1*A 32-year-old woman is in an automobile accident and suffers a
fracture of the left tenth and eleventh ribs. Which of the
following organs is most likely to have been injured by these
A. Descending colon
C. Left adrenal gland
D. Left kidney
2 .A 46-year-old woman presents to her physician with
"double vision" and is unable to adduct her right eye on
attempted left lateral gaze. Convergence is intact. Both
direct and consensual light reflexes are normal. Which of
the following structures is most likely to be affected?
A. Left oculomotor nerve
B. Medial longitudinal fasciculus
C. Right abducens nerve
D. Right oculomotor nerve
E. Right trochlear nerve
3*Which of the following CNS tumors has the worst prognosis and is
associated with the shortest survival?
A. Anaplastic astrocytoma (WHO grade III)
B. Glioblastoma multiforme
E. Well-differentiated astrocytoma (WHO grade II)
4*A 2-week-old child shows difficulty feeding, somnolence, failure
to thrive, and constipation. An alert pediatrician orders blood
studies that demonstrate low T4 and high TSH. If appropriate therapy
is not promptly instituted, which of the following complications
would most likely occur?
C. Hepatic cirrhosis
D. Mental retardation
E. Renal failure
5*The parents of a 5-year-old girl ask their family physician for
advice regarding their child. The mother had walked into the girl's
bedroom without knocking and discovered the child stimulating her
genitals. The parents are concerned, but seem to be receptive.
The best response the physician could give is:
A. "Do you think that someone's been molesting her?"
B. "Don't you think you should knock before going into her room?"
C. "She probably has a vaginal infection. Bring her in so I can examine her."
D. "This is perfectly normal behavior for a child this age."
E. "What disturbs you about this behavior?"
6*A newborn child has the most common type of tracheoesophageal
fistula (type C). When and how will this developmental anomaly most
likely be discovered?
A. Immediately, with his first breaths
B. On the first day, with his first meal
C. After one week, with persistent weight loss
D. Between 1 and 3 years, with exercise intolerance
E. Never; it is usually asymptomatic
7*Histones can bind DNA tightly because they have a high isoelectric
point. This is due to an enrichment in the amino acid
8*An 82-year-old man complains to his physician at his yearly checkup
that his legs begin to ache about half way through his daily 2-mile walk
. The pain subsides within 1 or 2 minutes after he stops walking.
He also complains of erectile dysfunction. Which of the following
is most likely to be decreased in this man?
A. Arterial oxygen content
B. Arterial pulse at the ankle
C. Oxygen extraction in his leg muscles
D. Peripheral vascular resistance
E. Serum lipid levels
9*A wrestler's chest is compressed during a match, causing a posterior
displacement of the clavicle at the sternoclavicular joint. Which of
the following structures would be most at risk?
D. Superior vena cava
10*A 6-year-old boy with a sore throat, cough, and fever is noted to have
a marked elevation in his serum C-reactive protein. This finding indicates
which of the following?
A. Developing autoimmune reaction
B. Ineffective immune response
D. Non-specific inflammation
E. Respiratory compromise
11*A 48-year-old male presents for a routine evaluation 3 months after
starting on an antihypertensive medication. His physical examination is
unremarkable and blood pressure is 128/83. Laboratory results reveal
the following lipid profile: total cholesterol 280 mg/dL, HDL 34 mg/dL,
LDL 188 mg/dL, and triglycerides 191 mg/dL. His lipid profile was normal
prior to beginning his antihypertensive medication. Which of following
medications most likely caused the patient's dyslipidemia?
12*A pathologist reports the presence of koilocytotic atypia in a
cervical biopsy from a 25-year-old woman. On the basis of this
histopathologic finding, which of the following conditions does
this patient most likely have?
A. Chlamydia infection
B. Gonococcal infection
C. Herpes simplex virus infection
D. Human papillomavirus infection
E. Severe squamous dysplasia
F. Squamous cell carcinoma in situ
G. Trichomonas infection
13*Examination of a karyotype taken from a metaphase preparation
reveals the presence of an extra chromosome. Which of the following
is the most common mechanism of producing this phenomenon?
A. Balanced translocation
B. Chromosomal breakage
C. Fertilization by two sperm
E. Unbalanced translocation
14*A 24-year-old woman presents to her physician with an inability
to close her right eye. Physical examination reveals weakness of
the right orbicularis oculi. Which of the following additional
symptoms would likely also be present?
A. Blurred vision
C. Inability to chew
D. Inability to feel the face
E. Inability to shrug the shoulder
15*A patient's left hypoglossal nerve (CN XII) is injured during a
carotid endarterectomy. Which of the following would most likely
result from this injury?
A. Decreased gag reflex on the left
B. Decreased salivation from the left submandibular and sublingual salivary glands
C. Deviation of the tongue to the left on protrusion
D. Inability to elevate the pharynx on the left during swallowing
E. Inability to perceive sweet and salt taste sensation on the anterior part of the left side of the tongue
16*During a physical examination, a physician asks a patient to
say "Kuh, kuh, kuh," "La-la-la," and "Mi-mi-mi." The patient is
unable to say "la" but says the other two sounds correctly. A
lesion of which of the following cranial nerves is most strongly
suggested by these findings?
17*An inexperienced resident examines the x-ray of the arm of a
child after a fall. There appears to be a fracture near, but not
at, the distal end of the ulna. Before diagnosing a fracture,
the resident should also consider the possibility that this is
actually which of the following?
A. Articular cartilage
B. Epiphyseal plate
D. Primary ossification center
E. Secondary ossification center
18*A 65-year-old male presents with a history of headache and
difficulty walking. He felt well the previous night, but woke
up with a severe headache and was unable to move his right
leg. Clinical examination reveals no higher cortical function
deficit. The optic discs are sharp, and the pupils are equal
and reactive. The direct and consensual light reflexes are normal,
and testing of the cranial nerves reveal no deficits. The right
leg is hypotonic, and the man is unable to move it. Deep tendon
reflexes are absent and Babinski's sign cannot be elicited. The
most likely cause for this problem is loss of blood flow in the
A. left anterior cerebral artery
B. left middle cerebral artery
C. left posterior cerebral artery
D. right anterior cerebral artery
E. right middle cerebral artery
F. right posterior cerebral artery
19*A 20-year-old healthy married Caucasian male undergoes a splenectomy
following a severe motorcycle accident. He is started on a prophylactic
course of antibiotics following surgery, which he discontinues 3
months later. 9 months after the splenectomy, he presents to the
emergency room with shortness of breath, pleuritic chest pain,
chills and fever, and is diagnosed with lobar pneumonia. Which of
the following is the most likely organism?
A. Chlamydia pneumoniae
B. Pneumocystis carinii
C. Pseudomonas aeruginosa
D. Staphylococcus aureus
E. Streptococcus pneumoniae
20*A 32-year-old woman notices a rock-hard lump in one breast. She
is diagnosed with breast cancer, and undergoes a mastectomy. During
the procedure, the surgeon notes that the breast tumor has spread
to involve the muscle layer immediately deep to the breast. Which
muscle is involved?
A. External oblique
B. Pectoralis major
D. Rectus abdominis
21*A 55-year-old man presents to a physician with jaundice.
Ultrasonography demonstrates a 5 cm mass in the head of the
pancreas. Endoscopic retrograde cholangiopancreatography with
cytologic sampling demonstrates cells with large hyperchromatic
nuclei and a high nuclear/cytoplasmic ratio. A few small glands
composed of these cells are also seen in the cytologic preparation.
The overall prognosis for this man will be most similar to that of a
patient with which of the following malignancies?
A. Adenocarcinoma of the breast
B. Adenocarcinoma of the colon
C. Adenocarcinoma of the esophagus
D. Adenocarcinoma of the prostate
E. Primary gastric lymphoma
22*A 1-week-old infant has a coarctation of the aorta just distal to
the subclavian arteries. The blood pressure distal to the constriction
is 50% lower than normal. Which of the following is increased in this
A. Blood flow in the lower body
B. Glomerular filtration rate
C. Plasma levels of angiotensin II
D. Renal excretion of sodium
E. Renal excretion of water
23*A 25-year-old-man presents with weight loss, abdominal pain, and
bloody diarrhea. Sigmoidoscopy/colonoscopy reveal mucosal erythema
and ulceration extending in a continuous fashion proximally from
the rectum. Which of the following pathologic findings would also
be characteristic of this patient's illness?
A. Bowel wall thickening
B. Cobblestone appearance of mucosa
E. Transmural lesions
24*Folate plays a role in single-carbon unit transfer in the
synthesis of nucleotides. Which of the following nucleotides
require folate for synthesis?
A. Adenosine, cytosine, and uracil
B. Adenosine, guanine, and thymidine
C. Adenosine, guanine, and uracil
D. Cytosine, thymidine, and uracil
E. Guanine, thymidine, and uracil
25*A normal birthweight, term baby with high APGAR scores fails to
pass meconium within 36 hours of birth. The neonate also has a
distended abdomen and has been vomiting and feeding poorly. Digital
rectal examination temporarily relieves the obstruction, but the
baby fails to pass stool thereafter. Barium enema examination
demonstrates a very narrow distal segment of rectum with
proximal dilation. Abnormalities of which of the following
are most likely etiologically related to this baby's disorder?
A. Chloride channels
B. Ganglion cells
C. Mucosal cells
D. Smooth muscle cells
E. Vagus nerve
26*Following a difficult delivery, a baby is noted to have an adducted
and internally rotated shoulder with an extended, pronated elbow.
Loss of flexion and supination by which of the following muscles
accounts for the elbow position?
E. Pronator teres
27*Which part of the brain is most often involved by septic emboli
in patients with infective endocarditis?
C. Frontal lobe
D. Occipital lobe
E. Parietal lobe
28*A 32-year-old male with a history of chronic drug abuse presents
to his primary care physician complaining of uncontrollable shaking
in his hands. He moves very slowly and walks with a stooped posture
and shuffling gait. Physical exam reveals cogwheel rigidity, a
pill-rolling tremor, and masked facies. His condition deteriorates,
and he eventually dies. Structures similar to which of the
following would be expected on autopsy?
A. Hirano bodies
B. Lewy bodies
C. Lipofuscin granules
D. Negri bodies
E. Neurofibrillary tangles
29*An aneurysm of the axillary artery within the axilla is most likely
to compress which of the following neural structures?
A. Axillary nerve
B. Long thoracic nerve
C. Lower trunk of the brachial plexus
D. Medial cord of the brachial plexus
E. Musculocutaneous nerve
30*A 51-year-old supermarket cashier begins to have difficulty working,
sometimes ringing up the wrong amount because her right hand
feels "weak." She also notes that her right hand sometimes feels
numb after working for long periods of time. Physical examination
reveals loss of sensation on the palmar aspect of her thumb and
first two fingers, as well as atrophy of the thenar eminence on
her right hand. The nerve most likely injured in this patient
also innervates which of the following muscles?
A. Adductor pollicis
B. Extensor digitorum
C. Extensor pollicis longus
D. Flexor carpi ulnaris
E. Flexor digitorum superficialis
31*While performing a surgical procedure in the neck, the surgeon
ligates the superior laryngeal artery. If the nerve that accompanies
this artery is damaged, which of the following functional losses will
A. Loss of sensation in the laryngeal mucosa above the vocal folds
B. Loss of sensation in the laryngeal mucosa below the vocal folds
C. Loss of sensation in the pharyngeal mucosa
D. Paralysis of the cricothyroid muscle
E. Paralysis of the lateral cricoarytenoid muscle
32*A young man is involved in a knife fight. Surgical exploration of
a posterolateral neck wound demonstrates a large muscle with investing
fascia on both its superficial and deep aspects. Damage to the fibers
of this muscle at this location would most likely impair which of
the following movements?
A. Depression of the medial end of the scapula
B. Elevation of the acromion
C. Flexion of the neck
D. Raising of the medial border of the scapula
E. Turning of the face sideways
33*A 40-year-old woman has had several episodes of rheumatic fever
as a child. She is currently afebrile and feels well, and has come
to a hospital for monitoring echocardiography. Which of the following
would be most likely to be seen in this patient's mitral valve?
A. Ballooning of valve leaflets
B. "Fish mouth" valve
C. Irregular beads of calcification in annulus
D. Large bulky vegetation with adjacent leaflet perforation
E. Tiny vegetations along line of closure of valve leaflet
34*A patient with chronic reflux esophageal symptoms undergoes
endoscopy, which demonstrates islands of red tissue above the
gastroesophageal junction. Biopsy of several of these lesions
demonstrates glandular epithelium with no atypical nuclei, with
no invasion into the adjacent tissue. For which of the following
cancers does this lesion predispose?
A. Adenocarcinoma of the esophagus
B. Adenocarcinoma of the stomach
C. Sarcoma of the esophagus
D. Sarcoma of the stomach
E. Squamous cell carcinoma of the esophagus
F. Squamous cell carcinoma of the stomach
35*A 40-year-old woman has the following family and personal history:
her mother died of breast cancer at age 64, she smokes one pack/day,
she drinks five or more cups of coffee/day, she has no children, and
she takes birth control pills. Which of the following is the most
significant risk factor for breast cancer in this patient?
A. Birth control pills
B. Caffeine consumption
C. Cigarette smoking
D. Family history
36*A 6-cm length of rectosigmoid colon containing a 2-cm diameter
sessile polyp is surgically removed. On sectioning, the lesion
shows finger-like papillae with cores of scant lamina propria.
The surfaces of the papillae are covered by dysplastic columnar
epithelium with considerable nuclear pleomorphism. No glandular
structures are seen in the base of the lesion or in the adjacent
muscle tissue. The margins of the specimen are free of dysplastic
epithelium. What further therapy does this person require?
A. Adjunct chemotherapy
B. Complete colectomy
C. Radiation therapy
D. Resection of regional lymph nodes
E. No further therapy is required
37*A 34-year-old man presents with weight loss, diarrhea, and flatulence.
Jejunal biopsy demonstrates marked atrophy of villi. This patient's
condition may improve with removal of which of the following from
38*A 61-year-old man presents with left leg pain and weight loss.
On examination, unilateral erythema, swelling, and warmth are
noted over the left leg. The man is scheduled for duplex venous
ultrasonography, but on the day of his diagnostic procedure,
the patient notes that his left leg is no longer painful, but
now his right leg is swollen. The ultrasound examination reveals a
deep venous thrombosis in the right leg, but no clot in the left
leg. Which of the following underlying conditions is the likely
cause of this man's presentation?
B. Pancreatic carcinoma
C. Progressive systemic sclerosis
D. Rheumatoid arthritis
39*A 2-year-old boy is undergoing an eye examination due to an abnorma l
light reflex his right eye, causing a so-called "cat eye." A whitish
elevation of the retina is observed and invasion of the optic nerve
by the tumor has begun. His family history is significant for
osteosarcoma in his father. He has a sister who is asymptomatic.
HindIII digestion of a PCR fragment of interest from a 180 kb
gene located on the proximal half of the long arm of chromosome
13 demonstrates two different alleles (shown on the Southern blot below).
Father Mother Daughter Son Band Size
________ ________ _________ _______ 2.1kb
________ _________ 1.5kb
Which of the following is the best conclusion that can be derived from
the given information?
A. The daughter inherited a 1.5 kb fragment from her mother
B. The daughter will develop the tumor
C. The disease is associated with the 2.1 kb fragment
D. The disease shows an autosomal dominant pattern
E. The mother was affected, but the tumor regressed spontaneously
40*A 78-year-old woman with type 2 diabetes, diabetic nephropathy,
and hyperuricemia presents to her physician for a physical examination,
which is remarkable for hypertension. Which of the following drugs would
be best for the initial treatment of this woman's hypertension?
Pulmonary artery pressure 45/25 mm Hg
Pulmonary wedge pressure 30 mm Hg
Left ventricular pressure 120/5 mm Hg
Aortic pressure 120/80 mm Hg
Cardiac catheterization was performed on a 51-year-old woman because
of a 9-month history of worsening fatigue and shortness of breath.
What is the most likely diagnosis based on the pressures shown above?
A. Aortic regurgitation
B. Aortic stenosis
C. Mitral regurgitation
D. Mitral stenosis
42*A child develops a tumor of the brainstem, which on biopsy
demonstrates bizarre, pleomorphic tumor cells accompanied by
necrosis and hemorrhage. Which of the following is the most
C. Glioblastoma multiforme
E. Pilocytic astrocytoma
43* The figure above illustrates an aortic pressure pulse contour
from a normal individual and one obtained from a patient. The
patient is most likely suffering from which of the following?
A. Aortic regurgitation
B. Aortic stenosis
D. Mitral regurgitation
E. Patent ductus arteriosus
44*Examination of a late aborted fetus reveals a small head,
small eyes, prominent cleft lip and palate, 6 fingers on each
hand, and dextrocardia. The developmental abnormalities noted
in this fetus were probably due to
B. 45, XO
C. trisomy 13
D. trisomy 18
E. trisomy 21
45*A patient presents to the emergency room with malaise. The
physician notices slight jaundice. Serum chemistries reveal
marked elevation of both aspartate aminotransferase (AST) and
alanine aminotransferase (ALT), with the AST/ALT ratio being 2.5.
Alkaline phosphatase is near normal. Serum copper and serum iron
are normal. Liver damage from which of the following diseases most
likely accounts for these findings?
A. Alcoholic hepatitis
B. Biliary cirrhosis
D. Hepatitis A
E. Wilson's disease
46*A 25-year-old man presents to the emergency room with severe
abdominal pain. Guaiac test on stool demonstrates occult blood.
The patient is taken to exploratory laparotomy, at which a small
area of infarcted small bowel is found and surgically removed.
Histologic studies on the removed section of bowel demonstrate
a recent thrombus occluding a small muscular artery. The adjacent
vessel wall shows fibrinoid necrosis with a mixed inflammatory
infiltrate containing neutrophils, eosinophils, and mononuclear
cells. Which of the following is the most likely cause of the
small bowel infarction?
B. Cystic medial necrosis
C. Mönckeberg's arteriosclerosis
D. Polyarteritis nodosa
E. Wegener's granulomatosus
47*A patient has had years of intermittent diarrhea and abdominal
pain, but has never consulted a physician. Eventually, he begins to
pass fecal material in his urine and he seeks medical attention.
Which of the following diseases is most likely to cause this complication?
A. Celiac disease
B. Crohn's disease
D. Ulcerative colitis
E. Whipple's disease
48*A 34-year-old female is evaluated for diffuse pelvic pain. Her
husband was treated one month previously for venereal disease,
but she was not treated at that time. Now she is febrile and
has a tender mass around her left adnexa. This condition, if
untreated, could lead to
E. polycystic ovary disease
49*A resident physician is performing a pelvic examination on a
young woman. The fingers of one of her hands is in the patient's
vagina and is palpating the cervix. The other hand is pressing on
the abdomen. With the palm of this hand, the physician feels a bony
structure in the lower midline. This structure is most likely the
50*A 22-year-old female Asian immigrant presents with complaints of
malaise, fever, arm pain, loss of appetite, and visual problems. Her
mother states that she fainted 1 week ago. The physician cannot palpate
the patient's lower extremity pulses and notes that the dial pulses are
weak. The erythrocyte sedimentation rate (ESR) is elevated. Which
of the following is the most likely diagnosis?
A. Buerger's disease
B. Kawasaki's disease
C. Takayasu's arteritis
E. Wegener's granulomatosus
1> E 11> D 21> C 31> A 41> D
2> B 12> D 22> C 32> B 42> C
3> B 13> D 23> D 33> B 43> C
4> D 14> B 24> B 34> A 44> C
5> E 15> C 25> B 35> D 45> A
6> B 16> E 26> A 36> E 46> D
7> C 17> B 27> E 37> E 47> B
8> B 18> A 28> B 38> B 48> B
9> E 19> E 29> D 39> C 49> D
10> D 20> B 30> E 40> B 50> C