ข้อสอบ MD NL 22 
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ชื่อ - สกุล *
เลขประจำตัวนิสิต *
1.Which amino acid is a major neurotransmitter in the brain? *
1 point
2. Sickle cell disease results in abnormal hemoglobin formation because of a point mutation in DNA that leads to the insertion of which amino acid into b-globin? *
1 point
 3.The mutation associated with Marfan syndrome is with the fibrillary protein fibrillin. What aspect of protein structure is affected in this disorder? *
1 point
4.Which condition can lead to life-threatening autodigestion of lipids and proteins? *
1 point
5. A 22-year-old woman is seen for the first time by her new physician, who notes that she has very thick bones in her extremities and face. The physician suspects acromegaly, caused by which of the following? *
1 point
6. Which of the following organelles divides by fission? *
1 point
7. A 2-year-old boy with Down syndrome requires intubation in the intensive care unit due to difficulty breathing. He is afflicted with congenital heart disease associated with the disease, and he dies shortly after admission. What is the most common genetic cause of Down syndrome? *
1 point
8. Depressed levels of MHC class I molecules on virus infected host cells can be detected by *
1 point
9. The adaptive immune system develops from stem cells originating in the *
1 point
10. A 3 year old presents with difficulty breathing and will not lie down to be examined. You suspect acute bacterial epiglottitis and examine the child’s epiglottis, which is highly inflamed. Which vaccine are you most likely to find that the child is missing *
1 point
11. A 54-year-old man develops a pyogenic infection along the suture line after knee surgery. The laboratory gives a preliminary report of a beta-hemolytic, catalase-positive, coagulase-positive, Gram- positive coccus. The most likely causative agent is *
1 point
12.A patient had surgery 2 months ago to put in a pacemaker. He felt fine for 1 month, but over the past month, he has been feeling worse. He is running a low-grade fever, tires easily, and has worsening heart murmurs. Which of the following staphylococcal organisms causes subacute bacterial endocarditis that occurs 2 months or more after heart surgery? *
1 point
13. A patient with severe anemia has a peripheral blood smear with oval macrocytes, hypersegmented neutrophils, and decreased platelets. The most likely cause of the anemia is *
1 point
14. An 18-year-old man is transported to the emergency department within 20 minutes of sustaining a stab wound to the chest. The patient is poorly responsive. Given that he may have lost as much as 1.5 liters of blood at the scene, which of the following is the most likely finding in this patient? *
1 point
15. A 23-year-old woman presents with cervical and mediastinal lymphadenopathy. Biopsy of a cervical lymph node reveals a nodular appearance with fibrous bands, effacement of the lymph node architecture, and numerous lacunar cells. Which of the following is characteristic of this disorder? *
1 point
16. A 3-year-old boy presents with epistaxis and fever. Multiple cutaneous petechiae are evident, and there is generalized enlargement of lymph nodes, as well as palpable splenomegaly. The hemoglobin and platelet count are markedly decreased, and the white blood cell count is elevated to 40,000 cells/μL, with a preponderance of lymphoblasts. Which of the following statements best characterizes this disorder? *
1 point
17. A 72-year-old man who has recently had an aortic valve replacement now presents with pallor and fatigue. The red blood cell count is decreased, and schistocytes are reported on examination of a peripheral blood smear. In addition, his indirect (unconjugated) bilirubin is significantly elevated. The cause of the anemia is likely *
1 point
18. A 35-year-old woman is seen 6 months after giving birth to a normal infant. She suffered severe cervical lacerations during delivery, resulting in hemorrhagic shock. Following blood transfusion and surgical repair, postpartum recovery has so far been uneventful. She now complains of continued amenorrhea and loss of weight and muscle strength. Further investigation might be expected to demonstrate which of the following findings? *
1 point
19. A 32-year-old woman presents with amenorrhea, galactorrhea, and visual field defects, all of several months’ duration. Magnetic resonance imaging reveals a hypophyseal mass impinging on the optic chiasm. This is most likely a(n) *
1 point
20. A 28-year-old man is evaluated for recurrent peptic ulcer disease, apparently refractory to pharmacologic intervention. Serum gastrin is markedly elevated. These findings are most characteristic of which of the following? *
1 point
21.A 14-year-old boy is seen because of increasing weakness, easy fatigability, and weight loss over the past 3 months. In addition, he has recently developed nausea, vomiting, and abdominal pain. His blood pressure is markedly decreased, and he has increased pigmentation of his skin creases. These findings are suggestive of *
1 point
22. 23-year-old woman presents with tremor, restlessness, heat intolerance, palpitation, and unexplained weight loss. The thyroid is symmetrically enlarged, the pulse is rapid, the skin is moist and warm, and exophthalmos is apparent. This condition is considered to be *
1 point
23. A 35-year-old woman presents with amenorrhea and weight loss despite increased appetite. The history and physical examination reveal exophthalmos, fine resting tremor, tachycardia, and warm, moist skin. Laboratory tests for thyroid function would be expected to yield a decreased value for which of the following? *
1 point
24. A 26-year-old primigravida develops gestational diabetes and remains hyperglycemic during the remainder of her pregnancy. Which of the following abnormalities in the newborn child is likely related to the maternal hyperglycemia? *
1 point
25. After suffering a seizure, a 23-year-old woman is found to have profound hypoglycemia. Determination of which of the following would aid in differentiating exogenous hyperinsulinemia from endogenous hyperinsulinemia? *
1 point
27. Which component of hair is used for DNA investigation? *
1 point
28.What is the most complicated of ARPKD in children   *
1 point
29.   A heavy smoker man with Pain in calves when have a short distance walking. His finger and toes are cold and pale. Which of the following is the most clinical diagnosis? *
1 point
30.  A 30-year-old woman is diagnosed with pulmonary valve stenosis. Which of these are the best mean axis deviation? *
1 point
31.  A 70 year-old male with chronic hypertension .He suddenly fell numbness in his leg and his toe is cold .Normal ECG .Where is the arterial thromboembolism source in this patient? *
1 point
31. A 60-year-old woman has blood leakage from intestinal hemorrhage. Where is the most likely location of blood accumulation in quantity when in supine, bedridden position? *
1 point
32.  A male patient with drowsiness and confusion. PE: jaundice, spider nevi, ascites. Lab: total protein 4.5, albumin 1.8, total bilirubin 14.8, direct bilirubin 10.4, AST 130, ALT 28, ALP 55, ammonia 280. What is the cause of his clinical manifestations? *
1 point
33.   sigmoid colon cancer. Large area sigmoid colectomy ต้องผูกหลอดเลือดใด *
1 point
34.  A child has come to the doctor with barking cough and stridor without hoarseness. Which structure is affected? *
1 point
35.  Pudendal nerve block ทำที่ตรงไหน *
1 point
36.  Japanese tourism complaint for gut obstruction. Physician did colonoscopy in small intestine and see nematode. The patient tell about history of raw sea fish consumption. *
1 point
37.  An alcoholic cirrhosis patient with confusion is diagnosed hepatic encephalopathy. Which of the Kreb's cycle intermediate is depleted in the patient? *
1 point
38.  A 2-year-old fever rash with Koplik’s spot at buccal mucosal. How this infection is transmitted?
1 point
Clear selection
39.  A 50 years-old man has well-controlled hypertension for 10 years. He wanted his doctor to sign him a medical certificate supporting his early retirement plan. Should the doctor do as he was requested? *
1 point
40. A 30 year-old female has progressive dyspnea, palpitation, sweating and weight loss for 2 months. Physical examination shows T 39C, P 130/min, irregular enlarged thyroid gland. Electrocardiography suggests atrial fibrillation. The patient is treated with propylthiouracil, Lugol’s solution and dexamethasone. Which of the following mechanism in thyroid hormone synthesis is primarily inhibited by Lugol’s solution? *
1 point
41 .An undernourished 2-year-old boy has developed ankle and leg edema, distended abdomen, thinning hair, skin hypopigmentation and dermatitis. Which of the following amino acids are deficient in this patient? *
1 point
42. Bloody discharge from nipple mass: branching fibrovascular core, fibrovascular change underlying epithelium *
1 point
43. A 60-year-old man with history of urination difficulty presents with pathologic fracture and multiple bone lesions. Bone biopsy reveals dysplastic glands infiltrating in the bone marrow. What is the most proper tumor-related marker in this patient? *
1 point
44. 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
45. An infant has simian crease, Mongolian face with slant eyes, small ears, increase skin back of neck, short neck and wide space between the big and the second toes ถาม karyotype *
1 point
46. 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
47.A 30 year-old woman with uncontrolled hypertension develop diplopia and drooping her right eyelid and muscle weakness on left arm. Physical examination shows ipsilateral medial gaze paralyze, contralateral weakness. Which is site of pathogenic? *
1 point
48.38 week pregnancy woman ask her doctor for C-section to terminate her child onspecific date that her family believe it will give her family big luck ละเมิด ethic ข้อใด *
1 point
49. A 5-year-old girl with thalassemia has to receive blood transfusion regularly.Which of thefollowing agent can protect her from complication of blood transfusion ? *
1 point
50. What is mechanism of Botulinum toxin? *
1 point
51. A boy has Lt.-sided complete cleft lip, normal fusion of palate. Which of the followingembryonic structures has developmental defect? *
1 point
52. A 30-year-old waiter presents with pain at lateral side of his right elbow. The pain isincreased while shaking hand. PE: Right elbow tenderness over lateral epicondyle. Whichmuscle is involved in his condition? *
1 point
53. A 50-year-old women has been presented with cirrhosis, high grade fever, hemorrhagicbleb T=40 BP 60/40 PR 130 After being punctated by Spine of shell fish Hemoculture: Gramnegative bacilli. Which one of the following is the causative organism? *
1 point
54. A 30-year-old man develops severe headache after ingestion of uncooked land snails.Neck stiffness is noted on physical examination. CSF examination reveals eosinophilia. Which of the following is the most likely causative parasite? *
1 point
55. Which is characteristic of cancer cells allow their survival from immune system? *
1 point
56. The person who was smoking for a long time usually has respiratory epithelial liningchangedto stratified squamous epithelium. What is this mechanism? *
1 point
57. The AIDS patients come to hospital because of fever, productive cough , dyspnea . Thesputum has shown binary fission yeast. What is causative organism ? *
1 point
58. The mother 35 years old who had been drinking alcohol, coffee, smoking has the childwithsmall head, maxillary hypoplasia, thin upper lip. Which of the following is the cause forabnormality in the child? *
1 point
59. A 68-year-old man has had low back pain over the past 2 months. Laboratory studiesshow a normochromic, normocytic anemia and azotemia. Serum and urine calciumconcentrations are abnormally increased, and increase globulin . Urinalysis shows excessive protein (4+) and proteinaceous casts. Bone marrow examination is most likely to show uncontrolled proliferation of which of the following cells? *
1 point
60. A 60-year-old woman has blood leakage from intestinal hemorrhage. Where is the mostLikely location of blood accumulation in quantity when in supine, bedridden position? *
1 point
61. A 30-year-old woman is diagnosed with pulmonary valve stenosis. Which of these arethe best mean axis deviation? *
1 point
62. A heavy smoker man with Pain in calves when have a short distance walking. His fingerand toes are cold and pale. Which of the following is the most clinical diagnosis? *
1 point
63. BP 100/60, HR 120/min ESV=160, EDV=200 หา ejection fraction เป็น % *
1 point
64. A female has wheezing. She is given salbutamol but wheezing still persist.Which drug should be given? *
1 point
65. A 2-year-old did not get what he wanted. Then,he screamed, cried and held his breath for about one minute and turned blue. Afterwhile, he rebreathed again. What is the most important stimulator causing him to rebreathe again? *
1 point
66. A man has total hip replacement. The patient has difficulty of walking (trendelenburggait). Which nerve is most likely injured from the operation? *
1 point
67. Harlequin ichthyosis มีdefect ที่ใด *
1 point
68. A 10-year-old girl has headache, puffy eyelid and bilateral leg edema for 2 days. Twoweek ago,She had sore throat and fever relieved by consuming over-the-counter drug. PE: BP140/80. UA: protein 2+, RBC 5-10/hpf, red cell cast 1-2/lpf. Which of the followingcondition is most compatible with the clinical presentation? *
1 point
69. A 5 year-old boy has hematuria and sensorineural deafness. Which type of collagen ismutated in this patient? *
1 point
70. A female use carbonic anhydrase inhibitor for glaucoma treatment. She developedmetabolicalkalosis. What is the site of renal tubule does this drug affect? *
1 point
71. A 30 year-old pregnant women attends an antenatal care clinic. A fetal defect issuspected. Which is the indication for a prenatal diagnosis? *
1 point
72. A 30 year-old female has progressive dyspnea, palpitation, sweating and weight loss for 2months.Physical examination shows T 39C, P 130/min, irregular enlarged thyroid gland.Electrocardiography suggests atrial fibrillation. The patient is treated with propylthiouracil, Lugol’s solution and dexamethasone. Which of the following mechanism in thyroid hormone synthesis is primarily inhibited by Lugol’s solution? *
1 point
73. 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
74. 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
75. 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, deficiency in which essential amino acid would make dietary choline essential for phosphatidylcholine synthesis? *
1 point
76. 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
77.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
78.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
79. 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
80. 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
81. 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
82. 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
83. 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
84 . 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
85.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
86. 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
87. 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
88.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
89. 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
90. 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
91.Which of the following types of hepatocellular injury is commonly seen after acetaminophen overdose? *
1 point
92. 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
93. 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
94.  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
95. A 3-year-old girl was in her usual state of good health 1 month ago when she developedan 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
96. 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
97. A 22-year-old man is diagnosed with medullary thyroid carcinoma, and his blood tests are signifi cant 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
98. A 50-year-old slightly obese man comes to the emergency department with his wife at 3 am complaining of severe pain in his left great toe. He said the pain began 5 hours ago while he was walking home after dinner, which consisted of steak and a few beers. His serum studies are unremarkable except for negative blood cultures and an elevated uric acid level. When asked about allergies, the patient states that he is allergic to nonsteroidal anti-infl ammatory drugs. An aspiration of the toe reveals negatively birefringent crystals. Which of the following is the best acute treatment for this condition? *
1 point
99. A 34-year-old man injures his lateral pterygoid muscle. Which of the following activities will be adversely affected by this injury? *
1 point
100. 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
101. 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 fi nding? *
1 point
102. 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
 103. A 76-year-old woman dies at home from sudden cardiac arrest after the onset of ventricular fibrillation. The family consents to an autopsy that reveals several small infarcts throughout the basal ganglia. Assuming that the defects arise from a single vessel within the central nervous system, pathology from which artery would be most consistent with this fi nding? *
1 point
104.During a right temporal craniotomy, the neuronal radiations projecting to the inferior bank of the calcarine sulcus are injured. Which of the following is the most likely visual disturbance to occur in this patient? *
1 point
105. A 42-year-old woman presents to her primary care physician with a chief complaint of paresthesias that started in her fingers and toes about 1 week ago. Since then, her symptoms have progressed to include paresthesias and muscle weakness in her lower legs. A nerve conduction study is performed and shows slowed nerve conduction velocities. As her disease progresses, which of the following acidbase disorders would she be expected to develop? *
1 point
106. A psychologist whose first child is now 4 years old is applying the principles of behavioral modification to child-rearing. For instance, if the child throws a temper tantrum in a store because she will not buy him candy, she just picks up the child and leaves the store; however, if the child behaves in the store, she takes him to the zoo. This is an example of which of the following kinds of behavior modifi cation? *
1 point
 107. A 45-year-old man who has received long-term treatment for schizophrenia has recently been noted to display involuntary movements that include lateral deviations of the jaw and “fly-catching” motions with his tongue. Which of the following agents is the most likely cause of his involuntary movements? *
1 point
108. A 35-year-old man with depression presents to the emergency department with flushing, diarrhea, sweating, and muscle rigidity. During the physical examination, he says that he began seeing a new psychiatrist because his sertraline was not working for him. His new doctor gave him a different medication, but he decided to use both medicines to “get rid of the depression.” Which of the following medications did the new doctor most likely prescribe for this patient? *
1 point
109. A 44-year-old schizophrenic patient on a psychiatric ward is interviewed daily as part of her treatment. She has been persistently reporting that she is married to Paul McCartney. This psychotic symptom is a disorder of which of the following? *
1 point
110. A 35-year-old woman presents to the emergency department with trembling hands and a facialtic. According to her mother, she has been seeing a psychiatrist for the past year. She has no other significant medical history. On examination the patient has repetitive facial grimaces with occasional protrusion of the tongue. She denies that these facial expressions are produced purposefully. Which of the following medications has this patient most likely been taking? *
1 point
111. 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
 112. A 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
113. Abnormal opening of the urethra on the ventral penis is caused by the failure of a certain urogenital structure to complete normal development in the fetus. This structure is present in both male and female infants, but has a different fate in each. What structure in the female infant is derived from the fetal structure described here? *
1 point
114. A 25-year-old medical student presents with a nonproductive cough, low-grade fever, and malaise of 3 weeks’ duration. He says that a few of the people he studies with have been feeling the same way. Sputum cultures come back negative. The patient denies exposure to farm animals, travel, or HIV. The physician decides to treat for an atypical pneumonia. Which of the following methods could identify the organism responsible for such a pneumonia? *
1 point
115. A 7-year-old boy is brought to the pediatrician because of a chronic cough, fatty diarrhea, and failure to thrive. Pseudomonas aeruginosa is cultured from his respiratory tract. The physician informs the patient’s parents that their son has a disease that is caused by a mutation in a specific ion transporter. This patient has a mutation in the ion transporter of which of the following electrolytes? *
1 point
 116. An 8-year-old boy comes to the physician with his mother, who wants to discuss respiratory problems that have arisen since an upper respiratory infection 4 months ago. The mother says that the patient has attacks characterized by wheezing and shortness of breath that usually resolve after an hour. On one occasion, an attack required a visit to the emergency department, and the mother remembers the treating physician saying something about an abnormally high level of eosinophils in the patient’s blood. Which cytokine is involved in the pathogenesis of this disease? *
1 point
 117. An HIV-positive 24-year-old man from Southern California comes in to his physician’s of- fice with a dry cough, headache, mild wheezing, and slight fever. A complete blood cell count shows elevated eosinophils, and a potassium hydroxide sputum smear is positive formicroorganisms. The infectious form of the organism causing the patient’s symptoms possesses which of the following key components? *
1 point
118. A 34-year-old obese woman has experienced heartburn from gastric reflux for the past five years after eating large meals. She undergoes upper gastrointestinal endoscopy, and a biopsy specimen of the distal esophagus is obtained. Which of the following microscopic changes, seen in the figure, has most likely occurred? *
1 point
119. An 11-year-old girl becomes infected with hepatitis A and experiences mild nausea for 1 week. On physical examination, she has minimal right upper quadrant tenderness and scleral icterus. Laboratory findings include serum AST of 68 U/L , ALT of 75 U/L , and total bilirubin of 5.1 mg/dL. Her laboratory findings most likely result from which of the following changes in her hepatocyte? *
1 point
120. A 68-year-old woman suddenly lost conciousness and on awakening 1 hour later, she could not speak or move her right arm. Two months later, a head CT showed a large cystic area in the left parietal lobe. Which of the following pathologic processes has most likely occurred in her brain? *
1 point
121. On day 28 of her menstrual cycle, a 23-year-old woman experiences onset of menstrual bleeding that lasts for 6 days. She has had regular cycle since menarche. Which of the following processes most likely occurs in her endometrial cells to initiate the onset of menstrual bleeding? *
1 point
122. An 11-year-old child falls and cuts his hand. The wound becomes infected. Bacteria extend into the extracellular matrix around capillaries. In the inflammatory response to this infection, which of the following cells removes bacteria? *
1 point
123. A 72-year-old man with severe emphysema has had worsening right ventricular failure for the past 5 years. For the past 4 days, he has had fever and increasing dyspnea. A chest radiograph shows an accumulation of fluid in the pleural spaces. Fluid obtained by thoracocentesis has a specific gravity of 1.030 and contains degenerating neutrophils. The most likely cause of this fluid accumulation is due to changes in which of the following? *
1 point
124. A 77-year-old woman experiences a sudden loss of consciousness, with loss of movement on the right side of the body. Cerebral angiography shows an occlusion of the left middle cerebral artery. Elaboration of which of the following mediators will be most beneficial in preventing further ischemic injury to her cerebral cortex? *
1 point
125. A 59-year-old woman with a history of diabetes mellitus had a myocardial infarction 3 months ago. Her BMI is 35. She is now taking a low dose of aspirin to reduce the risk for recurrent arterial thrombosis. On which of the following steps in hemostasis does aspirin have its greatest effect? *
1 point
126. A 21-year-old woman has had multiple episodes of deep venous thrombosis during the past 10 years and one episode of pulmonary thromboembolism during the past year. Laboratory tests show that her prothrombin time (PT), partial thromboplastin time (PTT), platelet count, and platelet function studies all are normal. Which of the following risk factors is the most common cause for such a coagulopathy? *
1 point
127. A 22-year-old man has a sudden loss of vision in the right eye. On physical examination, there is a subluxation of the right crystalline lens. On auscultation of the chest, a midsystolic click is audible. An echocardiogram shows a floppy mitral valve and dilated aortic arch. The patient's brother and his cousin are similarly affected. He is prescribed a beta-blocker. A genetic defect involving which of the following substances is most likely to be present in this patient? *
1 point
128. An 11-year-old child has exhibited poor wound healing, even with minor trauma, since infancy. On examination she has hyperextensible joints and fragile, extremely stretchable skin. A diaphragmatic hernia was repaired soon after birth. One parent and one of three siblings are also affected. A mutation in a gene encoding for which of the following type of proteins is most likely causing this child's disease? *
1 point
129. An epidemiologic study is conducted with children ages 1 to 5 years who are infected with HIV-1. Most of these children have CD4+ lymphocyte counts above 500/mm3 and undetectable plasma HIV-1 RNA levels. On physical examination they have no abnormal findings. What is the most likely mode of transmission by which these children get infected? *
1 point
130. In an experiment, phagocytosis of bacteria by neutrophils is studied. Bacteria are introduced into plasma containing neutrophils. It is observed that phagocytosis of Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis is reduced, compared with Enterobacteriaceae. Which of the following immune evasion mechanisms in these three bacterial species best explains this finding? *
1 point
131. A 40-year-old man has a positive stool guaiac test during a routine physical examination. A colonoscopy is performed and a 0.9-cm, circumscribed, pedunculated mass on a short stalk is found in the upper rectum. Which of the following terms best describes this lesion? *
1 point
132. In a study that examines granuloma formation in the lung in response to infection with Mycobacterium tuberculosis, it is observed that some cells within the granuloma express MHC class II antigens. These class II antigen-bearing cells are most likely derived from which of the following peripheral blood leukocytes? *
1 point
133. A 20-year-old man has had a mild fever with nonproductive cough, headache, and myalgia for the past week. On physical examination he has a temperature of 37.9° C and erythema of the pharynx. Diffuse crackles are heard on auscultation of the lungs. A chest radiograph shows bilateral extensive patchy infiltrates. A sputum Gram stain shows normal flora. Cold agglutinin titer is elevated. He receives a course of erythromycin therapy, and his condition improves. Infection with which of the following organisms is most likely to produce these findings? *
1 point
134.. A 70-year-old woman has had episodes of dyspnea with wheezing and coughing, accompanied by urticaria for the past 3 years. She has had bouts of rhinitis. She has a 10- year history of osteoarthritis. On physical examination she has nasal polyps. Use of which of the following medications is the most likely risk factor for her respiratory disease? *
1 point
135. A 19-year-old man has a history of recurrent mucoid rhinorrhea with chronic sinusitis and otitis media since childhood. He has experienced multiple bouts of pneumonia. His temperature is 37.7° C. On examination of his chest, there is tactile fremitus, rhonchi, and rales in lower lung fields. Nasal polyps are noted. A chest radiograph shows bronchial dilation with bronchial wall thickening, focal atelectasis, and areas of hyperinflation; his heart shadow appears mainly on the right. Which of the following abnormalities is he most likely to have? *
1 point
136. A study is conducted of individuals who smoked at least one pack of cigarettes per day for 30 years. These individuals undergo pulmonary function testing, and a large subset is found to have decreased FEV1, normal to decreased FVC, and FEV1/FVC ratios less than 70%. Autopsy data from this subset of individuals in the study with a low FEV1/FVC ratio are analyzed. Which of the following respiratory tract structures in the lungs is likely to be affected most by the underlying disease? *
1 point
137.A 72-year-old woman undergoes laparotomy for ruptured diverticulitis. A day later her WBC count is elevated and her blood pressure is 85/45 mm Hg. Her peripheral blood smear shows schistocytes. She receives 5 units of fresh frozen plasma. As the 5th unit is being transfused, she develops sudden severe dyspnea and begins coughing up large quantities of frothy sputum. A chest radiograph shows bilateral pulmonary edema. She is most likely to have developed a transfusion reaction to which of the following components of the donor blood product? *
1 point
138. A 53-year-old man comes to the physician because of a 6-month history of intermittent blood in his stool. He has had no pain with defecation. Physical examination shows a 1-cm, visible anal mass located below the dentate line. A biopsy of the mass is scheduled. If the mass if found to be malignant, it is most appropriate to evaluate which of the following lymph nodes for possible metastasis? *
1 point