1. A 14-year-old boy with sickle cell disease received a
The uptake of a novel drug by hepatocytes occurs down
blood
transfusion that caused his blood volume to increase
signifi cantly above normal. What changes in cardiac
contractility and total peripheral resistance (TPR) would
occur within a few minutes of receiving this transfusion?
A. Increased contractility and increased TPR
B. Increased contractility and decreased TPR
C. Decreased contractility and increased TPR
D. Decreased contractility and decreased TPR
1. A 50-year-old man with a persistent cough and diffi
culty breathing is referred by his family physician for
pulmonary function tests. The test results show that the
forced vital capacity (FVC), forced expired volume in 1
s (FEV1), and functional residual capacity (FRC) are all
signifi cantly below normal. Which of the following diagnosis
is consistent with these pulmonary function test
results?
A. Asthma
B. Chronic bronchitis
C. Emphysema
D. Pulmonary fi brosis
1. A 61-year-old woman visits her family doctor complaining
of severe fatigue, which has become progressively worse
over the past 6 months. She is referred to a hematologist
following the results of a complete blood cell count,
which shows decreased hematocrit (24%), decreased
hemoglobin concentration (8 g/dL), and decreased red
blood cell count 2.6 x 1012/L. The mean cell volume and
reticulocyte counts are normal. Which type of anemia
does the patient have?
A. Macrocytic anemia (large red cells)
B. Microcytic anemia (small red cells)
C. Normocytic, hypoproliferative anemia
D. Normocytic, hyperproliferative anemia
E. No anemia is present
1. A 67-year-old woman involved in a motor vehicle accident
lost 1 L of blood because of an open fracture of
her left femur. Paramedics were able to prevent further
bleeding. What changes to her intracellular fl uid (ICF)
and extracellular fl uid (ECF) volumes would be observed
15 minutes after this blood loss?
A. ECF volume smaller; ICF volume unchanged
B. ECF volume smaller; ICF volume smaller
C. ECF volume unchanged; ICF volume unchanged
D. ECF volume unchanged; ICF volume smaller
1. A novel drug produced by screening snake venoms was
found to kill glial cell tumors in culture. However, initial
in vivo studies showed that the drug did not enter the
brain of experimental animals and therefore could not
access glial cells in the intact brain. Which structure is
most responsible for preventing the entry of this drug
into the brain?
A. Arachnoid mater
B. Brain capillary endothelium
C. Choroid plexus epithelium
D. Dura mater
E. Pia mater
1.
an electrochemical gradient. Uptake is independent of
other solutes, and the rate of uptake is saturated at high
extracellular drug concentrations. Which membrane
transport process is most likely to account for all these
characteristics of drug uptake?
A. Antiport with Cl−
B. Cotransport with Na
C. Facilitated diffusion
D. Primary active transport
E. Simple diffusion through ion channels
F. Simple diffusion through plasma membrane
2. A 9-year-old boy awoke in the night complaining of
abdominal pain that was dull and poorly localized.
Which
of the following pathways conveys these sensations of
pain to consciousness?
A. Myenteric plexus
B. Sacral parasympathetic nerves
C. Splanchnic sympathetic nerves
D. Submucosal plexus
E. Vagus nerve
2. A 19-year-old man is taken to the emergency department
after being stabbed in the right side of the chest. The entry
of air through the wound resulted in a pneumo thorax on
the right side of his chest. What difference between the
right and left sides of the chest would be apparent on a
plain chest x-ray?
A. The lung volume on the right would be larger
B. The position of the diaphragm on the right would be
higher
C. The thoracic volume on the right would be larger
D. There would be no differences in thoracic geometry
2. A 21-year-old woman returns to the United States from a
student exchange visit to Australia. The morning after her
fl ight, she is awakened because she is experiencing a pain
throughout her right leg, which is of pale blue color. She
is taken to the emergency department, where a clinical
diagnosis determines that she has deep vein thrombosis.
Which of the following laboratory fi ndings would be
consistent with this history?
A. Antithrombin III defect
B. Decreased hematocrit
C. Decreased fi brinogen
D. Decreased platelet count
E. Factor VIII defect
2. A 28-year-old woman suffered severe trauma to the head
in a horseback riding accident that resulted in the complete
transection of the pituitary stalk. The plasma levels
of which hormone would be expected to increase as a
result of this accident?
A. Adrenocorticotropic hormone
B. Follicle-stimulating hormone
C. Growth hormone
D. Luteinizing hormone
E. Oxytocin
F. Prolactin
G. Thyroid-stimulating hormone
H. Vasopressin
1a
 D. Decreased contractility and
C. Facilitated diffusion
decreased TPR

C. Splanchnic sympathetic nerves D. Pulmonary fi brosis

C. The thoracic volume on the right C. Normocytic, hypoproliferative

would be larger anemia

A. ECF volume smaller; ICF volume

A. Antithrombin III defect
unchanged

F. Prolactin B. Brain capillary endothelium

1b

2. A 28-year-old woman was prevented from traveling by
air to a family wedding due to an acute episode of vertigo.
Over the next few months, she experienced several
transient, neurologic problems, including blurred vision,
sudden muscle weakness in her legs, loss of perineal sensations,
and urinary incontinence. What cellular defect is
most likely to account for these clinical fi ndings?
A. Atrophy of skeletal muscles
B. Demyelination of central nervous system (CNS)
neurons
C. Destruction of preganglionic sympathetic neurons
D. Loss of CNS dopaminergic neurons
E. Proliferation of Schwann cells
3. A 4-year-old boy was diagnosed with visual disturbances
due to a pituitary tumor secreting excess growth hormone.
Which of the following conditions would this boy
most likely develop without treatment?
A. Acromegaly due directly to excess growth hormone
B. Acromegaly due to excess insulin-like growth factor
(IGF)-1 production
C. Dwarfi sm due directly to excess growth hormone
D. Dwarfi sm due to excess IGF-1 production
E. Gigantism due directly to excess growth hormone
F. Gigantism due to excess IGF-1 production
3. A 28-year-old man is involved in a high speed motor
vehicle accident in which he suffers multiple rib fractures.
On arrival at the emergency department, he is
conscious but in severe pain. His respiratory rate is 34
breaths/min, and his breathing is labored. His blood
pressure is 110/95 mm Hg, and his pulse is 140 beats/
min. His arterial PO2 is 50 mm Hg, and he is unresponsive
to supplemental O2. His arterial PCO2 is 28
mm Hg. What is the most likely cause of this patient's
hypoxemia?
A. Alveolar hypoventilation
B. High ventilation/perfusion (V
/Q
Σ
) ratio
C. Increased dead space ventilation
D. Intrapulmonary shunt
E. Low V
/Q
Σ D. Mitral insuffi ciency
ratio
3. A novel drug aimed at treating heart failure was tested
in experimental animals. The drug was rejected for
testing in humans because it caused an unacceptable
decrease in the glomerular fi ltration rate (GFR). Further
analysis showed that the drug caused no change in
mean arterial blood pressure but renal blood fl ow (RBF)
was increased. The fi ltration fraction was decreased.
What mechanism is most likely to explain the observed
decrease in GFR?
A. Afferent arteriole constriction
B. Afferent arteriole dilation
C. Efferent arteriole constriction
D. Efferent arteriole dilation
3. In a laboratory experiment, a cortical neuron was electrically
stimulated to produce action potentials. The stimulated
neuron made synaptic contact with another neuron
in which a recording electrode was located. The recording
electrode detected a small depolarization following the
electrical stimulation of the fi rst neuron. Which neurotransmitter
was most likely to be released at the synapse
between these neurons?
A. GABA
B. Glutamate
C. Glycine
D. Met-enkephalin
E. Somatostatin
3. Paramedics were called to attend to a 74-year-old man
who fainted while watching a baseball game. When they
arrived, the man was conscious but confused. He was
noticeably short of breath, had profound bradycardia
(HR 25 beats/min) and appeared to be complaining of
chest pain. An ECG showed normal P waves that were
regularly spaced. QRS complexes were wide and regularly
spaced but were dissociated from P waves. What is
the most likely origin for electrical stimulation of this
patient's ventricles?
A. (SA) node
B. Atrial internodal conduction pathways
C. AV node
D. Bundle of His
E. Purkinje fi bers
4. A 16-year-old girl is found unconscious in the street. She
has no visible injuries but is cold and is taking shallow
breaths at a rate of 6-8 per minute. An arterial blood gas
analysis recorded in the emergency department shows that
her PO2 is 55 mm Hg and her PCO2 is 75 mm Hg. What is
the most likely cause of hypoxemia in this patient?
A. Alveolar hypoventilation
B. High ventilation/perfusion (V
/Q
Σ
) ratio
C. Increased dead space ventilation
D. Intrapulmonary shunt
E. Low V
/Q
Σ
ratio
4. A 40-year-old woman from a remote rural area is transferred
to a city hospital for treatment of a longstanding
heart valve abnormality. Her chief current complaint
is the inability to perform any physical work, although
she also reports waking several times each night with
severe shortness of breath. Auscultation reveals a long
rumbling diastolic murmur and an opening snap.
Which valve abnormality does this patient most likely
have?
A. Aortic stenosis
B. Aortic insuffi ciency
C. Mitral stenosis
4. A 42-year-old man with a family history of stroke and
heart attack decides to take a daily aspirin tablet, having
seen a television commercial. What is the main mechanism
by which aspirin reduces the likelihood of intravascular
blood clot formation?
A. Inhibition of the extrinsic clotting pathway
B. Inhibition of the intrinsic clotting pathway
C. Inhibition of platelet function
D. Stimulation of anticoagulant synthesis
E. Stimulation of fi brinolysis
F. Vasodilation
4. A 58-year-old woman complained of lethargy and weight
gain over the past year. Further investigation revealed a
painless goiter, thick coarse skin, peripheral edema, and
low iodine levels. Which of the following most likely
describes this patient's diagnosis and plasma thyroidstimulating
hormone (TSH) level?
A. Primary hyperthyroidism, high TSH
B. Primary hyperthyroidism, normal TSH
C. Primary hyperthyroidism, low TSH
D. Primary hypothyroidism, high TSH
E. Primary hypothyroidism, normal TSH
F. Primary hypothyroidism, low TSH
2a
 B. Demyelination of central nervous
E. Purkinje fi bers system (CNS)
neurons

F. Gigantism due to excess IGF-1

A. Alveolar hypoventilation
production

C. Mitral stenosis D. Intrapulmonary shunt

C. Inhibition of platelet function D. Efferent arteriole dilation

D. Primary hypothyroidism, high TSH B. Glutamate

2b
4. A 61-year-old man saw his physician with a complaint of
progressive diffi culty swallowing solid food. He reported
a weight loss of about 18 kg (40 lb) despite trying to eat.
He was frequently aspirating his food. The results of a
radiology series and esophageal manometry suggested
a diagnosis of achalasia. Which element of esophageal
function would be LEAST affected in this patient?
A. Relaxation of the upper esophageal sphincter
B. Peristalsis in the upper esophageal body
C. Peristalsis in the lower esophageal body
D. Relaxation of the lower esophageal sphincter
4. During the repolarizing phase of the nerve action
potential
shown, which ionic currents are fl owing when the
membrane potential is 0 mV?
A. Net current is zero at 0 mV
B. Net inward Kcurrent
C. Net inward Nacurrent
D. Net inward Cl−current
5. A 13-year-old boy was referred to a pediatrician due to
his unusual height of 196 cm (6 ft 5 in). The boy recently
reported visual disturbances. A pituitary tumor was discovered
using MRI scans, and was found to be pressing
on the center of the optic chiasm from below. What visual
fi eld defects are expected in this patient?
A. Binasal hemianopia
B. Bitemporal hemianopia
C. Left homonymous hemianopia
D. Right homonymous hemianopia
5. A 42-year-old man visited his physician with a complaint
that he was always tired. He described craving salty foods
and feeling lightheaded after missing lunch. Physical
examination shows a blood pressure of 100/70 mm
Hg. Laboratory studies show a decreased plasma [Na+],
increased plasma [K+], and decreased fasting plasma
[glucose]. Over the past several months, he said that his
skin had become tanned despite avoiding sun exposure.
The physician suspected that the patient's adrenal gland
was not functioning properly. Which profi le of cortisol
and adrenocorticotropic hormone (ACTH) levels are
consistent with the symptoms described?
A. High cortisol, high ACTH
B. High cortisol, low ACTH
C. Low cortisol, high ACTH
D. Low cortisol, low ACTH
5. A 54-year-old woman received a life-saving kidney transplant
6 months ago and had been well until the past few
days. She now reports severe fatigue and dizziness upon
standing. Urinalysis is positive for glucose, and there is
excessive excretion of HCO3
−and phosphate. In which
segment of the nephron is function most likely to be
abnormal?
A. Proximal tubule
B. Loop of Henle
C. Distal tubule
D. Collecting duct
5. Experiments were conducted using an in vitro stomach
preparation to determine individual dose-response
relationships for the stimulation of gastric acid production
by histamine, gastrin, and acetylcholine. The
dose corresponding to 50% stimulation was selected
for each agonist. Which combination of agonists at this
dose would produce the greatest stimulation of acid
production?
A. Histamine alone
B. Gastrin alone
C. Acetylcholine alone
D. Gastrin + acetylcholine
E. Histamine + gastrin
F. Histamine + acetylcholine
G. Histamine + gastrin + acetylcholine
5. If a second depolarizing stimulus of normal strength
was
applied at the arrow marked A on the fi gure, a second
action potential
A. has a lower peak voltage than normal
B. has slower depolarization
C. is additive with the fi rst action potential
D. is normal size but initiation is delayed
E. would not be triggered
6. A 40-year-old woman presented with dyspnea, hematuria,
and right fl ank pain. CT scans revealed a renal tumor,
with an extensive venous thrombus that had invaded
the inferior vena cava. Fragments of the thrombus
had entered the lungs and were blocking several major
branches of the pulmonary arteries. Assuming that there
was no change in VT or respiratory rate, what effect
would these pulmonary emboli have on arterial blood
gases within the fi rst few minutes of their occurrence?
A. Decreased PCO2 and decreased PO2
B. Decreased PCO2 and increased PO2
C. Increased PCO2 and decreased PO2
D. Increased PCO2 and increased PO2
E. No change in PCO2 or PO2
6. A 64-year-old woman with hypertension (blood pressure
of 160/110 mm Hg) and coronary artery disease
was treated with angiotensin-converting enzyme (ACE)
inhibitors. After a period when the treatment was no
longer effective, the dose of ACE inhibitors was abruptly
increased. Although this successfully reduced her blood
pressure to 130/80 mm Hg, she complained that the
medications now made her very dizzy. Reduced cerebral
perfusion, resulting in dizziness, is most likely to be
explained in this case by
A. decreased brain angiotensin II levels
B. decreased sympathetic tone
C. inadequate blood fl ow autoregulation
D. increased intracranial pressure
E. increased parasympathetic tone
6. A resident in internal medicine was called to the hospital
room of an 85-year-old patient in the middle of night.
The man was sitting up in bed coughing, and was severely
short of breath. Crackles heard in both lungs suggested
pulmonary edema. Which diuretic is most appropriate
for this patient?
A. Carbonic anhydrase inhibitor
B. Loop diuretic
C. Thiazide diuretic
D. Potassium-sparing diuretic
3a
 G. Histamine + gastrin + A. Relaxation of the upper
acetylcholine esophageal sphincter

E. would not be triggered C. Net inward Nacurrent

C. Increased PCO2 and decreased

B. Bitemporal hemianopia
PO2

C. inadequate blood fl ow
C. Low cortisol, high ACTH
autoregulation

B. Loop diuretic A. Proximal tubule

3b
7. A 9-year-old boy decided to fi nd out for how long he 8. A 61-year-old woman with moderate renal insuffi ciency
could continue to breathe into and out of a paper bag. ate a large amount of prunes in an effort to treat
After approximately 2 minutes, his friends noticed that chronic constipation. She was unaware that prunes
he was breathing very rapidly so they forced him to have high potassium content and the meal caused her
stop the experiment. What change in arterial blood gas serum potassium concentration to double. Which of
composition was the most potent stimulus for this boy's the following short-term intravenous infusions would
hyperventilation? be most effective at reducing her serum potassium
A. Decreased PCO2 concentration?
B. Decreased PO2 A. -Adrenoceptor agonist
C. Decreased pH B. Aldosterone antagonist
D. Increased PCO2 C. Dilute hydrochloric acid
E. Increased PO2 D. Insulin/glucose
F. Increased pH E. Parathyroid hormone

7. A 25-year-old man suffered muscle paralysis due to poisoning

8. A functional magnetic resonance imaging (fMRI) study
with -conotoxin. This molluscan peptide toxin
is known to interfere with voltage-sensitive Ca2channels of the thalamus showed changes in neuronal activity
at the neuromuscular junction. Which of the following in the thalamus in response to various sensory stimuli.
is the most likely explanation for muscle paralysis in this
patient? Which of the following sensory modalities would be
A. Failure of action potential conduction in the motor associated with the lowest level of thalamic neuronal
nerve terminal
B. Failure of acetylcholine synthesis in the motor nerve
activity?
terminal A. Audition
C. Failure of acetylcholine release from the motor nerve B. Conscious proprioception
terminal
D. Accelerated breakdown of acetylcholine in the synaptic C. Gustation
cleft D. Olfaction
E. Inhibition of postsynaptic nicotinic acetylcholine
receptors
E. Vision

7. A 46-year-old woman visited her family physician because 9. A 3-month-old infant presented with persistent vomiting
she was urinating many times a day and was constantly and was lethargic. Arterial blood gas analysis showed the
thirsty. She was evaluated in the hospital to fi nd out the following results:
cause of her severe polydipsia and polyuria. She was not PaO2 88 mm Hg
given any fl uids for 6 hours before testing, and no change PaCO2 44 mm Hg
in urine osmolarity was measured during this period. A pH 7.60
nonpressor ADH agonist was then given, which produced [HCO3
a rapid increase in urine osmolarity. Which diagnosis is −] 36 mEq/L
most likely to account for this patient's polydipsia and Base excess 12 mEq/L
polyuria? Which of the following primary acid-base disturbances
A. Central diabetes insipidus is present?
B. Compulsive overconsumption of water A. Respiratory alkalosis
C. Nephrogenic diabetes insipidus B. Respiratory acidosis
D. Type 1 diabetes mellitus C. Metabolic alkalosis
E. Type 2 diabetes mellitus D. Metabolic acidosis

9. A 52-year-old man with a history of alcoholism has

8. A 22-year-old woman who has Crohn's disease underwent recently developed generalized edema. Abnormal liver
function tests include increased serum levels of transaminase
surgical removal of the distal ileum. Without supportive enzymes. His blood clotting time is increased, and
therapy, this patient is most likely to develop which of the he is unresponsive to vitamin K treatment. What is the
following conditions within 1 year? most likely cause of edema in this patient?
A. Decreased capillary hydrostatic pressure
A. Anemia B. Decreased capillary oncotic pressure
B. Calcium defi ciency C. Decreased interstitial hydrostatic pressure
C. Caloric malnutrition D. Decreased interstitial oncotic pressure
E. Increased capillary hydrostatic pressure
D. Iron defi ciency F. Increased capillary oncotic pressure
E. Lactase defi ciency G. Increased interstitial hydrostatic pressure
H. Increased interstitial oncotic pressure

8. A 37-year-old woman with worsening muscle weakness

was diagnosed with myasthenia gravis. She was treated
9. A 58-year-old man presented to his physician feeling
with the acetylcholinesterase inhibitor neostigmine, generally unwell and complaining of excessive urination
and reported improved muscle strength within 1 day and thirst. He was morbidly obese. The urinalysis showed
of starting treatment. Which of the following is the glycosuria and proteinuria but no ketonuria. Which of
most likely reason for improved muscle performance in
response to neostigmine treatment?
the following conditions is most consistent with these
A. Increased action potential frequency in the motor fi ndings?
nerves A. Acromegaly
B. Increased acetylcholine synthesis in the motor nerve B. Central diabetes insipidus
terminals
C. Decreased acetylcholine breakdown at the neuromuscular
C. Nephrogenic diabetes insipidus
junctions D. Primary hypothyroidism
D. Decreased reuptake of choline by the presynaptic E. Type 1 diabetes mellitus
motor nerves F. Type 2 diabetes mellitus
E. Direct agonism at the nicotinic acetylcholine receptors
4a
 D. Insulin/glucose D. Increased PCO2

C. Failure of acetylcholine release

D. Olfaction from the motor nerve
terminal

C. Metabolic alkalosis A. Central diabetes insipidus

B. Decreased capillary oncotic

A. Anemia
pressure

C. Decreased acetylcholine
F. Type 2 diabetes mellitus breakdown at the neuromuscular
junctions

4b
9. A 68-year-old man visits his doctor complaining about
a tremor in his hands, which is particularly bad when he
tries to perform a task. He demonstrates past-pointing
when asked to perform a fi nger to nose test, and has diffi
culty producing rapidly alternating supination and pronation
movements of the hands. The doctor also notes
a wide, awkward gait. Based on these clinical fi ndings
alone, in which part of the motor system is a dysfunction
expected?
A. Basal ganglia
B. Cerebellum
C. Lateral spinal pathways
D. Primary motor cortex
E. Ventromedial spinal pathways
9. A group of medical students is experimenting with a peak
fl ow meter in the respiratory physiology laboratory. Two
students decide to compete to see which of them can
blow the hardest into the device. Which of the following
muscles is most effective at producing a maximal expiratory
effort such as this?
A. Diaphragm
B. External intercostal muscles
C. Internal intercostal muscles
D. Rectus abdominus
E. Sternocleidomastoid
9. A skeletal muscle was stimulated to produce an isotonic
contraction. Signifi cant muscle shortening was observed.
Which part of the sarcomere would retain a constant
length during this type of muscle contraction?
A. A band
B. Distance between adjacent Z disks
C. Distance from Z disk to M line
D. Distance between adjacent M lines
E. I band
10. A 14-year-old girl from the southern Caribbean was
rescued after a major hurricane. She was initially treated
for minor injuries and dehydration but was referred for
further investigations due to a persistently low blood
pressure (95/40 mm Hg). A continuous machinery-like
murmur was heard upon auscultation of her chest. An
ECG and an echocardiogram revealed left ventricular
hypertrophy. Which of the following cardiac abnormalities
is most likely to be present?
A. Aortic valve insuffi ciency
B. Aortic valve stenosis
C. Mitral valve prolapse
D. Mitral valve stenosis
E. Patent ductus arteriosus
20. A 59-year-old man is detained by police on suspicion
of driving under the infl uence of alcohol after a minor
automobile accident. The police offi cer assumed the
man was severely impaired due to his very wide gait and
inability to walk heel to toe in a straight line. However, a
breath test revealed an alcohol level just below the legal
limit. The man admitted being a heavy drinker for many
years but insisted that he had not consumed any alcohol
since the previous day. Neurologic examinations showed
no sensory, cognitive, or memory defi cits. Which of the
following structures is most likely to be dysfunctional in
this patient?
A. Amygdala
B. Basal ganglia
C. Cerebellum
D. Motor cortex
E. Vestibular labyrinth
24. A 50-year-old man with a chronic heart valve
abnormality
is evaluated for valve replacement surgery. Cardiac
catheterization produced the results shown in the fi gure
above. Which of the following heart valve abnormalities
does the patient have? (figure on page 391)
A. Aortic stenosis
B. Aortic insuffi ciency
C. Mitral stenosis
D. Mitral insuffi ciency
38. A 24-year-old man entered a 5-mile road race on a hot
day. Although in good health, he had not trained in preparation
for the race, and he did not drink any replacement
fl uids during the race. What changes to his intracellular
fl uid (ICF) and extracellular fl uid (ECF) volumes would
be observed at the end of the race compared to just before
the race?
A. ECF volume unchanged; ICF volume unchanged
B. ECF volume smaller; ICF volume smaller
C. ECF volume larger; ICF volume larger
D. ECF volume smaller; ICF volume larger
E. ECF volume larger; ICF volume smaller
41. A 56-year-old man visited his family physician for a
routine health checkup. A urine test revealed signifi cant
excretion of albumin. Which cell type is most likely to be
damaged or malfunctioning in this patient?
A. Glomerular endothelial cell
B. Juxtaglomerular cell
C. Mesangial cell
D. Podocyte
E. Vascular smooth muscle in afferent arteriole
50. A 64-year-old woman with glaucoma is given the carbonic
anhydrase inhibitor acetazolamide. Which ion
would have the largest increase in its fractional excretion
as a side effect of this drug?
A. Ca2
B. Cl−
C. HCO3
D. K
E. Na
52. A 15-year-old boy was busy with school activities and
did not drink any liquids from 8 am to 5 pm. When he
urinated late in the day, he noticed that his urine was dark
yellow. All of the following events were occurring in his
kidney during the day EXCEPT
A. reduced fractional Naexcretion
B. reduced fractional urea excretion
C. increased plasma antidiuretic hormone (ADH) concentration
D. increased Nareabsorption in the thin descending
limb
E. increased aquaporin 2 expression in the collecting
Duct
5a
 A. Aortic stenosis B. Cerebellum

B. ECF volume smaller; ICF volume

D. Rectus abdominus
smaller

D. Podocyte A. A band

C. HCO3 E. Patent ductus arteriosus

D. increased Nareabsorption in the

thin descending C. Cerebellum
limb

5b
64. A novel antibiotic drug was tested in animals. Side-effects 79. A 19-year-old patient produced a copious amount of
of the drug included increased intestinal motility, which dilute urine following a head injury sustained in a motor
was characterized by waves of peristaltic contractions vehicle accident. Damage to which of the following sites
approximately every 90 minutes. Which hormone is the could account for these symptoms in this patient?
antibiotic most likely to mimic?
A. Anterior pituitary
A. Cholecystokinin
B. Gastrin
B. Mamillary body
C. Glucagon-like peptide-1 C. Median eminence
D. Motilin D. Superior hypophyseal artery
E. Secretin E. Supraoptic nucleus

65. A 62-year-old man was admitted to the hospital with low

blood pressure and evidence of active bleeding from the 81. A 28-year-old woman visited her physician because of
anxiety. She was perspiring heavily and complained
upper gastrointestinal tract. He was administered fl uid about the high temperature of the waiting room. Physical
intravenously and a drug that vasoconstricts splanchnic examination showed a thin patient with notable tremor,
blood vessels. The drug also reduces gastric acid production muscle weakness, tachycardia. and an ophthalmopathy
and pancreatic secretion. Which hormone does the with a staring gaze. What is the most likely profi le of
drug mimic? serum thyroxine (T4) and thyroid-stimulating hormone
A. Acetylcholine (TSH) concentrations in this patient?
A. Low T4, high TSH
B. Cholecystokinin
B. Low T4, low TSH
C. Gastrin C. High T4, low TSH
D. Secretin D. High T4, high TSH
E. Somatostatin

69. A 39-year-old woman is treated for pancreatic cancer

82. A fi ne needle adrenal biopsy was performed in a 71-yearold
by complete surgical removal of the pancreas and duodenum.
man who had an unidentifi ed adrenal mass. Tests
Without supplemental treatment, which of the
performed on the sample included the expression of the
following mineral defi ciencies would most likely develop
enzyme aldosterone synthase. Which area of the adrenal
in this patient in the following weeks and months?
gland would show positive staining for this enzyme?
A. Iron and Ca2
A. Zona glomerulosa
B. Kand Ca2
B. Zona fasciculata
C. Kand iron
C. Zona reticularis
D. Naand K
D. Medullary chromaffi n cells
E. Naand Ca2

87. A 28-year-old medical resident who was accustomed

73. A patient with chronic steatorrhea is most likely to to eating regular meals was forced to skip breakfast
and lunch one day because of a heavy work schedule.
develop defi ciency of which of the following vitamins?
By midafternoon, he was feeling lightheaded and very
A. Vitamins A and B1 hungry. Compared to his typical day, the plasma concentration
B. Vitamins A and C of which of the following hormones would be
C. Vitamins A and D decreased at this time?
A. Cortisol
D. Vitamins B1 and C
B. Epinephrine
E. Vitamins B1 and D C. Glucagon
F. Vitamins C and D D. Growth hormone
E. Insulin

78. A 54-year-old woman visited her physician because of 90. A 19-year-old woman visited her physician complaining
persistent headaches and blurred vision. The physician of frequent urination and of being thirsty all the time.
noted that the woman has very large hands and feet, On physical examination, the woman appeared extremely
a wide jaw, a large tongue, and a prominent forehead. malnourished. Plasma analysis showed high concentrations
of both glucose and ketones. Which hormone is
Which of the following metabolic abnormalities would
most responsible for the presence of high ketone concentrations
most likely be present in this patient?
in this patient?
A. Decreased blood fatty acid concentration A. Cortisol
B. Decreased hepatic gluconeogenesis B. Epinephrine
C. Decreased protein synthesis C. Glucagon
D. Increased blood glucose concentration D. Growth hormone
E. Increased uptake of glucose in skeletal muscle E. Insulin

6a
E. Supraoptic nucleus D. Motilin

C. High T4, low TSH E. Somatostatin

A. Zona glomerulosa A. Iron and Ca2

E. Insulin C. Vitamins A and D

D. Increased blood glucose

C. Glucagon
concentration

6b
91. A healthy 34-year-old woman runs 5 miles at a fast pace, 101. Fetal acquisition of glucose occurs by placental
resulting in a large increase in the rate of glucose oxidation glucose
in her muscles. Which pair of hormones is most transport. What is the fi rst cell layer within the placenta
important to minimize the decrease in plasma glucose that glucose must cross during transport from maternal
concentration during her run?
to fetal blood?
A. Cortisol and growth hormone
B. Cortisol and insulin
A. Cytotrophoblast
C. Epinephrine and insulin B. Decidua
D. Glucagon and epinephrine C. Inner cell mass
E. Glucagon and thyroxine D. Mesenchyme
F. Growth hormone and thyroxine E. Syncytiotrophoblast

92. A 23-year-old medical student ingests several liters of 102. The luteinizing hormone surge measured during the
cola in an effort to stay awake over a 24-hour period of ovulatory
studying. This ingestion of cola represents a large intake phase of the menstrual cycle results from positive
of phosphate ions, which results in increased urinary feedback exerted by which of the following hormones?
phosphate excretion. Which hormone is most responsible
A. Estrogen
for stimulating phosphate excretion in this case?
A. Calcitonin
B. Follicle-stimulating hormone
B. Ergocalciferol C. Gonadotropin-releasing hormone
C. Parathyroid hormone D. Inhibin
D. 1,25-(OH)2Vitamin D3 E. Progesterone

95. A blood sample is taken from a 27-year-old woman for

hormone analysis. The sample contains low levels of 104. A 37-year-old man with four children elected to
follicle-stimulating hormone (FSH) and luteinizing hormone have a
(LH) and high levels of estrogen, progesterone, and
inhibin. Assuming a normal 28-day menstrual cycle, on
vasectomy. This procedure prevents conception
which day of this woman's menstrual cycle was the blood because
sample taken? A. no sperm are ejaculated
A. Day 1
B. Day 7 B. secretion from seminal vesicles is not ejaculated
C. Day 14 C. secretion from the prostate gland is not ejaculated
D. Day 21 D. no semen is ejaculated
E. Day 28

98. A 37-year old-woman who is breast-feeding her 4-monthold

107. When the gas composition of umbilical arterial
son is taking the train to see her mother who lives
several hours away. When the woman hears the cry of blood is
another infant, she notices that milk has been expressed compared to umbilical venous blood, the arterial blood
from both her breasts. The release of which hormone can has
account for this response? A. lower PO2 and higher PCO2
A. Estrogen B. lower PO2 and lower PCO2
B. Inhibin C. higher PO2 and lower PCO2
C. Oxytocin D. higher PO2 and higher PCO2
D. Progesterone
E. the same PO2 and PCO2
E. Prolactin

100. A 32-year-old woman and her partner were trying to conceive
a child. The woman had regular menstrual cycles of
about 30 days in length. Four days after missing her menstrual
period, she bought a commercial pregnancy testing
kit. The couple was excited to discover that her urine
sample indicated a positive result for pregnancy. Which
of the following hormones was detected in her urine?
A. Human chorionic gonadotropin
B. Estrogen
C. Follicle-stimulating hormone
D. Gonadotropin-releasing hormone
E. Inhibin
F. Luteinizing hormone
G. Progesterone
108. An 18-year-old man visited his physician because he was
concerned about his height. He is 152 cm tall (5 ft). He
described himself when he was in elementary school as
being self-conscious because he was taller than his peers.
He also recalled developing pubic and axillary hair at
about age 7 or 8. Physical examination showed a healthy
male of short stature with normal genitalia and male
secondary sexual development. Which endocrine abnormality
best explains the fi ndings in this patient?
A. Early maturation of the hypothalamic-pituitarygonadal
axis
B. Failure of pulsatile gonadotrophin-releasing hormone
secretion at puberty
C. Growth hormone excess in early childhood
D. Insulin-like growth factor-1 defi ciency
E. Panhypopituitarism
7a
 E. Syncytiotrophoblast D. Glucagon and epinephrine

A. Estrogen C. Parathyroid hormone

A. no sperm are ejaculated D. Day 21

A. lower PO2 and higher PCO2 C. Oxytocin

A. Early maturation of the

hypothalamic-pituitarygonadal A. Human chorionic gonadotropin
axis

7b
. A healthy 28-year-old woman participated in a study of
gastrointestinal function. She ingested a single nutritionally
balanced meal containing small inert plastic beads,
which could be visualized using medical imaging techniques.
What is the most likely location of the beads 8
hours after ingestion of the meal?
A. Arrested at lower esophageal sphincter
B. Arrested at the pyloric sphincter
C. Duodenum
D. Ileum
E. Sigmoid colon
F. Excreted in feces

8a
D. Ileum

8b