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He was adritedethe ospal 2 waoks ag bacausect sna ‘tramurd amonar myoeardalifacnen, Hehas aon aP adtanorg.c bboy ert araspin nce bang dseatged AMON Isheardavorhs pocraum When ote flownaistheros lay cause ct carn trans? (© my Adese ctu etert 6B) acne aszecen 5 C)autormaine easton 5b} Poswaimeraton 6 e}Recurenasheme{37- A 35scaroldvomanashad ype 1 dabets mel fr 20yoars and mirsturinua fr 3 yours. Whchafhefeeninaindngs is recive on uarnnstonct ave obtained enna ene? © s)cuakonatuy ot (6) sane agree wtloaton45. Aonamnacetcl compar is doloped 3 dug tat prevents fs" Ho he RarsyAO-ssperse NMDA receptor Yat Istermativey eto sauginapatertwih at ecu toKe? (© 8 Deceaced ek stares austomnpamammeseria 16 6} Fectaten aca" eyes eneuon ad rharcemat ct xcctouk meat col seb © C) parpetreanen ct mebrane anscenaicion hae © D] Povertin of Corey tothe neon credo of scttosn medal ath {5 €} Rapa deploraaienefmenerane nth enn te sear bresnas 46, thn morte ag, a SOssaroldmanhada mycarainiatin oie arte verncar wal Recovery unvan Bhetercrogian le area infarc sree Whence elvan macophags pros spriman response te ‘amin ans inth rs surah? Sn) Brea ronan factor (© 6) Formted peruse © Chreetaeny | 6 bjlederens Os Nata pees47. The 17 searldbayshora nto phetcech is brut he physician ater ain etn cc setae, Whichcfte feng ‘ral rang i met hay be ascosedondetaled eteytaang? (© A) Epes ottypomenia 1 6} Ecos of severe depression (©.C} Fem tsty or echt ~S-) Specl saxon egrnig ints rae 5 spedaleaxten benny nt ade 48, A.42seacoldman vith preumoceccal pneumonia has se Rbneus urs, Whichcf the fling proc ena i requed to fle he outa androsteneml plea nator? © A) Golapnase Se) ees 5 C)stonecysn 6 D} Mano Selmnean1, AGeyeacld man as hatersaygeusartl Iypeclestrka ich fe eoning ape vl docsae plasma VLDL andLL 1 C)rastayein et (6D) Fesagananes| Oe) suaneor (6 F}Mmioane ra) (0 6) vascecvetetnalpomesaoe (6 Ai Marine cnaoxne) 2 Vic ote oloning iste uneuehncton ce eral spregae panies (ried ne Hecate mgs?5. AGtyearcldman drabps cnt He hx mie bod yrs svoe sauna in 065, Hes no stay rhodanese tna on peyaraechanrescens ene Dood metiay sw evcece ot nnon ncaa 6 Orerto gas 6 marth, a4.yoa-cldweranhas had seer episodes cf ntousrss in wich her hea pounds aber sin tacos ‘lary Sheras aso had aut scsi and resent avlenedMypenanion Therosilal case lea npn nvhich-SuCare lebeed ont cross sancnd aavng ee absoren atbeleva of Ze11. Asearalamanceveops ave 4 des ate an stdorinalopetcton, Bloodcutwes gam Steanvececeus aureus Whihct Ne foling stm most se ectonon vai ne otganem pamedaccesstoMwe oe sean? 06) spaun SC) Set So}: Se} man 8 Bee 12, 10 4sacoM gens ie, ange, na eae rng Laborato sues show Hemglbin — @8 ge. (Net1 215) Hemetnet 208 (30-455) Leskoote count 1200hnn? Pleo cout 12,00? photograph ef ene mara ota ontop sheen The meet ety agri © Haesoricladaria ‘= Ehapintc anemia 5 Chimmane trembontsea pire © Ghretnbresie 16 Elam oanocoblamn cone5, A4S5ycarolavoman hashad bllsrales ofpain ad tempera sensations anherburkandupper ims er sveralyoas. Sh has rometer dec Wahatefakaerong pawn ae most tobe ast? © C)Reveuoapna acs37, A 1Oyearaldt has au facia swoing nd dicuy reabing. fn ited doioney of (fitelolonaginangsin seumyi best spparbis dogs? 16 8} reieasedconsnmaten of proper - eatrare nitric suepectod Wich 88, The stun insted yar Xonthe othe head es tin tich bony agin? (© Ajamrorcanaossa 6) masta snus Se) Mose cer toss8 16} Oe eat 6 e}Pomeror erat forse 16 Fi Reyacpakutretecse1, Tumor nesross factors the primary metiator of host responses inate by tpopolysaccharide (LPS) ang leading to septic shock. LP&mediated activation of transcription most Ike depends on whion ofthe folowing transcrpion factors? DA) eras } Nuclear factor-kappaB 1C) 953 D) Rb protein OE) VP-16 etoposiae) DA) 0B) OC) OD) OE) OF) eB)7. A37-yearolé man develops spiking fever in the intensive care unit ater an operation to control an abdminal hhemonhage. Evaluation doesnot show a focal infection Therapy witha broad spectum cephalospern ke Intated ter 3 days of antbictic therapy, te pallant nas abdominal pain and profuse watery aarthea Examination of stool for ava and parasites is negative, Stoo tects positive for Closidium difillo antigen. The most appropriate therapy is 1) amphotericin 8) erythromycin 1G) metrontazole ) periciin ) trmetnoprim-sutamethoxazole Oe} silea21. 41-year-old woman remains hospitalized and in bed for 10 days because of compscations folowing & hysterectomy for erin leiomyomas. On the tenth day, she suddenly develops severe respiratory distress and {colapses. She is resuscitated, but dias 2 days later. lung as seen al autopsy is shown. Which ofthe fallowing isthe mast skely agnosis? ) Bronchopneumonia 8) Interstitial preurvonia 1) Lung abscess 0) Pulmonary infarct >) Pulmonary metastases 22. A-2-year-old man begns cru therapy for hypertension. Three months later, he has a chronic nonproductive ‘Cough. Finnga cn ray fine ofthe chest are normal. He ia most Hay taleng which ofthe folowing antiyperensive dus? 8) Enalae 8) Hycrochorothisae 26) Prazosin. ©) Propranolol ) Verapami28. Amother reports that her ‘-year-old male infantis ess active. Weakness is progressive. The mother says that even though her on Is weak, his muscles appear larger than before, The most ikelydlagnosis is A) central core disease ©B) Duchemne's muscular dystrophy b-grade dystrophy ) myotonse dystrophy ) neraline myopathy 230, The dagram shows a Iver lobule, Long-term destruction ofthe hepatocytes. colense of the histologic arentecture, and production of fbrous material nthe areas inscates by the arrows most kely to real In ‘whieh ofthe fobowing? 1) Decreased intestinal motity ) Galstones 1) Inoreased central venous pressure ) Inereased hepatic venous pressure SE) Increased portal pressure45: Alter several courses of treatment for non-Hodgkin’ lymphoma, 2 33-year-old man develops gross hematwia, \Wrich ofthe folowing drugs Is most kely tobe responsibe fer this adverse effet? >A) Carmustne (BCNU) ©) Cyclophosphamide } Dauneraticin D) Methotrexate DE} Vineitine 48. Cerebrospinal ru leaving tne venticuar system through the median aperture (of Magentde) collects in which labeled space inthe sagittal MFI of the head”? pk .8, A 65-year-old man is brought to the emergency department because of a t-week history of confusion, sonentaton taking to hirsel, deksional ideas abou his landers, ang Incontinence, Mental status examination fon amtvalis dicut Because ne does not stay avake. Which of te folowing isthe most ikely agnosis? >A) Bipolar | disorder ©8) Delirium C) Dementia ) Malngering >) Schzoghrenia 10. A-year-alé boy has had the lesions shown for several morths. Weich ofthe fllowing Nstologi changes ‘would be most tke its lesion were biopsied? ) Cytoid bodies and less of adhesion to adjacent cels 8} Epidermal canthosie with subepidermal Bstar 1G) Epidermal timing with matked ilammatory dermal intrate D) Marked squamous eel dysplasia with thinned stratum comeum SE) Thickened stratum comeur and epidermis and vacuolated squamous cols21, A'55:year-ld man s hospitalized ater having a stroke. The MRI ofthe head is obtained 3 days later. The patient most Ikely has which ofthe folowing signs on the Hh? 1) Homonymous heianopia and numbness ofthe face 8) Weakness ofthe upper mb and aphasia } Weakness ofthe upper and lower limbs ) Weakness ofthe face. upper and lower limbs E} Weakness of the face and dysarthria OA) Aspirin 8) Digoxin C) Nifedipine D) Propranoiot OE} Warfarin 22. Renal dsease Is most skely to resut fom long-term admiistraton of which of he folowing rugs?25. A year-old boy has a mutation inthe calcium receptors on cet surfaces of his parathyroid gland and on the basolateral (blood) side ofthe tick ascending Imb of he bop of Herle, Which of he following pattems is ‘expected wih a mation that leads to activation of tus receptor inthe absence of binang ot ts kgand, olsun? Senan ca? Paratyroithormone Ure clean OA) Hypercalcemia high bioh 8) Hypercalceria Noh low ©) Hypeccaleria low hich 9) rypeccaicemia low ‘ow ©) rypocatcen’a nigh igh F) ypocatconta igh tow 6) Hypecsleia tow ion OH) Hypocaleoma bow tow 26. Two months after a real transplan, a 47-year-old man has increasing dyspnea. X-ray fim ofthe chest shows aninterstialinflrate. A photomicrograph of ung tissue obtained on biopsy is shown, Which of the fllowing Is the most likely causal organism? A) Cytomegalovirus 8} Epsten Garr veus ) Hepatitis B virus oD) HTLU-t ) Pepilomavirus OF) Parvowis B1927. 68-year-old woman i¢ admitted to the hospital for evaluation of gross hematuria. Two days ater admission ‘she cevelops aphasia and rght hemiplegia, folowed shortly by coma and death. The cut suTace of one of her ‘edneys as seen at autopsy is shown. Which ofthe folowing was the most Ikely cause ofthe hematuria? OA) Metastatic cancer 8) Pepllary necrosis. 1G} Polyeystic Kidney seas ©) Renal abscess SE) Renal cel carcinoma F) Renalinfaret 20. A 4year-old lr has had inereasing cficuty clmbing stars over he past 3 months. She has a normal etic twin ator and an & year-old brother with cima probleme; he has boen diagnosed wth Duchenne's muscular dystropty. Which ofthe folowing best explains the discordance inthe ientcal twins? 1) Ptemal genomic imprinting =B} Skewes X inactivation 0) SRY gene translocation )Trnuclectie repeat expansion ) Uniparental disomy41, A2T-year-old man who uses heroin intravenously develops fever folowed several days later by dysenea and pleurle chest pain. Xray fie ofthe chest obiained on suzeessive days show continuous appearance of new Diateralcavtary inttrates. Echecardography ascoses a 1.5-2m vegeta on the tieuspi valve, Cures of blood and sputum are most Ikaly to grow A) Enterococcus feociums 8) Mycobactorur tuberculosis (0) Staphylococcus aureus ) Strptoceccus pneumoniae } viridans streptecoce! ©) 0B) CC) OD) OB) OF)18. 58-year-old man develops an acute coronary thrombosis with resultant myocar the myocardial cells bordering the Infarct is most aly tobe due to 1) depletion of ATP 8) etmacot ca” © emacofNa® 1} inereaee of ntracedar pH DE) production of HO, infarction, The sweting of 18. An 83:yearold woman dios ater having progressive memory loss, aprala, and aphacia for 4 years. A photomicrograph of rain tissue chained on autopsy is shown. Which ofthe folowing is the most ely cause ‘ofthese fninge? OA) Creutsfelt-lakob disease 8) Dementia, Aheimers type ) Hypathyreiaicm ©) Vaseuar dementia OF) Vitamin 8 1 (e/eRoeobalain) decency36. A 26-year-old man reports extremely familar thouahts (aja vu) just before he has 2 seizure, Which labeled ‘rea inthe dagran le the most ikely site ofthe causal lesion?” A) 8) 06) OD) OF) SF) ST. A 16-year-old git has generated weakness and noctural leg cramps. She is net taking any medications. Laboratory stuies show: Serum Nat 135 mEgL cr 108 mEGL Kh 28me Qt. HOOT 21 met Urine pH 720 rich ofthe folowing isthe most tkely agnosis? ) Ackenal insufficiency } Hyporeninenc hypoaldosteronism (C) Nephrogenic dabetes insinius } Renal tubulr sedosic >E) Synarome of inappropriate ADH (vasopressin)8, The majority of catlar proteins and RNA are synthesize throughout the cel cycle and are only interupted briefly during M phase. Synthesis of which ofthe folowing proteins occurs predominarty in phase ofthe cell eyate? OA) Cyclin 8) DNosas: (C) Histones ) RNA polymerases OE) snRNPs (smal nuclear bonucteoproteins) OF) Tubulns following would nave been expected inthis patent? 1) Cerebral arterial aneurysms 8) Hypertensive heart disease 2) Mistile hepatic cysts ©) Nermal renal funtion ) Vesicoureteral refx38, A 10-year-old boy with asthma has been receiving oral hysrocortisone daly in increasing doses fr the past 2 Years, Hele abece and has gronth retardation and edema of his lower ime, Which of the falling Ie the most ikely expianation for the eaerra? ©) The drug binds to both glucocorticolé and mineralocotcold receptors ) The drug is converted to a mineraloccrticld inthe liver ‘C) Puimonaty production of angiotensin is increased >) Renin actvly ie increased because of strse OE} Secretion of ADH (vasopressin) is ncreased because of stress 34. Benign prostate enlargement causes a characters impression on the urinary Biader in which area ofthe coystogram? ©) =B) 0c) OD)37. When a ostogenetc abrormaity is suspected in aninfart vith mutipte congenital anomalies, chromosomes from crculting leuccoytes are analyzed. These chromosames ate most concensed ane easiest To evalute iy \woich ofthe fotowing states? DA) Araphase ©) Interphase (C) Metaphase D) Prophase DE) Telopnase 28. An afebrile €-yearold gi is evahiated for mie edema and a "puffy" face. She recavered from an untreated ‘sore throat and fever 3 weeks ago. Urinalysis shows moderate proteinuria and hematuria with covasional rea {cel caste. A photomicrograph of renal ieeue obtained on Bley fe shown, Whion ofthe folowing Ie moet likely responsible forthe celular lafitrate shown? >) Bradykinin =8) Coa (Histamine D) Nornyated peptides O€) Serotonin47. Phenyyketorura is an autosomal recessive disease. What s the probability thatthe asymptomatic brother or ‘iter ofa cid withthe daeave ie a heleronygous caer? ao 8) 14 20) 12 D2 53 48. A.S0-year-cld woman comes tothe physician because of swating ether left check for 2 weeks. An elevation ‘with a'sma opening in the erea shown by the arrow fs noted on examination ofthe oral mucosa, This area Is ‘ost ely the opaning of whieh of the elowing sirictures? A) Draining abscess 28) Fistula 0) Parotid gland duct D) Subinguel land duct } Submandbdar gland duct48. Apreviously symptomatic 42-year-old man who has been seropositive for HIV for 4 years comes to the Bhysician because of the recent onset of fever, cough, and weight los. An xray flm ofthe cheat shows, Diateral pulmonary intrates. A methenamine siver-stalned preparation of bronchoalvela lavage Nuc Is ‘shown. Which ofthe folowing immunologic abnormatios mest aly la to the davelopmert af tue pulmonary process? 1) Circulating immune complexcinduces inry 8} Decrease inthe nimber of COt+ T Ynphoeytes °C) activation of pumonary macroprages OD) Inerease in selective eytotoéc CDB+ Tymphoeyte activity ) Loss of natural ler cel function 50. During DNA replication, which activty conbutes tothe deity (accuracy) ofthe DNA polymerase? >) DNA ligase ©B) Endonucioase 1G) 37-5 Exonuctease D) 518" Broruclease. >} Hetease7. A 4S-year-olé woman has the recent onset ofshoriness of breath. She has had cough and a 14k (30-b) ‘weightloss over the past 8 months. An cay of the chest shows a 4-om mass inthe mie lobe ofthe ight ung Examination of tissue obtained on Sopsy shows a smal cel, eurcendoctne hng carcinoma, Which of the {lowing abnarmattes i mact ikely te develop inthis patient?” ©) Hypocsicamia 8) Hypoglycemia 16) Hyponatremia oD) Polyeytnemia fe & ia a fecal Se na eet Eee leucooyte court is 4500tnn and platelet court's 88.000Hmn. A peripheral blood smear is shown. Based on these fnnge, which ofthe fallowingaditional findings ia most Healy? ) Actparatal col artiboies in serum 8B) Decreased serum concentration oF ron (©) nereased hemoglobin Aon hemogobin electrophoresis ) Increased osmotic fragity ofthe erythrocytes OE} Pesttve dest antgobula testO, ma! a 19. A 16.yearcid gis brought tothe physician because of sore throat, fever, and malaise. She has corvical lymphadenopathy and @ tender, sighly enlarged spleen, Laboratory sluies snow Hemogicbin 14.4 git, Hematocrit 33.2% Leukoeyte count. 12,000/mn ‘A perphoral blood steals shown, Which ofthe folowing the mest Kly dlagnosls? |) Acute yrphooyti leukemia 8) Acute mvelogencus euKeria 20. A'59-year-old man comes tothe emergency departmert because of fever and shaking chils for 2¢ hours. He ‘Competed a course of fucrauracl fr a neaplaem 1 week ago, His tamperature ie 20°C (102.2°F), and baod pressure is 85/60 mm Ha, Physical examination shows no ther abnermalies. Hs hematocrits 30% leukocyte counts 400(nm’, and platelet count is 100, 000/me. Wich ofthe folowing agents will most ‘specifically compiement antibiotic therapy inthis patient? 1) Erytropoletn 8) Granulocyte colonystinuatng factor ) Leucovorin|25, Anormal train is shown, An 80% lo of neurons in the structure labeled X wl erete a state of eeinhiion In ‘which ofthe folowing areas ofthe brain? 1) Basal forebrain ©) Dente nusieus (¢) Hippocampus ) Hypothalamas Oe} Stature 26. A.45:yearold homeless man is brought to the emergency department 1 hour afer the sutden onset of bindness. He has alcoholism and drank approsimataly 2 liters of a substance he thought was ethanol Physio ‘examination shows sweet-smeling breath. Serum toxicology screenings postive for methancl. Which of the following cubetances le moet tkaly to be the eause ofthe Binenecs? 1) Acetone 28) Ethanol 20) Ferma acid )Isopropano E) Xylene28. Which of the folowing actions Is most ikely to be severely mpaied if a nerve is injured by a facture at site inthe xray? © A) Dorsifenion ofthe foct 8) Extension ofthe leg ( Flexon of the log ©) Inversion ofthe foot OE) Plartarfleéon of the foot 30. Two brothers. aged 26 and 28 years, have similar disorders. Both oftheir histories include Bue sclerae at bith Join hypermabilty, easy brasing, and moderate bilateral haarng nee. Each has had about 20 fractures eines birth, af of which have healed rapicy and without defonmty. Their symtoms are most Ikely caused by a defect Inthe synthesi of which of the fllowing compounds? |) Hydroxyapatite ©) Hycroxypratine ©) Procetagen ) Protrominresected hcney Is shown, Which ofthe folowing is the most Bkely cause ofthis patient's renal insufficiency? 1) Cervical cancer 8} Disseminated intravascular coagulation ) Endometriosis OD) Essential hypertension E} Fibromuscula dyapiasia ofthe renal etery IgA nephropathy ) Posttraptococcal lomanonephitis H) Preeciampsia 1) Type t diabetes metus © J) Vesicoureteral retux 44. A.35:year-old man comes tothe physician because ofa Sweek history of pain with whatlon and boad in his Urine a tho ond of urination. Has 2 fchery consutant wih the Pace Corpo and.etumed to the USA 1 month ‘390 folowing 2 2-year assionment in Atnca, He frequently came in contact wit lake water whe In Aca, ate Iccally prepared foods, and wae cevwally acve wih two women utile using condome coneletenly. Physical ‘examination shows no abnormaites. Utrasonography ofthe unary tract shows blaleral mid hyeronephrosis ‘and nodes in the blacdr. Exposure to which of the fetowing types of organisms the most likely cause of this patien’s conation? 1) Bactena 8) Fungus ) Mycobacterium D) Parasite ) ius5, AS4-yeat-old man comes to the physician because of an rtermittent rash and jit pein ding the past 9 ‘months. Physical exaranation shows erythematous, scaly plaques onthe extensor surfaces ofthe Upper and lower extremes. Removal ofthe scales resus in small leading ponisin te epidermis. Apotograph of the alien's inees is shown, ABiopsy specimen of one a the esions shows neurophis colecting wthin the stratum oineum, parakeratos's, and elongated dermal papitze, Which of he folowing cedar adoptions is most Bkely Inthe epidermis of affected sian in nis patlen? (C) Hypemiasia ) Hypertrophy OE) Metapiasia OF) Neoplasia 6, Scuthem boting is wsed to cstinguish maternal and patemal copies of chromosome 7 ina single person, The fagram on the top indicates the ONA region thats amplified and the predicted sites of digestion vith restriction endonucleases. The ste of hytrdzation of the labeled probe is also Indicated. The ge pattern obtained is shown, fn the bottom. This pattem is most key indicative of which ef th flowing? ) Chromosome walking B) Metis segregation 1G) Nondlsjuneton of chromosomes during meiosis11. During an expermert in vito, the ettects of Drugs X and Yon bactera are studied. The effects of Drug X alone, Drug alene, and the combination of Drugs X and ¥ on bacterial cellnumtar alr 12 hous are dopeted onthe ‘ar@oh shown Wich of the folowing pars of crugs best represents the combination of Drags X and Y? |) Amoxllin and ctepime 8) Ceftazidime and erytromycin (ow dose) (9) Giprotoxaci and mnocycine ©) Ieoriaaid and fuconazola E} Kanoeyeine and entrromyein high dose) E) Piperacitn and cefazame 26) Tebramyein and ampli. 12. At-year-cle boy is broug othe physician because ofa T-day history ofrestiessness,iitabity, and intense Denfectal icing, He atends a large day-care facity, Examination of the peivectal region shows small worms that low under righ ght. photomicrograph of a celophane tape test shown, Which ofthe folowing the ‘most appropiate pharmacotherapy? >A) Mebendazcle 8} Metronigazale ‘C)Matomycin C| ) Pentamiine: >} Tetracyelne23, 37-year-old mans brougt tothe emergency department after faling down a fight of sais, Physic ‘examination shows acute aleoholintenieation, 2 bruse over the left temple, anda evolen, paints writ, Over the next SU minutes, hs level of consciousness datererates, andthe le pun Decemes lated. Which ofthe fellowing isthe mast skaly cause of the nauroogle findings? ©) Cerebral contusion 8) Compression of he facial nerve 1G) Laveraton of the middle meningeal attery ©) Laceration ofthe superior cerebral (bging) veins E} Laceration ofthe temporal ttary FF) Occut brain tumor unmasked by the fat 24. A 10-year-old gts teought to the physician because of several 1=to em, Kah brown maces on het trunk a ‘shown inthe photograph. Physical examination shows alary Fecking. Neurclogsc examination shows no fecal findings. Wirich of he folowing the most ely agnosis? A) Dyspastic nevus syndrome 8) Neurofbromatoce } Osler Weber Rend dsease ©D) Tuberous sotrosis ) von HippebLindau disease27. A 4-year-ol cid develops a fever, sore throat, ulcerated lesions on the oral mucosa, and a rash onthe hands ‘and feet Which ofthe flowing is the most Ikely viral couse? A) Adenovirus type 12, ©) Coxsackevirus ) Cytomagalovins D) Infuse virus ) Marburg virus F) Mame virus 1G) Parvovirus B19 H) Potovins type 1 1} Rhinovirus type 8 28, Which ofthe folowing labeles structures in the electron micrograph is present in carchac muscle But nt In ‘skeletal muscle? oA) ©B) oc)28, A 73-year-old man s brought tothe emergency department because of excruciating low back pain tat began ‘able he wat pairing he garage 1 day ago. He vists the physiclan every 6 months for montoring of hypertension wel controked witha duetc. An xray ofthe spine shows Several osteoblast lesions Inthe Vertebras. Wich ofthe falawing is the mot ikaly agnosio? ) Malignant lymphoma 8) Metastatic ng carcinoma °C) Metactatis prostate earinoma ) taste myeloma ) Osteosarcoma ‘30. AS-year-cld girl with cystic fibrosis is brought to the emergency department because of a 12:hour history of fever, severe shoriness of breath, and cough productive of hick sputum. Her temperature is 20°C (102 2°F), pulse is 80imsn, resprations are 30/min, and blood pressure fs GOI60 mm Hg, Difuse wheezing and scattered fhonehi are heard on auscutation ofthe chest. The CT sean af he chest shown depicts mliple lates ‘sructures which are aresul of mutipe Infections (as inacatedby the arrows). The dlated structures are most Bkaly wich of the folowing? ) Bronchi 8) Inteobularseptae 0) Pulmonary arteries ) Pulmonary veins OE} Subploural septae3, Vitamin B, (pyridoxine) is required forthe enzyme that catalyzes the rate-Smiting step heme synthesis, Which ofthe follwing laeld compounds in the diagram is sythasizedin this reaction? 5 c > e F 8) om of 4. Which ofthe fetowing labeled areas int muscle is maximally covtractod?13. A 40-year-old man comes to the physician because of @ -montn history of mdepigastic clscomtor that is ‘eleved by eating. His vl signs are normal. Physical examination shows mid epigaste tenderness to Dabation. Test ofthe stoo for co2ut load Is postive. Endoscopy shows a gasinc ulcer wih neapec-up ‘agins surounded by edama and islammation.A biopsy specimen is placed in media containing [henobphinalen. En route othe laboratory, the color ofthe media changes from yelow to red, Which of he following best explaine the change in media pH? A) Bacterial catalase ©) Bacterial CO. production 20) Bacterial odase ) Bacteral weas ) Gastric acis 14 AS2.yearold woman who le seropositive fr HV is admitted tothe hospital because of inreasing confusion, She dios 2 days tale. issue section ofthe meninges obtained at autopsy is shown. Which af te folowing Is the mast ikely causal organism? OA) Candle abicans 8) Cryptococcus neoformans 1) Mycobacterium aviumnracelare ©) Pheumocy tis roves! formerly P. carn) OF) Toxoplasma gone18. Which ofthe folowing neural erest derivatives is involved in congenital absence of pan perception? OA) Large-dameter neurons of dorsal oot ganglia 8) Pesigangione parasympathetic neurons, 20) Posigangione sympathetic neurons ©D) Schwann cals £) Smalkctameter neurons of dorsal oot gangia 20, The termination of the pathvay tha erigiates inte skin of the righthand and travels trough the right cuneate jueleus to the lof verral posterolateral nucous ofthe thalamus cccurs at which ofthe folowing labeled cortical ‘areas ofthe brain? ) 20) OD) OF) OF) OG) OH OH OD23, A.4B:yoar-ld man with severe unconzoled systemic hypertension develops a headache and voriting. Two hows later he has ie-sided weakness folowed rapidly by loss of consciousness. He les shorty afer _amission tothe emergency department. A secion of his brain as sean at autopsy is shown. The most key ‘mechanism of the lesion shown Is hemorrhage fram wth ofthe folowing? |) Bridging vein B} Congenital arteriovenous malfermation 6) Intracerebral vein ©) Lenficustiate artery ) Seccular aneurysm ofthe anterior cerebral artery 24. A 32-year-old man comes tothe physician because ofa 3-year Mistry of kvfe-ske headaches centered on his le aye. Thay awaken him at night and are associated wth lat aye lnarmation and rinormes. Over a month period. ney ooeur nightly. last 20 minutes. and resolve, They typically do not occur again for another year. Which ofthe folowing is the most tkely agnosie? 1) Ouster headache: >8) lntracranial mass °C) Migraine ) Tenslomype heacache‘old woman Who is 2 marathon runner comes tothe physician because of @ month Nistory of Intermitent kee pain thats usualy exacerbated by her parcipation in a rave, Physical examination shows no abrormaltios, The stctice Indicated by the arrow on the oral MRI shown i njores. Which ofthe fotowing ‘Sructures fe most Ixy inured? ) Acterior cruciate Kgament 8) Lateral menisous (6) Medial meniscus B) Poplteal atery ) Pepiteal vein ) Pestanor cruciate Sgament 28. A 17-year-old gi has had general malaise and progressive interment pain in the knees over the past © ‘wooks. Sho has a history ofmouh ulcers. She is using hysrocartsone cream to treat a rash on her chooks Laboratory studies show: Hemogicin 7.2 4 Hematoent 2190 Lethe 2 cog! Platelet count 97,000! Which ofthe folowing isthe most tkaly agnosis? ) Gonococeal aris 8) Juvenile meumatoid artis () Lyme dsease D) Peoria athris OE) Reitareynerome F) Systemic hous erythematosus45. A 60-year-old postmenopausal woman comes to the physician because of back pain for 3 months. Her mothar ‘ander sister both had breast cancer. Physical examination shows mild tendemess ove: the tbat vertebrae. ‘ncray ofthe spina is cbtainad and shows evidence ofa disease process. A photograph representative of 3 ‘simlar condition s shown, To avoid a stimulatory effect onthe breast or endometrium reatmert ofthis Condon with which ofthe folowing drugs is mos! appropiate for this patient? -) Danazoi ) Ethinyl astral (C) Niepsistone ) Ralowtene O€} Tamoxifen 46. A 2,year-ol lis brought tothe physician for 2 routine examination. She Is Below the Sh percentile fer height ‘and weight, Physical examination shove no other abnormatties. Genetic screening chows a ner mutation in the ADH (vasopressiny 2 receptor. Water is restricted for 12 hous to test the functional signfteance ofthe ‘mutation. At the end ofthe 12 hours, which ofthe following eee of laboratory fringe ls moet Ikoly to confirm a loss of function detect inne vasopressin-2 receptor? Serum SerumADH GSU Urine Osmolality (asopressin) (mOsmovka) (mOsmotka) Decreased decreased 200 Decreased decreased 00 Decreases increased 200 Decreased increased 00 Increased ceoveaced 200 Increased decreased 00 Increased —_insreased 200 Increased increased 60017. The grap shows the oxygen dissociation curve of hemoglobin A for a healthy individual. Wich of the folowing curves best represents the dissociation curve for the same individual ater extensive physica training at high attuses? Foam ©A) ©B) ec) oD) ‘old woman has 2 pathologic facture ofthe hip. A photomicrograph of tissue obtained en aspiration of ‘bone marrow is shown. Which ofthe folowing ls the most ely agnosis? A) Acute myelogenous leukemia ) Chronic rrpnocyti leukemia ) Langerhans cel Fistocytoss OD) Metastatie adenocarcinoma ) Maile myeloma23, A year-old boy falls off is bieyle and hits his head: he has a transient loss of consciousness. Aer a bret ‘recovery he becomes progressively more somaelenl. On examination, he has weakness inthe right side of the {ace and rigt unger avremiy. CT san ofthe head is show, The Izy at the site label X fsa consequence ‘of upture af which ofthe flowing ateriae? ©) Arteriorcerebrat 8) Arteror choroidal 1G) Arterior communicating ©D) Madde cerebral } Mile meningeal 24. A.45:yearold man has had generalized jerang movemerts In his extremes, progressive dementia, and ‘ayenati behavior forthe past year. He mather ded ef a simlarilnezs when she was SO years old, ACT sean fof te esd is most likely to show atrophy of which of the folowing areas of he bra? A) Causate nucleus 8) Globus paldus 0) Hippocampus ) Putamen ) Substantia nigra