1- 20 patients with pneumonia were admitted to hospital A, 10 of them

died. 100 patients with pneumonia were admitted to hospital B, 25 of

them died. Which of the following statements is true:
- case fatality rate is 2 times higher in hospital A than B. *
- case fatality rate is 2.5 times higher in hospital B.
2- a cohort study was done to compare between two risk factors, relative
risk was found to be 4, what does that mean? The question was only
asking for the definition of relative risk.
3- A clinical trial is being conducted, a small group of volunteers from
college were involved in the trial, which phase is this?
- Phase I*
- Phase II
- Phase II
- Phase IV
4- HbA1c values for 10 patients were given in the question, calculate the
median.
5- If we increase the sample size, which of the following measures will
increase? Power
6- In a city with a high prevalence of HIV, and low medical supplies, the
medical director of a hospital decided to follow the WHO guidelines in
triage of patients with HIV, which of the following ethical principle does
this apply to?
- Autonomy
- Beneficience
- Nonmaleficence
- Justice
- Dignity.
7- An 80 year old Indian patient presented to your clinic with abdominal
pain and jaundice, and after investigations, you diagnosed him with
pancreatic cancer, his son asks you not to tell the patient about his
diagnosis, the patient is able to understand and make his own
decisions, what will you do?
- Tell the patient
- Discuss treatment options with the patient.
8- A doctor performs a study to determine the prevalence of a rare
disease in his community, what's the best type of study? Cross
sectional study.
9- A 40 year old female patient with SLE presented to you with diarrhea
and piloerection, she's on acetaminophen and oxycodone for joint pain,
she tells you that during the last month, her symptoms were worse
than usual, and only oxycodone could help with the pain, and she
doesn’t have enough supply of oxycodone, whats the most appropriate
course of action?
- Refill the prescription
- Refuse to fill the prescription, as she's clearly addicted to oxycodone
- Refer to another physician as you prefer not to deal with drug addicts
- Taper oxycodone
- Refer her to methadone detoxification
10- A 12 year old female diabetic patient keeps coming to you with diabetic
ketoacidosis, and her mother says that her daughter refuses to take her
insulin, what's the most appropriate course of action? : Discuss the
reasons behind the patient's reluctance to take her meds.
11- A 23 year old female patient with major depressive disorder was
admitted to the hospital under your service, on her last day of
hospitalization, she says that you’ve been a great physician, and she
invites you for dinner in her house to express gratitude, what would
you do:
- Refuse the invitation, telling her that this is inappropriate.
- Refuse the invitation, telling her that you appreciate the nice gesture.
12- A 4 year old healthy boy comes for a checkup, while you're assessing
his development, you pour equal amounts of chocolate in two cups,
one is wide and short, and the other is narrow and tall, and you ask him
which cup contains more chocolate, he points to the tall cup, based on
this finding, what else would you expect the child to have:
- Short attention span
- Inability to label objects
- Retrieve a hidden object
13- Definition of primary prevention.
14- An expirement about two drugs, one is a transcription activator, and
the other is an inhibitor, what are their mechanisms of actions: there
was a choice where one is an acetylator, and the other is a methylator.
15- Mechanism of action of Irinotecan: topoisomerase I.
16- Polymerase with 5' exonuclease activity: DNA polymerase I.
17- A question about DNA mutations, with the aminoacid table on the side,
the mutation showed amino acid substitution from Homocysteine to
 Tryptophan, what do you expect to find in the final protein: loss of a
disulfide bond.
18- A patient with breast cancer, she has a mutation in DNA mismatch
repair, what other cancer does she have increased risk for: colorectal
cancer.
19- A patient presented with liver injury, what do you expect to see in her
cell cycle: Hepatocytes stimulated to enter G1 from G0
20- An infant with coarse facial features and high plasma levels of
lysosomal enzymes, what is the organelle involved in his pathology:
Golgi.
21- What's the pathophysiology of cellular swelling after cell injury: Loss of
Na-K pump activity (I had 3 questions asking indirectly about this)
22- A direct question about RNA interference.
23- A question about the steps of ELISA.
24- A family with history of breast cancer, leukemia, osteosarcoma, what's
the mutation? P53
25- An infant with absent red reflex, she has increased risk of which of the
following malignancies when she grows up: osteosarcoma.
26- A patient with hemangioblastoma, his father had renal cell carcinoma,
what's the diagnosis? VHL.
27- A child from Amish population, presented with a very rare disease,
what's the reason? Founder effect.
28- A patient presents with muscle weakness, you notice that during the
handshake, it takes a while until he releases your hand, where's the
mutation? DMPK gene.
29- A patient with night blindness, dry scaly skin, he's found to have a
vitamin deficiency, what's the function of the deficient vitamin? It's
essential for differentiation of epithelial cells.
30- An alcoholic patient with confusion ophthalmoplegia and ataxia, locate
the size of pathology in this brain section.
31- A patient was found to have methylmalonic acid in urine,
methylmalonyl CoA mutase activity was found to be normal,
supplementation of which of the following is necessary? Vit B12
32- A protein with 6 subunits, it binds ATP, what's the action of this
protein?
- Activates adenylate cyclase.
- Activates phopholipase C
- Necessary for transcription activation
- It controls the activity of an ion channel.
33- A patient with infantile cataract, E.coli sepsis, what's the mechanism?
Abnormal metabolism of the sugar present in breast milk.
34- A 16 year old male presented with muscle cramps and myoglobinuria,
no rise in lactate levels post-exercise, where's the defect?
- Glycogen phosphorylase.*
- Carnitine acyltransferase.
35- A patient with muscle cramps, Lactic acid levels increased post
exercise, where's the defect?
- B oxidation of fatty acids.*
- Mitochondrial disease.
- Glycolysis.

(there was nothing related to glycogen storage diseases in the choices.)

36- A patient with dyslipidemia, presented with pancreatitis, he had

creamy layer in supernatant. Where's the defect? Lipoprotein lipase.
37- A patient with family history of cardiac disease, LDL level is very high,
where's the defect? Defective LDL receptor.
38- A female patient with prolonged use of tampons, she presented with
elevated AST/ALT, what's the explanation? A superantigen that binds T-
cells.
39- A patient presented with fever, temp 102, HR 60, rose spots on
abdomen, gram –ve rod was identified in the patients serum, what's
the organism? Salmonella typhi.
40- An outbreak of diarrhea in a daycare center, the causative organism is a
gram –ve rod. What's the virulence factor? – Pilus – Capsule –
endotoxin -
41- A patient who lives in Connecticut presents with a heart block, what's
the most likely organism? Borrelia Burgdorferi.
42- A patient with syphilis was started on penicillin a few days ago,
presents with fever, chills, headache, what's the explanation? Killed
spirochetes releasing toxins (Jarisch Herxheimer reaction)
43- A patient with gray vaginal discharge and a fishy smell, describe the cell
seen on microscopy? Vaginal epithelial cells.
44- A female patient with poorly controlled diabetes, she has multiple
sexual partners, she's on ACEI for hypertension, she presented with a
white vaginal discharge, and vaginal inflammation, what's the most
important predisposing factor?
- Poorly controlled diabetes
- Multiple sexual partners
- ACEI
45- A patient with a recent travel history, presents with foul smelling, fatty
diarrhea, what to do to diagnose his condition? Stool sample looking
for cysts or trophozoites.
46- A patient who recently travelled to Vietnam presents with
splenomegaly and jaundice, what's the organism? They had six pictures
of parasites, but I don’t think Plasmodium was one of them, I picked
schistosoma but im not sure if it's correct or not.
47- A picture of an egg with a lateral spine, what's the host? Snails.
48- A patient presented with pruritis serpiginous rash, what's the reason
behind this? Walking barefoot on contaminated beach.
49- A picture of a patient with vesicular eruption with dermatomal
distribution, what's the pathophysiology? Virus transport through
kinesin.
50- A patient with HIV infection, presented with forgetfulness, no focal
neurologic findings, MRI showed diffuse cortical atrophy and
ventriculomegaly, no focal lesions were identified, what's the most
likely diagnosis?
- HIV associated dementia*
- HSV infection
- CMV infection
- Toxoplasmosis.
51- A 21 yo female patient who's sexually active, presents with dysuria and
suprapubic pain, urinalysis shows bacteruria , positive nitrites, what's
the most likely organism? E.coli
52- A cirrhotic patient presents with diffuse abdominal pain, he was later
diagnosed with peritonitis, whats the most likely organism? E.coli
53- A 23 year old sexually active male, presents with testicular pain and
erythema, neutrophilic infiltrate, but no organism was identified on
gram stain, what's the most appropriate antibiotic? Azithromycin.
54- A patient presented with penile lesions, with no lymphadenopathy, he
mentioned that he had an exact similar episode last year, what's the
organism? HSV
55- A patient with strep pneumo infection, cultures show resistance to
penicillins and cephalosporins, whats the mechanism of resistance?
Change in penicillin binding proteins.
56- A patient with a fungal infection was started on caspofungin, with no
improvement, whats the mechanism of resistance? Change in B glucan.
57- Mechanism of resistance of a drug given for CMV retinitis? Mutated
viral kinase. There was no mutated DNA polymerase in the choice, so I
assumed they meant Ganciclovir.
58- What's the most important step in viral replication of a corona virus?
- Protein synthesis in the cytoplasm ( I think it's the answer because
corona is a +ve ssRNA)
- Incorporation in the genome.
59- A 5 month old patient with PCP pneumonia ( they showed a picture of
disc shaped organism on silver stain) , he was found to have low HLA-
DR levels, which of the following cells would you expect to be low?
- CD4 T Cell
- Dendritic Cell.
60- A patient with breast cancer, CT scan shows no mets, where's the first
place in lymph nodes that the cancer cells will go to?
- 1ry follicle
- 2ndry follicle
- Paracortex
- Medulla*
61- Which of the following is essential to free radical formation? NADPH
oxidase.
62- A patient with ESRD, what can we give to improve her anemia?
Erythropoietin.
63- A 28 patient with a pulmonary nodule that was found incidentally on
CXR, he's asymptomatic, non smoker, with no family history of cancer,
they did a biopsy, and they show a slide with a disorganized growth, so
I assumed it's a hamartoma.
64- A patient with muscle weakness and a mediastinal mass? Antibodies
against postsynaptic AChR.
65- 2 or 3 questions about Michaelis menten and Lineweaver burk plot.
66- A patient with allergic rhinitis was started on a medication for acute
relief of symptoms. Whats the mechanism of action? It activates
phospholipase C ( I assumed they meant phenylephrine)
67- A question about a patient on warfarin, his INR became low , which of
the following drugs can this be attributed to? Carbamezapine (Cyp450
inducer)
68- An ECG for a patient with Afib, what changes would you expect to see
in stroke volume, cardiac output, and pulse pressure? (all the possible
combinations were there).
69- Which of the following hemodynamic parameters would be lower in an
80 year old compared to a 20 year old? Pulse pressure.
70- Graphs for SBP and DBP and bronchial tone for a patient on
epinephrine and beta blocker. (similar to the one that was in UW).
71- Action potential curve for a patient on class IA antiarrhythmic.
72- A 2 year old female patient, her mom says that she doesn’t like to play
with kids, and whenever a kid tries to play with her toys, she slaps him,
her development is normal, what's the diagnosis?
- Autism spectrum disorder
- ADHD
- Normal behavior*
73- A 14 year old male patient with substance abuse, his physicians is
fighting the urge to slap him because he reminds him of his kid who did
the same when he was his age? Countertransference.
74- a patient who was raped 2 years ago, describes living out of body
experiences, what's the diagnosis? Depersonalization/derealization.
75- A patient presents with tactile hallucinations, and change in behavior,
what's the diagnosis? Substance abuse.
76- A patient presents with diarrhea, chest pain, and a bunch of other
unrelated symptoms, physical exam is normal, she was thoroughly
investigated by multiple doctors before, but all within normal range,
what's the diagnosis? Somatic symptom disorder.
77- Electrolye disturbance in a patient with bulimia nervosa? Hypokalemia.
78- A patient with dilated third and lateral ventricles, what's the
embryologic origin of the obstructed part? Mesencephalon (cerebral
aqueduct stenosis)
79- An expirement about rats who don’t gain weight despite food
availability, which of the following is deficient? Ghrelin.
80- Angiography for a patient with stroke, with an arrow pointing to the
MCA, what do you expect to see on physical exam? Aphasia.
81- A patient underwent aortic surgery, and the great radicular artery was
injured, what's the diagnosis? Anterior spinal artery syndrome. (great
radicular artery is the artery of adamkiewicz, but they didn’t mention
this name in the question)
82- Multiple CT scans (coronal and sagittal sections) asking to localize
strokes, the questions were easy, but it was difficult to localize the
structures, so make sure you study brain CT scans well.
83- A patient with complete loss of extraocular muscle movements, and
sensory loss in the ophthalmic division, and they show a picture of a
skull with arrows pointing to the foramina, the question was which of
the following foramina do the injured structures exit from? Superior
orbital fissure.
84- A patient who recently retired from the military comes with hearing
loss in his right ear, which of the following physical exam findings
would you expect to see? Air>bone in the right ear, weber localizes to
the left ear.
85- A patient with red eye, worse in the morning, with significant amount
of eye discharge in the morning when she wakes up, what's the
diagnosis?
- Blepharitis*
- Conjunctivitis
- Scleritis
- Episcleritis
- Uveitis
86- A patient who's on SSRI, presents with unilateral headache with nausea
and photophobia, her physician gives her a medication for the
headache, later, she comes back with hyperreflexia, hypertension, and
agitation, which of the following medication did her physician
prescribe? Sumatriptan (Serotonin syndrome) .
87- A patient presents with opioid withdrawal symptoms after taking
morphine, what was she taking? Butorphanol.
88- A child presents with tonic clonic seizure, activating which of the
following channels would be the most effective therapy? GABA.
89- An alcoholic patient presents delirium tremens, which of the following
medications do you give him?
- Alprazolam
- Triazolam
- Diazepam (I picked it because it's long acting)
90- A patient undergoes right adrenalectomy, which of the following
structures are at highest risk of injury during surgery?
- Celiac
- Inferior mesenteric
- Abdominal aorta
- Phrenic nerve
- IVC
91- A 70 year old patient presents with cough, the remainder of physical
exam is normal, CXR is normal, he asks you to give him a cough
suppressant that causes constipation the least, which of the following
medications would you give him?
- Oxycodone
- Codeine
- Morphine
- Dextromethorphan?
- Diphenhydramine
92- A patient presents with IBS, so you decide to give him a medication
that's a partial agonist on serotonin receptor 4, and has no activity or
serotonin receptor 3, what is it? Tegaserod.
93- A child with sensorineural hearing loss, undergoes a genetic analysis to
identify the cause, mutation in connexin 26 is found, transfer of which
of the following electrolytes does it mediate? Potassium.
94- A 51 year old female patient with presents with feeling of hotness,
that's worse during the night, wakes her up multiple times, her last
menstrual period was 3 months ago, which of the following set of labs
would you expect to find? (FSH and TSH, all the possible combinations
were there)
95- While doing fetal ultrasound, the obstetrician detects unilateral
hydrocephalus, where's the most likely site of obstruction? Foramen of
monro.
96- An IV drug user presents with fever, fatigue and new onset murmur,
blood samples were obtained, and gram stain was done, and they show
a picture of candida on gram stain, what's the drug of choice?
Amphotericin.
97- A picture of congenital diaphragmatic hernia, where's the defect?
Pleuroperitoneal membrane.
98- Which of the following arteries are most likely to be penetrated by
gastric ulcers? Left gastric (right gastric was not among the choices)
99- A patient was found to have a hilar mass, how many layers of the
pleura will we go through to obtain a biopsy? 1,2,3,4,5,6.
100- A picture showing a polyp, asking about its type.
101- A child with suspected salicylate toxicity, which of the following
clinical parameters is suggestive of intoxication? Tachypnea.
102- Mutation in B globin chain results in change from a positively
charged amino acid to a negatively charged aa, which of the following is
correct? Left shift of the HbO2 dissociation curve.
103- A patient with basophilia, low LAP, what's the diagnosis: CML.
104- Mechanism of action of paclitaxel? Hyperstabilize polymerized
microtubules.
105- Drug of choice for long term management of ankylosing
spondylitis? Infliximab.