1. Histologic
sections from an irregular, enlarging brown lesion on the left forearm of a
23-year-old male who is HIV-positive would most likely reveal which of the
following?
A.
|
Irregular
vascular spaces lined by nests of uniform cells
|
B.
|
Multiple
dilated endothelial-lined vessels that lack red blood cells
|
C.
|
Numerous
neutrophils, nuclear dust, and purple granules
|
D.
|
Proliferating
blood vessels, endothelial cells, and fibroblasts
|
E.
|
Proliferating
spindle stromal cells with slitlike spaces and extravasation of erythrocytes
|
2. A patient with the Marfan's syndrome is
evaluated at a clinic. He is noted to have a tall, thin body habitus, loose
joints, and arachnodactyly (spider fingers). Ophthalmologic examination reveals
lens dislocation. Echocardiogram reveals dilation of the aortic root. A family
history reveals that the patient's parents are medically normal, but that his
paternal grandfather and great-grandfather died in their forties with lens
dislocation and dissecting aortic aneurysms. A sister is found to have a
similar body habitus, dilation of the aortic root, and normal lenses. The
different findings in these different family members with the same disease are
best described by which of the following terms?
A.
|
Pleiotropy
|
B.
|
Founder
effect
|
C.
|
Variable
expressivity
|
D.
|
Incomplete
penetrance
|
E.
|
Genetic
heterogeneity
|
3. Which
of the following is a highly selective inhibitor of cyclooxygenase II?
A.
|
Aspirin
|
B.
|
Acetaminophen
|
C.
|
Ibuprofen
|
D.
|
Celecoxib
|
E.
|
Piroxicam
|
4. The
gross appearance of the kidney showed -dilation of the renal pelvis, clubbing
of the calyces, and irregular reduction in parenchymal mass . Microscopically,
there is atrophy and dilation of tubules with colloid in some tubules.The
cortex and medulla showed inflammation and fibrosis –It is most compatible with which of the following
conditions?
A.
|
Cystic
renal dysplasia
|
B.
|
Acute
pyelonephritis
|
C.
|
Chronic
pyelonephritis
|
D.
|
Acute
glomerulonephritis
|
E.
|
Chronic
glomerulonephritis
|
5. Which
of the following is seen most commonly in association with primary biliary
cirrhosis (PBC)?
A.
|
Positive
antinuclear antibody (ANA)
|
B.
|
Increased
ceruloplasmin
|
C.
|
Increased
ferritin
|
D.
|
Positive
hepatitis B surface antigen
|
E.
|
Positive
antimitochondrial antibody (AMA)
|
6. The
velocity of nerve conduction is increased with a decrease in the which of the
following?
A.
|
Diameter
of the nerve fiber
|
B.
|
Degree
of myelinization
|
C.
|
Space
constant of the nerve fiber
|
D.
|
Capacitance
of the nerve fiber membrane
|
E.
|
Resting
membrane potential
|
7. It
has been noted that infants placed on extremely low-fat diets for a variety of
reasons often develop skin problems and other symptoms. This is most often due
to
A.
|
Lactose
intolerance
|
B.
|
Glycogen
storage diseases
|
C.
|
Antibody
abnormalities
|
D.
|
Deficiency
of fatty acid desaturase greater than
 9 |
E.
|
Deficiency
of chylomicron and VLDL production
|
8. A
32-year-old male presents with scrotal enlargement. Physical examination,
including scrotal transillumination, reveals the presence of a testicular cyst
containing clear fluid. This abnormality most likely results from fluid
accumulating within which of the following structures?
A.
|
Ampulla
of the ductus deferens
|
B.
|
Appendix
testis
|
C.
|
Epididymis
|
D.
|
Seminal
vesicles
|
E.
|
Tunica
vaginalis
|
9. Which
of the following arterial pulse waveforms is consistent with severe left ventricular
impairment?
A.
|
Parvus
et tardus pulse
|
B.
|
Bisferiens
pulse
|
C.
|
Pulsus
alternans
|
D.
|
Hyperkinetic
pulse
|
E.
|
Dicrotic
pulse
|
10. A
long-lasting depletion of norepinephrine can be produced by administration of
which of the following?
A.
|
Amphetamine
|
B.
|
Apomorphine
|
C.
|
Clonidine
|
D.
|
Reserpine
|
E.
|
Yohimbine
|
11. An
apathetic male infant is found to have peripheral edema, a “moon” face, and an
enlarged, fatty liver. Which one of the following mechanisms is involved in the
pathogenesis of this child’s abnormalities?
A.
|
Decreased
protein intake leads to decreased lipoproteins
|
B.
|
Decreased
caloric intake leads to hypoalbuminemia
|
C.
|
Decreased
carbohydrate intake leads to hypoglycemia
|
D.
|
Decreased
fluid intake leads to hypernatremia
|
E.
|
Decreased
fat absorption leads to hypovitaminosis
|
12. A
3-year-old child presents at the physician’s office with symptoms of coryza,
conjunctivitis, low-grade fever, and Koplik’s spots. The causative agent of
this disease belongs to which group of viruses?
A.
|
Adenovirus
|
B.
|
Herpesvirus
|
C.
|
Picornavirus
|
D.
|
Orthomyxovirus
|
E.
|
Paramyxovirus
|
13. A
man breathing room air at sea level has a PaCo2 of 48 mmHg. Which
of the following is his alveolar oxygen tension (PaO2)?
A.
|
150
mmHg
|
B.
|
110
mmHg
|
C.
|
100
mmHg
|
D.
|
90
mmHg
|
E.
|
60
mmHg
|
14. Lack
of glucocorticoids and mineralocorticoids might be a consequence of which of
the following defects in the adrenal cortex?
A.
|
Androstenedione
deficiency
|
B.
|
17
 -hydroxyprogesterone deficiency |
C.
|
Estrone
deficiency
|
D.
|
C-21-hydroxylase
deficiency
|
E.
|
Testosterone
deficiency
|
15. Neutral
protamine Hagedorn (NPH) differs from extended insulin Zn suspension in which
of the following actions?
A.
|
It
activates receptor tyrosine kinases
|
B.
|
It
causes movement of intracellular glucose transporters to the cell membrane
|
C.
|
Following
subcutaneous injection, it reaches peak plasma concentrations in 6 to 10 h
|
D.
|
It
has a shorter duration of action
|
E.
|
It
increases lipogenesis
|
16. The
screening test for phenylketonuria (PKU) is called the Guthrie test. Based on
this screening method, which of the following is the most likely explanation of
a false-negative screen in a newborn?
A.
|
Bacteria
placed on the agar plate
|
B.
|
Excess
infant blood on the agar plate
|
C.
|
Sampling
of infant blood before adequate dietary intake
|
D.
|
Sampling
of infant blood after the newborn period
|
E.
|
Adding
an inhibitor of bacterial growth to the plate
|
17. An
increase in the P50 of an oxyhemoglobin curve would result from a
decrease in which of the following?
A.
|
Metabolism
|
B.
|
pH
|
C.
|
Temperature
|
D.
|
Oxygen
|
E.
|
2,3-DPG
|
18. A
55-year-old man who has worked for many years as a stevedore (stevedore = person
employed in loading and unloading ships.) develops pain and weakness in the
lower back that radiates down the posterolateral thigh and lower aspect of the
leg. This is characterized as which of the following?
A.
|
Mononeuropathy
|
B.
|
Brown-Séquard's
syndrome
|
C.
|
Polyneuropathy
|
D.
|
Mononeuropathy
multiplex
|
E.
|
Radiculopathy
|
19. Which
of the following compounds serves as a primary link between the citric acid
cycle and the urea cycle?
A.
|
Malate
|
B.
|
Succinate
|
C.
|
Isocitrate
|
D.
|
Citrate
|
E.
|
Fumarate
|
20. Which
one of the following individuals is most likely to have a tumor that has a histologic
appearance characterized by undifferentiated mesenchymal cells with immature
tubules and abortive glomerular formation?
A.
|
A
2-week-old infant with a mid-epigastric mass, projectile vomiting, and normal
urinary hydroxy-indoleacetic acid (HIAA)
|
B.
|
An
8-month-old infant with an abdominal mass and normal urinary vanillylmandelic
acid (VMA)
|
C.
|
A
14-month-old infant with an abdominal mass and increased urinary VMA
|
D.
|
A
13-year-old child with basophilic stippling of erythrocytes and increased urinary
aminolevulinic acid (
|
E.
|
A
39-year-old female with abdominal cramps, watery diarrhea, periodic facial
flushing, wheezing, and increased urinary HIAA
|
21. At
delivery, caudal analgesia is induced by administration of anesthetic into the
epidural space in the sacral region. The needle is introduced via which of the
following?
A.
|
Anterior
sacral foramina
|
B.
|
Dural
sac
|
C.
|
Intervertebral
foramina
|
D.
|
Posterior
sacral foramina
|
E.
|
Sacral
hiatus
|
22. Which
of the following is the single most important bacteria that causes diarrhea
world-wide?
A.
|
Helicobacter
pylori
|
B.
|
Staphylococcus
aureus
|
C.
|
Salmonella
spp.
|
D.
|
Shigella
spp.
|
E.
|
E.
coli
|
23. Sympathetic
and parasympathetic nerves reach the pelvic plexus by different pathways. If,
during surgical resection of the rectum, the sympathetic nerves were excised
bilaterally, which of the following complications would ensue?
A.
|
A
dilated and neurogenic bladder
|
B.
|
Loss
of control of the external urethral sphincter
|
C.
|
Impotence
(inability to obtain erection)
|
D.
|
Inability
to ejaculate
|
24. A
diabetic teenager is found to have a pH of 7.1 and normal electrolyte levels
(Na+ = 140 mM, K+ = 4 mM, Cl– =
103 mM) except for a bicarbonate of 11 mM (normal 22 to 28 mM).
The urine tests positive for ketone bodies, mostly due to acetoacetic acid and
acetoacetate (CH3C=OCH2COOH and CH3C=OCH2COO–),
which have a pK of 4.8. In this case, it is assumed that acetoacetate is
the only significant anion in the blood besides chloride, and that each
acetoacetate anion binds and removes one sodium cation during excretion by the
kidney. Given that the patient has a normal glomerular filtration rate of about
7 L of blood per hour without any retention of acetoacetate/acetoacetic acid,
the rates of sodium, acetoacetate, and acetoacetic acid loss will be
A.
|
10
mmol/h of each species
|
B.
|
50
mmol/h of sodium and acetoacetate, virtually no acetoacetic acid excretion
|
C.
|
100
mmol/h of sodium and acetoacetic acid, virtually no acetoacetate excretion
|
D.
|
200
mmol/h of sodium and acetoacetate, virtually no acetoacetic acid excretion
|
E.
|
300
mmol/h of each species
|
25. A
patient with chronic autoimmune (Hashimoto's) thyroiditis develops a rapidly
enlarging thyroid mass. Which of the following is the most likely diagnosis?
A.
|
Thyroid
lymphoma
|
B.
|
Medullary
thyroid carcinoma
|
C.
|
Papillary
thyroid carcinoma
|
D.
|
Anaplastic
thyroid carcinoma
|
E.
|
Follicular
thyroid carcinoma
|
26. Following
release of norepinephrine by sympathetic nerves and epinephrine by the adrenal
medulla, which of the following metabolic processes is decreased?
A.
|
Glycolysis
|
B.
|
Lipolysis
|
C.
|
Gluconeogenesis
|
D.
|
Glycogenolysis
|
E.
|
Ketogenesis
|
27. A
patient tells you that he had an episode of vomiting bright red blood twice in
1 day about 1 week ago, followed the next day by three or four episodes. Vomitus
looked like coffee powder. He did not seek medical help then and he said that
"it got better except for the pain." The past 3 days he noticed black
"sticky" stools and he finally came to see you. Which of the
following should be your first concern?
A.
|
Bleeding
colon cancer
|
B.
|
Bleeding
from lung cancer
|
C.
|
Crohn's
disease
|
D.
|
Cirrhosis
|
E.
|
Bleeding
peptic ulcer
|
28.
A child is evaluated by an ophthalmologist
and is found to have retinitis pigmentosa, a disorder characterized by
pigmentary granules in the retina and progressive vision loss. The pedigree
below is obtained and the family comes in for counseling. What is the risk for
individual II-2 of having an affected child if he marries an unrelated woman?
A.
|
100%
|
B.
|
75%
|
C.
|
50%
|
D.
|
25%
|
E.
|
Virtually
0
|
29. A 5-year-old boy presents with
clumsiness, a waddling gait, and difficulty climbing steps. Physical
examination reveals that this boy uses his arms and shoulder muscles to rise
from the floor or a chair. Additionally, his calves appear to be somewhat
larger than normal. Which of the following is the most likely diagnosis?
A.
|
Inclusion
body myositis
|
B.
|
Werdnig-Hoffmann disease
|
C.
|
Dermatomyositis
|
D.
|
Duchenne’s muscular dystrophy
|
E.
|
Myotonic dystrophy
|
30. Which of the listed types of cells
found within the liver is the major source of the excess collagen deposited in
cirrhosis?
A.
|
Hepatocytes
|
B.
|
Kupffer
cells
|
C.
|
Ito
cells
|
D.
|
Endothelial
cells
|
E.
|
Bile
duct epithelial cells
|
31. Which
of the following is the proper cytogenetic notation for a female with Down's
syndrome mosaicism?
A.
|
46,XX,+21/46,XY
|
B.
|
47,XY,+21
|
C.
|
47,XXX/46,XX
|
D.
|
47,XX,+21/46,XX
|
E.
|
47,XX,+21(46,XX)
|
32. A 2-day-old neonate becomes lethargic and
uninterested in breast-feeding. Physical examination reveals tachypnea (rapid
breathing) with a normal heartbeat and breath sounds. Initial blood chemistry
values include normal glucose, sodium, potassium, chloride, and bicarbonate
(HCO3–) levels; initial blood gas values reveal a pH of
7.53, partial pressure of oxygen (PO2) normal at 103 mmHg, and partial
pressure of carbon dioxide (PCO2) decreased at 27 mmHg. Which of
the following is the most appropriate treatment?
A.
|
Administer
alkali to treat metabolic acidosis
|
B.
|
Administer
alkali to treat respiratory acidosis
|
C.
|
Decrease
the respiratory rate to treat metabolic acidosis
|
D.
|
Decrease
the respiratory rate to treat respiratory alkalosis
|
E.
|
Administer
acid to treat metabolic alkalosis
|
33. Coenzymes
derived from the vitamin shown below are required by enzymes involved in the
synthesis of which of the following?
Vitamin folic acid
Vitamin folic acid
A.
|
ATP
|
B.
|
UTP
|
C.
|
CTP
|
D.
|
NADH
|
E.
|
NADPH
|
34. A 45-year-old male with an artificial
heart valve is given oral coumadin (Warfarin) to prevent the formation of
thrombi on his artificial valve. Which combination of laboratory tests is most
likely to be found in this individual?
Tourniquet
Test
|
Bleeding
Time
|
Platelet
Count
|
PTT
|
PT
|
||||
A
|
Positive
|
Prolonged
|
||||||
B
|
Prolonged
|
|||||||
C
|
Positive
|
Prolonged
|
Decreased
|
|||||
D
|
Prolonged
|
|||||||
E
|
Prolonged
|
Prolonged
|
||||||
A.
|
A
|
|||||||
B.
|
B
|
|||||||
C.
|
C
|
|||||||
D.
|
D
|
|||||||
E.
|
E
|
|||||||
35 A
34-year-old male patient visits a physician with complaints of fatigue, weight
loss, night sweats, and "swollen glands." The physician also observes
that he has an oral yeast infection.
The figure demonstrates a Western blot for
HIV. Based on these results, and assuming a repeatedly reactive ELISA HIV
screening test, which of the following is the best course of action?
A.
|
Repeat
the test immediately
|
B.
|
Inform
the patient that the test is falsely positive
|
C.
|
Wait
6 weeks and repeat the test
|
D.
|
Consider
anti-HIV therapy
|
E.
|
Order
an HIV RNA test
|
36. A
30-year-old male, requests a routine HIV test. The HIV ELISA was weakly
positive and is repeated with the same results. The Western blot result
is shown below. The patient denies any risk factors for HIV. Which of the
following is the most likely cause of a falsely positive HIV test?
A.
|
A
yeast infection
|
B.
|
Test
cross-reactivity with HTLV
|
C.
|
Test
cross-reactivity with Epstein-Barr virus
|
D.
|
Naturally
occurring HIV antibody
|
E.
|
A
recent "flu" shot
|
37. A
59-year-old man presents with heat intolerance and tremor. Thyroid function
testing reveals a free T4 of 3.0 (0.7 to 2.0) and TSH of 6.0 (0.5 to
5). Which of the following is the next best diagnostic test?
A.
|
Thyroid
scan and uptake
|
B.
|
MRI
of the pituitary
|
C.
|
Prolactin
|
D.
|
Thyroid
autoantibodies
|
E.
|
T3
|
38. A
37-year-old woman presents with a recurrent swelling in her left upper eyelid.
The lesion is biopsied by an ophthalmologist, and a section from that specimen,
showed chronic inflammatory reaction with giant cells that surround empty
spaces where the lipid vacuoles from the sebaceous glands had been located.
Which of the following is the diagnosis?
A.
|
Chalazion
|
B.
|
Hordeolum
|
C.
|
Xanthelasma
|
D.
|
Hydrocystoma
|
E.
|
Sebaceous
carcinoma
|
39. A 16-year-old boy presents without
pubertal development or development of secondary sexual characteristics. He
cannot smell (anosmia). The baseline testosterone and the LH response to LHRH
most likely are which of the following?
A.
|
Low
testosterone and normal LHRH response
|
B.
|
Normal
testosterone and normal LHRH response
|
C.
|
High
testosterone and normal LHRH response
|
D.
|
Low
testosterone and no LHRH response
|
E.
|
Low
testosterone and exaggerated LHRH response
|
40. Mr. Gopalan Nair is affected with
Crouzon's syndrome (123500) and has craniosynostosis (i.e., premature closure
of the skull sutures) along with unusual facies that includes proptosis
secondary to shallow orbits, hypoplasia of the maxilla, and a prominent nose.
His son and brother are also affected, although two daughters and his wife are
not. Mr. and Mrs. Gopalan Nair are considering having another child. What is
the risk that the child will be affected with Crouzon's syndrome?
A.
|
100%
|
B.
|
67%
|
C.
|
50%
|
D.
|
25%
|
E.
|
Virtually
0
|
41. A 7-year-old boy presents with bilateral
swelling around his eyes. His parents state that the child's eyes have become
"puffy" over the past several weeks, and his urine has become cocoa-colored.
Physical examination reveals bilateral periorbital edema, but peripheral edema
is not found. The boy is afebrile and his blood pressure is slightly elevated.
A urinary dipstick reveals mild proteinuria, while microscopic examination of
the boy's urine reveals hematuria with red blood cell casts. Laboratory tests
reveal increased ASO titers and decreased serum C3 levels, but C2 and C4 levels
are normal. A throat swab for streptococci is negative. A microscopic section
from the kidney reveals increased numbers of cells within the glomeruli. An
electron microscopic section of the kidney reveals large electron-dense
deposits in the glomeruli that are located between the basement membrane and
the podocytes. The foot processes of the podocytes are otherwise unremarkable.
Which one of the following renal diseases most likely produce the abnormalities
in
this young boy?
A.
|
Acute
post-streptococcal glomerulonephritis
|
B.
|
Focal
segmental glomerulonephritis
|
C.
|
Focal
segmental glomerulosclerosis
|
D.
|
Membranous
glomerulonephritis
|
E.
|
Minimal
change disease
|
42 Which
of the following regulators are said to act in "cis"?
A.
|
The
lac repressor and mammalian transcription factors
|
B.
|
The
lac repressor and the lac operator
|
C.
|
The
lac operator and mammalian enhancers
|
D.
|
The
lac operator and mammalian transcription factors
|
E.
|
Mammalian
transcription factors and enhancers
|
43. Hyperkalemia
is a contraindication to the use of which of the following drugs?
A.
|
Acetazolamide
|
B.
|
Chlorothiazide
|
C.
|
Ethacrynic
acid
|
D.
|
Chlorthalidone
|
E.
|
Spironolactone
|
44. A 65-year-old female receives digoxin and
furosemide for CHF. After several months, she develops nausea and vomiting.
Serum K+ is 2.5 mEq/L. Electrocardiogram (EKG) reveals an AV
conduction defect. What cellular effect is causing these new findings?
A.
|
Increased
intracellular K+
|
B.
|
Increased
intracellular cyclic guanosine 5''-monophosphate (cGMP)
|
C.
|
Increased
intracellular Ca2+
|
D.
|
Increased
intracellular norepinephrine
|
E.
|
Increased
intracellular nitric oxide (NO)
|
45. Which
one of the following proteolytic enzymes is activated by acid hydrolysis of the
proenzyme form?
A.
|
Trypsin
|
B.
|
Chymotrypsin
|
C.
|
Elastase
|
D.
|
Pepsin
|
E.
|
Carboxypeptidase
|
46. During the course of an evaluation for
thyroid function, a 33-year-old man who is infertile, is found to have very low
levels of luteinizing hormone. Which of the following is the likely site of his
infertility?
A.
|
Pretesticular
|
B.
|
Testicular
|
C.
|
Posttesticular
|
D.
|
Idiopathic
|
47. For
the severe form of nodulocystic acne vulgaris, the first line of therapy is the
systemic use of which of the following agents?
A.
|
Vitamin
A
|
B.
|
Retinol
|
C.
|
Tetracycline
|
D.
|
Isotretinoin
(13-cis-retinoic acid)
|
E.
|
Ciprofloxacin
|
48. Certain
amino acids are not part of the primary structure of proteins but are modified
after translation. In scurvy, which amino acid that is normally part of
collagen is not synthesized?
A.
|
Hydroxytryptophan
|
B.
|
Hydroxytyrosine
|
C.
|
Hydroxyhistidine
|
D.
|
Hydroxyalanine
|
E.
|
Hydroxyproline
|
49. A
40-year-old female with duodenal ulcers is treated with a combination of agents
that includes clarithromycin. Of the following enzymes, which is inactivated by
clarithromycin?
A.
|
Dihydrofolate
reductase
|
B.
|
Glucose-6-phosphate
dehydrogenase
|
C.
|
Cytochrome
P450
|
D.
|
Na+,K+-ATPase
|
E.
|
Na+,K+,Cl-
co-transporter
|
50. A
patient complained to his dentist about a draining lesion in his mouth. A
Gram''s stain of the pus showed a few Gram-positive cocci, leukocytes, and many
branched Gram-positive rods. Which of the following is the most likely cause of
the disease?
A.
|
Actinomyces
israelii
|
B.
|
Actinomyces
viscosus
|
C.
|
Corynebacterium
diphtheriae
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D.
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Propionibacterium
acnes
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E.
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S.
aureus
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InFebruary 2017, my immune system was not functioning correctly and my primarycare physician did a N.A.E.T. Treatment with Laser Acupuncture andAuricular Acupuncture to try to desensitize my body from the differentallergies and allergies to the metals. This procedure began to make me drained and very fatigued. He recommended that I have a GI Stool testdone as I was having GI issues in February 2017, to check for parasites,pathogens, bacterial flora, and fungi/yeasts. The results showed that I had a Bacterial Pathogen called Salmonella,high amounts of normal bacterial flora, called Enterococcus spp. andEscherichia spp., 2 parasites called Dientamoeba fragilis and Endolimax nana, and2 types of fungi/yeasts called Candida spp. and Geotrichum spp. The doctor recommended that I take Dr Itua Herbal Medicine to get rid of the Candida as that was the main concern at thetime and I did purchase Dr Itua Herbal Medicine and after taking it all as instructed I was totally cured so is a urged form of heart to believe in herbal medicines but yes indeed natural remedies should be recognize around the globe because is the only healing that has no side effect on each every healing, I will recommend anyone here with health challenge to contact Dr Itua Herbal Center on E-Mail drituaherbalcenter@gmail.com he capable of all kind of disease like Cancer,Hiv,Herpes,Kidney disease,Parkinson,ALS,Copd. with a complete cure without coming back.
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