ข้อสอบ MD NL ชุดที่ 24 
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ชื่อ - สกุล *
เลขประจำตัวนิสิต *
1. A young couple is having trouble conceiving and decides to undergo in vitro fertilization. The woman begins treatment to stimulate ovulation prior to ova collection and fertilization. Which of the following hormones is most directly responsible for ovulation? *
1 point
2. A 57-year-old woman is scheduled for elective hysterectomy. Severing which of the following structures during surgery would disrupt the most blood flow to the ipsilateral ovary? *
1 point
3. Which of the following is the function of the androgen-binding globulin? *
1 point
4. A 46,XY infant is born with a nonsense mutation in the SRYgene. Which of the following will be the symptomatic manifestation of this mutation? *
1 point
5. A woman in her seventh month of pregnancy asks her obstetrician why her breasts are enlarging. In which of the following locations is the hormone responsible for breast milk production synthesized? *
1 point
6. A patient complains of a boil located on her labia majora. Lymphatic spread of the infection would most likely enlarge which nodes?   *
1 point
7. An intrahepatic blockage of the portal venous outflow may cause intestinal blood to drain via portal-systemic anastomoses into the:   *
1 point
8. An infant was diagnosed as having hydrocephalus. It was determined that there was a blockage in the ventricular system of the baby's brain between the third and fourth ventricles. The blockage therefore must have involved the:   *
1 point
9. An 84-year old woman suffers a stroke, with paralysis on the right side of her body. Neurological tests show that the intracerebral hemorrhage has interrupted the blood supply to the posterior part of the frontal, the parietal and medial portions of the temporal lobes of the left cerebral hemisphere. Which vessel was involved?   *
1 point
10. A 15-year-old boy develops acute lymphoblastic leukemia. Shortly after birth, he was diagnosed with duodenal atresia, which was treated with surgical intervention. Which of the following factor as most likely contributed to the development of his condition?   *
1 point
11. A neonate is noted to have a holosystolic murmur on examination. An echocardiogram is performed, and the pulmonary valve is noted to have a normal structure, and the great vessels arise from the heart as they normally should. The boy is followed by his pediatrician until the age of 10 years, at which point the murmur has disappeared. What was the most likely diagnosis for the abnormalities noted upon examination of the heart?   *
1 point
12. Patients with renal artery stenosis may present with very high blood pressures due to increased renin secretion. Which of the following structures in the kidney is responsible for sensing inadequate perfusion and secreting renin? *
1 point
13. A 2-month-old infant is found to have a horseshoe kidney. Which structure prevents this abnormal kidney from occupying its appropriate position? *
1 point
14. A 40-year-old woman presents to the emergency department after a 5-day course of profuse vomiting. She has a history of rheumatoid arthritis, which is treated with celecoxib. She complains of joint pain at present. Which of the reasons below describes why celecoxib would be contraindicated in this patient at presentation? *
1 point
15. Mannitol, an osmotic diuretic, is sometimes used to lower intracranial pressure. Where along the nephron is the primary site of action of mannitol? *
1 point
16. A 40-year-old man was admitted to the neurology service for evaluation of persistent numbness over his left jaw and lower face. MRI revealsa schwannoma, which is compressing a cranial nerve as the nerve exits the skull. The cranial nerve involved in this case exits the skull through which of the following foramina? *
1 point
17. A 7-year-old boy is brought to the emergency department after falling from a tree; an x-ray film shows that he has a midshaft fracture of the humerus. Which of the following structures could be injured with this type of fracture? *
1 point
18. A 2-week-old girl is brought to the pediatrician for her first doctor’s appointment. Physical examination reveals a tuft of hair on her lower back; ultrasound shows no herniation of any kind. Which of the following conditions does this baby have? *
1 point
19. A 54-year-old homeless woman is found unconscious on the street. Upon admission to the emergency department, her laboratory tests show: Na+: 137 mEq/L K+: 3.3 mEq/L Cl–: 112 mEq/L HCO3–: 15 mEq/L Arterial blood gas on room air: pH 7.28 Partial carbon dioxide pressure: 28 mm Hg Partial oxygen pressure: 90 mm Hg Which of the following most likely caused her acidosis? *
1 point
20. During the autopsy of a patient who complainedof a severe headache shortly before dying, the pathologist removes the calvarium with the dura attached. On the surface of the brain, there is frank blood on visual inspection that she is unable to remove by rubbing orscraping the surface. Which of the following types of hemorrhages most likely caused this? finding? *
1 point
21. A 34-year-old man injures his lateral pterygoid muscle. Which of the following activities will be adversely affected by this injury? *
1 point
22. A 25-year-old man comes to the emergency department because of rapidly spreading cellulitis on his right hand. He tells the physician that he was bitten by a cat the previous day. Which of the following organisms is most likely responsible for this patient’s infection? *
1 point
23. A 56-year-old man is diagnosed with transitional cell carcinoma and treated with excision and chemotherapy. Which of the following risk factors most likely led to this patient’s cancer? *
1 point
24. A 58-year-old man has a past medical history significant for chronic renal insufficiency. He was recently diagnosed with transitional cell carcinoma of the bladder and will be started on chemotherapy. Which of the following chemotherapeutic agents should be avoided in this patient? *
1 point
25. A 20-year-old African-American man develops anemia after being treated for a urinary tract infection. A peripheral blood smear shows RBC lysis and precipitates of hemoglobin within the RBCs. Which of the following drug classes most likely caused his hemolytic anemia? *
1 point
26. A 49-year-old man presents to the emergency department complaining that “my skin has turned yellow.” Physical examination reveals the man is signifi cantly jaundiced. He has no abdominal pain and has a negative Murphy’s sign. The physician is concerned that he can feel the patient’s gallbladder and orders a CT scan. What is the most likely cause of this patient’s jaundice? *
1 point
27. A 5-year-old girl presented with moderate mental retardation, a poorly developed philtrum and thin upper lip. Her nose appeared to be short and flattened. Which of the following teratogens is most likely to be the cause for these anomalies?   *
1 point
28. A 35-year-old woman who is HIV-positive presents to the physician with jaundice and right upper quadrant abdominal pain. The patient reports having had multiple episodes of jaundice over the past 10 years. A hepatitis panel is positive for HBsAg and anti-HBc IgM, but negative for HBsAb and anti-HAV IgM. Which of the following would most likely be lower than normal in this patient? *
1 point
29. A 45-year-old woman presents to her physician with a 2-day history of right upper quadrant pain, nausea, gas, and vomiting. She reports that her symptoms are worse after she eats a fatty meal. Which of the following substances inhibits the hormone causing her right upper quadrant pain? *
1 point
30. A 17-year-old girl who is being treated with antibiotics for recurrent sinus tract infections presents to the physician with intractable watery diarrhea and cramps. Which of the following is most often associated with this patient’s condition? *
1 point
31.A 65-year-old white woman presents to the emergency department with persistent right upper quadrant pain with nausea and vomiting. Abdominal CT scan reveals a polypoid mass of the gallbladder protruding into the lumen, diffuse thickening of the gallbladder wall, and enlarged lymph nodes. This patient most likely has a history of which of the following? *
1 point
32. A 20-year-old man presents to his physician with a 2-day history of fever, vomiting, and diarrhea. His laboratory studies are unremarkable except for a serum albumin level of 7.5 g/dL. Which of the following conditions would most likely cause this patient’s laboratory abnormality? *
1 point
33. A 45-year-old woman who was diagnosed with scleroderma 5 years ago presents to her physician with increasing diffi culty swallowing. Which of the following abnormalities of esophageal muscle function is the most likely cause of these symptoms? *
1 point
34. A researcher studying a pedigree of familial type 1 diabetes mellitus discovers a mutation in the potassium channel expressed in the cell membrane of pancreatic islet β cells. This mutation impairs closing of the potassium channel. The efficacy of which of the following agents would be most profoundly affected by  this mutation? *
1 point
35.A 72-year-old man who receives treatment for congestive heart failure (CHF) presents to the emergency department with vomiting, abdominal pain, and changes in his color vision. He is confused and does not remember the names of his medications. His heart rate is 36/min. Which of the following most likely caused this patient’s symptoms? *
1 point
36. An infant with severe jaundice that is not corrected by phototherapy is in danger of developing kernicterus. This can occur in infants with Crigler–Najjar syndrome, a genetic disorder in which there is a near-complete deficiency of glucuronyl transferase. Which of the following laboratory fi ndings would be expected in blood tests in an infant with Crigler–Najjar syndrome? *
1 point
37. A 30-year-old African-American man comes to the physician with white macules on both his hands bilaterally. The patient is otherwise asymptomatic and states that he has had this condition for the past several years. Which of the following best describes the embryological origin of the affected cells in this patient? *
1 point
38. A 3-month-old infant presents with failure to thrive, poor feeding, and lethargy. A physical examination reveals an enlarged liver and jaundice. Laboratory analysis reveals an elevated blood galactitol level and increased urinary reducing substance. Which of the following could correctly describe the levels of intermediates of galactose metabolism in this patient? *
1 point
39. A 62-year-old man presents to his physician complaining of a milky discharge from his nipples. The physician determines that the patient is suffering from a prolactinoma. What is the embryologic derivative of the region of the pituitary gland responsible for prolactin secretion? *
1 point
40. A second-year medical student is under a lot of stress due to her impending biochemistry examination. She knows that her psychological stress leads to the release of endogenous glucocorticoid, which increases the glucose levels in her body. To raise glucose levels, glucocorticoids act via the enzyme phosphoenolpyruvate carboxykinase to increase which of the following? *
1 point
41. If either the ulnar or radial arteries are occluded, which arteries ensure adequate collateral arterial flow in the hand? *
1 point
42. An 18-month-old child is brought to the physician by her parents because of a sore throat, difficulty breathing, and a barking cough for the past day. On physical examination the toddler is found to have some respiratory stridor and a runny nose but is not in acute distress. The rest of the examination is unremarkable. Which of the following is the most appropriate treatment? *
1 point
43. A 64-year-old man with a history of coronary artery disease and high cholesterol presents to the physician with increasing lower extremity edema. His blood pressure is 190/110 mm Hg, and laboratory studies show hypernatremia and hypokalemia. Imaging shows no abnormalities except an area of right renal artery vessel constriction. Which of the following are the likely aldosterone and renin levels, respectively, in this patient? *
1 point
44. A 41-year-old man is admitted to the hospital for progressive obtundation. On admission the patient’s serum sodium level is 114 mEq/L. Treatment is initiated, and 7 hours later the patient’s serum sodium level is 134 mEq/L. Over the next 4 days the patient’s condition worsens with the development of dysarthria, dysphagia, and paraparesis. What pathologic process is most likely responsible for this patient’s new symptoms? *
1 point
45. Calcium channel blockers are commonly used cardiovascular drugs that are effective antihypertensives, antianginals, and antiarrhythmics. Diltiazem is more effective than nifedipine for cardiac indications because diltiazem slows the recovery of the slow calcium channel while also reducing the influx of calcium into the myocyte. Which of the following is an effect of diltiazem? *
1 point
46. 45 year-old alcoholic man presents with fever, severe epigastric pain, nausea, and vomiting.Laboratory test : increased serum amylase. Which of the following type of necrosis is most likelyto occur in the affected organ? *
1 point
47. A girl has microcytic hypochromic anemia & basophilic stripping. Radiological finding reveals dense lines in epiphyseal of long bone. She live near factory. What substance can cause this finding? *
1 point
48. A 60-year-old man suffering from depressive disorder for a year gets better with fluoxetine treatment. Which of the following neurotransmitters is affected by this medication? *
1 point
49. A 50 years old heavy smoking man complains of numbness, cold, pain in fingers and toes.Some gangrene is also observed in some of his fingers and toes. What is the diagnosis of his disease? *
1 point
50. A 53-year-old woman experiences hot fl ashes associated with menopause. She calls her primary care physician to ask for advice about the risks and benefits of hormone replacement therapy (HRT). Which of the following is a potential benefit of HRT? *
1 point
51. A 38-year-old nulliparous woman comes to the physician for an annual check-up.  She reports a 10-pack-year smoking history and a family history of early mastectomy. Physical examination is notable for a scaly patch on her right nipple. On palpation, there is a firm mass and a clear discharge from the nipple. Which of the following would most likely be seen on a histological examination of this mass? *
1 point
52. A young couple is having trouble conceiving and decides to undergo in vitro fertilization. The woman begins treatment to stimulate ovulation prior to ova collection and fertilization. Which of the following hormones is most directlyresponsible for ovulation? *
1 point
53. A 57-year-old woman is scheduled for elective hysterectomy. Severing which of the following structures during surgery would disrupt the most blood flow to the ipsilateral ovary? *
1 point
54. Patients with renal artery stenosis may present with very high blood pressures due to increased renin secretion. Which of the following structures in the kidney is responsible for sensing inadequate perfusion and secreting renin? *
1 point
55. A 48-year-old man is hospitalized for shock after massive blood loss in a motor vehicle accident. On the patient’s second day in the hospital, his blood urea nitrogen (BUN) and creatinine levels begin to rise and he develops pitting edema to his knees. A subsequent urinalysis shows numerous granular casts. Which of the following is the most appropriate treatment? *
1 point
56. A 25-year-old man comes to the emergency department with bloody sputum. A few weeks later he progresses to renal failure with significant hematuria and hypertension. A renal biopsy shows linear immunofluorescence. Which of the following types of hypersensitivity reaction is this patient experiencing? *
1 point
57. 28-year-old woman who is 6 months pregnant presents to the emergency department with a temperature of 38.2° C (100.8° F) and complains of shaking chills and pain on her right side, which she locates by pointing to the area above her right iliac crest. During the examination she is tender to percussion at the junction of the lower ribs and the thoracic vertebrae. Urinalysis reveals WBC casts. Which of the following is the most likely diagnosis? *
1 point
58. A 2-month-old infant is found to have a horseshoe kidney. Which structure prevents this abnormal kidney from occupying its appropriate position? *
1 point
59. Diuretics are medications that increase the amount of urine flow by inhibiting transport proteins or enzymes in the nephron. Different classes of diuretics affect different parts of the nephron. Which of the following diuretics will  also decrease the amount of calcium excreted from the kidney? *
1 point
60. A 40-year-old man was admitted to the neurology service for evaluation of persistent numbness over his left jaw and lower face. MRI reveals a schwannoma, which is compressing a cranial nerve as the nerve exits the skull. The cranial nerve involved in this case exits the skull through which of the following foramina? *
1 point
61. An 82-year-old woman suffers an ischemic stroke with numerous sequelae, including uvular deviation to the right side. Assuming the defect is in the lower motor neuron, damage to which of the following cranial nerves is consistent with this abnormality?   *
1 point
62. A 7-year-old boy is brought to the emergency department after falling from a tree; an x-ray film shows that he has a midshaft fracture of the humerus. Which of the following structures could be injured with this type of fracture?   *
1 point
63. An otherwise healthy infant boy born via vaginal delivery has an abnormal appearance of his right upper limb. His arm hangs by his side, pronated and medially rotated. Which of the following muscles is still functioning in this patient? *
1 point
64. A 16-year-old gymnast presents to the emergency department after landing awkwardly on her ankle. She is diagnosed with a sprained ankle. Which of the following ligaments is most commonly injured in an ankle sprain? *
1 point
65. A biopsy of one of several red, tender, subcutaneous nodules from the anterior lower legs of a 27-year-old man is obtained by a dermatologist. On histopathology, she sees a panniculitis (inflammation of subcutaneous fat) with widening of tissue septa from edema, increased neutrophils, and fibrin exudation. Which of the following diseases is often present in someone with these nodules? *
1 point
66. A 20-year-old woman presents to the emergency department with several deep lacerations on the medial side of her wrist after a suicide attempt. She receives prompt psychiatric evaluation. The function of which of the following muscles might be affected by these injuries? *
1 point
67. A 50-year-old man presents to the emergency department because of severe pain with even slight abduction of his arm following a skiing accident. He is diagnosed with a rotator cuff tear. Which of the following is most commonly injured in a rotator cuff tear? *
1 point
68. A 22-year-old woman who is a professional tennis player presents to the physician with pain on the lateral aspect of her elbow radiating down her forearm. Repetitive use of which of the following muscles most likely lead to this  patient’s condition? *
1 point
69. A 20-year-old man presents to the physician with a nontender indurated mass over his mandible. He has had this mass for 4 months and decided to come to the physician because the mass started to ooze a thick yellow exudate. Yellow granules are seen on microscopic examination of the discharge. Which of the following organisms is most likely responsible for this man’s lesion? *
1 point
70. A 25-year-old man develops acute onset of fever, malaise, muscle pain, hypertension, abdominal pain, bloody stool, and prerenal failure 6 months after recovering from an acute hepatitis B infection. Which of the following disease processes is most likely responsible for the patient’s fi ndings? *
1 point
71. A 15-year-old boy is brought to the emergency department because he has pain in his hand following a fist fight. The physician tells the patient that he has broken his hand. Which of the following is the most likely site of this patient’s  fracture? *
1 point
72. 60 years old male, blurred vision while taking amitriptyline due to blockade of which following receptor   *
1 point
73.  A asthmatic patient with recurrent asthma attack. He is too young to use inhaled corticosteroid. His patient prescribed Montelukast. What is the mechanism of action of the drug?   *
1 point
74. A pap smear from 25-year-old woman cells with high N/C ratio, condensation of chromatin, irregular nuclear membrane and perinuclear halo. What is organism the patient infected?   *
1 point
75. 10 years old boy, suffering from chronic cough and low-grade fever for 3 months. Chest X-rays found radio-opaque nodular and peritracheal lymphadenopathy. His mother has a history of pulmonary tuberculosis. Which of following is the finding from tracheal lymph node?   *
1 point
76. different families of membrane-associated carrier proteins: the glucose transporter facilitators (GLUT) and the sodium-coupled glucose transporters (SGLT). If a patient has a defect in the non-sodium-coupled glucose transporters, which cell line is still able to acquire glucose? *
1 point
77. A 31-year-old white woman is trying to get pregnant. She has a niece who suffers from a genetic disease characterized by recurrent respiratory infections and pancreatic failure. She would like to assess her chances of having a child with this disease. Which of the following laboratory techniques could be used to determine if this woman and/or her husband is a carrier of the mutant gene? *
1 point
78.หญิงอายุ 45 ปี ตรวจพบ pericarditis with pericardial effusion แพทย์ทำ pericardiocentesis หัตถการดังกล่าวต้องเจาะบริเวณ intercostal space ด้านซ้ายชิดกับ sternum ช่องใดต่อไปนี้ *
1 point
79. หญิงอายุ 40 ปี เหนื่อยง่ายมา 2 เดือน ตรวจร่างกายพบ systolic murmur at 5th intercostal space, 5 cm. from left side of sternum ลักษณะดังกล่าวเข้าได้กับ โรคใดต่อไปนี้มากที่สุด *
1 point
80. ชายอายุ 55 ปี หอบเหนื่อย นอนราบไม่ได้ ขาบวมทั้ง 2 ข้างมา 4 วัน ตรวจร่างกายพบ BP 140/90 mmHg, normal S1, S2, S3 gallop, fine crepitation at both lungs แพทย์สั่ง การรักษาด้วย furosemide ข้อใดเป็นกลไกของ furosemide ที่ใช้ในการรักษาผู้ป่วยรายนี้ *
1 point
81. A patient comes to you for anemia, and you work them up nicely, even giving them a digital rectal examination which came out normal. Serum creatinine, iron, B12, folate are all normal. The reticulocyte count is 0.5%. What could not have caused the anemia? *
1 point
82. บริเวณที่ใช้เป็นตำแหน่งทำ Bone Marrow biopsy ในผู้ใหญ่ อยู่ที่ใด   *
1 point
83. เด็กทารกอายุ 2 สัปดาห์ คลอดเองที่บ้าน มีอาการซึมลง ชักเกร็ง เข่าขวาบวม มีจ ้าเลือดตามผิวหนัง เกิดจากการขาดสารใด   *
1 point
84. ชายอายุ 70 ปีมีต่อมน ้าเหลืองโตทั่วตัวจากการท้า lymph node biopsy พบเซลล์มะเร็งที่เหมือนกับเซลล์ที่พบใน chronic lymphocytic leukemia จงให้การวินิจฉัยโรค   *
1 point
85. ผู้ป่วยเป็นมาลาเรีย 1 สัปดาห์ก่อนได้รับการรักษาด้วยยา 2 ชนิดวันนี มีอาการเหนื่อยปัสสาวะมีสีด้าย้อมเลือดด้วย Brilliant Cresyl Blue พบดังภาพอาการที่เกิดขึ นน่าจะเกิดจากสาเหตุใด   *
1 point
86. ชายอายุ 35 ปีท้างานในห้องปฏิบัติการเคมีมา 5 ปีมารพ. ด้วยอาการอ่อนเพลียเหนื่อยง่ายมา 3 เดือนโดย 1 เดือนก่อนเริ่มพบจ ้าเลือดที่ขา ทั งสองข้างตรวจร่างกายพบซีดปานกลางไม่เหลืองตับม้ ามและต่อมน ้าเหลืองไม่โตมีเลือดออกตามไรฟันและจ ้าเลือดที่ขาสองข้าง CBC: Hct 18%, Hb 6 g/dL, WBC 2,000/μL, PMN 10%, L 90%, platelet 12,000/μLท่านคิดว่าสาเหตุของโรคเกิดจากอะไร   *
1 point
87. 25-year-old female presented with a history of easy bruising for 3 months and extensive skin bleeding for 1 day. Physical examination was normal except extensive petechia and purpura all over her body. CBC: Hb 12.0 g/dL, MCV 79 fL, RDW 16.5 %, WBC 6.7x109/L, PMN 75%, L 20%, M 4%, E 1%, no abnormal cells, platelet 5.0x109/L. Anti-HIV was negative. The most likely diagnosis is *
1 point
88. ชายอายุ 25 ปีเป็น beta thalassemia/HbEได้รับการตัดม้ามเมื่ออายุ 10 ปีเนื่องจากมีซีดและม้ามโตมากตรวจ peripheral blood smear ในผู้ป่วยรายนี จะพบอะไร   *
1 point
89. A patient with mild congestive heart failure is treated with high-dose furosemide and diureses 25 pounds of fluid. A complete blood count (CBC) taken before the diuresis shows an RBC count of 4 million/mm3; a CBC taken after diuresis shows a RBC count of 7 million/mm3. Which of the following is the most likely explanation?   *
1 point
90. A patient has long-standing severe hemolytic anemia characterized by hypochromic cells. Electrophoresis studies demonstrate a near complete absence of beta chains. Several years later, the patient develops cardiac failure. Intracardiac deposition of which of the following would be most likely to contribute to the cardiac failure?   *
1 point
91. ผู้ป่วยหญิงอายุ 35 ปี มีไข้ต่ าๆ ปวดข้อเข่าและข้อมือมา 4 วันก่อนมาโรงพยาบาล มาพบแพทย์เจาะน้ำข้อเข่าตรวจพบ WBC = 89000, PMN = 90%, G/S: gram negative intracellular diplococci การรักษาข้อใดต่อไปนี เหมาะสมที่สุด *
1 point
92. ผู้ป่วยชายวัยกลางคน ชักแบบ Generalized Tonic clonic ปฏิเสธประวัติอุบัติเหตุหรือการใช้สารเสพย์ติด ผู้ป่วยไม่เคยมีอาการชักแบบนี้มาก่อน ไม่มีไข้ จากการตรวจร่างกายเบื องต้นไม่พบ neurological deficitใดๆ แต่พบว่ามี papilledema ผล  CT scan : multiple calcified cystic lesion เชื อก่อโรคในข้อใดต่อไปนี น่าจะท าให้เกิดอาการในชายผู้นี มากที่สุด *
1 point
93. เด็กชายอายุ 9 ขวบ มาโรงพยาบาลด้วยไข้สูง หายใจหอบเหนื่อย ไอ แพทย์ท้าการตรวจร่างกายพบว่ามี BT= 39.0 C, PR= 120 /min, RR= 40 /min, crepitation both lungs, decreased breath sound left lung ผู้ป่วยมีแผลตุ่มหนองและ cellulitis ที่ขาซ้าย เชื้อก่อโรคในข้อใด *
1 point
94. ผู้ป่วยหญิงไทยอายุ 40 ปี มีอาการปวดบวมต้นขาซ้ายและมีไข้ แพทย์ทำการตรวจร่างกายพบว่ามี BT = 39 c, erythema and tender at left upper thigh เจาะแล้วได้หนอง เชื้อก่อโรคในข้อใดต่อไปนี้น่าจะทำให้เกิดอาการในผู้ป่วยรายนี มากที่สุด *
1 point
95. A 20-year-old man became very agitated at a party, and as a result was brought to the emergency department, where he is belligerent and uncooperative. A physical examination reveals fever, tachycardia, horizontal nystagmus, and hyperacusis. Which of the following substances may cause the behavioral changes and physical findings exhibited by this patient? *
1 point
96. A new antihypertensive medication is being investigated in a clinical trial. Investigators have noted a decrease in blood pressure in the group treated with the drug compared to the placebo group. While examining the study’s participants, investigators notice that the experimental group has a lower mean age. What is this an example of? *
1 point
97. Phosphatidylcholine is a major component of red blood cell membranes, myelin, surfactant, and cholesterol. Phosphatidylcholine is synthesized through phosphorylation of choline obtained from the diet or with reused choline derived from phospholipid turnover. De novo synthesis requires an addition of three methyl groups, transferred from an aminoacid. Without the turnover component, defi ciency in which essential amino acid would make dietary choline essential for phosphatidylcholine synthesis? *
1 point
98. Heme synthesis occurs in the bone marrow and liver. Defi ciency of δ-aminolevulinic acid hydrase would lead to the accumulation of which of the following? *
1 point
99. A 5-year-old girl is brought to her pediatrician because her mother says she is frequently bumping into stationary objects while playing. Visual field examination shows bilateral peripheral vision defects. CT of the head reveals calcifi cations in the pituitary fossa. Which of the following is the most likely origin of this child’s brain tumor? *
1 point
100. A 1-week-old infant presents with a urachal fi stula, which occurs when the allantois fails to regress. Normally, the allantois and urachus regress to form a specifi c structure in the fully matured neonate. Which of the following is the mature structure derived from the fetal allantois and urachus? *
1 point
101. A 30-year-old woman comes to the physician because of a fever of 38.4°C (101.1°F) and a diffuse macular rash on her torso. Her blood pressure is 91/51 mm Hg. The physician obtains a culture from her vagina that shows catalase-positive, gram-positive cocci. Over the next few days, the rash on her torso desquamates. Which of the following organisms is most likely responsible for this patient’s symptoms? *
1 point
102. A 50-year-old man develops nonbloody watery diarrhea while working as an aid worker in a refugee camp in Bangladesh. He arrived in the area 2 days ago. A stool smear shows no WBCs. He subsequently develops dehydration and electrolyte abnormalities leading tocardiac and renal failure. Which of the following organisms is the most likely cause of this man’s enterocolitis? *
1 point
103. A 40-year-old man comes to the emergency department because of diplopia and dysphagia that developed after he consumed homemade strawberry jam. While in the emergency department, he develops general muscle weakness and requires intubation due to sudden respiratory muscle paralysis. Which of the following pathogens is most likely responsible for this patient’s condition? *
1 point
104. A 13-year-old boy is diagnosed with a hyperactive immune system. Normally an antigen will activate the immune system to trigger a proinflammatory response. Following the proinflammatory response, anti-inflammatory signals then dampen the immune response to prevent it from causing damage. This patient has trouble dampening the immune response after it is no longer needed. Decreased activity in which of the following anti-infl ammatory cytokines is most likely the basis for this boy’s condition? *
1 point
105. A 32-year-old man with Hodgkin’s lymphoma is scheduled to undergo a bone marrow transplant. HLA typing of his immediate family shows that his identical twin brother is a suitable match for harvesting an allogenic bone marrow graft. This type of graft can be classified as which of the following? *
1 point
106. A 50-year-old man comes to the physician with hemoptysis and diffuse joint pain. He states that both his father and cousin had similar symptoms and were diagnosed with microscopic polyangiitis, a disease affecting medium-to small-sized arteries that is believed to have an autoimmune component to its pathogenesis. Which of the following autoantibodies might be present in this patient? *
1 point
107. A mother brings her 5-year-old son to his pediatrician’s office. The boy has been experiencing frequent falls as well as progressive difficulty with walking, jumping, and hopping. Laboratory testing reveals a creatine kinase level of 2840 U/L. Muscle biopsy reveals variation in fi ber diameter, an increased number of internalized nuclei, and musclefiber degeneration and regeneration. Western blot analysis will most likely reveal the complete absence of which of the following? *
1 point
108. A 55-year-old recent immigrant from Taiwan presents to the clinic with a 3-month history of worsening nasal congestion, epistaxis, and recurrent ear infections. Physical examination reveals painless firm lymph node enlargement in the neck. CT of the head reveal a large mass situated in the upper nasopharynx. Biopsy of the lesion shows large epithelioid cells intermixed with numerous infi ltrating lymphocytes The infectious agent directly associated with this patient’s pathology is best described by which category? *
1 point
109. A 33-year-old woman with a history of Graves’ disease is brought to the emergency department unresponsive following a bout of confusion and agitation. On physical examination her temperature is 39.2° C (102.5° F), her blood pressure is 100/70 mm Hg, and her pulse is 165/min. A systolic ejection murmur is heard at the apex, and the patient has 3+ pitting edema at the ankles. Following primary stabilization, which of the following would constitute appropriate pharmacotherapy for this patient’s underlying condition? *
1 point
110. The plasma concentration of drug Y is 50 mg/L, and it is eliminated at a rate of 2 mg/ min. Which of the following is the clearance rate of drug Y? *
1 point
 111. A 24-year-old law student has been experiencing frequent headaches for which he has been taking increasingly large doses of aspirin for 3 months. One night he takes a particularly large dose, becomes confused, and falls into a seizure. He presents to the emergency department with a serum salicylate level of 130 mg/ dL. Which of the following is the most appropriate treatment? *
1 point
112. A 52-year-old man with end-stage renal disease presents to his renal clinic with a hemoglobin concentration of 8 g/dL and an absolute reticulocyte count of <25,000 cells/mm3 .His WBC count is 11,000/mm3 and the differential is within normal limits. A peripheral blood smear shows hypochromic, microcytic RBCs. Iron staining of a bone marrow aspirate shows macrophages positive and RBCs negative for iron within the cytoplasm. Which of the following is the most likely cause of this patient’s condition? *
1 point
113. A physician decides to place a patient on a calcium channel blocker for treatment of her angina. Calcium channel blockers can relax the smooth muscle of blood vessels and can also have various effects on cardiac contractility, conduction, and heart rate. Which of the following calcium channel blockers would be most effective in reducing heart rate and contractility? *
1 point
114. A medical student working in the emergency department sees a female baby, born 2 weeks ago, who is brought in by her anxious mother. The mother tells the student that her baby seems “purple,” especially her fi ngers and toes, and looks extremely blue when crying. On physical examination the sleeping baby has mild cyanosis of the face and trunk, but moderate cyanosis of the extremities. Which of the following is the most common cause of cyanosis within the first few weeks of life? *
1 point
115 . A certain endocrine disorder can lead to an elevated blood pressure, decreased potassium levels, sodium and water retention, and decreased renin activity. Which of the following is the most likely diagnosis? *
1 point
116. A 34-year-old man with moderately severe ulcerative colitis has been taking oral prednisone for 4 months. Which of the following symptoms is the most likely adverse effect of this drug? *
1 point
117. A 34-year-old man with moderately severe ulcerative colitis has been taking oral prednisone for 4 months. Which of the following symptoms is the most likely adverse effect of this drug? *
1 point
118.A 60-year-old woman with a history of type 2 diabetes mellitus comes to the clinic for a follow-up examination after being placed on a new agent to help her achieve tighter glycemic control. She complains that she has suffered occasional abdominal cramps and diarrhea, adding that she has recently been experiencing increased fl atulence, which has become an embarrassing nuisance. Which of the following agents best accounts for this patient’s complaints? *
1 point
119. A 55-year-old woman presents to her doctor with feelings of fatigue, increased appetite, increased sweating, and palpitations. Physical examination is unremarkable except for exophthalmos. She receives pharmacologic treatment for her condition, but soon develops a fever and multiple infections in her throat and gastrointestinal tract. Her doctor quickly discontinues the medication Which medication was she most likely prescribed? *
1 point
120. A healthy 25-year-old man comes to the physician for a routine examination. His laboratory tests show a serum bilirubin level of 4 mg/dL and a direct bilirubin level of 0.3 mg/dL. The patient’s liver function tests are normal. Which of the following best explains this patient’s serum and indirect bilirubin levels? *
1 point
121.Which of the following types of hepatocellular injury is commonly seen after acetaminophen overdose? *
1 point
122. An 8-year-old boy presents to the emergency department with a 2-hour history of vomiting after eating dinner at a seafood buffet. Arterial blood gas analysis reveals a pH of 7.50, an bicarbonate level of 34 mEq/L, and partial carbon dioxide pressure of 40 mm Hg. Which of the following best describes the acid-base disturbance occurring in this patient? *
1 point
123. A 24-year-old man presents to the physician with diarrhea and abdominal cramps. A fecal occult blood test is positive. On questioning, it is learned that the patient wentswimming in a lake during a camping trip 2 days ago. A stool sample is sent for laboratory evaluation. This patient is most likely infected with which of the following? *
1 point
124. A healthy 55-year-old woman presents to the physician with a 1-year history of an unchanging, palpable mass in her left cheek. A parotid gland biopsy reveals groups of well-differentiated epithelial cells in a chondromyxoid stroma surrounded by a fi brous capsule; multiple cell types are visible on light microscopy. The pathologic description of the mass is most consistent with which of the following conditions? *
1 point
125. Low-molecular-weight heparins (LMWH) are distinct from unfractionated heparin in several ways. Which of the following is the primary target of LMWH? *
1 point
126. A 60-year-old woman presents to her physician with findings of decreased proprioception in her lower extremities and gait instability consistent with subacute combined degeneration secondary to cobalamin defi ciency. However, blood tests show normal hematocrit and nearnormal mean cell volume. The physician orders additional tests. Which of the following laboratory results would support a diagnosis of cobalamin defi ciency? *
1 point
127. A 3-year-old girl was in her usual state of good health 1 month ago when she developed an acute viral upper respiratory infection. She now presents to the emergency department with nonblanching purple skin lesions. The rest of her physical examination is unremarkable. The complete blood count demonstrates a low platelet count, while the peripheral blood smear is notable only for large platelets. Which of the following laboratory findings would most likely be present in this patient? *
1 point
128. A 29-year-old man presents to his primary care physician with a painless testicular mass. Laboratory studies show an elevated serum human chorionic gonadotropin level. Which of the following is the most likely site of nodal metastasis in this tumor? *
1 point
129. A 22-year-old man is diagnosed with medullary thyroid carcinoma, and his blood tests are significant for hypercalcemia and increased plasma catecholamine levels. He reports that his mother also had medullary thyroid carcinoma in her twenties and that she recently had surgery to remove her parathyroid glands. These findings suggest a possible mutation in which of the following genes? *
1 point
130.A 34-year-old man injures his lateral pterygoid muscle. Which of the following activities will be adversely affected by this injury? *
1 point
131. A 21-year-old man presents to the emergency department following an injury to his shoulder that he sustained while playing football. His shoulder appears fl attened, and he is not able to abduct his arm. He is found to have a fracture at the surgical neck of his humerus. The muscle that is most likely injured in this patient receives innervation from which of the following nerve roots? *
1 point
132.A 22-year-old woman who is a professional tennis player presents to the physician with pain on the lateral aspect of her elbow radiating down her forearm. Repetitive use of which of the following muscles most likely lead to this patient’s condition? *
1 point
133. A 27-year-old man comes to the physician’s office with a 6-month history of low back pain and stiffness that wakes him up during the night and is worst in the morning. The patient was diagnosed with bilateral sacroiliitis 4 months ago because of his tenderness to percussion of the sacroiliac joints and pain on springing the pelvis up. He has severe limitation of motion of his lumbar spine. Laboratory test results are negative for antinuclear antibody and rheumatoid factor, and show the patient’s human leukocyte antigen status is B27- positive. Which of the following is the most likely diagnosis? *
1 point
134. During the autopsy of a patient who complained of a severe headache shortly before dying, the pathologist removes the calvarium with the dura attached. On the surface of the brain, there is frank blood on visual inspection that she is unable to remove by rubbing or scraping the surface. Which of the following types of hemorrhages most likely caused this finding *
1 point
135. A 40-year-old man was admitted to the neurology service for evaluation of persistent numbness over his left jaw and lower face. MRI reveals a schwannoma, which is compressing a cranial nerve as the nerve exits the skull. The cranial nerve involved in this case exits the skull through which of the following foramina? *
1 point