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    04a. Nbme 26 BL 4 Q Only

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    04a. Nbme 26 BL 4 Q Only

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    04a. Nbme 26 BL 4 Q only

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    5 views52 pages

    04a. Nbme 26 BL 4 Q Only

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    04a. Nbme 26 BL 4 Q only

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    © All Rights Reserved
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    of 52
    ar a trtetcon +o 0- 41. 40-year-old woman has easy bruising and menorthagia Pateet count Is 100,000!mm?, and bleeding ime is prolonged. Factor Vil (antihemophilic actor) ‘concentration is decreased, and platelet achesion to collagen is abnormal. Which ofthe folowing isthe most Ikely diagnosis? O A) Hemophilia A O 8) Hemophilia B © ©} Immune thrombocytopenic purpura © 1) Ingestion of aspirin O E) Systemic lupus erythematosus © F) Thrombotic thrombocytopenic purpura O 6) von Willebrand disease PN € e 4 starttestcom a 2. 14-year-old boy is brought tothe physician's office because of decreased appetite and abdominal pain over the past 3 weeks. His mother says that during the same time he has withdrawn from everyone and sleeps constantly. He describes his symptoms vaguely. Physical examination is normal. During further riston-taking, itis most ertcal forthe physician to obtain information about which ofthe following? © A) Developmental history O 8) Family history of afective disorders: © €) Orientation to time, place, and person D) Schoo! history © E) Suicidal ideation or attempts ar sttetcon +o 0- 3. Which ofthe following best explains why deaxygenated blood can carry mare carbon dloxide fora glven Pco, than oxygenated blood? © A) Deoxyhemogiobin does not bind to 2,3-bisphosphoglycerate as efficiently as oxyhemoglobin © B) Deoxyhemoglobin has a lower capacity to form carbamino compounds than axyhemogiobin © ©} Deoxyhemaglobin has @ ower pKa than axyhemoglobin © D) Deoxyhemoglobinis a better buffer of hydrogen ions than oxyhemoglobin © E) Oxygen and carbon dioxide compete for the same binding site in hemoglobin O F) Oxyhemoglobin binds nic oxide with a higher affinity than deoxyhemoglobin € e 4 starttestcom +oo0- 4. ASS.year-old man has a cough, hemoptysis, and dyspnea. He has smoked 2 packs of cigaretes dally forthe past 30 years. Examination shows bilateral Conjunctival edema, distention of sublingual veins, and edema of the upper extremities. Which ofthe folowing addtional findings is most likely tobe present (on examination? © A) Bisferions carotid pulsation © 8B) Increased jugular venous pressure © €) Pansystolc apical murmur Oo)ss Oce)s4 eas ° ©) acd laste s syndrome 6 200 z OCOOOOC e 4 starttestcom +00 ‘One hundred patients discharged from the hospital with a diagnosis of proximal deep venous thrombosis were followed forthe development of venous ‘ulceration for up to 8 years (DVT group). They were compared to a group of 200 patients who were discharged fom the hospital wth a agnosis of ‘pneumonia (the control group). A the end of 5 years, 25 patients inthe DVT group and 10 patients inthe control group developed venous ulceration. Which ‘ofthe following isthe atiibutable (excess) ik per one hundred patients for development of venous ulceration folowing deep venous thrombosis over 5 years? B)2 cy 24 D) 25 E)10 F) 20 G) 24 Hy 25, ar a trtetcon +o 0- 7. An 80-year-old man comes tothe physician because of bleeding gums and bruises under his skin. He lives by himself and follows a diet low in vegetables ‘and fruits. His prothrombin time is normal. Which of the folowing enzymes is most Ikely compromised in this clinical scenario? O A) 23-€paxide reductase © B) Glucose 6-phosphate dehydrogenase O C) Hexokinase © d) Methionine syntnase O E) Proly| hydroxyiase O F) Pyruvate carboxylase © G) Pyruvate dehydrogenase € e 4 startiestcom +00 8. 40-year-old woman comes to the physician because of a 2-month history of increasing redness around her nose and cheeks, and pimples around her mouth. Sne appears very upset and tls the physician, “look ke a teenaged Santa Claus.” Which ofthe following inal responses by the physician is most ‘appropriate? © A) "Can you tell me how often you go out inthe sun and what kind of protection you use?" © 8) "Don't worry. Let me assure you this is not a serious condition.” © €) "tts upsetting when you have a skin problem on your face* © D) "Maybe a ite. Atleast you are keeping your sense of humor about the situation." © E) "You really do look rather odd. | can understand why you are so upset." € e 4 startesticom a 8. 40-year-old woman has had hypercalcemia for t year and recenty passed a renal calculus. Serum parathyroid hormone and calcium concentrations are ‘increased, and serum phosphate concentration is decreased. Parathyroid hormone most likely causes an increase in the serum calcium concentration by Which of the folowing mechanisms? O A) Decreased degradation of 25-hydroxycholecalcferol © B) Direct action on intestine to increase calcium absorption © ©) Direct action on intestine to increase magnesium absorption O D) Increased synthesis of 25-hydroxycholecaleiferol © E) Inhibition of calcitonin production © F) Stimulation of 1,25-dinydroxycholecalciferol production € e « startestcom +oo- 10. In a 3.wook-old knockout mouse, a lag bone reaches only half the length ofthat ofa simlar-aged wild-type mouse. The epiphyseal plates in the bone ofthe transgenic animal are significantly narower than in the bone ofthe wic-type animal. The knockout mouse most likely has a deficiency of which ofthe following? O A) Cakitonin O 8) Cotto O €) Insulin-tke growth factor | © D) Platelet-derived growth factor © €) Thyroxine (74) € e 4 starttestcom +00 ‘1. 60-year-old man develops palpitations over a 6-week period during which he has been drinking approximately 8 cups of coffee per day. Achythm strip from his ECG is shown. Which of the following is mos ikely responsible for the palpitations in this man? © A) Second-dereeatovenrcua block OB) Sinoatia ox back © ©) sugraveniclar premature beats Ob) Third-dogreeatioventcuer Bock © €) Venter tactyoaria ar * antsicon +o 0- 12, In an experimental dasign evaluating assays forthe bactriidal effect of intammatory calls, which ofthe fllowing compounds is considered the most eficient inthe kling of bacteria by neutrophils? © A) Bactericidal permeability increasing protein O 8) Hypochionte © ©) Lactoferrin O D) Lysozyme © E) Major basic protein € e 4 starttestcom + oO 18. A36-year-old woman is brought tothe emergency department comatose ater she sustained mutipl injuries in a ‘motor vehicle colision, During the next few days, she develops sepsis and respiratory insufciency, and then she les. A photomicrograph of her lungs obtained at autopsy is shown. I this patient had recovered, regeneration of the alveolar epithelium would have been accomplished via hyperplasia of which of the folowing cel types? O A) Alveolar capilary endothelial cell © 8) Alveolar macrophage O ©) chondrocyte © B) Giliated columnar epithelial cell O E) chub cett O F) Goblet cet! O 6) Kulchitsky colt © H) Squamous epithelia cot O 1) Type | pneumocyte. O 4) Type It pneumocyte ar s-trtetcon +o 0- 14. A36-year-old man comes tothe physician after he noticed a dark lesion on his back. Physical examination shows a dark, regularly shaped, raised region ‘on the back. He has a history of frequent sun exposure at the beach. A biopsy specimen ofthe region confirms the chagnosis of a melanoma. Which ofthe following embryonic issues most ikely formed this tumor? O A) Dermatome O B) Lateral plate mesoderm O ©) Neural crest D) Nonneural ectoderm © E) Prechordal plate mesoderm € e 4 startestcom a 15. A3t-year-old woman is brought tothe emergency department by her husband because of dificult breathing and severe muscle weakness for 10 minutes ‘She has a 3-year history of myasthenia gravis treated with neostigmine. The husband reports that she doubled her dosage 2 days ago because she was, feeling extraorcinarily weak, but her weakness has increased since then. Which ofthe folowing events i the mest likely cause of the increased muscle weakness in this patient? © A) Autoimmune hyperactivation of nicotinic receptors © B) Autoimmune inactivation of muscarinic receptors O C) Desensitization of nicotinic receptors O D) Excessive degradation of acetylcholine O E) Hypersensitization of muscarinic receptors: O F) Insulficient release of acetyicholine € e 4 startestcom L+o0- 16. A25.year-old woman at 38 weoks' gestation undergoes an oxytocin stress testo evaluat the intogty ofthe placental circulation. Based onthe results, a fulkscale induction of labor with oxytocin i started. Treatment with oxytocin is most likly to activate which ofthe following substances inthis patent's Uterine smooth muscle? O A) Adrenergic nerve terminals O 8) Cholinergic nerve terminals © €) Ligand-gated calcium channels © 0) Na-K-ATPase © E) Voltage-gated chloride channels ar a trtetcon +o 0- 17. A73.year-old man wth polymicrobial sepsis begins treatment with a variety of antbiotes, including gentamicin (current dose indicated in table). Three days, later, serum gentamicin concentrations are 8.8 pgimL. (peak) and 2.5 pg/mL (tough). Which ofthe fllowing dose regimens Is most appropriate for ‘achieving a peak serum gentamicin concentration between 4 and 10 igi and a rough concentration of less than 2 ym? Dosage Intravenous Administration (mg) Time Between Each Dose (hours) (Current = 80 mg) (Current = 8 hours) Oo” 60 6 Os 80 6 Oo 80, 12 Oo) 120 8 Of 120 2 € e 4 startiestcom + oo: 18. 17-year-old boy with chronic ronal insufcancy undergoes a unilateral nephrectomy. A photograph of the resected kidney is shown, Which of the following pathologic processes is ‘most kel present inthe kidney? © A) Acute gimertonephis O 8) Acato tubular necrosis © 6) Argomyoizoma © ©) Autosomal recessive plyystic kidney disease OE) Fitromuscuar dysplasia OF) Hydronephross O 6) Neptrobiastoma srcomer me O i) Papi racrosis O 1) Renal vein tembosis © 8) staghom cacuus 1 Comprehensive Basic na a ttetcon +o 0- 18, researcher in a pharmaceutical company designs a new protease inhibitor that inhibits replication of HIV in T lymphocytes in culture. In subsequent assays, which of the folowing fincings Is most ikely to indicate that the compound is working specifically asa protease inhibitor? O A) The drug prevents integration of proviral DNA into the host genome O 8B) The RNAis partially reverse transcribed into proviral DNA. © ©) There is a lack of a mature core © D) Transcription from the HIV promoter is blocked © E) The virus does not bind to CDS in the presence ofthe drug € e 4 starttestcom +00 20. A.42-year-old woman comes tothe physician because ofa 3-week history of numbness ofthe fingers onthe left hand. Neurologic examination shows loss fof touch graphesthesia and loss of two-point discrimination inthe let hand. This patient most ikely has a lesion In which ofthe folowing locations of the hemispheres shown? lolelerere} e 4 startiestcom +00 oOo lolelererelerels ‘of touch graphesthesia and loss of two-point discrimination inthe left hand. This patient most tkely has a lesion in which ofthe following locations of the hemispheres shown? e5e ana £0 21, 35-year-old woman with sicke cll tats brought tothe emergency department because of severe lft ank pain for 1 hour. She has a history of frequent headaches. Her blood pressure is 150/90 mm Hg. Pressure onthe costophrenic angle causes pain. Urinalysis shows a few RBCs and numerous ‘eutrophs. ACT scan ofthe abdomen shows obstruction and dation ofthe let ureter and blunting of several renal papillary pyramids. Which of the fellowing i the most likely dlagnosie? O A) Acute glomerulonephritis O B) Acute tubular necrosis: © ©) biabetic nephropathy © D) Papitary transitional cell carcinoma, O E) Renal papillary necrosis ar strtetcon +o 0- 22. A6B.year-old man with dementia, Alzheimer type, has improvement in memory and cognition with donepezil therapy. Which ofthe follwing i the mast likely mechanism of ths beneficial effect? O A) Blockade of choline reuptake into presynaptic terminals © B) Blockade of effects on the nicotinic receptors on muscle © C) Enhanced influx of calcium into the presynaptic terminal O D) Prevention of acetylcholine release from subsequent action potentials © E) Prolongation of acetylcholine effects in the synaptic cleft € e 4 starttestcom +00 22, The.yaph shows he elton btwn serum apn concansaton an BMI expesto as (wiht ink) {ret mmtersor eg palens labled Atrought The dshed ins nat fe upper and owe ins Stora! Which re eowing patente most} hes primary lop elonay? QA) Patents © &) Paten's O C) Patient c O D) Patient D O &) patente mom?) O F) Pat O 6) Patents Om Patent e5e a wate £0 24. AS0.yearold man s brought tothe physician 2 days after the onset of double vision and drowsiness. Three weeks ago, he began using over-the-counter ‘cmetidne for dyspepsia, He has eplepsy treated with phenyton forthe past 2 years. Physical examination shows nystagmus and an ataxic gait. Which of the folowing effects of cimetcine on phenytoin is the mos key cause of the adverse effects in this patient? O A) Atered binding to plasma proteins O B) Attered binding to tissue receptors © ©) Altered distribution to active receptors D) Inhibition of metabolism © E) Inhibition of renal excretion € e ¢ stantesteom 24 25. AS59.year-old man comes tothe physician because of a 3-month history of progressive dificlty swallowing: he has had a 6 kg (151b) weight loss during this period, He has smoked 1 pack of cigarettes dally for 40 years and consumes four to six beers dally. He Is cachectc. Bilateral wheezes are heard on ‘auscultation of the chest. A chest x-ray shows enlargement ofthe partracheal and hilar lymph nodes. Subsequent endoscopy shows a 6-cm mass inthe rid esophagus. The mass is centrally ulcerated with an elevation ofthe surrounding mucosal rim. Examination ofa biopsy specimen ofthe mass is most likely to show neoplastic cals with which ofthe folowing? O A) Acinar formation O B) Foci of keratinization © ©) intracytoplasmic pigment O D) Neuroendocrine granules: O E) Smooth muscle differentiation eoe¢ a startestcom Pw 28. 25-year-old primigravid woman at 12 weks' gestation comes tothe physician 1 hour after she passed a small amount of tissue vaginally at home. Gross ‘examination of his tissue shows an obvious fetus. Microscopic examination of issue obtained via dilatation and curettage shows chorionic vill with focal ‘edema and trophoblastic prolferation. Which of the following is the most ikely agnosis? O A) Choriccarcinoma © 8B) Complete hydaticiform mole C) Partial hydaticitorm mole O D) Placenta accreta © E) Placental site trophoblastic tumor € e 4 starttestcom +a 27. A2%.year-old boy is admitid to the hospital because of generalized weakness, repeated episodes of vomting, and coma after several days of reduced food intake because of a minor febrile ness. He is treated successfuly with intravenous glucose. After 13 hours of fasting when the chilis well his serum glucose, B-hydroxybutyrate, and free camitine concentrations decrease markedly, and serum concentrations of long-chain ecycamitines increase. “eiglycerdes containing only medium-chain fay acids are fed, andthe serum -hydroxybutyrate concentration increases tothe reference range. Which of the folowing disorders of faty acid metabolism isthe most Ikely dagnos's? O A) Camitine-acylcamitine transiocase deficiency © B) Dietary carnitine deficiency © C) Fatty acy! CoA synthetase deficiency O D) Medium-chain acy! CoA dehydrogenase deficiency © E) Short-chain acy! CoA dehydrogenase deficiency © ¢e 4 starttest.com +oo- 28. AS2:yearold man comes to the physician because of a 5-day history of headaches and muscle weakness. His blood pressure is 175/95 mm Hg, Physical ‘examination shows no other abnormalities, Laboratory studies show: Serum Nav 142 meq ke 2 meq. Hoos 33 mEqL, Creatinine 1.4 mold Cortisol <2. ‘Asteria blood gas analysis on room air pH 745 Peo, 48 mmHg Plasma rein activity is undetectable. Which ofthe folowing isthe most ikely cause ofthis patients hypertension? O A) Addison disease © B) Chronic kidney disease O ©) Cushing disease O D) Hyperaidosteronism © E) Pheoehromecytoma ar strtetcon +o 0- 29. 35-year-old homeless man is brought tothe emergency department by police after they found him slumped on a bench. His pulse is 40min, respirations {are T0imin, and blood pressure Is 100/60 mm Hg, He Is stuperous but can be aroused when shaken milly, Physical examination shows constricted pups ‘This patent is most Iksly abusing which of the folowing substances? O A) Abcoho! O 8) Barbiturates: O €) Benzodiazepines O D) Marijuana O E) Opicias, € e 4 startestcom L+o00- 30. A22.yearold man s brought tothe emergency department 1 hour after belng involved ina motor vehicecolision. Physical examination shows deep lacerations tothe right lower extremity. Which ofthe following functional capabilties ofthe involved muscles wll be decreased by fibrotic scar formation at the sites of injury? © A) Formation of glycogen deposits © B) Maintenance of protonged tension O ©) Passive stretching © D) Relaxation after contraction 4 startestcom +60 31. Astudy is conducted to assess the prevalence and incidence of obesity in a group of middle-aged men. A total of 200 man between the ages of 40 and 50 years are chosen to participate, The table shows the number of partcpans al baseline and at the folow-up study 6 years later for each BMI range. ‘Number of Participants BM (gina, Normal (< 25) ‘Overweight (between 25 and 20) (Obese (2 30) Baseline ' Years Later 300 225 500 525 400 150 “The prevalence of obesity inthis study population after 5 years is which ofthe folowing? O A) sant00 O B) 50500 O ¢) 50800 © b) 50/900 O €) 150075 O F) 150/525 O @) 150/750 O ¥) 1507900 € e 4 starttestcom + oo: 32. ASS:yearold man comes tothe physician because of a -month history of hoarseness and dificly swallowing. He underwent an operation to resect a obo of his lung because of lung cancor 1 year ago. Physical examination shows ploss of the lft eyelid and miosis of tho lft pupil. There is diminished flushing and sweating onthe leh haf ofthe face, This patient most ikely has

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