Paracetamol

3rd Quarter, 2015

1- If a person replaced all his carbohydrates with fat what would the expected
change to the lab values of cholesterol, LDL and HDL be? (I tried to draw it as
accurate as I can, the numbers might not be very accurate but the idea and
graph were very similar to this one)

Changes in lab values

3%
2%
2%
1%
1%
0%
-1%
-1%
-2%
-2%
-3%
A B C D E

Cholesterol LDL HDL

I chose C.
2- Woman who recently delivered a baby decided not to breastfeed him. Which
of the following is responsible of the involution of her breast:
A- Bcl-2
B- BAX
C- Perforins
D- Granzyms
I chose B

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3- An old patient (maybe was 70 or 75 yo) who came with his daughter. The
daughter tells you that her father is forgetting things more frequently but he
can do his daily activities like paying bills, shopping and cleaning his house
with the help of a housekeeper 2 times a week. What should you do next in
obtaining this patient’s history:
A- Interview the patient and daughter together, direct your questions to the
daughter.
B- Interview the patient and daughter together, direct your questions to the
patient.
C- Ask the daughter to step out and interview the patient alone.
D- Ask the patient to step out and direct your questions to his daughter.
I chose B
4- A group of investigators are trying a new drug. A big number a patients were
given the new medication, while another group with the same number was
given the standard of care. This medication was studied before on a small
number of healthy and diseased individuals. What is the study phase?
A- 0
B- 1
C- 2
D- 3
E- 4
I answered D
5- A new screening test is being developed and the researchers are trying to
reduce the number of false positives. Which of the followings need to be
increased:
A- Sensitivity
B- Specificity
6- A mother wants to enroll her child in a clinical trial (I think he was 14-15 yo).
Who should give the consent?
A- Consent only the mother
B- Consent only the child
C- The mother should sign the consent with the child’s assent
D- The boy should sign the consent with the mother’s assent
E- He is a minor, so no need for a consent

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7- A mother brought her son for checkup. She tells you that her teacher was
complaining recently that his performance in English classes has dropped. He
is doing fine in math. The mother asks if he has ADHD. What is the best
response?
A- We can’t tell for sure, let’s give him a trial of medications
B- Learning problems and ADHD usually overlap
C- Yes he has ADHD
D- Reassure her. This is normal behavior
8- A researcher wanted to study glucose values in 5000 patients. His results
were represented in the following graph:

A- 68% of the patients fall within 2 standard deviations

B- The results represent a normal distribution because of the large sample
size
C- The middle value (120) represents the mean and median but not the mode
I chose B
9- Patient who developed renal failure and can’t pay for the treatment. What
should he do:
A- Apply for Medicaid
B- Apply for medicare
10- Patient has an insurance plan: when he goes to an in-network provider he has
to pay 5$ copay, while if he goes to an out of network provider he won’t have
an insurance coverage. What is the type of his insurance:
A- Health Maintenance Organization (HMO)
B- Preferred provider organization
C- Managed care organization
There were other choices … I picked A but not sure

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11- A patient with some kind of end-stage cancer who came with his wife. You
told him about a new clinical trial that tests a drug that might be very
effective for his condition. His wife is very excited about these news and asks
you to enroll him in the trial, while on the other hand the patient refused that
and told you that he just wants to spend the rest of his life with his family and
loved ones and doesn’t want to be distracted by any other things. You have a
strong belief that this new medication is effective for him. What should you
do:
A- Respect his request and leave him alone !
B- Arrange hospice care for him
C- Try to re-convince him with the trial
I chose C
12- You want to start a patient with breast cancer on a new medication called
letrozole. What’s the mechanism of action?
Can’t recall the exact choices, but know that it’s an aromatase inhibitor and
you’ll be fine (blocks estrogen production from androgens)
13- Patient died after having respiratory problems, pharyngitis, enlarged lymph
nodes and gray membrane in his mouth. They put a gross picture for the
patient’s trachea and asked which organ would most likely be involved.
I assumed it was diphtheria and chose “heart”
14- If you increase a sample size in a study, what will the effect be on each of:
type I error, type II error, and study power
I chose: type I (no chane), type II (decrease), power (increase)
15- 2 questions about child development, both of them were normal. You need to
know the milestones very well
16- A question about a damaged tissue and they took a sample that was positive
for Desmin (and other 2 stains), and asks: these findings represent an activity
for which type of cells:
I chose Myocytes
17- Heavy drinker with hypoglycemia, why?
Alcohol prevent gluconeogenesis by converting oxaloacetate to malate
18- Patient experiences painful muscle cramps and red urine after exercise. What
is the missing enzyme?
Glycogen Phosphorylase

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19- Patient with a kidney stone and increased urine PH. An image was shown,
very similar to this:

What is the type of the stone?

A- Calcium oxalate
B- Calcium with phosphate
C- Ammonium, magnesium, phosphate
D- Uric acid
I chose A
20- A young patient with heart problems, including cardiomyopathy and problems
with exercise. They asked about the defective enzyme.
It looks like Pompe’s disease, so I chose Acid maltase
21- I had a question about a valvular problem (I think It was mitral but not sure)
and then asked to locate the valve on a CT scan. Know how to distinguish
between these on CT.
22- Patient had some kind of respiratory infection which was treated medically.
Few days later she developed a watery diarrhea. What is the causative
medication ? → Clindamycin
23- Patient was treated for malaria caused by P. vivax. What should you give to
prevent recurrence ? → Primaquine
24- Young patient with shortness of breath and cough. Signs of hemolysis and
positive cold agglutinins. → Mycoplasma
25- Patient is using niacin and is having flushing, how to prevent that? → COX
inhibitor

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26- Young patient with symptoms of STD, and gives a similar picture:

What is the diagnosis? → N. Gonorrhoeae

27- Patient with abdominal discomfort and epigastric pain. Endoscopy showed
gastric acid, but was negative for any organisms. I think the mentioned also
that the antacids didn’t help that much. What is the diagnosis?
A- GERD
B- Gastric Ulcer
C- Idiopathic gastric acid hypersecretion
I’m sorry I don’t recall the other options but from the description they gave, C
looked the most reasonable answer after they told you every possible test is
negative.
28- Picture for a head with round lesion. It looked like a fungal infection (tinea)
but the choices were confusing:
A- Candida Albicans
B- Aspergillus
C- Pityrosporum
D- Trichophyton
I had no idea, but I picked C. Later I figured that Trichophyton is the causative
agent for tinea capitis
29- Female patient had neurological symptoms with decreased sensations to
vibrations in her toes (or legs not sure). Where is the problem:
A- Fasciculus gracilis
B- Fasciculus cuneatus
I picked A

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30- Patient was diagnosed with ovarian cancer. It’s associated with ?
Can’t remember the choices but I chose Ascites which I believe is
characteristic for this cancer
31- Patient is using aspirin and developed SOB and wheezing. What should you
give ? → Montelukast
32- A patient with some GI bleeding near the hepatic flexure, What artery you
should embolize?
A- Left colic
B- Mid colic
C- Iliocecal
I chose B
33- Patient with recurrent respiratory infections, diarrhea and failure to thrive.
What’s defective? → transmembrane protein that regulate ions
34- Patient who took his flu vaccine at the bingeing of the season but later he got
flu and died of it. Why did that happen?
New viruses from reassortment
35- The most common cause for Down syndrome → meiotic nondisjunction
36- A researcher wanted to study some lab values in 8 patients. He recorded the
following values:
Patient Value
1 0.8
2 0.8
3 0.9
4 1.0
5 1.1
6 1.1
7 1.3
8 8
If the reading in patient 1 was mistakenly put 0.8 instead of 8. How would each of
(median, mean, mode) change if that value was corrected to 8
All of them will increasae
37- A patient had a burn that covered her left arm entirely. What is the
percentage of the burn? → 9%
Remember:

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38- A patient developed signs of sepsis. Which surface protein is most likely
involved? → CD 14
39- A group of researchers are studying different effects of the drug A when
added to different other drugs. Which one is the most potent competitive
antagonist for A.

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 40- Patient had a tumor similar to this in her leg:

It’s most likely associated with → Paget disease (osteosarcoma, the real picture
was better than this one)
41- A medication is being used in stage 3 and 4 renal failure patients. How would
Checked the initial dose and interval change?
Correct
Initial dose (unchanged), interval (increase)
42- Patient with bone pain in multiple sites with signs of renal insufficiency, X-ray
showed multiple lytic lesions, what cells are involved? → plasma cells
43- Patient with DM type 2 with a histology image from his pancreas, then asks
about the protein deposits:
A- Alpha sheets
B- Beta pleated
I chose B
44- Patient had an injury in his brachial plexus, where is the best place for the
surgeon to open for repair? → scalene triangle (between anterior and middle
scalene)

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45- A child who is 95th percentile in head circumflex, and 10th (or 5th) percentile in
limbs, what’s defective? → FGFR3
46- What should you check before starting Cetuximab ?
A- PTEN
B- KRAS
C- P53
I’m sure there was no EGFR. I answered A
47- The highest O2 content in a fetus is in:
A- PDA
B- SVC
C- Umbilical Arteries
I chose PDA, I don’t think there was Umbilical vein or IVC
48- Patient with Mycoplasma, Which drug should you use:
A- Amoxicillin
B- Ceftriaxone
C- Penicillin
D- Azithromycin
I chose D (all the other options were beta lactams)

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49- 2 questions about testicular cancer and then asked which lymph nodes will be
involved? → para-aortic
50- Why would a DKA patient lose conciseness? Hyperosmolar serum.
I don’t recall the choices but I picked: neurons lose their ability to perform
glycolysis or something like that, not sure
51- Patient with polycythemia vera developed hepatomegaly with abdominal pain
and splenomegaly. Diagnosis?
A- Portal vein thrombosis
B- Budd chiari
52- Patient with recent transplant, his renal functions are deteriorating. What is
he using? → Cyclosporine
53- Old female patient with symptoms of giant arteritis, what will you see:
A- Fibrinoid Necrosis
B- Granulomatous Necrosis
54- Beta blockers effect on contractility → Decrease
55- A patient had a surgery recently and later developed itching in her neck and
trunk. Which medication was used in this patient:
A- Lidocaine
B- Morphine
C- Maybe they put fentanyl also
I chose B. As I recall that morphine induces histamine release
56- Patient with the following heart volume loop:

The solid line is the baseline and the dashed line after giving a drug. They
asked about the medication given?
A- Beta blocker Calcium channel blocker= Not much role in preload, decreases afterload
B- CCB
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 C- Maybe there was ACEi
I’m 100% sure about the graph but can’t recall all the answers, sorry!
57- Patient with bright red bleeding from rectum, they did anoscopy (or
sigmoidoscopy) and took a biopsy. Histology picture was shown and asked
about the diagnosis:
A- Squamous cell carcinoma of the anal canal
B- Hemorroids
I don’t want to put a picture because I’m not sure, but I saw a big blood vessel
in the middle of the slide that took half of the screen, so I chose B but I wasn’t
100% convinced In CNS T4 is converted to T3 which causes negative feedback. Here T3 not
made. so no negative feedback. So T4 increase, T3 decrease and TSH increase
58- Patient with wait gain and constipation has a defect in deiadinase only in
peripheral tissues. How would the values of (T4, T3, TSH) change?
T4 (increase), T3 (I think I put decrease but not sure), TSH (I assumed it will
decrease since there is no problem in converting T4 centrally)
59- Hypothyroidism symptoms with granulomatous inflammation on histology →
Subacute thyroiditis (de Quervian)
60- Patient with hashimoto’s, what will you see in his blood?
A- Antibodies against thyroglobulin
B- Antibodies against thyroxine-binding globulin
Answer is A (Don’t be confused between these two)
61- Patient with bone pain, his pth and calcium levels were measured and
represented by the black dot in the graph

What’s the diagnosis? → Osteomalacia

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62- Patient with a family history of colon cancer and positive APC gene. She had
colonoscopy done with a polyp resection. What is the most likely type of that
polyp:
A- Tubulovillous
B- Tubular (most common 60 %)
C- Villous
I chose C

Good Luck

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