1. 12-year-old boy is admitted to the hospital because of lethargy, hip pain, and a temperature of 39 4°C (103°F). He has been hospitalized several other times because of pneumonia, His neonatal period was normal. Complete blood counts are within normal limits, and atest for HIV antibody is negative. Blood cultures grow Staphylococcus aureus. Serum electrophoresis is most ikely to show which ofthe folowing patterns? ahh2. Free purine and pyrimidine bases are reutlized in normal metabolism. In children with Lesch-Nyhan syndrome who have intelectual dsabilty, poor muscle ‘coordination, and self mutation tendencies, thoe is a defect in the salvage of which of the folowing pairs of bases? O A) Adenine and thymine B) Guanine and hypoxanthine O ©) Guanine and uric acid © D) Uracil and cytosine: © E) Xanthine and hypoxanthine3. 42-year-old man is struck by a motor vehicle. His only injury is a closed fracture ofthe proximal tba. Inal neurovascular examination shows no deft. ‘Twenty-four hours later, he has increased leg pain and paresthesias inthe dorsal space between his fist and second toes. The patient begins to pass dark ‘ed urine and becomes oiguic. Urinalysis is positive for blood but no erythrocytes are seen on microscopic examination. Which ofthe following acute disorders isthe most Ikely cause of the renal failure? O A) Glomeruionephitis (© 8) Hemolyt-uremic syndrome © €) Interstitial nephts O D) Nephrotic syndrome O E) Tubular necrosis4. Amale newbom is found to have a defect in anchoring ibis. Which ofthe following skin findings is most likely inthis patient?” O A) Blisters © B) Easy bruising © ¢) Eczematous rash D) inabitty to sweat © E) Thickened skin O F) Uroors5. A6S-yearold woman has ascites. Which ofthe following addtional findings indicates a diagnosis of constrictive pericarditis rather than cithosis? O A) Edema ofthe lower extremities © B) Esophageal varices © ©) Hypoatbuminemia © D) Hyponatremia © E) increased jugular venous pressure OF) Splenomegaty6. 62-year-old man is being evaluated for rectal bleeding. An x-ray ofthe gastrointestinal tract with contrast ‘material is shown. Which ofthe following is the most likely explanation forthe feathery appearance in the portion ofthe gastrointestinal tract indicated by X when compared withthe portion indicated by Y? O A) Absence of circular muscle O 8) Fewer vit O 6) Greater bowe! motility O D) Greater mucosal surface area © E) Less circular and longitudinal smooth muscle7. A68-year-old man who has chronic lymphocytic leukemia has the sudden onset of fatigue and shortness of breath Laboratory studies show: ‘Hemoglobin 85 oid Hematocrit 19% > ‘Leukocyte count 50,000/mm? Platelet count 1170,0001mmm3 Reticulocyte count a% ‘Serum birubin Total AmgidL Conjugated 05 mgiat. ‘peripheral blood smear is shown. Which ofthe flowing is the most likely cause of the anemia? O A) Aplastic anemia © 8) Autoimmune hemolysis O C) Hereditary spherocytosis: O D) Microangiopathic hemolysis © E) Monoctonal gammopathy8. 47-year-old man wih a history of rheumatic valvular disease comes to the physician because of chest pain and Ocur O dyno O gym |45. 70-year-old man with poctly controled hypertension is brought to the emergency department 30 minutes after the sudden onsat of waakness ofthe lft ‘ide of his face and body. He is alert and able to folow commands. His pulse is 80/min, and blood pressure is 180/90 mm Hg. Physical examination shows ‘mild flattening of the nasolabial fold onthe let side and weakness and hyperefexia ofthe lft upper and lower extremities. There are no sensory deficits, ‘but he has mild dysarthria. Six months later, histologic examination of the area ofthe injury is most likely to show proliferation of which ofthe following cell types? © A) Astrocyes OB) Ependymal celts © ©) microti! cats O D) Neurons (OE) Otigodendrocytes48. 35-year-old man comes tothe physician because of a 6-month history of burning abdominal pain that occurs 1 to 2 hours after he eats. He also has had black stools for 2 days. Use of over-the-counter antacids and hstarine-2 (H;)-receptor blocking agents has not been effective in relieving his symptoms. He is sweating profusely and has lightheadedness when he stands. His blood pressure is 105/70 mm Hg while siting. Physical examination shows: ‘epigastric tenderness. ACCT scan ofthe abdomen shows a 1-cm mass in the pancreas. Immunohistochenical labeling of neoplastic cells in a biopsy ‘specimen is most kal to involve the use of antibodies directed to which of the folowing substances? O A) Amylase O B) Gastrin ©) Glucagon O D) Human pancreatic polypeptide OE) Insutin O F) Lipase O 8) Serotonin O 1) Somatostatin © 1) Vasoactive intestinal polypeptide47. A S6-yearold man is brought tothe emergency department 1 hour after having a generalized tonic-clonic seizure during his moming run. Vital signs are within nonmal mits. MRIs ofthe brain show a mass in the lateral aspect of te precentral gyrus of the frontal lobe. Based on the MRI findings, which ofthe following addtional deficts Is most Ikely inthis patent? O A) Atrophy of the lef upper extremity O B) Decreased proprioception in the right upper extremity © €) Decreased sensation in the lat lower extremity © D) Deviation ofthe tongue tothe right © E) Weakness of the left lower area of the face © F) Weakness of the right lower extremity48. 23-year-old woman is brought tothe emergency department because of shorts of breath for 2 weeks. Her respirations are 28min. Physical ‘examination shows no other abnormalities. Laboratory studies show: Serum Nat 135 mEq, kK 4.0 mEq. ce 110 meg Heo, 15mg ‘Aterial pH on room sir 7.25 Urine ‘Sodium 20 mEq Chlorine 30 meg Potassium 1SmegL Which ofthe folowing isthe most ikely agnosis? O A) Alcoholic ketoacidosis O 8) Crohn disease O ©) Diabetic ketoacidosis O D) Lactic acidosis © E) Renal tubular acidosis O F) Salicylate poisoning49. An investigator conducts a clinical study of 300 patients with stages Il and IV colon carcinoma. It is found that overtime, metastases show an increasing potential for growth and resistance to chematherapy. Which ofthe following mechanisms of the cell cycle best explains this observation? © A) Decreased expression of ein 8 during G/M transition © 8) Decreased phosphor/ation of RBI protein during GS transion © ©) Genomic insubity dung SG, nd M phases © D) Overexpression a 15,16, and p18 during G, phase © E) Overexpression of p21, p27, and p57 proteins during all phases50. An investigator conducts a phase 1 clinical tal to test the efficacy of a systemic antagonist to lymphocyte function-associated antigen 1 (LFA-t). The drug |s approved fr topical administration to treat keratoconjunctvs sicca in patients with multple sclerosis. During the tril iis found that these patients are ‘tan increased risk for bacterial infection as a resutof this drug. The mos key explanation for this risk is drug-induced blockade of which ofthe folowing ‘Segmented neutophil activites? O A) Activation of phagocytosis © 8B) Adhesion o the endothelium © €) Diapedesis trough the capiary wal © D) Migration tothe site of injury O E) Rolling at the vessel periphery