1. A single mRNA producing different types of proteins – why?

Splicing

2. Gluà Val mutated to Gluà Lys. They showed the table with the genetic codes and asked
the minimum number of base pair changes that could occur? I put 3 but double check.. not
too sure

3. CF question – Pt had high Cl content in sweat, foul-smelling stool due to pancreatic

insufficiency, recurrent pulmonary infections. Caused by? Misfolding

4. Normal cells have a check-point from G1àS phase. Mutation occurred in this region –
which is it? P53 (be careful bc they also have HYPERphosphorylated Rb but that’s not it)

5. Pt with HIV is resistant against NNRTI, NRTI, protease inhibitor. Tx? Anything else –
answer was Enfuvirtide that is a fusion inhibitor

6. I-cell disease – Pt had coarse facial features, scoliosis. This is a problem with the:
LYSOSOMES – they had a million of options so we careful

7. Desmin = Muscle

8. Pt cut himself with a knife; after a year, his scar was barely noticeable. What is involved
in remodelling of scar? I put Matrix Metalloproteinases

9. Pt is a boy who has a mitochondrial disorder. What is the % that HE will pass it on to
his offspring? 0%

10. Ovarian CA – lymph drainage? Runs along the ovarian vessels

11. Split-hand deformity – the child has the disease, the parents did not show the disease,
but the grandparents did. Why? Due to Penetrance

12. Mother was homozygous for sickle cell (SS) + father was heterozygous for HbC (CA) -
what is going to be passed on to the offspring? 50% SC (with sickle cell) + 50% SA (sickle
cell trait). Be very careful of the wording, but just just that SC and SA - find it out by doing
the punnet square

13. RCC question - they asked pt presents with painless hematuria, and a mass in the
lower/upper lobe of the kidney, pt is a smoker. What type of cell will most commonly be seen?
Options Clear cell (I chose that), but Urothelial was also an option (thats more for bladder
cancer in my opinion)

14. They described Tuberous Sclerosis (thats the answer) - pt with repetitive seizures and ash-
leaf

15. Pt had high HbA, high HbF (they said y-chains), very low b-chains. What is the Dx? B-globin
defect
16. Vitamin B12 deficiency - what can be used to diagnose it? Methylmalonate

17. This Q vas very weird. I think it was a 15 yo Pt who hiked for the entire day so she was
exposed to the sun, and she was being treated with Isotretinoin (vit A) - she developed a painful
rash over her shoulders. what is causing this? Options: phototoxic reaction (I put this), or drug
reaction

18. Answer was Glutamate - Pt is intoxicated with Methamphetamines, what pathway is

affected? Remember this acts through the NMDA pathway so glutamate (and it had over words)

19. Vitamin C deficiency (answer) - Pt had easy bruising, petechiae and ecchymosis, bleeding
from gums as well.

20. Pt just gave birth AT HOME - baby has an erythematous umbilical cord that easily bleeds.
Why? Vitamin K deficiency (they said due to problems in carboxylation of glutamate residues)

21. Horner’s syndrome: ptosis, miosis on the left. What structure of the spinal cord is affected?
Left Lateral horn - its ipsilateral

22. Pt has Protein C deficiency - what factors are affected? Factor ⅝

23. Question with Hepatic Aldehyde DH (thats the answer)

24. Pt has MCAD, she has accumulation of Acyl-carnitines, hepatomegaly - this is a problem
with? FA oxidation

25. Pt is a boy who has a hx of MVC, he had to undergo splenectomy. Blood cells will show:
Howell-jolly bodies

26. Pt has an accumulation of TGs that cannot be broken down by the body or metabolized. I
put there was a problem with LPL. Other options were Hormone-sensitive lipase, ACC

27. Question with Gallstones came up - tx? Ursodiol

28. Question showed a ~70 yo pt with OA. They showed a picture of both knees, with cartilage
degradation of the medial side of each (answer). Don’t remember the exact words

29. Question with PPAR showed up (answer) - MOA of -glitazones and Fibrates

30. Pt has recurrent infections, a child less than one year of age - months after birth he had
serious infections (I think Pseudomonas). Q was asking what does the child have a problem
with or is defective in? I put IgG - I think this Q is talking about Hyper IgM syndrome (review it -
not sure)

31. Q saying mother was RA-, father was RA+. What is the fetus most likely to suffer from?
Type II HSN reaction, which means IgG of the mother attacking the fetus (answer)
32. Pt was a child, super hyper. He was with his father at the doctor’s office and he kept jumping
around, opening/closing doors. He is ok at school - thats why I didn’t put ADHD. Dx? Disruptive
behavioural disorder.

33. They showed a baby with positive Nikolski sign and said what was the problem? I put
problem with the keratinocytes (don’t remember the other words but thats it). That is SSSS -
and in FA if you look it says keratinocytes’ problem in the Stratum granulosum

34. Answer Th-cell and MHC-II (they were referring to the Superantigen). Pt had an
erythematous rash coming up his legs with fever.

35. Pt has a positive PPD test - what characteristic of TB is responsible for this? IFN-y and IL12

36. Pt has been diagnosed with HIV for a very long time, he had a positive PPD test in the past,
but not the PPD test is showing as negative. Why? I put bc of low CD4 counts

37. Pt has edema of the lips (very swollen). She was taking a lot of meds. What was the cause?
ACEI (Lisinopril)

38. Pt has Gonorrhea - penile discharge, multiple sexual partners, maybe UTI too. What
characteristic of this organism causes this? I put Pilli (Polysaccharide capsule was also an
option - but I think thats more Neisseria meningiditis) Gonorrhea has no capsule so yes.

39. CGD, SCID: A Pt that suffers from a lot of infections - all of the organisms listed (E. coli,
pseudomonas, borkhelderia) were Catalase (+) (that’s the answer)

40. Community is thinking of giving Polio virus vaccines (live) - what Ig would increase as a
result? IgA

41. Man with HTN, renal angiogram shows peaks and valleys. Dx? Fibromuscular Dysplasia (I
had to think twice bc it was a guy, but thats the answer)

42. Goodpasture syndrome (answer). Pt has pulmonary infections with hemoptysis and renal
proteinuria/hematuria.

43. Pt gets muscle weakness after a long day, feels better after he sleeps. Dx. Myasthenia
gravis (Abs against postsynaptic channels) - but that was not answer. What is seen in this Pt?
Thymic hyperplasia (or a mass in the anterior mediastinum). Know this. Thymoma

44. GVHD (answer) - Pt had a kidney transplant - after 3 weeks she develops a rash, abdominal
pain. This is the one with the variable timeline, they get a RASH for sure

45. Pt is very sick and at the end they say he has a t(9,22) - that’s CML. Tx: Imatinib (answer)

46. They gave us a picture of Crypto with the india ink stain (know this)

47. Pt prevents with a struvite calculus (pic is shown). What causes is? Proteus
48. Pt has recurrent asthma attacks, with FEVER. I put Acute Bronchopulmonary Aspergillosis.
Hypersensitivity reaction was also an option, but this seem more like it because of the fever.

49. Pt comes in with Gonorrhea, tx with Ceftriaxone. What other drug needs to be given?
Macrolide is usually the case but that was not one of the options, so I put Doxycycline

50. Pt has an infection with an organism that has Lipid A protein. What is it? Staph aureus

51. Strep pneumonia question - showed a picture of gram (+) diplococci. There were a bunch of
questions with strep pneumo in it

52. Pt had a lower lobe pneumonia, the organism also was gram (+) diplococci or in chains -
what causes it? Strep pneumo

53. Enterococci question - know the treatment options. I think they said the Pt is Ampicillin
sensitive - so what other drug has to be given? Gentamicin, erythromycin (other macrolides) ..
come back to this

54. Pt has Neisseria meningiditis (answer) (a baby) - he has several petechiae, ecchymosis all
over him and he also has shock.

55. Pt is taking STEROIDS for a very long time. What would be seen? That would cause
atrophy of the adrenal glands - which would lead to decreased steroid synthesis. Other options
were: decreased T synthesis from the gonads (this sounds more like it bc it causes testicular
atrophy) - I think I got this wrong

56. Pt is 46,XX with has external male-sexual characteristics, clitoromegaly, hirsutism. High 17-
progesterone, high testosterone. What is the cause? This is 21b-hydroxylase deficiency but they
worded it differently (deficiency of an enzyme in the adrenal glands)

57. Pt just gave birth to a child who has chorioretinitis, intracranial calcifications, hydrocephalus.
What is the cause? Toxoplasma (answer)

58. Pt recently had an organ transplant. She is infected by an organism that has both
intracytoplasmic AND intranuclear inclusions. What is this organism? CMV (answer)

59. What is the tx for H pylori? Clarithromycin, Amoxicillin, Lasoprazole (answer)

60. Pt is presenting to the ER with severe abdominal pain, he has a gastric volvulus. They try to
put a tube in but it doesnt go through. What else is going on? I put paraesophageal hernia

61. That question where an CXR was shown and you can see air under the diaphragm. What is
the cause? Duodenal ulcer rupture - all other options did not make sense

62. Pt is a woman who complained a lot with abdominal pain around the umbilicus. The doctor
though it was an ovarian/uterine mass. During surgery, he noted that it was a mass 9 feet away
from the ileum. Dx? Meckel’s diverticulum
63. Pt has SOB, he has been exposed to birds, and has pulmonary edema. I thought right away
of Chlamydia.

64. A bunch of college students were experiencing runny nose, cough, chills. Mode of
transmission? Respiratory droplets

65. Pt has lymphadenopathy, rash, it bleeds with other symptoms. She has a lot of cats with
they have been infested with FLEAS lately. Cause? Yersinia pestis (I think they answer asked
directly about yersinia or about the fleas)

66. Pic with Malassezia furfur

67. Pic of the back of a pt with bullous vesicles - cause? HSV

68. Pt has anal itching and you can see worms in his stool. Cause? Strongyloides stercolaris
(other options have eggs, not worms)

69. Lady that recently fell so she’s immobilized, she is getting a lot of ulcers and ankle edema.
What is the best tx? Compression socks - I didnt like the other options

70. Pt has inguinal lymphadenopathy with genital ulcers with a shallow base - cause? HSV
(Chancroid was also there - but they said shallow base, vesicular)

71. Q where the pt is infected with Coronavirus - you need to know that this organism is (+)
sense which does not need the cell’s machinery to divide. So how does it infect the cell? I put
lysis of the cell

72. Couple of Qs with emphysema - know that FEV1 is decreased, FVC is normal (know how to
distinguish from the other answers by process of elimination)

73. Pt has jaundice, hepatomegaly, high indirect bilirubin. What is defective?

Glucosyltransferase deficiency

74. E. coli question - the pt was very old, she has UTIs, bleeding, and ultimately shock. What
caused this? I put platelet aggregation (but double check with the other answer choices)

75. Pt was alcoholic - they asked what value would be the most important determinant of his
disease. I put increased AST

76. Pt is a kid who got hit on the lateral side of his knee. On physical examination, his leg could
be displaced medially. What is the structure defective here? Very tricky - options were: lateral
collateral ligament, lateral meniscus, lateral femoral condyle (I put lateral meniscus but Im not
sure) MCL or medial meniscus?

77. Resistance against Levofloxacin. How? Through mutation of Topoisomerase

78. Pt has a hx of CA (maybe CML) and has been treated with Doxorubicin, Bleomycin - the
SEs of these drugs is mostly caused by? Generation of oxygen free radicals

79. The Q described a Pt with TB and they described the Tx options - I remember it has
something to do with INH

80. Pt comes in having a heart attack, and she has elevated CKMB - this is caused by: Damage
to the plasma membrane (that’s what I put) - other options included mitochondrial swelling

81. There was a Q with a picture of a liver with metastasis - the Pt had a mass around the
terminal ileum. The Dx is Carcinoid syndrome - with high levels of serotonin (know this)

82. C-reactive protein was elevated. They straight up asked where is it synthesized? I put liver
(it’s correct - I have it on my FA written down)

83. Pt has been in the ICU for a while, old man - he is bleeding from all his catheters. What
does he have? DIC

84. Pt has BPH - but he is experiencing Orthostatic hypotension - what is the drux being used?
A-antagonist (Terazocin)

85. Pt has prostate CA (with nodules) - what is the first thing we should do? Bone scan

86. Pt has Mesothelioma (they explained it but they did not say it) - Cause? Asbestosis (look for
asbestos in the answer choices)

87. Pt has a family history of diabetes - she doesnt have diabetes yet but she is developing
Acanthosis nigricans. We know this is caused by Insulin resistance, but the way they worded
the Q was very very weird so be careful

88. Pt has lung CA, picture of small-cell type. Pt is also experiencing muscle weakness. Why is
this caused? Lambert-eaton (Abs against presynaptic Ca channels)

89. Okkkk Question about the grams, and what is the loading dose to maintain a certain range
of the drug. The peak was 85, the trough was 25. I honestly did not know how to answer that
question. Used the equations but I just decided to put 120 and 10

90. Q about you to calculate GFR - watch out the units. Answer had to be in ml/min/1.73m^2.
Volume was given for 24 hours so change that to mins. Urine is given in mg - change ml. 1 mg
= 0.001 ml. The calculation was long - I dont remember the number come back if u remember

91. Experiment where you give Succinylcholine - phase 1, when treated with drug X it does not
change; phase 2, when treated with drug X the muscle contractions decrease. Drug is
Neostigmine

92. Pt wants to quit smoking - what drug can be given? Varenicline

93. Pt has been complaining a lot of back pain. Tx with Baclofen - what does it target? Y-
amminobutyric acid b

94. Pt has a very low HR and you want to try and bring it up. Which drug should you give?
Atropine

95. Pt is suffering from increased intracranial pressure. What drug should be given?
Acetazolamide

96. Pt is experiencing glaucoma - a drug was given to tx this, but now the Pt is experiencing
SOB, difficulty breathing. I thought about Pulmonary edema that is caused by
Acetazolamide/MANNITOL - What is the MOA of the drug used to tx the glaucoma? I put
Carbonic anhydrade inhibitor

97. Pt is suspected on having used an illicit drug - he is diaphoretic, very fast breathing,
PUPILLARY CONSTRICTION. What drug did he take? Opioids

98. Pt is sweating, flushed, with headaches - Dx? Pheochromocytoma

99. Pt has ascites, cirrhosis, liver failure - he has blood on stool. What two arteries that
anastomose cause this? Superior and Inferior renal arteries

100. Pt has an obstruction in the 3rd and 4th parts of the duodenum. What artery is most likely
to be compressed? SMA

101. Pt has been diagnosed with a lower esophageal cancer - what structure that is immediately
posterior to the esophagus is most likely to be affected? The thoracic duct

102. Pt has HF, LVH. He is now complaining of SOB, pulmonary edema. What is the cause of
the edema? I put due to increased hydrostatic pressure (other option was due to vessel
permeability)

103. Pt has abdominal aortic aneurysm right above the bifurcation of the aorta into the common
iliac arteries. What is the most likely cause for this? Atherosclerosis

104. Pt just came home from travelling on a 6-hr plane. She is experiencing left sided weakness
of her arms and legs, left facial droop. What allows this to occur? Patent foramen ovale

105. Pt has Sx of stroke - what is the main drug that should be given? It’s tPA but they
explained the MOA (It said enhances plasminogen, which breaks down Fibrinogen to fibrin -
something like that)

106. Pt is experiencing fatigue, microcytic anemia, heavy vaginal bleeding - what is the cause?
Fe-deficiency

107. Gout (pollagra - painful toe). Pt is already being treated with Indomethacin. What is the
best long-term tx? Allopurinol
108. Pt has upper abdominal pain that radiates to the back - PANCREATITIS. What substance
will be a sign of this disease? I put increased Amylase (lipase was not an option). AST was also
an option but thats more related to alcohol and the liver, GGT, ALP were other options.

109. AGRANULOCYTOSIS (know this) - Pt is schizophrenic and she is being treated with
Clozapine. What would be the lab values? Very weird - it is in one of the recalls. Lymphocytes:
0%, platelet count: 20000, and absence of megakaryotes (that’s what I put but I was very
doubtful - other option was: lymphocytes: 100%, normal platelet, acellular BM (no)/absence of
development of the myeloid lineage)

110. Pt was hyperthyroidism - what drug causes agranulocytosis? PTU

111. They describe a Pt with HYPOthyroidism - she has gained a lot of weight recently,
constipation. What is causing this? This is Hashimoto’s thyroiditis - answer was autoantibodies
against thyroid peroxidase

112. Pt has a thyroid CA - she is being treated with Iodine-ablation. The anterior mediastinum
takes up the iodine. What causes this? Options were: Iodine is taken up by normal thyroid tissue
(that’s the one that seemed more reasonable to me), other was taken up by extra thyroid like at
the back (be careful with this Q)

113. That picture on one of the recalls of the Vertebral compression (the exact same picture) -
Pt has osteoporosis and it’s old

114. Ethosuximide - Pt is a child who has absence seizures (they explain this - he stares for
long periods of time, EEG reaks speaks of 3 Hz). MOA of the medication: targets Ca*** (T-type)

115. A weird Q where the Pt has schizophrenia and it’s being treated with Haloperidol, and also
statin for hyperlipidemia. She is experiencing tardive dyskinea, EPS. so what would you treat
this with? Normally, I would have but Benztropine but that was not an option - of the options, the
most reasonable one was Propanolol (SSRI - Paroxetine was another option)

116. They described a study and said that SN was increased - what else would happen?
Answer was that NPV would also increase

117. They gave a normal distribution with the mean and the standard deviation - they gave
95%CI and 99%CI. They asked what was the number between I think it was 38.8 and 41.2
(basically between the upper 95 and 99% - which is 2% of the entire population). The answer
was 4 I think but double check with your work

118. Easy Q - asked to calculate RR, just organize in a table

119. Q said that RR of a study was calculated to be 1.8, CI was between 1.3 and 2.7 I think.
Then they asked what would be the p-value of this experiment after chi-square analysis was
done? I got confused. At this I put <0.05.. But then remembered something about RR>1 but
means that the p-value is higher (just check)
120. A Q asked to calculate the RR but it was of 2 different studies. 3/10000 was treated with
something (that is the rate of occurrence) but 50000 were in that group, while the other group
was 8/10000, and 50000 sample size. I put that RR could not be calculated - the answer
choices were very weird

121. A Q asked about PRECISION - we cannot determine precision based on this study
(precision is if you repeat the study multiple times, you get the same results). They just said a
study was done, and the results were all within a range.

122. Two populations being studied - one had 1000 people and the other had 50. What is the
difference between these 2? The group that has 50 people has a lower power, or a higher risk
of type II error.

123. Pt is schizophrenic - she has been to the hospital multiple times. She receives money from
a trust fund, but she lives on the street because she likes being outside where she can hear the
birds and the stars, she does not take her medication bc it makes her feel weird. While in the
hospital, she was to be discharged against medical advice. By letting her go, what ethical
principle are we referring to.. Autonomy

124. Pt has a melanoma in his back. The daughter asks the doctor if he cannot tell her dad that
he has cancer, because he could kill himself. He has been depressed lately and his wife just
passed away. After evaluating his mental status and suicidal risk, what should you do? Tell the
Pt

125. A baby is born. What is the main factor that determines closure of the Ductus arteriosus?
Decreased pulmonary resistance

126. Pt was born with a diaphragmatic hernia. What is the most likely complication? Pulmonary
hypoplasia

127. Baby is born with cleft lip/palate, malformed mandible, external auditory tubes. What
pharyngeal arches are affected? 1st and 2nd

128. Pt recently suffered from an MI. 3 days later, she had developed a new murmur - this is
caused by? Rupture of the papillary muscle (this leads to MR)

129. Pt is a girl who experiences a weird feeling in her chest - she has a murmur characterized
by a mid-systolic click. Her mother also has this. Dx? MVP

130. Pt has congestive HF, with pulmonary edema, elevated JVP, and peripheral edema. What
would be the findings in the heart? CO, SV, LV ejection fraction (I don’t remember exactly what I
put)

131. Know what happens with MR - increased SV, increased EDV

132. Pt has a lung disorder - she has developed an enlarged LN right under the right clavicle, in
the 2nd and 3rd intercostal spaces. What lobe of the lung is affected? Right upper lobe

133. Reading of an ECG are given; PR 150 sec, QRS. What is the area of slowest conduction in
the heart? Between the lower portion of the atria and the bundle of his

134. Clubbing - spongy base of the finger, with 180 degree angle of the nailbed

135. Sarcoidosis - they said the Pt has a non-caseating granuloma. What is the first line of tx? I
put Prednisone

136. A picture of an old NBME came up with an ULS of a fetus with an enlarged scrotum and
the testes were seen inside. What is the cause of this? Patent processus vaginalis

137. Pt has the feeling of having a bag of worms. It goes away when he lies down. What other
thing can you do to determine the Dx? Transilluminate it

138. Pt has angina - oral nitroglycerin was given. MOA: increases cGMP

139. What is the main drug used to decrease the levels of LDL? Statins

140. Drug that inhibits the REABSORPTION of cholesterol? Ezetimibe

141. It looked like SIADH (know this) - they showed the lab values.