21. A35:year-old woman, gravida 3, para 2, develops a massive hemorrhage after the vaginal delivery ofa heathy female newborn at 38 weeks’ gestation ‘She underwent a cesarean delivery 2 years ago because of cephalopelvic isproporton. A hysterectomy is required at this me to control te bleeding. The {9108s and microscopic appearances ofthe uerus are shown, Which of the folowing is the most Iikely cause ofthe postpartum hemorrhage inthis patent? O A) Abruptio placentae, O 8) Ectopic pregnancy © ©) Endometiosis O D) Letomyomata uteri O E) Placenta accreta O F) Placental site trophoblastic tumor22. An 18-month-old boy in West Atica with perinatall acquired HIV infection Is exposed to a child in his vilage with afover and an erythematous, ‘maculopapular rash. Three weeks later, the 18-month-old boy develops giant cll pneumonia, but there is no evidence ofa rash. Which ofthe folowing Viruses is the most likely cause ofthe preumonia? O A) Coxsackievirus © 8) Intuonza virus O ¢) Measies virus. O D) Rubetta virus O E) West Nile virusTama “AB pe TOaear Me Fasting Serum Ghucose 23. During an investigational study, fasting serum glucose concentrations are collected from a population of healthy individuals and a population of pationts with type 2 diabetes mellitus. The results are shown inthe graph. Switching from cut point A to cut point B would most likely result in which of the following ‘changes in test characteristics regarcing identification of patients with type 2 diabetes mellitus? O A) Decreased specificity O B) Improved sensitivity © ©) increase in false-negatives © ©) increase in false-positives O E) Nochange24, 30-year-old man develops urinary incontinence 2 weeks aftr successful treatment ofa facture ofthe left polvs that was sustained at work. He was. pinned against a loading dock by a truck moving in reverse. Physical examination shows a distended bladder. Cystomelrography shows absence of micturition reflexes. After the bladder fils to capacity, overfow of urine occurs through the urethra a few drops ata time. This patent most ikoly sustained ‘adional injury o which ofthe following during his ital accident?” © A) External urinary sphincter O 8) Hypogastric nerve O ©) PeWvicnewves: O D) Pudendal nerves © E) Skeletal motor fibers25. A.1-yoar-old boy is brought tothe physician by his parents because ofa 4-week history of progressive generalized tonc-loic solzures and a strange odor tohis urine. He has a history of delayed development. He was adopted from an orphanage in Russia atthe age of 6 months. Physical examination shows. fair skin and blond hair. His phenylalanine hydroxylase gone is homozygous fora point mutation (GT—AT in intron 12 ofthe affected gone that causes. ‘skipping of exon 12. Which ofthe folowing isthe most Ikely explanation for exon skipping inthis patents affected gene? © A) Aterative polyadenylation ste © B) Deletion of 5‘ untranslated region © ©) Expansion of tinucteotide repeat © D) Gone duplication O E) Nonhomologous recombination O F) Nonsense mutation O &) RNA splice error O ¥) X inactivation26. Anealth care screening fr diabetes melitus is conducted ata weekend market with subjects including both men and women ranging in age from 25 to 95 years. Blood samples are obtained, and the blood glucose concontratons ae determined, The results aro shown inthe table: Patient Glucose (mg/d) 1 70 2 120 3 120 4 140 5 10 6 95 7 8 8 145 9 105 10 85 1 85 2 20 3 120 4 100 8 190 Which of the folowing best represents the median blood glucose concentration for this group (in mg/dL)? Oars O 8) 105 Ocy10 O bj 120 vin Sau) 12527. 32-year-old woman comes tothe physician 1 day after she noticed a large red lesion on her hack. One week ago, she returned from vacation in Cape Cod. After evaluation, a diagnosis of erythema chronicum migrans is made, Prior to prescribing an antibiotic, the physician asks the patient she could possibly be pregnant because an adverse effect ofthe antibiotic active against the causal organism is incorporation Into fetal bones and teeth, causing yellow discoloration. The mos ikely mechanism of this drug is inhibition of which ofthe folowing? © A) Attachment of RNA to ribosomes. O 8) Dinydotlatereauctase © 6) DNA repair by ONA gyrase Ob) etectron tansport OE) Transpopidaton of poptogtean28. Afemale newbom is delivered vaginally at 37 weeks! gostation after an uncomplicated pregnancy, labor, and delivery. Physical examination shows a ‘arrow cranium thats elongated in the anteroposterior dimension. Premature closure of which ofthe folowing during embryogenesis isthe most likely cause ofthis anomaly? O A) Bregma © 8) Corona suture O ¢) Lambda O D) Lambdoid suture O E) Sagital suture29. 40-year-old woman comes tothe physician for a follow-up examination 1 week after having a second increased blood pressure measurement. Her pulse | 72)min, and blood pressure is 168/104 mm Hg in both arms while siting. Physical examination shows no other abnormalities. Treatment wih isinopi ‘and hydrochiorothiazide i inated, One month later, her blood pressure Is 120/80 mm Hg, Which of the folowing sats of hormonal changes is mst Ikaly inthis pation? ‘Angiotensin ‘Angiotensin Bradykinin On 1 1 ‘0 change On + 1 t Oo tr 4 4 Ovo 4 1 1 Of 1 1 130. A85-yoar-old woman with systemic lupus erythematosus has an increased serum C-reactive protein (CRP) concentration. Which ofthe following ks tho ‘0s! key source ofthe increased serum CRP concentration inthis patient? O A) Bone marrow O 8) Brain O ©) Kidney O bd) tiver © E) Lymph node OF) stna bag of worms. Which of the folowing veins is most likely obstructed in O Ay Inferior mesenteric vein © 8B) Interior vena cava 6) Inferior vesical vein © D) intemal itiae vein O E) Left renal vein32, AS5-yoar-old man comes tothe physician because of @ 2-month history of decreased appetite; he also has had a 9-4 (20-8) weight loss and an Intermittent rash during this period. Physical examination shows necroytc migratory erythema over the axilae and groin, Laboratory studies show a serum ‘glucose concentration of 280 ma/dL and plasma glucagon concentration of 1600 pg/ml. (N=20-100). ACCT scan of the abdomen shows a mass atthe head ofthe pancreas. Which ofthe following processes is most likely occurring in tis patient’ liver? © A) Decreased activity of camitine acetyransferase © 8) Giycogen synthesis, © €) Increased activity of acetyCoA carboxylase © D) Inhibition of ketogenesis © E) Patial oxidation of fatty acids‘38. A45-yoar-old homeless man Is brought tothe emergency department by police 30 minutes after he was found unconscious. His breath and clothes smal ‘of alcohol. His temperature is 968°C (98 2°F), pulse is 68min, respirations, bronzed skin and spider angiomata onthe chest. Laboratory studies show: Hemoglobin Homatoort ‘Mean corpuscular volume Leukocyte count ‘Segmented noutrophis Lymphocytes Monocytes Platelet count Serum Ferttin Vitamin B (cobalamin) RAC folate ‘re 14/min, and blood pressure is 110/55 mm Hg, Physical examination shows 10 gt 30% 110 um 000/mm? 70% 20% 10% 160,008? 200 ngimL 500 pgimL (N=160-250) 20 ngiml_ (N=188-640) ‘Apetipheral blood smear shows occasional hypersegmented neutrophils and 3+ oval macrocytes. Serum studies are most likely to show which ofthe following sets of additional ndings? Methyimalonic Acid Homocysteine On tocreneed eressed Os increased noma! ae Oo) fy ale oo Oe) = 23 On Methyimatonic Acid Homocysteine Normal ermal Normal decreased Decreased Increased Decreased ‘normal Decreased decreased‘34. AS4-year-old woman with a 25-year history of rheumatoid arthritis that i refractory to therapy is admitted to the hospital fora joint replacement operation. Preoperative laboratory studies show: Hemoglobin 105 94 Mean corpuscular volume 79 um? Leukocyte count ‘89001? Platelet count 230,000? Seuum ‘ron 40 ygidt. Transfert £220 mg/dl (N=200-400) ‘Aphotomicrograph ofa Prussian blue ion-stained smear of bone marrow aspirate is shown. Which of the following is the most likely cause of the anemia? © A) Autoimmune hemolysis O B) chronic disease © €) Iron deficiency © ©) Marrow replacement by neoplastic tissue O E) Myetodyspiasia © F) B-Thalassemia minor35. Anowbom s delivered at 40 weeks’ gestation to @ 20-year-old woman after ]an uncomplicated pregnancy. Physical examination shows male-ke external genitalia, wit clitoral hypertrophy and labial fusion. The karyotype is 46,XX. The serum concentration of cortisol is decreased and serum concentrations of ‘T-hydroxyprogestorone, androstanadione, and tatosterone ara increased. Which of the folowing isthe most Ikaly cause of the findings in this newborn? O A) Androgen receptor mutation © 8) Defectin adrenal sero biosynthesis © ©) Deficiency of enzyme activity in gonadal steroid hormone biosynthesis © ©) Increased anti-miilerian hormone secretion O E) Translocation of the SRY gene to one of the X chromosomes36. A.40-yoar-old woman with chronic paraplegia caused by multiple sclerosis Is brought tothe physician because of severe, debilitating muscle cramps forthe past 3 weeks. Treatment with bacofen resolves her muscle cramps. Which of the folowing receptors most likely decreased the muscle spasticity in this pation? O A) asherenereceptr O 8) prharencreepte © ) yaminabuyric ag recoptr O 0) calcu sensing receptor © E) Ryanodine receptor37. A20-month-old gi is brought tothe physician by her mother because the mother is concemed about hor daughter's development and behavior. The gi is able to walk and run and has a vocabulary of atleast 100 words. However, when she attends playdates with other children, she prefers to play by herself and wil strike another child on the head if that child attompis to join her in playing witha particular toy. Which ofthe following best explains tis pationt's ‘actions during play? © A) Attention-defictinyperactivity disorder O 8) Conduct disorder O ©) Early sign of autistic disorder © D) Oppositional defiant disorder © E) Normal behavior for age38. AS5-yoar-old woman who is @ physician Is admited tothe hospital because of a fractured femur sustained in a motor vehicle colsion. Two days after admission, she develops tachycartia, restessness, diaphoresis, and anxiety. She says that ‘vague shapes" are coming out ofthe walls. Which of the following isthe most Ikely cause of this patient's current condition? O A) Acute stress disorder © 8) Alcohol withdrawal O ©) Bipotar disorder O D) Histrionic personality disorder O E) Panic disorder39, An investigator is studying a laboratory stain of HIV-1. During the experiment, point mutations ae introduced in the long terminal repeat region of the viru. Infection of a human T-lymphocyte ine withthe mutant virus results in markedly decreased vial replication compared with infection with the wildtype virus. ‘Amutation most ikely drecty affected which ofthe folowing phases ofthe viral Ife cyclo? O A) Attachment of the virus to the cell surface © 8) Budding of the vius fom th coll membrane © ¢) Fusion of the viral envelope and cell membrane © ) Integration of the provirus into the host cell genome O E) RNA splicing o produce an mRNA encoding the envelope glycoproteins40. 52-year-old woman undergoes surgical excision of a large multinodular golter. During the operation, the superior thyroid artery is used as a landmark to ‘avoid damage to a nerve proximal to that vessel. Which of the folowing best describes this nerve?” © A) extemal branch of he superior ayngeal nerve B) Inferior root of the ansa cervicalis © ©) Nerve to the mylohyoid O D) Phrenic nerve © E) Transverse cervical nerve