Block 1:

1) 72yo man ER 1 wk severe abdominal pain. T101F, HR 106, Abdominal distention and
rebound tenderness localized to LLQ. Leukocyte count 18K (80% segmented neutrophils, 10%
bands, 10% lymphocytes). Abdominal CT scan w/ contract shows 7mm, thickend colonic wall,
and pericolic fat inflammation; there is collection of contrast in this region. Dx?
Diverticulitis?

2) A prospective study exam between gastric cancer and exposure to Selenium. RR of gastric
cancer 0.3 in individuals with high-Selenium diet (95% CI 0.1-0.8), Interpretation?
Selenium is associated w/ lower risk of gastric cancer

3) 10yo boy T1DM 1 yr receiving insulin. 1 hr after morning does, becomes tremulous and
diaphoretic and tachycardia. Hours later, symptoms resolve. Blood glucose now increased. Cause
of hyperglycemia
Inhibition of hepatic protein kinase A

4) 39yo man stabbing pain behind L eye 5 nights. headache begin 1 hr after bed and last 1 hr.
During pain, L side nasal stuffiness and tearing from left eye. Similar series of nightly headaches
6 wks several yrs ago. Dx?
Cluster Headache

5)Couple unable to conceive for 2 yrs. Woman regular cycles no contraceptive. Semen:
Quality: Normal; Quantity: Normal
Color: white; Fructose: 5% of normal
Infertility?
Seminal Vesicles

6) 55 yo man ER 45min after collapsed. HR 120, R: 16, BP: 80/45. Px no other abnormalities.
Hemoglobin 8g/dL, hematocrit 24%, platelet 240K. Endoscopy bleeding duodenal ulcer,
surgically repaired. Received 4 units PRBC. 2 days later lab:
BUN: 70
Creatinine: 3 mg/dL
Sediments: Granular casts
2 wk later, urine sediments clear and renal function is normal. Histo?
Regenerating Tubular epithelial cells.

7) 3 cases of nosocomial pneumonia Klepsiella pneumo in 13 bed ICU. Each pt private, enclosed
room. Infection control?
Promote thorough hand cleaning before and after medical personnel visit each patient.

8)29mo boy 2 wk h/o green nasal d/c and cough. Past h/o frequent respiratory tract illness and
pneumonia. 6m h/o large foul smelling stools, salty taste when she kisses him. No Fx similar
conditions. 5th % for ht 3rd % wt. T100.9F. Abdominal distention. Cystic fibrosis
transmembrane conductance regular gene. Which modification destruction of misfolded
proteins?
Ubiquitination

9) 32yo woman. 5 yrs no conceive. Husband fertility normal. 28d menses. BP 110/70. Exam,
hysterosalpingography, hormone normal. Tx?
Clomiphene

10) 15yo boy 1m behavior changes. Failing class, late night. Family moved. P110, R24,
BP140/85. Pupillary dilation, diaphoresis. Affect agitated, thoughts confused. Dx?
Amphetamine

11) 72yo woman bloody diarrhea 12h diffused abdominal pain 4d. Hx cerebral infarction 3y ago,
recovered completely. Watery stool w/ red blood. Colposcopy patch ulceration area near splenic
flexure. Dx?
Ischemic Colitis

12) 4yo girl 3d puffy eyes. URT infection 1 wk. urine 3+ protein. Urinalysis no RBC/WBC, no
casts. Dx?
Loss of negative glomerular charge

13) 23yo woman 2m no menses. Start 14yo, 28d cycle. Blue tinged vaginal mucosa. Uterus
lower segment, size of orange. Adnexa nontender w/ normal size ovaries. Next?
Measure beta HCG.

14) 70yo man 7d rash. 4-6cm tense bullae filled w/ clear fluid over forearm, lower abd, groin and
thighs. Skin biopsy non-acantholytic blister w/ separation of epidermis from basement
membrane. Autobodies against?
Hemidesmosomal proteins

15) 23yo woman 45mins injury to R shoulder. Hold her R arm external rotation. Tenderness and
absent sensation over lateral aspect of forearm. After reduction, no flex elbow against gravity.
Dx?
Musculocutaneous nerve

16) 78 yo man. 3m h/o increasing back pain. 12lb wt loss. Pain at night by movement. ASA no
relieve. No trauma. Chronically ill. P100, BP160/100. Tenderness to L4-5. No skin lesion, Urine
4+ protein. Bone marrow aspiration pic. Dx?
Multiple Myeloma

17) 26yo P0 women deliver 6lb male. 6m ago received GBS vaccine. Screening indicate
antibody to vaccine. Antibody detected in serum during labor. Newborn appears lethargic. CSF
and blood grew GBS. Which isotype mom has?
IgM

18) 16yo boy T1DM need daily insulin. Poor BG control still. Dr. response?
Giving youself insulin injection can be difficult. Whats it like for you?
19) 25yo man advanced testicular cancer. Cisplatin included, MOA?
DNA

20) Drug X treat trematode and cestode infection. X increase cell membrane permeability to Ca,
causing paralysis, dislodgement, and death. Whats X?
Praziquantel

21) Tracing contractile reponse of skeletal muscle to electric simulation at 5 different

frequencies. Ca in SR highest ?
A?

22) 40yo man MVC. DOA. h/o fever, HA, chills, pain in URQ of abd 5d ago. Liver histo
disruption of normal hepatic lobule. Small shrunken hepatocytes w/ intease eosinophilic
cytoplasm. Fragmented nuclear chromatin. Cytoplasmic bleb formations. Process?
Apoptosis.

23) 20yo man 3m hemoptysis, hematuria, 22lb wt loss. Hypochromic microcytic anemia.
Microscopic?
Light: Glomerular Crecents; GBM: IgG/C3, electron: no deposits

24) 42yo Asian woman n/v/lethargy. 25pack year. 4g wine daily. High dose APAP for
headaches. No illicit drugs. BMI 21. Responsive to painful stimuli. Increased ALT/AST. EtOH
effect?
Induction of cytochrome P450

25) Homologous pairing of chromosomes in prophase 1?

Crossing over

26) 70yo man weakness, nausea, lower abd and back pain radiates to lower extremities. Pale,
cold sweat. HR110, BP90/60. Lower extremities weak pulse. Lower abd bruit. Dx?
Leaking aortic aneurysm

27) 6yo boy almond shaped eyes, temp instable, MR, hyperphagia, obesity. Balanced
tranlocation involving chromosome 15q11-q13. Father and paternal aunt with identical balanced
translocation. Aunts 5yo daughter h/o inappropriate laughter, abnormal gait, MR. why?
Imprinting

28) 25yo woman radical mastectomy w/ removal of axillary lymph nodes on L side. Develop
painful edema of left upper ext. what therapy?
Compression sleeve

29) 33yo woman R handed 3d h/o progressive weakness, numbness of arms/legs. Proximal/distal
weakness of extremities. Areflexia. Vibration/joint position decreased in fingers/toes. Slow nerve
conduction in median, ulnar, peroneal and tibial nerves. What channels impaired?
Voltage gated Na channels
30) 2yo girl PO cephalexin for impetigo by GAS. MOA?
Interference with bacterial cell wall synthesis.

31) 31yo woman 10mins difficulty breathing, severe muscle weakness. 3y h/o Myasthenia gravis
tx c neostigmine. Double dose 2 days ago. Weakness increased, why?
Densensitization of nicotinic receptors.

32) 50yo man 2m h/o wrist pain, skin color change, fatigue. Brother T2DM/cirrhosis. Bronze
color skin, MCP join pain, and hepatosplenomegaly
AST 100, ALT 110, Ferritin 1200, Transferrin sat: 80%.
Liver biopsy increased Fe conc. Why?
Increased intestinal iron absorption.

33) 50yo man T2DM several fainting episodes and fatigue. Chronically ill. Vitals normal.
Hemoglobin 8, hematocrit 24%, BUN 60, creatinine 6. Other heme lab normal. Tx?
Erythropoietin

34) male newborn delivered at 34 wks gestation uncomplicated spontaneous vaginal delivery
develops RDS 30mins later. RR40. Cyanosis and lower rib retraction with respirations. CXR fine
densities with reticulogranular appearance b/l. Dx?
Pulmonary surfactant deficiency

35) 25yo man w/ CF 3d fever, cough, SOB. T100, RR 32. B/L crackels and rhonchi. Grows
aerobic, oxidase +, G rod form slimy colonies and produce pyocyanin. Abx no eradication of
organism. Why?
Biofilm formation in the lower respiratory tract.

36) 20 subjects participate study cardiopulmonary physiology. Pulomary circulation compared to

bronchial circulation?
Larger % of cardiac output.

37) autopy of 46yo women died of colon adenocarcinoma. 5cm round neck mass next to
bifurcation of carotid art. Slide positive for synaptophysin, chromogranin, and neuron-specific
enolase. EM shows numerous electron-dense, membrane bound neurosecretory granules.
Adrenal gland no mass. Dx?
Paraganglioma

38) 40yo man with ED. L bourbon per day for 15y. P:88, BP 130/80. Scleral icterus and spider
angiomata. Liver span 5-6cm midclavicular line. Spleen tip 5-6 cm below L costal margin. what
decreased?
Testosterone

39) Study molecular events in cause of autoimmune disease developes monoclonal antibodies to
ribosomal proteins. A monoclonal antibodies inhibit ribosomal peptidyl transferase. What
effected?
Establishment of covalent bonding between amino acids.
40) 24yo man 25yo woman unable to conceive 3y. wife normal. Mans semen immotile but
normal numbers of sperm. What other problems?
Sinusitis

41) 60yo man 2wk fatigue and exercise intolerance. Dx w/ stage 1 HTN and began tx with
propranolol. Today P56, before P72. Switched to Pindolol. Symptoms resolved in 1 month. P68.
Why
Partial agonism.

42) 9yo boy 2 days of fever, chest pain, migratory joint pain of shoulders, hips and knees. 4 wk
ago, febrile pharyngitis resolved 2wk later w/o tx. T102, lungs clears to auscultation. Pericardial
friction rub and quiet heart sounds heard. Throat culture no pathogens. Increased antibody titers
to streptolysin O. Death?
Myocarditis

43) 57yo man dies of MI. Autopsy lung tissue shows alveoli containing epithelial cells cuboidal
in shape w/ electron dense lamellar bodies. Produce?
Surfactant

44) 52yo man epigatric abd pain. 15lb weight loss. Osteoarthritis tx w/ naproxen PRN.
Immigrated from japan to USA 6 months ago. 60 pack yr. 3-4g wine daily. BMI 28. Exam
epigastric tenderness. Endoscopy show 4cm ulcer. Biopsy adenocarcinoma. What risk factor?
Naproxen

45) 63yo man R chest pain and SOB after 10h truck drive. Pain severe on inspiration. No
smoking. P110, R32, lungs clear to auscultation. V/Q scan?
Absence of perfusion in some areas that are ventilated

46) 40yo man severe pain L leg while playing tennis. Ruptured L Achilles tendon. Surgical
repair and cast immobilization. After 6 months, 2cm decrease in circumference compare to R
calf. Dx?
Increased protein degradation.

47) 45yo man severe headache. Worst headache ever. Lethargic. BP 130/80. Nuchal rigidity, CT
scan w/o contract shown. Dx?
Subarachnoid hemorrhage

48) Study on cardiovascular disease in AA men/women in USA. Series of factor defined. Census
tracts representative of national census data sampled. Technique?
Population based.

49) 23yo woman T1DM f/u. Recurrent yeast infections. Deficiency of myeloperoxidase. Dx?
Inability to produce hydroxy halide radicals.

50) 48yo woman R breast ductal carcinoma has modified radical mastectomy. Results in wing
scapula when pressed arm against wall. Nerve?
Long thoracic.

Block 2:
1) 40yo woman dies after MVC. Controlled seizures for 25yrs. Gross coronal section of brain
photographed. Dx?
Vascular Malformation

2) 48yo man difficulty open mouth, neck and back stiffness. Puncture wound to arm 1 wk ago.
Received no medical care for 30yr. Exam trismus and opisthotonos. Why?
Blockade of inhibitory neurotransmitter release.

3) 38yo woman 32 wk pregnant h/o fever, nausea, vomiting and muscle aches. T102, R20. Gram
stain given (looks like G+rod). Dx?
Listera Monocytogenes.

4) 30yo woman, G2P2, vaginal bleeding after vaginal delivery. Uncontrolled hemorrhage,
hysterectomy to control. Uterus shows fragments of placenta adherent to uterine wall. Absence
of decidua basalis. Dx?
Placenta Accreta

5) 22 yo G0 woman cannot conceive for 18m. irregular menses since 13yo. BMI32. T98, P88,
BP140/90. Moderate hirsutism and mild acne over face/back. Pelvic/genitalia normal. Bimanual
exam limited by obesity. Dx?
PCOS

6) 22yo man study of heat rate regulation. Sitting on bicyle and start to pedal in 5 mins. 1 min
before heart rate increases. Why?
Transmitter: Norepi, Receptor: beta1

7) 55yo man 2 episode of painless, blood tinged urine. Last time was 2 days ago. 35pack yr.
vitals/physical exam normal. Urine microscopic blood. Dx?
bladder cancer

8) 7yo girl 3yr history of temper tantrums when separated from parents. Refuse sleep alone and
attend friends parties. Mom angry with daughters behavior. Father recalls same behavior when
young. Dx?
Separation anxiety disorder

9) 76yo woman 3hr h/o headache, slurred speech, confusion. 2 yo h/o A fib. Difficulty
understanding and answer questions. But cooperative. Optho exam hemianopia and gaze to right.
PERRL. Neuro exam shows left side numbness and paralysis more severe in face and upper
exterimity and lower. Which artery?
Middle Cerebral

10)28yo woman with marital problems. She wants to go out, husband likes to be alone, prefer
hiking, indifferent to sexual intimacy and shows no emotion nor understand her feelings at all.
Dx?
Schizoid

11)76yo man admitted 2wk h/o UTI. BMI 20. IV abx to obtain serum concentration of 8mg/L.
Volume of distribution is 0.35L/Kg. 24hr creatinine clearance normal. Loading dose?
150

12)27yo woman 2y h/o sporadic diplopia and arm numbness and tingling. Symptoms more
severe when in-laws visit. 4 episodes of urinary incontinence. Exam mild dysarthria. Mild
worried mood and reactive affect. Brain MRI few, scattered nonspecific white matter plaques.
Dx?
Multiple Sclerosis

13)55yo manhepatic encephalopathy w/ confusion and increased lethargy. Cirrhosis due to hep
C. T98. Physical exam scleral icterus, asterixis, protuberant abd, ascites. Stool occult blood
negative. Med?
Lactulose

14)60yo man weakness and light headedness for 3 months. Healthy balanced diet of fruits,
vegetables, whole grain, lean chicken and fish. 10yr h/o chronic autoimmune (Hashimoto)
thyroiditis tx w/ thyroxine. Physical exam shows pallor. Serum increased concentration of
methylmalonic acid and total homocysteine. Blood smear shows megaloblastic anemia. Dx?
Failure of intrinsic factor production

15)55yo woman scheduled for transvaginal hysterectomy and oophorectomy for uterine
bleeding. Uterus separated from all surrounding structures. Incision of what structure that
attaches to cervical region and extend posteriorly ?
Uterosacral ligament

16)24yo woman pain in left leg while walking. T98, P84, BP135/78. Exam: Left lower extremity
decreased pulse. Faint diastolic heart murmur at apex. Angiograph of lower extremity show
complete obstruction of distal L femoral artery by thrombus. Occlusion removed and specimen
shows scattered mesenchymal cells with abundant extracellular matrix. Echo confirm cardiac
tumor. Dx?
Myxoma

17)3yo boy multiple ecchymoses, bleeding into joint, bloody diarrhea 48h after ingesting lots of
warfarin. PT80 (INR=20). Tx?
Fresh Frozen Plasma
18)35yo man 5y h/o recurrent genital herpes tx w/ acyclovir. Pt complain of recurrent lesions.
Explain?
Established latent infection of sensory nerve cells

19)49yo man pancreatic cancer undergoes Whipple resect distal stomach, duodenum, head of
pancrease. Stomach joined w/ jejunum. Which nerves can be cut to reduce ulcers in jejunum?
Vagal trunks.

20)22yo woman admitted due to polydipsia and polyuria. Urination awakes pt at night. Taking
Lithium for bipolar. Dose increased 6 months ago due to recurrent manic. Vitas and physical
exam normal. 24hr Urine excretion 6.5L. Serum Na: 75, osmolality 315, urine osmolality 75.
Output and osmolality no change after desmopressin. Nephron tubular osmolality compared to
serum?
PCT: isotonic, Juxt: hypotonic, Collect Duct: hypotonic.

21)6yo girl severe abd pain, nausea, vomit after attending friend party. Cake and pastries served.
Appears acutely ill and mildly dehydrated. T98, P104, R20. BP: 96/60. Normal skin. Bowel
hyperactive. Dx?
Enterotoxin ingestion

22)31 yo woman 1yr infertility. Hysterosalpingogram shown. Malformation?

Paramesonephric (mullerian) ducts.

23)40yo woman genetic counseling of family history of muscle weakness. No treatment b/c
symptoms not severe. Her children have profound muscle weakness and fatigue. Analysis of
mtDNA shows mutation in 50% of mother mtDNA and 100% in all 4 childrens mtDNA.
Genetic principle?
anticipation?

24)Male newborn delivered at 38wks uncomplicated pregnancy. 12 hr post, sucking frantically

and crying inconsolably. Overreacts to stimuli and marked startle response. Resolved after 2-3
wks. Maternal use?
Heroin

25)21 yo AA man w/ sickle cell disease, severe pain to abdomen and knees. 6 episodes in 4 yrs.
2 episodes of pneumonia and small cerebral infarction in past 2 yrs. Asks for extra pain meds,
unbearable to symptoms. Dr tx?
Reevaluate patient after pain has been controlled.
26)72 yo woman admitted to ICU after surgical repair of ruptured colonic diverticulm. 2 wk
developed recurrent fevers. Blood grew yeast, micafungin started. MOA?
Cell Wall
27)25yo man admitted to tx viral pneumonia. Mechanically ventilated due to respiratory failure
due to hypoxemia. Open lung biopsy shows acute lung injury. What suggest diffuse alveolar
damage rather than bronchioloitis obliterans-organizing pneumonia?
Alveolar hyaline membrane

28)54 yo woman severe mid back pain. Point tenderness over T6 vertebra. Serum show Ca: 13.4,
urine: Bense Jones proteins. Hypercalcemia?
Local IL-1 and TNF effects.

29)15yo boy intracranial neoplastm, MR, seizure due to tuberous sclerosis. AD. 41yo mother is
healthy but has angeofibromas. Which are benign skin lensions of TS. Why?
Variable Expressivity.

30)Study conducted assess effectiveness of vitamin C to prevent common cold in children. Pt

randomly assigned to receive either vitamin C or no intervention. Common colds are reported by
parents monthly for 1 yr. Results show vitamin C children had fewer colds (p<0.05). whats
problem?
Variability in outcome assessment?

31)54yo man burning epigastric pain. Divorced. Fast food diet. Smoke cigars and drinks on
weekends. Treated for H. pylori 1 yr ago. Takes OTC IBU600 daily for chronic joint pain.
Abdominal exam show tenderness to deep palpation of epigastric area. Peptic ulcer suspected.
Risk?
Ibuprofen use

32)2mo boy dies of meningitis despite abx tx. CSF grew mycobacterium Tuberculosis. 2
brothers died of atypical mycobacterial infection. Dx?
Interferon gama receptor deficiency.

33)23yo woman h/o chills, nausea, vomiting, flank pain, urinary frequency and urgency, pain w/
urination. T102, P125, BP96/60. Right CVA tenderness. Urine 25 WBC, pink colonies on
Lactose-MacConkey agar. Green sheen on eosinmethylene blue agar, indole positive. What
virulence?
Adhesions

34)9yo girl severe pain in right shoulder after fall. Exam pain on movement and tender right
clavical. XR shows nondisplaced fracture of right clavical. Which structure produce new bone
healing?
Periosteum

35)18yo woman mild MR with decreased ability to see in reduced light. Chronic diarrhea. 2 y
ago lack of muscle control of her arms and legs and generalized weakness. 16 yo brother has
similar symptoms. Eye exam bilateral retinitis pigmentosa. Ataxia and loss of DTR. Erythrocytes
with spiny projections and total cholesterol: 40. Which APO deficient?
APO B
36)39yo woman at end stage renal disease by SLE undergoes allograft kidney transplant.
Rejection after 6 months. Biopsy of transplant show numerous infiltrating CD8+ T lymphocytes.
Why?
Direct Cytotoxicity

37)23 yo woman tx with acetazolamide to prevent acute altitude sickness 3 days before mountain
climbing expedition. MOA?
Proximal tubule

38)retrospective study assess incidence and outcome of subarachnoid hemorrhage. Annual

incidence is 15 per 100000 ppl. Fatality rate 40%. Whats annual mortality rate?
0.4 x 15

39)51yo man bloody cough. 6.6lb wt loss. 62 pack yrs. HTN treated w/ metroprolol. Clubbing
fingers. Wheezing over right upper lob anteriorly. No crackles. LAB:
Na: 125, Cl: 85, Creatining: 0.4
CT Chest 2.4x1.2cm speculated noncalcified mass in right upper lobe eroding into right
bronchus. Which hormone excess?
Brain Natriuretic peptide

40)Experiment cuff oclcuder placed on left renal artery of normal rat inflated to cause 90%
decrease in artery cross section. Catherter placed in Left/Right renal veins. What higher in
effluent of left than right?
Renin

41)21yo man dies of cardiac arrest after snorting cocaine. Dx?

Norepi reuptake.

42) 18yo man twisted ankle while playing football. Tear of lateral collateral ligament. What
limits ligament healing?
blood vessels

43)82yo woman tx for small right pleural effusion. Exam dullness to percussion at level of 7th
rib and below on right. Pt sitting up. Whats location for thoracentesis?
above 9th rib in the midscapular line

44)32 yo man intermittent flashing spots, blurred vision, vomiting, confusion and difficulty
walking. Painter and claims cleaned up spilled bottle of paint thinner. Eye exam show dilated
pupils w/ hyperemia of optic disc and retinal edema. Physical show tachypnea. Serums anion gap
metabolic acidosis. Meds inhibit what?
Alcohol Dehydrogenase

45)52 yo man renal failure with abdominal pain for 6 months. treated for renal calculi and HTN.
Physical exam shows bilateral palpable masses in upper abdomen. Urinalysis crenated
erythrocytes and mild proteinuria. CT abdomen ID cause, Dx?
PCKD
46)22 yo woman f/u exam. Dx w/ PE. 2 yrs ago delivered a female stillborn at 23wk. today
normal. Platelet: 250K. PT normal, increased PTT. Dx?
Antiphospholipid antibody syndrome.

47)62yo man progressive difficult breathing and mild left shoulder pain. Symptoms started after
ran up stairs. Poorly controlled HTN and mild angina pectoris. 20 pack yr. uncomfortable with
labored breathing. Diffused crackles, rhonchi, scattered wheezing on posterior lung fields. PO2
58. Dx?
Pulmonary edema

48)Mouse melanoma, B16, highly metastatic. B16 clone infected into tail vein of mice. Tumor
found in lungs, liver and ovaries. When antibody to liver cell surface antigen is injected before
B16. Only tumors in lungs and ovaries, No tumor in lungs. In vitro no cytotoxic effect of
antibody to B16 or hepatic cells. Why?
Homing

49)64 yo woman heartburn and difficult swallow solid food and liquid. No nausea no vomit. Pain
in wrist and hands. No meds. No smoke. No wrinkles on face and neck. Vitals normal. Synovial
thickening of wrist bilaterally. Photo of hand provided. Abdominal exam normal. Esophageal
manometry?
Esophagus Peristalsis: decreased; esophagus Sphinter tone: decreased

50)33 yo woman 35lb wt gain despite diet. BMI 37. BP 156/96. Round ruddy face with
hirsutism, excess wt in shoulders and abdomen and purple striae over the abdomen. MRI mass in
pituitary gland. CT abdomen enlarged adrenal glands. Histo changes of adrenal glands?
Cortical hyperplasia.

BLOCK 3:
1) 18mo boy facial abnormalities and slow growth. Older brother w/ same abnormalities with
MR. Pt below 3rd % for length and 10th % for wt. Exam coarse facial features,
hepatosplenomegaly, joint stiffness. Urine dermatan sulfate and heparin sulfate increased.
Deficiency?
Iduronate sulfatase

2) 45 yo woman heart murmur and hepatomegaly. Flushing with hypotension and crampy
diarrhea. Primary neoplasm?
small intestine.

3) 43 yo man BMI 30. Physical exam no abnormalities. Older brother DM. Pt does not want to
be DM. what diet?
low Calorie

4) 35yo man gradual ED. Decreased facial hair. Puberty started at 12. BMI 23. Vitals normal.
Physical exam typical male pattern hair, genital normal. Serum TSH: 2, prolactin 120. Total
testosterone 25 (N= 10~35). Semen decreased sperm count with impaired motility. MRI brain
1cm lesion in pituitary gland. Tx?
Bromocriptine

5) 60yo man skin blistering. Blisters in mouth easily ruptured. Scattered blisters over
upper/lower extremities, trunk intermingled with crusted denuded areas. Biopsy intraepidermal
vesicle formation. IgG deposit in keratinocytes. What structure involved in skin?
Desmosomes.

6) 60yo man progressive weakness to hands. Carpenter w/ difficulty handle tools. 45 pack yr. 2
beers daily, 6 beers on weekends. No LAD. Decreased strength (4/5)in upper and lower
extremities and atrophy in hand muscles. Diffuse hyperreflexia. Fasciculations noticed on
muscles on hands and upper extremities. Next?
Difficulty Swallowing

7) male newborn 34wk delivered vaginally. no abnormalities except 1cm raised red area on
anterior section of neck. Dr explain lesion is hemangioma. Origin?
Endothelium

8) 42 yo with numbness to fingers on left hand. Neuro exam shows loss of touch graphesthesia
and loss of 2 point discrimination on left hand. Where is lesion?
B?

9) 25 yo woman decreasing urine output despite ample fluid intake. Removed perforated
appendix 3 wks ago. IV gentamicin for 2 wks. Physical Exam normal. BUN: 35, Creatinine: 2.9,
Urine protein: 2+, Casts: brown granular. Histo where is necrotic cells?
Proximal Tubule

10) Pharm company design new Protease inhibitor what inhibit HIV in T lymphocytes in culture.
What finding indicate PI is working?
Lack of mature core

11) 5 yo boy headache, clumsiness and fatigue. Generalized tonic clonic seizure 1 month ago.
Often falls during running. Eye exam ptosis of left eye and b/l external ophthalmoplegia.
Weakness of left lower extremity. Increased lactate concentration. Calf muscle biopsy shows
ragged red fibers. What impaired?
Oxidative phosphorylation.

12) 42 yo man muscle cramping and pain. Treated w/ simvastatin for hypercholesterolemia.
Marked improvement after 1 month but triglyceride remain increased. Gemfibrozil added to
decrease triglyceride. Physical exam normal. Why myalgia?
Inhibition of cytochrome P450 metabolism.

13) 2 clinical trials. Trial X and Trial Y to assess efficacy between new and current antibiotics
for UTI. Studies identical, except statistical power. Trial X = 0.8 and Trial Y = 0.9. Type 2 error?
Greater in Trial X than in Trial Y
14) 43 yo man lower back pain. Complain about PCP to ER dr. Whats response?
Encourage pt to make appointment with physician to communicate his concerns

15) 44 yo man angina pectoris with increasing chest pain. 5 similar episodes needing increased
nitroglycerin. T98, P105, R16, BP150/90. S4, ST depression in precordial leads. Given ASA,
heparin, nitroglycerin and monoclonal antibody against platelet IIb/IIIa receptor. Prevent what
binding to platelets?
Fibrinogen

16) 44 yo woman pain, swelling, stiffness to both hands. Worst in mornings symptoms improve
with activity. Painless nodules on extensor surfaces of arms and tenderness and swelling of MCP
and PIP joints. What path process?
Pannus formation

17) 4 yo boy headache, nausea, vomiting and dizziness. Physical exam severe lethargy. Venous
blood bright red. Carboxyhemoglobin sat 30% (N<5%). Which electron transport pathway
effected?
Cyt a/a3 O2

18) 3 yo girl grade 4/6 loud harsh, high pitched holosystic murmur radiates over the precordium
and palpable thrill at left sternal border. Defect?
VSD

19) 48 yo woman 3 hr history of nausea and sharp right abdominal pain radiate to back. Physical
exam Enlarged right ovary, pregnancy test negative. U/S confirm enlarged right ovary. Dopple
U/S decreased adnexal flow. What affected?
Suspensory ligament

20) 65 yo woman diabetic ketoacidosis, fever and proptosis of left eye. Unable to move left eye.
Black eschar on nasal mucosa. Dx?
Mucormycosis.

21) 22 yo woman painless, slowly enlarging mass on left side of neck. Physical exam freely
mobile, soft, cystic mass with cutaneous surface opening. Dr explain imcomplete fusion during
embryonic development. Wheres location of duct?
Anterior to SCM

22) 55 yo man fever and shaking chills. End stage renal disease tx w/ hemodialysis. T 102, P110,
BP 156/92. Physical exam tunneled central venous catheter enter right side of chest below
clavicle; not tender. Echo 3cm vegetation on tricuspid valve. Dx?
Staph aureus

23) 42 yo man autoimmune disorder proximal muscle weakness of lower extremities. Arrows
show indicate membranes that contain high concentrations of channels targeted by disease. Dx?
Myasthenic(Lambert-Eaton) syndrome
24) 18yo G0 woman at 16 wk gestation, nausea, vomiting. No prenatal care. Uterus consistant
with 20 wk gestation. B-HCG increased, urine protein 4+. U/S echogenic material within
endometrial cavity but no fetus. What proliferated?
Trophoblastic tissue

25) 30 yo woman and 25 yo husband ask having another child w/ Tay-Sachs. 6 month old son
Dx w/ Tay-Sachs. Both has Fx of disease. Whats risk?
25%

26) 20 yo man cramping periumbilical pain. Pain shifts to RLQ and consistant. T104, WBC
20,000 with 90% neutrophils. What mediator cause fever and leukocytosis
IL-1

27) 47 yo man sharp left flank pain and fever. T100, Abdominal exam exquisite tenderness in
Left CVA. Labs normal. Image show hydronephrosis of left kidney and staghorn calculus.
Nephrectomy done, calculus composed of Struvite. Bug?
proteus mirabilis

28) 12 yo AA girl fever, severe rib pain. Recurrent, paternal aunt/uncle same. T102. Lungs clear.
Abdominal exam tenderness to palpation. Blood smear shown. Cause?
Polymerization of hemoglogin w/ hypoxic conditions due to amino acide substitution to beta
chain

29) 43 yo woman metastatic colon cancer remission with bevacizumab. Bevacizumab works
because?
the agent being a humanized antibody

30) 32 yo woman progressive SOB and anxiety. Symptoms worse as day progresses. BMI 24.
Breath sounds normal, but pt difficult taking long breath.
pH 7.33, PCO2: 70, PO2: 65. Pulmonary function test show decreased vital capacity, tidal
volume and expiratory reserve volume. Residual volume normal. Dx?
Myastenia Gravis

31) 15 yo boy painless swelling in left breast for 1 month. 65% ht, 70% wt. P65, BP 118/76.
PHyscial exam mild facial acne, thickening mustache hair on face, axillary hair. No adenopathy.
Left breast mildly enlarged with palpable breast buds. Right breast normal. Genitalia tanner stage
3. Statement?
this is a common condition for teenage boys and should resolve in time.

32) 3 yo girl consumed 25 metformin tablets. Physical exam normal. Greatest risk?
Increased lactic acid concentration

33) 18yo man T101, sore throat, cervical lymph node enlargement. EBV antibody positive.
Atypical cells with abundant lacy cytoplasm in blood smear derived from?
T lymphocytes.
34) Trangenic mice develops severe fasting hypoglycemia. Glucagon does not correct
hypoglycemia but epinephrine results increase in serum glucose. What protein defective?
glucagon receptor

35) 3 yo boy unexplained fever, lack perspiration, absence response to noxious stimuli, self
mutilating behavior Dx congenital insensitivity to pain with anhidrosis. Gene analysis shows
missense mutation of tyrosine kinase domain of TrkA gene. This only single defect. Whats
disrupted?
Phosphorylation of downstream molecules in response to nerve growth factor

36) 60yo woman DM with decreased vision over past year. Eye show milky opacity of both
lenses. What metabolite responsible?
Sorbitol

37) 6yo boy fever, sore throat, occasional vomit. T102. Physical exam erythema and purulent
exudate over posterior pharyngeal wall and tonsils. Anterior cervical glands enlarged and tender.
Throat culture grows GAS. Allergy to PCN. Tx w/ erythromycin. MOA?
Interferes with translocation.

38) 60yo man fluctuating weakness. Difficulty lifting books. Drooping of eyelids and double
vision. Difficulty climbing stairs and regurgitation of liquids into nose. PHyscial exam weakness
increases with repeated exercise. CXR mediastinum mass. Lab positive?
Actylcholine receptor antibody

39) 12 yo woman throbbing headache associated with sensitivity to light and sound. Neuro exam
normal. Sumatriptan initiated for migraie. Activate what receptor?
serotonin

40) 5 yo girl listlessness, fatigue, dull pain URQ abdomen. Ht/wt below 25%. Beta globin chain
15%-20% normal. Point mutation from AATAAA to AACAAA. mRNA for beta globin is
decreased to 10% normal. Whats AATAAA function in mRNA synthesis and processing?
Cleavage and polyadenylation

41) Investigator study human immune reponse to tumor cell antigens in malignancies. Which set
cancer: tumor antigen produces highest antibody titer?
Cancer type: Cervical cancer; tumor Antigen: HPV type 16E6 protein

42) 54 yo man light headedness. Started after skiing at 9000ft. taking carbonic anhydrase
inhibitor. BP110/60, sitting BP95/50. Physical exam normal. Why hypotension?
Hypovolemia

43) 23yo man low grade fever, nasal congestion, muscle aches. Eyes yellow, no clay colored
stools or dark urine. Taking IBU. No foreign travel, tattoos, or IV drugs or exposure to blood
products. BMI 23, physical exam mild scleral icterus but no subungual icterus. Total bilirubin
2.6. Dx?
Gilbert syndrome
44) 55yo man recovered from stroke. Lives alone. Risk?
Major Depressive disorder

45) 42 yo man SOB, night sweats, wt loss, fatigue. CXR enlargement of hilar lymph nodes and
nodular infiltrates in both lungs. PDD test negative. Lung biopsy shows multiple noncaseating
granulomas with many giant cells. No organisms. Dx?
Sarcoidosis

46) 48yo man concerned about wt. BMI29. Waist circumference 41in. BP140/90. Protuberant
abdomen. Serum glucose and insult remain increased after 75g of oral glucose. Serum finding?
Triglycerides: increased, HDL: decreased; FFA: increased.

47) 20yo man cramping abdominal pain and diarrhea. 10lb wt loss. Pain after meals. Camping
trip upstate new york, swimming in lakes and hiking in mountains. Vital signs normal. Physical
exam normal. Test?
microscopic examination of stool for ova and parasites

48) screening test detect prostate cancer in 100,000 men. Sensitivity 70%, specificity 90%. Test
used to screen second population which prevalence of prostate cancer is different. Whats PPV?
increases as prevalence increases

49) healthy person, thyroid gland produce and secretes T4. What describes T4 biding substance
in blood and type of cellular receptor?
Binding substance in blood: Globulin; Receptor in peripheral tissue: Nuclear

50) 77yo woman dies, vertebral column shown. Process associated w/ what increase?
Interleukin 1

BLOCK 4
1) 32 yo man back pain and joint stiffness. Improve after mild exercise. Fatigue and 7lb wt loss.
Physical exam and xray of sacroiliac joint confirm ankylosing spondylitis. Test to evaluate
susceptibility of 2 children?
Analysis of class I MHC allele expression

2) epidemiologist investigate diarrhea outbreak among 1000 consumers. 800 ate tomato, 200 ate
lettuce. 400 became ill, 80 ate tomatoes, 40 ate lettuce. Whats probability of diarrhea who ate
lettuce?
0.2

3) 55 yo man intermittent heartburn. 2 episode weekly develop burning pain between chest and
abdomen when lie down for nap after dinner. Bitter taste with pain. Alcohol before and during
dinner. BMI 36. Physical exam no other abnormalities. Tx: Wt loss and decrease EtOH. What
drug?
Omeprazole
4) 35yo man farmer. Difficulty breathing sweating, excess salivation, diarrhea. Symptoms started
when applying insecticide to crops. T96, P50, R22, BP 90/60. Tx?
Atropine

5) 59yo woman metastic renal carcinoma receiving cyclophosphamide, paclitaxel and IL2. Why
IL2?
stimulate T lymphocytes.

6) 76 yo man CHF, SOB after walk stairs. Nausea, 2 pillow for sleep. Diffuse moist crackles
heard both lungs. Pitting edema above ankles. Function of product secreted by atrial myocytes?
Inhibition of renin release

7) study death from CAD. Persons 30+ studied. BP, cholesterol, smoking assessed along w/
death from CAD. Perons w/ increased BP compared to normal BP to determine greater mortality
from CAD. Study type?
Observational cohort study

8) 32 yo man generalized band like headaches and dizziness everyday. Physical exam and CT
scan normal. What findings dx hypochondriasis rather than somatoform disorder?
disproportionate fear of serious disease

9) 47 yo woman complain about wrinkles. Tx: tretinoin. MOA?

activation of nuclear gene transcription

10) 35 yo man wt loss, chronic abdominal pain, bloating, frequent voluminous, greasy
malodorous stools. Adolescent symptoms resolved spontaneously. Mother similar illness
controlled by restricting wheat, barley and rye in diet. Pt chronic pruritic rash on elbow. Dx?
Dermatitis Herpetiforms

11) 25yo man receives Bupivacain block median nerve for carpal tunnel syndrome. MOA?
Decreased permeability to Na+

12) 15 yo boy sneezing, coughing, watery eyes immediately after mows lawn. 15 mins later red
rash soft to touch. Physical exam shows boggy, soft, raised pruritic, erythematous lesions with
wheal and flare eruptions over the face, trunk, and back. MOA?
type 1 (immediate) hypersensitity

13) 46 yo man SCC of esophagus. Barium swallow shown. Esophagectomy involve ligation of
arterial branches of?
Aorta

14) 8 yo boy severe MR, self mutilating behavior, biting fingers. Male cousins similar
symptoms. Physical exam shows spasticity, chorea, and mutilation of digits. Labs show?
Hyperuricemia

15) 26 yo woman 30lb wt gain. Irregular periods, constipation, fatigue. Increased difficulty
concentration and memory. BP 145/84, dry skin, decreased muscle stretch reflex at ankles.
Cholesterol 310, K: 4, what to test next to Dx?
Thyroid stimulating hormone

16) 30yo woman severe abdominal pain and confusion. Brother, father, and paternal
grandmother similar problems. Started low calorie diet. P120, BP160/110. Physical exam
restlessness, excess sweating and tremors. No abdominal tenderness. Urine studies increased
porphobilinogen concentration. What inheritance pattern?
Autosomal dominant

17) 2 yo girl fever, sore throat. Difficulty swallowing and become irritable, listless, and
uninterested in eating. Adopted, immunization history unknown. T101, P150, R40. Physical
exam dull red throat, gray exudate lifted with tongue blade. Cervical lymphadenopathy.
Organism produce toxin cause ADP-ribosylation at what target?
Elongation Factor 2

18) 22 yo man SOB and wheezing. R12, physical exam normal. Symptoms start after taking
ASA. Lab shows serum IgE normal and no eosinophilia. Symptoms caused by excessive
production of what?
Leukotrienes

19) 5 month boy difficulty feeding. Physical exam macroglossia and enlargement of anterior
neck at midline. CT neck 4cm, well defined, cystic structure. Remnant?
Thyroglossal duct

20) 35 yo man chronic cough. 30pack yr. worried have lung cancer like his dad. Physcial exam
and xray normal. Dr comment?
Have you considered quit smoking?

21) 22 yo G0 women right flank pain after appendectomy and right ovarian resection due to
appendiceal abscess. Menses 28d. vital signs normal. Physical exam mild right flank tenderness.
Accidental ligation?
Ureter

22) 23 yo woman persistent cough worse to cold air in apartment. No smoke, no meds, no
asthma or COPD. Physical exam normal. Short term cough suppressant tx started w/o
constipation and low abuse?
Dextromethorphan

23) 70yo woman burning pain with urination. Physical exam uterine prolapse. Urine mild
increase in leukocytes. U/S abdomen shows bilateral dilation of renal collecting system. Greatest
risk?
Pyelonephritis

24) 49yo man faint in street. Watery diarrhea, no improvement w/ fasting. No change in diet, no
foreign travel. BP 90/60. Physical exam flushed face and dehydration. Serum study K:2,
Glucose: 150, admitted to hospital, IV fluid started. Passs stool with volume 3.5L. Dx?
Vasoactive intestinal polypeptide secretion

25) 38yo woman lying on sidewalk. Pt is conscious but too weak to stand. Physical exam red,
swollen, tender tongue; angular stomatitis, and spoon shaped nails. Hemoglobin and MCV
decreased. Dx?
Iron Deficiency

26) 65yo man dies after occlusion of LCA. Left ventricle has large irregular area that is soft and
pale. Dx?
Coagulation necrosis

27) 19yo woman severe pain to right hip. Refractory IBD with arthritis to hands treated w/
chorticosteriods. Pelvis Xray show collapse of superior half of right femoral head with
preservation of articular cartilage. Left hip normal. Dx?
Aseptic necrosis

28) 63 yo woman drooping left eyelid. Intermittent pain in left eye. Large pupil. Husband say
wife looking sideways. Eye exam shows ptosis, lateral strabismus, mydriasis of left eye. Brain
MRI aneurysm of left PCA. What muscle intact?
Superior Oblique

29) Deceased woman is philanthropist. Designated large sum of money to educate public of
leading cause of death in woman. What?
Cardiovascular Disease

30) 1 yo girl multiple bacterial infections since birth. 40% length and weight. White hair, pale
skin, blue irises and prominent red pupils. CBC shows neutropenia. Blood smear shows giant
granules in neutrophils. MOA?
Defect in phagolysosome function

31) 76 yo woman fever, cough. T101. Treatment with ciprofloxacin. Admitted to hospital due to
progressive cough, T102. Sputum culture grew Strep pneumonia. Mutation of gene cause
resistance to cipro?
DNA gyrase

32) Experiment model treatment for sickle cell disease involve reactivating gene code for beta
chain of fetal hemoglobin. Tx increase affinity of hemoglobin for what?
Oxygen

33) 56 yo man. Cardiac exam show systolic heart murmur best heard at right sternal border 2nd
interspace transmitted to carotid arteries. Murmur begins after S1 rises in crescendo before
falling in pitch, and ceases before S2. Dx?
Aortic Stenosis
34) 73 yo woman urinary frequency and urgency. Difficulties with walking, conversation, and
memory. Neuro exam shows normal strength and sensation. Mini Mental state exam 21/30. Wide
base walk, shuffling gait. Head CT shows marketed enlargement of ventricles. DX?
Normal-Pressure hydrocephalus

35) 54 yo man SCC of lung. Germline DNA shows 2 alleles, m and n, at microsatellite locus Z
tightly linked to p53 gene. Neoplastic cells shows only m allele. What process?
Loss of heterozygosity

36) female newborn delivered at 34 wks. Dx of persistant pulmonary HTN. Careful monitor for
methemoglobinemia, best tx?
Nitric Oxide

37) 60 yo man SOB w/ exertion. 2 younger siblins similar symptoms. Mother dies of dilated
cardiomyopathy. Physical exam show jugular venous distention and ankle edema.
Hypatomegaly. Inspiratory crackles heard over both lung bases. CXR show cardiomegaly and
pulmonary congestion. Angiograph confirm dilated cardiomyopathy. Atrial biopsy show
abnormal sacromeres with paracystalline inclusions in mitochondria. mtDNA shows G to A
transition. Results added A:T base pari to 3end of tRNA thus shortening the C loop. What effect
on mitochondrial function?
Decreased protein synthesis

38) 25 yo woman w/ OSA, oily, fatty bowel movements since starting drug for weight loss. 11lb
wt loss, BMI 27. BP 130/80. Before BP140/85. PHyscial exam normal. Serum lipid study, LDL
250 150; triglycerides 300 200. Whats drug?
Orilstat

39) 92 yr man chest pain and SOB. Dx CHF. Diuretic therapy started. Symptoms resolved. Pulse
44, fatigue w/ minimal exertion. Dr say pacemaker. Pt refuse invasive procedures. Dr presents
benefits of pacemaker fully, but describes risks and f/u in a cursory manner. Whats violated?
Informed consent

40) 25 yo man pain and burning with urination and frequent urinary urgency. Sexually active w/
several female partners. No condoms. T98, urine protein 2+, culture grow on chocolate agar.
Gram stain shows G-neg diplococci. What virulence factors?
Pili

41) 25 yo med student father died of alcoholism and cirrhosis. Med student gets angry at patient
with alcoholism. He recognize working with these pts distress him. So he learned how to deal
more effectively with these pts. Mechanism?
Suppression
42) 59 yo man 80pack yr develop ulcerated laryngeal neoplasm. Biopsy?
Squamous cell carcinoma

43) 6 wk male newborn persistent nonbilious projectile vomiting. Physical exam show prominent
peristalsis. Lab: metabolic alkalosis. MOA?
Hypertrophy of pyloric sphincter

44) 60 yo woman flank pain and pain w/ urination. HTN, recurrent UTI, hypothyroidism. T98,
P96, BP152/92. Physical exam normal. Urine 3+blood, 1+leukocytes, few bacteria. U/S show
large calculus filling the entire right renal pelvis. Composition?
Struvite

45) Autopsy on 50yo man died of pneumonia. Alcoholism. Sagittal section of cerebellum is
show. Whats neurologic exam present?
Gait ataxia.

46) 36 yo man seropositive to HIV nonproductive cough. CXR show diffused interstitial
infiltrate. Silver stain of lung biopsy shown. Dx?
Pneumocystis jirovecii

47) 5 yo boy progressive clumsiness and fatigue. Legs are tired. Delivered at term after
uncomplicated pregnancy. Met all developmental milestones. Some delay compared with other
children his age. Alert. Difficulty rise from chair. Uses arm to push himself into standing
position. Unable to jump with both feet together. Physical exam show hypertrophy of calf
muscles. Weak hip adduction result dysfunction of muscle inserting on the femur from what
location?
Ischium

48) investigator study b2 adrenoreceptors in female animals. During experiment, epinephrine

injected IM and effects of b2-adrenoreceptor are observed. What physiologic effects most likely
observed?
Uterine relaxation

49) 33 yo woman found mass in her right breast. Exam right breast 2.5cm hard mass in upper
outer quadrant. What predicts prognosis?
Lymph node involvement by cells originating in the lesion

50) 95 yo man T102, headache, cough, and muscle aches. Several other residents have similar
symptoms. Physical exam shows no other abnormalities. Tx with neuraminidase inhibitor started.
MOA?
Release of virus from infected epithelial cells.