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<1>A72yearoldmaleisnotedashavinga9poundweightlossoverthepast
fewweeks.Hispastmedicalhistoryissignificantforoatcellcarcinomaof
thelung,withoutknownmetastases,forwhichheiscurrentlyundergoing
treatment.Thepatientstatesthateventhoughhiswifeispreparinghis
favoritemeals,heisnothungry.Whichofthefollowingwouldbethe
besttreatmentoptiontoimprovehiseatinghabits?

A.
Amitriptyline

B.
Megestrolacetate

C.
Methotrexate

D.
Neostigmine

E.
Prochlorperazine

Answer

<2>A45yearoldhomelessmanhasachroniccough,acavitarylesionofthe
lung,andissputumpositiveforacidfastbacilli.Whichofthefollowing
istheprincipleformofdefensebywhichthepatient'sbodyfightsthis
infection?

A.
Antibodymediatedphagocytosis

B.
Cellmediatedimmunity

C.
IgAmediatedhypersensitivity

D.
IgEmediatedhypersensitivity

E.
Neutrophilingestionofbacteria

Answer

<3>Aresearcherisexaminingthedistributionofanionchannelproteinin
thekidney.Sheincubatesslicesofkidneytissueinadilutesolutionof
aspecificantibodydirectedagainsttheprotein,thenusesthe
immunoperoxidasemethodtolocalizetheionchannelproteins.
Shenotesthepresenceofbrownpigmentinapopulationofepithelial
cells,whichoncloserexamination,haveabrushborder.Theresearcher
concludesthattheproteinisprobablypresentincellsofthe

A.
collectingduct

B.
deepportionofloopofHenle

C.
distalconvolutedtubule

D.
glomerulus

E.
proximalconvolutedtubule

Answer

<4>A38yearoldpregnantwomanwithapastmedicalhistorysignificantfor
chronichypertensionpresentswithabloodpressureof158/105mmHg.Which
ofthefollowingantihypertensiveagentswouldbemostsuitableforinitialtherapyinthispatient?

A.
Bumetanide

B.
Fosinopril

C.
Hydrochlorothiazide

D.
Methyldopa

E.
Valsartan

Answer

<5>A3yearoldboyisbroughttoaphysicianbecausethemothernoticestha
tthechildisengaginginlessactiveplayandtireseasily.Duringphysical
examination,thepediatriciannoticesthatthechild'sthighsarelarger
thannormalforageandthatthechildcannotstandupwithoutusinghis
armstohelp.Furtherstudiesdemonstrateadefectivedystrophingenein
theboy.Whichofthefollowingpeopleinthechild'sfamilyismost
likelytoalsohavethisdisease?

A.
Father

B.
Father'sbrother

C.
Mother

D.
Mother'sbrother

E.
Sister
Answer

<6>Theleukocytepicturedabovestainsintenselywithacidicdyessuch
aseosin.Whichofthefollowingsubstancesiscontainedinthecrystalline
coreofthegranuleatthearrow?

A.
Lactoferrin

B.
Majorbasicprotein

C.
Myeloperoxidase

D.
Histamine

E.
Tartrateresistantacidphosphatase

Answer

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<7>A7yearoldboyisbroughttoaphysicianbecauseofanearlyconfluent,
fine,erythematous,macularrashthatismostpronouncedonhistrunk.He
hashadamildfeverfor36hours,butdoesnotappearverysick,andis
happilyplayingwhenthepediatricianenterstheexaminingroom.Physical
examinationdemonstratesareddenedthroatwithtonsillarexudates,
enlargedcervicalnodesincludingtheoccipitalnode,andquestionable
splenomegaly.Themothersaysthattheboyhasnotbeencoughing,and
noKoplikspotsarenoted.Whichofthefollowingisthemostlikely
diagnosis?

A.
Bullouspemphigoid

B.
Dermatitisherpetiformis

C.
Herpessimplex

D.
Measles

E.
Rubella

Answer

<8>Achildwhohashadabnormaldevelopmentofthemembranousboneshasa
broadskullwithassociatedfacialanddentalanomalies.Whichotherbones
aremostlikelytoalsobeaffected?
A.clavicles

B.
Femurs

C.
Metatarsals

D.
Phalanges

E.
Tibias

Answer

<9>A33yearoldwomanpresentswithfever,vomiting,severeirritative
voidingsymptoms,andpronouncedcostovertebralangletenderness.
Laboratoryevaluationrevealsleukocytosiswithaleftshift;blood
culturesindicatebacteremia.Urinalysisshowspyuria,mildhematuria,
andgramnegativebacteria.Whichofthefollowingdrugswouldbest
treatthispatient'sinfection?

A.
Ampicillinandgentamicin

B.
Erythromycin

C.
Gentamicinandvancomycin

D.
Phenazopyridineandnitrofurantoin

E.
Tetracycline

Answer

<10>Asurgicalpathologyspecimenfroma24yearoldwomanseenata
reproductivemedicineclinicdemonstratesaciliatedcolumnarepithelium.
Fromwhichofthefollowinglocationsinthefemalegenitaltractwasthe
biopsyobtained?

A.
Cervix

B.
Endometrium

C.
Fallopiantube

D.
Ovary

E.
Vagina
Answer

<11>Inagenotypicmale,thetestesfailtodevelop,anddonotsecrete
testosteroneorMllerianregressionfactor.Whichofthefollowingbest
describestheinuteroreproductivesystemdevelopmentofthisindividual?

A.
Bothmaleandfemaletypeinternalreproductivetractsandmaletypeexternalgenitalia

B.
Femaletypeinternalreproductivetractandfemaletypeexternalgenitalia

C.
Femaletypeinternalreproductivetractandmaletypeexternalgenitalia

D.
Maletypeinternalreproductivetractandfemaletypeexternalgenitalia

E.
Maletypeinternalreproductivetractandmaletypeexternalgenitalia
Answer

<12>Apulmonologististestingapatient'slungvolumesandcapacitiesusing
simplespirometry.Whichofthefollowinglungvolumesorcapacitiescannot
bemeasureddirectlyusingthistechnique?

A.
Expiratoryreservevolume

B.
Functionalresidualcapacity

C.
Inspiratoryreservevolume

D.
Tidalvolume

E.
Vitalcapacity
Answer

<13>Contractionofwhichofthefollowingmusclescontributesmosttothe
backwardmovementofthelowerjawduringtheprocessofmastication?

A.
Digastric

B.
Lateralpterygoid

C.
Medialpterygoid

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D.
E.

Mylohyoid
Temporalis

Answer

<14>A28yearoldfemalepresentstothedoctorcomplainingofsyncopal
episodesthatlastafewminutes.Sheisnottakinganymedicationsand
hasnopreviousmedicalhistory.EEGandEKGstudiesareperformedand
areunremarkable.Anechocardiogramshowsasingleballshapedmass
danglingintheleftatriumnearthemitralvalve.Themostlikely
diagnosisis

A.
angiosarcoma

B.
mesothelioma

C.
myxoma

D.
rhabdomyoma

E.
rhabdomyosarcoma

Answer

<15>Apatientwhohasbeenexhibitingvariousendocrineabnormalities
hasanMRIscanofthehead.Thisscanrevealsasmalltumorofthe
pituitarygland.Ifthistumorexpandslaterally,whichofthefollowing
nerveswillmostlikelybeaffectedfirst?

A.
Abducensnerve

B.
Oculomotornerve

C.
Opticnerve

D.
Trigeminalnerve

E.
Trochlearnerve
Answer

<16>Aliverbiopsyfroma54yearoldmanshowsmanyMallorybodies.This
findingismostsuggestiveofwhichofthefollowingdiseases?

A.
Alcoholabuse

B.
Alpha1antitrypsindeficiency

C.
HepatitisA

D.
HepatitisB

E.
Wilson'sdisease

Answer

<17>A27yearoldmanhasbeenarrestedbythepoliceforhitting,cursing
at,andverballyberatinghiswifeof8years.Thewifetellsthepolicehe
alsoregularlyphysicallywhipshis7yearoldsonwithaleatherbeltand
oftenstrikestheboywithhishand.Whenaskedwhyhedoesthis,he
respondsthatthisis"howmyfathertreatedme,it'showmenshouldact."Thisrepresentswhichofthefollowingtypesoflearning?

A.
Classicalconditioning

B.
Cognitivelearning

C.
Imprinting

D.
Operantconditioning

E.
Sociallearning
Answer

<18>A64yearoldmanpresentstohisdoctorwithaching,burningpainafte
rmeals.Hehadbeenselfmedicatingforseveralmonthswithantacids,but
hefoundthistobeincreasinglyineffective.Hisphysiciandecidestotake
himofftheantacidsandinsteadplaceshimonacombinationofranitidine
andsucralfate.Whyisthiscombinationabadidea?

A.
Ranitidineincreasesthetoxicityofsucralfate

B.
Ranitidineinhibitstheactionofsucralfate

C.
Sucralfateandranitidinecoprecipitate

D.
Sucralfateincreasesthetoxicityofranitidine

E.
Sucralfateinhibitstheactionofranitidine
Answer

<19>A42yearoldfemalepresentswitharecentonsetoffatigue,malaise,
constipation,anda12poundweightgain.Onexamination,herthyroidis
firmandenlarged.Whatlaboratorytestismostlikelytoconfirmthe
expecteddiagnosis?

A.
Antithyroidantibodies

B.
Serumthyroidstimulatinghormone(TSH)measurement

C.
Serumthyroxine(T4)measurement

D.
Serumtriiodothyronine(T3)measurement

E.
T3resinuptake
Answer

<20>A70yearoldmanwithahistoryofatrialfibrillationisstartedonan
oralanticoagulant.Hisprothrombintimeismonitoredonaregularbasis.A
fewmonthsintohistherapy,hebeginstreatmentforaduodenalulcerand
hedevelopssymptomsofableedingdiathesis.Whichofthefollowingulcer

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medicationsismostlikelyresponsibleforthischangeinhishemostatic
status?

A.
Cimetidine

B.
Famotidine

C.
Misoprostol

D.
Omeprazole

E.
Ranitidine

Answer

<21>Anelderlywomanwithahistoryofmultipleoralulcerspresentswith
flaccidbullaeonherscalp,face,andtrunk.Manualpressureontheskin
producesseparationoftheupperlayeroftheepidermis,followedby
eventualsloughingoftheskin.Thepatienthasbeeninrelativelygood
healthuntilrecently,anddeniestakinganymedications.Abiopsyofone
oftheskinlesionsrevealsseparationofepithelialcellsabovethe
basallayer.Autoantibodiestowhichofthefollowingcomponentswould
mostlikelybefoundinthispatient?

A.
Epidermalbasementmembraneproteins

B.
GlycoproteinIIb/IIIa

C.
Intercellularjunctionsofepidermalcells

D.
Intrinsicfactor

E.
TypeIVcollagen

Answer

<22>A35yearoldwomannoticesachangeintheappearanceofamoleonher
neck.Physicalexaminationrevealsthatthelesionisanirregular,nodular,
superficialmasswithavariegatedappearance.Biopsydemonstratesaprimarymalignanttumor.Whichofthefollowingfactorsismostpredictiveofthepatient's

A.
Circumferenceoflesion

B.
Darknessoflesion

C.
Degreeofcolorvariation

D.
Depthoflesion

E.
Sharpnessofborderbetweenlesionandadjacentskin
Answer

<23>Duringembryologicaldevelopment,hematopoiesisoccursindifferent
organsatdifferenttimes.Whichofthefollowingarethecorrectorgans,
inthecorrectsequence,atwhichhematopoiesisoccursembryologically?

A.
Amnion,yolksac,placenta,bonemarrow

B.
Placenta,liverandspleen,yolksac,bonemarrow

C.
Placenta,spleenandlymphaticorgans,bonemarrow

D.
Yolksac,bonemarrow,liverandspleen

E.
Yolksac,liver,spleenandlymphaticorgans,bonemarrow
Answer

<24>A6montholdboyisbroughttothepediatricianbyhisparents,whoare
firstcousins.Thisistheirfirstchild.Physicalexaminationrevealsa
small,thin,lethargicinfantwithslightlymisshapenlongbones.His
featuresaresomewhatcoarse.Jointmovementsarerestricted,hiscorneas
areclouded,andhisgumsareunderdeveloped.Hisliverisnotenlarged.
Serumlevelsofacidhydrolasesarefoundtobeelevated.Thechildmost
likelyhasadefectinwhichofthefollowingmetabolicactivities?

A.
Degradationofdermatansulfateandheparansulfate

B.
Degradationofgangliosides

C.
Degradationofglycogen

D.
Degradationofsphingomyelin

E.
Phosphorylationofmannosemoieties

F.
Phosphorylationoftyrosinemoieties
Answer

<25>Aparticularassociationdeterminesmembershiponthebasisofmembers'
IQscores.OnlythosepersonswhohavedocumentedIQscoresatleast2
standarddeviationsabovethemeanontheWechslerAdultIntelligence
Scale(WAIS)areeligibleforadmission.Ofagroupof200peoplerandomly
selectedfromthepopulationatlarge,howmanywouldbeeligiblefor
membershiptothissociety?

A.
1

B.
2

C.
3

D.
4

E.
5

Answer

<26>5mLofsynovialfluidisaspiratedfromaninflamedkneejoint.The
fluidisyellowwhiteandcloudyandcontains
200,000WBC/mm3(85%neutrophils).Needleshaped,
stronglynegativelybirefringentcrystalsareseenbothwithin
andoutsideneutrophils.Thesecrystalsmostlikelyhavewhichof
thefollowingcompositions?

A.
Basiccalciumphosphate

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B.
C.
D.
E.

Calciumoxalate
Calciumpyrophosphatedihydrate
Cholesterol

Monosodiumurate

Answer

<27>Apatienthasapainfululceronthetipofhistongue.Whichofthe
followingcranialnervescarriesthepainsensationheexperiences?

A.
V2

B.
V3

C.
VII

D.
IX

E.
X

Answer

<28>A30yearoldveterinarianonacattleranchpresentswitha1to2month
historyofmalaise,chills,drenchingmalodoroussweats,fatigue,and
weakness.Hehasanorexiaandhaslost15pounds.Hehasintermittent
feversthatrangeupto103F(39.4C).Hecomplainsofvisualblurring.
Aphysicalexaminationrevealsmildlymphadenopathy,petechiae,anda
cardiacmurmurconsistentwithaorticinsufficiency.Whatisthemost
likelyetiologicagent?

A.
Bacillusanthracis

B.
Brucellaabortus

C.
Coccidioidesimmitis

D.
Erysipelothrixrhusiopathiae

E.
Trichinellaspiralis

Answer

<29>Theparentsofa6montholdchildwhowasnormalatbirthbringher
intotheclinic.SincetheiremigrationtotheU.S.fromEasternEurope
soonafterherbirth,thechildhasdevelopeddiminishedresponsiveness
,progressiveblindnessanddeafness,andrecently,seizures.Serumlevels
ofwhichofthefollowingcompoundswouldbeexpectedtobedecreasedin
bothoftheparents?

A.
Dystrophin

B.
HexosaminidaseA

C.
Hypoxanthineguaninephosphoribosyltransferase(HGPRT)

D.
Phenylalaninehydroxylase

E.
VitaminD3
Answer

<30>A60yearoldmalewithanginacomestotheemergencyroomwithsevere
chestpainunresponsivetosublingualnitroglycerin.AnEKGshowsST
segmentelevationintheanterolateralleads,andthrombolytictherapy
isinitiated.Ifstreptokinaseisgiventothispatient,itmayproduce
thrombolysisafterbindingtowhichofthefollowingproteins?

A.
AntithrombinIII

B.
Fibrin

C.
Plasminogen

D.
ProteinC

E.
Thrombomodulin
Answer

<31>Theleftadrenalveindrainsdirectlyintowhichofthefollowingveins?

A.
Hemiazygosvein

B.
Inferiorvenacava

C.
Leftrenalvein

D.
Splenicvein

E.
Superiormesentericvein

Answer

<32>Aprematureinfantdevelopsprogressivedifficultybreathingoverthe
firstfewdaysoflife.Deficientsurfactantsynthesisbywhichofthe
followingcelltypesmayhavecontributedtothebaby'srespiratoryproblems?

A.
Alveolarcapillaryendothelialcells

B.
Bronchialmucouscells

C.
Bronchialrespiratoryepithelium

D.
TypeIpneumocytes

E.
TypeIIpneumocytes

Answer

<33>Asurgeonperformsanexploratorylaparotomy,producingalargeincision
inthepatient'sabdomen.Poorbloodsupplytowhichofthefollowingis
mostlikelytocauseproblemsduringthehealingprocess?

A.
Adiposetissue

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B.
C.
D.
E.

Aponeuroses

Looseconnectivetissue
Muscle
Skin

Answer

<34>A1yearoldchilddevelopsvoluminouswaterydiarrheaandvomiting.She
isbroughttothepediatricianbyherparentsandevaluated,thensenthome
withinstructionsfortheparentstogivethechildanelectrolyte
replacementsolution.Whichofthefollowingvirusesisthemostlikely
causeofthechild'sdiarrhea?

A.
Coronavirus

B.
Lymphocyticchoriomeningitisvirus

C.
Norwalkagent

D.
Orbivirus

E.
Rotavirus

<35>A2yearoldchildpresentstothepediatricianwithhematuria.
Examinationrevealshypertensionandanabdominalmass.Atumorislocalized
totherightkidneyandbiopsyrevealsastromacontainingsmoothand
striatedmuscle,bone,cartilage,andfat,withareasofnecrosis.
Thegeneforthisdisorderhasbeenlocalizedtowhichofthefollowing
chromosomes?

A.
5

B.
11

C.
13

D.
17

E.22
Answer

<36>Anewbornbabyhasaprominentdefectatthebaseofhisspinethrough
whichhismeningesandspinalcordprotrude.Afailureofwhichofthe
followingprocessesisthemostcommoncauseofthistypeofdefect?

A.
Developmentofprimaryvertebralossificationcenters

B.
Developmentofthebody

C.
Developmentofthepedicle

D.
Developmentofthesuperiorarticularprocess

E.
Fusionofthevertebralarches
Answer

<37>A45yearoldmalepresentstothephysicianwithmusclecramps,
perioralnumbness,andirritabilityoverthepast3to4months.Lab
resultsrevealhypocalcemia,normalalbuminlevel,andhyperphosphatemia
.Parathyroidhormonelevelisdecreased.Alkalinephosphataselevelis
normal.Whichofthefollowingismostlikelycausingthisclinical
scenario?

A.
Bonemetastases

B.
Hashimoto'sthyroiditis

C.
HypervitaminosisD

D.
Hypomagnesemia

E.
Previoussubtotalthyroidectomy
Answer

<38>Inwhichofthefollowingorgansarefenestratedendothelialcells
common?

A.
Heart

B.
Liver

C.
Lungs

D.
Pancreas

E.
Stomach
Answer

<39>Amacroscopichepaticchangeknownasnutmegliverisindicativeof

A.
acuteleftsidedheartfailure

B.
acuterightsidedheartfailure

C.
alcoholtoxicity

D.
chroniccongestiveheartfailure

E.
livercirrhosis
Answer

<40>A26yearoldmanisadmittedthroughtheemergencydepartmenttothe
hospitalforaheroinoverdose.Hisheartrateis45beats/min,andhis
bloodpressureis75/40mmHg.Whichofthefollowingbestdepictsthe
resultsfromanarterialbloodsample?

pH
PaCO2(mmHg) HCO3(mEq/L)

A.
7.22 66
26

B.
7.34 29
15

C.
7.40 40
24

D.
7.47 20
14

E.
7.49 48
35

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Answer

<41>Themaximumexpiratoryflowvolumecurveshownaboveiscreatedwhen
thepatientinhalesasmuchairaspossibleandthenexpireswithmaximum
effortuntilnomoreaircanbeexpired.Whatistheforcedvitalcapacity
ofthispatient?

A.
1.5Liters

B.
2.5Liters

C.
3.5Liters

D.
4.5Liters

E.
6.0Liters

Answer

<42>A25yearoldmalegetsintoabrawloutsideabar.Duringthe
altercation,someonepullsoutagunandshootshiminthehead.
Thebulletenterstheman'stempleandsevershisrightopticnerve
completely.Heisquicklytransportedtoanearbyemergencyroomand
anemergencyphysiciantestshispupillaryresponsebyshiningalight
intherighteye.Whatwillthephysicianmostlikelyfind?

A.
Nopupillaryconstrictionintherighteye,andnopupillaryconstrictioninthelefteye

B.
Nopupillaryconstrictionintherighteye,butpupillaryconstrictioninthelefteye

C.
Pupillaryconstrictionfollowedbypupillarydilatationinbotheyes

D.
Pupillaryconstrictionintherighteye,andnopupillaryconstrictioninthelefteye

E.
Pupillaryconstrictioninbotheyes

F.
Pupillarydilatationinbotheyes
Answer

<43>Apatientcomplainingofchestpainwithexerciseisevaluatedby
cardiaccatheterization.Theleftanteriordescending(LAD)branchof
thecoronaryarteryisvisualizedbutthecontrastangiographyispoor
.ADopplertippedcatheterisinsertedandthebloodvelocityisobserved
toincreasetransientlyfrom10cm/secto70cm/secandthendecreasebac
kto10cm/secastheprobepassesaparticularlocationintheartery
.Whatwasthecauseofthesechangesinvelocitymeasurements?

A.
Acoronaryarteryaneurysmwithacrosssectionalarea1/7ththesizeofthenativeartery

B.
Acoronaryarteryaneurysmwithacrosssectionalarea7timesgreaterthanthenativeartery

C.
Acoronaryarteryobstructionwithacrosssectionalarea1/7thofthesizeofthenativeartery

D.
Acoronaryarteryobstructionwithacrosssectionalarea7timesgreaterthanthenativeartery
Answer

<44>Typeofbloodvessel
Aortaandlargearteries
Smallarteries1020
Arterioles
50
Capillaries
25
Venulesandsmallveins
Venacave
<1

Fallinbloodpressure(mmHg)(%oftotalperipheralresistance)
<1

Thetableaboveshowsthefallinbloodpressurethatoccursforthe
varioustypesofbloodvesselsasbloodflowsfromtheaorta(100mmHg)
totherightatrium(0mmHg).Whichofthefollowingtypesofblood
vesselislikelytohavethehighestratioofwallcrosssectional
areatolumencrosssectionalarea?

A.
Aortaandlargearteries

B.
Smallarteries

C.
Arterioles

D.
Capillaries

E.
Venulesandsmallveins

F.
Venacavae
Answer

<45>Evaluationofaninfantwithavarietyofcongenitalabnormalities
revealshypocalcemiaduetoalackofparathyroidhormone.Onxray,the
thymicshadowisabsent.Afailureofdevelopmentanddifferentiationof
whichofthefollowingembryonicstructureswouldmostlikelybe
responsiblefortheobservedpresentation?

A.
Secondpharyngealarch

B.
Secondpharyngealcleft

C.
Secondpharyngealpouch

D.
Thirdpharyngealarch

E.
Thirdpharyngealpouch
Answer

<46>Apersonliftsonefootpriortotakingastep.Whichofthefollowing
nervesinnervatesthemusclegroupthatallowsthepersontomaintain
balancebyholdingtheweightofhisbodyoverthefootremainingon

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theground?

A.

B.

C.

D.
E.
Answer

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Femoralnerve
Firstandsecondsacralnerves
Obturatornerve
Superiorglutealnerve
Tibialnerve

<47>A21yearoldcollegestudentfromConnecticutwithapasthistory
ofLymediseasepresentswithchronicpainandswellinginhisright
knee.Hestatesthathehashadproblemswiththekneeforthepast
twoyears.WhichofthefollowingHLAalleleswouldyouexpectto
bepresentinthisindividual?

A.
HLAB9

B.
HLAB17

C.
HLAB27

D.
HLADR3

E.
HLADR4
Answer

<48>Whichofthefollowingmetabolicprocessesoccursexclusivelyin
themitochondria?

A.
Cholesterolsynthesis

B.
Fattyacidsynthesis

C.
Gluconeogenesis

D.
Glycolysis

E.
Hexosemonophosphateshunt

F.
Ketonebodysynthesis

G.
Ureacycle

Answer

49>Analertpediatricinternnoticesthataneonatewithdysmorphicfacies
istwitchingabnormally.Ashewatches,thebabyexperiencesaseizure.
Statlaboratoriesindicateaglucoseof90,serumsodiumof140,serum
potassiumof4.2andserumcalciumof3.9.Overthenextseveralmonths,
thechildisadmittedtothehospitaltwiceforCandidainfections,and
onceforaviralexanthem.Whichofthefollowingisthemostlikely
diagnosis?

A.
Ataxiatelangiectasia

B.
Bruton'shypogammaglobulinemia

C.
DiGeorgesyndrome

D.
Severecombinedimmunodeficiency

E.
WiskottAldrichsyndrome

Answer

50>A2montholdboyisevaluatedforfailuretothrive.Asthepediatrician
isexaminingthepatient,shewitnessesaseizure.Physicalexamination
isremarkableforhepatomegaly,afindinglaterconfirmedbyCTscan,
whichalsorevealsrenomegaly.Serumchemistriesdemonstratesevere
hypoglycemia,hyperlipidemia,lacticacidosis,andketosis.Whichof
thefollowingdiseasesbestaccountsforthispresentation?

A.
Gaucher'sdisease

B.
McArdle'sdisease

C.
NiemannPickdisease

D.
Pompe'sdisease

E.
vonGierke'sdisease

Answer
Answer

Answers

1>ThecorrectanswerisB.Oneofthemostcommonsideeffectsofanyantineoplastictherapyisweightlosssecondarytodecreasedappetiteand/ornauseaandvomi
Amitriptyline(choiceA)isatricyclicantidepressantusedinthetreatmentofdepression.Thereisnothingmentionedinthecasestudytosuggestthatthepatie
Methotrexate(choiceC)isanantimetaboliteandfolicacidantagonistcommonlyusedinvariousneoplasticdisordersandinthetreatmentofrheumatoidarthritis.
Neostigmine(choiceD)isacarbamylatingacetylcholinesteraseinhibitorthatwouldnotincreaseappetite.
Prochlorperazine(choiceE)isaphenothiazinederivativeusedprimarilytocontrolseverenauseaandvomiting.Thispatientisnotexperiencingnausea.Furthermo

2>ThecorrectanswerisB.Theprinciplehostdefenseinmycobacterialinfections(suchasthispatient'stuberculosis)iscellmediatedimmunity,whichcausesfo
Whileantibodymediatedphagocytosis(choiceA)isamajorhostdefenseagainstmanybacteria,itisnottheprincipledefenseagainstMycobacteria.
IgAmediatedhypersensitivity(choiceC)isnotinvolvedinthebody'sdefenseagainstMycobacteria.
IgEmediatedhypersensitivity(choiceD)isnotinvolvedinthebody'sdefenseagainstMycobacteria.Itisimportantinallergicreactions.

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Neutrophilingestionofbacteria(choiceE)isamajorhostdefenseagainstbacteria,butisnottheprincipledefenseagainstMycobacteria.

3>ThecorrectanswerisE.Theimmunoperoxidasemethoduseshorseradishperoxidasetoproduceavisiblepigmentwhenaspecificantibodybindstoantigenicsites

4>ThecorrectanswerisD.Pregnantwomenwithchronichypertension"require"antihypertensivetherapywhenthediastolicpressureisgreaterthan100mmHg;howe
Diuretics,suchasbumetanide(choiceA)andhydrochlorothiazide(choiceC),areoftenavoidedsincetheseagentscanproducehypovolemia,leadingtoreduceduter
Fosinopril(choiceB)isanangiotensinconvertingenzyme(ACE)inhibitorthatshouldnotbeadministeredtopregnantwomen,especiallyinthesecondorthirdtri
Alongthesamelines,theuseoftheangiotensinIIreceptorantagonists,suchasvalsartan(choiceE),isnotrecommendedsincetheseagentscausefetalcomplica

5>ThecorrectanswerisD.ThediseaseisDuchennemusculardystrophy,anXlinkedrecessivemusculardiseaseusuallycausedbyadeletioninvolvingthedystrophi
Thefather's(choiceA)sideofthefamily,includingthefather'sbrother(choiceB),mostlikelydoesnotcarrythedefectivegene(sincetheythemselveswould
Themother(choiceC)andpossiblythesister(choiceE)arecarriersof,butnotaffectedby,thedefectivegene.

6>ThecorrectanswerisB.Thecellpicturedisaneosinophil,amemberofthegranulocyticlineageofwhitebloodcells.Thecrystallinecoreofthegranulecont
Lactoferrin(choiceA)isfoundinthespecificgranulesoftheneutrophil.Itinhibitsthegrowthofbacteriabyinterferingwithironmetabolism.
Myeloperoxidase(choiceC)isfoundintheazurophilic(large)granuleoftheneutrophil.Thisenzymeisalsodestructivetobacteria,destroyingtheircellwalls
Histamine(choiceD)isproducedbythebasophilandthemastcell.Thehistaminaseoftheeosinophilregulatestheinflammatoryreactionofthesetwocelltypes.
Tartrateresistantacidphosphatase(choiceE)isamarkerforhairycellleukemia,aneoplasmoftheBlymphocyteline.

7>ThecorrectanswerisE.Thispresentation(fine,nonblotchy,truncalrashinanotveryillchild)ischaracteristicofrubella,orGermanmeasles.IgMspecifi
Bullouspemphigoid(choiceA)produceslarge,tenseblisters.
Dermatitisherpetiformis(choiceB)causesrecurrentcropsofsmallvesiclesorpapules.
Herpessimplex(choiceC)ischaracterizedbycropsofvesiclesonoralorgenitalsites.
Measles(choiceD)causesablotchy,maculopapularerythematousrashthatbeginsonthefaceandspreadsdownward.Patientswithmeaslesareusuallymuchsickert

8>ThecorrectanswerisA.Inasyndromecalledcleidocranialdysostosis,absenceofpartoftheclaviclesaccompaniesabroadskull,andfacialanddentalanomal
Thefemurs(choiceB),metatarsals(choiceC),phalanges(choiceD),andtibias(choiceE)arecartilaginous(formedbyendochondralossification)ratherthanmem

9>ThecorrectanswerisA.Acutepyelonephritisisaninfectiousdiseaseinvolvingthekidneyparenchymaandtherenalpelvis.Gramnegativebacteria,suchasEsc
Erythromycin(choiceB)andtetracycline(choiceE)arebothbacteriostaticantibioticsandwouldnotberecommendedinapatientwithasevereinfection,suchas
Vancomycin(choiceC)isprimarilyusedinthetreatmentofseveregrampositiveinfections.
Phenazopyridine(choiceD)isaurinaryanalgesic,andnitrofurantoin(choiceD)isaurinarytractantiinfective.Althoughnitrofurantoinisindicatedforthet

10>ThecorrectanswerisC.Thefallopiantubeistheonlystructureinthefemalegenitaltractwithaciliatedcolumnarepithelium;thebeatingoftheciliahel
Thecervix(choiceA)andvagina(choiceE)arelinedbysquamousepithelium.
Theendometrium(choiceB)islinedbycolumnarepithelium(althoughafewciliatedcellsmaybepresent).
Thecoveringoftheovary(choiceD)iscuboidalepithelium,andcystswithintheovarycanbelinedbycuboidalornonciliatedcolumnarepithelium.

11>ThecorrectanswerisB.Thedescriptionisthatofgonadaldysgenesis.Intheabsenceoftestosterone,theWolffianductswillregressandfailtodifferentia
SelectivedysgenesisoftheSertolicellscouldproducethesituationdescribedinchoiceA.NormalLeydigcellswouldsecretetestosteroneandproducenormalmal
Femaletypeinternalreproductivetractandmaletypeexternalgenitalia(choiceC)wouldnotbelikelytooccurunderanycircumstances.
ThesituationdescribedinchoiceDcouldoccurwith5areductasedeficiency.Normalmaletypeinternaltractscanformbecausethereisnorequirementfordihyd
ThesituationdescribedinchoiceEisnormal,andwouldnotoccurintheindividualdescribedwhohastesticulardysgenesis.

12>ThecorrectanswerisB.Thefunctionalresidualcapacityistheamountofairleftinthelungsafteranormalexpiration.Becausethisvolumecannotbeexpir
Theexpiratoryreservevolume(choiceA)isthevolumeofairthatcanbeexpiredafterexpirationofatidalvolume.
Theinspiratoryreservevolume(choiceC)isthevolumeofairthatcanbeinspiredafterinspirationofatidalvolume.
Tidalvolume(choiceD)istheamountofairinspiredorexpiredwitheachnormalbreath.
Vitalcapacity(choiceE)isthevolumeofairexpiredafteramaximalinspiration

13>ThecorrectanswerisE.Masticationisacomplexprocessinvolvingalternatingelevation,depression,forwardmovement,andbackwardmovementofthelowerjaw
Thedigastric(choiceA)helpstodepressthelowerjawduringchewing.
Thelateralpterygoid(choiceB)helpstomovethelowerjawforwardduringchewing.
Themedialpterygoid(choiceC)helpstoelevatethelowerjawduringchewing.
Themylohyoid(choiceD)helpstodepressthelowerjawduringchewing.

14>ThecorrectanswerisC.Thevignetteillustratesatypicalpresentationforatumoroftheheart.Primarycardiactumorsarerareandusuallyrequireaninten
Angiosarcoma(choiceA)isamalignanttumorofvascularoriginthatcanoccurasaprimarycardiactumor.Itisthemostcommonmalignantprimarycardiactumor,
Mesothelioma(choiceB)isabenigntumorofmesothelialoriginthatcanrarelypresentasaprimarycardiactumor.Itisusuallyasmallintramyocardialtumorth
Rhabdomyoma(choiceD)isabenigntumorofmuscleorigin.Itcanoccurasaprimarycardiactumor,typicallyininfantsandchildren,inwhomitmaybeassociate
Rhabdomyosarcoma(choiceE)isamalignantneoplasmthatcanalsooccurasarareprimarycardiactumor.Itisofmuscleoriginandusuallyaffectstherighthear

15>ThecorrectanswerisA.Thepituitaryglandislocatedinthepituitaryfossawithintheskull.Thefloorofthisfossaisformedbythesellaturcica.Thela
Theoculomotornerve(choiceB)liesinthelateralwallofthecavernoussinus.Itisfurtherfromthepituitaryglandthanistheabducensnerve.
Theopticnerve(choiceC)isanterosuperiortothepituitarygland.Upwardexpansionofthetumormaycompresstheopticchiasm.
Thetrigeminalnerve(choiceD)isfoundposteriortothecavernoussinus.Twoofitsthreedivisions(ophthalmicandmaxillarydivisions)passthroughthelatera
Thetrochlearnerve(choiceE)isalsointhelateralwallofthecavernoussinus,andwouldbeaffectedlaterifthetumorcontinuedtoexpand.

16>ThecorrectanswerisA.Mallorybodiesareeosinophiliccytoplasmicinclusions("alcoholichyaline")thatarefoundinthelargestnumbersinalcoholichepati

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Alpha1antitrypsindeficiency(choiceB)involvementoftheliverischaracterizedbyperiodicacidSchiff(PAS)positivecytoplasmicgranulesinhepatocytes.
HepatitisA(choiceC)andhepatitisB(choiceD)infectionsaredefinitivelyestablishedwithserologicmarkers.
InWilson'sdisease(choiceE),thereisexcesscopperdepositionintheliver

17>ThecorrectanswerisE.Insociallearning,alsoknownasmodeling,behaviorisacquiredbywatchingotherpersonsandassimilatingtheiractionsintothebeh

18>ThecorrectanswerisB.SucralfateisapromisingdrugthatisnotpresentlyinwidespreadusebecauseitisincompatiblewithH2antagonistssuchascimetidi

19>ThecorrectanswerisB.Thepatient'spresentationisconsistentwithhypothyroidism.Serumthyroidstimulatinghormone(TSH)measurement(choiceB)ismostl
Ahightiterofantithyroidantibodies(choiceA)ischaracteristicofchronicthyroiditis,whichisthemostcommoncauseofhypothyroidism.However,detectiono
T3resinuptake(choiceE)measurementisnotanaccuratetestofthyroidfunction;itisprimarilyusedtoexcludevariousabnormalitiesinthethyroidhormoneb

20>ThecorrectanswerisA.Warfarinistheoralanticoagulantthepatientwasmostlikelytaking.Thisdrugiscommonlyprescribedtopatientswithatrialfibril
Famotidine(choiceB)isanH2blockerthatdoesnotaffectlivermetabolism.
Misoprostol(choiceC)isaprostaglandinE1analogusedinpepticulcerdisease.Itdoesnotaffecthepaticmetabolism.
Omeprazole(choiceD)isaprotonpumpinhibitorusedtodecreaseacidproductioninpatientswithpepticulcerdiseaseorreflux.Itdoesnotaffectdrugmetabol
Ranitidine(choiceE)isanotherH2blocker.Itdoesnotinhibitliverenzymesasstronglyascimetidinedoes.

21>ThecorrectanswerisC.Bullaewiththecleavageplaneabovethebasallayeroftheepidermissuggestspemphigusvulgaris,whichiscausedbyautoantibodiest
Antibodiestoepidermalbasementmembraneproteins(choiceA)areseeninbullouspemphigoid,whichisabullousdiseasecharacterizedbyblisterswithacleavage
AntibodiestoglycoproteinIIb/IIIa(choiceB)areseeninautoimmunethrombocytopenicpurpura.
Antibodiestointrinsicfactor(choiceD)areseeninperniciousanemia.
AntibodiestoTypeIVcollagen(choiceE)areseeninGoodpasture'ssyndrome.

22>ThecorrectanswerisD.Thelesionisamalignantmelanoma.Melanomascandevelopeitherdenovoorinanexistingmole.Sunlightexposureisasignificantri
Thecircumferenceofthelesion(choiceA)ismuchlessimportantthandepth,sinceoneformofmelanoma(superficialspreading)canstillhavegoodprognosisdes
Thedarkness(choiceB)ordegreeofvariationincolor(choiceC)donothaveprognosticsignificanceoncemelanomaisdiagnosed.
Irregularity,orfuzzinessattheborder(choiceE)ofamolelikelesionisagoodcluetopotentialmalignancy,butdoesnotaffectprognosisonceamelanomais

23>ThecorrectanswerisE.Bythethirdweekofdevelopment,hematopoiesisbeginsinthebloodislandsoftheyolksac.Beginningat1monthofageandcontinuin

24>ThecorrectanswerisE.ThepatienthasIcelldisease,alsoknownasmucolipidosisII,whichisduetoadefectiveUDPNacetylglucosamine1phosphotransfera
DeficiencyofalphaLiduronidaseresultsinlysosomalaccumulationofdermatansulfateandheparansulfate(choiceA)inseveralconditionssuchasmucopolysacch
HexosaminidaseAdeficiency(TaySachsdisease)isoneexampleofaconditioninwhichgangliosideaccumulationoccurs(choiceB).
Thereareanumberofdiseasesinwhichglycogendegradation(choiceC)isdefective.Thesearecollectivelytermedglycogenstoragediseasessincetheyresultin
Deficiencyofsphingomyelinase(choiceD),anenzymeinvolvedindegradationofsphingomyelin,resultsinNiemannPickdisease.
Phosphorylationoftyrosinemoieties(choiceF)isunrelatedtolysosomesorlysosomalenzymes;however,decreasedabilitytophosphorylatetyrosinemoietiesmigh

25>ThecorrectanswerisE.95%ofanormallydistributedpopulationwillfallbetweenplusorminus1.96standarddeviationsfromthemean.Sincethepopulation

26>ThecorrectanswerisE.Allthecompoundslistedcanproducecrystalsinjointfluid,butonlymonosodiumurate(associatedwithgout)andcalciumpyrophospha
Basiccalciumphosphate(choiceA)isseeninapatiteassociatedarthropathyandproducessphericalclumpsofnonbirefringentsubmicroscopiccrystals.
Calciumoxalatecrystals(choiceB)areseeninprimaryoxalosisandarebipyramidal,positivelybirefringentcrystals.
Calciumpyrophosphatedihydratecrystals(choiceC)areafeatureofpseudogoutandarerodtorhomboidalshaped,weaklypositivelybirefringentcrystals.
Cholesterolcrystals(choiceD)areseeninchronicandchylouseffusionsininflammatoryanddegenerativearthritis,wheretheyformlarge,flat,rhomboidalplat

27>ThecorrectanswerisB.Theinnervationofthetongueiscomplex.Themandibulardivisionofthetrigeminalnerve(V3)carriesgeneralsomaticsensationfrom
Themaxillarydivision(V2,choiceA)carriessomaticsensationfromthepalate,uppergums,andupperlip.
Thefacialnerve(VII,choiceC)carriestastefromtheanteriortwothirdsofthetongue.
Theglossopharyngealnerve(IX,choiceD)carriessensationandtastefromtheposterioronethirdofthetongue.
Thevagusnerve(X,choiceE)carriessensationfromthelowerpharynx.

28>ThecorrectanswerisB.Brucellaabortusproducesachronic,granulomatousdiseasewithcaseatinggranulomas.Mostcasesoccurinfourstates(Texas,Californ
Bacillusanthracis(choiceA)isthecausativeagentforanthrax.Itusuallyproducescutaneousdisease(malignantpustuleoreschar)atthesiteofinoculationi
Coccidioidesimmitis(choiceC)isadimorphicfungaldiseaseproducingagranulomatouspulmonarysyndromethatismoresevereindarkskinnedindividuals.Dissem
Erysipelothrixrhusiopathiae(choiceD)isapleomorphic,gramnegativerodthatcausesalocalizedskininfection.Itisanoccupationaldiseaseoffishermen,fi
Trichinellaspiralis(choiceE)isanematodeinfectioncausedbytheingestionoflarvaefoundinundercookedmeat.Porkisthemostcommoncontaminatedmeat.Ho

29>ThecorrectanswerisB.ThispatienthasTaySachsdisease,anautosomalrecessivedisordercausedbythedeficiencyofhexosaminidaseA,whichleadstothea
Adefectinthedystrophin(choiceA)geneproducesDuchennemusculardystrophy,characterizedbyonsetofweaknessinearlychildhood.
AseveredeficiencyinHGPRT(choiceC)willleadtoLeschNyhansyndrome,characterizedbyexcessiveuricacidproduction,mentalretardation,spasticity,selfm
Deficiencyofphenylalaninehydroxylase(choiceD)resultsinclassicphenylketonuria,adiseaseinwhichphenylalanine,phenylpyruvate,phenylacetate,andphenyl
HypophosphatemicricketsisanXlinkeddominantconditioncausingabnormalregulationofvitaminD3(choiceE)metabolismanddefectsinrenaltubularphosphate

30>ThecorrectanswerisC.Thefibrinolyticactivityofstreptokinaseisduetoitsabilitytobindandcleaveplasminogen,producingplasmin.Plasmindirectlyc
AntithrombinIII(choiceA)isacoagulationinhibitorthatbindstoandinactivatesthrombin.AntithrombinIIIisanticoagulant,notfibrinolytic.
Fibrin(choiceB)isnotdirectlyacteduponbystreptokinase.Itisindirectlycleavedthroughtheactionofplasmin.
ProteinC(choiceD)isaglycoproteinthatmodulatescoagulationbyinhibitingtheprocoagulantactivitiesoffactorsV/VaandVIII/VIIIa.ProteinChasnoinher
Thrombomodulin(choiceE)isananticoagulantproteinthatbindstothrombinanddiminishesitscapacitytoactivatefibrinogen,FactorV,andplatelets.Thrombom

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31>ThecorrectanswerisC.Theleftadrenalveinandtheleftgonadalvein(eithertesticularorovarian)drainintotheleftrenalvein.Theleftrenalveinthe
Thehemiazygosvein(choiceA)receivesthevenousdrainagefromthebodywallontheleftsideofthethoraxandabdomen.Novisceralorgansdraindirectlytoth
Theinferiorvenacava(choiceB)receivesthedirectvenousdrainagefromtherightadrenalvein,butnottheleftadrenalvein.Remember,theinferiorvenacava
Thesplenicvein(choiceD)receivesthevenousdrainagefromthespleenandpartofthepancreasandstomach.Thesplenicveinispartoftheportalvenoussyste
Thesuperiormesentericvein(choiceE)receivesvenousdrainagefrommuchoftheintestinaltract.Itispartoftheportalvenoussystemandjoinswiththesple

32>ThecorrectanswerisE.Thechildhasneonatalrespiratorydistresssyndrome(hyalinemembranedisease).Thisconditioniscausedbytheinabilityoftheimma
Alveolarcapillaryendothelialcells(choiceA)areimportantinmaintainingthecapillarystructureandpermittingflowofgasesintoandoutofthebloodstream
Bronchialmucouscells(choiceB)producetheusuallythin(inhealthyindividuals)coatofmucusthatlinesthebronchi.
Theciliatedbronchialrespiratoryepithelium(choiceC)isresponsibleformovingthedustcoatedmucuslayeroutofthebronchi.
TypeIpneumocytes(choiceD)arethesquamouscellsthatlinealveoliandpermiteasygasexchange.Thesecellstendtobeimmature(andthick)inprematureinfa

33>ThecorrectanswerisA.Surgeonsworryabouttheirobesepatientsmorethantheirskinnyones,becauseathicklayerofrelativelypoorlyvascularizedsubcuta
Aponeuroses(choiceB)arestrongthickeningsofmusclesheaththatusuallysutureandhealwellaftersurgery.
Looseconnectivetissue(choiceC)iswellvascularizedandsurgeonsdonotusuallyworrymuchaboutitduringthehealingprocess.
Muscle(choiceD)usuallyhealswellaftersurgery.
Skin(choiceE)usuallyhealswell,unlessitbecomesinfected.

34ThecorrectanswerisE.Rotavirusisthemajorcauseofdiarrheaininfantsandchildrenundertheageof2.Thereplicatesintheintestinalmucosa,producing
Coronaviruses(choiceA)usuallycausecoldlikeillnesses.
Lymphocyticchoriomeningitisvirus(choiceB)cancauseheadache,malaise,myalgia,conjunctivitis,and,occasionally,meningitis.
Norwalkagent(choiceC)canalsocausediarrhea,butusuallyaffectspatientsolderthan2years.
Orbivirus(choiceD)isthecauseofColoradotickfever,whichistheonlytickborneviraldiseaseintheUnitedStates.

35>ThecorrectanswerisB.Thisisatoughtwostepstylequestion.Youfirstneededtomakethediagnosis,andthenyouneededtorecallthelocalizationofthi
Theremaininganswerchoicesprovideustheopportunitytodiscusssomeotherknownrelationshipsbetweengenesanddisease.Thisisatopicofintenseresearcht
Chromosome5(choiceA)isthesiteofthetumorsuppressorgeneAPC,whichisinvolvedinthepathogenesisofcoloncancerandfamilialadenomatouspolyposis.
Chromosome13(choiceC)isthesiteofthetumorsuppressorgeneforretinoblastomaandosteosarcoma(Rb)aswellastheBRCA2geneforbreastcancer.
Chromosome17(choiceD)isthesiteofp53(involvedinmosthumancancers),NF1(neurofibromatosistypeI),andBRCA1(breastandovariancancer).
Chromosome22(choiceE)ishometotheNF2gene,whichisinvolvedinneurofibromatosistypeII.

36>ThecorrectanswerisE.Theconditiondescribedisspinalbifidawithmyelomeningocele.Afailureoftheposteriorlylocatedvertebralarchestofuseposterio
Failureofdevelopmentofoneofthepairedprimaryossificationcenters(choiceA)ofthebodycanproduceveryseverescoliosis.
Thebodiesofthevertebrae(choiceB)arethestackingovoidstructuresontheanterioraspectofthespinalcanal.
Thepedicles(choiceC)attachthebodyringthatsurroundsthespinalcanaltothebodyofthevertebrae.
Thesuperiorarticularprocess(choiceD)articulateswiththeinferiorarticularfacetofthevertebraaboveit.

37ThecorrectanswerisE.Thispatientisexperiencingsymptomsofhypocalcemiasecondarytodiminishedparathyroidhormone(PTH)secretion.Thismustalwaysbe
Bonemetastases(choiceA)wouldcausehypercalcemia,asaresultofosteolysis.
Hashimoto'sthyroiditis(choiceB)isthemostcommoncauseofhypothyroidismandresultsindecreasedthyroidhormoneandelevatedTSHlevels.Serumcalciumand
HypervitaminosisD(choiceC)wouldcausehypercalcemia.
Hypomagnesemia(choiceD)maycauseafunctionalhypoparathyroidismbecausemagnesiumisneededforPTHactivityintissue.However,insuchacase,actualPTHle

38>ThecorrectanswerisB.Fenestrated("windowed")endothelialcells,whichpermitfreeflowofserumacrosstheendothelium,areanunusualfeatureofthehepa

39>ThecorrectanswerisD.Chronicheartfailureresultsinbloodstasisinthecentralveinsandcentralsinusoidsofhepaticlobules,withsubsequentcentralh
Acuteleftsidedheartfailure(choiceA)givesrisetoacutepulmonaryedema,withextravasationofplasmaandredbloodcellsintoalveolarspaces.
Acuterightsidedheartfailure(choiceB)leadstoacutecongestionoftheliver,whichdoesnotacquirethetypicalnutmegappearanceasinchroniccongestion.
Alcoholtoxicity(choiceC)leadstoanumberofhepaticalterations.Fattychangeresultsfromalterationinlipoproteinmetabolism,leadingtoaccumulationoff
Livercirrhosis(choiceE)isanendstageconditionthatmaybecausedbyanumberofchronicinsults,suchasalcoholtoxicity,viralhepatitisBorC,andhemo

40>ThecorrectanswerisA.Thismanhasarespiratoryacidosis.Overdosewithdrugsthatsuppressventilation(e.g.,heroin,morphine,barbiturates,methaqualone
ChoiceBreflectsmetabolicacidosis.
ChoiceCisnormal.
ChoiceDreflectsrespiratoryalkalosis.
ChoiceEreflectsmetabolicalkalosis.

41>ThecorrectanswerisD.Theforcedvitalcapacity(FVC)isthedifferenceinvolumebetweenthetotallungcapacity(TLC)andtheresidualvolume(RV).TheTL

42>ThecorrectanswerisA.Thispersonisblindintherighteye.Theafferentlimbofthepupillarylightreflexiscarriedbytheopticnerve(CNII),andthe

43>ThecorrectanswerisC.Flowhasincreased7fold,indicatingadecreaseincrosssectionalareabyafactorof7.Thiswouldbecausedbyanobstruction,not
ChoiceAisincorrect,becauseacoronaryarteryaneurysmwouldproduceanincreaseincrosssectionalarearatherthanadecrease.
Flowhasincreased7fold,indicatingadecreaseinvesseldiameter,thuschoicesBandDareincorrect.

44>ThecorrectanswerisC.Thetableshowsthatthegreatestfallinbloodpressure(50mmHg)occursinthearterioles,whichindicatesthatthearteriolesacco

45>ThecorrectanswerisE.Thethirdpharyngealpouchnormallygivesrisetotheinferiorparathyroidglandsandthethymus.Cellsfromthesepouchesmigratecau
Thesecondpharyngealarch(choiceA)givesrisetoseveralskeletalandmuscularstructures.Theseincludethestapes,styloidprocess,stylohyoidligament,apo
Thesecondpharyngealcleft(choiceB)isnormallyobliterated.Apersistenceofthiscleftmayresultinalateralcervicalcyst,sinus,orfistula.
Thesecondpharyngealpouch(choiceC)givesrisetothetonsillarfossaandthepalatinetonsils.
Thethirdpharyngealarch(choiceD)givesrisetomostofthehyoidboneandthestylopharyngeusmuscle.Thethirdaorticarch,whichpassesthroughthethirdph

46>ThecorrectanswerisD.Themusclesinquestionarethegluteusmediusandgluteusminimus,whicharetheinnervatedbythesuperiorglutealnerve.Textbooks
Thefemoralnerve(choiceA)innervatesmusclesoftheanteriorthigh,allowingextensionofthelegattheknee.

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Thefirstandsecondsacralnerves(choiceB)innervatethepiriformismuscle,whichisalateralrotatorofthethighatthehip.
Theobturatornerve(choiceC)innervatesmusclesofthemedialthigh.
Thetibialnerve(choiceE)innervatesmusclesoftheposteriorlowerleg.

47>ThecorrectanswerisE.Approximately60%ofpatientsintheUnitedStateswhocontractLymedisease,butarenottreatedwithantibiotics,willdevelopfrank
HLAB9(choiceA),andHLAB17(choiceB)arenotthoughttobeassociatedwithLymediseasearthritis.
HLADR3(choiceD)isassociatedwithavarietyofdisorders,butnotLymediseasearthritis.
HLAB27(choiceC),althoughassociatedwithreactivearthritis,isnotassociatedwithLymediseasearthritis.

48>ThecorrectanswerisF.Oftheprocesseslisted,onlyketonebodysynthesisoccursexclusivelyinthemitochondria.Othermitochondrialprocessesincludethe
Processesthatoccurexclusivelyinthecytoplasmincludecholesterolsynthesis(choiceA;incytosolorinER),fattyacidsynthesis(choiceB),glycolysis(choi
Notethatgluconeogenesis(choiceC)andtheureacycle(choiceG)occurinboththemitochondriaandthecytoplasm.

49>ThecorrectanswerisC.DiGeorgesyndromeisduetofetalmalformationofepithelialelementsofthethirdandfourthpharyngealpouches,leadingtothymicap
Inautosomalrecessiveataxiatelangiectasia(choiceA),progressivecerebellarataxiaisaccompaniedbymultipletelangiectasiasonexposedskinandavariable,
InBruton's(Xlinked)agammaglobulinemia(choiceB),childrenhavenormalnumbersofcirculatingTcellswithveryfewcirculatingBcellsandonlytinyamounts
Severecombinedimmunodeficiency(choiceD)isactuallyaclusterofseveraldiseaseswithvariablegeneticscharacterizedbyseverelydeficientTcellfunctions
WiskottAldrichsyndrome(choiceE)isanXlinkeddiseasewiththrombocytopenia,lymphopenia,anddecreasedTcellfunction.Lymphoidmalignancy(e.g.,acutelym

50>ThecorrectanswerisE.vonGierke'sdiseaseisaglycogenstoragediseasecausedbyadeficiencyofglucose6phosphatase.Ittypicallypresentswithneonata
Evenifyoudonotrememberallofthedetailsofthepresentationofthesegeneticdiseases,youshouldbeabletonarrowthechoices:
Gaucher'sdisease(choiceA)andNiemannPickdisease(choiceC)arelipidstoragediseases,andwouldnotbeexpectedtoproducehypoglycemia.
Theotherdiseasesareglycogenstoragediseases,butMcArdle's(choiceB)andPompe's(choiceD)diseaseaffectmuscleratherthanliverandwouldnotbeexpecte

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