1. A patient takes antihypertensive drugs. On his last day, Dr. prescribes anti-diabetics also.

On next visit his glycemic control is not normal and Dr. asks about whether he took
medication. He said “I have lost my job and don’t have money and don’t want to spend a
lot of money on those things which I don’t feel are necessary.” What should be the
response by the Dr.?
a. Ans: How much do you think you can spend
b. Other options: Did you ask pharmacy about the drug cost; Tell him if he doesn’t take
his meds his condition will deteriorate; If you don’t want to be treated, then why did
you come to me?
2. Patient takes cough suppressant excessively and now has run around the house acting
crazy. His overdose should be treated like which of the follow?
a. Ans: Atropine
3. Graph of norepinephrine as it is in FA
4. A young patient brought by his friends as he has just returned to his home. On interview
he tells you about a drug that he uses excessively and fell cool. Now prevents with
tachycardia, excessive sweating, dilated pupils, opioid withdrawal, diarrhea, abdominal
pain. Also tells that he hasn’t used drug for 36 hours
a. Treat- Ans: Clonidine
5. There is a large hospital for immigrants but they are not “all using it”. They conducted a
research in a community via interview that asked why they are not using hospital, they
made a massive report, summarizing the comments of the people of the population.
Which type of study is it?
a. Ans: Qualitative study
b. Case control
c. Cohort
d. Cross sectional
6. Simple question on the drug intervention trial done on 50 healthy people, now they want
to check drug in 1—diseased people. Asked which phase
a. Ans: 2
7. General pharma question- which of the follow has intrinsic activity
a. Answer: graph which shows activity above the line

8. Which agonist opposes the intrinsic activity?

9. Multiple cutaneous lesions on half of the side of body. Pigmented lesions on iris. What
gene defective? NF-1
10. Patient presenting with mood change, apathy, some psychotic features, choreform
movements, uncontrollable extremity movements. What drugs can be given to treat
motor symptoms?
a. Haloperidol (Huntington disease)
11. One question on CF. Lung was removed due to recurrent hemoptysis. Had to identify
structure on gross picture. What cell type is this?
a. Looked like segmental/lobular bronchus. Pseudostratified columnar.
12. IV catheter induced sepsis. No murmur. Culture grows gram negative bacteria that does
not ferment lactose. DOC?
a. Ans: Cefepime
b. Ceftriaxone
c. Vancomycin
13. Cholera scenario. MOA of toxin? (Confusing options)
a. Answered: Inhibit GTP breakdown on ds subunit by Gs (double check)
14. Child with rhinorrhea for a few days. Now presents with ear pain. Bulging tympanic
organism?
a. Ans: Strep pneumonia
b. H. influenzae
c. Viruses
15. ECG Ventricular preexcitation beats.

a.
16. ECG- II, III, AVF ST elevation. Reason why this occurred. History of chest pain since 3
hours, fatigue/weakness 7 days. Diagnosis?
a. Infarction
b. Pericarditis
c. Ventricular Tachycardia
d. Atrial fibrillation
17. H/o infection. 40 leukocyte count. Neutrophils predominate, Promyelocyte 30% and
peripheral blood smear shows Dhole Bodies. Why did this happen?
a. Ans: Premature release of WBC’s from the Bone Marrow
b. Tyrosine Kinase defect
18. Long scenario of road traffic accident. Cervical spinal injury at C6 level. What should
occur?
a. Ans: ↓ CO, ↓ Preload, ↑ Venous blood
19. Renal transplant patient, IV cannula for dialysis. Now presents with fever, chills,
hypotension, tachycardia. Gram stain of blood sample shows (a picture with a budding
yeast ) What drug to treat with?
a. Ans: Amphotericin B
20. Experimental question: AML (M3) series ATRA is given and results show no effect.
Another drug is given that inhibits histone deacetylase. After giving drug cells start
differently. What is the effect of this drug?
a. Ans: Transcription
b. Translation
c. Ubiquitination
d. Folding of protein
21. Virus scenario: A retrovirus contains genes for thymidine kinase and has been inserted in
malignant cells. Not we use the drug Ganciclovir which stops the growth of the malignant
cells. What process has been prevented?
a. Ans: Replication
22. 15 year old child. Development is normal until 6 months. Now she cannot hold her head
or stand on her own. Sometimes crosses her upper extremity to her chest. Head size has
decreased from 50th percentile to 25th percentile.
a. Ans: Rett Syndrome
23. Pedigree showing two people with hemangioblastomas, two people with renal cell
carcinoma. Which gene is defective?
 a. Ans: VHL
24. Graph of country, population pyramid given. What should be the best strategy for health
policy makers?
a. Ans: Spend more of the budget on long term diseases
b. Aid on Contraception
c. Provide clean water
d. To reduce infections during child birth
25. Researcher conducts a study, He sets a value of .01, instead of normal. Why?
a. Ans: To decrease the risk of type I error
26. Patient presenting with left side body numbness, severe pain. Loss of sensation on left
side of body. A month ago there was a history of stroke? Which structure is involved?
a. Ans: Thalamus
27. UW question regarding pacemaker rate. Sequence was different from UWorld. Park at
ventura Avenue concept.

28. Audio murmur. History helped diagnose:

a. Ans: Aortic Stenosis
29. Audio murmur. History helped diagnose:
a. Ans: Mitral Regurgitation
30. A C/V of adenocarcinoma of colon. What determines the metastasis of this tumor?
a. Ans: Loss of E-cadherin function
b. Evasion of apoptosis
c. G1/S phase transition
31. Experimental question: Muscle function reduced. Actin does not detach from myosin
head. Defect lies in what?
a. Ans: ATP binding to myosin head.
32. C/V of ischemic injury. Why are cells swollen?
a. Ans: Decreased function of energy dependent pump
33. 75 year old patient presenting with fatigue, bone pain. Peripheral smear shows
pancytopenia. MCV: 123. Diagnosis?
a. Ans: Myelodysplastic syndrome? (Answered due to bone pain)
b. Folate deficiency
34. Experimental question. Two children groups from African country have malaria. Group 1:
Hb- 8.4, Hct- 25. Group 2: Hb- 6.4, Hct- 17. What other parasitic infection is present?
a. Necator
35. C/V Anemia, fever 103.5, chills, cough. Went home during college vacation in Rhode
Island. Trophozoites in RBC’s. Exposure to what? pg. 157
a. Ans: Tick? - Babesia
 b. Mosquito?
36. An old lady presents with shortness of breath. On examination, JVD, hepatomegaly,
pitting bipedal edema. Keeps 2-3 pillows to sleep. What is seen?
a. ↑ Pulmonary capillary blood
b. ↑ Pulmonary lymph flow
c. ↑ Pulmonary end diastolic pressure
37. C/V. showing features of anemia. Peripheral smear done. Arrows on cells (looked like
reticulocytes). What would be primary mode of protein formation in these cells?
a. Ans: Translation. (Reticulocytes have no nucles  No transcription)
38. Experiment done to induce atherosclerosis in experimental animal. Vessels are artificially
damaged. What would be first response of endothelium?
a. Releases vWF to attract platelets/bind
b. Macrophages ingest oxidized LDL to form fatty streaks
39. Hypertensive patient prescribed valsartan. Creatinine done. It increased from 2.0 to 2.3.
What is the cause?
a. Ans: Dilation of efferent arterioles.
40. Left renal artery stenosis. BP 220/110. What will be seen in right renal vein?
a. Ans: ↓ Renin, ↓ AT, ↑ Aldosterone
41. Patient presents with dementia, vomiting, fever, fatigue. Went on a hiking trip. He used
boiled water/food and bottled water. Also went boating in salt fish lakes and shallow
ponds. Causative organism?
a. Ans: Vibrio Vulnificus. (other options were 4 nematodes)
42. Patient has history of cellulitis now presents with features of septic shock. What is the
MOA of toxin that causes this via binding.
a. Ans: TLR-4
b. TLR-1
c. TLR-2
d. TLR-8
43. An old lady, living alone brought by her son as she hit his car a few days back. Has
normal BMI. She recalls 2 things out of 3. Has cataract on physical examination. No
history of accident prior to this. Dianogse?
a. Ans: Old age
b. Alzheimer’s
44. A female taking TCA’s, has anticholinergic symptoms. She also is on a drug which has
effects on cytochrome p450 (omeprazole). Which CYP do TCA’s act on?
a. Ans: CYP 2D6
45. A female nurse comes for routine check up. Everything is normal on physical exam. On
the dorsum of her hand, her skin is dry and ulcers are felt. What advice do you give?
Diagnosed: Xerosis (s-word?)
a. Use a lighter soap
b. Prevent from exposure of cold
c. Barrier lotion use
d. Use sunblock and prevent exposure to sun
46. Patient undergoes chemo. She has excessive vomiting after chemo. Drugs are
chemotherapeutic and is on ondansetron. What is the next anti-emetic that can be added?
pg. 555
a. Dronabinol
47. Newborn presents with recurrent vomiting, upper abdominal distension after feeding. X-
ray is given with double bubble sign. Slow passage of meconium, polyhydramnios.
a. Ans: Duodenal Atresia
48. C/V of Down syndrome
a. ↑ hCG, ↑ nuchal translucency, ↓ other fetal markers
49. Pregnant woman with a complaint of acne. What drug is contraindicated?
 a. Isotretinoin
50. Patient presents to the hospital after sudden collapse. History of MI 2 years ago which
resolved without any complication. The patient dies despite resuscitation. On autopsy, left
ventricular aneurysm is found. Thrombus is found within the walls of the aneurysm loosely
attached to the wall. What is the major constituent of the thrombus?
a. Ans put was Fibrin, but unsure
51. Patient presents with fever, cough, sputum. Bilateral crackles. Occasional blood tinged
sputum. Breath sounds are decreased. What is the first step?
a. Ans: Chest X-ray
b. Sputum culture
52. A new drug was used vs standard treatment in 200 people. 100 were given the new drug
and 100 were given standard care. After 1 year, 15 died out of 100 who were given the
new drug and 35 died out of 100 who were given the standard care. How many patients
are required to save 1 patient (NNT)?
53. Graph on population pyramid. Wide at base, very narrow at the apex. How would you
define this population?
a. Ans: High birth, high mortality
b. High birth, low mortality
c. Low birth, low mortality
d. Low birth, high mortality
54. 20 year old female presents with weight loss, fever. She is from India. There are features
of renal disease. Gross specimen of kidney given, shows whitish lesions. Diagnosis?
a. Tuberculosis

55. Salmonella question, typical features of typhoid. Answer choices did not have
contaminated source. pg. 144
a. Ans: Turtle exposure.
56. Pregnant lady, severe hemorrhage follow delivery. Planned for hysterectomy.
Hypotension. Given packed RBC’s. Which gland is most vulnerable for ischemia? pg. 343
a. Ans: Pituitary
57. Scenario of infectious mononucleosis. What do the antibodies target?
a. Ans: Cattle erythrocytes
58. Other scenario of infectious mononucleosis. Reactive lymphocytes are seen. Which cells
are atypical?
a. CD 8+ve – Downey cells.
59. Which of the following is the best competitive antagonist?
60. A 70 year old female patient has breast cancer with vertebral metastasis and severe pain.
She was prescribed al-fentyl. She has arrived three times this month, requiring increases
dosing and refills. The doctor agreed and increased dosing. Now the patient is in distress,
having hand on her chest and she can’t stand still. This time is she asking to increase her
dose more. What pharmacologic action is this?
a. Ans: Tolerance??? Doesn’t seem right haha
b. Drug seeking behavior
c. Addiction
61. A long C/V on stable angina. Doctor prescribes a drug which irreversibly inhibits?
 a. Ans: COX-1
62. An experimental study on a lethal parasitic infection. An enzyme is expressed both in
humans and the parasite. The enzyme is stable in the parasite but rapidly degraded and
renewed in humans. Which drug will be most effective in the parasite?
a. Ans: Irreversible antagonist – it would inhibit the enzyme indefinitely in
the parasite, while the human would be renewed.
b. Competitive antagonist
c. Noncompetitive antagonist
63. A scenario about drug intervention being used on 100 randomized sample. 50 patients
received the drug and 50 patients were given nothing. What was defective in this study?
a. Ans: Blinding
b. Other options: Confounding, effect modification
64. A hospital wants to use a test in OPD to detect a disease. 4 tests (diagnostic, labeled A,
B, C, D) were used. All tests have equal cost. Which test shall be used for detecting the
disease?

a. This is an ROC curve. We use the top/highest one P.

65. A young female has asthma and takes albuterol. Now she uses her boyfriend’s inhaler
(salmeterol) along with her own inhaler which controls her symptoms better. What other
drug to prescribe with salmeterol?
a. Ans: Fluticasone
66. Experimental question: Heat shock proteins are induced. What is the function? pg. 45
a. Ans: Ubiquination
b. Is this correct? Heat shock proteins are involved in maintaining protein folding
67. An experimental question: Proteins are produced, then glycosylated, mannose residues
are phosphorylated. These proteins are then injected into a cell. Where will we find these
proteins?
a. Ans: Lysosomes
68. 70 year old patient has BPH symptoms and also uses over the counter drug for normal
decongestion (or does it say depression?). What could this drug effect?
a. Urinary retention (TCA)
69. Patient has been given methotrexate. What organ should be monitored? pg. 427
a. Ans: Lung (causes pulmonary fibrosis)
b. Other options were: Heart, Brain, Kidney
70. Patient has toxicity and history of ingestion. She is now given dimercaprol as an antidote.
a. Mercury
71. Patient is overly conscious, takes vitamins. Lab reports shot ↑ ALT, AST. Cholestatic
symptoms are present. What drug can cause this?
a. Ans: Niacin
b. Other options were Folic acid, B12
72. The patient has a history of cystic fibrosis. Additionally, patient has bone pain, muscle
tenderness, and gross osteopenia on x-ray. This graph is shown, with these values.
Diagnosis?
 a. Vitamin D deficiency (osteomalacia)
73. A patient with psychotic issues, murmurs by himself. Police arrest him. He is not on
antipsychotic medications because he lost his job 3 months ago. The physician asks him
why he doesn’t take his drug. Patient says this happened due to his previous boss and
says “I will kill him because he fired me from my job.”
a. Inform the previous employer regarding a potential threat
b. Other options: Confine patient involuntarily in the psychiatric ward, Treat as
outpatient
74. 28 year old female, blood pressure is 230/110. Mother and maternal aunt also have a
history of hypertension. Morphology?
a. String of bead appearance.
75. A picture shows skin tags (resemble acrochordon). You must be able to recognize them.

a. Ans: Skin tags

b. Other option: Xanthoma
76. Patient with a history of hyperlipidemia. LDL 200, HDL 50, TG’s 200. Which drug should
be used?
a. Ans: HMG-CoA reductase
77. Endocardial cushion defect?
a. Ans: Membranous VSD
78. Patient is 19 years old, plays sports, has tachycardia. Murmur increases on standing.
Diagnosis?
a. Ans: HOCM
79. Which antiarrhythmic?

a. Ans: Disopyramide
80. Diagram points to nodes of Ranvier and asks what channels are present here.

a. Ans: Voltage-gated Na+ channels

b. Other options: Leaking sodium/calcium channel, Ligand gated sodium channel
81. Patient has anemia. Reticulocyte count in increased. Indirect bilirubin is increased. There
is icterus and fatigue. Pyruvate kinase deficiency is detected. What is deficient?
a. Ans: ATP
82. A child presents with photosensitive rash, 3-6 mm. History of diarrhea and mood change-
temper tantrums. Which amino acid absorption is decreased?
a. Ans: Typtophan (presentation sounds like Hartnup)
83. Food enters the stomach, mixes with gastric juices and converts into liquid substance,
processed to small intestine via pyloric channel. Release of which of the following is
primarily involved in aiding these smooth muscles?
a. NO ?? Is this the best answer
b. VIP
c. Ach
84. Simple question about confounding variables
85. Question about Confidence Interval. Blood pressure is measured for 20 people, the mean
is 130 and SD is 10. If BP is taken from 50 people, how will this effect the confidence
interval?
a. Ans: Narrower width of CI
86. A lethal disease/event has occurred. Hospital care/staff arrice at scene. The government
orders to treat people according to severity. Which ethical principle is this?
a. Ans: Justice
87. A female patient with a vesicular lesion in genital areas. The scraping of the lesion is sent
for biopsy. She is monogamous with her twenty year old husband who uses condoms
consistently. She is curious whether this is herpes. She is asking repeatedly why this
happened? What should the response be of the doctor?
a. Ans: I am sorry to say, it resembles herpes. Condoms don’t always prevent
herpes transmission
b. Don’t worry, wait until the lab results arrive
c. Bring your husband, I will examine him and let you know
88. Tuberculosis like features (cough, upper lobe cavitation, cutaneous manifestation). Acid
fast stain looks like branching filaments
a. Ans: Could this be Nocardia?
89. Woman presents with groin pain. Severity is 8/10. It started in the flank. She has a
history of gout. The doctor starter her on allopurinol a month ago. Urine is positive for
blood and positive for RBC’s. Abdominal x-ray shows a stone. The patient is on a thiazide
due to hypertension. Diagnosis?
a. Ans: Uric acid stone
90. 4th degree vaginal tear extending to involve the anal canal. It also extends laterally. What
nerve is at risk of damage?
a. Ans: Posterior labial
 b. Other options: anterior labial, obturator, pelvic, inferior rectal.
91. Tracheoesophageal fistula in a neonate. Surgical intervention to correct the fistula is
done. The trachea is moved to the right in front of the esophagus. During the operation,
which structure is prone to damage on the left side?
a. Ans: Recurrent laryngeal nerve.
92. A patient presents with eye pain, conjunctival injection, discharge, etc. He underwent an
ocular procedure for cataracts 3 days ago. What species causes infection?
a. Ans: Bacillus cereus
93. GI flora cultured. Which bacteria is most prevalent?
a. Bacteriodes/coliforms
94. Pseudomonas is cultured with E. coli. Transfer of multidrug resistance is via what?
a. Conjugation
b. Other options: Transposition, DNA recombination
95. Patient presents with shortness of breath, has history of smoking. There is increased
resonance and decreased breath sounds. Increased activity of what enzyme is seen?
a. Ans: Elastase
96. Patient presents with ↑ blood pressure and ↑ creatinine. USG abdomen shows multiple
renal cysts. His father’s USG shows fewer renal cysts and he does not have normal
hypertension or abnormal creatinine. Why?
a. Ans: Variable expression
97. Calculate carrier frequency via Hardy-Weinberg equation.
98. A child has a known disease is brought to the doctor for treatments. On the first visit he
cries excessively and does not allow the nurse to administer an injection. On subsequent
visits, his crying reduces. On his most recent visit he does not cry, even on administration
of the injection. What phenomenon is this?
a. Ans: Habituation
b. Other options: Explosive burst, Generalization
99. 9 month old child, with features of dorsal column disturbance. Increased methylmalonic
acid. Patient presents with severe hypoglycemia. Mutation in Methylmalonyl CoA mutase
is not detected. What substance should you administer?
a. Vitamin B12 (double check this answer)
100. Nasopharyngeal swab taken. The causative organism grows in chocolate agar, one
of which contains vancomycin and the other does not contain vancomycin. Growth in
vancomycin negative culture = 20 colonies/species. Growth in vancomycin positive culture
= 30 colonies/species. Why is there increased growth in the vancomycin positive culture?
a. Ans: Vancomycin inhibits the growth of normal floral
b. Other option: Vancomyin is a growth factor for H. influenza
Moh 1st march 2018

Two questions about dka:

Cause
Mechanism

Around 4 questions about odds ratio and relative risk, included calculations

Image of blood smear showing target cells. Diagnosis was asked

Options sca
Thalassemia
Spherocytosis
Elliptocytosis

Question about dementia, old male, best advise: options included

dietary changes,
activities involving more cognitive response, etc

Best time for breast self examination

Options were like
before the start of menstruation,
After the menstruation,
Every fortnight

Image of ganglion

Two questions about Clinical scenarios of multiple joint pains, options included
osteoarthritis
rheumatoid arthritis
Ankylosing spondylitis

Pt presents with crvo, high bp around 180/140, how to reduce diastolic bp

Options like 110-120 in 6 hrs
80-90 in 24 hrs, etc

Endocrinology questions:
Lab values to interpret, related to calcium options had to choose correct diagnosis
One scenario about
Di George syndrome
Other about lung ca metastasis

Ecg of ventricular tachycardia

Trauma patient, what to do first step

Question about milestones, scenario of 11 month child, standing with support, speaking two syllable words
like ma ma
Concerned mother
Your advice

Patient on insulin early morning and evening dose , for surgery next day, npo from midnight, ur advice about
to take insulin on day of surgery

3-4 Questions about oral hypoglycemic agents,

Which agents cause hypoglycemia options were sulfonylureas, biguanides, etc
Another had metformin side effects,

One question about myringotomy indication

Clinical scenario, answer correct diagnosis about acoustic neuroma

Causative organism for cat scratch disease

Scenario of optic neuritis, dx

Options multiple sclerosis, gb syndrome, etc

Female with Recurrent uti, multiple course of antibiotics done. Your advice
Options were like drink more water, cleaning after urination from back to front, etc

Xray image of erect abdomen showing dilated colon , scenario of young boy about 7-8 yrs maybe , with
Recurrent loose stools, options : hirschsprung disease, toxic megacolon, etc

Asthma child with intermittent attacks ? on exertion, treatment advised

Options: salbutamol, salmeterol, etc

Pregnant female ?34wks with bp around 160/100, already on anti hypertensives, seen obstetrician 1 month
back. Since one wk, pain in wrist, generalised body swelling including hands, your advice

Two case scenarios about indirect inguinal hernia

Diabetic with diarrhea, lab values normal, physical examination normal, drinking lot of water, treatment adv
Options included ors solution, antibiotic, imodium
 Step 1
*All the references are from the first aid 2018*
1. A woman got a transplant and developed fever, malaise, jaundice, renal failure, etc. They tell you
she had a 3-week valganciclovir prophylaxis. They ask what is the most probable etiologic agent
causing this patient’s symptoms?
Answer: BK virus (ref: p. 164)
2. A woman traveled to brazil a few weeks ago, and now she has retroorbital pain, 40 C of fever,
jaundice, but what I noted is that her heart rate was only 60x’. They tell you that she took
atovaquone/proguanil as malaria prophylaxis before traveling. They ask a vaccine directed to
which of the following agents would most likely have prevented this patient’s disease?
Answer: Yellow fever (ref: p. 168) On the first aid it is incomplete, but remember that yellow
fever has relative bradycardia for the degree of fever (Faget sign), but be careful, because
they also put typhoid as a distractor (which also presents with Faget sign).
3. A patient has HIV and HepB, they ask which of the following drugs can be use to treat both
conditions, so you’re looking for a drug that inhibits reverse transcriptase.
Answer: Lamivudine (3TC) [ref: p. 203] Be careful, because they also put didanosine (ddl)
as an option, but only lamivudine is indicated for both infections.
4. They tell you about a girl that went camping, and on her bed she found a lot of bugs, and she
brought them for you to see them, and they show you an image like this:

Here in the US, they call this bugs “bed bugs” (Cimer lectularius). Then they ask you, this girl is
predisposed to which of the following infection? And they show the names of various
microorganisms (s. aureus, trypanosome, etc.). Since bed bugs are not known vectors of any
disease, you only have to worry about the bite site getting infected.
Answer: S. aureus
5. They conduct a study with 100 participants, and they show you the results. Then they ask that if
they are to repeat the study with 100,000 participants, what changes would you expect on
standard deviation, standard error and confidence interval. It was an “arrows” question, and I am
not sure about the answer, but the thing that I know is that standard error and confidence interval
decrease (because the formula of standard error has the number of participant as denominator,
and the confidence interval is based on standard error, so if standard error decreases, the
confidence interval “narrows” [i.e. decreases].) And the formula for standard deviation also has the
number of participants as denominator, but the thing is that it sums up the differences between
individual values and the mean, and also depending on the data set, you can get extreme values
that would disperse the measurements, so I answered that you couldn’t predict how it would turn
out to be, but I don’t know, you better do some research.
6. A patient has an apical lung tumor (Pancoast), and they ask you what symptom would this patient
have on his hand (lower trunk of brachial plexus injury). (ref: p.438)
7. A patient with mastitis that was treated with cephalothin for 2 weeks, but her symptoms haven’t
improved and now the lesion has expanded from her nipple. They culture the sample and they find
an acid-fast bacilli. They also tell you that this is a mycobacterium that grows on regular agar.
 Then they ask you which of the following non-tuberculous mycobacterium is the most likely cause
of this patients symptoms? They give you MAC, m. marinum, m. fortuitum, etc.
Answer: M. fortuitum
8. They say a patient gravid 3 para 3 delivered a healthy newborn. They show you the following labs:
Mother: ABO: O, rh(-); newborn: ABO: O, r(+). They tell you she received RhoGam at 28 weeks as
well as with all her previous children’s pregnancies. Now they run coombs on the mother and
newborn, and they find direct coombs in the mother to be negative, and weakly positive on the
newborns umbilical cord sample. Then they ask you what is the reason for this findings.
9. A patient with cough, they show you the results of a stool sample, with an image similar to this
one:

|----------------------|
200 um

They ask you which of the following mechanisms of infection does this organism has?
Answer: Walking barefoot (ref: p. 159)

10. They show you almost this exact image:

They ask you, which of the following T cells are on the superior right square?
Answer: T regs
11. A patient with rickets, they ask about serum changes (arrows). Check page 451
12. A patient with stable angina, they try to reperfuse him by grafting. When they try to do a
sternotomy, the sternum breaks easily, and they find a mass attached to it. They show you an
image similar to this:
 They also show you labs compatible with multiple myeloma
Answer: Multiple myeloma (ref: p.399)
13. They ask you about a defect on the renal tubules that has to do with claudin-16. They ask you in
which of the following components does this molecule has an impact on.
Answer: Tight junctions (ref: p. 461)
14. A lady with terminal breast cancer says she is not interested in experimental treatment, and that
she had lived a good life, so she’s going to volunteer in a charity of ladies that have survived
breast cancer. They ask about the mechanism of defense that she is using
Answer: Altruism (ref: p. 539)
15. They say that juxtaglomerular cells can’t be cultured, so they ask that if they want to know the
expression of renin, what is the best test to asses that
Answer: Northern blot (ref: p. 53)
16. They present a stem of a patient with APL, they give you the diagnosis and the translocation
t(15;17), they ask what is the action of the therapy for this disease
Answer: Enhanced differentiation (ref: p. 66)
17. They ask about RNA interference. Check p.56
18. They present a stem of a 19yo patient that came to the office to get tested for gene disorders. He
says his father started with symptoms at age 20 and he died at 46. He says they didn’t tell him the
name of the disease, but they told him that the father had “schizophrenia and liver problems”. His
sister is starting to have liver increases in AST and ALT. Then they tell you that the father actually
died in a car accident. After all this confusing stem, they want you to pick Huntington’s, but I think
it actually was Wilson’s disease. But you better do some research.
19. Prader-Willi patient, they ask who has the deletion.
Answer: The father (ref: p.58)
20. They give you a diagram of mode of inheritance, the family members have a lot of different
cancers, but all according to the spectrum of Li-fraumeni syndrome. They ask you, where is the
defect.
Answer: TP53
21. A patient with vitamin A deficiency, they ask about what is the risk for this patient’s cornea
Answer: Keratomalacia (ref: p.66)
22. A homeless patient that took ethylene glycol. They ask for the drug and the enzyme affected by
this drug, to treat this patient.
Answer: Fomepizole/alcohol dehydrogenase
23. A newborn with jaundice, hepatomegaly, with meningism that the CSF culture shows E. coli
infection. What is the enzyme involved in this patient’s clinical presentation
Answer: Galactose-1-phosphate-uridyltransferase (ref: p.80)
24. Patient with recurrent meningococcal infections, they ask where is the defect
Answer: C7 (it was the only option from the terminal complement) [ref: p.107)
25. They tell you about a kid with hemolysis and azotemia, they tell you the cultured organism grows
white colonies on MacConkey. They tell you, where did this child most probably get the infection
Answer: Eating undercooked hamburger (ref: p.145)
26. They ask for sporicidal disinfection. P.204
27. They tell you one of Light’s criteria, protein/serum ratio of 0.8 and put you different options. You
have to choose the one with exudate. P. 217
28. A patient with narcolepsy, they ask where in the brain is orexin-1 produced
Answer: Hypothalamus
29. Extra axial mass in the spinal cord. Biopsy shows spindle cells in a whorl pattern. Diagnosis?
Answer: Meningioma
30. A lady comes with fever, malaise. They tell you that she works in a farm and that she just started
helping delivering sheep. They tell you all the clinical signs of endocarditis, with a new heart
murmur. They ask which of the following organisms would most likely be encountered on the valve
leaflets.
Answer: Coxiella burnetti
31. They ask you about the components of the synovial fluid, in pairs.
32. They tell you about a patient that is going to start taking acetazolamide before climbing a
mountain. They ask for arrows on arterial blood gases
33. They ask about a third degree burn and they ask for how long is it going to take for the basal layer
cell turnover to cover the wound.
34. They ask why if an ovarian tumor metastasizes to the peritoneum, why does only the anterior part
of the liver gets involved, but the superior part is spared?
35. African American woman, bilateral hilar lymphadenopathy of the lung, lesions in the nose, what
would you find in the biopsy.
Answer: Noncaseating granulomas
1. There were at least five questions on different types of shocks so KNOW THEM ALL: know what happens to CO, TPR, MVO2
etc. (cardiogenic, hypovolemic, neurogenic, septic)

2. A guy had MI and ended up having a ventricle aneurysm and they were asking. What is the biggest component of the mural
thrombus?
a. Ans: Platelets
b. Other options: RBCs, fibrin, wbc
c. “The thrombus is composed predominantly of platelets held together by fibrin” – Goljan, 253

3. An old man got vaccinated for influenza but still developed influenzas. What are some age related changes in the
immunity?
a. Ans: Decreased Antibody production
b. Other options: decreased leukocytes in the blood, decreased T-cell memory

4. Which enzyme allows pyloric sphincter to relax; pg. 365

a. VIP

5. Someone undergoing surgery got halothane and thiopental and then they suddenly got a fever died few hours later what
can you check to find out the diagnosis
a. Ans: LFT’s
b. Other options: CPK, CBC

6. A college students admitted to doing some type of drug everyday usually 8 times per day because if makes him “happy and
relaxed”. Today he comes in with dilated pupils, rhinorrhea, hypotension, bradycardia and he used the drug 36 hours
before what is the treatment?

a. I think this is opioid withdrawal and you would use buprenorphine or methadone but those choices weren’t there,
b. Ans: Clonidine provides symptom control in opioid withdrawal (pg. 239)
c. Other options: the other treatment options were phenobarbital, diazepam, propranolol

7. First year med school student who's dad died last year has a patient that reminds her of her dad. And she becomes really
irritated and agitated. What kind of mechanism is she portraying?
a. Ans: Countertransference **
b. Other options: abnormal grief reaction, regression, suppression

8. A woman comes in who is shot and is bleeding out. She keeps telling the nurse to keep her alive. She dies a few hours later.
Then her mother comes and asks the doctor if her daughter died without suffering and the doctor said yes. What is he
using?
a. Ans: Beneficence
b. Other options: Fidelity, objectivity, autonomy
9. Which motor tracts are affected by alcoholism?
a. Spinocerebellar? Double check

10. Know the difference between Obsessive compulsive disorder and Obsessive compulsive personality disorder
a. OCD is ego dystonic. Actions cause severe distress.
b. OC personality disorder is ego syntonic. It lacks true obsessions/compulsions.

11. Bladder anatomy question: There is a stone stuck between the bladder and the ureter, at which junction is it exactly stuck
at
a. Ans: Ureter orifice
b. Other options: trigone of bladder, internal urethral sphincter

12. A woman is really nervous before coming into the doctor’s office to the point where sometimes her pulse gets really low.
What is the mechanism behind decreased heart rate?
a. Ans: Nervousness  ↑ pressure on carotid sinus  ↑ stretch  ↑ afferent baroreceptor firing  ↑ AV node
refractory period  ↓ HR.
13. Embryonic origin for neuroendocrine cell tumors: pg. 595
a. Neural crest

14. A kid with cleft lip and they asked mechanism:

a. Ans: malformation
b. Other options: deformation, sequence, disruption, hypoplasia

15. What is the mechanism behind why isotretinoin causes limb defects
 a. Excess Vitamin A (isotretinoin) interferes with neural crest cell migration and homeobox gene expression
(homeobox sequence=180 DNA bp that regulates anatomical development)

16. What does inferior thyroid artery come off of?

a. Ans: Thyrocervical trunk

17. What is the arterial supply of anal canal that is 2cm above the anal verge. (wasn’t sure if this was below or above pectinate
line)
a. The length of the anal canal is about 4 cm (range 3-5 cm). 2/3 of anal canal is above the pectinate line, 1/3 is below
it.
b. I would guess 2 cm above anal verge would be above the pectinate line.
c. Ans: Arterial supply is by Superior rectal artery, branch of IMA.

18. A woman comes in with problems of infertility. Doctor tells her to measure her body temperature. They gave a graph where
her body temperature rises rapidly at day 15 and then stayed high till day 40. And they asked what the cause of this was.
a. Ans: Pregnancy
b. Body temperature elevation is due to progesterone release after ovulation during the luteal phase.
c. Other options: Anovulation, loss of luteal phase

19. Which hormone is decreased in PCOS  Estrone will rise in Fat BUT Estradiol will fall in ovaries
a. Options (all of these are increased): Estrone, estradiol, androstenedione, insulin, insulin-like growth factor
b. Hormones I found that are decreased: Progesterone, FSH, SHBG, “IGF Binding protein”

20. Showed a baby with bilious vomiting and double bubble sign

a. Ans: Duodenal atresia

21. Another picture with a baby who died at 1 day old. The baby had a black liver, pale stool, dark urine. Asked what the cause
was (biliary atresia, neonatal hepatitis, hemolysis)??
 a. Biliary atresia, from BNB:

22. There was a picture of blood in the maxillary sinus asked which part of the nose it drains into

a. Ans: Middle meatus

23. Asked to pick the pulmonary finding of pleural effusion (tactile fremitus, percussion, etc)
a. Ans: Dullness on percussion, ↓ breath sounds, ↓ fremitus

24. Gerstmann syndrome question

a. Due to dominant parietal cortex damage – agraphia, acalculia, finger agnosia, left-right disorientation

25. Question of mycosis fungoides: pg. 418

a. Erythroderma, lymphadenopathy, hepatosplenomegaly, atypical T cells

26. What kind of cancer can be caused my Sjogren syndrome

a. Ans: MALT lymphoma

27. Asked about all the mediators of cachexia

a. IL-1, IL-6, INF-y, TNF (there were other list of them but this was the right answer)
28. Asked about the mechanism of RET
a. Receptor tyrosine kinase (increases receptor synthesis)
b. Pathoma refers to it as a “neural growth factor receptor”

29. Paraneoplastic cerebellar degeneration by breast cancer affects what cells

a. Purkinje cells

30. What is the histology of pancreas in person with type II diabetes pg. 345
a. Islets are full of amyloid

31. The nerve used for pronation is damaged when which part of the humerus is fractured-
a. Radial nerve – midshaft fracture of humerus

32. What is the muscle used for the extension of digiti minimi
a. Extensor digiti minimi and extensor digitorum communis extends the pinky.
b. At the level of interphalangeal joint, the lumbricals and interossei are involved in extension

33. 21-a hydroxylase deficiency

a. Features: Congenital adrenal hyperplasia, hypotension, hyperkalemia, increased sex hormones  precocious
puberty, virilization in females

34. A couple come in to see the doctor with their 6 year old kid. The physician makes a joke and the parents laugh and the 6
year old watches them and starts laughing too. What is he displaying
a. Ans: Cortical mirror neurons***
b. Other options: Activation of the hearing system, firing in the amygdala, occipital and temporal lobe activation)

35. Which is a characteristic steroid hormone

a. Ans: Goes through membrane freely
b. Other options: Flows freely in plasma, needs to be glycosylated in the cytosol
36. A woman comes in with weight loss, anxiety, tremors. Doc checks TSH and its pretty normal (but on the low side) asked
what was the cause?
a. The only answer that seemed reasonable was subclinical hyperthyroidism.
1. Vignette described maple syrup disease and asked what amino acid accumulated (Isoleucine, leucine,
valine)
2. Female with chest pain, ECG given, diagnosis is acute myocardial infarction (ST elevations in multiple
leads)- identify ECG
3. Male patient with dizziness, ECG given, it is A-Fib- identify EKG (Red arrow is abnormal, Purple is
normal)

4. African American male, long vignette, picture of fingers given – psoriatic arthritis
5. What cells kill cancer? Natural killer cells
6. Sirolimus MOA – binds FK, mTOR inhibition
7. Coccidoides – vignette with histo description
8. OB – two weeks post birth, patient has fecal incontinence, what muscle was damaged – puborectalis

9. OB – third degree tear, what nerve is most likely to be damaged – inferior rectal branch of pudendal
nerve
10. Anxiety disorder, medication – Sertraline
11. 2 questions on incontinence and asked what type it was
12. 2 questions about hip dysplasia with breech child
13. 2 heart murmur questions (tricuspid regurg and mitral stenosis or regurg)
14. Vignette that describes alpha-1 anti-trypsin deficiency disorder, question asked what part of the
hepatocyte would be affected. I chose endoplasmic reticulum
15. Shigella (bloody diarrhea question)
16. Schenckii using lymphatics for travel. pg. 154
17. 2 questions on Schistosoma - one asking entry, another asked vector. Entry is via Skin, Vector is Snail
18. Gross pathology pic of Meckel’s diverticulum – asked the embryologic origin – vitelline
(omphalomesenteric) duct
19. Fluoroquinolones – tendon rupture
20. CT of elderly lady with fever, I chose diverticulitis (initially it sounded like a UTI but then they gave the
CT)

21. Port wine stain on baby’s face, question asked what they were at risk for developing – cavernous
hemangioma
22. Vincristine – peripheral neuropathy
23. Crane operator with allergies, what to prescribe that wouldn’t cause drowsiness – loratidine (this
question was almost exactly like one found on a practice NBME)
24. 2 questions – Parkinson’s patient, what type of neural deposits would be found and where
25. Baby with Tay Sachs – asked what is needed for DNR
26. How does pathogen enter lymph node – chose afferent lymph
27. Lancefield groups (carbohydrate composition)
28. Necrotizing fasciitis – asked description of microbe
29. Radial nerve damage – location in brachial plexus
30. Tinea corporis (pic) – woods lamp, KOH

31. Virulence factor for yeast – pseudohyphae was a choice

32. AIDS cryptosporidium
33. Respiratory acidosis (at least 2 questions with arrow choices given)
34. Increased altitude, change expected in RBC when altitude decreases 3 days later
35. Hot thyroid picture, asked anatomy question
36. Kid with upper ext pain, X-ray shows bone lifting, asked cause (translocation, mismatch gene repair).
Ewing’s sarcoma is translocation.
37. Valve replacement, expect to see schistocytes.
38. RBC has basophilic stippling – what causes the stippling? Lead deposits was not a choice, it was more of
a “what is going wrong within the cell that leads to stippling” kind of question
39. Overdose on cholinergics – what is the treatment - Atropine
40. Young girl with finger like projections in throat, respiratory distress, cause? HPV 6/11
41. Constipated girl with bad diet, chose to add more fiber to diet for the answer (they were trying to
distract with possible symptoms of anorexia but her BMI and physical exam were normal)
42. Multiple myeloma patient with multiple lytic lesions in hips, asked treatment – biphosphonates, not
calcitonin
43. First line tx for AMI, this drug inhibits what pathway. Cyclooxygenase (ASA)
44. Pt with hyperchylomicronemia, asked the gene mutation - Lipoprotein lipase or apolipoprotein C-II
deficiency
45. Testicular lymph drainage – para-aortic
46. Liver lymph drainage – celiac lymph nodes
47. Acute endocarditis, what kind of murmur
48. Struvite composition – MAP
49. Ehlers Danlos syndrome – problem is with collagen NOT elastin
50. Grapefruit diet what CYP enzyme is inhibited – 3A4
51. Ovarian tumor that has Schiller-Duval bodies, what marker do you monitor? AFP
52. UTI, nitrate positive, what is organism – E. coli
53. 2 questions on Methotrexate and damage to lungs
54. Malaria question with picture – vivax, ovale

55. Mercury antidote given and asked what the chemical toxicity was caused by
56. Ceftriaxone MOA – inhibits transpeptidases
57. Nephritic syndrome with mesangial deposits – IgA glomerular disease
58. What antibiotics cause ototoxicity – Aminoglycosides
59. Calculate percentage of population with type O blood – only one number given maybe (0.12) – 40%
60. Hysterectomy, the major vessel that the surgeon needs to be cautious of, branches off of what –
uterine, branch of internal iliac
61. Post motor vehicle accident, pt develops RUQ pain, what is the next step? MRI was a choice, CT was
not listed (USG is listed as well)
62. Wegener’s – very specific and weird histo question about the nasal cells maybe – granuloma
63. Sickle cell disease and septic arthritis – Salmonella
64. Kid scraped his knee, what is involved in healing process (ie keratin layers…) – stratum basale
65. Lateral gaze affected in one eye, what cranial nerve is affected? CN 6
66. Metoclopramide clinical use – Diabetic Gastroparesis
67. Pt is on heparin, platelets continue to decrease, why? Antiplatelet antibodies
68. Dwarfism, what embryologic signal was affected (WNT, HOX, etc). The gene was not a choice..
FGFR???
69. Standard deviation question (I had at least 2-4 biostats questions per block – KNOW biostats – I’m
pretty sure this is why I failed!)
70. Lateral throat mass, what is the embryologic origin – branchial cleft cysts (from 2nd branchial cleft)
71. Saddle injury, what is damaged – bulbar spongy urethra
72. Teenager stays up late on iPad, has trouble waking up for school, sleeps in on weekends, asked if this
was a normal teenage circadian cycle, overexposure to blue light, choices like that. I think answer is
blue light
73. Sleep wave forms, mostly REM maybe?

74. Picture of obese male with shingles, asked dermatome affected, picture was of back and he was fat so
it was hard ☹
75. Neuropath picture and asked what symptoms would be expected
76. Infertility drug question x2
77. Renal stone that was yellow and chalky, asked what would be elevated in blood – Oxalate stones?
78. Lung tumor in base of the lung and histo description – Peripheral is adenocarcinoma, large cell
carcinoma
79. Pancoast tumor and anatomy affected
80. At least two questions about IBS, Crohn’s, or UC
81. 4-5 vignettes on errors of inborn metabolism
82. 3-4 vignettes on genetics/embryology
83. Pt with erectile dysfunction after prostate removal, asked what nerves were damaged – Pelvic
Splanchnic Nerves that arise from the Sacral Nerves (S2-S4) and provide parasympathetic innervation
to the Penis
84. Pt with alpha-1 antitrypsin deficiency, asked a question about what is wrong within the lung cell
85. Population graph question