1. A. 48.yoo-od woman comes otha physician because of a2.month istry of urinary fequoncy and urgency Physical examination shows no abrarmaies. Te physician ‘resctes @ medication tht wl ale! fe noma simulsbon a badder contactan Which othe fang the mast ikely elect of ths dg? A) Blockase of parasympaitotic Inervaten of he datuser muses 8) Blockate of pesigangione sympathetic Imervaten ofthe Bader tigone ©) Blockace orpragangienc parasympathete wansmssion 1) Enhancement facet feacack frm the blader stretch receptors ) Emancementof pesos of he wees F) Enhancement ef sympathettpreganolonic ransmission2. A7S.yoa-cld man win domonta, Azneinor typo sought tothe nos by hs we because of cough. alfcuty breathing, and aptation hat began ar no ae breakfast 2 nous ‘ago. He has boon arasidant ofa skled nursing care ait fer 7 years His wo ists the fact daly o fod hm hs midday mools His two adult chen vst hi several tae recy His wf mentions tat hep tna been couvng during hie sai fo several wenke. He asa has Been tng lange fo en avon smal porbon of fod. este of imaging stuzes are consistent wh asproten pneurna Win 8 devoiping comgyonisea swallowing hncten His meccal rears show ne advance ectves. In speaking With he Paton tami ts most approprae Toth pysican to aiess fo sO feed tbe 0 whieh Ge Toxowing manners? 'A) Encourage te famty to come to a consensus based on the perception ofthe patos wines 8) pina tat focing tubo cut 2 montar and may net prevent aspraton| C) Follow ony iho wshos of ho we ) Hep the aaut hiltren encourage the vf o start gradual whrawal or the patient £} Recommend tubo, because feeding Wi be mote een and prevent starvation3. A 12.year-ld boy win asthma s brought to the physician Because of whodzing or 2 hous. Trostment whan mile broncnodtator nas nol complooly resolved ns symptoms. \Weie of th etewing ports of the away is mos suscepsbl to fow miation de io soe mustlo cnacton inthis patent? AA) Alvear duet 8) Alves ©) Bronchiie 1) Nasal passage 5) Trachea4, Apreviousy neat 18 yeaa man develops pan a mutpe jos as Fatigue, Two months ago, he had a ash and fuk ness while warking 2 a counselor at cam onthe ‘New England coast Whi of te folowing ithe most sly diagnosis? |) Acute rheumatic fever 1) Brucetois ©) Lyme dsaese 1) ainaromse meunatsm ) Rocky Mountain sated fer5. Asz.year-old woman coms te physician fo olow-up care of ramping abdominal pan and constipation fr 2 mons. Tratment wih smoticone nas powdod some rte of Symptoms. She also has had a kg 20-b) weight los, creasing fala and a need for more sloop Endoscopy, clenoscopy and a CT scan ef tho abdomen shone to Sstnarmsite: morn aga She beteves her afcitysieepng de fo wore: scout her som wha has ben using ge during the pact feu monte Over tha pat weeks he began fo wony hat se has cancer andl never gt beter Vial ins are able, Physical examination shows mi. Use dbsonunalfondoress, She nok anemic. end al cher laboratory nds a win teerence ranges When Gre olowng ined achons bythe pryscian Most appropiate? ‘A) Evaluation ote patent for major doprossive disorder 8) Inerease in the amount of itary fer ©) Baum enema ) Repeat CT scan ) Repeat colonoscopy©. A3menh.okd gl wih congenta HV infections troup tthe physician by her mother because ofa 2neok histor of a ings rash {hot spread ts her abdoreen and highs Physica examination shows cists erythematous popes and pustules stout over the ldamen atch and thane A photameregraph ofa sraping fem ane ctf lescne shown When ete flowing the moet aly Sec oe causal expan? 1) Bie roping 8) Contaminated sot 0) Infected focal atonal ) tnfocted wine ) Normal skin Fora7. A2e.yoar-old man nas af testicular mass. A tozensecten obtained dur a planned crchiscmy shows a seminoma, When ote folowing povies th proalast sk taetor tssoctd wth hs conden? AN) Alcona buss 8) Cryporeniasm (©) Mumps orcas ) Vancoceio Vasectomy8. A 32.year-old woman has had fecal ncontinence since ging birth cher ist child yeer ago, Which fhe following is the most ely cause ofthe fecal continence in his patent? A) Acholasi ofthe internal ana sphincter B) Damage tothe ana sphincter ©) Inceased pressure othe anal sphincter ) Spaste cntacion ofthe puborecials muscle ) Spaste extomal ana sphincter8. A 10year-o gras a sant panfl 2mm subcutaneous nodule on he chin, Ton weeks apo, she required sures ater She lactated ne chin laying besketal A photomicrograph of UsUe obtained on psy ofthe Nodues sNown MT ot {Me eloumng best doscibes tho patoogi: atures? 18) Arnos 8) Granulation tissue ©) Grama 1) Lymphnoyt mato ) Nouopie ita10. 24-year-old man s brought othe emergency department 1 hour after @ meio veil colision He has lost an estat 2 L of blood ram tho tour associated with et {einoal actu His blood pressure fs 7040 mm Fh Following mmiedale cperave rear, physical examination shows multiple echymoses over te medal aspects ofthe upper aims. Tore bod Mom venipuncture sees Laboratory sides show Peet count 75.000 Dretrombin ie Bi sac (NR=1 7) Partaltremboplastn time 56 se Plasma itnegen ‘00 mpd. (N=200-400) ich ofthe flowing coagulatonabnomaliiess most key in this patent? ‘4) Consumption coaguopaty 8) Hemophia A ©) Hemep nia 1) Henach Schenein purpura 1) Mnamin K decency11 A 30,yoarold man s brought to the emergency department 20 minutes ater bong stun by several wasps. He is confuse and hes citicuty breathing His empertue i 36°C (100.°F pulse £22, resprations are Minn, and bood pressure s 800 in Hg Physical examination shows dy skin and decreased cepa rfl Thee ee mule ‘xythomaions, famed marks he back and T= ping edema othe ankles. n addon othe adrwnstaton of 09% saina, he most appropriate nest sep n managements ‘scminstation of which ote fallow? |) ACE nhtor B) angetensin I receptor bicker ©) Parasympathatic locker ) Perasympathomimete agent E) Sympatot blocker F) Sympathomimetc agent (3) Whale blot12. A -ysor-od boy who emigrated with his arly rom Aiea 4 days ago bought othe physica by his mater bacauee ofa 2ay hstry of headache and rcument ever ‘sccompaned by back pan. The mother repos thal a child inthe vlage whee they sed oie had sina condon 10 das ago. The pats temperatures 39°C (102 2°F) ‘Physic! examination shans weakness of he et ove extamy The Fes eek wee one ft Neurdogi Sxandnalon shows Tasciuatons Othe ower exams, Which ofthe folowing = tho mest ily sagnost? |) Amyotrophic lateral sco B) Carsacaevis econ ©) Herpes encephalis D) HIVintecton E) Felomyelts F) Rabies 1G) West Nila encephalitis18. A7a.yeor- aK man comes tothe physician because of a 4month histo oflacalizad mid:back pain. He has hypertension and type 2 dabetas malts. He nid cscomtxt bt ‘ble walk who problems. There pain wih percussion over the over thrace spine. Neurologic exertion shots ro focal feds. ays of he seine shovel Coral tuckaeing ofthe endplates, creating pete ame’ vertetae WN ae flowing Sets serum studs smth ns pant? a 8) So 5) 5) calcium No change Ne ehanas Phosphorus nochange nochange hochange nochange ‘Alkaline Phosphatase ro change ro change ho enange Parathyroid Hormone nochange nochange14. A42.yeor-ad woman develops hearing foes while being tested or pyekanepiis, Shes most aly taking wc rm which ofthe folowing classes’? |) Aminoaycosides B) Guinclones ©) Semisyntnetc penins ) Sulfonamides ) Thie.generatonceshelosponns15, 61-year-old man has erat dystuncion di o spina cor injury a2 Siena Sly o markedly crrct the cstincbon by acting at wich ofthe following labeled ‘Siuties nthe transverse section of the penis?16. A45.yea-od man comes tothe physician because of aradualy worsening heartburn over te past3 months. Physical xaminaton i unvemarable Enoscope examination ofRis stomach sta a tikenes, Noosa mucose with Mo Sete Uceratons. A representative Stoner siver-staned gasc bopsy 400K is shown. The aboermaly shown most commerly sssonatod wih he development of which ha folowing diseases? |) Atoinmune ostis 8) Colac dsease ©) Ciotn dsease D) Gaaiass ) Poste ucer disease F) Rofux esophants17. Apreviousty heathy 24yoar-oK man is adrtie othe hospital afer raving a ganeaizedfon-cenc seine Ho's somnolent Serum studios show a soaum concantion of 118 ImegI and potassium concentaton of 0 mEq. Usnahis shows a space ray of 1005, The sda concentration siowy fetus othe reletence range over the ned 36 ‘outs after raat. The pon! remains sasha somraint ana taysin bed. On the wa hospi day, serum oso 230 NOsMAg, and wo random Measurements of {Unne esmolty are 260 and 272 mOnmlkg. respec t/a. The patel more ale and actve, He's cbselved ak a Ge arent of walt (mere than O Mars nt day)-and| Fis serum sodium concertaton begin decrease When war festctns are tipesed he dinks fom wale founlahs rote ors. He Says hs doos not have excesste {ht Which of te fang ete most key causa of te patients cancion? A) Atrenalinsiiciency B) Conia dabotos nspidus ©) Nephvogenicdabetes sus ) Psjchoganicpekipsia ) Sarome of napprepnatesecreon ot ADH (vasopressin)18. During a study of pumonay artery pressure, subjects wi hypertension experiance a dacroase in this pressure alr eceWving a phosphodisterase inhibi This mproverent in pulmonary artery presse most Ike medial by an incteasen the inraceluar concent of whch af the folowing? 8) Adenosine 8) Calum ©) come ) Endothatin 5) Nine cnt10. A70.yoa-old man develops a progressive dsinnbito syndrome characterize by episodes of emetonal outbursts, napproprate use of anguoge, and social nappropits fbehanor Which afte folowing lzeked Shuchres most ikely damaged? Ay 08) 00 00) Of OF OG om Ob OW20, Anew numanizad monacionl antbody is bing investigated forthe rman ofa ciical conden, Ths monoclonal anthody is monomer, crosses ha placa ‘Serum hae of aout 21 dys Woh of he flowing the most key saypeof hs anody? 4) A 5) 90 ©) 9 5) tos ©) Mt and nasaa tna case contol study, 109 men whe have bladder cancar wore compare vith 100 cantos. Cases and cons were asked about tt alcohol consumption. The imestatrs Coeuaied an 08 aio f 30. the St conidence rv was 181066 tor fe associin of bader cancer and eicaol consumption Which of fe following isthe most ‘props nerproation ois tesut? |) Atloast 5% of he blader cancers canbe atrbulad o consumption of leche B) Atleast 5% of consumers of alcohol wil develop cancer ef he fladcer ©) Tholmoitood is 05% matt tue val forth odds rato is between 1.3 and6.6 1) There atleast % neraaeag nak fr ladder cancer aneng caneumers of slechal E) Mon who dink leant ao 5 umes more Maly o develop bladder cancer han thse who donot dink aeono! F) Theresa 95% chance thatthe tus os rato 3.022. A year woman comes he physician because ofa S.month history of fatigue, weakness, oss of appt, and wsight Iss. Her Sarum aratyrid hormone concentrations ‘te increased ays ofthe skeletal syste show generalzed osteopenia, wh subperiosteal resorption of bone win the phalanges. Wie othe folowing mechanisms the ‘ost ket cause ote sell changes cbserved nis patent? A) impaired caleieation of preformed estos 8) Peracnne stimulation of osteoclasts by osteoblasts ©) Paranyro nermone-oaaied induction of caetonn 1) Paratyros nemone mactedncition of tere? (IL-4) E) Paratyiod homone-medatod production of wanstorming growth actor B28 Auday ld Ltr nebo develops jaundice. The most Maly cause of te jaundice sa raducton inthe rt af which ofthe flowing? A) Bairabin synthesis B) Conjugation of tintin o cura ack (©) Ghicuront acid synthesis ) Release ef birubi ino tho circulation by the spl ) Release of ron into he exculaton by he spleen F} Remeval of ld entry rom erculaton bythe speon24, A s0yearod woman s brought fo the emergency dopartment because of a6 hour history ofrausea and vomsing She has hed ype 1 dabots melts othe pas 10 years: She ‘Scontised and sleepy Pulse 130tme.respratans ae Sle, and blood pressure f BONO mm Ha. Laboratory ste show ‘sou Na" 134 mE gL, ra Sameat. Heo. Tmeat ucose 900 mata Urea nitogen (GUN) sD.mpCL ‘tera aed pH m4 Pros 23mmta Urine outs scant nd urna is dark. Shei gen nsuin and an infision of oon ana, Which ofthe fllwng changes inaboraory findings ara most Hkaly 4 hours iter the ‘dmeistation of nul and sine? serum Arteria Blood Ke Heo, BUN "BH Peo, a er t 1 ot 8) 7 t ©) Nochange | 1 td DB) Nachange 5 A) 1 126, A 24yearold woman comes the gynecologist because of 6.enth story of painful menstnl periods. She misses 21 3. days of work each month because ofthe pan. There ‘So pan dunng the madpont of he menstual cycle. She has had wo episodes orci beedag associated wih menses Wh ote followng's Ne most key dagnoss? 8) Conseal cancer 8) Ectope pregnancy ©) Eniometnosis ) Ovarian cancer ) Ulerne leomyoms26 The acon potential causes cuenta low deep win the skeletal muscle fiber by which ofthe folowing? ‘A) Elecrogent: No~K-punpeetvty at he sarcoplasmic reticulum 3) Eloctctonic sproadof ho potental fom one myotbel othe neat ©) Release of sodium rm he sercoplasmie etiam ) Synchronous contacion of he myotbals ) Transmission along T tubules27. A26yearold man has signicant oodles ater he sustains fracture of ight tha ding a soccer mah, Prior to emergency estmant, hich ofthe folowing most key to Compensae forhis decreased Blood value? ” 5) ° 5) 5 F ‘Deeieased seeaton a ronin Fritaten of ud fem systomic cpiaries Increased socteton of tal nature peptide FReabsorlion offs into systemic caplianes Felaxaton of systemic atertes Relaxation of vencus smooth muscle28. ne agra of roxial el tua eptalu, fe abated rans deol pastways and mechanism f nel movement of Wako sos. Which the follwing eters ‘pathway best describes the transepithelial transport of water? —_ iia ‘ A 0B) 66) ed) 0820, A.26.yearold woman has recent developed nervcusness and amine billy. Her pulse is 11min and blood pressure is 13677 mm Ha. She has a wide. cyed, siting ga; fer sins warm and most andthe fingers of bh hands show a ine err when extended Hey thon land 9 diselyenarged Which ofthe flowing ste os! ely Cause ‘ofthe tyrod changes? A) Aatityridcyctoxe Tymphocjies 8) Thyrod antinyogiobuin autoantibodies ©) Thy peroxidase tantmeiosoma) autoantibodies 1) Thyotepn receptor autoantibodies ) Thyroxine (7) autoantboaes20 A26yearo man vith eczematousdermatts comes tothe pyscan for evaluation A bopsy specimen ofthe skin shows Langethan calle nating the dermis, Which of he {oiling s HAY chractersbe of he col fog ots Condon? A) sock granules 8B) Desmosomes (maculae adherents) () eratonyaine granes D) Melanofiaments ) Melanesomes F) Newesecretery granules 1G) Odend bodes H) Teno3, During a study itis und hat characteris mations of ambos exposed te retin acid involve repreducbe changes in homeobox (HOX) gene expression Beth retinic ai cet ard HOK gee ots ean erin i Spectc DNA secs al names Ses on mute cronosones, Which ofthe along best dss he A) Adapter proteins F) Promotors 8) ints factors 6 Sinal ecoontion partes, ©) ganas Hy signal sequences 1) Peymerases 1) Transcription factors ) rors 4) Transducers22 The symptoms associated with scurvy ate mos! kay to be caused by decreased acy of wich af the folowing? A) Ghacosyttenstrase B) Lys onase| ©) Procollgen pepddase 1) ro hyenas ) Transgixamaase23 A 38 yearold woman has a month nist of deprassad mood. ont gan, muscle weakness, memory problems, msomri, palpation, and blared von. The symplome very ‘itaon ond severy She has a sloy of exythema migrann. Wish of Te owing i the ros key diagnos? |) Gryptoeaceoss 8) Cytomegalovins infection ©) Herpes ncophatis ) Histoplasmosis E) Lyme-isease‘4. A32year od woman comes the physician because het sister recon ded of melanoma. Other ist dgree family monbers havebbeen sear acted, and oho amy ‘members also have ge pigmented skineskns Wich! the flown leks fs most ike on bat suvexposed ard nonsun-exposed areas af patents ska? A) Aeannosis ican B) Basal call carcinoma, ©) atue now ) Dysplastic nei ) Pamente sebormeckeatoss5 A¢2.yearo man comes to he physician because of progressive weakness of his hands during tha pat 10 months Physical examination shows avophy of fe hand muscles wth {ascitishons. There ae ao fascclatons of he engue and Vacezivs muscles Eecronyagrany contin the agnoss of nyaephic lateral scleeas Which ot he folie ‘na statements by he pysican most appropeal? a 8) °) » 5) "You have amyoropic ata sclrosis, also caled Lou Goi soso, whichis aterminal ines. You wil eventual neato goon a respator Have you thous about cance drectves?” "You nave an incurable nes. Fn sony to say meres esting can do or you. Ave you religious” "You have Lou Get sease: Have you ever heard anything aut this dsease boone” "You have amid case of enoonti aleal sclerosis, also called Lou Geni disease Wel check every few months uso see itis proressng "You may have amyotophclatra sclerosis: Wet check overy fon months and fi progresses then wel kn fr sure”26, During a study of the digestion of poi flowing a med a substance tha s produced i the gastointeshna ict isolated and axaminod. This substance causes the activation ‘of pancreatic Iypsinogen to typsi. 6s wellas the subsequent actaton of other protec zymogens, Ths substance most close resembles which ofthe flowing? A) Carbeaypaptisose A 5) Elastase ©) Ertoropoptidaso ) Pepsin B) Sectetn237. Serum cholesterol concentrations are measured as pat of community sty. The mean and standard deviation ee given for women by age group ‘Age vests) Cholesterol (met) e ‘Dosa sos 2a 300 sae desea 60.82 244335 Accuming serum cholestarcl concentrations follow anormal (Qaussin) étrbuton, which af the folonng i the probability hata woman baleen the age of 0 and 5¢ years has ‘serum chaste concentaon greater than 296 ma.0L? at 5) 25% 6) 58 ) 10% 5) 9%38 During an experont ts found that stilton cf ip into the duodenum fads to he release of @ hermocal substance fem endocrine cats in the duodenal mucosa, Which of the folowing best describes the major pysoboge acon of ts substance? 8) Garoiadae contraction 8) increased gasticcontactty () Pancreat endocee stration ) Salivary gland stimulation ) Splorchnc vasocanstncton20, Hitone acetranseracse catalyze th acetylation of sina residues inthe amino-terminal of histones: Which of he flwing i the mostly effec ofthis covalent ‘modiicaton en ceematn suche? ” 5) ° 5) 5 F ‘Deeteases he afin of isones for DNA Decreases he nucleosome content of he nucleus Increases te ant of histones for DNA Increases the nucleosome content ofthe nucleus Removes hisone #1 fom DNA Removes histone H4 fom DNA40, A 20,yearod woman comes he physician because of nai o conceive chllron She has had 10 menstualparods ithe past year, but hr menstus pats i ary erate ‘nd unprediclale Shea been advised that she may not be onan. She had some it pelvic pein 4 days ago. and she suspects tat his pan an indian fat she has ‘lated Whe att alowng changes inseam homone concen asin She bes vitae tal ovation has Cet? 1A) Docreasoin asta 8B) Decrease in eile stating hormone ©) Decteasoin progostrone ) Increase in atadiat ) increase ftce simulating hormone F) increase in progesteroneImmunizaton of @3month infant uth tetanus oxod rss italy n an okt anetanus antbady response felowed by antetarus IgG antbody response, Which of the {olbwing 8-10 Tmphocyee interaction s essen fo his insuinologc preonencn? 4) cb40~ cos ngans 8) CD44 — nyalurone cit ©) cb64— ig ) C8 — complement companent Ca ) cbs5—Fasigand42. A é6.year old woman wth cancers undergoing an intensive 2.wook course of chemmherapy with blastn, Which ofthe following changes is most kay to cecur bythe en of {is veaiment? 8) Decreased numbac a auton: 8B) Decreased ransterin saturation ©) Increased acwatod part rombopiastn tne ) Increased hematecré| ) creased serum gluse concetvaton48, A é0yearod woman undergoes choo vilus sampling ai 11 weoks!gataten bocausa of hr age-estad creased sk er having ach wth aneupiody. Cremosome ‘alysis shows 46 XY m 14 cls studied and 47 XY=15 nan aditona 25 els stcied Subsequent chromosome studies of nici hd show 48 XY n 50 cel, Whi of he {otowing best sxpians ins arenca? |) Confined placontal mosaicism 8) Cross-patent contamnation ©) ota mosaicism ) Laboratory eror ) Pscudomosaicism44 Dunng a perod of 2¢ hours, 25.yesr-od man hasan upper expan infecton wih features of he common col. Which ofthe folowing wal or host factors most ential in he Ina esistvet of he nection? A) Actvaton of ater vrs wit ephaiacas 8} nnbiion of nlamatory mediators () inhoinon of sys of gAantbodies ) Lysis of CD8* Thmphacytes E) Presence of vr receptor molecules on epi cls45, Asexvaly active 20ers woman has had pan erythematous, veskcuar lesions onthe vata for2 days. Examination by speculum aso shows lesions inthe vaginal vat fan on the er A hotomcrograph of a seaping of the bose ofan Unvooted veskess shown Wich of he flowing th mest IKON ages? |) Candi vans 8B) Cendyometa acuminata ©) Gent herpes ) Syphis ) Trchomones vaginas vaginits46, A 3.day ald male nowtom has progressive abdominal distin ae ncreaing distress. One of tse slings has ystc fess, He has had no bowel movements since bith X. ‘ay ofthe absemen suggest smal-bowe! ebstuchon Which othe flowing ste most ely diagnos? |) Abotalipoproteinamia 8B) Congontal mogaccien (Hesthsprung ssease) ©) Fypertopnic pyc stanoss ) Meckal vertu ) Meconum tes47, Two members of a ikng cub that rent retumed fom 25-day ken Arizona develop an infecton and requre hosptszaion. The infections characterized by the sudden ‘onset offever hits, weakness, ad headache, lowed ty the devecoment ct unttera,tensely ender rnghadenepahy i the gran. A Grom st of Mad ken am bah ‘ode shows gram-nagatvecoccobaci Wich ofthe ang sD ost I causal orgs? |) Gnyptocaccus neoformans 8) Flavwrus () Plasmodium rateparum ) iin choerse E) Yorsina posts48, A eat 25.yoa-oKdman undergoes an exercise stess test Which fhe folowing sets of physiologic changes mos key to occurin this man's exercising stoetl muscles? ‘Ateriolar ameter Tasue Adenosine Concentration Vascular Conductance 5) 3) D t i I 5 t 1 F) 3) »)48. A 60.yearols woman sbrovaht fo the physician because of ereasinly severe jit pan and sweling dunn te past 8 yeas She says hat she snow amost ncapactaid beease exer conaton, Physical exanvoalon shows iegulst asymmet Sargerents 0 mltoe ts of he gars and toes, le bow, and ighthnes. wi focal eration of he over SMA photograph of tho ef hand shown, Sun studios show ie Ge Urea ivogen (BUN) ‘Glucose Crate Phosphorus Proton tla Choesioo! ‘Akal phospatase ast aur Ure aca Which ofthe folowing isthe most kel iagnosis? 1) Gout 8) Hyperparatyrodism ©) Ostecarmtus 1) Pseucegout ) Rhoumatos arts 48meqt 101 mga a mga toma Teng asmgdl Bad or mg50. A 1yearol gti brought ote physician because of 1-day History of pan and swaling of her nghtindx ager. Her ampere i 375°C (00°F). Examination of he rh hand shows a tender erythematous, edematous nex tng wth a act wooden spite embod ate soft tue. A whe exudae ound inthe son dn volo the Siler Ths materal sprodonsnartly composed of wnih ote folowing peso cele? A) Bacophis 8) Ecsinophis ©) Lymphocytes 1) wenosytan ) Nowtophis