Exam 16 Corrections

62-year-old F with recurrent non-small cell carcinoma of the lung is treated with chemo including vincristine. Which intracellular targets most likely affected by this drug?
A. bcl-2
B. Cyclin D1
C. DNA topoisomerase
D. Tubulin
D. Tubulin

Vinca alkaloids that bind
β-tubulin and inhibit
its polymerization into
mitotic spindle formation
(M-phase arrest).
Used for: Solid tumors, leukemias,
Hodgkin (vinblastine) and
non-Hodgkin (vincristine)
AE: Vincristine: neurotoxicity
(areflexia, peripheral neuritis),
constipation (including
paralytic ileus).

25-year-old F with irregular menstrual periods and progressive acne. BMI 35. Voice is deep. Dark hair over the upper lip and chin, and open and closed comedones over the face, chest and back. Serum will show?
(Fasting insulin;Testosterone; Luteinizing Hormone)

A. Increased; Increased; Increased
B. Increased; Increased; Decreased
C. Increased; Decreased; Increased
D. Decreased; increased; decreased

A. Fasting insulin=increased; Testosterone=increased; and LH= increased.

Hyperinsulinemia and/or insulin resistance hypothesized to alter hypothalamic hormonal feedback
response-> increased LH:FSH and increases androgens (testosterone) from theca interna cells.

4-month-old boy with autosomal recessive skeletal dysplasia involving abnormal endochondral bone formation. Genetic analysis shows null mutations in a gene for a protein that controls the traffic of vesicles into the Golgi complex. Electron microscopy of cells will show?
A. Decreased rough ER
B. Decreased smooth ER
C. Dilated rough ER
D. Increased smooth ER
C. Dilated rough ER

Null mutation: A mutation (a change) in a gene that leads to its not being transcribed into RNA and/or translated into a functional protein product.

So protein that controls the traffic of vesicles into the golgi complex is non-functional. Golgi is the distribution center for proteins and lipids from ER (particularly the rough ER) to the vesicles and plasma membrane.

Rough ER= Site of synthesis of secretory (exported) proteins

Smooth ER=Site of steroid synthesis and detoxification of
drugs and poisons.

8-year-old girl is brought to the physician for a well-child examination. Her mother says that she has been well except for an occasional cold. Her immunizations are up to date. She is at the 50th percentile for height and 60th percentile for weight. Physical examination shows breast bud development and a few pubic hairs. The mother asks whether her daughter’s development is normal. Which of the following is the most appropriate initial response by the physician?
A. I am concerned that your daughter may of precocious puberty
B. I would like to order labs to ensure your daughter’s development is normal
C. Your daughters development is normal
C. Your daughters development is normal

Has some breast bud development and a few pubic hairs so beginning Tanner Stage II Development which is age appropriate (should be reached by ~10-11.5 years)

Viral Reassortment
When viruses with segmented genomes (eg, influenza virus) exchange genetic material.
Ex of segmented viruses: Bunyavirus (Hantavirus), Orthomyxovirus (Influenza), Arenavirus, and Reovirus (Rotavirus)

To understand which viral gene segments are assoc with a particular phenotype look at the resassortment strains and determine how the presence of the segment affects the growth of the virus

Female newborn delivered to 35-yo F. Pregnancy complicated by untreated maternal Graves disease. Respirations are 66/min. Stridor, nasal flaring, intercostal retractions, and an asymmetric neck mass. Cause of the stridor?
A. Cystic hygroma
B. Enlarged thyroid gland
C. Thyroglossal duct cyst
D. Tracheomalacia
B. Enlarged thyroid gland

GRAVES DISEASE often presents during stress (like pregnancy). Thyroid-stimulating immunoglobulin (IgG so crosses the placenta) stimulates the TSH receptors on newborns thyroid too!

Thyroglossal duct cyst presents as an anterior midline neck mass that moves with swallowing or protrusion of the tongue.

51-year-old M with 3-mo hx of hepatitis B antigen-negative polyarteritis nodosa has progressive proximal muscle weakness and myalgia. A biopsy specimen of involved muscle would show?
A. Central vacuolization with lipid accumulation
B. Periodic acid-Schiff positive intramyofibrillar vacuoles
C. Segmental ischemic necrosis
C. Segmental ischemic necrosis

PAN=Medium vessel vasculitis
Typically involves renal and visceral vessels, not
pulmonary arteries.
Immune complex mediated.
Transmural inflammation of the arterial wall
with fibrinoid necrosis.

Period acid-Schiff stain= tains glycogen, mucopolysaccharides; used to diagnose Whipple disease

76-year-old M with a 1-month hx of pulsatile abdominal mass dx with an abdominal aortic aneurysm. CT scan with contrast also showed incidental finding of a horseshoe kidney. Surgical approach to repair aneurysm to be further complicated be presence of which?
A. Abnormal origin of the SMA
B. Anomalous origins of multiple renal arteries to each kidney
C. Multiple ureters with abnormal courses
B. Anomalous orgins of multiple renal arteries to each kidney

Horseshoe kidney: Inferior poles of both kidneys fuse
abnormally. As they ascend from pelvis during fetal development, horseshoe kidneys get trapped under inferior mesenteric artery and remain low in the abdomen. Will only have max of 2 ureters originating from it

55-year-old F has headache, T to 40 C, stiff neck and confusion. Spleen removed due to injury in MVC 7 months ago. Most likely organism in cerebrospinal fluid?
A. Cryptococcus neoformans
B. Haemophilus influenzae
C. Streptococcus pneumoniae
C. Strep pneumoniae
Asplenic so encapsulated microbes: Encapsulated microbes, especially SHiN
(S pneumoniae >> H influenzae type B >
N meningitidis)

Most common cause of meningitis in ppl 6-60 yrs:
S pneumoniae
N meningitidis (#1 in teens)

Incidence of H influenzae meningitis has greatly decreased with introduction of the conjugate H influenzae vaccine in last 10-15 years. Today, cases are usually seen in unimmunized children.

Investigator studying strains of streptococcus pneumoniae to monitor effect of a conjugate polysaccharide vaccine on expression of different capsule types. After incubation of a nonencapsulated strain of S. pneumoniae with the lysate from heat-killed S. mitis, colonies of S. pneumoniae expressing the new capsular type are identified. However, no colones of S. pneumo are isolated after addition to DNAse to the lysate. Mechanism causing transfer of genes encoding new capsular type?
A. Bacteriophage transduction
B. Natural transformation
C. Plasmid transfer
B. Natural transformation

Ability to take up naked DNA (ie, from cell lysis) from environment (also known as “competence”). A feature of many bacteria, especially S pneumoniae, H influenzae type B, and Neisseria (SHiN). Any DNA can be used. Adding deoxyribonuclease to environment will degrade naked DNA in
medium->no transformation seen.

Transduction= A “packaging” event. Lytic phage infects bacterium, leading to cleavage of bacterial DNA. Parts
of bacterial chromosomal DNA may become packaged in phage capsid. Phage infects another bacterium, transferring these genes

49-year-old woman with breast cancer develops increased numbness of both hands and feet between chemotherapy doses. Sensation to pinprick and fine touch decreased over hands, wrists, ankles, and feet. Which is most likely disrupted in this patient as a result of the chemo?
A. Microtubules for axonal transport
B. Myelin sheaths for saltatory conduction of action potentials
C. Neurofilaments for structural support of axons
A. Microtubules for axonal transport

Chem agent: Paclitaxel, other taxols
Hyperstabilize polymerized
microtubules in M phase so
that mitotic spindle cannot
break down (anaphase cannot
Used for: Ovarian and breast carcinoma
AE: Myelosuppression, neuropathy,

Microtubules are involved in slow axoplasmic transport in

9-year-old boy with 1-yr hx of cough productive of mucoid sputum, wheezing, and shortness of breath with exertion. Hx of recurrent URI and sinus infections since birth. 25%ile for height and weight. Younger sibling is beginning to develop similar problems. Mild clubbing of the fingers, markedly increased sweat chloride and sodium concentrations. Defect in which of bronchial epithelium causing symptoms?

A. Adrenoreceptors
B. Membrane receptors
C. Nuclear receptors
D. Protein regulation
E. Protein structure

E. Protein structure

CTFR gene defect-> misfolded protein-> protein retained in RER and not sent to cell membrane

CFTR encodes an ATP-gated Cl− channel that secretes Cl− in lungs and GI tract, and reabsorbs Cl− in sweat glands. So there’s a defect in this channel which is a protein structure

Study to evaluate the relationship between ambient noise and hearing loss in automobile manufacturing plant. Each employee is given a test for hearing acuity, and then the ambient noise is measured at his/her workstation. Study design?
A. Case series
B. Cohort
C. Crossover
D. Cross-sectional
D. Cross-sectional
Collects data from a group of people to assess
frequency of disease (and related risk factors) at
a particular point in time.
Disease prevalence.
Can show risk factor association with disease, but
does not establish causality.

Cohort=Compares a group with a given exposure or risk
factor to a group without such exposure. Looks to see if exposure affects the likelihood of disease.

Study to assess 32 patients in a community of 1000 who have developed drug-resistant tuberculosis during a 1-year period. Patients removed from the community for Rx. Assuming risk for infection and susceptibility to disease is constant, which best represents the number most likely to develop drug-resistant TB during the next year?
A. 27
B. 29
C. 31
D. 32
E. 33
32/1000 = 3.2%
1000 – 32 = 968
3.2% X 968 = 31
12-year-old girl. Three months ago, sustained complex fracture of the left tibia. Cast is removed, and left calf is smaller than the right calf. Which process in myocytes is cause?
A. Anaerobic glycolysis
B. Fatty acid degradation
C. Glycogenolysis
D. Oxidative phosphorylation
E. Polyubiquitination
E. Polyubiquitination
INCREASED PROTEIN DEGRADATION = increased polyubiquitination in the muscle cells.
In order for proteins to be degraded via proteasomes, they have to be modified by ubiquitination.
24-year-old woman stung on her right thumb by a bee 30 minutes ago. Urticarial lesion at site of sting. Six hour later, area has become indurated and firm. Explanation of the induration?
A. Decrease in the expression of adhesion molecules on vascular endothelial cells
B. Decrease in serum C-reactive protein concentration
C. Influx of macrophages producing IL-1, IL-6, and tumor necrosis factor-a
D. Vasoconstriction
C. Influx of macrophages producing IL-1, IL-6, and tumor necrosis factor-a

Induration= an increase in the fibrous elements in tissue commonly associated with inflammation and marked by loss of elasticity and pliability

Bee sting-> Anaphylaxis Type 1 hypersensitivity

Induration formation simular to granuloma formation. Macrophages produce:
IL1= Causes fever, acute inflammation. Activates
endothelium to express adhesion molecules.
Induces chemokine secretion to recruit WBCs.
IL-6= Causes fever and stimulates production of acute phase
TNFa= Mediates septic shock. Activates endothelium.
Causes WBC recruitment, vascular leak.

65-year-old F with HTN with 3-hr hx of headache, chest pain, and shortness of breath. BP 230/110. Initiate treatment with a nonselective antagonist that blocks alpha-1 and beta. Which drug most appropriate?
A. Hydralazine
B. Labetalol
C. Phenoxybenzamine
D. Phentolamine
B. Labetalol
This and Carvedilol are the two nonselective alpha and beta antagonists

Phentolamine= nonselective reversible alpha blocker. Given to patients on MAOIs who eat tyramine containing food

27-year-old F concerned she has sleep apnea. Snores twice during past year. Feels rested in the morning, no daytime sleepiness. BMI 23. Pulse is 60/min and BP is 115/65. No abnormalities on PE. Most appropriate initial action?
A. Reassurance
B. Recommend that the patient keep a sleep diary
C. Order an arterial blood gas analysis
A. Reassurance

Sleep Apnea: Repeated cessation of breathing > 10 seconds during sleep->disrupted sleep->daytime
somnolence. Normal Pao2 during the day.

27-year-old nulligravid inability to conceive for 2 years. Menses at 3- to 4-month intervals since menarche at 14 years Follicle-stimulating hormone, luteinizing hormone, and estrogen wnl. Most appropriate Rx?
A. Clomiphene
B. Low-dose estrogen
C. Medroxyprogesterone
A. Clomiphene
Is a selective estrogen receptor modulator: Antagonist at estrogen receptors in hypothalamus. Prevents normal feedback inhibition and increases release of LH and FSH from pituitary, which stimulates ovulation. Used to treat infertility due
to anovulation (eg, PCOS).
May cause hot flashes, ovarian enlargement, multiple simultaneous pregnancies, visual disturbances.

Medroxyprogesterone is used for contraception

83-year-old M with 3-day hx of painful blisters on his torso. Numerous 0.5- to 1-cm, clear-fluid-filled, tense blisters over the trunk. Histopathologic exam shows a subepidermal blister. Production of autoantibodies directed at which?
A. Bullous pemphigoid antigen
B. Collagen, Type VII
C. Cytokeratin
D. Desmoplakin
A. Bullous pemphigoid antigen

Less severe than pemphigus vulgaris (autoAB against desmoplakin causes flaccid bullae) . Involves IgG antibody against hemidesmosomes (epidermal basement membrane; antibodies are “bullow” the epidermis). Causes tense blisters that contain eosinophils.

10-year-old girl appears pale. Father underwent splenectomy as youth for “low blood” and recently had cholecystetomy. CBC shows Hb 6.4, MCV 90.2, WBC 6K, platelets 188K, reticulocytes 9%. Blood smear shown. Most common underlying abnormality that accounts for these clinical manifestations?
A. Abnormal HB structure
B. Abnormal Fe Absorption
C. Deficiency of erythrocyte spectrin
D. Impaired oxidative enzyme function
C. Deficiency of erythrocyte spectrin

Hereditary spherocytosis=Spheroid erythrocytes due to spectrin or ankyrin defect; hemolytic anemia; increased MCHC, increased RDW. Results in small, round RBCs with less surface area and no central pallor. Autosomal dominant
Treatment: splenectomy.

A 35 year old women participates in a study of diagnostic test of steroid hormones in saliva. Menses occurs at regular 28 day intervals and she ovulates on day 14. When her saliva is tested on a particular day of the cycle labs show an increased concentration of estradiol and decreased concentration of progesterone. On which of the following days in this patient’s menstrual cycle were these hormones most likely measured?
A. Day 1
B. Day 6
C. Day 12
D. Day 18
E. Day 26
C. Day 12
Increased concentration of estrogen and decreased concentration of progesterone means she is around ovulation period (Day 14). Estrogen concentrations hit their peak just before ovulation
70yo F with persistent fever despite intravenous broad-spectrum antibiotic after surgery for recurrent cervical carcinoma. T 38.5. Has central venous catheter, well healing wound, two drains. Blood cultures grown on sheep agar plate. Gram stain shows 4-um, elliptical, purple, budding organisms. Which of the following is most likely causal organism?

A. Candida albicans
B. Cryptococcus neoformans
C. E.coli
D. S.aureus

A. Candida albicans
Forms pseudohyphae and budding yeasts at 20°C

S.aureus would be purple spherical clusters. Beta hemolytic so on blood agar: Complete lysis of RBCs->clear area surrounding colony on blood agar

70yo F 45 minutes after unresponsive in living room. Has generalized anxiety disorder treated with diazepam. Recently began taking OTC med for heartburn. Interaction with which drug is cause of her condition?
A. Calcium carbonate
B. Cimetidine
C. Famotidine
D. Magnesium trisilicate
E. Ranitidine
B. Cimetidine= CYP450 inhibitor
So phase I of drug metabolism is inhibited and diazepam (benzo) hangs around a little longer causing overdose effects (CNS depressant)
12yo girl immigrated to USA from central Africa with 5-week hx of increasingly severe abdominal pain and vomiting blood. T 37.8, P 110/min rr 27/min. Hepatosplemonmegaly and abdominal ascites. Labs: Leukocyte count=13,400 (n=4500-13500), Segmented neutrophils 42% (low), Eosinophils 15% (high), Lymphocytes 37%, Monocytes 6%, Photomicrograph of stool specimen shown. Appropriate Rx?
A. Fluconazole
B. Levofloxacin 
C. Metronidazole 
D. Praziquantel 
12yo girl immigrated to USA from central Africa with 5-week hx of increasingly severe abdominal pain and vomiting blood. T 37.8, P 110/min rr 27/min. Hepatosplemonmegaly and abdominal ascites. Labs: Leukocyte count=13,400 (n=4500-13500), Segmented neutrophils 42% (low), Eosinophils 15% (high), Lymphocytes 37%, Monocytes 6%, Photomicrograph of stool specimen shown. Appropriate Rx?

A. Fluconazole
B. Levofloxacin
C. Metronidazole
D. Praziquantel

D. Praziquantel (only anti-helminth)
Most likely Schistosoma on photomicrograph which can cause spleen and liver enlargement

Metronidazole=Treats Giardia, Entamoeba, Trichomonas

2 days after right hip replacement, 67yo F has SOB and pain on right side of back with deep breathing. Appears anxious. P 100/min, rr 24/min. Pleural friction rub heard in right lung base. Right calf shows erythema and induration. Rx with Oxygen, rL/min. ABG shows: pH 7.54 (high), PCO2 29 (low), PO2 61 (low). CT angiography shows large embolism occluding blood flow to the right lower lobe. Which describes ventillation-perfusion relationship in right lower lobe?
A. Dead space
B. Diffusion abnormality
C. Hypoventilation
D. Low FiO2
E. Shunt
A. Dead space= Pathologic dead space—when part of the
respiratory zone becomes unable to perform gas exchange. Ventilated but not perfused!

FiO2= fraction of inspired oxygen

23yo M with 2-week hx of back pain refractory to OTC meds. Demands opioid drugs. Physical is normal. Most appropriate action by physician?
A. Determine which drugs have been prescribed for the patient in the past
B. Obtain serum tox screening on the patient
C. Order a MRI of the spine
D. Refer the patient to a drug addiction program
A. Determine which drugs have been prescribed for the patient in the past
2 sets of patients (Group X and Y) or similar age, weight, gender, and health status are given general anesthesia by inhalation. In Group X anesthesia is induced by adminstering isoflurane at a concentration 1.5 times the min. alveolar concentration (MAC) for this drug. In Group Y, anesthesia is induced by administering a combo of isoflurane and nitrous oxide, each at 0.75 times the MAC for that drug. The onset of anesthesia is found to be significantly faster in Group Y than in Group X. The different response rates btw the 2 groups is best explained by differences in which of the following properties of isoflurane and nitrous oxide?
A. Blood: gas partition coefficient
B. Brain:blood partition coefficient
C. Brain: gas partition coefficient
D. Hepatic metabolism
E. Lipid solubility
F. Minimal alveolar concentration
A. Blood:gas partition coefficient

Drugs with decreased solubility in blood= rapid induction and recovery times. Nitrous oxide tends to have decreased blood and lipid (crossing the blood-brain barrier) solubility so has fast induction and low potency

MAC = Minimal Alveolar Concentration (of inhaled anesthetic) required to prevent 50% of subjects from moving in response to noxious stimulus (eg, skin incision).

A pale 62 yo man presents with increasing fatigue and indigestion over the past few months and decreasing appetite over the past few weeks. He has moderate splenomegaly but no lymphadenopathy.
Labs: Hb 9 (low), Hemocrit 27% (low) Leukocyte count 3100 (low) Neutrophils 20% (low) Lymphocytes 75% (high) Monocytes 5%, Platelet count 75,000 (low).
The lymphocytes have cytoplasmic projections and are acid phosphatase positive even in the presence of tartrate. Dx?

A. Acute lymphoblastic leukemia
B. Acute myelogenous leukemia
C. Chronic lymphocytic leukemia
D. Chronic myelogenous leukemia
E. Hairy cell leukemia

E. Hairy cell leukemia

Age: Adult males. Mature B-cell tumor. Cells have filamentous, hair-like projections (fuzzy appearing on Light Microscopy ).
Causes marrow fibrosis->dry tap on aspiration. Patients usually present with massive splenomegaly.
Stains TRAP (tartrate-resistant acid phosphatase) ⊕. TRAP stain largely replaced with flow cytometry.

16-year-old girl 20 minutes after generalized tonic-clinic seizure at home. Two more seizures after arrival. Unable to urinate, confused. P 120/min rr 24min, BP 170/109. Enlarged uterus. Deep tendon reflexes are 4+ with 1+ clonus bilaterally. Lab: Leukocyte count 15,000 (high); Platelet count 90,000 (low); Uric acid 9.6 (high); Lactate dehydrogenase 328 (high), ALT & AST (high), Creatinine 1.7 (high)
Ultrasonography shows normal fetus consistent in size with 30-week gestation. Diagnosis?
A. Drug overdose
B. Eclampsia
C. Epilepsy
D. Renal disease
E. Sepsis
B. Eclampsia
Preeclampsia(New-onset hypertension with either proteinuria
or end-organ dysfunction after 20th week
of gestation) + maternal seizures + HELLP syndrome (Hemolysis (increased LDH), Elevated Liver enzymes,
Low Platelets.)
40 yo women come to ER with 1 week history of abdominal pain and watery, bloody diarrhea. 1 month ago went on 2 week vacation to Kenya. Vital signs normal. Microscopic exam of stool specimen shows 12 nm trophozoites displaying erythrophagocytosis. Most likely causal organism?
A. Entamoeba histolytica
B. Leishmania donovani
C. Taenia saginata
D. Toxoplasma gondii
E. Trypanosoma cruzi
A. Entamoeba histolytica
Amebiasis—bloody diarrhea (dysentery) liver abscess
(“anchovy paste” exudate), RUQ pain; histology shows flask-shaped ulcer.
Dx via: Serology and/or trophozoites (with engulfed RBCs in the cytoplasm) or cysts with up to 4 nuclei in stool
23yo M with difficulty maintaining an erection. Damaged his thoracic spinal cord, affecting motor and sensory function of the lower trunk and extremities. Able to obtain erection through physical contact and erection does not last long. Best explanation is an intact spinal reflex arc between the sacral parasympathetic nerves and which of the following?
A. Genitofemoral nerves
B. Illioinguinal nerves
C. Lumbo sacral trunks
D. Obturator nerves
E. Pudendal nerves
E. Pudendal nerves

Erection—Parasympathetic nervous system
(pelvic nerve):
Emission—Sympathetic nervous system
(hypogastric nerve).
Ejaculation—visceral and Somatic nerves
(pudendal nerve).

28 yo women gravida 2 and para 1 comes to physician at 36 weeks gestation bc of a 3 week history of intermittent anal itching, pain with defecation, and occasional bright red blood with wiping. She admits to intermittent constipation for which she used mineral oil enemas. On exam perianal areas has erythemotous with brownish purple lesion. Which of the following is the most likely underlying cause of the lesion on this patient?
A. Candidiasis
B. Lymphatic obstruction
C. Varicella-zoster virus infection
D. Venous hypertension
D. Venous hypertension

Hemorrhoids develop when the veins of the rectum or anus become dilated or enlarged and can be either “internal” or “external.”
External hemorrhoids receive somatic
innervation (inferior rectal branch of pudendal nerve) and are therefore painful if thrombosed-> pain with defecation and bright red blood on wiping. Associated w/ low fiber diet and constipation.

62yo M with pain in the left hip for 3 weeks. X-ray of the hip shows 4.5-cm osteoblastic lesion with fracture in the proximal femur and two separate similar smaller lesions in pelvis. Biopsy of femur shows metastatic carcinoma. Most likely primary site of cancer?
A. Colon
B. Kidney
C. Lung
D. Pancreas
E. Prostate
E. Prostate
Mets to the bone: Prostate (blastic), breast (mixed) > lung (mixed), thyroid (lytic), kidney(lytic)
80 yo women with fever and cloudy urine 4 days after undergoing total left knee replacement. Temp= 38 C (100.4F0 PE: bandaged left knee and indwelling Foley catheter. Micro analysis of urine clean catch shows 12 WBC/hpf and numerous gram negative rods. Urine culture grows greater than 100,000 bacterial colonies/mL w/ a predominant colony type that is oxidase positive and produce a diffusible green pigment. What is the causal organism?
A. E.coli
B. Klebsiella pneumoniae
C. Proteus mirabilis
D. Pseudomonas aeruginosa
E. Strep. pyogenes (group A)
D. Pseudomonas aeruginosa
Associated with Nosocomial infections (catheters,
Aerobic, motile, gram ⊝ rod. Non-lactose
fermenting, oxidase ⊕. Produces pyocyanin
(blue-green pigment A )
62 yo man come to doctor for follow up appointment for followup. 2 weeks ago had a acute MI. Smokes 2 packs a day and drinks 4 12oz beers daily. His diet most consists of cured meats and fast food and he doesnt exercise. He tells doc ” i know that i need to make some changes in how i live so that my heart can be healthier. I just dont have the willpower to quite smoking and drinking and all that stuff right now.” Which of the following best describes this patients stage of behavioral change?
A. Precontemplation
B. Contemplation
C. Preparation
D. Action
E. Maintenance

1. Precontemplation—not yet acknowledging that there is a problem
2. Contemplation—acknowledging that there is a problem, but not yet ready or willing to make a
3. Preparation/determination—getting ready to change behaviors
4. Action/willpower—changing behaviors
5. Maintenance—maintaining the behavior changes
6. Relapse—returning to old behaviors and abandoning new changes

35 yo women is given 500 mg of drug X via IV. Several minutes later the serum concentration of drug X=12.5 mg/L. 2 hours later the serum concentration is 10 mg/L. Assuming drug X has first order elimination kinetics, which of the following will be the serum concentration of drug X (in mg/L) in another 2 hours?
A. 6
B. 6.5
C. 7
D. 7.5
E. 8
F. 8.5
E. 8
1ST order elimination = CONSTANT FRACTION (of drug eliminated per unit of time)

12.5 – 10 = 2.5 is the concentration eliminated in 2 hours
2.5 / 12.5 = 0.2 or 20% ELIMINATION (fraction of drug eliminated in 2 hours)
10 X (0.20) = 2
10 – 2 = 8 mg/L

26 month old boy is brought to the doc for a 3 day h/o of cough and mild SOB and 1 week h/o of fever. He has multiple cutaneous abscesses due to S.aureus during the past 9 months. Each of these abscesses were debrided and treated with systemic antibiotics. At birth, he was at the 50th percentile for length and weight. Today he is at the 10th percentile for length and 5th percentile for weight. He doesnt appear distressed. His temp is 39C (102.2F), pulse is 140/min respiration are 24/ min and BP 80/40 mmHg. Pulse oximetry on room air= 93% oxygen saturation. Oropharyngeal exam shows no abnormalities. Crackles are heard over the left posterior lung field. A chest x-ray shows a cavitary infilitrate in the left lingula. Cultures obtained via bronchoscropy grow a filamentous gram positive rod. What is the most likely causal organism?
A. Bacillus anthracis
B. Candida parapsilosis
C. Nocardia asteroides
D. Pneumocystis jiroveci
E. Streptococcus gallolyticus (formerly S.bovis)
C. Nocardia asteroides
Gram ⊕ and form long, branching filamentous rod resembling fungi.
Aerobe, causes pulmonary infection in immunocompromised
An animal study is conducted to assess the effects of smoking on pulmonary defense and maintenance mechanisms. For 1 week, normal male rats are exposed to levels of cigarette smoke comparable to those encountered by humans who smoke cigarettes. Results of pulmonary testing are compared with baseline levels obtained the week before the smoke exposure. Which of the following sets of changes is most likely to be observed?
(Mucus production and secretion; Activity of Airway Cilia; Alveolar Macrophage Function)
A. Increased; Increased; Increased
B. Increased; Increased; Decreased
C. Increased; Decreased; Decreased
C. Increased Mucus production; Decreased activity of airway cilia, and decreased alveolar macrophage function

Increased mucus production assoc with Chronic bronchitis
Decreased activity of airway cilia and alveolar macrophage function assoc with Bronchiectasis (chronic necrotizing infection of bronchi-> permanently dilated airways)

67-year-old F brother and mother have history of colon cancer. Physician recommends colonscopy, but patent only wants her stool to be tested for blood. Physician says that testing stool for occult blood is not appropriate in this case. Most likely concerned about which of the following regarding this test?
A. Low sensitivity
B. Low specificity
C. Potential for a false positive result
A. Low sensitivity
Sensitivity=Proportion of all people with disease who test
positive, or the probability that when the disease is present, the test is positive.

So with low sensitivity there too high of a chance for a false positive that would create a lot of stress.

29-year-old woman for advice on losing weight. Has been taking thyroxine for several months in attempt to lose weight. Her thyroid function is normal. Which findings is most likely on histopathologic eam of the thyroid gland?

A. C cell hypoplasia
B. Columnar metaplasia
C. Follicular atrophy
D. Glandular hypertrophy
E. Squamous metaplasia

C. Follicular atrophy

Thyroxine= thyroid hormone supplement. So exogenous thyroxine will inhibit the hypothalamus and anterior pituitary-> decrease in TRH(hypothalamus) and TSH (anterior pit)-> decrease in stimulation of thyroid follicular cells and follicular atrophy.

48-year-old man with possible hypertension. On basis of ten measurements, the patient’s average diastolic blood pressure is 113, and standard deviation is 8. If four rather than ten measurements are made, which is the expected impact on 95% confidence interval?
A. Change, but the direction cant be predicted
B. Decrease in width
C. Increase in width
D. Remain the same
C. Increase in width
Confidence interval= mean ± Z(SEM).
Standard Error of the Mean(SEM)= SD/ square root of (N)
SD= standard deviation and N= number of measurements
CI= mean ± Z(SD/ square root of (N)).
As N↑ SEM↓ and the CI gets wider!
5-year-old-boy with mental retardedation is grossly obese and has facial features of Prader-Willi syndrome. Karytoyping and flourescent in situ hybridization studies do not show deletion in the usual site. Which to confirm PWS?

A. Deletion in the short arm of chromosome 15
B. Duplication within the chromosome 15
C. Large trinucleotide repeat expansion in the PWS area of chromosome 15
D. Maternal origin of both chromosomes 15
E. Translocation in the short arm of chromosome 15

D. Maternal origin of both chromosomes 15

Imprinting= At some loci, only one allele is active; the
other is inactive (imprinted/inactivated by methylation). With one allele inactivated, deletion of the active allele →disease.

PWS= Maternal imprinting: gene from mom is normally
silent and Paternal gene is deleted/mutated. Results in hyperphagia, obesity, intellectual, disability, hypogonadism, and hypotonia.

30-year-old woman with Li-Fraumeni syndrome found to have adenocarcinoma of the breast. Family history includes osteosarcoma. Which mechanisms underlies this condition?
A. Activated proto-oncogenes
B. Defective detoxification enzymes
C. Defective DNA repair enzymes
D. Impaired regulation of apoptosis
E. Impaired signal transduction
D. Impaired regulation of apoptosis

Li-Fraumeni Syndrome: Abnormalities in TP53→multiple malignancies at an early age. Also known as SBLA cancer syndrome (sarcoma, breast, leukemia, adrenal gland).
TP53 gene: p53, activates p21, blocks G1→ S phase leads to apoptosis!

64 yr old alcoholic man with 1 day of confusion. Disoriented, disheveled. Dehydrated, jaundiced. and has spider angiomata over face and chest. Has flapping up and down of the hands when his arms are outstretched. Abdominal distention and bulging flanks. He is administered oral neomycin. Question asks which of the following primary mechanisms of action is most likely to occur in this patient as a result of the drug treatment?
A. Binding of ammonia and other hepatically cleared toxins in the gut
B. Blockade of new protein synthesis
C. Blockade of 2 succesive steps in the metabolism of folic acid
D. Increased endotoxin production where bacterial overgrowth occurs in the gut
E. Killing of bacteria in the gut that generate ammonia
E. Killing of bacteria in the gut that generate ammonia (NH4)
67-year-old man with 2-month hx of weight loss. Has type 1 DM, gallstone removal 12 years ago, smoked 1 pack daily for 45 years. BMI 34, Calcium concentration of 11 mg/dL. Abdominal CT shows a pancreatic mass, biopsy shows pancreatic adenocarcinoma. Strongest predisposing factor?
A. BMI of 34
B. Cigarette smoking
C. History of gallstone disease
D. Hypercalcemia
E. Type 1 DM
B. Cigarette smoking
7-year-old girl 30 minutes after being hit in the mouth with basketball. Something stuck in her throat. Part of one tooth is missing. Lateral x-ray of the neck and chest is shown; arrow shows part of the tooth. Greatest risk for aspiration into which lobe of the lung?
A. Left upper
B. Lingula
C. Left lower
D. Right upper
E. Right lower
E. Right lower

Right lung is more common site for inhaled foreign body because the right main stem bronchus is wider and more vertical than the left.
While upright— foreign body would enter inferior segment of
right inferior lobe.

During an experimental study of oxygen consumption in the kidney, experiemtnal animals are ventillated with 100% nitrogen. Cells from which of the following areas of the kidney first show signs of anoxic injury?

A. Bowman capsule
B. Distal convoluted tubule
C. Efferent arteriole
D. Glomerulus
E. Proximal tubule

E. Proximal tubule

Carries out most of the re-absorption in the nephron so needs.

PCT and medullary segment of the thick ascending limp particularly susceptible to ischemic damage-> acute tubular necrosis

1400-g female newborn delivered to a 33-year-old primigravid at 37 weeks’. Cardiac exam shows rough, grade 2/6, continuous, machine-like murmur along the left sternal border, as well as increased precordial activity and bounding peripheral pulses. Appropriate treatment will inhibit activity of which of the following enzymes?

A. Angiotensin converting enzyme
B. Cyclooxygenase
C. Guanylyl cyclase
D. Nitric oxide synthase
E. Phospholipase A2

B. Cyclooxygenase

Machine like murmur along left sternal border= Patent ductus arteriosus

Tx: w/Indomethacin to close PDA (inhibits COX1 and COX2)

56-year-old with palpable hard nodule on prstate has increased serum prostate-specific antigen concentration. Fine-needle biopsy specimen shows adenocarcinoma. Patient undergoes radical prostatectomy. Which structure is at greatest risk for injury during removal of prostate?
A. Dome of the bladder
B. Obturator Nerves
C. Pelvic parasympathetic nerves
D. Penile urethra
E. Ureterovesical junction
C. Pelvic parasympathetic nerves
33-year-old man with 3-month hx of muscle weakness and cramping, appears shortly after he begins exercising. Serum creatine kinase increased. Venous blood from antecubital vein show lactate concentrations do not increased compared with preexercise values. Deficiency of which enzymes in muscle?
A. Carnitine palmitoyltransferase-1
B. Fumarase
C. Glucose 6-phosphatase
D. Glycogen phosphorylase
E. Succinate dehydrogenase
D. Glycogen phosphorylase

Rate determining enzyme in glycogenolysis (Glycogen→glucose)

McArdle disease: (skeletal muscle glycogen phosphorylase
deficiency) Increased glycogen in muscle but muscle can’t break it down to use it. Chronic exercise intolerance with myalgia, fatigue, painful cramps, myoglobinuria.

2-year-old boy with developmental delay. Hx of hearing loss in mother and delayed speech in older sister. Maternal uncle had stroke-like episodes at the age of 25 years. Physical shows ophthalmoplegia and hypotonia. Lactic acid concentration increased. Explanation for the findings in this family?

A. Autosomal dominant inheritance
B. Decreased penetrance
C. Heteroplasmy
D. Imprinting
E. X-linked recessive inheritance

C. Heteroplasmy

Presence of both normal and mutated mtDNA, resulting in variable expression in mitochondrially inherited disease.
Ex: Mitochondrial myopathies!

56-year-old man scheduled for physical therapy 3 days following right shoulder operation. Therapy to strengthen the infraspinatus and teres minor muscles. Which should this patient perform against resistance?

A. Abduction
B. Adduction
C. Extension
D. Lateral (external) rotation
E. Medial (internal) rotation

D. Lateral (external) rotation

Infraspinatus (suprascapular nerve)—laterally
rotates arm; pitching injury.

Teres minor (axillary nerve)—adducts and
laterally rotates arm.

48-year-old woman with 6-month hx of irregular menstrual periods and hot flashes. LMP 35 days ago, and had scant blood flow. Menses had previously occurred at regular 28-day cycles. Mild thinning of the vaginal tissue. Labs most likely to show which of the following serum concentrations?

A. Decrease in adrenocorticotropic hormone
B. Decreased LH
C. Decreased TSH
D. Increased FSH
E. Increased prolactin

D. Increased FSH

↑↑ FSH is specific for menopause (loss of
negative feedback on FSH due to ↓ estrogen

16-year-old girl with cystic fibrosis with 3-week history of generalized weakness, numbness and tingling of her arms and legs, and difficulty walking. Not adhered to medications. Bilateral weakness and decreased deep tendon reflexes in the upper and lower extremities. Walks with an ataxic gait. Cause is deficiency of which?
A. Folic acid
B. Vitamin A
C. Vitamin B6 (pyridoxine)
D. Vitamin D
E. Vitamin E
E. Vitamin E

CF-> pancreatic insufficiency-> ADEK vit deficiency

Vit E deficiency: Hemolytic anemia, acanthocytosis,
muscle weakness, posterior column and spinocerebellar tract demyelination.

Vit A: Night blindness (nyctalopia); dry, scaly, skin (xerosis cutis); corneal degeneration (keratomalacia); Bitot spots on conjunctiva; immunosuppression.

25-year-old man comes to the physician 8 hours after the onset of severe pain of his low back that radiates down his left leg. He started a weight-lifting regimen earlier in the day during which he tried to lift a bar loaded with 91 kg (200 lb) from the ground to over his head. The pain began almost immediately after this attempt Which of the following is the most likely cause of this patients pain?
A. A fracture of a lumbar vertebra
B. Rupture of the deltoid tendon
C. Rupture of an intervertebral disc
D. A tear in the sciatic nerve
E. A torn muscle in the low back
C. Rupture of an intervertebral disc
Evidence of a Traumatic injury–> disc rupture/ herniation–> disc can impinge on other nerves cause radiating pain.

Nerve root impingement at the L5/S I intervertebral foramen level can result i n radiating low back pain down the back of the thigh into the leg to the foot,called sciatica.

Poliovirus mRNA lacks a 5′ m7G cap but is translated efficiently by cellular ribosomes. Which of the following additional structural features of poliovirus mRNA is the most likely cause of its ability to be translated in the absence of a cap?
A. Absence of a 3′ untranslated region
B. Absence of a poly (A) tail
C. Presence of an internal ribosome entry site
D. Very short open reading frame
C. Presence of an internal ribosome entry site

Translation goes from 5′ end→3′ end
The 5′ cap plays a role in the ribosomal recognition of messenger RNA during translation into a protein. Prokaryotes do not have a similar cap because they use other signals for recognition by the ribosome.

31-year-oldwoman with invasive squamous cell carcinoma of the cervix. Biopsy shows tumor cells express human papillomavirus, type 16 antigens. Which cell types plays a role in recognizing and killing these virus-infected tumor cells?
A. Dendritic cells
B. Macrophages
C. Myeloid precursors
D. Plasma cells
E. T lymphocytes
E. T lymphocytes
Endogenous antigen (like from an HPV infected tumor cell) would present it on an MHCI and CD8s would take care of it!

Dendritic cells are antigen presenting cells and express MHCII

35 y/o man with 3 yr history of enlarging nose, coarse facies, muscle weakness, increased hand/foot size. Large fleshy nose and prognathism on exam. High IGF-1 in serum. MRI shows pituitary adenoma. Morphologic analysis of the tumor shows a densely granulated somatotroph adenoma. Further studies show that the G alpha-s subunit of the tumor G proteins lack GTPase activity. The tumor cells most likely have an increased activity of which enzyme?
A. Adenylyl cyclase
B. Guanylyl cyclase
C. Janus kinase
D. Phospholipase C
E. Tyrosine kinase
A. Adenylyl cyclase
GTPase hydrolyze GTP->GDP which inactivate G protein so if there’s a mutation the G-protein/ G subunit will remain active leading to the increased activity of their respective enzyme.

Gs subunit and Gi subunit–> adenylyl cyclase

Gq subunit–> Phospholipase C

54yo F with acute myocardial infarction. No signs of heart failure, no murmur. 2 days later becomes SOB and diaphoretic. P 100/min, BP 160/98. Crackles bilaterally, murmur is heard. Most likely murmur?

A. Grade 2/6 diastolic decrescendo murmur heard best over the second and third left intercostal spaces
B. Grade 2/6, rumbling diastolic murmur heard best 2 cm left of the sternal border at the fourth left intercostal space
C.Grade 3/6 crescendo-decrescendo systolic murmur heard best at the second left intercostal space
D. Grade 4/6 continuous systolic and diastolic murmur heard best along the left sternal border
E. Grade 4/6, holosystolic murmur heard best over the lower left sternal border and the cardiac apex

E. Grade 4/6, holosystolic murmur heard best over the lower left sternal border and the cardiac apex

Post MI→Mitral Regurgitation:

Holosystolic, high-pitched “blowing murmur.”—loudest at apex and radiates toward axilla. MR is often due to ischemic heart disease (post-MI), MVP, LV dilatation.

Screening program for detection of vaginal Chlamydia trachomatis infection. seen in 500 of 2500 students. One year later, infection in additional 200 students. Annual incidence?
A. 8%
B. 10%
C. 16%
D. 20%
E. 28%
B. 10%

Incidence Rate = # of new cases/ # of people at risk (during a specified time period)

INCIDENCE = 200 new cases / 2000 at risk = 10%

79-year-old F fracture of the right hip. BMI 21. She swims, knits, gardens. What is most likely to decrease the patient’s risk for additional fractures?
A. Discontinue consumption of all alcoholic beverages
B. Discontinue gardening
C. Go for a long walk outside daily
D. Increase participation in swimming pool-based exercise classes to at least 3 times weekly
E. Lose weight
C. Go for a long walk outside daily

Gets sun exposure for vit D! and is considered a weight bearing exercise too!

Vit D (activated) increases GI and renal absorption of Ca

27-year-old M with Hodgkin lymphoma receives bone marrow transplant from first cousin. 2 weeks later, develops generalized erythematous maculopapular rash, diarrhea, and elevated concentrations of liver enzymes and bilirubin. Cause?

A. Donor macrophages secreting cytokines and affecting host cells
B. Donor plasma cells elaborating antibodies against host cells
C. Donor T lymphocytes reacting against host cells
D. Host macrophages secreting cytokines and affecting donor cells

C. Donor T lymphocytes reacting against host cells

Graft vs Host disease (Type IV hypersensitivity)
Grafted immunocompetent T cells proliferate in the
immunocompromised host and reject host cells with
“foreign” proteins →severe organ dysfunction.

Delayed (T-cell-mediated) type—sensitized T cells encounter antigen and then release cytokines (leads to macrophage activation).

38 yo F with 10-week hx of epigastric pain and frequent stools. Has had two episodes of renal calculi in 2 yrs. Superficial lipomata and mild epigastric tenderness. Upper endoscopy shows two large, nonbleeding duodenal ulcers. Gastric pH is 2.3, gastrin concentration is 2000. PPI started. Measurement of which is next step?

A. Serum calcium concentration
B. Serum cortisol concentration
C. Serum tissue transglutaminase activity
D. Stool a1-antitrypsin concentration
E. Urine 5-hydroxyindoleacetic acid concentration

A. Serum calcium concentration

Possible MEN 1:
Pituitary tumors (prolactin or GH)
Pancreatic endocrine tumors—Zollinger-
Ellison syndrome, insulinomas, VIPomas,
glucagonomas (rare)
Parathyroid adenomas

24-year-old African American M with 3-mo Hx of red bumps on his face and chin, istchy and painful. Hyperpigmented papules over the cheeks, jawline, and neck. Dx?
A. Acne vulgaris
B. Cutaneous lupus erythematosus
C. Keloids
D. Pseudofolliculitis barbae
E. Rosacea
D.Pseudofolliculitis barbae

Foreign body inflammatory facial skin d/o characterized by firm, hyper-pigmented papules and pustules that are painful and pruritic. Located on the cheeks, jawline, and neck. Commonly occurs as result of shaving (razor bumps). Primarily affects black males

39-year-old F with T1DM with fatigue for 3 weeks. Having hypoglycemic events. Needs injection of a drug with which mechanism during hypoglycemic events?
A. Decreased intestinal absorption of glucose
B. Enhances metabolism of insulin
C. Promotion of peripheral insulin uptake
D. Promotion of skeletal muscle glucose release
E. Stimulation of hepatic glucose production
E. Stimulation of hepatic glucose production
Glucagon stimulate liver to preform Glycogenolysis, gluconeogenesis (glucose production)
Lesch-Nyhan syndrome, an x-linked recessive disease, seen in 1/100,000 males. Expected prevalence of heterozygous females?
A. 1/1000
B. 1/10,000
C. 1/50,000
D. 1/200,000
E. 1/10,000,000
C. 1/50,000

X-linked recessive so heterozygous females are the carrier and will have more prevalence than the males whos are actually affected by disease

18-year-old M with acute lymphoblastic leukemia with 3-day hx of fever & left sided chest pain. Taking chemo asparaginase, disorubicin, prednisone, and vincristine. ANC less than 500. T 39.2. Lower lobe infiltrate and a moderate pleural effusion on the left. Photomicrograph of a periodic acid-Schiff stain of pleural fluid obtained via thoracentesis is shown. Appropriate Rx?
A. Amphotericin B
B. Ertapenem
C. Ganciclovir
D. Infliximab
E. Rituximab
A. Amphotericin B

Binds ergosterol (unique to fungi); forms membrane pores that allow leakage of electrolytes.
Used for: Serious, systemic mycoses. Cryptococcus (amphotericin B with/without flucytosine for cryptococcal meningitis), Blastomyces, Coccidioides, Histoplasma, Candida, Mucor. Intrathecally for fungal meningitis.
Supplement K+ and Mg2+ because of altered renal tubule permeability.

periodic acid-Schiff stain: stains glycogen and mucopolysaccharides so the cell walls of fungi stain magenta; this only works on living fungi

Budding yeast.

Possibly crypto?

2-year-old boy with increased thirst, urinary frequency, and failure to thrive. T 38C (100.4F), dehydration and decreased muscle tone. Diagnosed with Fanconi syndrome. Which change in fractional reabsorption in kidneys?
(Amino Acids; Glucose; Phosphate; HCO3)

A. Increased; Increased; Increased; Increased
B. Increased; Increased; Decreased; Decreased
C. Decreased; Decreased; Increased; Decreased
D. Decreased; Decreased; Decreased; Decreased

D. Amino Acids decreased; Glucose decreased; Phosphate decreased; HCO3 decreased

Fanconi’s syndrome:

Generalized reabsorptive defect in PCT.
Associated with ↑excretion of nearly all amino acids, glucose, HCO3-, and PO4. May result in metabolic acidosis (proximal renal tubular acidosis).

Causes include hereditary defects (eg, Wilson disease, tyrosinemia, glycogen storage disease, cystinosis), ischemia, multiple myeloma, nephrotoxins/drugs (eg, ifosfamide, cisplatin, tenofovir,expired tetracyclines), lead poisoning.

Investigator studying regulation of pulmonary lymphatic flow. Catheters in femoral vein, pulmonary artery (where drugs can be directly injected), and main lymphatic vessel draining the lungs in animals. Which will most likely increase the flow of pulmonary lymph in these animals?

A. Administration of endothelin-1 into the pulmonary artery
B. Administration of phenyelephrine into pulmonary artery
C. Decreasing the inspired oxygen concentration from 21% to 10%.
D. Increasing the inspired carbon dioxide concentration from 0.3% to 3%
E. Intravenous infusion of 0.9% saline for 5 minutes
F. Intravenous infusion of 20% albumin solution (20g/100ml saline) for 5 minute

E. Intravenous infusion of 0.9% saline for 5 minutes

0.9% Saline→ ↑pulmonary hydrostatic pressure (pushes saline like the NaCl out of capillary)→0.9% saline freely filtered→ ↑filtration→ ↑fluid volume in the extracellular space→ ↑lymph flow

Lymph come from extracellular fluid to the only way to increase it would be to adjust the tonicity of blood stream by adding a solution so either E or F.

Albumin (F) would increase the oncotic pressure and pull fluid in to the capillary where as 0.9% saline would increase the hydrostatic pressure just enough to push the saline out to be filtered and increase the lymph flow

12-year-old boy with 6-mo hx of difficulty walking and leg pain. Mild atrophy of the lower extremities and hammer toes. High-stepping gait. Nerve biopsy will show?
A. Abnormal myelin sheaths
B. Absence of Schwann cells
C. Degeneration of astrocytes
D. Degeneration of oligodendrocytes
A. Abnormal myelin sheaths

Charcot Marie Tooth disease:
Also known as hereditary motor and sensory neuropathy (HMSN). Group of progressive hereditary nerve disorders related to the defective production of proteins involved in the structure and function of peripheral nerves or the myelin sheath. Typically autosomal dominant inheritance pattern and associated with foot deformities (pes cavus), lower extremity weakness and sensory deficits.

Oligodendrocytes myelinate axons in CNS

24-year-old M with nasal congestion, discharge, and sneezing. Happen each spring. Which drugs is most effective in relieving these sx in the short term?

A. a-adrenergic agonist
B. a-adrenergic antagonist
C. Nicotinic cholinergic agonist
D. Nicotinic cholinergic antagonist

A. a-adrenergic agonist
Pseudoephedrine, phenylephrine
α-adrenergic agonists, used as nasal decongestants
Reduce hyperemia, edema, nasal congestion; open obstructed eustachian tubes.
35-year-old M at work-sponsored depression screening program. For past 2 years has felt down. Unmotivated and pessimistic about the future, little energy for relationships or work. No change in appetite or sleep, and able to continue to work. No suicidal thinking. Dx?
A. Adjustment disorder with depressed mood
B. Biopolar disorder
C. Dysthymic disorder
D. Major depressive disorder
C. Dysthymic disorder
AKA persistent depressive disorder (dysthymia)= depression often milder lasting at least 2 years
54yo M has aneurysm in the distal portion of his abdominal aorta. Cross-sectional area is 2cm^2 and mean velocity of blood flow is 20 cm/sec. Which is the flow rate (L/min) through the aneurysm?

A. 1.0
B. 2.4
C. 3.2
D. 3.6
E. 4.0

B. 2.4

Volumetric flow rate (Q) = flow velocity (v) ×
cross-sectional area (A)

Q= 20 cm/sec × 2 cm^2= 40 cm^3/sec ×60 sec/min×0.001L/cm^3= 2.4 L/ min

0.001L= 1 cm^3

40-year-old F. Eats only natural organic foods. Serum triglyceride of 380. Suggests to try taking fish oil and a supplement to treat dyslipidemia. Which describes mechnaism of action of appropriate vitamin for this patient?

A. antagonized VLDL cholesterol secretion
B. Increases catabolism of LDL cholesterol
C. Inhibits cholesterol uptake
D. Stimulates PPAR-a receptors

A. antagonized VLDL cholesterol secretion

Niacin=Vitamin B3
Inhibits lipolysis (hormonesensitive lipase) in adipose
tissue; reduces hepatic VLDL synthesis

Fibrates stimulate PPAR-a receptors to induce HDL synthesis

Study of Plasmodium infection in animal model. Animals inoculated with various species. Chloroquine is administered and the effects of the treatment on hypnozoites in liver are observed. After treatment hypnozoites from Which two Plasmodium species will stay viable?

A. P. falciparum and P. malariae
B. P. falciparum and P. ovale
C. P. faciparum and P.vivax
D. P. vivax and P.ovale

P. vivax and P.ovale

Chloroquine: (for sensitive species), which blocks
Plasmodium heme polymerase;

P vivax/ovale—48-hr cycle (tertian;includes fever on first day and
third day, thus fevers are actually48 hr apart); dormant form
(hypnozoite) in liver
So tx with Cloroquine add primaquine for hypnozoite (test for
G6PD deficiency)