some NBME forum 2 questins

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Posted by Nasi from IP 65.112.121.29 on February 06, 2006 at 13:17:42:

Endothelial cells of the postcapillary venules increase expression of intercellular adhesion molecule-1 (ICAM-1) in response to cytokines. The increased expression of ICAM-1 results directly in which of the following neutrophil functions?

A
) Activation

B
) Adherence

C
) Chemotaxis

D
) Demargination

E
) Transmigration


A 78-year-old woman has a 2-month history of flailing movements of the limbs on one side. There is no family history of a similar movement disorder. Which of the following structures is most likely to be involved?

A
) Cerebellar hemisphere

B
) Cingulate cortex

C
) Primary motor cortex

D
) Striatum

E
) Substantia nigra

F
) Subthalamic nucleus

6. A child born without limbs is found to have a mutation in a receptor for a fibroblast growth factor. The absence of limbs most likely resulted from a disruption of the processes controlling which of the following?

A
) Apoptosis

B
) Differentiation

C
) Epithelial-mesenchymal conversions

D
) Proliferation

7. A 30-year-old woman is brought to the emergency department because of pain in her upper arm after falling off a horse. X-ray films show a closed simple fracture of the upper humerus. Serum studies 3 weeks later are most likely to show an increased concentration of

A
) alkaline phosphatase

B
) calcium

C
) creatine kinase

D
) -glutamyltransferase

E
) phosphorus

A 16-year-old girl has generalized weakness and nocturnal leg cramps. She is not taking any medications. Laboratory studies show:

Serum
Na+ 135 mEq/L
ClC 108 mEq/L
K+ 2.8 mEq/L
HCO3C 21 mEq/L
Urine pH 7.0

Which of the following is the most likely diagnosis?

A
) Adrenal insufficiency

B
) Hyporeninemic hypoaldosteronism

C
) Nephrogenic diabetes insipidus

D
) Renal tubular acidosis

E
) Syndrome of inappropriate ADH (vasopressin)

10. A 24-year-old man dies suddenly. At autopsy, there is evidence of cocaine abuse but no evidence of gross or microscopic structural alterations of the heart. Which of the following is the most likely cause of the cardiac malfunction in this man?

A
) Blockade of Ca2+ channels

B
) Blockade of dopamine synthesis

C
) Potentiation of norepinephrine and blocking of its presynaptic uptake

D
) Potentiation of serotonin at postsynaptic sites in the atrioventricular node

E
) Stroke due to malignant hypertension

11. A 58-year-old man develops an acute coronary thrombosis with resultant myocardial infarction. The swelling of the myocardial cells bordering the infarct is most likely to be due to

A
) depletion of ATP

B
) efflux of Ca2+

C
) efflux of Na+

D
) increase of intracellular pH

E
) production of H2O2

12. Serum LDL-cholesterol concentrations are measured in blood samples collected from 100 healthy volunteers. The data follow a normal distribution. The mean and standard deviation for this group is 130 mg/dL and 20 mg/dL, respectively. The standard error of the mean is 5.0. The 95% confidence interval about the mean is 120 to 140 mg/dL. If blood samples are collected from 25 healthy volunteers instead of 100, which of the following best expresses the expected impact on the standard error and the 95% confidence interval about the mean?


Standard error Width of 95% confidence interval

A
)


B
)


C
)
no change

D
)


E
)


F
)
no change

G
)
No change

H
)
No change

I
)
No change no change

13. Which of the following enzymes acting on phosphatidylcholine will directly generate diacylglycerol?

A
) Hormone-sensitive lipase

B
) Lipoprotein lipase

C
) Pancreatic lipase

D
) Phospholipase C

E
) Sphingomyelinase

14. A 40-year-old woman has a fever and petechiae. Laboratory studies show:

Hemoglobin 9 g/dL
Leukocyte count 5000/mm3
Neutrophils 10%
Lymphocytes 20%
Blasts 70%
Platelet count 20,000/mm3

A peripheral blood smear shows Auer rods. The most likely diagnosis is

A
) acute lymphoid leukemia

B
) acute myeloid leukemia

C
) chronic lymphocytic leukemia

D
) chronic myelogenous leuk


16. Periodic world-wide pandemics of respiratory infections occur because of shifts in the antigenic properties of which of the following viruses?

A
) Coronavirus

B
) Influenza A

C
) Influenza B

D
) Influenza C

E
) Parainfluenza virus

F
) Respiratory syncytial virus

G
) Rhinovirus

17. A 16-year-old girl is evaluated because she has not yet had a menstrual period. She is 147 cm (4 ft 10 in) tall and weighs 42 kg (93 lb). Breast development is Tanner stage 1 of 5 and pubic hair growth is Tanner stage 2 of 5, respectively. She has a low hairline, short 4th metacarpals bilaterally, and multiple pigmented nevi. A cervix is seen on pelvic examination. Laboratory studies show an increased serum follicle-stimulating hormone concentration. Serum thyroid-stimulating hormone concentration and serum prolactin concentration are within the reference ranges. Which of the following is the most likely diagnosis?

A
) Androgen insensitivity syndrome

B
) Gonadal dysgenesis 45,X (Turner's syndrome)

C
) Gonadotropin-secreting pituitary tumor

D
) Isolated gonadotropin deficiency

E
) Paramesonephric (mllerian) aplasia


18. An 83-year-old woman dies after having progressive memory loss, apraxia, and aphasia for 4 years. A photomicrograph of brain tissue obtained on autopsy is shown. Which of the following is the most likely cause of these findings?

A
) Creutzfeldt-Jakob disease

B
) Dementia, Alzheimer's type

C
) Hypothyroidism

D
) Vascular dementia

E
) Vitamin B12 (cyanocobalamin) deficiency


19. The graph shows the population distribution for values obtained from a test on a group of healthy and diseased persons. A, B, C, D, and E represent various decision points for determining distinctions between diseased and normal populations. Which cut-off point will give a specificity of 100%?

20. A 38-year-old woman has noticed the gradual development of a goiter. Thyroid function studies show serum thyroxine (T4) and triiodothyronine (T3) concentrations to be within the reference range. Serum concentration of thyroid-stimulating hormone is slightly increased. The serum contains a high level of antimicrosomal (antiperoxidase) antibodies, but no thyroid-stimulating hormone receptor antibodies are detected. The most likely diagnosis is

A
) autoimmune (Hashimoto's) thyroiditis

B
) diffuse toxic goiter (Graves' disease)

C
) primary atrophy of the thyroid gland

D
) Riedel's struma

E
) subacute thyroiditis

21. A 23-year-old woman has a fever and a cough productive of rust-colored sputum. A gram-positive coccus isolated from the sputum is sensitive to optochin. Which of the following is the most likely causal organism?

A
) Enterococcus faecium

B
) Streptococcus agalactiae (group B)

C
) Streptococcus pyogenes (group A)

D
) Streptococcus pneumoniae

E
) Streptococcus sanguis

22. A 59-year-old man undergoes repair of an abdominal aortic aneurysm. During the procedure the distal abdominal aorta is clamped, occluding blood supply to the legs for 45 minutes. The period of ischemia is short enough that no permanent damage is done to the affected tissues. Examination of tissue obtained on biopsy of the gastrocnemius muscle at the end of the period of ischemia is most likely to show

A
) coagulation necrosis

B
) erythrophagocytosis

C
) hydropic swelling

D
) karyolysis

E
) karyorrhexis

23. A 5-month-old male infant develops lethargy, somnolence, hypothermia, feeding problems, and persistent jaundice. After several days, he develops a hoarse cry and hypotonic muscles. The tongue is large and protruding, and an umbilical hernia is noted. Hematologic evaluation shows no abnormalities. Which of the following abnormalities is most consistent with these findings?

A
) Agenesis of the parathyroid glands

B
) Congenital adrenal hyperplasia

C
) Maternal diffuse toxic goiter (Graves' disease)

D
) Thyroid hypoplasia

E
) Trisomy 21 (Down's syndrome)
24. A 26-year-old woman has a Trichomonas vaginalis infection and begins metronidazole therapy. The patient should be advised to avoid which of the following during therapy?

A
) Cheese

B
) Milk

C
) Sunlight

D
) Tobacco

E
) Wine

5. A previously healthy 19-year-old woman comes to the medical clinic because of severe abdominal pain for the past 18 hours. She has had increasingly frequent painful urination over the past 24 hours. She is not sexually active. Temperature is 38.5 C (101.3 F), pulse is 90/min, respirations are 14/min, and blood pressure is 115/76 mm Hg. The suprapubic area is tender on palpation. Microscopic examination of urine shows pyuria, hematuria, and bacteriuria. Which of the following organisms is the most likely cause of these symptoms?

A
) Chlamydia trachomatis

B
) Escherichia coli

C
) Neisseria gonorrhoeae

D
) Pseudomonas aeruginosa

E
) Staphylococcus aureus

. A 28-year-old woman is undergoing evaluation at 37 weeks' gestation. Blood pressure is 120/75 mm Hg sitting, 115/70 mm Hg standing, and 90/60 mm Hg supine. The most likely explanation for these findings is

A
) compression of the vena cava

B
) gestational diabetes mellitus

C
) peripartum cardiomyopathy

D
) preeclampsia

E
) uterine contraction


27. An 18-year-old man has multiple bilateral angiomyolipomas. Which of the following lesions is most likely to be found within the central nervous system?

A
) Adenocarcinoma

B
) Cortical hamartoma

C
) Glioblastoma multiforme

D
) Metastatic angiomyolipoma

E
) Subependymal meningioma

8. A 45-year-old woman has a 3-month history of a persistent cough and increasing shortness of breath. She denies chest pain or other illnesses. Blood pressure is 110/70 mm Hg, and pulse is 110/min. She has diffuse basilar crackles and an S3 gallop, but no murmur. ECG shows sinus tachycardia and nonspecific ST-T wave changes. Echocardiography shows a dilated left ventricle and a diffusely hypokinetic heart. The most likely diagnosis is

A
) acute pericarditis with effusion

B
) dilated cardiomyopathy

C
) hypertrophic cardiomyopathy

D
) severe mitral valve prolapse

E
) silent subendocardial infarct

29. A 60-year-old man comes to the physician's office because of confusion and inability to concentrate. Which of the following is the best way to assess his concentration?

A
) Calculating the sum of four numbers

B
) Recalling four unrelated words after 5 minutes

C
) Repeating a digit sequence backward

D
) Reproducing figures from memory

E
) Writing from dictation

30. A 3-week-old infant has milk intolerance due to a defect in the enzymes that digest lactose. This enzyme is located at which of the following sites in enterocytes?

A
) At the apical surfaces

B
) At the basolateral surfaces

C
) Within the Golgi complex

D
) Within lysosomes

E
) Within peroxisomes

31. A 31-year-old black man with acute sinusitis requires antibiotic therapy. He says that several family members have developed hemolysis after taking drugs. Which of the following antimicrobial drugs should be avoided in this patient?

A
) Ciprofloxacin

B
) Erythromycin

C
) Penicillin

D
) Sulfisoxazole

E
) Tetracycline

32. The absorption of calcium from the intestinal tract results principally from the direct action of which of the following?

A
) Calcitonin

B
) Cyclic AMP

C
) 1,25-Dihydroxycholecalciferol

D
) 25-Hydroxycholecalciferol

E
) Parathyroid hormone


33. An obese 62-year-old woman is brought to the emergency department in a coma by emergency medical technicians (EMTs). The EMTs report that she said she had palpitations and double vision before becoming unresponsive 10 minutes ago. A Medic Alert bracelet shows that she has hypertension and type 2 diabetes mellitus. A number of prescription drugs are found in her purse. Serum glucose concentration is 50 mg/dL. Which of the following drugs is the most likely cause of the hypoglycemia?

A
) Acarbose

B
) Captopril

C
) Digoxin

D
) Glyburide

E
) Methyldopa

34. A 14-year-old boy develops a pruritic vesicular rash on his face and hands 3 days after hiking in the woods. Which of the following are most likely to be involved in his illness?

A
) Antibody, complement C5-9

B
) Circulating immune complexes, complement C5a, neutrophils

C
) Cytotoxic T lymphocytes

D
) IgE, mast cells, histamine, cytokines

E
) Lymphocytes, cytokines, macrophages
35. After activation, neutrophils demonstrate an increased tendency to migrate out of blood vessels and into the extravascular compartment. Which of the following is the most likely cause?

A
) Altered expression of adhesion molecules

B
) Heightened phagocytic ability

C
) Increased synthesis of lysosomal enzymes

D
) Release of interleukin-1 (IL-1)

E
) Upregulated synthesis of Fc receptors

36. A 45-year-old woman with rheumatoid arthritis calls the physician on a Saturday morning because she cannot turn the bathroom faucet due to pain and weakness in her hands and wrists. She is tearful and says, "My husband has already left for work and my hands are too weak to turn the water on. It hurts too much and now I can't even take a bath." Which of the following is the most appropriate response?

A
) "Come to the office right away and I will give you a cortisone shot."

B
) "I know this must be difficult. Perhaps a plumber may be able to help you."

C
) "I sympathize with you. Unfortunately, it looks like your only option is to wait until your husband comes home."

D
) "Many people with rheumatoid arthritis have difficulty turning faucets. Perhaps you would be interested in joining a support group."

E
) "People with rheumatoid arthritis often feel that their independence has been lost because of their pain. Perhaps using a tool with a long handle would help."

37. A 20-year-old man has a painless 2-cm nodule in his right scrotum. The nodule is difficult to distinguish from the right testis and does not transilluminate. There is no additional swelling or inguinal adenopathy. The most likely diagnosis is

A
) cryptorchidism

B
) hydrocele

C
) scrotal cyst

D
) testicular cancer

E
) testicular torsion

F
) varicocele
40. Alveolitis with interstitial edema, inflammatory cell accumulation, and type II epithelial cell hypertrophy and hyperplasia is believed to be an early and central event in the pathogenesis of

A
) anthracosis

B
) asthma

C
) centriacinar emphysema

D
) chronic bronchitis

E
) pulmonary fibrosis


41. Eukaryotic proteins that exist as a nonmembrane-associated, glycosylated, disulfide-linked dimer in the mature form are generally found in which of the following?

A
) Cytoplasm

B
) Extracellular space

C
) Mitochondrial matrix

D
) Nuclear matrix

E
) Nuclear pore


. A 2-year-old boy has a unilateral cleft lip and cleft palate. He has no other malformations and is otherwise healthy. He has no family history of birth defects. His parents are not related. Which of the following genetic mechanisms is most likely to have caused these congenital abnormalities?

A
) Autosomal dominant inheritance

B
) Autosomal recessive inheritance

C
) Chromosome aneuploidy

D
) Chromosome deletion

E
) Mitochondrial DNA mutation

F
) Multifactorial inheritance

G
) X-linked recessive inheritance


43. A 38-year-old man comes to the physician because of involuntary movements of the arms and legs for the past month and progressive facial twitching and grimacing over the past year. Neurologic examination shows athetoid and choreiform movements of the arms and legs, dystonic movements of the tongue, dysarthria, impairment in immediate and short-term memory, and dyscalculia. Which of the following is the most likely diagnosis?

A
) Amyotrophic lateral sclerosis

B
) Dementia, Alzheimer's type

C
) Huntington's disease

D
) Korsakoff's syndrome

E
) Multi-infarct dementia

F
) Parkinson's disease

G
) Wernicke's encephalopathy

44. A male neonate has a palpable midabdominal mass. Abdominal ultrasonography shows no kidneys in the normal anatomic position and a single U-shaped renal mass with two collecting systems near the aortic bifurcation. Which of the following embryologic events best explains this finding?

A
) Division of the metanephric diverticulum

B
) Failed development of the ureteric bud

C
) Failed differentiation of the urogenital sinus

D
) Fusion of the metanephric masses

E
) Normal development of two ureteric buds

45. An 18-year-old man has nausea, vomiting, headache, a temperature to 39.4 C (103 F), and painful swelling of the parotid glands. He is at increased risk for

A
) appendicitis

B
) arthritis

C
) cystitis

D
) episcleritis

E
) orchitis


46. Amino acids that contribute at least one nitrogen or carbon to the purine ring during the biosynthesis of purine nucleotides are

A
) alanine, asparagine, and lysine

B
) alanine, methionine, and histidine

C
) aspartate, arginine, and histidine

D
) aspartate, glycine, and glutamine

E
) glycine, serine, and tyrosine

47. During a marathon, a 28-year-old woman initially has pain and distress but suddenly feels exhilaration about halfway through the race. The best explanation is most likely to be increased release of

A
) ACTH

B
) -endorphin

C
) epinephrine

D
) glucagon

E
) somatostatin

48. A 73-year-old man with a history of angina is undergoing cardiac catheterization via the right femoral artery. As the pig-tail catheter is advanced into the apex of the left ventricle, which of the following valves will be crossed?

A
) Aortic

B
) Mitral

C
) Pulmonary

D
) Tricuspid

49. A 2-year-old boy has brittle depigmented hair, cerebral atrophy, delayed myelination, motor delay, and mental retardation. Lysyl oxidase activity is decreased. The function of which of the following substances is most likely to be defective in this patient?

A
) Albumin

B
) Ceruloplasmin

C
) Chondroitin sulfate

D
) Collagen

50. A 34-year-old woman comes to the physician's office because she has had a cough, fatigue, low-grade fever, mild dyspnea, and aching joints for the past month. Physical examination shows no abnormalities. X-ray film of the chest shows bilateral hilar adenopathy with mild diffuse parenchymal infiltrates. Examination of tissue obtained by transbronchial biopsy during bronchoscopy shows noncaseating granulomas. Which of the following is the most appropriate therapy?

A
) Azathioprine

B
) Methotrexate

C
) Prednisone

D
) Rifampin

E
) Zidovudine (AZT)


1. A 3-year-old boy has a 5-week history of weight loss and bulky, frothy, foul-smelling stools. Dietary modification results in clinical improvement. Which of the following is the most likely finding on examination of a biopsy specimen from the small intestine?

A
) Atrophy of villi and microvilli

B
) Degenerative changes of the myenteric plexus

C
) Multiple outpouchings through the muscle coat

D
) Numerous ulcerations and pseudopolyps

E
) Pseudomembrane covering the luminal surface

2. Hepatitis B virus is the major cause of hepatocellular carcinoma. Replication of its nucleic acid is schematically depicted:

1 2 3

Partial double- single- single-stranded
Double-stranded stranded stranded RNA and DNA hybrid
DNA DNA RNA

The enzyme involved at step 2 is most likely to be

A
) DNA ligase

B
) DNA polymerase

C
) reverse transcriptase

D
) RNA ligase

E
) RNA polymerase

3. A 2-year-old boy is brought to the physician's office for a well-child visit. He was treated in the hospital at birth for moderate hyperbilirubinemia. He has had three episodes of otitis media. He has a vocabulary of 100 words and is starting to use two-word sentences. He can run without falling but cannot ride a tricycle. Which of the following best describes his motor and language development?


Motor Language

A
)
Delayed delayed

B
)
Delayed normal

C
)
Normal delayed

D
)
Normal normal


4. Acting bilaterally, the external oblique muscles produce which movement of the vertebral column?

A
) Extension

B
) Flexion

C
) Lateral flexion

D
) Rotation


5. A 40-year-old man has the recent onset of right-sided chest pain, difficulty breathing, and fever. On auscultation he has crackles, decreased respiratory sounds, and evidence of a right-sided pleural effusion. Which of the following best describes the expected type of inflammatory process involving the lung?

A
) Fibroblasts, collagen deposition, replacement of intrinsic tissue

B
) Macrophages, lymphocytes, increased concentrations of immunoglobulins

C
) Mast cells, histamine, smooth muscle contraction

D
) Neutrophils, increased vascular permeability, edema

E
) Vascular budding, fibroblasts, edema, proteoglycans

6. A 3-year-old boy has a mutation in the calcium receptors on cell surfaces of his parathyroid gland and on the basolateral (blood) side of the thick ascending limb of the loop of Henle. Which of the following patterns is expected with a mutation that leads to activation of this receptor in the absence of binding of its ligand, calcium?


Serum
Ca2+ Parathyroid hormone Urine calcium

A
)
Hypercalcemia high high

B
)
Hypercalcemia high low

C
)
Hypercalcemia low high

D
)
Hypercalcemia low low

E
)
Hypocalcemia high high

F
)
Hypocalcemia high low

G
)
Hypocalcemia low high

H
)
Hypocalcemia low low


Renal disease is most likely to result from long-term administration of which of the following drugs?

A
) Aspirin

B
) Digoxin

C
) Nifedipine

D
) Propranolol

E
) Warfarin

8. Basic fibroblast growth factor is applied to an experimentally induced dermal wound. A histologic section is prepared 72 hours later. Compared with an untreated wound, the most likely alteration in this wound is

A
) decreased numbers of fibroblasts

B
) increased breakdown of matrix

C
) increased numbers of blood vessels

D
) increased numbers of eosinophils

E
) Increased numbers of giant cells

9. A 75-year-old man who is being treated for atrial fibrillation has an adequately controlled ventricular response rate at rest. During exercise or stress, his heart rate increases to an unacceptable rate. Which of the following drugs is most likely to be effective in controlling the patient's ventricular response rate during activity or stress?

A
) Adenosine

B
) Lidocaine

C
) Nifedipine

D
) Propranolol

E
) Quinidine

10. A case-control study is conducted to determine if women who delay childbearing are at increased risk for having children with low birth weight. A group of women who were at least 35 years old during their first pregnancy are compared with a group of women who were between the ages of 20 and 24 years during their first pregnancy. The following data are obtained:


What is the odds ratio for an older woman (relative to that of a younger woman) to have an infant with a low birth weight?

A
) (21 / 425) / (54 / 799) = 0.73

B
) (54 / 799) / (21 / 425) = 1.37

C
) (54 / 745) / (21 / 404) = 1.39

D
) (54 / 799) x 100 = 6.8

E
) (54 / 75) / (745 / 1149) = 11.1


11. A 26-year-old man who is an executive has a 1-month history of episodes of tachypnea, dyspnea, feelings of choking, and a sensation of not being able to take in enough air while at work. Findings on physical examination after the first episode showed no abnormalities. Serum chemistry profile, arterial blood gas analysis, ECG, spirometry, and x-ray films of the chest show no abnormalities. Which of the following is the most likely diagnosis?

A
) Conversion disorder

B
) Generalized anxiety disorder

C
) Hypochondriasis

D
) Panic disorder

E
) Somatization disorder

12. A 56-year-old man with extensive coronary artery atherosclerotic disease has evidence of coronary vasoconstriction and myocardial ischemia. The most likely cause of the vasoconstriction is failure of the endothelial cell layer of the diseased coronary arteries to produce a substance with which of the following actions?

A
) Activation of Na+ channels

B
) Closure of K+ channels

C
) Opening L-type Ca2+ channels

D
) Stimulation of ATP accumulation

E
) Stimulation of cyclic GMP accumulation

13. A 16-year-old boy is brought to the emergency department because of respiratory distress. Examination shows a large mediastinal mass and 3-cm firm cervical lymph nodes bilaterally. Examination of tissue obtained on cervical lymph node biopsy shows small lymphocytes interspersed with binucleate cells with clear chromatin and large eosinophilic nucleoli. The most likely diagnosis is

A
) Burkitt's lymphoma

B
) diffuse noncleaved cell lymphoma

C
) follicular lymphoma

D
) Hodgkin's disease

E
) lymphoblastic lymphoma
14. A 35-year-old woman has a 1-month history of intermittent ptosis and diplopia. She has limited abduction and elevation of the right eye and fatigable ptosis of the left. After 2 days of pyridostigmine therapy, her ocular symptoms resolve. One week later she develops nausea and abdominal cramping that are most severe 30 minutes after her dose of pyridostigmine. Administration of which of the following medications is most likely to ameliorate her gastrointestinal symptoms?

A
) Atropine

B
) Bromocriptine

C
) Neostigmine

D
) Phenoxybenzamine

E
) Propranolol

15. Methimazole is effective for the treatment of Graves' disease because it has which of the following mechanisms of actions?

A
) Blockade of binding of thyroxine to its receptor

B
) Decreased uptake of iodide by the thyroid gland

C
) Inhibition of thyroidal peroxidase activity

D
) Prevention of the proteolysis of thyroglobulin

E
) Stimulation of production of serum thyroid-binding globulin

16. In the diagram of a blood vessel, what is the principal site of nitric oxide action in producing vasodilation?



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