good questioins with answers

[Anonymous]

9- 28 year old woman with sarcoidosis presents with violaceous plaques on the nose with telangiectasia around the plaques, what is the most likely diagnosis?
A. leprosy
B. rhinophyma
C. lupus pernio
D. Kaposi's sarcoma
-------------------------
The correct answer is (C)

10- What causes scarlet fever?
A. salmonella
B. escherichia coli
C. clostridium perfringens
D. group A beta-hemolytic streptococcus
-------------------------
The correct answer is (D)


11- Blood pressure is greater in lower limbs than in upper limbs in which of the following cardiovascular disorders?
A. tetralogy of Fallot
B. Takayasu's arteritis
C. coarctation of the aorta
D. persistent ductus arteriosus
-------------------------
The correct answer is (B)


12- 26 year old overweight woman complains of hirsutism and abnormal menstruation, what is the most likely cause?
A. acromegaly
B. Cushing's syndrome
C. polycystic ovary disease
D. adrenal or ovarian tumor
-------------------------
The correct answer is (C)


13- 32 year old man has an ejection systolic murmur in the left 2nd and 3rd intercostal space and a wide fixed split of the 2nd heart sound, ECG shows right bundle branch block and atrial fibrillation, what is the most likely diagnosis?
A. atrial septal defect
B. mitral valve prolapse
C. tricuspid regurgitation
D. ventricular septal defect
-------------------------
The correct answer is (A)


14- Populations who consume goat milk and other diary products have a higher risk of developing brucellosis when compared to other communities in which diary products rarely used, this is an example of:
A. Cohort effect
B. random error
C. ecological fallacy
D. endemic occurrence
-------------------------
The correct answer is (D)

15- 68 year old man develops fever and cough the day after cholecystectomy, what is the most likely cause?
A. aspiration
B. atelectasis
C. pneumothorax
D. pleural effusion
-------------------------
The correct answer is (B)


16- 56 year old woman complains of headache and visual field impairment, skull X-*** shows subarachnoid space extended into the s ella turcica, what is the most likely diagnosis?
A. prolactinoma
B. pituitary adenoma
C. craniopharyngioma
D. empty s ella syndrome
-------------------------
The correct answer is (D)


17- 72 year old diabetic man complains of pain in the left ear, there is a purulent discharge in the external canal, what is the most likely cause?
A. nocardia
B. escherichia coli
C. neisseria gonorrheae
D. pseudomonas aeruginosa
-------------------------
The correct answer is (D)


18- 72 year old man complains of fatigue, blood tests show low reticulocyte index, high serum iron, high transferrin saturation, and high ferritin levels, what is the most likely diagnosis?
A. sideroblastic anemia
B. iron deficiency anemia
C. folate deficiency anemia
D. vitamin B12 deficiency anemia
-------------------------
The correct answer is (A)


19- 64 year old woman complains of pain in the distal interphalangeal joints that worsens by movement and relieves by rest, what is the most likely diagnosis?
A. pseudogout
B. osteoarthritis
C. psoriatic arthritis
D. rheumatoid arthritis
-------------------------
The correct answer is (B)


20- 56 year old woman with giant cell arthritis complains of stiffness and aching of the neck and shoulder muscles, what is the most likely diagnosis?
A. dermatomyositis
B. myasthenia gravis
C. polymyalgia rheumatica
D. chronic fatigue syndrome
-------------------------
The correct answer is (C)


21- 66 year old man has ascites, edema of the extremity, weakness, and diastlic murmur and opening snap at the left sternal border and subxiphoid region, ECG shows right atrial enlargement, what is the most likely diagnosis?
A. mitral stenosis
B. aortic stenosis
C. tricuspid stenosis
D. mitral regurgitation
-------------------------
The correct answer is (C)


22- 34 year old man presents with headache, dry cough, constipation, fever, bradycardia, erythematous maculopapular rash that blanches on pressure, and splenomegaly, what is the most likely diagnosis?
A. malaria
B. measles
C. typhoid fever
D. infectious mononucleosis
-------------------------
The correct answer is (C)


23- 26 year old woman with cystic fibrosis has thick, foul-smelling green sputum, on examination there is clubbing and the chest X-*** shows thickened bronchial walls and multiple cysts containg fluid, what is the most likely cause?
A. asthma
B. emphysema
C. bronchiectasis
D. Wegener's granulomatosis
-------------------------
The correct answer is (C)

24- A convicted pedophile acts as if he is schizophrenic by giving senseless answers and making absurd statements, what is the most likely diagnosis?
1. Ganser's syndrome
2. conversion disorder
3. borderline personality disorder
4. Munchausen by proxy syndrome
The correct answer for the above question is 1, this is a typical short case of Ganser's syndrome. For conversion disorder think of a woman who frequently visits physicians because of multiple complaints that are NOT deliberately produced by her (this is unlike malingering or factitious disorder) and physicians find no medical condition. For borderline personality disorder think of a young woman who is drug abuser and suicidal and who has intense bouts of anger and anxiety that usually last few hours, this is similar to histrionic personality disorder. For Munchausen by proxy syndrome think of a mother who deliberately poisons her 5 year son in order to make him feel sick and take him to physicians.

25- Pt with lung disease underwent spirometry, the result shows:

decrease TLC, RV, VC
normal FEV1/FVC, FEF 25-75%,
decrease DLCO

the most likely diagnosis?

a. Chronic bronchitis
b. emphysema
c. pneumonia
d. pulm fibrosis
e. kyphoscoliosis
answer is d. it s a restrictive lung disease, eg. pulm fibrosis.

- 26
which one of these melanoma has the worst prognosis?

a. lentigo maligna
b. superficila spreading
c. acral lentiginous
d. nodular
answer is d.
what is the most common form of malginant melanoma in african american pt?

a.lentigo maligna
b.superficial spreading
c. nodular malignant
d. acral lentiginous
answer is d.

27- name 2 diseases that could have "spherocytosis" in peripheral blood smear.
hereditary spherocytosis
warm antibody autoimmune hemolytic anemia

28- what s the most common cancer in a pt exposed to asbestos?
a. mesothelioma
b. lung ca
c. skin ca
answer is b. the most common ca caused by asbestos exposure is lung ca.
but if u have mesothelioma, u must have been exposed to asbestos. It’s highly related to asbestos, though it s a very rare tumor.

29- What's the most common condition involving both hearing and vision impairment? ( Hint, its autosomal recessive) ( 2nd hint, a form of night blindness)
Most common cause of inherited deafblindness - Usher's Syndrome (sensory hearing loss and retinitis pigmentosa).

Most common cause of vision and hearing impairment - aging
Other causes include - congenital rubella, CMV infection, accidents and trauma. Alport's syndrome also includes vision and hearing impairment but it inherited AD or X-linked

30- A 19-year-old white male presents to the infirmary complaining of pharyngitis, rhinorrhea, and intermittent wheezing. Pertinent social history includes enlistment in the U.S. Army two months ago, and the patient is currently stationed at Fort Bragg, North Carolina. A physical exam reveals injected conjunctivae bilaterally and diffuse wheezing bilaterally on pulmonary auscultation. Positive cold agglutinin reaction is noted. A virus is isolated in cell culture, and further evaluation reveals a non-enveloped virus with double-stranded linear DNA. Which of the following statements is correct, concerning this viral infection and neoplasia?

A. This viral infection is linked to Burkitt's lymphoma
B. This viral infection can cause progressive multifocal leukoencephalopathy.
C. This viral infection is linked to hepatocellular carcinoma.
D. This viral infection is linked to histiocytoma.
E. Infection by certain serotypes may cause sarcoma.
F. This viral infection is linked to nasopharyngeal carcinoma.
This is a case of adenovirus infection, the only problem is that adenovirus doesn't induce malignant cell transformation in humans. In baby hamsters and cultured cells - they are known to induce variety of solid tumor, including sarcoma. So answer is E.

31- A seven-year-old child presents to his pediatrician with loss of balance. On CT, he is noted to have a cystic structure in his cerebellum with a solid structure in the wall of the cyst. After the tumor is resected, what does the pathologist expect to see?

A. Elongated, brightly eosinophilic structures within astrocytes
B. Faintly basophilic PAS plus lamellar bodies located at astrocytic end processes
C. Gemistocytic astrocytes
D. Gray matter astrocytes with a large nucleus and intranuclear glycogen droplet
E. Swelling of the astrocyte cytoplasm
the answer is A
This girl most likely has pilocytic astrocytoma, for which cystic appearance and presence of astrocytes with elongated processes with Rosenthal fibers are diagnostic clues.

32- A 66 y/o man with SCC of the lung has an increased serum alkaline phosphatase activity. Metastatic disease is suspected. Measurement of serum activity of which of the following enzymes will be most useful in differentiating bone and hepatic metastases?
A ) Acid phosphatase
B ) Aldolase
C ) Amylase
D ) ã-Glutamyltransferase
E ) Lactate dehydrogenase
Answer is D- GGT is a hepatic-specific marker, LDH would be incresed in both cases

33- Von W's factor is a tumor marker for ????????????
it is related to angiogenesis so it is a tumor marker for Kaposi's sarcoma.

34- Thrombocytosis ( plt= 500000/ microlit ) is seen in:
A) hemosiderosis
B)hereditary spherocytosis
C)T.B
D)hemolytic uremic syndrome
E) none
answer is TB. Chronic inflammation/Infection releases IL-6(main one responsible), IL1, TNF and other cytokines which cause the liver to produce Thrombopoeitin which acts on the CSF-Megakaryocyte (precursors) more megakaryocytes more platelets.
Since it is not mentioned that the case of hereditary spherocytosis is post splenectomy, choice B is not the correct answer.

35- which one of the following tissues can metabolize glucose, fatty acid, and ketone bodies for ATP production?
a)liver
b)muscle
c)brain
d)RBCs

Answer is b:muscle
muscle cells r the only cells that r capable of utilizing all energy sources avaible:glucose,FAs,during fasting keton bodies.
RBCs can’t utilize FAs, keton bodies,since mitochondria required for their metabolism.
FAs can’t cross BBB,so brain can use glucose&keton bodies.
Hepatocytes are the site of keton bodies production, but the mitochondrial enzyme necessary for utilization of ketone bodies is not present in hepatocytes.

36- What’s the first and second marker you see in acute Hepatitis B?

What’s the marker or markers you see in someone who is carrier of Hepatitis B?
1st marker :HBsAg 2nd marker :Anti-HBc-IgM
Carriers would be HBsAg(+) , HBcAb(+) ,
HBeAg(+) associated with chronic infections and active viral disease

37- A 29 y/o nonsmoker homosexual male has nonpainful white patches located on the lateral borders of tongue.The patches do not wipe off with a guaze.You suspect that the pathogensis of these lesions is closely related to:
A. a neoplastic process
B.a fungal infection
C. a dysplastic process
D. a viral infection
E. an autoimmune disease
Answer is D.
The condition is oral hairy leukoplakia by Ebstein Barr virus. The fact that it does not wipe away with a guaze is the main hint to differentiate from thrush (candida).

38- 20 y/o man complains of painful discharge from urethral meatus.The discharge was yellow coloured and creamy.He also complains of pain on urination since 2 days ago. He states that burning started abruptly and was very painful from onset. He gives history of sexual encounter 4 days back. What would be the likely diagnosis?
A) NSU due to chlamydia trachomatis
B) gonococcal urethritis
C) Acute cystitis
D) epididymitis
Answer is B. Gonococcal urethritis is abrupt in onset, acute illness, discharge is yellow and creamy. Where as NGU is slow gradual illness, discharge is not present or if present its mucoid or mucopurulent.

39- Name the diseases which are caused by tri nucleotide repeats?
- FragileX syndrome
- Huntington's dis
- Friedrich's ataxia
- myotonic dystrophy

40- All of the followings are the complications of gonococcal urethritis in males EXCEPT:
A) urethral stricture
B) epididymitis
C) orchitis
D) proctitis
E) no findings
Answer is C- orchitis

41- The least common cause of genital ulcer:
A) chlamydia trachomatis
B) hemophilus ducreyi
C) calymmatobacterium granulomatis
D)HPV
E) treponema pallidum
Answer is D- HPV.

42- How would you differentiate factitious hyperthyroidism from Grave's disease (according to thyroid function tests)?
Common to both Grave's and factitious Hyperthyroidism is :Serum T4 increased ; Decreased TSH; Increased T 4 BR; Increased F T4 I.
The only difference is that grave's shows increased uptake of I 131 whereas factitious hyperthyroidism shows decreased uptake of I 131. Also autoantibodies ( anti-TSH receptor Abs or TSI ) which is specific for Graves & not factitious hyperthyroidism.

43- Which of the followings is the FIRST enzyme to appear in the acute pancreatitis?
A. lipase
B.amylase
c.AST
D.ALT
Which one is more specific?
Eventhough lipase is a more specific marker, amylase appears earlier. In acute pancreatitis serum lipase rises after 72 hrs , whereas amylase appears just after 1 day.

44- A 55-yr old man with a long history of poorly controlled hypertension suddenly develops severe retrosternal chest pain that raidates into the upper back bewteen the scapulae. On examination he has diaphoresis and severe SOB. Pulse is 125 / min & regular, BP 130/60mmHg left arm and 80/50mmHg in the right arm. There are diffuse, wet, inspiratory crackles in both lung fields, distand heart sounds and a perviously undetected grade 2/6 blowing, early diastolic murmur in the 2nd right and 3rd left intercostal spaces adjacent to the sternum. The most like diagnosis is?

A.) dissecting aortic aneurysm
B.) MI
C.) Pericarditis with tamponade
D.) Pulmonary embolism
E.) Ruptured chordae tendineae
F.) Ventricular septal rupture
Guys, plz discuss this q & explain your answer, bcoz I have a doubt on this one… Thanks.
My answer is A) dissecting aortic aneurysm & here is my reason:
The pain is typical(abrupt onset of retrosternal pain radiating to upper back). The dissection might be close to the aortic valve, so the aortic insufficiency (blowing early diastolic murmur in aortic ausculatory regions) can be heard. Also the dissection is leaking into the pericardial space, causing tamponade(distant heart sounds), compromising the expansion of the heart(wet inspiratory crackles).
The dissection seems to be sparing the blood supply to the left subclavian against the right subclavian, hence different blood pressures. Any comments??

45- Few days after the baby was born a lactating mother noticed sudden cessation in lactation. On history it was revealed that she had problems during her pregnancy with her blood pressure. What type of necrosis would be associated with this problem?
a) liquifactive
b) coagulative
c) calcific
d) caseous
e) fibrinoid
f) enzymatic fat necrosis
answer is b- coagulative. Although the pituitary is a part of brain and liquifactive is typical for necrosis brain, since anterior pituitary is from Rathke's pouch, it will be coagulative. A case of Sheehan’s syn.

46- CA19-9 tumor antigen is associated with which cancer.?
It’s a marker for pancreatic cancer

47- A physician noticed that a patients hand went into spasm while he was checking his blood pressure. On further investigation Serum Ca levels were found to be low, phosphate levels were found to be lower than normal as well. Which of following may be a correct statement for patient's condition?

a) suffering from primary hyperparathyroidism
b) suffering from Vit. D deficiency
c) history of chronic renal failure
d) prim. hypoparathyroidism
e) suffering from increased levels of Vit D
it is vitamin D deficiency because both Ca and Po4 levels are low. In hypoparathyroidism, Ca would be low while Po4 would be high (as in absence of PTH, PO4 would be more easily reabsorbed from PCT). In CRF, Ca will be low while PO4 will be high(due to the renal failure).

48- A young female patient presented in emergency room in hyperventilating state. On history it was revealed that she is having problems getting along with her family. She is also having muscle spasms in her both hands. What is most probable cause of her muscle spasm?
a) Increased levels of Ca
b) Low levels of Ca
c) Increased pH of blood
d) Decreased pH of blood
e) none of the above
Answer is C.
Well, this question has two aspects.

Hyperventilation is psychogenic in origin (common in conversion reaction in young females under stressful condtion)

This is an example of tetany with normal serum Ca levels, however the free Ca levels will be decreased.

Explanation:
1) Ca is bound to albumin in blood, but only free Ca is the effective form (like lipid sol hormones). Bound and free Ca are in equlibrium with each other.

2) Hyperventilation produces resp. alk. which causes increased dissociation of amino acids in albumin and greater negative charge on albumin

3) greater -ve charge on albumin increases the binding of Ca to albumin. Results in increased bound fraction and decreased free fraction. So it will clinicall present as tetany though the total Ca levels will be normal.

49- Arterial bood gas analysis reveals a pH of 7.26, and the patient's anion gap is 12. Which of the following statements correctly describes this metabolic acidosis due to renal failure?

A.) A large anion gap indicates good compensation
B.) The metabolic acidosis is caused by excessive production of ammonia in the tubule cells
C.) The large anion gap indicates that the plasma bicarbonate is elevated
D.) This patient has probably already passed the hyperchloremic phase acidosis
E.) Longstanding metabolic acidosis is not related to renal osteodystrophy
answer is D.
In renal failure, the kidney fails to reabsorb HCO3 and secrete H+ . In a normal anion gap acidosis, the plasma HCO3 is less and to counteract this, plasma Cl- increases.
Causes of normal anion gap: Remember : HARDUP
H- hyperalimentation, A- Acetazolamide, R- RTA, D- diarrhea, U- uremia, P- post-intubation hypocapnia.

50- What’s the mechanism of visual disturbances in preeclampsia?
It results from decaresed cerebral perfusion of the occipital cortex.

51- A pt with previous diagnosis of carcinoid syndrome, presents with weakness, loss of appetite, abdominal pain & vomiting.His Ph.E significant for bright red glositis& pigmented, scaling skin rash in sunlight exposure areas. what’s the pathophysio mechanism of this current presentation?
The cause is Niacin deficiency: this px presents s/s of pellagra, in pts with carcinoid syndrome there’s an increased conversion of tryptophan into serotonin, so tryptophan not avalaible to convert to niacin!

52- What are spur cells and smudge cells associated with?
Spur cells: are seen in abetalipoprotenemia, a condition asso/w absence of B-48 lipoprotein. its absence make it impossible for the small intestine to absorb and release the chylomicrons from the brush border cells. The patient land up with 'steatorrhea' and a deficiency of essential lipids... making RBC memb. unstable and making the apearance of 'spur cells' (also called acanthocytes) in blood smears. They have spikes on their surface.

And Smudge cells are seen in CLL. they are abnormally fragile leukemic cells which disintegrate while making a blood smear.

53- A 45 yr old white man with a Hx of small cell lung cancer presents to the ER of a local hospital and exhibits agitation and confusion, ataxia, nystagmus, peripheral sensory loss, and generalized weakness. The most likely eitology os this disorder is:

A.) Hypercalcemia
B.) Paraneoplastic syndrome
C.) Cerebral vascular accident
D.) Myasthenia gravis
answer is B. It’s a case of SIADH.

54- In a serious automobile accident, pt brought with profuse bleeding in the neck. A surgeon finds the bleeding is from carotid a. Against what structure the surgeon can press the artery to stop bleeding?

a- 2nd cervical
b- 3rd cervical
c- 4th cervical
d- 5th cervical
e- 6th cervical
f- 7th cervical
answer is e- 6th cervical

55- Reason optic neuritis may cause permanent loss of vision but facial neuritis causes temporary loss of function is
a) facial neuritis may be infective in origin so it is temperory and reversible
b) optic is a sensory nerve while facial nerve has both sensory and motor fibers
c) facial nerve has better blood supply than optic nerve
d) facial nerve develops from neural crest cells while optic nerve develops from neural tube cells
e) optic nerve has longer course in the CNS than facial nerve
answer is d.
optic n. is not a true nerve it develops from forebrain (Diencephelon) and is myelinated by oligodendrocytes which cannot regenerate.

56- What’s the most common cause of secondry HTN in young men & women?
YOUNG MEN: excessive alcohol intake
YOUNG WOMEN: OCP use, second cause: renal artery stenosis due to fibrous dysplasia

57- High systemic venous oxygen saturation is a characteristic of which type of shock?
a- hypovolemic
b- cardiogenic
c- neurologic
d- septic
answer is d- septic

58- - why measurement of acid phosphatase is not used for screening of prostate cancer?
it's only + with tumor extention out of the capsule, so it's too late.

59- A 58 y/o man presents/w fatigue. His P/E is normal except for the presence of splenomegaly. Lab results: CBC:Hct: 29%, plt: 90,000, WBC: 2700 (diff:12%monocytes,12%granulocytes,76%lymphocytes) and an essentially normal red cell morphology. A BM aspirate & biopsy were performed. The aspirate was dry and the biopsy is pending. Based on the available info,the most likely diagnosis in this case is:
a- CLL
b- CML
c- hairy cell leukemia
d- myelofibrosis
e- multiple myeloma
Answer is c- hairy cell leukemia!
pts with hairy cell leukemia typically presenting with pancytopenia, splenomegaly and a dry BM aspirate. although we have dry BM aspirate in myelofibrosis too, but NORMAL RBC morphology is against this diagnosis.

60- which one is not a physical finding in sarcoidosis?
a- cranial nerve palsy
b- angina
c- erythema nodosum
d- uveitis
e- digital clubbing
answer is e- digital clubbing
sarcoidosis can cause angina by involving coronary arteries, but it's very rare! but clubbing is not seen at all.

61- Increase in LDH is seen in which type of pneumonia?
PCP and also LDH>700 seen in legionella pneumonia

62- A high( >47IU/L ) concentration of adenosine deaminase in pleural fluid suggests which one of the following diagnosis?
a- TB
b- pancreatitis
c- pulmonary thromboembolism
d- rheumatoid arthritis
e- CHF
answer is a- TB

63- After 6mo of drug therapy, a patient develops HTN & creatinuria without proteinuria. A biopsy shows ischemic damage to glumeroli and some tubular damage, what drug was the px on:
a) penicillinG
b) gentamicin
c) cyclosporine
d) naproxen
e) cyclophosphamide

answer is cyclosporine. It causes nephrotoxicity & hypertension.
PenG, causes acute hypersensitive interstitial nephritis..., gentamicin causes toxic ATN but that would be acute too & it would involve the tubule mainly...
naproxen may cause chronic analgesic nephropathy.. but that would first manifest as papillary necrosis.. & cyclophosphamide causes cystitis....


64- A 50 y/o male always arrives 15 minute late for his appointment, which personality disorder he has?
a) schizoid
b) borderline
c) histrionic
d) passive-aggressive
e) obcessive-compulsive

I think it's D because it's a possibility that the patient wants to show his unhappiness via coming late all the time instead of confronting. Again, it could be E as well only if there was an explanation in the question that the patient comes late to appointment because he was preoccupied to lock his house door many times.


65- anti-TB drug that can cause tubulointerestitial nephritis?
Rifampin


66- A 20 y/o man with new onset of seizures and no hx of HTN is evaluated with a contrast-enhanced CT scan of the head, which demonstrates a mixed parenchymal and subarachnoid hemorrhage. The parenchymal hemorrhage is centered over one cerebral hemisphere. Which of the following is the most likely source of the hemorrhage?
A: AVM
B: Berry aneurysm
C: Bridging vein
D:Charcot-Bouchard aneurysm
E: Middle meningeal artery
I think answer is A. The fact that px is young & does not have any predisposing factor like HTN is a clue for hemorrhage from AVM. Hemorrhage from bridging vein causes subdural hematoma which passes the suture lines. Middle meningeal A. hemorrhage causes epidural hematoma & it does NOT passes the midline BUT it’s usually due a temporal Fx which is not mentioned in the q.

67- A 30 year old woman with high T4 levels, TSH is within normal limits, what is it?
this 30 years old lady is either pregnant or taking oral contra ceptive, she has increase TBG due to increase in estrogen. so, Total T4 will increase, TSH will be Normal, and if you check free T4( which we don't have in this case ) it will be normal.

68- What disease causes abnormal gait , oculocutaneous telangiectasia, and decrease IgG and IgA?
ataxia telengectasia. Thymic hypoplasia with cellular and humoral (IgA and IgG2) immunodeficiencies.

69- Which is characterized by normal BP, decrease K, metabolic alkalosis?

a)Sjogrens syndrome
b)Hypoaldosteronism
c)Hyperaldosteronism
d)Liddle’s syn.
e)Barrter’s syn.
answer is e- barter’s syn.
It’s due to a defect in Cl- reabsorption in ascending tubule ( the same place that loop diuretcs like furosemide act which blocks the Cl pump ), so chronic volume depletion results in hyperplasia of JGA , release of rennin & subsequent release of Ald. Note that BP is NORMAL & rennin is high in this condition which help to diff. it from primary hyperaldosteronism.

70- A 5 y/o boy with a hx of recurrent ear infections receives his preschool booster immunization of DTP. He is participated in a community-sponsored study to determine the humoral immune response to tetanus toxoid (tt). His response is well below normal for age- & sex-matched children. Peripheral B & T lymphocyte count and function are within the reference range. The antibody he makes is positive in both the passive hemagglutination and complement-mediated lysis of tt-coated erythrocytes. His antibodies do not opsonize tt-coated latex particles for phagocytosis and do not directly precipitate tt efficiently. This child most likely has a defect in which of the following processes?

A.) Affinity maturation of immunoglobulins
B.) Immunoglobulin isotype switching
C.) Recombination of heavy chain variable region genes
D.) Recombination of light chain variable region genes
E.) Somatic mutation of immunoglobulin genes
Since complement is activated, it could be IgG or IgM. But since it does not opsonize, I would think the antibody he is producing is only IgM. So I think the answer is B. Any comments???

71- A 65 y/o man comes into his FP's office for a routine prostate exam. His blood is drawn and his PSA measures 8.6. The physician recommends waiting 6 months and testing it again. 6 months later, the PSA reads 6.5. What test should the physician order to make an accurate Dx.

a. acid phosphatase
b. alkaline phosphatase
c. Gleason score
d. free PSA
e. urinalysis
answer is d- free PSA. if > 25 its probably NOT prostate CA.
Gleason score is more invasive at such an early time since that requires Bx.

72- 55 y/o male with long-standing hx of maldigestion presents with dementia and inability to walk straight. Neurological examination shows positive babinsky sign.
1) what should be the first lab test from the following?
a) CT Scan
b) MRI
c) Urine methylmalonic acid
d) Chromosomal analysis
e) Plasma electrophoresis

2) what other conditions this patient is also likely to develop?
a) hypercholesterolemia
b) atherosclerosis
c) renal failure
d) Colon cancer
e) none of the above
answer is: 1- c, 2- b
its b12 deficiency and UMA is lab test for b12 deficiency.
But b12 defiency also causes increased homocystein levels (no methionine from homocystein) hence can cause atherosclerosis. Homocysteine acts as an atherogenic and thrombophilic agent. An increase in total plasma homocysteine represents an independent risk factor for coronary, cerebrovascular, and peripheral arterial disease as well as for deep-vein thrombosis

73- Name 5 hypercoagulable states.
antithrombin III deficiency
protein C and S deficiency
antiphospholipid antibodies syndrome( SLE)
high estrogen- oral contraceptives, pregnancy, high estrogen tumors
prolonged bedrest (the Virchow triad)/immobilisation
malignancy (pancreatic head - trosseu migratory)

74- What kind of tumor is it if it occurs at the junction between the gray and white matter of the brain?
which one is associated with crossing the midline?
Metastatic tumor- GBM ( butterfly like )

75- In Acute Tubular Necrosis, what is the main reason for administration of a loop diuretic during the oliguric phase?

a. may convert the Px to a more manageable condition
b. improves outcome
c. fluid retention due to excess ADH secretion
d. reverses ischemic necrosis
e. this is not the Rx for ATN
It’s a.
The goal of giving a loop is to convert an oliguric Px to a polyuric Px, because it is easier to manage a polyuric Px in acute renal failure. It does not improve the outcome, but the doc can rely on adequate fluid movement, he/she has more at his/her disposal. The idea though is not to remove fluid, but to maintain fluid flow through the kidney and a loop is specifically indicated in Rx of the oliguric phase of ARF.

76- A 36 y/o female is brought to the ER by her husband who says that she "complained of a severe headache then lost consciousness." She has a Hx of HTN and had been on several different medications. The examining physician notes that she is unable to move her arms and legs, but can blink her eyes. When the physician asks her to blink twice if she can hear him, she promptly does so. In which of the following structures is this woman's lesion most likely located?
A. Cervical spinal cord
B. Medulla oblongata
C. Midbrain
D. Pons
E. Thalamus
answer is D. this is locked in syndrome. lesion in ventral pons.

77- A 12 y/o boy presents/w a 2 day hx of tea-colored urine. He recently completed a 5 day course of penicillin for Streptococcal pharyngitis. On P/E periorbital edema & elevation of BP is noted. Which of the following is the most likely microscopic renal lesion?
A- Basement membrane immune complex deposition
B- Basement membrane thickening
C- Foot process effacement
D- Mesangial proliferation
E- Subepithelial immune complex deposition

Answer is E. PSGN most commonly follows a Streptococcus pyogenes pharyngitis by 9–14 days. Clinically, there is often hypertension, edema, and hematuria (smoky or tea-colored urine). The typical microscopic lesion is subepithelial immune deposit.


78- What is the primary target of the antimicrobial action of ciprofloxacin?
A- Binding of the 30S subunit
B- Binding of the 50S subunit
C- Competitive inhibition of dihydrofolate reductase
D- Inhibition of DNA-dependent RNA polymerase
E- Inhibition of DNA gyrase

Answer is E- DNA gyrase is the enzyme responsible for supercoiling, nicking, and sealing bacterial DNA. It is the target of the quinolone antibiotics, like ciprofloxacin, which are bactericidal against a wide variety of aerobes and facultative anaerobes.

79- A 24 y/o female presents/w CC of a pruritic rash present for the last several days. The rash began after a relaxing resort weekend that she spent swimming, snorkeling, and sitting in the hot tub. The rash is concentrated in areas covered by her swimming suit. Which of the following is the most likely etiologic agent?
A- Pseudomonas aeruginosa
B- Pseudomonas pseudomallei
C- Streptococcus pyogenes
D- Staphylococcus aureus
E- Staphylococcus epidermidis
Answer is A- Pseudomonas aeruginosa is a cause of folliculitis. In hot tubs and heated swimming pools that are not frequently cleaned, large numbers of the organism flourish and cause a folliculitis that is concentrated in areas covered by swimming suits (as these areas are persistently damp).

80- Which of the following best describes the thrombolytic action of streptokinase?
A- Activation of antithrombin III
B- Activation of circulating plasminogen
C- Activation of plasminogen bound to fibrin
D- Cleavage of fibrinogen to fibrin
E- Competitive inhibition of fibrin degradation
Answer is B.
Streptokinase forms a complex with circulating plasminogen, allowing activation of the complex in place of tissue plasminogen activator (factor XIIa). The fibrinolytic cascade then proceeds with plasmin cleaving fibrinogen and fibrin into degradation products.

81- A 28 y/o male is brought to the ER who lost his balance while on a top of a tree and slipped, barely avoiding a fall by grasping a limb with his right arm. He is unable to flex his wrist or move several of his fingers. There is numbness of the medial arm, forearm, and hand. Which of the following injuries is most likely?
A- Axillary nerve
B- Inferior trunk of the brachial plexus
C- Long thoracic nerve
D- Superior trunk of the brachial plexus
E- Thoracodorsal nerve
Answer is B.
Injury to the inferior trunk (C8 and T1) of the brachial plexus may occur when someone grasps an object to break a fall. The resulting paralysis and anesthesia are a reflection of the injury to the ulnar nerve with paralysis of the wrist flexion and intrinsic hand muscles and anesthesia of the medial portion of the arm, forearm, and hand.

82- A 4 mo/o female is brought by her mother who is concerned about some photographs she recently had developed. In the photographs, only the child’s right eye demonstrates a red reflex. Examination of the left eye confirms absence of a red reflex. Which of the following mechanisms is most likely involved?
A- Deletion in the long arm of chromosome 13
B- Deletion in the short arm of chromosome 5
C- Deletion of the short arm of chromosome 11
D- Nondisjunction of chromosome 18
E- Nondisjunction of chromosome 21

Answer is A.
Retinoblastoma are the result of inherited or acquired deletions of the retinoblastoma tumor suppressor gene on the long arm of chromosome 13. The tumor arises most frequently in the first 2 years of life with leukocoria, absence of the red reflex & poor vision.

83- A 45 y/o male is brought to the ER by his family, who has noted him to be behaving bizarrely. There is a family Hx of early death. He is unable to control pronounced choreiform movements of his upper extremities and trunk. Which of the following is the most likely neurotransmitter disturbance?
A- Depletion of acetylcholine
B- Depletion of dopamine
C- Depletion of ã – aminobutyric acid
D- Excessive production of acetylcholine
E- Excessive production of dopamine
F- Excessive production of ã – aminobutyric acid
G- Excessive production of norepinephrine

Answer is C.
Huntington's disease is an AD disorder characterized by involuntary choreiform movements, cognitive disturbance, and emotional dysfunction. Onset is in the fifth decade. There is atrophy of the caudate nucleus with depletion of ã – aminobutyric acid.


84- A 24 y/o female presents/w complaints of weakness and fatigue, worse in the afternoons for the last several months. The fatigue is relieved with a short nap. She has prominent bilateral ptosis. Which of the following is the target of the autoantibodies in this disease?
A- Acetylcholinesterase
B- Muscle fiber acetylcholine-gated ion channels
C- Muscle fiber membrane
D- Nerve fiber calcium channels
E- Nerve fiber membrane
Answer is B.
Autoantibodies in myasthenia gravis block the binding of acetylcholine to muscle fiber ion channels causing end-plate potentials too weak to properly stimulate muscle fibers.


85- An 18 day/o infant presents/w a fever of 39C (104F). The infant is lethargic. Blood cultures are obtained which isolates a gram-positive cocci. Which of the following is the most likely isolate?
A- Haemophilus influenza
B- Neisseria meningitides
C- Staphylococcus aureus
D- Staphylococcus epidermidis
E- Streptococcus agalactiae
F- Streptococcus pneumoniae
G- Streptococcus pyogenes
Answer is E.
Streptococcus agalactiae is the most common cause of sepsis in the neonatal period. Premature rupture of maternal membranes and prematurity increase the risk. Exposure during birth is common as 10–30% women have vaginal colonization with the organism.

86- 58 y/o man with fainting spells and exercise intolerance is found to have a bicuspid aortic valve with marked aortic stenosis. Which of the following physical findings would be prominent in this patient?
A. Diastolic murmur
B. Heave at left parasternal border
C. Loud S2 heart sound
D. Loud S3 heart sound
E. Weak peripheral pulse

answer is E. due to low SV. ( findings: S4, soft S1, dec S2, Systolic crescendo-decrescendo murmur )


87- A 52 y/o woman has long-standing RA and is being treated with corticosteroids and
NSAIDs drugs. Which of the following cardiac complications may arise in this clinical setting?
A. Constrictive pericarditis
B. Dilated cardiomyopathy
C. Hypersensitivity myocarditis
D. Hypertrophic cardiomyopathy
E. Restrictive cardiomyopathy

answer is E. RA-->secondary amyloidosis--->restrictive cardiomyopathy.


88- Which of the following amino acids is post-translationally hydroxylated in the cytoplasm of fibroblasts?
A. Cysteine
B. Glycine
C. Proline
D. Serine
E. Tyrosine

answer is C. proline (collagen formation)


89- A 27 y/o man develops bilateral parotid gland swelling and orchitis, and is generally ill with fever of 102° F. Which of the following substances is most likely to be significantly elevated in the patient's serum?
A. ALT
B. Amylase
C. AST
D. Ceruloplasmin
E. CPK-MB

answer is B. Mumps....associated with pancreatitis+ orchitis+ parotitis.

therefore amylase is elevated.


90- 71 y/o man has been in excellent health, and practicing competently as an attorney. He is brought to the emergency room following a MVA. A workup, including imaging of the spine, thorax, and head, is negative, but the patient is admitted for overnight observation. His injuries include several lacerations to the face and extremities as well as several contusions to the thorax. Three wks later, he is admitted to the hospital for confusion. A neurologic exam is normal except that he is not oriented to time or place, and can recall only 1 out of 6 objects after 3 minutes. Which of the following is the most likely diagnosis?
A. Alzheimer's disease
B. Brain metastases
C. Epidural hematoma
D. Normal pressure hydrocephalus
E. Subdural hematoma

Answer is E. subdural ( chronic subdural hematoma )
it collects over a period of time and it is more common in elderly because of cortical atrophy and stretching of cerebral veins.


91- A child develops a tumor of the cerebellum. Biopsy reveals evidence of both neuronal and glial differentiation. Which of the following is the most likely diagnosis?
A. Astrocytoma
B. Glioblastoma multiforme
C. Medulloblastoma
D. Meningioma
E. Oligodendroglioma

answer is C.
medulloblastoma has primitive embryonic tissues , similar to nephroblastoma, neuroblastoma. All these are capable of forming different cell types.


92- A 56 y/o man presents/w complaints of complete exhaustion after mowing the lawn in his small front yard. He also complains of dizziness, irritability, difficulty sleeping, and loss of libido. On P/E, the man's skin, conjunctiva, and oral mucosa are pale. A blood test indicates Hgb of 7 g/dL. Which of the following findings is also likely to be present in this man?
A. Bradycardia
B. Cyanosis
C. Low stroke volume
D. Warm hands
E. Wide pulse pressure

I think answer is E. There’s a hyperkinetic circulation in anemia. Systolic pressure is high and Stroke vol is high as heart is trying to meet demands of tissues, and diastolic pressure is low due to local metabolites causing vasodilation.


93- A 48 y/o man complaining of chest pain is brought to the ER. P/E followed by echocardiography demonstrates aortic stenosis. His coronary blood flow is increased.
Which of the following is the most likely explanation for the increased coronary blood flow in this individual?
A. Decreased left ventricular oxygen consumption
B. Decreased left ventricular pressure
C. Decreased left ventricular work
D. Increased cardiac tissue adenosine concentration
E. Increased cardiac tissue oxygen concentration

answer is D.
cardiac workload increase so its pressure and therefore its O2 consumption. Also, Adenosine is a vasodilator.


94- Maximal ventricular Na+ channel conductance occurs during which phase of the ECG?
A. P wave
B. QRS interval
C. ST interval
D. T wave
E. U wave

answer is B. QRS interval ( polarization of ventricles )


95- A 55 y/o man had been in good health since receiving a heart transplant for severe atherosclerotic disease. Five yrs after transplantation, the patient died suddenly, without any premonitory symptoms, while working in his garden. He had been maintained on cyclosporin since his transplant. Which of the following complications would most likely be found at autopsy in the transplanted heart?
A. Allograft rejection
B. Atherosclerosis of coronary arteries
C. Graft vascular disease
D. Hyaline arteriolosclerosis
E. Hyperplastic arteriolosclerosis

answer is C. Graft vascular disease.
The fact that he died without any premonitory symptoms ( sudden death )is in favor of coronary vascular dis.
Or B?? dur to recurrence of dis.


96- t 14:18 translocation is associated with?
it is seen in about 85% of follicular lymphoma and up to one-third of diffuse lymphomas.
( bcl-2 gene expression (anti-apoptosis gene) = B cell follicular lymphoma )


97- A 42 y/o man was in a MVA and suffered severe pelvic trauma. The bulb of the penis and the urethra were torn from the inferior surface of the urogenital diaphragm. This has allowed urine to extravasate from the urethra. Into which of the following regions will the urine flow?
A. Deep perineal space
B. Ischioanal space
C. Rectovesical pouch
D. Retroperitoneal space
E. Superficial perineal space

Answer is E. ( refer to anatomic atlas )


98- During surgery to treat an ischioanal abscess, the inferior rectal nerve is damaged. This nerve is a direct branch of which of the following nerves?
A. Inferior gluteal nerve
B. Pelvic splanchnic nerve
C. Pudendal nerve
D. Sciatic nerve
E. Superior gluteal nerve

Answer is C.


99- Which of the following neurotransmitters is most important for the induction of REM sleep?
A. Acetylcholine
B. Dopamine
C. Epinephrine
D. Norepinephrine
E. Serotonin

Answer is A. Ach


100- A 52 y/o woman presents to her physician for a check-up. She is recovering from a wrist Fx after a fall. Dual energy x-*** absorptiometry of the hip had shown her to have osteoporosis. She became menopausal at age 50 and did not begin HRT because of a strong family hx of breast cancer. She now fears a future hip Fx and would like to begin a bone loss prevention regime.Which of the following pharmaceutical agents is most appropriate for this patient?
A. Calcitonin nasal spray
B. Oral conjugated estrogen
C. Raloxifene
D. Tamoxifen
E. Transdermal estradiol

Answer is C.
Note: it has an estrogen-like effects on bone and lipid metabolism, while antagonizing the effects of estrogen on mammary tissue & behaves as an estrogen antagonist in the uterus.


101- A 55 y/o man presents/w crushing substernal pain and left shoulder pain of 2 hrs duration. The pain is not relieved by sublingual nitroglycerin, and the ECG shows ST elevation in several leads. Aspirin and streptokinase therapy are initiated, and the patient is admitted to the ICU. The next morning, serum cardiac enzymes are elevated to 4 times the upper limit of normal, and the ECG changes are still present. Which of the following is the most likely Dx?
A. Prinzmetal's angina
B. Stable angina
C. Subendocardial infarction
D. Transmural infarction
E. Unstable angina

Answer is D. Consider subendocardial if ST depression.


Which of the following class II antigens would be most likely to play a contributing role in hay fever?
A. DR2
B. DR3
C. DR4
D. DR5
E. DR7

answer is A. DR2 ??? doubt


102- 17 y/o woman G1P0 with 10 yr Hx of asthma undergoes pulmonary evaluation & spirometery. She doesn’t have any respiratory complaints or Sx. Which of the ffg regarding her status during pregnancy is true?
A- RR increases
B- Vital capacity decreases
C- Minute ventilation increases
D- Functional residual capacity remains unchanged
E- Tidal volume decreased

Answer is C. since Px does’t have any respiratory problem, she’ll undergo the normal changes in respiratory physiology that occur during pregnancy:
- RR is unchanged
- TV is increased
- Minute ventilation is increased
- VC remains unchanged
- FRC is decreased ( uterus elevates the resting position of diaphragm )


103- A family is referred to a genetic specialist because of mild mental retardation in several of the school-age children. Laboratory evaluation demonstrates a specific chromosomal breakage site in metaphase studies of lymphocytes cultured with methotrexate. Which of the following chromosomes is most likely to be specifically
affected?
A. X
B. Y
C. 13
D. 16
E. 21

answer is A. sounds like fragil X syn.


104- Which of the following chemotherapeutic agents is specific for the
M phase of the cell cycle?
A. Cytarabine
B. Daunorubicin
C. Hydroxyurea
D. Mechlorethamine
E. Vincristine

answer is E.


105- P/E of a neonate shows abnormal facies with a small lower jaw, low-set ears, and a prominent occiput. The feet have a rocker-bottom deformation, and the infant is hypertonic. Cardiac evaluation demonstrates VSD. Which of the following is the average life-span for infants with this neonate's syndrome?
A. 2-3 months
B. 1-2 years
C. 4-7 years
D. 15-25 years
E. Normal life expectancy

Answer is A. mostly die within 1 yr of age.


106- A newborn presents/w severe acidosis, vomiting, hypotonia, and neurologic deficits. Serum analysis reveals elevated levels of lactate and alanine. These observations suggest a deficiency in which of the following enzymes?
A. Alanine aminotransferase
B. Glutamate dehydrogenase
C. Lactate dehydrogenase
D. Pyruvate carboxylase
E. Pyruvate dehydrogenase

answer is E.


107- To evaluate hypoglossal nerve function, a neurologist asks her patient to protrude his tongue. On doing so, his tongue deviates to the right side. This finding results from paralysis of which of the following muscles?
A. Left genioglossus
B. Left hyoglossus
C. Left palatoglossus
D. Right genioglossus
E. Right hyoglossus
F. Right palatoglossus

answer is D. tongue deviates to the weak ( Rt ) side bcoz of the unopposed action of opposite genioglusus muscle.


108- A child is 2 SD below the expected mean height for his age. He also has delayed bone maturation and a goiter. Analysis of genetic material reveals a point mutation in the thyroid hormone receptor. Which of the following laboratory results would be expected in this patient?
A. Decreased radioactive iodine uptake test (RAIU)
B. Decreased resin T3 uptake test
C. Decreased plasma TSH concentration
D. Increased basal metabolic rate (BMR)
E. Increased plasma T4 concentration

answer is E. Generalized resistance to thyroid hormones ( Refetoff's syndrome )was first described in 1967 by Refetoff and coworkers as a familial syndrome of deaf mutism, stippled epiphyses, goiter, and abnormally high thyroid hormone levels with normal TSH. The clinical presentation in the more than 500 cases that have been reported has been variable; while most patients are euthyroid, many present with goiter, stunted growth, delayed maturation, attention deficits, hyperactivity disorders, and resting tachycardia. Seventy-five percent of reported cases are familial. Inheritance is autosomal dominant. Laboratory tests reveal elevated T4, FT4, T3, and normal or elevated TSH.


109- A 3 y/o child with cystic fibrosis presents with weight loss, irritability, and a chronic productive cough. On physical exam, he is afebrile and lung exam reveals intercostal retractions, wheezing, rhonchi, and rales. Chest x-*** demonstrates patchy infiltrates
and atelectasis and Gram's stain of the sputum reveals slightly curved, motile gram-negative rods that grow aerobically. The microorganism responsible for this child's pneumonia is also the most common cause of which of the following diseases?
A. Croup
B. Epiglottitis
C. Meningitis
D. Otitis externa
E. Otitis media

answer is D.
In CF px the MCC of recurrent pneumonia is pseudomona which also is the cause of otitis externa.


110- A 50 y/o woman presents with complaints of difficulty rising from a chair or combing her hair. Physical examination is remarkable for erythema and edema of cheeks, eyelids, and the backs of the hands. The lesions have a distinctive mauve color and mauve papules are noted on the knuckles. Approximately 30% of patients with this disorder also may have:
A. a mutation in a skeletal muscle protein
B. abnormal circulating lymphocytes with cerebriform nuclei
C. an underlying malignancy
D. bacillary bodies in macrophages in the lamina propria of the intestine
E. flattening and blunting of villi in the jejunum

Answer is c.
Malignancy is possible in any patient with DM.


111- A 65 y/o woman with a long-standing disease has bone marrow fibrosis and increased bone remodeling, with bone resorption exceeding bone formation. She has a history of passing calcium-oxalate kidney stones. Which of the following lab result profiles would be expected in
the serum of this patient?
Calcium Phosphate PTH
A. decreased decreased increased
B. decreased increased decreased
C. decreased increased increased
D. increased decreased increased
E. increased increased increased

answer is D.
This is a case of primary hyperparathyroidism, since Px has hx of ca-oxalate stones & also bcoz q clearly mentions that bone resorption > bone formation. In this dis. PTH & Ca are increased while Ph is decreased. As u remember function of PTH is as follows:
- inc bone resorption of Ca & Ph
- inc kidney resorption of Ca in DCT
- dec kidney resorption of Ph
- inc 1,25(OH)2 VitD production

So it causes: inc serum Ca, dec serum Ph, inc urine Ph.

[Anonymous]

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