) E) Streptococcus pneumoniae

22. A 43-year-oldw oman has slow relaxationo f stretchr eflexesa nd a hoarsev oice. She has a
decreased plasmat hyroid-stimulatingh ormonec oncentrationth at increases
after she is givent hyrotropin-releasingh ormone.T he most likely diagnosis is hypothyroidismc
aused by which of the following?
<!:) A) Abnormality in the hypothalamus
@ B) Abnormality in the pituitary gland
<!:) C) Abnormality in the thyroid gland
<!:) D) Dietary iodine deficiency
<!:) E) Resistance to thyroid hormone
23. A 45-year-oldm an comes to the emergencyd epartmenta fter inadvertentlyta king an
overdoseo f metoprolol.H is pulse is 40/min and blood pressurei s 80/50 mm Hg.
Glucagoni s administeredi ntravenouslyF. ive minutesl ater, his pulse is 70/min and blood
pressurei s 130/80 mm Hg. Which of the followingb est describest he mechanism
of action of glucagon in this patient?
ro A) Inhibition of cardiac muscarinic 2 (M) receptors
ro B) Inhibition of phosphodiesterase
ro C) Opening of K• channels
ro D) Potentiation of drug-induced hypoglycemia
@ E) Stimulation of adenylyl cyclase

24. A 19-year-oldw omanw ith a 5-year historyo f poorlyc ontrolledt ype 1 diabetes mellitusg
ives birth to a plethoricm ale newbornw ho weighs 5 kg (11 lb). Twelveh oursl ater
the newbornh as hypoglycemiaW. hich of the followingi s the most likely cause of these findings
in the newborn?
<!:) A) Increased fetal pancreatic secretion of insulin
<!:) B) Increased fetal production of cortisol
<!:) C) Increased fetal production of growth hormone
@ D) Maternala nti-insulina ntibodies,w hich cross the placenta
<!:) E) Maternal insulin, which crosses the placenta

25. A 24-year-old medical student received hepatitis B virus vaccination 2 years ago. Which of
the following findings is most likely on serologic studies at this time?
HBsAg HBsAb HBcAb HBcAg
e> A) +
@ B) +
e> C) + +
e> D) + +
e> E) + +
26. A 32-year-oldn ulligravidw oman is being evaluatedf or infertility.H er last menstrualp eriod
occurred6 monthsa go. Menarcheo ccurreda t the age of 13 years;m ensesh ad
occurreda t regular2 8-day intervals.P hysicale xaminations hows a milky dischargef rom both
breasts.I f pharmacotherapyis indicated,t he most appropriatet reatmenti s a
drug with which of the following mechanisms?
ro A) Inhibition of a2-adrenergic receptors
ro B) Inhibition of dopamine receptors
ro C) Inhibition of estrogen receptors
ro D) Stimulation of a2-adrenergic receptors
@ E) Stimulation of dopamine receptors
ro F) Stimulation of estrogen receptors
27. A patient with a peptic ulcer is treated with drug X. Several weeks later the patient is also
given diazepam for treatment of anxiety, tension, and insomnia. The patient falls
asleep much more quickly and sleeps for a longer period of time than normally experienced with
diazepam. Drug Xis most likely to be which of the following?
<!:) A) Atropine
@ B) Cimetidine
<!:) C) Omeprazole
<!:) D) Propanthelni e
<!:) E) Rani ti dine

28. Bacterial strain Xis resistant to ampicillin and sensitive to kanamycin. Bacterial strain Y is
resistant to kanamycin and sensitive to ampicillin. Bacterial strains X and Y are
grown in mixed culture in medium without antibiotics, then the culture is plated on medium
containing both ampicillin and kanamycin. Bacterial colonies grow on the plates.
In a second experiment, DNase is added to the mixed culture medium. When this mixed culture
is plated on medium containing both antibiotics, no colonies grow.
Assuming that bacterial cells are impermeable to DNase, which of the following processes best
explains these observations?
<!:) A) Conjugation
<!:) B) Mutation
@ C) Transduction
<!:) D) Transformation
<!:) E) Transposition
29. A 32-year-old woman and her 31-year-old husband come to the physician because they want
to have a baby but are concerned about the impact this will have on the wife's
emotional state. She has had three major depressive episodes and numerous panic attacks within
the past 10 years. She discontinued her antidepressant medication 6
months ago and has been asymptomatic for the past year. She is concerned that she may become
depressed while pregnant and will be unable to take any medication
because of the pregnancy. Which of the following is the most appropriate response for the
physician?
<!:) A) "The depression associated with pregnancy is unrelated to major depression; therefore,
you are not at greater risk for being depressed while pregnant."
@ B) "The risk for depression is greatest after delivery and depression during pregnancy can
often be safely treated."
<!:) C) "The risk for depressioni s greatestd uring pregnancy,b ut electroconvulsiveth erapyi s
quite safe."
<!:) D) "Since you have been symptom-freefo r the past year, you shouldn ot be at greater risk for
depressiont han the normalp opulation."
<!:) E) "We will need to follow you closely since the suicide rate is higher for women who are
pregnant than for women who are not pregnant."

30. A 51-year-oldm an is admittedt o the hospitalf or treatmento f advancedp ulmonaryfi brosis.

His IQ is 78, and he has a historyo f major depressived isorder. When
questioned, he says that he no longer smokes, but his wife immediately yells at him and says that
he continues to smoke despite her best efforts to tell him daily not to do
so. Throughouth e interview,t he patient continuallyo pens his wallet and countsh is credit cards
to checkt hat they are all there. Physicale xaminations hows no other
abnormalities.W hich of the followingp sychosocialf actors is the strongestc ontraindicationto
lungt ransplantationfo r this patient?
@ A) Continued cigarette smoking

o B) Current marital discord

e) C) History of major depressive disorder

o D) Mild mental retardation

e) E) Obsessive-compulsived isorder

31. A 32-year-old woman receives a dose of warfarino rallyf or a large deep venoust hrombuso f
the right leg. She is currentlyta king an oral contraceptive.H er prothrombint ime
is 12 sec (INR 1.0). Two hours after the administration ofwarfarin, her prothrombin time remains
12 sec (INR 1.0). Which of the following best explains why this patient's
prothrombin time did not change?
ro A) The large thrombus increases the dose of warfarin required
ro B) Oral contraceptives accelerate the clearance of warfarin
@ C) Preexisting circulating coagulation factors have not been cleared
ro D) Prothrombni ti me is not a measureo f the efficacyo f warfarin
ro E) Warfari n should have been administered intravenously
32. A 27-year-old woman has had menses once every 4 to 6 months since age 16 years.
Menarche occurred at age 12 years, and she had regular 28-day cycles until she
joined the high school track team at age 16 years. She now runs 30 to 40 miles weekly. She eats
a healthy diet. She is 170 cm (5 ft 7 in) tall and weighs 61 kg (135 lb); BMI
is 21 kg/m2. This woman has an increased risk for developing which of the following?
e> A) Anorexia nervosa
e> B) Endometriosis
@ C) Osteoporosis
e> D) Ovarian cancer
e> E) Vitamin B12 (cobalamin) deficiency
33. The diagram shows contractiono f a blood vessel segmenti n responset o in vitro
administrationo f norepinephrine( NE) and drug X. Drug Xis most likelyt o be whicho f the
following?
o A) Cocaine
O B) Guanethidine
@ C) lsoproterenol

o D) Metoprolol
o E) Phenoxybenzamine
o F) Reserpine
o G) Tyramine
34. A 16-year-old boy comes to the physician for a physical examination required for a lifeguard
job at a local pool. Physical examination shows no abnormalities. Which of the
following advice by the physician is most appropriate?
@ A) Advise him to wear a wide-brimmed hat, sunglasses, and sunscreen
<!:) B) Suggest that he wear goggles when swimming in the pool
<!:) C) Tell him he could make more money mowing lawns
<!:) D) Tell him that he is fine and to enjoy himself at the pool this summer
<!:) E) Warn him to wait about 1 hour after eating before going swimming

35. A 42-year-oldm an has pancreatitisa ssociatedw ith hypertrigtyceridemiaH. is brothera nd

father have a similar condition.T he patient'ss erum VLDL concentrationis
increased. Which of the following is the most appropriate therapy for the hypertriglyceridemia?
<!:) A) Cholestyramine
@ B) Gemfibrozil

o C) Lovastatin
<!:) D) Probucol
<!:) E) Psyllium hydrophilic mucilloid
36. An 18-year-oldw omanw ho has hepatocellularc arcinomai s treated with a new
chemotherapeutica gent. One week after initiation of therapy,e xaminationo f tissue obtained
on biopsy of the liver showst hat manyn eoplasticc ells have decreased in size. Manyf ragmentso
f membrane-bounds tructuresc ontainingc ondensedn uclearc hromatin
and organelles are identified. Electrophoresis on agarose gel of DNA isolated from this tissue
shows a "ladder" consisting of multiple regularly spaced DNA bands.
Activation of which of the following enzymes is most likely to be responsible for the alterations
in DNA?
<!:) A) DNA ligase
<!:) B) DNA polymerase
@ C) Endonuclease

o D) Phospholpi ase ~
<!:) E) Transglutaminase

37. A 55-year-old man is given atropine and midazolam before undergoing hip replacement
surgery. Anesthesia is induced with thiopental and maintained with nitrous oxide
and sevofluraneV. ecuroniumi s administeredt o obtain muscler elaxation.O ne hour after
completiono f the operation,s pontaneousr espirationh as not returned,a nd
stimulationo f the ulnarn ervei ndic ate s continuedn euromusculabr lockade.W hich of the
followingd rugs is most appropriatef or restoringn euromusculafru nctioni n this
patient?
e) A) Atropine
0 B) Bethanechol
e) C) Carbachol
@ D) Neostigmine
e) E) Nicotine
0 F) Pralidoxime

38. A 49-year-oldm an undergoesr adical neck dissectionf or a malignancyA. ll four parathyroidg

lands are removed.H e has hypocalcemiap ostoperativelyC. alcium
concentrationr eturnst o the referencer angew ith calciuma nd vitamin D supplementationW. hich
of the followingb est describest he resulto f loss of parathyroidh ormoneo n
vitamin D metabolism?
ro A) Decreased cutaneous synthesis of vitamin D from steroid precursors
ro B) Decreased hepatic conversion of vitamin D to 25-hydroxycholecalciferol
ro C) Decreased intestinal absorption of dietary vitamin D
ro D) Decreasedn umbero f 1,25-dihydroxycholecalciferroel ceptors
@ E) Decreasedr enal conversiono f 25-hydroxyvitaminD to 1,25-dihydroxycholecalciferol
ro F) Increased hepatic catabolism of vitamin D
39. A 25-year-oldm an comes to the physicianf or a follow-upe xaminationT. wo weeks ago, he
underwentin guinalo rchiectomya nd operativer emovalo f the retroperitoneal
lymphn odes because of a metastaticn onseminomatousg erm cell tumor of the testes. At today'sv
isit, the physicianr ecommendsa djuvantc hemotherapyin cluding
vinblastine. Which of the following best describes the mechanism of action ofvinblastine in this
patient?
ro A) Alkylates DNA
ro B) Causes single-and double-stranded DNA breaks
ro C) Destroys asparagine
ro D) Inhibits dihydrofolate reductase
@ E) Prevents microtubule polymerization

40. A 12-year-old girl is brought to the physician by her parents because of a sore neck for 4
days. Her temperature is 37.7°C (99.9°F). Physical examination shows tender
swelling anterior to and just above the thyroid notch of the neck. The physician explains that
there is a cyst in the tract along which the thyroid gland descended. All of the
tract tissue must be removedb etweenw hich of the followingt wo structurest o treat this
patient'sc ondition?
ro A) Left lobe of thyroid gland and tonsillarfossa
ro B) Right lobe of thyroid gland and epiglottis
ro C) Right lobe of thyroid gland and hyoid bone
@ D) Thyroid isthmus and foramen cecum
ro E) Thyroid isthmus and piriform recess
41. After being given an infusion of mannitol (400 mM), a healthy person is most likely to have
which of the following changes in plasma osmolality and plasma ADH
e A) e B) @ C) e D) e E)
42. The dashed line on the graph shows alveolar ventilation 01 A) as a function of Pa CO2
(arterial CO2 tension) under normal conditions. Which of the following curves best
represents the relationship between PaC02 and VA after equilibration with 1.8 MAC halothane?

e A) e B) @ C) e D) e E)
43. Certain chromosomal abnormalities can result in rudimentary development of the cerebral
hemispheres. Which of the following labeled structures in the cross section of a
normalb rain stem is expectedt o be most underdevelopeda s a resulto f such an anomaly?
e, A) @ B) O C) e, D) e, E)
44. A 68-year-old man comes to the emergency department because of chest pain for 30 minutes.
An ECG shows a regular rate and rhythm and inverted Twaves. While
laboratory studies are being done, he is given oxygen and aspirin. Aspirin is most appropriate in
the treatment of this patient because of the inhibition of which of the
following enzymes?
@ A) Cyclooxygenase
e> B) Lipoxygenase
e> C) Phospholipase A2
e>D ) Prostacyclin( PGl2
)synthase
e>E ) ThromboxaneA 2 synthase
45. A 30-year-oldw oman is being treated with leuprolidef or estrogen-dependenbt reast cancer.A
fter 2 monthso f continuoustr eatment,w hich of the followingi s the most likely
effect on the secretiono f luteinizingh ormonea nd follicle-stimulatingh ormonef rom the
pituitaryg land?
Luteinizing Hormone F olli cle-sti mulati ng Hormone
@ A) ! !
e, B) I • B
e) C) T T
e) D) T B
e) E) B I •

46. A 48-year-old man comes to the physician with his wife because of a 10-month history of
headache and daytime sleepiness. His wife says that he snores at night and often
stops breathing while sleeping. He has no history of any major medical illness and takes no
medications. He is 173 cm (5 ft 8 in) tall and weighs 115 kg (253 lb); BMI is 39
kg/m2. His blood pressurei s 150/110m m Hg. Physicale xaminations hows no other
abnormalities.O vernightp olysomnographyc onfirmst he diagnosis.N octurnatl reatment
with nasal bi-level positive airway pressure is most appropriate for this patient to accomplish
which of the following?
@ A) Allowing the airway to remain patent for appropriate ventilation
<!:) B) Decreasing the work of breathing during the respiratory cycle
<!:) C) Reducing airway secretions during the ventilatory cycle
<!:) D) Stimulating increased lung compliance on inspiration and decreased lung compliance on
expiration
<!:) E) Stimulating increased res pi rations by splinting the mouth and nose

47. A 20-year-old woman comes to the physician for an examination prior to participating on the
college varsity volleyball team. She has a 1-month history of mild facial acne.
Physical examination shows no other abnormalities. Treatment with a topical agent is begun.
Three weeks later, she returns to the physician because of leg swelling and
weight gain. Physical examination shows severe facial acne and acne on the chest and back.
There is 2+ pitting edema of the lower extremities. Laboratory studies show a
miI dlyi ncreaseds erum direct bilir ubin concentrationa nd serumt ransaminasea ctivities.T he
most Iik ely cause of her conditioni s self-admni is tratio n of which of the following
substances?
e> A) ACTH
e> B) Ethinyl estradiol
e> C) Growth hormone
e> D) Hydrocortisone
@ E) Methandrostenolone

48. An investigationa l antivirald rug blocks activityo f a virus-encoded,R NA-dependentD NA

polymerase.T his drug is most Iik elyt o inhibit repI ic ation of whicho f the following
viruses?
<!:) A) Adenovirus
<!:) B) Herpes simplex virus
@ C) HIV
<!:) D) Influenzav irus
<!:) E) Poli ovi rus

49. A 66-year-old man comes to the physician because of a 3-month history of difficulty
urinating, constant loss of small amounts of urine, and the sensation of incomplete
bladder emptying.H e has hypertensiont,y pe 2 diabetes mellitus,a nd pollena llergies.C urrentm
edicationsi ncludem etoprolol,h ydrochlorothiazidein, sulin,m agnesium
hydroxide,a nd dip henhydramni e. His blood pressurei s 176/98 mm Hg. Physicale xaminations
hows no other abnormalities.W hich of the followingm edicationsi s the most
Ii kely cause of the urinary problems in this patient?
@ A) Diphenhydramine

o B) Hydrochlorothiazide
e) C) Insulin

o D) Magnesium hydroxide
e) E) Metoprolol

50. Snake venom is a potentv asodilatoro f some portionso f the arterial tree, particularlyi n the
arterioleso f skeletalm uscle.T his effect is unalteredb y ~-adrenergicb lockade
but is markedlye xacerbatedb y pretreatmenwt ith captopril.V enom-inducedr elease of which of
the followings ubstancesi s most consistentw ith these findings?
<!:) A) Adenosine
@ B) Bradykinin
<!:) C) Histamine
<!:) D) Platelet-activatingfa ctor
<!:) E) Serotonin