NBME 28 Q.pdf

NMbE28 questions, USMLE USMLE Step 2

1. TutorialSection:Screen10of10 NationalBoardofMedicalExaminers
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2. ExamSection1:Item1of50 NationalBoardofMedicalExaminers^
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1.A25-year-oldmanisbroughttotheemergencydepartmentbecauseofsevereabdominalpain,nausea,andvomitingfor1hour.Thepainoriginatesintheleftflankandradiatestohisgroin.Hisputseis100/min,respirationsare18/min,andbloodpressureis
150/100mmHg.Physicalexaminationshowstendernessoftheleftflankandtheleftlowerquadrantoftheabdomen.Bowelsoundsaremildlyhypoactive.Testofthestoofforoccultbloodisnegative.Whichofthefollowingbestexplainsthesefindings?
.A)Colonneoplasm
B)Diverticulitis
OC)Epididymitis
0D)Renalinfarction
.E)Torsionofthetestis
F)Ureteralcalculus
900
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3. ExamSection1:Item2of50 NationalBoardofMedicalExaminers^
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2.WhichofthefollowingtypesofsensoryinformationiscompromisedbylesionsofthestructureatsiteXinthephotographshown?
A)Consciousproprioception
B)Painsensation
0C)Two-pointdiscrimination
D)Unconsciousproprioception
E:)Vibrationsense
& * f*
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4. ExamSection1:Item3of50 NationalBoardofMedicalExaminers^
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3.Movingtheforearmagainstresistancefrompalm-downtopalm-up(supination)positionrequirestheuseofwhichofthefollowingmuscles?
3A)Bicepsbrachii
B)Brachialis
OC)Triceps
D)Flexorcarpiradialis
!JE)Pronatorteres
900
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5. ExamSection1:Item4of50 NationalBoardofMedicalExaminers^
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4.A35-year-oldmanisadmittedtothehospitalbecauseofa5-dayhistoryoffeveranddyspneaHeunderwentabonemarrowtransplantationGmonthsago:theprocedurewascomplicatedbyseveregraft-versus-hostdisease.Histemperatureis38-C
(100.4T).andrespirationsare30/min.Scatteredcracklesareheardonauscultationofthechest.Achestx-rayshowspatchyinfiltrates.Atransbronchialbiopsyspecimenshowsfindingsconsistentwithcytomegalovirusinfection.Intravenousadministrationof
ganciclovirisbegun.Thisdruginterfereswiththefunctionofwhichofthefollowingenzymes?
A)DNApolymerase
3B)Integrase
oC)Reversetranscriptase
30)RNApolymerase
JE}Thymidinekinase
*
m O m
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6. ExamSection1:Item5of50 NationalBoardofMedicalExaminers^
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5.Thegraphshowschangesinserumestradiolconcentrationduringanormalmenstrualcycle.Whichofthefollowingovariancellsisprimarilyresponsibleforthearomatizaiionofandrostenedionetoestradiolatthetimeindicatedbythearrow?
A)Granulosa
'
B)Luteaf
.)G)Stromal
D)Thecaexterna
E)Thecainterna
O
*
r-ooo
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7. ExamSection1:Item6of50 NationalBoardofMedicalExaminers^
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6.A14-year-oldgirlisbroughttothephysicianbyherparentsbecauseofa1-monthhistoryofarashthatappearswithsunexposure,Herparentstellthephysicianthatshehasbeeneatingfiittlefood.Physicalexaminationshowsapruriticrashontheexposed
areasofthebody.HerserumtryptophanconcentrationisdecreasedUrinestudiesshowincreasedexcretionofaminoacids
:predominantlyalanine,isoleucine,leucine,phenylalanine
:tryptophan,andvaline.Productionofwhichofthefollowingvitaminsis
mostlikelyimpairedinthispatient?
A)Niacin
0B)VitaminB,(thiamine)
0G)VitaminB
2
(riboflavin)
00)VitaminB
5
(pantothenicadd)
E)VitaminC
*
m O m
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8. ExamSection1:Item7of50 NationalBoardofMedicalExaminers^
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7.Aminoglycosideantibioticsareusedfortheirsynergisticactionagainstbacteria,incombinationwithotheragents.Theseantibioticsdemonstrateinvitrosynergyforseveralbacterialspecieswhencombinedwithwhichofthefollowingclassesofantibiotics?
3A)Fluoroquinolones
S)Macrolides
OC)Penicillins
D)Rifamycrns
!JE)Tetracyclines
*
m O m
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9. ExamSection1:Item8of50 NationalBoardofMedicalExaminers^
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8.A16-year-oldboywithmoderateintellectualdisabilityisbroughttothephysicianforaroutineexamination.Thereisafamilyhistoryofmildandmoderateintellectualdisabilityinhismotherandbrother,respectively.Physicalexaminationshowsalongface
;
prominentears,andmoderatelyenlargedtesticles.Whichofthefollowingbestdescribesthegeneticmechanismofthispatient'sdisorder?
.A)Mutationinamitochondrialgene
8)Presenceofanextrasexchromosome
.JC)Translocationofaportionofanautosome
'
3D)TrinucleotiderepeatmutationontheXchromosome
.E}Trisomyofanautosome
O
*
900
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10. ExamSection1:Item8of50 NationalBoardofMedicalExaminers^
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9.A75-year-oldwomancomestothephysicianbecauseofa3-monthhistoryofanenlarginglesiononherface.Physicalexaminationshowsa1,5-cm,brown-black,mottled,scalylesionwithirregularborders.Microscopicexaminationofabiopsyspecimenofthe
lesionshowsatypicalmelanocytesspreadalongthebasilarlayeroftheepidermis.Whichofthefollowingisthemostlikelycauseofthesefindings?
A)Acanthosisnigricans
8)Actinickeratosis
C)Compoundnevus
D)Lentigomaligna
E)Seborrheickeratosis
O
*
m O m
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11. ExamSection1:Item10ol50 NationalBoardofMedicalExaminers^
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10.Aphysicianwishestodeterminetheproportionofnewbornsdeliveredatalocalhospitalwhohadadiagnosisofcongenitalheartdiseasewithinthepastyear.Whichofthefollowingstatisticalmeasurementsbestdescribesthesedata?
QA)Attributablerisk
S)Incidence
OC)Oddsratio
D)Prevalence
'
JE)Relativerisk
*
m O m
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12. ExamSection1:Item11of50 NationalBoardofMedicalExaminers^
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11.A25-year-oldwomancomestothephysicianafterherbloodpressurewasfoundtobe130/105mmHgatahealthfair.Shetakesnomedications.Thereisnofamilyhistoryofhypertension.Herlastmenstrualperiodwas1weekago.Herbloodpressuretoday
is180/110mmHg.Bilateralabdominalbruitsareheard.Treatmentwithanangiotensin-convertingenzyme(ACE)inhibitorwillmostlikelyhavewhichofthefollowingacuteeffectsonthispatient'srenalfunction?
.A)Decreasedconcentratingabilitysecondarytorenalangioedema
B)Decreasedglomerularfiltrationratesecondarytodilationofefferentarterioles
.5C)Decreasedrenalbloodflowsecondarytodilationofafferentarterioles
'
!D)increasedconcentratingabilitysecondarytoachangeinpermeabilityofthecollectingduct
.E)Interstitialnephritissecondarytoallergicdrugreaction
*
m O m
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13. ExamSection1:Item12ol50 NationalBoardofMedicalExaminers^
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12A16-year-ofdboyisbroughttothephysicianbecauseofa3-monthhistoryofshortnessofbreathwhileplayingsports.Hehasnoshortnessofbreathatrest.Hesays
7
"WheneverIrunaroundIcough,soidon'twanttobeonthebasketballteamanymore."He
takesnomedicationsandhasnoknownallergies.Thereisafamilyhistoryofhypertensionandasthma.Heis165cm(5ft5in)tallandweighs68kg(150lb):BMIis25kg/m
2
.Hisrespirationsare12/min,andbloodpressureis115/75mmHg.Cardiac
examinationshowsnoabnormalitiesexceptforamidsystolicclickattheapex.Thelungsarecleartoauscultationofthechest.Whichofthefollowingbestexplainsthispatient'ssymptoms?
A)Deconditioning
3B)Exercise-inducedasthma
oG)Malingering
30)Mitralvalveprolapse
JE}Thyroiddisease
O m O m
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14. ExamSection1:Item13of50 NationalBoardofMedicalExaminers^
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1hr12min53sec
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13.A25-year-ofdmancomestothephysicianbecauseofa3-dayhistoryofpainandswellingofhisrightleg.Hehasnohistoryofmajormedicalillnessorrecenttrauma.Examinationoftherightlowerextremityshowsedemaandtenderness.Duplex
ultrasonographyoftherightlowerextremityshowsathrombusextendingintothesuperficialfemoralvein.FurtherstudiesshowproteinCdeficiency.Inactivationofwhichofthefoliowingcoagulationfactorsismostlikelyasaresultofthisdeficiencyinthis
patient?
A)FactorsV(proaccelebn)andVIII(antihemophilicfactor)
3B)FactorsV(proaccelebn)andIX(plasmathromboplastincomponent)
OC)FactorsV(proaccelebn)andXI(plasmathromboplastinantecedent)
3D)FactorsVIII(antihemophilicfactor)andIX(plasmathromboplastincomponent)
QE)FactorsVIII(antihemophilicfactor)andXI(plasmathromboplastinantecedent)
(JF)FactorsIX(plasmathromboplastincomponent)andXI(plasmathromboplastinantecedent)
*
m O m
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15. ExamSection1:Item14ol50 NationalBoardofMedicalExaminers^
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TimeRemaining:
1hr12min50sec
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14.Whichofthefollowingismostdirectlyresponsibleforconcentratingtestosteroneinthelumenoftheseminiferoustubules?
3A)Androgen-bindingprotein
^
S)Follicle-stimulatinghormone(FSH)
OG)FSH/gonadotropin-releasinghormone
oQ)Irthibm
'
JE)Luteinizinghormone
O m O m
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16. ExamSection1:Item15ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr12min47sec
0Mar
*
15.A23-year-oldwomanhashadthelesionsshownInhermouthfor3days.Shehashadfrequentsimilarepisodesoverthepast15years.Thelesionsareexacerbatedbyspicy,salty
:andacidicfoodanddrinks.Theylastapproximately1weekandresolve
spontaneously.Visitstothedentistseemtotriggerthedevelopmentofthesores.Whichofthefollowingisthemostlikelydiagnosis?
A)Aphthousulcers
3B)Candidiasis
0C)Geographictongue
O0)Koplikspots
^
E)Leukoplakia
F)Lichenplanus
'
G)Psoriasis
o 900
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17. ExamSection1:Item16ol50 NationalBoardofMedicalExaminers^
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16.A20-year-oldwomancomestotheemergencydepartment30minutesafterslippmgoniceandextendingherhandtobreakherfall.Palpationoftheanatomicsnuff-boxproducespain.Awristx-rayismostlikelytoshowafractureofwhichofthefollowing
carpalbones?
.A)Scaphoid
8)Lunate
.)C)Triquetrum
D)Pisiform
..E)Trapezium
F)Trapezoid
.)G)Capitate
H)Hamate
O
*
m O m
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18. ExamSection1:Item17of50 NationalBoardofMedicalExaminers^
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TimeRemaining:
1hr12min38sec
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17.A7G-year-ofdmanundergoeslaparotomyforresectionofanabdominalaorticaneurysm.Duringtheprocedure,anincidentalfindingofacquiredcolonicdiverticulaismade.Thediverticulainthispatientaremostlikelypresentinwhichofthefollowing?
A)Ascendingcoion
iS)Cecum
Q
G)Descendingcolon
D)Sigmoidcolon
!JE)Transversecolon
*
m O m
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19. ExamSection1:Item13ol50 NationalBoardofMedicalExaminers^
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18.Duringaperiodof36hours,an80-year-oldwomanhasincreasinglysevereabdominalpainfollowedbyfeverchills,tachycardia
:hypotensionand.finally,shock.BloodculturesgrowEscherichiacoti.Herconditionworsensand.despitesupportivetherapy
andantibiotics
;shedies4daysaftertheonsetoftheillness.Whichofthefollowingisthemostlikelycauseoftheinitialhypotension?
.A)Excessiveproductionofnitricoxide
B)Generationofhydrogenperoxide
oC)Hemorrhage
!D)Inductionofendothelialadhesionmolecules
.E}Plateletaggregation
*
m O m
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20. ExamSection1:Item19of50 NationalBoardofMedicalExaminers^
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1hr12min16sec
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19.A65-year-oldwomancomestothephysicianbecauseofa3-monthhistoryofheadache,weaknessofherarms,andleftflankpain:shealsohashada14-kg(31-Eb)weightlossduringthisperiod.Physicalexaminationshowsweaknessoftheproximalupper
andlowerextremitymuscles.Thereisaugmentationofstrengthwithrepetitivetestingofthedeltoidmuscles.AnMRIofthebrainshowsasinglewell-demarcatedmasssurroundedbyedemaintherightfrontallobe.Astereotacticbiopsyspecimenofthelesion
showsamalignant;smaltbluecellneoplasmthatexpressescytokeratin,chromogranin,andsynaptophysin.Whichofthefollowingisthemostlikelydiagnosis?
A)Anaplasticependymoma
3B)ExtranodaEprimarycentralnervoussystemlymphoma
oC)Glioblastomamultiforme
30)Primarycerebralneuroblastoma
E}Pulmonarysmallcellcarcinomametastatictothebrain
®0 000
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21. ExamSection1:Item20ol50 NationalBoardofMedicalExaminers^
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1hr12min12sec
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20.Failureofnormaldifferentiationoftheendodermintheembryoniclungbudismostlikelytoaffectthedevelopmentofwhichofthefollowing?
3A)Capillarypatterns
3S)Cartilageinbronchi
OGjSmoothmuscleonthebronchi
JD)Surfaetantsecretion
3E)Trachealrings
ooo
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22. ExamSection1:Item21ol50 NationalBoardofMedicalExaminers^
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TimeRemaining:
1hr12min9sec
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21.A67-year-oldwomancomestothephysicianforahealthmaintenanceexamination.Herbrotherandmotherhaveahistoryofcoloncancer.Thephysicianrecommendscolonoscopy
:butthepatientsaysthatshewouldpreferonlyforherstooltobetestedfor
biood.Thephysicianexplainsthattestingthestoolforoccultbloodisnotappropriateinthiscase.Thephysicianismostlikelyconcernedaboutwhichofthefollowingregardingthistest?
.A)Lowsensitivity
8)Lowspecificity
.JC)Potentialforafalse-positiveresult
3D)Uncertainnegativepredictivevalue
.E)Uncertainpositivepredictivevalue
*
m O m
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23. ExamSection1:Item22ol50 NationalBoardofMedicalExaminers^
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TimeRemaining:
1hr12min5sec
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22A5-year-oldboyisbroughttotheemergencydepartmentafteringesting10ozofahouseholdcleaningsolventHeistreatedforacutehepaticandrenalfailurefor1weekandthendischarged.Duringthenextmontfrregenerationofthisboy'smature
hepatocytesandrenaltubularepithelialcellswillbeaccomplishedmostlybywhichofthefollowingmechanisms?
.A)ActivationofstemcellstoenterG
1
phaseofthecellcycle
8)DecreasedapoptosisatGrMtransitionofthecellcycle
.JG)RecruitmentofcellsfromG
0intothecellcycle
’
3D)Shortenedtimeforprogressionofcellsthroughthecellcycle
.E)Terminaldifferentiationbyceltsexitingfromthecellcycle
O0 I*000
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24. ExamSection1:Item23of50 NationalBoardofMedicalExaminers^
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23.A17-year-oldboyisbroughttothephysicianbyhismotherbecausesheisconcernedthathispubertyisdelayed.Themotherstates."Heissoshort.Hisfatheris6feet5inchestalkIdon'tunderstandwhyhehasnothadhisgrowthspurt."Whenthemother
leavestheroom,thepatientstates
:
'
I
'mfine.Idon'tknowwhat'sthematterwithher.Shewantsmetobetalllikemydad."Thepatientis175cm(5ft9in)taliandweighs70kg(155lb):BMIis23kg/m
2SexualdevelopmentisTannerstage4.inadditionto
reassuringthemotherthathersonisfine,whichofthefollowingisthemostappropriateinitialstatementbythephysiciantothemother?
A)"Sinceyoursonisfinewithhisheightyoushouldtrytoaccepthimasheis."
3B)"Tellmemoreaboutyourconcernsaboutyourson'sheight.
"
oC)"Welldosomebloodtestsjusttobesurethatallyourson'shormonelevelsareokay."
3O)"Yoursonisaverageforhisheightandweight."
JE)"Yoursonisnotgoingtobeanytaller."
*
m O m
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25. ExamSection1:Item24ol50 NationalBoardofMedicalExaminers^
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TimeRemaining:
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24.A34-year-oldwomanisadmittedtothehospitalfortreatmentofpulmonarytuberculosis.Infliximabtherapywasinitiated6monthsagoforsevereCrohndisease.Thispharmacotherapymostlikelyinhibitedwhichofthefollowingimmunologicfunctionsinthis
patient?
.A)ActivationofnuclearfactorK8toinduceexpressionofinterleukin-10(IL-10)
8)Directtoxicitytothecausalorganism
.JC)Maintenanceofgranulomas
'
3D)Recruitmentofsegmentedneutrophilstoingestandkillthebacteria
(_yE)StimulationofBlymphocytestoproduceneutralizingantibodiesagainstthecausalorganism
*
m O m
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26. ExamSection1:Item25ol50 NationalBoardofMedicalExaminers^
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25.An8-year-oldboycontinuestobleedexcessivelyaftertoothextraction.Prothrombintime,bleedingtime,andplateletcountarewithinthereferencerange.Partialthromboplastintimeisprolongedbutcorrectsafteradditiontotheassaychamberofplasma
fromapatientwithhemophiliaA.Whichofthefollowingisthemostlikelydiagnosis?
.A)Acutedisseminatedintravascularcoagulation
8)PactorV(proaccelerin)deficiency
.JC)FactorVII(proconvertin)deficiency
D)HemophiliaA
..E)HemophiliaB
F)Immunethrombocytopenicpurpura
.J
.G)vonWillebranddisease
O
*
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27. ExamSection1:Item26ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr11min56sec
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26.Thediagramshowsthemajorfactorsthatdeterminebloodpressure.Whichofthefollowinglabeledfactorsisaffectedmostbyanaradrenergicantagonist?
^
Centralnervoussystem
m®
Peripheralresistance
farteridfat)
CardiacoutputxBloodpressure
©
Strokevolume
^
Heortrale
J
"
Contractilityj
^
Venousreturn
Capacitancevesseltone
(v&nutar)
Bloodvolume
©
OA)
O
8)
OC)
OD)
OE
)
m O m
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28. ExamSection1:Item27of50 NationalBoardofMedicalExaminers^
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TimeRemaining:
1hr11min54sec
®Mark
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27.Apreviouslyhealthy21-year-oldwomancomestotheofficebecauseofa2-month
,historyofshortnessofbreathandfatigue.Hermostrecentmenstrualperiodwas3monthsago.Mensespreviouslyhadoccurredatregular28-dayintervals.Shetellsthe
physicianthatshethinksshemaybepregnant.Shetakesnomedicationsandhasnotseenaphysicianforseveralyears.Sheappearshealthy.Sheis160cm(5ft3in)tallandweighs54kg(120ib);BMIis21kg/m
2Vitalsignsarewithinnormallimits.The
lungsaredear.CardiacexaminationshowsanormalS
(fawidelysplitS
2
thatdoesnotchangewithrespiration,andagrade3/6holosystoMcmurmurthatisloudestatthelowerleftsternalborderandradiatestotheupperleftsternalborder.EGGisshown.
Themostlikelycauseoftheseffndingsisdysfunctionofwhichofthefollowingstructures?
A)Atrialseptum
3B)Ductusarteriosus
QC)Interventricularseptum
D)Pulmonicvalve
E)Tricuspidvalve
*
m O m
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29. ExamSection1:Item28ol50 NationalBoardofMedicalExaminers^
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TimeRemaining:
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®Mark
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28.A53-year-oldmanhashadprogressivedifficultyswallowingforthepast3months.Hehasa10-yearhistoryofheartburnwithesophagealregurgitationofgastriccontents.Tissueobtainedonbiopsyofthelowerthirdoftheesophagusisshown.Whichofthe
followingbestdescribesthenatureofthislesion?
A}Basalzonehyperplasiaofsubmucosalglands
!JB)Intestinalmetaplasiaofsquamousepithelium
OG)Malignanttransformationofepitheliumintosquamouscarcinoma
'0)Squamousmetaplasiaofsubmucosalglands
«10 rrr»;(IS
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30. ExamSection1:Item29of50 NationalBoardofMedicalExaminers^
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TimeRemaining:
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29.A50-year-oldmancomestotheemergencydepartmentbecauseofa2-weekhistoryofprogressiveshortnessofbreath.Hispufseis90/min,respirationsare26/min
:andbloodpressureis120/S0mmHg.Physicalexaminationshowsnootherabnormalities.
Laboratorystudiesshow:
ArterialPco
2
ArterialPo
2
Arterial02content
MixedvenousPo
2
Mixedvenous02content
30mmHg
96mmHg
12vol%(N=17%-21%)
36mmHg
8vol%(N=10%
-1:6%)
Whichofthefollowingisthemostlikelyexplanationforthesefindings?
A)Anemia
B)Drug-inducedalveolarhypoventilation
C)Residenceatahighaltitude
D)Severeregionalmismatchingofalveolarventilationandpulmonarycapillaryperfusion
E)Voluntaryhyperventilation
*
m O m
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31. ExamSection1:Item30ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr11min46sec
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30.Aninvestigatorisstudyingtheeffectsoftriiodothyronine(T
^
)andthyroxine(TJinhepatocytesinanexperimentalanimalmodel.Whichofthefollowingbestdescribestheactionofthesethyroidhormonesonthistargettissue?
3A)BothT
3
andT
4
bindtothemelanocortin2receptoronthecellsurface
JB)BothT
3andT
4
enterthenucleus
(G)T
3isconvertedtoT
4inthecytosol
JD)ThyroidhormonereceptorspreferentiallybindT
4
overT
3
O m O m
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32. ExamSection1:Item31ol50 NationalBoardofMedicalExaminers^
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TimeRemaining:
1hr11min42sec
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31.Afemalenewborndeliveredat38weeks'gestationtoa28-year-oldwoman
;gravida1,para1developsrespiratorydistress.Pregnancyanddeliverywereuncomplicated
'
amnioticfluidwasclear,andtheplacentawasnormal.FetalultrasonographyandMRf
at34weeks’gestationshowedacongenitaldiaphragmatichernia
:withevidenceofsmallbowelandstomachherniationintolefthemithorax.Sheis52cm(20.4in)longandweighs3500g(7lb11oz).Hertemperatureis37.5°C(99.ST),pulseis138/min.
respirationsare50/min,andbloodpressureis70/55mmHg.Physicalexaminationshowsperipheralcyanosisthatimprovesafteradministrationofoxygenviaendotrachealintubation.Breathsoundsaredecreasedontheleft.Cardiacexaminationshows
normalheartsoundswithoutmurmurs.Whichofthefollowingcomplicationsofthedescribedpathologyismostlikelytobelifethreateningtothisnewborn?
A)Activepneumonia
.B)Alveolaredema
0C)Amnioticembolism
00)Inadequatesurfactantsynthesis
E)Pulmonaryhypoplasia
*
m O m
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33. ExamSection1:Item32ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr11min35sec
®Mark
32An18-hour-oldmalenewbornIs61cm(24in)longandweighs5443g(12lb).Hismotherhastype1diabetesmellitus.Hisserumglucoseconcentrationis20rrig/dLWhichofthefollowingfetalconditionsimmediatelypriortobirthmostlikelyprecipitatedthe
newborn'spostnatalhypoglycemia?
.A)Decreasedgluconeogenesis
8)Decreasedglycogenconcentration
.JC)Decreasedglycogensynthetaseactivity
3D)DecreasedseruminsuEinconcentration
.E}Increasedseruminsulin-likegrowthfactor
O
*
m O m
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34. ExamSection1:Item33of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr11min31sec
®Mark
33.Thesynthesisoftheenzymesnecessaryforthereplicationofthegenomeoccursduringwhichofthefollowingphasesofthecellcycle?
OA)
OB)
OC)
OD)
OE)
*
m O m
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35. ExamSection1:Item34ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr11min29sec
®Mark
34.A22-year-oldwomanisbroughttotheemergencydepartmentinasemicomatoseconditionaftercollapsingneartheendofrunningamarathon.Herpreraceweightwas47kg(103lb).Shenowweighs50kg(110lb).Herpulseis115/min,respirationsare
15/min,andbloodpressureis90/50mmHg.Physicalexaminationshowscool,dryskin.Sheisresponsivetopainfulstimuli.Laboratorystudiesshow:
Serum
Na
+
116mEq/L
4.8mEq/L
89mEq/L
22mEq/L
22mg/dL
101mg/dL
1mg/dL
K-
ci
-
HCO
3
-
Ureanitrogen
Glucose
Creatinine
Thispatient'sconditionismostlikelyduetowhichofthefollowing?
oA)DecreasedADH(vasopressin)
6}Decreasedaldosterone
QC)Excessivefluidintake
!_D)Inadequatefluidintake
O
E)Increasedaldosterone
*
m O m
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36. ExamSection1:Item35ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr11min26sec
®Mark
35.A36-year-oldwomanwithtype2diabetesmellituscomestothephysicianforafollow-upexamination.Currentmedicationsincludeasulfonylurea.Sheis173cm(5ft3in)tallandweighs95kg(210lb):BMIis32kg/m
2Physicalexaminationshows
acanthosisnigricans.Treatmentwithmetforminismostlikelytoproducewhichofthefollowingeffectsinthispatient?
.A)Decreaseintestinalcarbohydratedigestion
B)increasebeta-cellinsulinsecretion
.JC)Increasedepositionofadipocytefat
'
3D)increasehepatictriglyceridesynthesis
.E}Inhibithepaticgluconeogenesis
O
*
m O m
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37. ExamSection1:Item36ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr11min23sec
®Mark
36.A23-year-oldmanintheemergencydepartmenthasapneaandpinpointpupils.Needletracksarepresentonhisarms.Activationofwhichofthefollowingopioidreceptorsinthecentralnervoussystemismostlikelytoberesponsiblefortheapnea?
OA)5
OB)K
OC)u
OD)a
O
*
m O m
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38. ExamSection1:Item37of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr11min21sec
®Mark
37.A5-year-oldgirlwithprematuresexualdevelopmentisdiagnosedwithprecociouspuberty.Pelvicexaminationshowsamassconsistentwithanovariantumor.Laboratorystudiesshowdecreasedserumconcentrationsofgonadotropinsandamarked
increaseincirculatingestrogens.Theovariantumorismostlikelyderivedfromwhichofthefollowingcelltypes?
.A)Endothelialcells
8)Germinalepithelium
.)G)Granulosacells
0D)Stromalfibroblasts
E)Thecalcells
*
m O m
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39. ExamSection1:Item33ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr11min19sec
®Mark
38.Ahealthy22-year-oldwomanundergoestestingtodeterminewhethersheisasuitablekidneydonorforher25-year-oldbrotherwithend-stagerenaldiseasecausedbytype1diabetesmeilitus.Immunologicstudiesshowthatsheishumanleukocyteantigen
(HLAJ
-DR3/DR6positive
;andherbrotherisHLA-DR3/DR4positive.Todeterminetheextentofalioreactivity
:amixedlymphocytereactionisdoneusingirradiatedstimulatorcellsisolatedfromthedonorandrespondercellsisolatedfromtherecipient.TheT
lymphocytesthatproliferateinthesecultureswillmostlikelyreactwithwhichofthefollowingHLAtypes?
A)DR3only
OB)OR3andDR4
oC)DR3andDR6
o0)0R4only
E)DR4andDR6
OF)0R6only
O
*
I* m O m
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40. ExamSection1:Item39of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr11min17sec
9Mark
39.A67-year-oldmanwithpoortycontrolledunstableanginaisabouttoundergocoronaryangiographywithstentplacementPriortotheprocedure,treatmentisinitiatedwithaspirinandadrugthatinhibitsplateletinteractionwithfibrinogen.Thisdrugismost
likelywhichofthefollowing?
.A)Abciximab
8)Celecoxib
0C)Cilostazol
_D)Cloptdogrel
.E}Dipyridamole
*
m O m
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41. ExamSection1:Item40ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr11min15sec
®Mark
40.Lesch-Nyhansyndrome,anX-linkedrecessivedisease
;isseeninapproximately1/100.000males.Whichofthefollowingistheexpectedprevalenceofheterozygousfemales?
OA)1/1000
cB)1/10,000
oC)1/50,000
'
0)1/200,000
oE)1/10,000,000
o m O m
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42. ExamSection1:Item41ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr11min12sec
®Mark
41.Thespecimenshownisfroma65-year-oldman.Whichofthefollowingisthemostlikelydiagnosis?
OA)Acuteleukemia
B)Coloniccarcinoma
0C)Hepaticcellcarcinoma
D)Leiomyosarcoma
E)Liposarcoma
ooo
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43. ExamSection1:Item42ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr11min10sec
®Mark
42A45-year-oldmanwhoisabletobicycle45minutesadayhasswitchedtoarowingmachine.After5minutesonthemachine,heexperiencesvertigo,lightheadedness.andfatigueoftheleftupperextremity.Withinafewminutesofstoppingtherowing
exercise,allsymptomsresolve..Whichofthefollowingfindingsismostlikelyonphysicalexamination?
OA)Diastolicmurmuratthecardiacapex
8)increasedjugularvenouspressure
.JC)Pansystolicmurmuratthecardiacapex
D)Rightcarotidbruit
.E)Supraclavicularbruit
O
*
m O m
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44. ExamSection1:Item43of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr11min8sec
9Mark
43.A55-year-oldmancomestothephysicianbecauseofa2-monthhistoryofincreasingdifficultyswallowingandregurgitationofundigestedfood.Healsohasnoticedunusualrumblingsoundsinhisvoicethathefeelsoriginateinhisneck.Physicalexamination
showshalitosis.Avideofluoroscopicswallowingstudyshowsa4-cm,posteriormidlinepouchprotrudingbetweenthethyropharyngeusandcricopharyngeusportionsoftheinferiorpharyngealconstrictormuscle.Thesemusclesaremostlikelyinnervatedby
whichofthefollowingnerves?
A)Glossopharyngealnerve
0B)Hypoglossalnerve
0G)Motorfibersfromthevagusnerve
00)Parasympatheticfibersfromthevagusnerve
O
&)Sympatheticfibersfromthesuperiorcervicalganglion
*
m O m
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45. ExamSection1:Item44ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr11min6sec
9Mark
44.A5-year-oldgirlisbroughttothephysicianbecauseoflist;essness
:fatigue,anddulfpainintherightupperquadrantoftheabdomen.Herheightandweightarebelowthe25thpercentile.Laboratoryfindingsindicatethatthecontentofherp-globinchainis
15%to20%ofnormal.Sequencingofthe(3-globingeneshowsapointmutationinasequence3'tothecodingregioninwhichAATAAAisconvertedtoAACAAA.Consequently,theamountofmRNAfor(3-globinisdecreasedto10%ofnormal.Whichofthe
followingfunctionsinrriRMAsynthesisandprocessingismostfikefyencodedbythesequenceAATAAA?
A)CappingwithGTP
3B)Cleavageandpofyadenylation
oC)Silencingofthepromoter
30)SplicingoftheinitialmRNAtranscriptinthenucleus
JE}TransportofthemRNAoutofthenucleus
*
m O m
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46. ExamSection1:Item45ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr11min3sec
9Mark
45.A7G-year-oldmancomestothephysicianforafollow-upexamination.Hehashypertensiontreatedwithap-adrenergicantagonistHelivesonafarmincentralCaliforniaandsayshehasalwaysdistilledhisownliquorBeforeretiringf0yearsago,he
workedinahatfactoryandsubsequentlyinatextilefactory.Hehassmoked2packsofcigarettesdailyforthepast55years.Hetellsthephysicianthathehashadseveralepisodesofpainfulswellingofhisrightgreattoe.Physicalexaminationshowsseveral
lesionsconsistentwithgoutytophiovertheelbowsbilaterally.Laboratorystudiesshow:
HemoglobinA
Serum
Glucose
Creatinine
Uricacid
5.6%
1c
93mg/dL
3.2mg/dL
7.9mg/dL
Themostlikelycauseofthispatient'sconditioniswhichofthefollowing?
A)Cigarettesmoking
^
B)Drinkinghome-distilledliquor
C)FarmingincentralCalifornia
QD)Workinginahatfactory
E}Workinginatextilefactory
o
*
900
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47. ExamSection1:Item46ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr11min1sec
9Mark
46.A22-year-oldwomancomestothephysicianbecauseofa6-monthhistoryofdifficultyswallowing.Shesaysthatshefeelslikesheischokingonbothsolidsandliquids.Shehasnopainwith
swallowing.Shehashada4.5-kgf10-lb)weightlossduringthistime.Thereisnohistoryoffeverorchills.Sheisnotsexualfyactive.Shedoesnotsmokecigarettesoruseillicitdrugs.Sheis170cm
(51!7in)tallandweighs59kg(130lb);EMis20kg/m
2Hervitalsignsarewithinnormallimits.Physicalexaminationshowsnoabnormalities.Anx-rayoftheesophagusisshown.Whichofthe
followingisthemostlikelyexplanationforthispatient'ssymptoms?
OA)Acidrefluxintotheloweresophagus
QB}Atrophyofthesmoothmuscleintheesophagus
oC)Inflammatorydegenerationofesophagealwaifneurons
D)Longitudinalmucosaltearattheesophagogastricjunction
E)Perforationoftheesophagealwall
«r
*
m O m
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48. ExamSection1:Item47ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr10min59sec
®Mark
47.A4S-year-oldwomancomestotheofficebecauseofa4-monthhistoryofheadaches,itchyskimdifficultyswallowing,heartburn,chesttightness,paininherarmsandlegs
;andaburningsensationwithurination.Shehasahistoryofsimitarsymptomssince
theageof14yearsbutpreviousexaminationsshowednoabnormalities.Hervitalsignsarewithinnormallimits.Physicalexaminationandlaboratorystudiestodayshownoabnormalities.Whichofthefollowingisthemostlikelydiagnosis?
A)Conversiondisorder
8)Factitiousdisorder
.JC)Illnessanxietydisorder(hypochondriasis)
D)Malingering
.E}Somaticsymptomdisorder
O
*
m O m
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49. ExamSection1:Item43ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr10min56sec
®Mark
48.Basedonthegraphofju-aminohippurate(PAM)concentrationversusPAHsecretion,whichofthefollowingisloweratpointYthanatpointX?
A)Glomerularfiltrationrate
B)PAHclearance
QC)PAHexcretionrate
'
D)PAHfilteredbad
E)Renalbloodflow
Y
80-
“O
at
c
£
X
Q
OJ
&
<n
l40—
x
<
0 iT T
020406080100
Plasmap-aminohippurate
(PAH)concentration
mg/dL
ooo
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50. ExamSection1:Item49of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr10min52sec
®Mark
49.A41-year-oldwomanisevaluatedbecauseofincreasinglysevereheadachesfor6weeks.Herbloodpressureis160/100mmHgwhilestandingandsupine.Abruitisheardovertheleftcostovertebralangle.Urinalysisshowsnoabnormalities.Anangiogram
oftheleftrenalarteryshowsalternatingareasofstenosisandaneurysmaldilatation("stringofbeads"sign).Whichofthefollowingconditionsoftherenalarteryisthemostfikelydiagnosis?
.A)Fibromusculardysplasia
8)Hyalinearteriolosclerosis
.JC)Intimalfibroplasia
30)Periarterialfibroplasia
.E}Perimedialhyperplasia
O
*
900
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51. ExamSection1:Item50ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr10min51sec
®Mark
50.Acohortstudyassessingriskfactorsforacquisitionofinfectionwithanewlyidentifiedagentisperformed.Onlynewlydiagnosedsubjectsareeligible,andcontrolsareselectedonthebasisofage.Theresultsofthisstudyareshown:
InfectionPresent InfectionAbsent
Turtleexposure
Noturtleexposure
60 20
40 80
Whichofthefollowingistherelativerisk,fortheexposurevariable?
OA)0-7
OB)1.0
OC)1.7
OP)2.2
OE)3.1
*
m O m
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52. ExamSection2:Item1of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min55sec
9Mark
1.A30-year-oldmanwithHIVinfectionhasbeentreatedwithacombinationofantiretroviraldrugs,includingzidovudine(AZT)
;for3years.LaboratorystudiesshowamarkedincreaseinhisplasmaHIVviralloadduringthepast3months.Viralresistanceto
zidovudineissuspected.Amutationinwhichofthefollowingismostlikelytoexplaintheresistancetozidovudineinthispatient?
A)Integrase
8)Neuraminidase
.C)Protease
!D)RNA-dependentDNApolymerase
.E}Thymidinekinase
900
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53. ExamSection2:Item2of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min51sec
9Mark
2.Aninvestigatorisstudying[
^
adrenoreceptorsinfemaleexperimentalanimals.Duringtheexperiment,epinephrineisinjectedintramuscularlyintoeachanimal,andtheeffectsonp
^
-adrenoreceptorsarethenobserved.Whichofthefollowingphysiologiceffects
ismostlikelytobeobservedintheseanimals?
.A)Increasedmyocardialcontractility
8)internalurethralsphinctercontraction
OC)Lipolysis
3D)Pilomotorcontraction
..E)Pupillarydilation
F)Uterinerelaxation
*
m O m
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54. ExamSection2:Item3of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min43sec
9Mark
3.A16-year-oldboyisbroughttotheemergencydepartmentbecauseofa2-dayhistoryofincreasinglysevereabdominalpain.Histemperatureis39X(182:2X1pulseis86,'min,respirationsare18/min,andbloodpressureis120/60mmHg.Abdominal
examinationshowsexquisitetendernessoftherightlowerquadrant.Hisleukocytecountis16
:000/mma.Anappendectomyisdone;theappendixisswollenwithatanexudateontheserosalsurface.Whichofthefofiowingbestcharacterizestheleukocytosisin
thispatient?
A)Basophilia
0B)Eosinophiiia
0G)Lymphocytosis
00)Monocytosis
JE}Neutrophilia
*
m O m
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55. ExamSection2:Item4of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min46sec
®Mark
4.A32-year-oldprimigravidwomandeliversaheafthy3402-g(7-lb8-oz)malenewbornafteranuncomplicatedcesareandeliverybecauseofanonreassuringfetalstresstest.Twodayspriortodischargefromthehospitalshehaspersistentnumbnessofthe
areasurroundingtheabdominalincision.Thephysicianassuresthepatientthatsensationwillgraduallyreturnasthenervesregenerate.Whichofthefollowingbestdescribestherate-limitingstepinthispatient'sreturntonormalsensation?
.A)Dorsalrootganglioncel!proliferation
8)Fastanterogradeaxonaltransport
0C)Fibroblastproliferation
0D)Retrogradeaxonaltransport
.E)Slowanterogradeaxonaltransport
*
m O m
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56. ExamSection2:Item5of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min44sec
®Mark
5.An18-year-oldwomancomestothephysicianbecauseofprogressivefevergeneralmalaise,andbloodinherurinesinceshebeganoralantibiotictherapyforaurinarytractinfection5daysago.Shealsohasa3-dayhistoryofarash..Hertemperatureis
38°C(1DG.43F),pulseis75/min,respirationsare12/mrn,andbloodpressureis125/80mmHg.Physicalexaminationshowsapetechialrashoverthechest.back
:andupperandlowerextremities.Urinalysisshows:
Blood
Protein
Leukocytes
Eosinophils
3+
1+
150/hpf
30%
Whichofthefollowingisthemostlikelydiagnosis?
oA)Acutetubularnecrosis
6}Glomerulonephritis
QC)IgAnephropathy
D)Interstitialnephritis
OE)Papillarynecrosis
*
m O m
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57. ExamSection2:Item6of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min33sec
9Mark
6.A33-year-oldwomanhashadweaknessoftherightlowertwothirdsofthefaceforthepast2months.Whichofthefollowinglabeledregionsinthenormalbrainshownisthemostlikelysiteofthelesioncausingthissymptom?
Centralsulcus
E
F
C
/
G
B
\r
r
£$
I
>
J
(h:
kM
A
-5
rcd
--i
I.--
Ll
m-wr
r m-—
.
-J
3«
»r.
j
i
H
.
^
.
ip
OA)
OB)
O
C)
OD)
OE)
OF)
OG)
OH)
On
OJ)
00 #0 0
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58. ExamSection2:Item7of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min36sec
®Mark
7.A4G-year-oldwomancomestothephysicianbecauseoftemperaturesof38to39X(100.4to102.2aF)andmalaiseforthepast2days.Shehaschronicalcoholdependence.Thereareseveralspiderangiomasontheface,chestandback;sheisnot
jaundiced.Theabdomenisprotuberantandnontender.Thereisshiftingdullnesstopercussion.Afirmliveredgeisballotable3cmbelowtherightcostalmargin.Routinelaboratorystudiesshowmiidanemia
;mildlyincreasedhepatictransaminaseactivities
:
andadecreasedserumalbuminconcentration.Peritonealaspirationyieldsserousfluidwith1100leukocytes/mm
3{80neutrophils)and100erythrocytes/mm
3Whichofthefollowingprocessesbestaccountsforthepatient'sfebrifeilEness?
A)Acutecholecystitis
3B)Chronicpancreatitis
oC)Exacerbationofautoimmunehepatitis
30)PelvicinfEammatorydisease
E}Spontaneousbacterialperitonitis
O
*
900
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59. ExamSection2:Item8of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min34sec
9Mark
8.Apatientwitha6-monthhistoryofheatintolerance.fatigue
;episodesoftachycardia
:andweightlosshasadiffuselyenlargedthyroidglandSerumconcentrationsoftriiodothyronine(T
3
)andthyroxine(TJareincreased;thyroid-stimulatinghormoneis
decreased.Whichofthefollowingisthemostlikelydiagnosis?
OA)Autoimmunethyroidhyperplasia
8)Pituitaryneoplasm
OG)SurreptitiousingestionofT
4
D)Thyroidneoplasm
O
*
m O m
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60. ExamSection2:Item9of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min31sec
9Mark
9.A19-year-oldmanwhoisacollegestudentisbroughttotheemergencydepartmentbecauseofthesuddenonsetofright-sidedchestpainanddifficultybreathingafteranaccidentinwhichhewasthrownfromhisbicycle.Hehasdifficultywalkingandcannot
climbstairsbecauseofpainandshortnessofbreath.Heisslightlycyanotic,afebrile
:andtachypneic.Whichofthefollowingismostsuggestivethatfracturedribscausedtherespiratoryproblem?
A)Bronchophony
B)Expiratorystridor
0C)Inspiratorystridor
0D)Subcutaneouscrepitus
.E)Succussionsplash
*
m O m
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61. ExamSection2:Item10of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min29sec
®Mark
10.A62-year-ofdwomandevelopsdifficultybreathing.Pulmonaryfunctiontestsbeforeandafterbranchediiatortherapyshownochanges.Predictedandpatientvaluesare:
PredictedTest Patient
FVC(L)
FEV
1
(L)
FEV/FVC
TotalEungcapacity(L)
Residualvolume(L)
5.0 4.0
4.0 2.4
0.8 0.6
6.0 7.2
1.6 2.7
Whichofthefollowingisthemostlikelyexplanationforthesefindings?
AirwayResistance LungCompliance
OA)
OB)
OC)
O
0)
OE)
T T
normalT
Normal 1
I T
4
*
m O m
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62. ExamSection2:Item11of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min26sec
®Mark
11.A3-year-oldgirlisbroughttothephysicianbecauseofa2-weekhistoryofdiarrhea.Hertemperatureis37.6CC(99.8aF}
:pulseis70/min,respirationsareWmjn
;andbloodpressureis110/70mmHg.Physicalexaminationshowsgeneralized
[ymphadenopathy.ACTscanofthechestandabdomenshowsenlargedlymphnodesinthemesenteryandpara-aorticregion.Examinationofalymphnodebiopsyspecimenshowsmarkedproliferationofhistiocytesandnumeroussegmentedneutrophils.
Granulomataareabsentandspecialstainsshownumerousacid-fastbacilli.whicharesubsequentlyidentifiedasMycobacteriumavium-intracellulare.SerumstudiesshownormalconcentrationsofIgA,lgG
;IgM,Blymphocytes,Tlymphocytes,andCD4?and
CD8+-Tlymphocytes.Thispatientmostlikelyhasdefectivefunctionorexpressionofwhichofthefollowingproteins?
A)ClassIMHGmolecules
.8)Interferon-gammareceptor
0G)interleukin-2(IL-2)receptor
)0)Leukocytefunction-associatedantigen-1
'
E)MADPHoxidase
*
m O m
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63. ExamSection2:Item12of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min24sec
®Mark
12DrugXisusedtotreatpainassociatedwithrheumatoidarthritis.Thedrugisaweakacid,withapKaof4.4;itisabsorbedprincipallythroughthestomach.ItisdeterminedthatDrugXisabsorbedefficientlybythebodybecauseoftheionizationconditions
underwhichitexistsatgastricandbloodpH.Whichofthefollowingsetsofphysicalchemicalstatesofthedrugismostfikely?
AtGastricpH
Ionized
Ionized
Nonionized
AtBloodpH
ionizedOA)
OB)
O
C)
OD)
nonionized
ioniized
Nonionized nonionized
*
m O m
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64. ExamSection2:Item13of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min21sec
®Mark
13.Apreviouslyhealthy10-year-oldgirlisbroughttothephysicianbyhermotherbecauseofa6-weekhistoryofheadache,nausea,anddifficultywalking.AnMR]ofthebrainshowsamassiintheposteriorfossathatisfoundtobeanastrocytoma,ihistumor
developedfromcellsthatnormallyservewhichofthefollowingfunctionsinthebrain?
.A)Formationofmyelinsheathsinthecentralnervoussystem
8)Phagocytosisofrecycledsynapticterminalmembrane
.C)Productionandsecretionofcerebrospinalfluid
QD)Terminationofactionpotentials
.E)Transportofhormonesfromthecerebralspinalfluidtocapillaries
F)Uptakeofaminoacidneuretransmitters
*
m O m
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65. ExamSection2:Item14of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min19sec
9Mark
14.A26-year-oldwomancomestothephysicianbecauseofa1-weekhistoryofrectalpainthatismademoreseverebydefecation,andoccasionalbloodonthetoilettissueafterabowelmovement.Shesaysthather
stoolsappearnormalandthatshehasnothadanytrauma.Shehasahistoryofchronicconstipation.Visualrectalexaminationshowsthefindingsinthephotograph.Whichofthefollowingisthemostlikelydiagnosis?
A)Analfissure
3B)Bowencarcinoma
C)Condylomaacuminatum
OD)Perianalabscess
E)Prolapsedinternaihemorrhoid
O
*
& *
C
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66. ExamSection2:Item15of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min16sec
9Mark
15.Amoderatelyobese55-year-oldmanisbroughttotheemergencydepartmentbecauseofa10-hourhistoryofseverechestpain.Hehasa5-yearhistoryofexercise-inducedangina.Hispulseis109/min,respirationsare15/min,andbloodpressureis
132/92mmHg.Physicalexaminationshowsdiaphoresis.Abloodsampleobtained2hoursafteradmissionshowsincreasedserumactivityofcreatinekinaseME.Whichofthefollowingisthemostlikelycauseofthisaboratoryfinding?
.A)IncreasedGoEgicomplexactivity
8)increasedpermeabilityoftheplasmamembrane
OG)Mitochondria!swelling
D)Muclearlysis
.E)Proliferationoftheendoplasmicreticulum
O
*
900
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67. ExamSection2:Item16of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min12sec
9Mark
16.AGG-year-ofdwomancomestothephysicianbecauseofa6-monthhistoryofpaininherhipsandknees.Physicalexaminationshowsfindingsconsistentwithosteoarthritis
;andthephysicianrecommendsiibuprofen.Thepatientrefusesandasksabouttaking
glucosamine.Whichofthefollowingresponsesbythephysicianismostappropriate?
.A)"Glucosaminehasn'tbeenstudiedwellenoughformetorecommendit."
8)"Glucosamine'ssideeffectsaren'tlisted.Itmaybemoredangerousthanwerealize."
.G)"Ibuprofenhasbeenproveneffectiveforyourcondition."
'
!D)"Whathaveyouheardaboutusingglucosaminetotreatarthritis?"
.E)"Whydidyoucometomeifyoudon’twanttotakewhatIrecommend?
11
F)"Youshouldreallyseeanaturopathicdoctor."
*
m O m
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68. ExamSection2:Item17of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min10sec
9Mark
17.An88-year-oldmanwholivesaloneisbroughttothephysicianbyhisdaughterbecausesheisconcernedthathehasnotbeeneatingawell-balanceddietfor9months.Heis170cm(5ft7in)tallandweighs50kg(110fb);BMIis17kg/m
2Physical
examinationshowsmultipleecchymosesontheupperandlowerextremities.Laboratorystudiesshow:
Plateletcount
Prothrombintime
Serum
VitaminB
6
(pyridoxine)
VitaminC(ascorbicacid)
Folicacid
160,000/mm
3
12sec(INR=1}
9ng/dL(N=5—30)
0.1mg/dL(N=0.4-2)
5ng/dL(N=2—20)
Theecchymosesinthispatientaremostlikelyduetoadisorderofwhichofthefollowing?
A)Arachidonicaddproduction
Q
B)Bindingofcarboxyglutamicacidtophospholipid
CC)Carboxylationoffactorfl(prothrombin)
JD)Prolinehydroxylafion
E}Transferofmethylgroupstoorganicacids
*
m O m
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69. ExamSection2:Item13of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min3sec
®Mark
18.A14-year-ofdboyhaspersistentleukocytosisandneutrophiliawithoutevidenceofacurrentinfection.Hehasahistoryofrecurrentinfectionsoftheskin
:upperandlowerairways,andperirectalarea.Gram-negativeandgram-positiverodshavebeenisolated.
ThenumberandfunctionofBandTlymphocytesarenormal.Productionofhypochlorousacidbyneutrophilsandthenitrobluetetrazoliumreductiontestarenormal;.Neutrophilchemotacticresponsetotheformyl-MetLeuPhe(fMLP)peptideisdiminished.
Whichofthefollowingdisordersofneutrophilsisthemostlikelydiagnosis?
A)Chronicgranulomatousdisease
3B)Cyclicneutropenia
oC)Leukocyteadhesiondeficiency
30)Myeloperoxidasedeficiency
E}Neutrophil-specificgranuledeficiency
O
*
m O m
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70. ExamSection2:Item19of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min5sec
®Mark
0-r0
1
x
2
I
>4
^
0
2
^
36
1 1
n 2£
33
31 2
11 1 1
o
4
HI
22
33
5 2
6 3
1 2 3
1 11
IV
25
36
2
3
2 31 4
Affectedmale
#Affectedfemale
Unaffectedmale
OUnaffectedfemale
0Affectedmale,deceased
0
Unaffectedfemale,deceased
19.Aninvestigatorisstudyingalargefamilywithmanymemberswhoareaffectedbyadisordercausedbyafullypenetrantautosomaldominantinheritedgenemutation.Apedigreeisshown.Mostaffectedmembersalsohaveararealleleatafocusthoughtto
becloselylinkedtothediseasefocus.Afather(individual111-3)andhisdaughter(individualiV-3)havethedisorder,buttheyhavethewild-typealleleatthelinkedlocus.Whichofthefollowingisthemostlikelycauseofthesefindings?
(JA)InsertionofaLINEsequence
8}Randomsegregation
QG)Recombination
D)Singlenucleotidepolymorphism
E)Transduction
®0 000
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71. ExamSection2:Item20ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min3sec
®Mark
20.A45-year-oldwomancomestothephysicianbecauseofa6-monthhistoryofshortnessofbreathwithexeitionandanonproductivecough.Shesometimeshasdifficultyswallowingandoftenhasheartburn,especiallyifshefiesdownafterameal.Sheadds
thatherfingershaveswollen,andshehashadtogetherweddingringresized.Herfingersalsobecomewhiteandpainfulincoldweatherorcotdwater.Herpulseis75/min
:respirationsare20/min,andbloodpressureis150/100mmHg.Physical
examinationshowstight,smoothfacialskinwithoutwrinkles.Additionaltestingismostlikelytoshowwhichofthefollowingsetsofcardiovascularchangesinthispatient?
LeftVentricular
DiastolicCompliance
MeanPulmonary
ArteryPressure
CoronaryVascular
Resistance
OA)
OB)
O
C)
OD)
OE)
OF)
OG)
OH)
f f f
T T I
T
*
V
4 4
t tv
'
l i
A.
1
4 V V
© 15fE
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72. ExamSection2:Item21ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min45sec
9Mark
21.A25-year-oldwomancomestothephysicianforaroutinehealthmaintenanceexamination.Sheiscurrentlypreparingforan8-km(5-mile)race,andshesprinttrainstwiceweekly.Duringthistraining
:sheruns200-metersprintsintwogroupsof10sprints
separatedbya30-secondrestbetweeneachsprintinagroup
:anda2-minuterestbetweeneachgroupof10.Aftertheworkoutherlegsfeelweak,andhermusclesburnandsometimescramp.Whichofthefollowingbestexplainshersymptoms?
A)Decreasedactivityofthesodium-protonantiporter,resultinginanacidicsarcoplasm
8)increasedactivityofthesodium-protonantiporterresultinginanacidicsarcoplasm
OC)increasedoxygendeliverytothemuscle
:leadingtoincreasedmetabolismandacidproduction
'
D)RegenerationofNAD
+fromNADH
;whichproducesacid
*
m O m
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73. ExamSection2:Item22ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min42sec
®Mark
22A14-year-oldgirlisbroughttothephysicianbecauseofa1-monthhistoryofmigraine-likeheadaches,vomifing
:andmultipleleft-sidedfocalseizures.Shehashadhearingfosssincetheageof11years.Hermotherandmaternalgrandmotherhavehigh-tone
deafness.PhysicalexaminationshowsJossofvisioninonehalfofthevisualfieldoftherighteyeandweaknessoftherightupperandtowerextremities.Serumandcerebrospinalfluidconcentrationsoflacticacidareincreased.Thispatientmostlikelyhasa
mutationofwhichofthefallowing?
OA)EndoplasmicreticulumglycosyItransferase
3B)Lysosomala-gfucosidase
oC)MitochondrialtRNALeu
30)Nuclearproteasomeactivator
JE}Peroxisomalcatalase
O m O m
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74. ExamSection2:Item23of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min40sec
9Mark
23.Acase-controlstudyisconductedtodetermineifobesityisariskfactorforgastroesophagealrefluxdisease(GERD).AquestionnaireisusedtoselectsubjectswithseveresymptomsofGERDandsubjectswithnosymptoms.ABMfiscalculatedforeach
subject.Theresults(inkg/m
2)areshown:
BMI<25 25<BMK30 30<BMk35 BMI>35
SubjectswithGERDsymptoms
Subjectswithnosymptoms
303 900 200 50
700 900 200 30
WhichofthefollowingrepresentstheoddsratioforGERDsymptomsinsubjectswithBMfsgreaterthan35comparedwithsubjectswithBMIslessthan25?
A)(50
*
30)/(300
*
700)
oB)(50
*
700)I(30x300)
ocj[50/(30+50)31[300/(300+700)]
:D)[50/(50+300)31[30/(30+700)3
.
^
E)[50/(50+200+900+300)3'
[30/(30+200+900+700)3
*
m O m
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75. ExamSection2:Item24ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min33sec
0Mar
*
24.A14-year-oldboyisbroughttothephysicianbyhismotherbecauseofdailyheadachesfor2months.Theheadachesaredescribedasabilateralachinginthetempfes.HismotherstatesthathealsoTiasnotbeenhimself'forthepastfewmonths.Heseems
moreconfused,oftenforgettingnames,dates,andplaces
:andheisclumsywithfrequentfalls.Hisschoolperformancealsohasdeclinedoverthepastquarter.Physicalexaminationshowsabroad-based
;ataxicgait.Heisalertandorientedtoperson
:place,
andtime
:butheisslowtoanswerquestions.Chronicabuseofwhichofthefollowingsubstancesisthemostlikelycauseofthispatient'scondition?
A)Cocaine
CB)Ethanol
0G)Inhaledgfue
00)Methamphetamines
0E}PCP(phencyclidine)
*
m O m
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76. ExamSection2:Item25ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min36sec
9Mark
25.Astudyisdesignedtomeasuretheimpactofexerciseontheincidenceofmyocardialinfarction.Subjectsareenrolledinthestudyanddividedintotwogroupsbasedontheirself-reportedexercisehabits.Attheendofthestudy
;subjectswhoreported
exercisinghavehalftheincidenceofmyocardialinfarctioncomparedwiththesubjectswhodidnotexercise.Whichofthefollowingbestdescribesthisstudydesign?
A)Case-control
8)Caseseries
.C)Cohort
oD)Cross-sectional
.E}Randomizedclinicaltrial
*
m O m
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77. ExamSection2:Item26ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min33sec
9Mark
26.An18-year-oldwomanisbeingevaluatedforamenorrhea.Shehasneverhadamenstrualperiod.Sheis183cm(6ft)tall.Breastdevelopmentandexternalgenitaliaarenormal.Thereisnoaxillaryorpubichair.Whichofthefollowingkaryotypesismost
likely?
OA)45.X
O
0)46,xx
OC)46,XY
OD)46.X,i(Xq)
OE)47,XXX
*
m O m
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78. ExamSection2:Item27of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min31sec
®Mark
27.A50-year-oldmancomestothephysicianbecauseofa2-monthhistoryofpainofhiswrists
;changesinskincolor,andprogressivefatigue.Hisbrotherhastype2diabetesmefliitusandcirrhosis.Physicalexaminationshowsbronze-coloredskin,tenderness
ofthemetacarpophalangealjointsinbothhands,andhepatosplenomegaly.Serumstudiesshow:
AST
AIT
Ferritin
100U/L
110U/L
1200ng/mL
Totaliron-bindingcapacity200pg/dL(N=25G-400)
Transferrinsaturation 80%(N=20—50}
Analysisofaliverbiopsyspecimenshowsamarkedlyincreasedironconcentrationandcirrhosis.Whichofthefollowingisthemostlikelycauseofthefmdingsinthispatient?
A)Increasederythropoietinaction
QB)Increasedintestinalironabsorption
QC)Increasedoralironintake
!D)Decreasederythropoiesis
)E)Decreasedironexcretion
F)Decreasedserumtransferrinconcentration
m O m
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79. ExamSection2:Item28ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min29sec
®Mark
28.Thepresenceofargininosuccinateintheurineindicatesadefectintheconversionofwhichofthefollowing?
0
A)Ammoniatourea
JS)LysinetoglutarylCoA
0G)MethioninetosuccinylCoA
JD)Phenylalaninetofumarate
!JE)Tryptophantoindole
ooo
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80. ExamSection2:Item29of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min26sec
®Mark
29.A55-year-oldwomanisbroughttotheemergencydepartmentafterbeinginjuredinamotorvehiclecollision.Shehasaninjuryofthesofttissueofthefacethatpreventsherfromdrinkingfromaglasswithout
spillingthecontents.Severaldayslatershestilthasthisproblem.Thephotographshowsherattemptingtopurseherlipstowhistle.Whichofthefollowingnervesismostlikelydamaged?
A)Buccalbranchofthefacialnerve
B)Inferioralveolarbranchofthemandibulardivisionofthetrigeminalnerve
O Infraorbitalbranchofthemaxillarydivisionofthetrigeminalnerve
D)Mandibularbranchofthefacialnerve
E)Pharyngealbranchesofthevagusnerve
*
m O m
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81. ExamSection2:Item30ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min24sec
®Mark
30.Apreviouslyhealthy6-month-ofdboyisbroughttothephysicianbecauseofacoughfor1week.Initiallyhehadalow-gradefeversneezing,congestion,andrunnynose.Hethendevelopedadryintermittentcough.Theparentsnownotethatwithanystartle
thebabychokesandgasps.Hehasnothadanyimmunizations.Physicalexaminationshowsparoxysmsof'‘machinegun"-likecoughingwithaforcedexpiratorygruntattheendofcoughing.Leukocytecountis30
;000/mm
3(70%lymphocytes).Neutrophil
chemotaxisandoxidativemetabolismaredefectiveduetoincreasedactivityofwhichofthefollowingenzymes?
A)Adenyly!cyclase
3B)Myeloperoxidase
oC)NADPHoxidase
O0)PhospholipaseC
JE}ProteinkinaseC
*
m O m
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82. ExamSection2:Item31of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min22sec
®Mark
31.A22-year-oldwomancomestotheofficebecauseofa3-dayhistoryofnonproductivecough.Shealsohasa1-weekhistoryoffatigue
:progressiveshortnessofbreathwithexertionandwhitelyingdownandswellingofherlegsandfeet.Shedeliveredamale
newbornviauncomplicatedvaginaldelivery1monthago.Shehasnohistoryofmajormedicalillnessandtakesnomedications.Hertemperatureis37.7aC(99.8aF)
:pulseis104/min,respirationsare20/miinPandbloodpressureis126/80mmHg.Bilateral
basilarcracklesareheard.Thereis1+edemaofthelowerextremitiesbilaterally.Whichofthefollowingisthemostlikelydiagnosis?
A)Amnioticfluidembolism
3B)Cardiomyopathy
oC)Majordepressivedisorder
30)Pneumonia
JE}Pulmonaryembolism
'F)Pulmonaryfibrosis
o
*
900
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83. ExamSection2:Item32ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min20sec
®Mark
32A63-year-oldmanisscheduledtoundergocoronaryarterybypassgraftingwithaportionofthegreatsaphenousvein.Anincisiontoremoveaportionoftheveinshouldbegininwhichofthefollowinglocations?
3A)Alongthelateralsurfaceoftheleg
JS)Alongthemedialsideoftheanklejoint
(3G)Alongtheplantarsurfaceofthefoot
0}Anteriortothekneejoint
'
JE)Posteriortothehipjoint
*
m O m
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84. ExamSection2:Item33of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min18sec
9Mark
33.A62-year-oldmanisbroughttotheemergencydepartment2hoursafterthesuddenonsetofpainandcoolnessofhisrightleg.Heisotherwisehealthyexceptformildhyperthyroidismtreatedwithpropylthiouracil.Examinationofthetowerextremitiesshows
normalskimnaiis
:andhairgrowthpatterns.Pulsesareabsentintherightlowerextremityandnormalontheleft.Whichofthefollowingisthemostlikelydiagnosis?
A)Cellulitis
8)Deepvenousthrombosis
OC)Embolicarterialocclusion
3D)Lumbarcischerniation
.E}Rhabdomyolysis
*
m O m
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85. ExamSection2:Item34ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min16sec
9Mark
34.A32-year-oldwomancomestothephysicianforafollow-upexaminationafteratypicalcellswerenotedonarecentPapsmear.Physicalexaminationshowsa1x1-cmareaofleukoplakiaonthecervixAbiopsyspecimenofthelesionshowsinvasive
squamouscellcarcinoma.Malignantcellsfromthissitewillmostlikelydrainfirsttowhichofthefollowinglymphnodesinthispatient?
.A)Femoral
8)inferiormesenteric
OC)Internaliliac
D)Lumbar
.E)Superficialinguinal
*
m O m
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86. ExamSection2:Item35ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min14sec
9Mark
35.A70-year-oldmandiesinamotorvehiclecollision.HehadbeenundergoingevaluationforoccultbloodinthestoolAphotographofasectionofthetransversecolonobtainedatautopsyisshown.Whichofthefollowingis
themostlikelydiagnosis?
..A)Hyperplasticpolyp
QB)Inflammatorypseudopolyp
C)Juvenilepolyp
OD)Peutz-Jegherssyndrome
E)Tubularadenoma
& * f*
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87. ExamSection2:Item36ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min12sec
9Mark
36.A61-year-oldmanhaserectiledysfunctionduetospinalcordinjuryatL-2.Sildenafilislikelytomarkedlycorrectthedysfunctionbyactingatwhichofthefollowinglabeledstructuresinthetransversesectionofthepenis?
OA)
OB)
O
C)
OPi
00 ©0 0ns
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88. ExamSection2:Item37of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min10sec
9Mark
40-i
37.Whichofthefollowingisthemeannumberofepisodesofurinarytractinfectionsforchildren(n=100}inthesampleshowninthegraph?
OA)1
cB)1.55
oC)2.07
D)Cannotbedeterminedfromthisgraph
g30-
I
JiBUBn
o
8
2
°
-
_Q
I10-
«
30 1 2
Numberofurinarytract
infections
m O m
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89. ExamSection2:Item33ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min3sec
®Mark
38.A3-year-oldboyisbroughttothephysicianbecauseofa1-monthhistoryofpaleskin.HisparentsareofEuropeandescent.Hehasnopersonalorfamilyhistoryofmajormedicalillness.Physical
examinationshowspallor.Laboratorystudiesshow:
Hemoglobin
Hematocrit
Meancorpuscularhemoglobinconcentration
Meancorpuscularvolume
3g.'dL(N=11-15)
24%(N=28-45)
34%Hb/cell(IM=31-36)
90pm
3(N=77-98)
Aphotomicrographofaperipheralbloodsmearisshown.Genetictestingismostlikelytoshowwhichofthefollowingfindingsinthispatient?
A)Heterozygousmutationintheankyringene
B)Heterozygousmutationinthea-globingene
O -P)Heterozygousmutationinthep-giobingene
D)Homozygousmutationintheankyringene
OE)Homozygousmutationinthea-globingene
F)HomozygousmutationintheP
-globingene
*
m O m
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90. ExamSection2:Item39of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min5sec
®Mark
39.A24-year-oldwomanisbroughttotheemergencydepartment15minutesafterthesuddenonsetofshortnessofbreathfollowingabeesting.Herpulseis130/min,andbloodpressureis70/30mmHg.Threehourslater,herbloodpressurereturnstonormal
followingadministrationofintravenousfluids,corticosteroids.antihistamines
:andepinephrine.Thenextday.shehasminimalurineoutput.Whichofthefollowingareasofthekidneyislikelytobemostaffectedwiththispatient'sprolongedhypotension?
OA)Glomerularepithelialcells
8)LoopofHenle
0G)Medullaryinterstifium
D)Mesangialcells
.E)Proximaltubules
*
m O m
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91. ExamSection2:Item40ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min3sec
®Mark
40.A65-year-oldmandevelopsurinaryincontinenceimmediatelyafteranoperationforprostatecancer.Themostlikelycauseofhisconditionisdamagetotheprostaticnerveplexusthatresultedindenervationoftheinternalurethraisphincter.Thefunctionof
whichofthefollowingtypesoftissueismostlikelyimpairedasaresultofthisdamage?
.A)Denseirregularconnectivetissue
8)Denseregularconnectivetissue
.C)Skeletalmuscle
D)Smoothmuscle
.E}Transitionalepithelium
*
m O m
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92. ExamSection2:Item41ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min0sec
®Mark
41.A10-year-oldboywhohasbegunchemotherapyforacutemyelogenousleukemiaawakensatnightwithfeverandseverepainintheankles.Treatmentwithover-the-counteranalgesicsdoesnotresolvethepain.Thenextmorning,hehaspainwithurination
andbloodintheurine.Anincreasedserumconcentrationofwhichofthefollowingcompoundsisthemostlikelycauseofthispatient'ssymptoms?
A)Cystine
8)Glycine
.;C)Magnesium
VD)Urea
..E)Uricacid
*
m O m
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93. ExamSection2:Item42ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr12min53sec
9Mark
42A27-year-oldwomanisbroughttothephysicianbyherfamilybecauseshehasbeenprogressivelylethargicandunwillingtoleaveherapartmentoverthepastweek.Shehasbeenreceivingtreatmentinamentalhealthcenterfor10yearsbutmissedherlast
appointment13daysagobecauseofasnowstorm.Sheisnowreluctanttoreturnbecauseshebelievesthestaffisinvolvedinanextraterrestrialplot.Threeyearsago
;shehadsimilarsymptomstreatedwithelectroconvulsivetherapy.Sheappears
disheveled.Sheishavingauditoryhallucinationsofseveralpeopletalkingabouther.Physicalexaminationshowsnormalfindings.Shehaspooreyecontact,aflataffectandslowspeech.Shedescribesanelaboratedelusionalsystemabouttheplotatthe
mentalhealthcenter.Thoughtcontentisotherwiseimpoverished.Whichofthefollowingisthemostlikelydiagnosis?
A)Bipolardisorderdepressed
.B)Borderlinepersonalitydisorder
0C)Delusionaldisorder
)D)Schizophrenia
E)Schizotypalpersonalitydisorder
*
m O m
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94. ExamSection2:Item43of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr12min56sec
®Mark
43.AviralgeneproductisfoundtodecreaseexpressionofclassiMHCmoleculesonthesurfacesofinfectedcells.Amutantstrainofvirusisisolatedthathasanonfunctionalformofthisgene.Whichofthefollowingtypesofcellsarelikelytocontributemore
effectivelytocontroloftheparentalstrainofthevirusthantocontrolofthemutantvirus?
0A)CD4+-7lymphocytes
8)CD8+-Tlymphocytes
.)C)Folliculardendriticcells
'
_D)Naturalkillercells
..E}Plasmacells
*
m O m
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95. ExamSection2:Item44ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr12min54sec
®Mark
44.Apreviouslyhealthy40-year-oldmanisbroughttotheemergencydepartment1hourafterthesuddenonsetofseverepaininhisleftlegwhileplayingtennis.HeisfoundtohaverupturedtheleftAchillestendonandundergoesoperativerepairandlongleg
castimmobilization.Sixmonthslater,theleftcalfshowsa2-cmdecreaseincircumferencecomparedwiththerightcalf.Whichofthefollowingisthemostlikelycauseofthisdecrease?
.A)Decreasedglycogensynthesis
8)Decreasedmyosinlightchainphosphataseactivity
.JC)Increasedphosphatidyldegradation
'
jD)increasedproteindegradation
.E)Mitochondriadamage
F)Necrosisofmusclefibers
*
m O m
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96. ExamSection2:Item45ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr12min50sec
®Mark
45.A5G-year-oldwomanhasrecentlydiagnosedcarcinomaofthebreast.Anx-rayofthechestshowsatumornexttotherightsideoftheheart.AnenhancedCTscanwiththetumorinvadingthe
pericardiumisshown.Whichofthefollowingstructuresismostlikelyinvolved?
A)Coronarysinus
B)Greatersplanchnicvein
C)Rightphrenicnerve
D)Rightvagusnerve
E)Thoracicduct
O
*
900
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97. ExamSection2:Item46ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr12min4£sec
®Mark
46.A25-year-oldwomanwithahistoryofrheumaticfeverandmitralvalvedysfunctioncomestothephysicianbecauseofa2-weekhistoryoffeverandfatigue.Sheunderwentarootcanalprocedure1monthago
;
beforewhichshehadtakenasingledoseofamoxicillin.Hertemperatureis38.4*0(10129F).Agrade4/6blowingmurmurisheardonauscultationundertheleftaxilla.AphotomicrographofaGramstainofthe
organismrecoveredfromabloodculturespecimenisshown.Onbloodagarplates
;theorganismshowsalphahemolysis.Whichofthefollowingisthemostlikelycausalorganism?
A)Enterococcusfaecalis
B)GroupAbeta-hemolyticstreptococci
0C)Staphylococcusaureus
D)Streptococcusmitts
E)Streptococcuspneumoniae
O
*
m O m
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98. ExamSection2:Item47ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr12min46sec
®Mark
47.A24-year-oldwomancomestothephysicianforadviceaboutcontraceptivemethods.Sheisrecentlymarriedandisnotinterestedinhavingchildrenuntilhermid30s.Whichofthefollowingcontraceptivescarriesthehighestriskforinterferencewithfertilityin
thispatientEaterinlife?
.A)Cervicalcapwithspermicidaljelly
8)Condomsandspermicidalfoam
oC)JUD
oD)Oralcontraceptive
..E)Progestinimplant
O m O m
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99. ExamSection2:Item43ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr12min44sec
®Mark
48.Topicalcorticosteroidcreamsandphototherapyareofteneffectiveinthetreatmentofpsoriasis.Thiseffectivenesssuggestsaroleformetabolismornuclearbindingofwhichofthefollowingvitaminsinthetreatmentofpsoriaticlesions?
A)Niacin
^
S)VitaminB
1
(thiamine)
0G)VitaminB
2
(riboflavin)
J0}VitaminB
6
(pyridoxine)
0E)VitaminC
.
'
F)VitaminD
0G)VitaminE
H}VitaminK
*
m O m
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100. ExamSection2:Item49of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr12min42sec
®Mark
49.A21-year-oldwomanofJapanesedescentcomestotheemergencydepartmentbecauseofa3-hourhistoryoffacialflushing.Hersymptomsbeganshortlyaftershedrankaglassofchampagneforthefirsttimeataweddingreception.Physicalexamination
showsprofounderythemaovertheface.Themostlikelycauseofthesefindingsisamutationinthegeneforwhichofthefollowingenzymes?
.A)Acetyl-CoAreductase
8)Alcoholcatalase
.)C)Alcoholdehydrogenase
'
_D)Alcoholreductase
.E)Aldehydedehydrogenase
O
*
900
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101. ExamSection2:Item50ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr12min39sec
®Mark
50.A35-year-oldwomanisbroughttotheemergencydepartmentaftershesustainsafractureoftheneckofthefibulaofherrightleg.Shewasstruckbyacarwhilecrossingthestreet.Whichofthefollowingfindingsismostlikelyonexaminationoftheaffected
leg?
PainOver
ProximalFibula
PainOver
DistalFibula
absent
present
absent
DorsiflexionPlantarFlexionAchillesReflex
OA)
OB)
O
C)
OD)
OE)
Absent 4/5 1/5 1+
Absent 0/S 4/5 1+
Present 1/5 4/5 2+
Present absent
present
5/5 0/5 absent
Present 4/5 4/5 2+
*
m O m
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102. ExamSection3:Item1of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min57sec
9Mark
1.AG5-year-oldmancomestothephysicianbecauseoffeverandaworseningcoughproductiveofapproximatefy%cupofblood-tingedsputumdaily.HehassmokedVApacksofcigarettesdailyfor45years.Histemperatureis38.4X(1012aF)
;respirations
are20/min,andbloodpressureis140/90mmHg.Physicalexaminationshowsbilateralclubbingofthedigits.Pulmonaryexaminationshowsegophony.whisperedpedoriloquy,anddullnesstopercussionintheareaoverlyingthe2ndand3rdribsontheright
anteriorlyjustinferiortotherightclavicle.Whichofthefollowingstructuresisthemostlikelysiteofanobstructingcarcinoma?
A)Maincarina
0B)Rightlowerlobebronchus
0G)Rightmainbronchus
00)Rightmiddlelobebronchus
JE}Rightupperlobebronchus
m O m
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103. ExamSection3:Item2of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min54sec
9Mark
2.A43-year-oldwomancomestothephysicianbecauseofa4-weekhistoryofintermittentepisodesofsevereabdominalpain
:especiallyaftereatingfattyfoods.Physicalexaminationshowsnoabnormalities.Abdominalultrasonographyshowsseveral
3-to4-mmgallstonescontainedwithinthegallbladder.Thepatientdeclinessurgery.Adrugwithwhichofthefollowingmechanismsofactionismostappropriateforthispatient?
.A)Decreasedgallbladdermusclecontractility
8)increasedgastrinproduction
.JC)increasedmetabolismofbitesalts
oD)inhibitionofbiliarycholesterolsecretion
.E}InhibitionofcytochromeP450activity
O m O m
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104. ExamSection3:Item3of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min52sec
®Mark
3.A24-year-oldwomancomestothephysicianforanexaminationpriortoemployment.Physicalexaminationshowsnoabnormalities.AnECGshowsasinusrhythmof70/min
;PRintervalof152msecandQRScomplexof84msec:therearenoectopicbeats.
Whichofthefollowingbestrepresentsthelongestconductiontimeinthispatient?
A)Anteriorleftbundlebranch
8)intra-atrial
G)LowrightatriumtobundleofHis
D)ProximalbundleofHistoventricularmyocardium
E)Rightbundlebranch
O
*
m O m
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105. ExamSection3:Item4of50 NationalBoardofMedicalExaminers
®
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min46sec
®Mark
4.An18-year-oldwomanwithmildintellectualdisabilityisbroughttothephysicianbecauseofa3-dayhistoryofdecreasedabilitytoseeinreducedlight.Shehasalifelonghistoryofchronicdiarrhea.Twoyearsago
;shedevelopedalackofmusclecontrolofher
armsandlegs
:andgeneralizedweakness.Her16-year-oldbrotherhashadsimilarsymptoms.Ophthalmologicexaminationshowsbilateralretinitispigmentosa.Thereisataxiaandlossofdeeptendonreflexes.Laboratorystudiesshowerythrocyteswithspiny
projectionsandaserumtotalcholesterolconcentrationof40mg/dL.Whichofthefollowingapolipoproteirsismostlikelydeficientinthispatient?
O
A)ApoA-l
OB)ApoA-l
oC}ApoB
OD}ApoC
OE)ApoE
oo &r
#
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106. ExamSection3:Item5of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min41sec
®Mark
5.Aninvestigatorisstudyingobesityinanadolescentpopulation.Fivethousandnormal-weightpatientsarefollowedfromtheageof10yearstotheageof15years.Attheconclusionofthestudy,1100patientsmeetthecriteriaforobesity.Whichofthefollowing
bestrepresentstheincidenceper1000patient-yearsofobesityduringthecourseofthisstudy?
OA)10
O
8)25
OC)44
oD)50
OE)64
O
*
m O m
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107. ExamSection3:Item6of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min33sec
9Mark
t"
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6.A2S-year-oldwomanat32weeks'gestationcomestothephysicianbecauseofa4-dayhistoryoffeverandbackpain.Shesays:hatduringthistimesheafsohasbeencryingfrequentfy.Hertemperatureis38X
(100.4°F).Physicalexaminationshowscostophrenicangletenderness.Thephotomicrographshownrepresentsherdisease.Whichofthefollowingmechanismsiisthemostlikelycause?
QA)Chorioamnionitis
3B)Endometritis
QG)Glomerulonephritis
OD)Hematogenousinfection
QE}Obstructiveuropathy
F)PelvicinfEammatorydisease
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108. ExamSection3:Item7of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min35sec
®Mark
7.A54-year-oldmanwitha1-yearhistoryofmultiplesclerosishasincreasinglypainfulmusclespasms.Anagonistthatactsatwhichofthefollowingreceptorsismostlikelytoalleviatetheincreasedextensortoneandclonus?
3A)y-Aminobutyricacid
^
S)Histamine-1(Ht
)
oG)Histamine-2(H
^
iD)Muscarinic-1(M,)
3E)Muscarinic-2
3F)Nicotinic
E
o m O m
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109. ExamSection3:Item8of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min32sec
®Mark
8.A27-year-oldprimigravidwomanat36weeks'gestationcomestothephysicianforaprenatalvisit.Physicalexaminationshowsauterusconsistentinsizewitha33-weekgestation,sothepatientisreferredforultrasonography,whichshowsnormalfetal
measurements.Theultrasonographyshowrnisanimageofthemalefetalscrotum;thetestesareindicatedbythearrows.Whichofthefollowingisthemostlikelyunderlyingcauseofthisfinding?
A}Highattachmentofthetunicaalbuginea
.8)Lackofscrotalattachmentoftheguberrtaculum
'
G)Obstructionoftheposteriorurethra
J0)Patentprocessusvaginalis
E}Twistingofthespermaticcord
*
m O m
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110. ExamSection3:Item9of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min28sec
®Mark
9.A98-year-oldwomandiesofrespiratoryfailure.Atautopsy
:grossexaminationshowsasmallheartwithabrowndiscoloration.Histologicexaminationofthecardiactissuebylightmicroscopyshowsfightbrownpigmentwithinthecardiacmyocytes,particularly
intheperinuclearregion.Thismaterialdoesnotstainpositivelyforiron.Whichofthefollowingbestdescribesthispigment?
.A)Anthracoticpigment
8)Freefattyacids
.C)Hemosiderin
D)Laminin
..E)Lipofuscin
O
*
m O m
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111. ExamSection3:Item10ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min24sec
®Mark
10.A43-year-oldwomanhashadincreasingfatigue,intolerancetocold
:anddrythickenedskinfor7weeks.Thethyroidglandisfirm,nodularanddiffuselyenlarged.Examinationoftissueobtainedonbiopsyofthethyroidglandshowsadiffuseinfiltrationof
lymphocyteswithoccasionallymphoidfollicles.Whichofthefollowingisthemostlikelydiagnosis?
.A)Chronicautoimmune(Hashimoto)thyroiditis
8)Diffusetoxicgoiter(Gravesdisease)
0C)Granulomatousthyroiditis
0D)Papillarycarcinoma
.E)Toxicmultinodulargoiter
F)Viralthyroiditis
*
m O m
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112. ExamSection3:Item11of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min20sec
®Mark
11.A3-year-oldgirlhasahistoryofrecurrentinfections,fnvitro,neutrophilsisolatedfromthispatientarecapableofphagocytosisandcankillLactobacillusspeciesbutnotStaphylococcusaureus.Thispatientmostlikelyhasadefectinvolvingwhichofthe
followingenzymes?
.A)Catalase
8)Elastase
.C)Myeloperoxidase
oD)NADPHoxidase
.E}Superoxidedismutase
O m O m
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113. ExamSection3:Item12ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min17sec
9Mark
12A7-year-oldgirlisbroughttothephysicianbecauseofa2-weekhistoryofpainfulswellingunderherrightamiwhichhasbecomeincreasinglysevereduringthepast3days.Physicalexaminationshowsa2x1-cm,tenderrightaxillarylymphnodeanda
smallpapuleonthedorsumoftherighthand.Asilver-stainedbiopsyspecimenofthepapuleshowspleomorphicbacilli.Whichofthefollowingisthemostlikelycausalorganism?
OA}Bartonellahenselae
8)Brucellamelitensis
oC)Burkholder!amallei
0D)Franciseltatuiarensis
.E)Streptobacitlusmoniliformis
*
m O m
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114. ExamSection3:Item13of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min14sec
9Mark
13.Anewbornbornat3uweeks'gestationdies3dayslaterThephotographshownisofasectionofbrainasseenatautopsy.Whichofthefollowingisthemostlikelyunderlyingdisease?
A)Biliaryatresia
B)Cyanoticcongenitalheartdisease
O®)Hemolyticdiseaseofthenewborn
D)Neonatalmeningitis
OE)Respiratorydistresssyndrome
ooo
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115. ExamSection3:Item14of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min10sec
9Mark
14.A50-year-ofdwomanisbroughttotheemergencydepartment20minutesafterthesuddenonsetofpaininherepigastriumthatradiatestoherbackandisassociatedwithnausea.Shehasahistoryofcholelithiasis.Sheappearsrestless.Hertemperatureis
37.6X(99.7aF)
:pulseis120/min,andbtoodpressureis115/60mmHg.Abdominalexaminationshowsdistentionwithreboundtendernessandguarding.Thepainispartiallyrelievedwhenthepatientbendsforward.ACTscanoftheabdomenshowsfluid
surroundingthepancreas.Obstructionofwhichofthefollowingisthemostlikelycauseofthefindingsinthispatient?
A)AmpullaofVater
0B)Cisternachyli
0G)Commonhepaticduct
00)Cysticduct
JE}Superiormesentericartery
*
m O m
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116. ExamSection3:Item15ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min7sec
®Mark
15.A74-year-ofdmancomestotheofficebecauseofa3-weekhistoryofprogressiveshortnessofbreathwithexertion.Hehashaddifficultyclimbingoneflightofstairs.Healsohasa20-yearhistoryofpoorlycontrolledhypertension,forwhichherarelytakeshis
prescribedmedicationandosteoarthritistreatedwithnaproxendaily.Histemperatureis37.1CC(98.8QF)
;puiseis76/min,respira:ionsare20/min,andbloodpressureis180/98mmHg.Pulseoximetryonroomairshowsanoxygensaturationof92%.Physical
examinationshows10-cmjugularvenousdistentionabovethesternalangle.Crackiesareheardoverbothlungbases.AnS
4
isheard.Echocardiographyshowsanormalejectionfraction.Whichofthefollowingbestexplainsthispatient'ssymptom?
)A)DecreasedmyocardiaEoxygensupply
'
JB)Externalcompressionoftherightventricle
0C)Impairedleftventricularrelaxation
'
JD)Increasedturbulentflowacrossthemitralvalve
JE}Obstructionoftheleftventricularoutflowtract
O0 I*000
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117. ExamSection3:Item16ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min4sec
®Mark
25i16.Astudyisconductedtoassesstheeffectofanewselectiveestrogenreceptormodulator(SERM)onbonefractures.Twothousandwomenwithahistoryofvertebralfractureand5000womenwithno
fracturehistoryarerandomlyassignedtoaplaceboortoSERMatadoseof60mgor120mg.Thegraphshowsthepercentofwomenwhohadanewfractureduring5yearsoffoJIow-up
(±standarderrorofthemean).Whichofthefollowingisthemostaccurateconclusionaboutpreventingnewfracturesbasedonthesedata?
A)High-doseSERMtreatmentismoreeffectivethanlow-doseSERMtreatment
B)Low-doseSERMtreatmentismoreeffectivethanhigh-doseSERMtreatment
3C)Placebotreatmentiseffectiveonlyinwomenwithahistoryofvertebralfracture
D)SERMtreatmentiseffectiveonlyinwomenwithahistoryofvertebralfracture
E)SERMtreatmentiseffectiveonlyinwomenwithnohistoryoffracture
T
£20
o
15
T T
0)
10
£ T T T
5
-
o
o
0
NofracturehistoryFracturehistory
Placebo
SERM60mg
SERM120mg
O
*
900
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118. ExamSection3:Item17of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min0sec
®Mark
17.A23-year-ofdmancutshistipinadvertentlywhileshaving.Secondsaftertheinjurythebleedingnearlystops.Whichofthefollowingmechanismsisthemostlikelycauseoftheearlyrapidcontrolofbloodlossinthisman?
3A)ActivationofantithrombinHi
^
8}Localizedsecretionofendothelin
Q
G)Oxygen-stimulatedcleavageofthromboplastin
D)Polymerizationoffibrin
«r
*
m O m
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119. ExamSection3:Item13ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min57sec
9Mark
18.A21-year-oldwomancomestothephysicianforaroutinehealthmaintenanceexamination.Her3-year-oldsisterwasrecentlydiagnosedwithcysticfibrosis.Priortoanygenetictesting
;whichofthefollowingbestapproximatesthispatient'sriskofbeinga
heterozygoteforcysticfibrosis?
OA)0
O
8)1/2
OC)1/4
oD)2/3
OE}3/4
O
*
900
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120. ExamSection3:Item19of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min54sec
9Mark
19.A25-year-oldwomanwitha3-yearhistoryofceliacdiseasecomestothephysicianbecauseofamarkedlyitchyrashonherscalp,arms,buttocks
:andlegsfor5weeks.Examinationoftheskinshowsmanycrustedpapulessurroundedbyexcoriationsover
theupperandlowerextremitiesandafewvesiclesonthebuttocks.Askinbiopsyspecimenshowsthevesiclestobesubepidermal.DirectimmunofluorescenceofthevesiclesshowsgranulardepositsofIgAintheepidermal-dermaljunction.Whichofthe
followingisthemostlikelydiagnosis?
A)Bullouspemphigoid
3B)Dermatitisherpetiformis
oG)Dyshidroticeczema
3D)Epidermolysisbullosaacquisita
JE)Pemphigus
*
m O m
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121. ExamSection3:Item20ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min50sec
9Mark
20.A1-year-oldboyisbroughttothephysicianforaweli-chiidexamination.Themotherisconcernedbecauseherson'sfine,palehairhasnotchangedcolorsincebirth.Hiseyesareblue.Duringophthalmologicexamination,thepatientturnsawayfromthe
flashlightandstartscrying.Whichofthefollowingisthemostlikelycauseofthepaieskincolorinthispatient?
.A)Aberrantmigrationofneuralcrestcells
8)Decreasednumberofepidermalmelanocytes
.JC)immunedestructionofmelanocytes
'
3D)inabilitytoproducemelanin
.E}Melanindropouttothedermis
O
*
m O m
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122. ExamSection3:Item21ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min46sec
®Mark
21.AGS-year-oldmanwithrecurrenturinarytractinfectionscomestothephysicianbecauseofa2-dayhistoryoffeverandpainwithurination.Urinalysisshowspus.Heistreatedwithfevofloxacin.Hissymptomsworsen,andabloodculturegrowsPseudomonas
aeruginosathatisresistanttolevofloxacin.AlterationofwhichofthefollowingbestexplainstheresistanceofP.aeruginosatolevofloxacininthispatient?
OA)Dihydrofolatereductase
8)p-Lactamase
.JC)30Sribosomalsubunit
D)Topoisomerase
.E}Transpeptidase
*
ooo
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123. ExamSection3:Item22ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min42sec
®Mark
22Asexuallyactive20-year-oldwomanhashadpainful,erythematous,vesicularlesionsonthevulvafor2days.Examinationbyspeculumalsoshowslesionsinthevagina!vaultandonthecervix.Aphotomicrographofascrapingofthebaseofanunroofed
vesicleisshown.Whichofthefollowingisthemostlikelydiagnosis?
A)Candidalvaginitis
B)Condylomataacuminata
.C)Genitalherpes
OD}SyphiEis
!_E)Trichomonasvaginalisvaginitis
O
*
m O m
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124. ExamSection3:Item23of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min39sec
9Mark
23.A67-year-oldwomanwithCrohndiseaseisadmittedtothehospitalforbowelrestandparenteralhyperalimentation.Acentralvenouscatheterisplaced.Sevendaysafteradmission,shedevelopsatemperatureof39i2*C(102.63F)andshakingchills.Broad-
spectrumantibioticsareadministeredpendingbloodcultures.Shecontinuestohavedailytemperaturespikes.Twodayslaterbloodculturegrowsyeastforms.Whichofthefollowingisthemostlikelycausalorganism?
OA)Aspergillusturnigatus
B)Blastomycesdermatitidls
0C)Candidaalbicans
0D)Cr/ptococcusneoformans
.E)Mucorramosissimus
*
m O m
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125. ExamSection3:Item24ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min35sec
0Mar
*
24.A25-year-oldwomancomestothephysicianbecauseofa6-monthhistoryofawhitedischargefromherbreasts.Herfastmenstruafperiodwas6monthsago.Shehashadnoheadachesorvisualfieldchanges.Shehasneverbeensexualiyactive.Gentle
palpationofbothbreastsproducesexpressionofamilkydischarge.Serumstudiesshow:
Thyroid-stimulatinghormone
Follicle-stimulatinghormone
Luteinizinghormone
Prolactin
1.5|jU/mL
6mlLI/mL
6mlU/mL
200ng/mL
A5-daycourseofmedroxyprogesteronefailstoinducemenses.AnMRIofthebrainshowsan8-mm
;
esioninthepituitarygland.Themostappropriatetreatmentforthispatientisadrugfromwhichofthefollowingclasses?
3A)Dopamineagonist
_.6}Dopamineantagonist
QC)Oxytocinagonist
D)Oxytocinantagonist
^
E)Serotonin(5-HT,)agonist
F)Serotonin(5-HT,)antagonist
*
0G®
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126. ExamSection3:Item25ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min33sec
9Mark
25.A23-year-oldwomanisadmittedtothehospitalaftertakinganoverdoseof16acetaminophentablets.Sheingestedtheacetaminophenaftershebrokeupwithherboyfriendof2months.Shehasbeenadmittedtothehospitalseveraltimesduringthepast5
yearsfortreatmentofsuicideattemptsandotherself-harmattempts.Herhistoryincludeschildhoodsexualabuse
;andshehasdifficultyholdingajob.Shetellsthephysicianthatshehasreceivedsubstandardcarefromthiishospitalinthepast.Shesays
;
"Butnowthatyou'remyphysician!knowI'mgoingtogetbetter.Icantellbecausewehaveaconnection.
'
1
Heraffectisbrightandcheerful.Thispatientmostlikelyhaswhichofthefollowingtypesofpersonalitydisorders?
A)Antisocial
0B)Borderline
OG)Dependent
30)Marcissistic
(JE)Schizoid
*
m O m
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127. ExamSection3:Item26ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min30sec
9Mark
26.A13-year-oldboyisscheduledtoreceivechemotherapyforaleukemiathathasthehistologicfeaturesofmalignantlymphocytes.Thisneoplasmisfurthertypedforcellsurfaceandintracellularmarkersspecificforlymphocytesubsets.Theneoplasticcellsdo
notexpressthefollowingmarkers:CD4.CDS
:surfaceIgM,surfaceIgG,cytoplasmicIgMandp-heavychain,cytoplasmiclgG
:andy-heavychain.TheleukemiccellsexpressclassIMHCmoleculesandshowrearrangementoftheT-lymphocytereceptor13
-
chaingeneDandJsegments.Whichofthefollowingisthenormalcounterpartofthesemalignantlymphocytes?
OA)Activatedcytolyticeffector!lymphocytesinthecirculation
3B)MatureIgM-secretingBlymphocytesinthelymphnode
OC)Matureimmunoglobulin-secretingplasmacellsinthelymphnode
30)Pre-BlymphocyteprogenitorofmatureBJymphocytesinthebonemarrow
E}T-lymphocytethymocytesfocalizedtothethymiccortex
O
*
m O m
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128. ExamSection3:Item27of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min27sec
9Mark
27.Thetracingshowscontractileresponsesofaskeletalmusclepreparationtoelectricalstimulationatfivedifferentfrequencies.Theamountofcalciumsequestrationinsarcoplasmicreticulumishighestduringwhichofthefollowinglabeledresponses?
ABCD E
H I/
O
c
0
Stimulus
frequency1-Hz3-Hz6-Hz9-Hz 12-Hz
Time
OA)
OB)
OC)
OPJ
OE)
m O m
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129. ExamSection3:Item28ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min24sec
®Mark
28.A33-year-oldmancomestothephysicianbecauseofintermittentnumbnessandpainofhisrightarmduringthepast6months.Hisbloodpressureis120/80mmHginbothupperextremities:thepulseexaminationshowsnoabnormalities.Achestx-ray
showsarightcompletecervicalrib.ACTscanoftheneckandchestshowscompressionofthebrachialplexus.Whichofthefollowingvesselsisatgreatestriskforinjuryduringoperativeremovaloftherightcervicalrib?
.A)Brachiocephalicartery
B)Rightcommoncarotidartery
.)C)Rightinternalcarotidartery
_D)Rightsubclavianartery
*
m O m
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130. ExamSection3:Item29of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min23sec
®Mark
29.A24-year-oldmanwhoiscomatoseisadmittedtothehospitalbecauseofadrugoverdoseandpneumonia.Onadmissionheisintubatedandmechanicallyventilated.Whilereceivingatidalvolumeof500ml_
.thepatient'send-expiratorypressureis+5cm
H20
:andhisend-inspiratoryairwaypressureis+25cmH20
.Anesophagealballoonisinserted,andanend-inspiratorypleurafpressureof+20cmHpismeasured.Whichofthefollowingbestrepresentsthispatient'srespiratorysystemcompliance?
A)0.01cmHp/mL
B)0.04cmHp/mL
oC)0.05cmHp/mL
oD)20mLfcmHP
.E)25niL/cmHp
F)100fflL/cmHp
*
m O m
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131. ExamSection3:Item30ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min20sec
®Mark
30.A5-month-oldgirlisbroughttothephysicianbecauseofa3-dayhistoryof"floppiness"whenshesits.Shealsohashaddifficultyfeedingandirritabilitysincetheageof1month.Sheisatthe3rdpercentileforlength
:50thpercentileforweight,and
3rdpercentileforheadcircumference.Hertemperatureis36°C(9G.BT),pulseis10G/minprespirationsare29/min
;andbloodpressureisSO/50mmHg.Neurologicexaminationshowsbilateralhorizontalnystagmusdecreasedextensortone
:hyperreflexia.
andankleclonus.Babinskisignispresentbilaterally.RespiratorychainenzymestudiesonculturedfibroblastsshowdecreasedcomplexIIactivity.Themostlikelycauseofthesefindingsisadefectinwhichofthefollowingprocesses?
OA)Couplingofelectrontransporttoprotongradientformation
3B)CouplingofprotongradienttoATPsynthesis
oC)Oxidationofsuccinatetofumarate
30)Reductionofpyruvatetolactate
JE}TransferofelectronsfromNADHtocoenzymeQ
'
JF)Transferofelectronsfromubiquinoltocytochromec
o 900
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132. ExamSection3:Item31ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min17sec
9Mark
31.A2S-year-oldwomanwhoworksasaglassblowerhasrecentlysustainedburnsonherhandstautfeelslittlepain.Neurologicexaminationshowsdecreasedpainsensationintaothupperextremitiesandweaknessandatrophyoftheintrinsicmusclesofboth
hands.Whichofthefollowingbestexplainsthesefindings?
.A)Cysticfesioninvolvingmidlinestructuresandbothventralhornsinthecervicalenlargement
8)Demyelinationoftheleftcorticospinaltractatalllevelsofthecord
OG)LesionoftheleftanterolateralquadrantatG-2
'
3D)Lassofmyelininthedorsalcolumnwhitematter
.E)Lossofmyelininthelateralcolumnwhitematterandlossofventralhornmotoneurons
*
m O m
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133. ExamSection3:Item32ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min15sec
9Mark
32A67-year-oldwomanhashaddecreasedpainandtemperaturesensationintheleftlowerextremityfor1week.Themostiikelycauseisdamagetowhichofthefollowinglabeledsitesinthecrosssectionofthespinalcord?
Left Right
H
w
G
OA)
O
8)
OC)
OD)
OE
)
OF
)
O
G)
OH)
OD
O
J)
*
&
*
C
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134. ExamSection3:Item33of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min10sec
9Mark
33.A78-year-oldmanisbroughttotheemergencydepartmentafterfallingfromaladder.Onarrival,heislucid.Physicalexaminationshowsaseverescalpcontusionandlaceration.Neurologicexaminationshowsno
abnormalities.Onthesecondday
;heisstuporousandhasaheadache.Examinationshowsslightweakness,hyperreflexisandanextensorplantarreflex,allontheright.ACTscanoftheheadisshown.Themostlikely
causeofthesefindingsistraumatowhichofthefollowingvascularstructures?
A)Arteryinthesubarachnoidspace
QS)Duralbridgingveins
QC)Middlecerebralartery
O0)Middlemeningealartery
E)Superiorsagittalsinus
*
m O m
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135. ExamSection3:Item34ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min7sec
®Mark
34.Aheafthy24-year-oldwomanparticipatesinastudytodeterminetheroleofghrelininappetite.Sheisgivenfreeaccesstofoodduringthestudy.Thegraphshowsplasmaconcentrationsofghrelininthewomanduringthestudyperiod.Whichofthefollowing
labeledpointsonthecurvemostlikelyrepresentstheconsumptionofameal?
c
o
tc
<D
c
o
£3
<U
OJ
CO
E
</)
CO
CL
Time
OA)
OB)
O
C)
Onj
OE
)
O m O m
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136. ExamSection3:Item35ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min4sec
®Mark
35.A2-month-oldgirlisbroughttotheemergencydepartmentbyhermotherbecauseofdifficultybreathingforShours.Physicalexaminationshowscyanosis.Aloudsystolicmurmurisheard.Laboratorystudiesshowhypocalcemiaandlymphopenia.
EchocardiographyshowstetralogyofFallot.ThediagnosisofDiGeorgesyndromeismade,andakaryotypeisordered.Chromosomalanalysisbyhigh-resolutionG-bandingisreportedas46,XX.Whichofthefollowinggeneticmechanismsisthemostlikely
causeofthispatientsanomalies?
A)Deletion
3B)Nondisjunction
oC)Paracentricinversion
30)Pericentricinversion
JE}Reciprocaltranslocation
OF)Robertsoniantranslocation
G)Trinucleotiderepeat
'
JH)Uniparentaldisomy
O m O m
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137. ExamSection3:Item36ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr12min56sec
®Mark
36.A6S-year-oldwomanhashadprogressiveshortnessofbreathwithexertionsinceshestartedtreatmentwitheyedropsforglaucoma2weeksago.Pulmonaryfunctiontestsshowadecreasedforcedexpiratoryvolumein1sec(FEV
^
.Thelungsaredearto
auscultation.Theeyedropsaremostlikelyfromwhichofthefollowingclassesofdrugs?
.A)o-Adrenergicagonist
6)p-Adrenergicagonist
OC)p-Adrenergicblocker
3D)Carbonicanhydraseinhibitor
.E)Cholinesteraseinhibitor
F)Prostaglandinanalog
o
*
900
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138. ExamSection3:Item37of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr12min54sec
®Mark
37.Aphysicianissadbecausehehastoinformapatientofrecenttestresultsthatindicateprogressionofcarcinomatotheterminalphase.Whenthepatientseesthephysician'sface,hebeginstocryandsays
;"It'sbadnews,isn'tit?"Whichofthefollowing
responsesbythephysicianismostappropriate?
.A)"HowhaveyoubeensincethelasttimeIsawyou?
'
1
8)"Let'stalkaboutthepositiveaspectsfirst/'
.C)
"Lookonthebrightsideofthings."
D)"Tellmehowyouarefeeling."
.E)"Thereareotherpeoplewhohaveitalotworsethanyou."
OF)"Yes,itis.
11
G)"You'vehadseveralyearsbetteroffthanmanyotherswiththisdisease."
*
m O m
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139. ExamSection3:Item33ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr12min51sec
®Mark
38.An18-year-oldmancomestothephysicianbecauseofnonpittingfacialedemaanddifficultybreathingseveralhoursafteradentalprocedure.Hehasahistoryofunexplainedepisodesofabdominalpain.HisserumC2concentrationisfoundtobemarkedly
decreased.Whichofthefoliowingbestexplainsthispatient'sillness?
A)Absentpyrin
8)DecreasedC1esteraseinhibitors
0C)Increasedurineporphyrins
D)Penicillinallergy
.E}Superantigenproduction
O m O m
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140. ExamSection3:Item39of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr12min49sec
®Mark
39.A67-year-oldwomanwithacutemyelogenousleukemiadevelopsfeverandchills6daysafterundergoinginductiontherapy.Hertemperatureis38.3GC(100.9QF)
;andbloodpressureis110/60mmHg.Physicalexaminationshowsscatteredpetechiaeover
theupperandlowerextremitiesandtrunk.Laboratorystudiesshowaleukocytecountof100/mms(98%lymphocytesand2%monocytes)andplateletcountof4000/mmBloodculturesgrowPseudomonasaeruginosa.Adeficiencyofwhichofthefollowingis
themostlikelypredisposingfactorfordevelopmentofbacteremiainthispatient?
A)Complement
0B)Immunoglobulin
0G)Lymphocytes
00)Macrophages
E)Platelets
F)Segmentedneutrophils
o
*
900
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141. ExamSection3:Item40ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr12min46sec
®Mark
40.A54-year-oldwomanwithchronickidneydiseasecomestothephysicianbecauseofa2-weekhistoryofitchyskimincreasinglyseverenausea,anddecreasedurination.Currentmedicationsarehydrochlorothiazideandliisinopril.Herpulseis80/min,
respirationsare14/min,andbloodpressureis160/90mmHg.Physicalexaminationshowsnoabnormalitiesexceptforexcoriationsfromitching.Laboratorystudiesshow:
Hemoglobin
Hematocrit
Meancorpuscularvolume
Leukocytecount
Plateletcount
9.3g/dL
30.1%
89pm
3
5600/mm
3
287,000/mm
3
Whichofthefollowingisthemostlikelycauseofthefindingsinthispatient?
A)Hypoalbuminemia
B)Hypothyroidism
C)Uremia
D)VitaminCdeficiency
'_)E)VitaminKdeficiency
o
*
m O m
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142. ExamSection3:Item41ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr12min44sec
®Mark
41.An8-year-oldgirlisbroughttothephysicianforawell-childexamination.Hermothersaysthatshehasbeenwellexceptforanoccasionalcold.Herimmunizationsareuptodate.Sheisatthe50thpercentileforheightand60thpercentileforweight.Physical
examinationshowsbreastbuddevelopmentandafewpubichairs.Themotheraskswhetherherdaughter'sdevelopmentisnormal.Whichofthefollowingisthemostappropriateinitialresponsebythephysician?
.A)'1amconcernedthatyourdaughtermayhaveprecociouspuberty.
'
1
8)"Ithinkthatyourdaughterislikelytobeginmenstruatinginthenextfewmonths/'
0C)
'
!wouldliketoorderlaboratorystudiestoensurethatyourdaughter'sdevelopmentisnormal.
1
'
'
jD)
!
lYourdaughter'sbreastdevelopmentissomewhatlessthanmightbeexpectedforherage.”
.E}'Tourdaughter'sdevelopmentisnormal
^
*
m O m
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143. ExamSection3:Item42ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr12min41sec
®Mark
42An11-year-oldboyhashadpersistentpaininhisrightkneesincehetwisteditinasoccergame3weeksago.Physicalexaminationshowsatenderareainthedistalfemurbutnoperceptiblemass.Anx-rayofthefemurshowsanosteolyticmassthathas
erodedthroughthecortexandelevatedtheperiosteum:themassissurroundedbyreactiveboneinsomeareas.BiopsyofthemassshowsatypicalcellswithhyperchromaticpleomorphicnucleiThecellsaresurroundedbyaneosinophilicmatrix
:someof
whichiscalcified.Thistumorismostlikelytospreadfirsttowhichofthefollowingareas?
A)Brain
3B)Cervicallymphnodes
G)Liver
C0)Lung
JE)Vertebrae
*
I* m O m
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144. ExamSection3:Item43of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr12min38sec
®Mark
43.A52-year-oldmanwithlungcancercomestothephysicianforafollow-upexamination.Smokingcessationhasbeenrecommended,butthepatientsaysthatheisunabletoquitbecauseheexperiencesapleasurablesensationasheinhalesthesmoke.He
hassmoked2packsofcigarettesdailyfor30years.Whichofthefollowingmechanismsbestexplainshownicotineproducesthissensationleadingtoaddictioninthispatient?
.A)Activationofopioidreceptorsinthemidbrain
8)increasedreleaseofdopamineinthenucleusaccumbens
JC)Inhibitionofy-aminobutyricacid(GABA)releaseinthehypothalamus
'
3D)Inhibitionofglutamatereceptorsintheamygdala
.E)PotentiationofGABAreceptorsinthecerebralcortex
*
m O m
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145. ExamSection3:Item44ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr12min36sec
®Mark
44.A65-year-oldmandiesofrenalfailure.Urinalysisshows:
Blood
Protein
Glucose
BenceJonesprotein
negative
negative
negative
positive
Atautopsy
:thekidneysarefoundtobeenlarged.Ahistologicsectionofrenaltissueisshowninthephotomicrograph.Whichofthefollowingisthemostlikelydiagnosis?
A)Acutetubularnecrosis
B)Amyloidosis
OCjjLipoidnephrosis
D)Membranousglomerulonephritis
^
E)Pyelonephritis
00 #0 0
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146. ExamSection3:Item45ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr12min33sec
®Mark
45.A5G-year-oldmancomestothephysicianbecauseofa3-monthhistoryofamild,nonproductivecough.Hehasa20-yearhistoryofalcoholism.Physicalexaminationshowsnoabnormalities.APPDskintestresultispositive.Achestx-rayandaGramstain
ofinducedsputumshownoabnormalities.Treatmentwithisoniazidandadailymultivitaminisbegun.Thepatientiscompliantwiththeisoniazidtherapybutnotwiththemultivitaminsupplementation.Twomonthslaterhedevelopstinglingandnumbnessof
bothfeet.Deficiencyofwhichofthefollowingisthemostlikelycauseofthefootsymptomsinthispatient?
A)Folicacid
0B)Niacin
0G)VitaminB
2
(riboflavin)
0D)VitaminB
6
(pyridoxine)
JE}VitaminBl2
(cobalamin)
O
*
m O m
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147. ExamSection3:Item46ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr12min30sec
®Mark
46.Humoralantibodyproducedagainstmanyvirusesfollowingnaturalinfectionmediatesprotectionagainstreinfectionwiththesamestrainprimarilybywhichofthefollowingmechanisms?
3A)Activationofmacrophages
JS)Blockingofviralattachmenttocellreceptors
(3G)Inhibitionofviralnucleicacidreplication
JD)Kiltingofintracellularvirus
'
JE)Preventionofreleaseofvirionsfrominfectedcells
O m O m
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148. ExamSection3:Item47ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr12min28sec
®Mark
47.AninvestigatorisstudyingaT-iymphocyteclonethatrecognizesapeptidefromthehemaggfutininglycoproteinofinfluenzavimsboundbyclassIIhumanleukocyteantigen.Thisclonemostlikelyrecognizesapeptidethatwascombinedwithahuman
leukocyteantigeninwhichofthefollowingcellularcompartments?
.A)Cytosol
8)Endoplasmicreticulum
.C)Endosomes
D)Mitochondria
E)Nucleus
*
m O m
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149. ExamSection3:Item43ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr12min25sec
®Mark
48.A45-year-oldmanisbroughttothephysicianbecauseofa4-weekhistoryofmildconfusion,memorydifficulties,generalizedmuscleaching,andintermittenttinglingofhislipsandfingers.Hesayshehasbeensleepingmorethanusual,andthathefeels
’downinthedumps.
"Vitalsignsarenormal.Physicalexaminationshowsnoabnormalitiesexceptfordry
:scalyskinanddryhair.Tappingwithareflexhammerovertheleftsideofthefacejustanteriortotheearcausesleftfacialmusclecontractions.Whichof
thefollowingisthemostlikelydiagnosis?
A)Addisondisease
3B)Gushingdisease
oC)Hyperparathyroidism
30)Hyperthyroidism
E}Hypoparathyroidism
'F)Hypothyroidism
o
*
900
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150. ExamSection3:Item49of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr12min23sec
®Mark
49.A38-year-oldmancomestothephysicianbecauseofa1-weekhistoryofadischargefromhispenisandtesticularpain.Heissexuallyactiveandusescondomsinconsistently.Physicalexaminationshowsathickgreen
urethraldischargeandexquisitetendernessoftherighttestis.Thepainisrelievedbyelevationofthescrotum.AphotomicrographofaGramstainofthedischargeisshown.Whichofthefollowingisthemostlikely
causalorganism?
A)Chlamydiatrachomatis
QB)Mycoplasmagenitalium
oG)Neisseriagortorrhoeae
OD)Trichomonasvaginatis
E)Ureaplasmaurealyticum
*
m O m
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151. ExamSection3:Item50ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr12min21sec
®Mark
50.Onethousandofficeworkersaresurveyedtodeterminewhetherornottheyusecomputersandwhetherornottheyhavesymptomsofcarpaltunnelsyndrome.Whichofthefollowingbestdescribesthisstudy?
3A)Case-controlstudy
3S)Caseseries
OG)Cohortstudy
D)Cross-sectionalsurvey
3E)Randomizedclinicaltrial
*
m O m
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152. ExamSection4:Item1of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min58sec
9Mark
1.Amalenewbornisdeliveredvaginallyat39weeks'gestationtoa24-year-oldprimigravidwoman.Tbepregnancywascomplicatedbypolyhydramnios.Soonafterbirth
:thenewbornhasfrothingatthemouth,cyanosis,andrespiratorydistress.Anunsuccessful
attemptismadetopassanasogastrictube.Anx-rayshowsanair-distendedstomach.Whichofthefollowingisthemostlikelycauseofthesefindingsinthispatient?
.A)Abnormalityofaorticarchresultinginvascularring
8)Deviationofthetracheoesophagealseptum
.C)Failureofre-formationofduodenallumen
'
!D)Hypertrophyofpyloricmusde
.E)Incompleteformationofthetrachealcartilagerings
900
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153. ExamSection4:Item2of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min55sec
9Mark
2.A22-year-oldmanisbroughttotheemergencydepartment30minutesafterafriendfoundhimunconsciousonthefloorAdrugoverdoseissuspected.Hispulseis120/minrrespirationsare4/minwithapparentlowtidalvolumes
:andbloodpressureis
120/100mmHg.Physicalexaminationshowsmildcyanosis.Heisintubatedandmechanicallyventilatedwithpositivepressureventilation(rate=12/min;VT=7mL/kg)using10cmH20positiveend-expiratorypressure(PEEP).Whichofthefollowingsetsof
findingsbestdescribestheeffectsofthemechanicalventilationwithPEEPonthispatient'salveolar(PJandintrapleural(Pip>
pressures?
PeakInspiratoryPjp
positive
positive
zero
PeakinspiratoryPA
Positive
Positive
Zero
Zero
Negative
Negative
End-TidalPA
positive
zero
End-TidalPip
positive
negative
negative
zero
positive
negative
OA)
OB)
O
C)
OD)
OE)
OF)
zero
negative
positive
zero
positive
negativezero
*
m O m
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154. ExamSection4:Item3of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min52sec
®Mark
3.A35-year-oldwoman,gravida1,para1.comestothephysicianforafollow-upexamination1monthafterdeliveringahealthymalenewborn.Duringherpregnancy,shewasdiagnosedwithgestationaldiabetes.Hermotherandsisteralsodevelopedthis
conditionduringpregnancy.Today,laboratorystudiesshowaserumglucoseconcentrationof103mg/dL.Thispatientmostlikelyhasdecreasedactivityofwhichofthefollowingenzymes?
.A)D13kinase
8)Glucokinase
OC)Mevalonatekinase
3D)Phosphofructokinase
..E}Pyruvatekinase
*
m O m
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155. ExamSection4:Item4of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min50sec
9Mark
4.An18-month-oldboyisbroughttothephysicianbyhisparentsbecauseofeyepainfor3days.Hehasahistoryofmultipleinfectionssincetheageof3weeks,inctudingupperrespiratorytractinfections,staphylococcalosteomyelitis,andtwoepisodesof
pneumonia(oneduetoStaphylococcusaureusandtheotherduetoAspergillusfumigatus).Ophthalmologicexaminationshowserythemaoftheconjunctivaofthelefteyewithasmallamountofpurulentdischarge.Physicalexaminationshowsmultiple
ulceratedlesionswitherythematousbordersovertheface,neck
7andback:cervicalandaxillarylymphadenopathy;andhepatosplenomegafy.SerumIgE.!gG
:andIgMconcentrationsarewithinthereferenceranges.Cultureoftheconjunctivalsecretionsgrows
Staphylococcusepidermidis.andcultureofseveralskinlesionsgrowsStaphylococcusaureus.Thispatientmostlikelyhaswhichofthefollowingimmunodeficiencydiseases?
A)Chediak-Higashisyndrome
OS)Chronicgranulomatousdisease
0C)DiGeorgesyndrome
)0)PerinatalHIVinfection
E)Wiskott-Aldrichsyndrome
O m O m
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156. ExamSection4:Item5of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min47sec
9Mark
5.A10-year-oldboyisbroughttothephysicianbyhisparentsbecauseofincreasedurinaryfrequencyandprogressivefatigueduringthepast3weeks.Physicalexaminationshowsnoabnormalities.Hisfastingserumglucoseconcentrationis350mg/dL
Urinalysisshows4+glucose.Whichofthefollowingmechanismsintheproximaltubuleisthemostlikelycauseoftheglycosuriainthispatient?
.A)Decreasedsodiumdiffusionacrosstheapicalmembrane
8)inhibitionofthesodium,
'
'glucosecotransporter-1(SGLT-1)carrierprotein
OG)Saturationofthegfucosetransporterprotein-1(GLUT-1)carrierprotein
'
3D)Saturationofglucosetransporterprotein-2(GLUT-2)carrierprotein
.E)Saturationofthesodium/glucosecotransporter-1(SGLT-1)carrierprotein
O
*
m O m
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157. ExamSection4:Item6of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min45sec
9Mark
6.A5-year-oldboyhasseverecholestaticliverdiseaseandpoorbilesecretion.ThispatientisalsolikelytohaveadeficiencyofvitaminEbecauseitsabsorptionrequireswhichofthefollowing?
0A)Bindingtocholesterol
JB}Conversiontoanactiveformbytheliver
0G)Formationofmicelles
0D)Intrinsicfactor
E)Trypsin
O m O m
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158. ExamSection4:Item7of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min40sec
®Mark
7.A23-year-oldwomancomestothephysicianbecauseofa1-weekhistoryoffatigue
;musclepain
;andgeneralizedweakness.Sheisunabletoclimbstairsbecauseofthesymptoms.Shealsohasa1-monthhistoryofarashonherface
:elbows,antiknuckles.
Hertemperatureis38.3PQ(100.9T}
:pulseis100/min,respirationsare20/minandbloodpressureis115/65mmHg.PhysicalexaminationshowsthefindingsinthephotographsThereisalsoproximalmuscleweaknessofthelowerextremitiesbilaterally.
Whichofthefollowingisthemostlikelydiagnosis?
oA)Dermatomyositis
8}Guillain-Barresyndrome
o
C)Nephroticsyndrome
D)Psoriasis
QE)Systemiclupuserythematosus
®0 000
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159. ExamSection4:ItemBof50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min32sec
®Mark
8.A58-year-oldwomanisbroughttotheemergencydepartment6hoursafterthesuddenonsetofleft-sidedfacial,armandlegweakness.Shehashypertensiontreatedwithadiuretic.Shereportsthesensationofaflutteringheartfor1week.Herpulseis
125/minandirregularandbloodpressureis135/80mmHg.Physicalexaminationshowsaleft-sidedfacialdroop.Thereisflaccidweaknessoftheleftupperandlowerextremities.AnECGshowsarapid
:irregularventricularratewithnodiscernablePwaves.
Whichofthefollowingtherapieswouldbestimprovefunctionoftheweakenedmusclesoverthenext3hours?
A)Acetylcholineagonist
0B)Acetylcholineantagonist
0G)Antifibrinolytic
00)Fibrinolytic
JE}Procoagulant
O m O m
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160. ExamSection4:Item9of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min29sec
®Mark
9.AninvestigatorisplanningtocreategenetherapyforLeighsyndrome,whichiscausedbyanA^GmutationinthemitochondrialtRNALeugene.WhichofthefollowingisthemostlikelyreasonwhymitochondriaencodetheirowntRNA?
3A)MitochondriacannotimportproteinsorRNA
^
S)Mitochondriaproducelargeamountsofreactiveoxygenspecies
(3G)Mitochondriauseanon-standardgeneticcode
JD)TheunusuallyhighmitochondrialpHdenaturesnuclear-encodedtRNA
'
JE)TheunusuallylowmitochondrialpHhydrolyzesnuclear-encodedtRNA
*
m O m
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161. ExamSection4:Item10of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min26sec
®Mark
S i
10.A47-year-oldmanhasmicroscopicbloodonurinalysis.ACTscanoftheabdomenshowsa5-cmmassintheleftkidneyAphotomicrographoftissueobtainedonrenalbiopsyisshown.Whichofthefollowingisthe
mostlikelydiagnosis?
CA)Angiomyolipoma
B)Nephroblastoma
.C)Oncocytoma
OD)Renalcellcarcinoma
E)Transitionalcellcarcinoma
fli
'N
V
O & *
C
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162. ExamSection4:Item11of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min24sec
®Mark
11.A27-year-oldmancomestothephysicianbecauseoffeverandcoughfor1month.Anx-rayofthechestshowsdiffuseinfiltrates.Tinyintracellularyeastformsareseenondirectsmears
;andtuberculatemacroconidiaareseenaftercultureatroom
temperature.Whichofthefollowingexposuresismostconsistentwiththispatient'sillness?
.A)Birddroppings
B)Desertsandstorm
OC)Insectbite
'
_)D)Moldyhay
.E}Rosethornpuncture
O
*
m O m
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163. ExamSection4:Item12of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min22sec
®Mark
12A63-year-oldmanwithtype2diabetesmellitus
;hypertension,andhyperlipidemiacomestodiephysicianbecauseofpainwithurinationbloodinhisurine
;andfatigueduringthepastweek.Hehasa6-monthhistoryofincreasedurinaryfrequencywithsmall
volumeandnighttimeurination.Hehashadtwoepisodesofacutecystitisduringthepast8months.Histemperatureis38.3°C(100.9CF)
:pulseis92/min,respirationsare20/mm,andbloodpressureis108/72mmHg.Physicalexaminationshowssuprapubic
tendernessandanenlarged,softprostate.Ultrasonographyshowsabladderdiverticulumandenlargedkidneyswithdilationofrenalpetvesandcalyces.AurineculturegrowsEscherichiacoli.Whichofthefollowingisthemostlikelyunderlyingcauseofthis
patient'scondition?
A)Benignprostatichyperplasia
.B)Hypertension
0C)Nephrolithiasis
,0)Type2diabetesmellrtus
E)Xanthogranulomatouscystitis
*
m O m
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164. ExamSection4:Item13of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min19sec
9Mark
13.Aspartofanannualphysicalexaminationahealthy5G-year-aEdmanhaslaboratorystudiesdone3hoursafteranovernightfast.Hisserumglucoseconcentrationis75mg/dLActivationofwhichofthefollowingreceptorsinlivercellsmostlikelymaintained
theserumglucoseconcentrationinthispatient?
A)Cytokine
8)Gprotein-coupled
..C)Nuclear
D)Serinekinase
.E)Tyrosinekinase
*
m O m
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165. ExamSection4:Item14of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min17sec
9Mark
14.A73-year-oldmanwithstageIVcoloncancerbeginschemotherapywith5-
fluorouracil-irinotecan.andleucovorin.Thispatientisatgreatestriskfordevelopingsignsofdrugtoxicityinwhichofthefollowingtissues?
3A)Bonemarrow,gutmucosa,andhairfollicles
^
B}Liver,kidney,andendocrineorgans
Q
G)Nerves,bone
:andheartmuscle
JD)Skeletalmuscle
:heartandbone
'
JE)Trachea,bronchialepitheiiuniandliver
m O m
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166. ExamSection4:Item15of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min14sec
9Mark
15.Aninvestigatorisconductingastudyofthelipopolysaccharidesynthesispathway.Duringthestudy,apolymerasechainreactiontestisdevelopedthatdetectsageneinvolvedinlipidAbiosynthesis.Whichofthefollowingorganismsismostlikelytoyielda
positiveresultusingthispolymerasechainreactiontest?
.A}Candidaalbicans
8)Clostridiumdifficile
OC)Mycoplasmapneumoniae
0D)Pasteuretiamultocida
CE)Staphylococcusaureus
*
m O m
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167. ExamSection4:Item16of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min11sec
®Mark
16.A25-year-oldwomancomestothephysicianbecauseofgeneralmalaiseandafacialrashfor1week.Shehasa10-yearhistoryofepisodesofpleurisyandarthriticpaininperipheraljoints.Physicalexaminationshowsanerythematousmalarrashthatdoes
notinvolvethenasolabialfolds.Resuitsofcardiolipinantibody
;anti-dsDNA,andanti-Smantibodyassaysarepositive.Whichofthefollowinghematologicabnormalitiesismostlikelyinthispatient?
.A)Hemolyticuremicsyndrome
8)Macrocyticanemia
.C)Multiplenucleatederythrocytes
!0)Rouleauxformations
.E}Thrombocytopenia
O0 000
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168. ExamSection4:Item17of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min7sec
®Mark
17.Whichofthefollowingcharacteristicsoftheglucocorticoidreceptoristhemostlikelycauseofthepersistenceofthepharmacologiceffectsofdexamethasoneafterthedrugiseliminatedfromthebody?
3A)Catalyzesformationofstabletyrosine-phosphatebonds
iS)Competeswithp-arrestinforbindingtoadrenergicreceptors
OC)CouplestoGproteinswithlowintrinsicGTPaseactivity
JD)Depletescellularstoresofglutathione
'
JE)Inducesproteinsthatremainfunctionalafterthedrugiseliminated
*
m O m
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169. ExamSection4:Item13of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min4sec
®Mark
18.A23-year-ofdwomancomestothephysicianforadviceonhowtoloseweight.SheteIJsthephysicianthatshebingesonhigh-carbohydratefoodstwotothreetimesweekly,usuallyforcingherselftovomitafterabinge.Sheis168cm(5ft6in)tallandweighs
63kg(140lb);BMlis23kg/m
2Whichofthefollowingadditionalphysicalfindingsismostlikelyinthispatient?
A)Bradycardia
B)Decreasedvibratorysensationattheankles
.C)Parotidglandenlargement
'
!D)Sluggishdeeptendonreflexes
.E}Sparseaxillaryandpubichair
*
m O m
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170. ExamSection4:Item19of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr14min0sec
®Mark
19.Stripsoftrachealmusclecontractafteradministrationofcarbacholthenrelaxafteradministrationofepinephrine.Thegraphshowsmuscletensionasafunctionofthelogdoseofepinephrineunder
controlconditions(solidcurve)andinthepresenceofequalconcentrationsofantagonistsX(dashedcurve)andY(dottedcurve).XandYaremostlikelytobewhichofthefollowingdrugs?
cn
£=DrugX
Clonidine
DrugY
yohimbine
propranolol
prazosin
phentoiamine
metoprolol
clonidine
O
OA)
OB)
O
C)
OD>
O&)
OF)
CO
£Z
OJ
OJ
Metoprolol
Phentoiamine
o
CO
=
3
**
Prazosin
Propranolol
Yohimbine
Log[epinephrine]
O m O m
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171. ExamSection4:Item20ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min57sec
9Mark
20.A19-year-oldwomancomestothephysician6hoursafterthesuddenonsetofleft-sided,crampingabdominalpain.Shedoesnothavenausea.Shealsohasa3-weekhistoryofpainwithsexualintercourse,andsheissexuallyactivewiththreemale
partners.Herlastmensesstarted5daysago.Currentmedicationisanoralcontraceptive.Hertemperatureis38CC(1D0.4°F).Physicalexaminationshowsanormalcervixwithnodischarge.Bimanualexaminationshowstendernessandfullnessontheleft
sidecomparedwiththeright,andcervicalmotiontenderness.Aurinepregnancytestresultisnegative.Whichofthefollowingstructuresismostlikelyaffectedbythispatient'scurrentcondition?
A)Appendix
OB)Bladder
'
G)Endometrium
00)Kidney
JE)Peritoneum
F)Uterine(fallopian)tube
*
m O m
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172. ExamSection4:Item21ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min53sec
9Mark
21.A21-year-oldwomanwithprimarypulmonaryhypertensionbeginstreatmentwithbosentan.Asaresult,blockadeofwhichofthefollowingismostlikelytooccur?
0
A)AngiotensinIIreceptors
0S)Calciumchannels
0G)Endothelinreceptors
JD)Productionofphosphodiesterase5
'
JE)Voltage-gatedsodiumchannels
O m O m
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173. ExamSection4:Item22ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min51sec
9Mark
22AGG-year-oldwomancomestothephysicianbecauseofa1-monthhistoryofbleedingfromalesiononhernose.Shehasnohistoryofmajormedicalillnessandtakesnomedications.Physicalexaminationshowsa1-cmlesionontherightnaris.Microscopic
examinationofabiopsyspecimenofthemassshowsneoplasticcellsthatexhibitdensepigmentgranules.Whichofthefollowingisthemostlikelydiagnosis?
.A)Actinickeratosis
8)Basalcellcarcinoma
.C)Melanoma
3D)Rhabdomyosarcoma
.E}Squamouscellcarcinoma
O
*
m O m
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174. ExamSection4:Item23of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min4£sec
®Mark
23.A13-year-oldgirlisbroughttothephysicianbecauseofamassifithethoracicregionthathasbeenenlargingduringthepastmonth.Shewasplacedinafosterhome1yearago.Sheisatthe70thpercentileforheightandweight.Breastandpubichair
developmentisTannerstage2.Physicalexaminationshowsa3-mm
;mildlypigmentedmasslocatedinthemidclavicularineatthe10thrib.Themasshasasmoothsurface,uniformouterborderandcentralpapule.Therearenootherpigmentedlesions.
Whichofthefollowingisthemostlikelydiagnosis?
A)Accessorynipple
3B)Benignpigmentednevus
G)Melanoma
30)Neurofibroma
JE}Seborrheickeratosis
O
*
900
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175. ExamSection4:Item24ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min45sec
9Mark
24.A52-year-oldwomancomestotheemergencydepartmentbecauseofa2-weekhistoryofprogressiveshortnessofbreathandfatigue.Herpulseis102/mrn,respirationsare22/min,andbloodpressureis100/BummHg.Physicalexaminationshowsmuffled
breathsounds.Echocardiographyshowsalargepericardialeffusion.Pericardiocentesisyieldsdowdy,serosanguineousfluid.AnalysisofthefluidshowsanincreasedproteinconcentrationnumerousRBCs.andasmallnumberofWBCs .indicativeof
malignancy.Metastasisfromwhichofthefollowingsitesisthemostlikelycauseofthefindingsinthispatient?
A)Bladder
0B)Breast
oC)Colon
00)Ovaries
JE)Stomach
O m O m
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176. ExamSection4:Item25ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min42sec
®Mark
25.A5-month-oldboyisbroughttotheemergencydepartmentbecauseofa3-dayhistoryoffeverandseverewetcough.Histemperatureis40.5*0(104.9aF)
;andrespirationsare65/minCracklesare
heardoveralllungfields.Aphotomicrographofasilver-stainedspecimenobtainedviabronchoalveolarlavageisshown.Inadditiontoalackofexpressionofhumanleukocyteantigen-DRmolecules
bylymphocytes,flowcytometryofaperipheralbloodspecimenwillmostlikelyshowmarkedlydecreasedpopulationsofwhichofthefollowingcelltypes?
A)CD4+-Tlymphocytes
S)Dendriticcells
C)Monocytes
OQ)Naturalkillercells
E)Segmentedneutrophils
O m O m
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177. ExamSection4:Item26ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min39sec
9Mark
26.A29-year-oldwomancomestothephysicianbecauseofirregularmenstrualperiodssincemenarcheattheageof12years.Sheis1GOcm(5ft3in)tailandweighs86kg(190lb);BMIis34kg/m
2Sheisevaluated,andthediagnosisofpolycysticovarian
syndromeismade.Afterexplainingthediagnosis,thephysiciandiscussesbehavioralchanges,includingdietarymodificationandexerciseaspartofhertreatmentplan.Whichofthefollowingismostlikelytoresultinpatientadherencetothisplan?
OA)Ascertainthepatient'seducationallevelandprovideappropriatepublications
B)Askthepatienttobringafamilymemberorfriendtothenextappointment
.JC)Informthepatientofthehealthconsequencesofnottreatinghercondition
'
3D)Providefollow-upappointmentstoassessthepatient'sprogressinattaininghergoals
.E}Referthepatienttoasupportgroup
O
*
900
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178. ExamSection4:Item27of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min37sec
9Mark
27.Astudyisconductedtodetermineifconcomitantoraladministrationofciprofloxacinandsucralfateresultsinadecreasedplasmaciprofloxacinconcentration.Twelvesubjectsareenrolledinthestudy;sixreceiveciprofloxacinonly,andsixreceiveboth
treatments.Thehalf-lifeisdetermined,anda1-weekwashoutperiodfollows.Eachsubjectthenreceivestheothertreatmentandhaff-lifeismeasuredagain.Whichofthefollowingbestdescribesthedesignofthisstudy?
A)Case-control
8)Caseseries
.C)Crossover
3D)Historicalcohort
.E)Prospectivecohort
*
m O m
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179. ExamSection4:Item28ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min33sec
9Mark
28.A32-year-oldwomanisfoundtohavepanicdisorderwithagoraphobia.Adrugisprescribedthatactivatesbenzodiazepinebindingsitesonthey-smmobutyricacid
A
(GABAJreceptor.Thisdrugismostlikelywhichofthefollowing?
A)Alprazolam
S)Buspirone
OC)Flumazenil
3D)Hydroxyzine
3E)Ramefteon
O
*
900
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180. ExamSection4:Item29of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min31sec
®Mark
29.A1-year-oldAfricanAmericangirlisbroughttothephysicianbecauseofaslowgrowthrate.Atbirthshewasatthe25thpercentileforlengthand30thpercentileforweight.Shehasbeenexclusivelybreast-fedsincebirth.Herlengthandweightarenowatthe
5thpercentile.Physicalexaminationshowsbowedlegs,swellingofthewrists,andabulgingofthecostochondraljunctions.Herserumcalciumconcentrationiswithinthereferencerange,andherserumphosphorusconcentrationisdecreased.Whichofthe
followingsetsofserumfindingsismostlikelyinthispatient?
ParathyroidHormone 25-HydroxyvitaminD
OA)
OB)
O
C)
OD)
OE)
OF)
T T
T I
Normal I
normali
! T
i 1
*
m O m
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181. ExamSection4:Item30ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min27sec
9Mark
30.Apremenopausal49-year-oldwomanasksherphysicianaboutherriskforosteoporosis.Hermotherhadosteoporosisanddisablingbonefracturesaftermenopause.Thepatientworksasagardenerforalandscapeserviceandplaystennis3timesaweek.
Shedoesnotsmoke
7drinks1glassofwineaweek,andtakesnomedications.Herweightis55kg(121lb).Whichofthefollowingadditionalinformationisneededtoevaluateherriskforosteoporosis?
.A)Ageatfirstsexualintercourse
8)Dietaryhistory
.JC)Exposuretoionizingradiation
3D)Exposuretoorganophosphate
.E)Familyhistoryofrheumaticdiseases
F)Socioeconomichistory
*
m O m
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182. ExamSection4:Item31of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min24sec
®Mark
31.A5-year-oldboyisbroughttothephysicianbyhisparentsbecauseoflethargyfor1week.Hehasahistoryofoccasionalcoldsandearinfections.Physicalexaminationshowsmildpittingedemaofthelowerextremities.Auscultationofthechestandpalpation
oftheabdomenshownoabnormalities.Laboratorystudiesshow:
Hemoglobin
Hematocrit
Leukocytecount
Serumcholesterol
Urine
Blood
Protein
15g/dL
45%
7300/mms
380mg.'dL
absent
3+
Ifakidneybiopsyspecimenwereobtained
:lightmicroscopicexaminationwouldmostlikelyshowwhichofthefollowing?
A)Crescentswithintheglomerularspace
B)Focalsegmentalglomerulosclerosis
OC)Neutrophilicinfiltrationoftheglomerulartuft
JD)Thickenedglomerularbasementmembranes
E)Nopathologicabnormality
O
*
m O m
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183. ExamSection4:Item32ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min21sec
®Mark
32Feedbackinhibitionoftheactivityoftheenzymethatcatalyzesthisreactioniscriticalinthecontrolofthedenovosynthesisofwhichofthefollowing?
OA)Complexcarbohydrates
B)Folates
QC)Pentosephosphates
D)Purinenucleotides
QE)Pyrimidinenucleotides
®-o—
H
H
OH OH
Glutamine
lutamate
SPFi
©-O-CHj
^
O
NHa
H
H\H H
OH OH
ooo
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184. ExamSection4:Item33of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min18sec
9Mark
33.A72-year-oldwomanwithcoronaryarterydiseasecomestothephysicianbecauseofa2-monthhistoryofprogressiveanginasymptomswithexertion.Fivemonthsago,thepatientunderwentstentplacementforsignificantstenosesoftheproximalanterior
interventricular(leftanteriordescending)andrightcoronaryarteries.Sheremainedsymptom-freefor3months.Herpulseis76/minandregularandbioodpressureis135/85mmHg.AnEGGatrestshowsnoabnormalities:anexercisestresstestshowsST-
segmentchangesinleadsII,IIIandaVF.Whichofthefollowingisthemostlikelycauseofthispatient'srecurrentanginasymptoms?
A)Aneurysmoftherightcoronaryartery
3B)Dissectionoftherightcoronaryartery
oC)Neointimaformationintherightcoronarystent
3D)Thrombosisoftherightcoronarystent
E}Vasospasminthestentedrightcoronaryartery
*
m O m
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185. ExamSection4:Item34ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min15sec
9Mark
34.A55-year-oldmancomestothephysicianbecauseofa3-weekhistoryofnightsweats,weakness,fatigue,lossofappetite,andlumpsinhisneck.HeownsaprintingbusinessandworkswithpaintsandsoEvents.Physicalexaminationshowsedematous
:
tenderaxillaryandinguinallymphnodes.Hisleukocytecountis45.570/mm
3(30%large,pleomorphicblastswithAuerrods).Occupationalexposuretowhichofthefollowingmostlikelycontributedtothedevelopmentofthispatient'sdisease?
.A)Benzene
B)Cadmium
0C)Chlordane
0D)Naphthylamine
.E}Vinylchloride
O m O m
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186. ExamSection4:Item35ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min11sec
®Mark
35.Amatchedcase-controlstudyisconductedtoassesstheassociationbetweenthefrequentuseoftanningbedsduringteenageyearsandthedevelopmentofmelanoma.Agroupofwomenwithmelanomaarematchedwithagroupofcancer-freewomenof
thesameageandethnicity.Anoddsratio(OR)of1.4isobtained.Whichofthefollowing95%confidenceintervalsfortheORisthemostprecisestatisticallysignificantinterval?
A)-0.9to0.9
O
0)0.9to1.7
OC)0.98to1.01
oD)1.01to1.73
.E)1.2to1.7
O
*
m O m
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187. ExamSection4:Item36ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min9sec
®Mark
36.AG-week-oldmaleinfanthasapersistentdischargefromaswollenumbilicalstump.Ifthedischargecontainsintestinalfluid,towhichofthefollowingportionsofthegastrointestinaltractisthefistulamostlikelyconnected?
OA)Cecum
^
B)Duodenum
0G)ileum
0D)Jejunum
E)Sigmoidcolon
*
m O m
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188. ExamSection4:Item37of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min5sec
®Mark
37.A32-year-oldmancomestothephysicianbecauseofa6-monthhistoryofprogressivedroopingoftheeyelidsandfacialweakness.Muscleweaknessisexacerbatedbyuseandrelievedbyrest.Ifaneoplasmisthecauseofthesefindings,whichofthe
followingisthemostlikelylocationinthispatient?
A)Femur
8)Liver
.C)Lymphnodes
'
_D)Meninges
..E)Thymus
*
m O m
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189. ExamSection4:Item33ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr13min2sec
®Mark
38.Whencontrollymphocytesaretreatedwithcorticosteroids,amajorityofcellsshrinkinsizeanddevelopperipheralchromatincondensation;cytoplasmicorganellesareintact.DNAisolatedfromthecontrollymphocytes
:electrophoresedonanagarosegeland
stainedwithethidiumbromide,showsaladderofregularlyspacedhands.WhenEymphocytesfromthesameculturearetransfectedsothattheyoverexpressGeneX.whichencodesanormalproteinproductthecellscontinuetoproliferateanddonot
undergoanyofthemorphologicchangesseeninthecontrolcells.GeneXismostlikelytoencodewhichofthefollowing?
A)BCL2protein
0B)ERBB2protein
G)p53protein
30)Platelet-derivedgrowthfactor
E)Rbprotein
*
m O m
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190. ExamSection4:Item39of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr12min59sec
9Mark
39.A65-year-oldmancomestothephysicianforafollow-upexamination.Hehasa15-yearhistoryofpoorlycontrolledtype2diabetesmellitus,resultingiinmultipleperipheralneuropathies.Neurologicexaminationshowswastingoftheinterosseousmusclesof
thelefthandandinabilitytoabductthefngersofthishand:plantarflexionoftherightfootisabsentThefunctionofwhichofthefollowingpairsofnervesismostlikelyimpairedinthispatient?
.A)Medianandcommonfibular(peroneal)
8)Medianandtibial
.JC)Radialandcommonfibular(peroneal)
D)Radialandtibial
.E}Ulnarandcommonfibular(peroneal)
F)Ulnarandtibial
*
m O m
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191. ExamSection4:Item40ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr12min56sec
®Mark
40A12-year-oldgirlisbroughttothephysicianbecauseofarashonherlet!buttockforthepast2days.Therashdevelopedafterthefamilyreturnedfroma2-week-longearlysummervacationinMaine.Hervitalsignsarewithinnormallimits.Aphotographof
thelesionisshown.Thelikelycauseofthispatient
'sinfectionistaxonomicalfyandmorphologicallymostsimilartotheinfectiousagentofwhichofthefollowingconditions?
A)Bacillaryangiomatosis
OB)Chancroid
C)Leptospirosis
JD}Lymphogranulomavenereum
._E)Qfever
®0 000
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192. ExamSection4:Item41ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr12min53sec
9Mark
41.Asingle,oral.6-mgdoseofashort-acting(3
^
agonistisstudiedtodetermineitspharmacokineticsandpharmacodynamicsinyoungsubjectswithstablemildasthma.Inthisgroup,theCma:/AUCfollowingoraldosingvariesbylessthan&%.However,in30%
ofsubjects
:themaximalFEV,increaseis25%lowerthanthatoftheothersubjects.Whichofthefollowingmechanismsbestexplainstheseobservationsinthissubgroup?
A)DecreasedcatecholO-methyltransferaseactivityinbronchialsmoothmuscle
8)DecreasedphosphodiesteraseIVinbronchialsmoothmuscle
.JC)IncreasedgastrointestinalP-glycoprotein
'
3D)Receptorpolymorphismwithreducedsignaltransduction
(_yE)Receptorupregulation
*
m O m
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193. ExamSection4:Item42ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr12min50sec
®Mark
42A19-year-oldmancomestotheemergencydepartmentbecauseofincreasinglysevereshoulderandabdominalpainfor3days.Histemperatureis3EPG(102.2T).Physicalexaminationshowssigns
ofacuteperitonitis.Anabdominalx-rayisshown.Whichofthefollowingisthemostlikelycauseofthispatient
'scurrentcondition?
A)Ileus
QB)Intraperitonealabscess
C)Nephrolithiasis
OD)Perforatedviseus
E)Retainedforeignbody
O m O m
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194. ExamSection4:Item43of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr12min47sec
9Mark
43.A2S-year-oldmanisparticipatinginastudyoftheeffectofaltitudeandconditioningoncombatreadiness.HeisaSpecialForcessergeantinthearmy.Whileheexercisesinanenvironmentalchamber,theambientPo
2
isdecreasedfrom160mmHgto60
mmHg.ThedecreaseinambientPo
?willmostlikelycauseanincreaseinwhichofthefollowinginthispatient?
.A)Arterialdiastolicpressure
8)Arterialpulsepressure
OG)Arterialsystolicpressure
'
3D)Meanarterialpressure
.E}Meanpulmonaryarterypressure
*
m O m
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195. ExamSection4:Item44ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr12min44sec
®Mark
44.A52-year-oldwomanisadmittedtothehospitalbecauseofchestpainandshortnessofbreathfor2hours.Herpulseis102/miarespirationsare35/min,andbloodpressureis110/65mmHg.Cardiacexaminationshowsalaterallydisplacedapex,asystolic
thrill,andagrade4/6
:crescendo-decrescendosystolicejectionmurmur.Cardiaccatheterizationshowsapulmonarycapillarywedgepressureof40mmHg(N=5—16).Whichofthefollowingsetsofchangesinthispatient'sleftventricleismostlikely?
Stroke
Work
Increased
MyocardialOxygen
Consumption
increased
increased
decreased
decreased
MyocardialOxygen
Tension
increased
decreased
Adenosine
Concentration
decreasedOA)
OB)
O
C)
OD)
OE)
OF)
OG)
OH)
increased increased
Increased increased increased
increased decreased increased
Decreased increased increased increased
Decreased increased increased decreased
Decreased decreased increased increased
Decreased decreased decreased decreased
O
*
900
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196. ExamSection4:Item45ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr12min41sec
®Mark
45.A65-year-oldwomanwithseveresensorineuralhearinglossundergoessurgicalplacementofacochlearimpEant.Thisneuralprosthesisconvertssoundenergytoelectricalsignals,whichresuitsinstimulationofwhichofthefollowingstructures?
3A)Auditorynerveendingsinthecochlea
J8}Cochlearnerveasitentersthepons
(J
:G)Innerhaircellsofthecochlea
JD)Olivocochlearefferentaxonsthatinnervateouterhaircelfs
'
JE)Ovalwindowofthecochlea
*
m O m
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197. ExamSection4:Item46ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr12min38sec
®Mark
46.A4S-year-oldmanbeginsfurosemidetherapyforpedaledemaassociatedwithbiventricularfailureandhypertension.Fivedayslater,theedemaisnotfullyresolvedandhisserumpotassiumconcentrationhasdecreasedfrom4.2mEq/Lto3mEq/L.Adrug
withwhichofthefollowingactionsshouldbeaddedtothispatient'smedicationregimen?
.A)BlocksbasolateralK
+channelsinthecollectingduct
B)DecreasestheluminalpermeabilitytoNa
+inthecollectingduct
.JC)IncreasesthedeliveryofNa
+andK
+tothecollectingduct
'
3D)increasesthenegativechargeoftheluminaltubulefluid
..E}StimulatesNaMOATPaseinthecollectingduct
*
m O m
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198. ExamSection4:Item47of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr12min35sec
®Mark
47.A70-year-oldmancomestothephysicianbecauseofa4-monthhistoryoffatigueandcoughproductiveofblood-tingedsputum.Hehasahistoryofhyperlipidemia.Hehadsmoked1packofcigarettesdailyfor
30yearsuntilhequit5yearsago.Histemperatureis37.2GC(993F),pulseis120/mirj,respirationsare20/min
:andbloodpressureis130/85mmHg.Diffusecracklesandwheezesareheardoninspiration.Achest
x-rayisshown.Serumstudiesshow:
Na
+ 138mEq/L
5.0mEq/L
102mEq/L
24mEq/L
15mg/dL
K
+
Cl
-
HCG,-
Ca
2+
Inadditiontointravenoushydrationandinductionofdiuresistotreathishypercalcemia,itismostappropriateforthispatienttobegintherapywithadrugthatinhibitstheactivityofwhichoftheMowingcells?
A)Chondroblasts
^
B)Chondrocytes
C)Osteoblasts
_!D)Osteoclasts
E)Parathyroidcells
*
#&0
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199. ExamSection4:Item43ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr12min32sec
®Mark
48.A22-year-oldmancomestothephysicianbecauseofa2-monthhistoryoffoul-smelling,waterydiarrheawithsignificantflatulence:healsohashada4.5-kg(10-lb)weightlossduringthisperiod.Herecentlyreturned
fromatriptoruralIndonesia,wherehedidnotalwayshaveaccesstocleanwater.Heappearsthin.Physicalexaminationshowsasoftmildlydistendedabdomenwithactivebowelsounds.Aphotomicrographofastool
specimenisshown.Themostappropriatepharmacotherapyhaswhichofthefollowingmechanismsofaction?
A)Enhancementofcellmembranepermeabilitytochlorideions
QS)Formationofdestructivefreeradicals
C)InhibitionofDNApolymerase
O0)Inhibitionofproteinsynthesis
E)Preventionofmicrotubuleassembly
*
& *
C
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200. ExamSection4:Item49of50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr12min29sec
®Mark
49.A70-year-oldwomanisbroughttotheemergencydepartment30minutesaftershewasfoundunresponsiveathome.Sheappearsstuporous.Physicalexaminationshows2-mm-diameterpupilsthatare
reactivetolight.Eyemovementsarefullwithicewatercaloricstimulation.Shewithdrawstheextremitiessymmetricallytopainfulstimuli.AnMRIofthebrainisshown;thearrowheadsindicateabnormalities.
Whichofthefoilowingismostlikelytobepresentinthispatient2monthslater?
A)Difficultyrecognizingfamiliarfaces
8}Hesitant,telegraphiclanguageoutput
C)Impairedabstractionandproblemsolving
O0)Inabilitytolearnandrecallnewfacts
E)Inappropriate,disinhiibitedbehavior
O
*
900
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201. ExamSection4:Item50ol50 NationalBoardofMedicalExaminers^
ComprehensiveBasicScienceSelf-Assessment
TimeRemaining:
1hr12min26sec
®Mark
50.A34-year-oldwomancomestothephysicianbecauseshehasbeenfeelingweepyandoverwhelmedsincedeliveringahealthymalenewborn6weeksago.Shehashadfatigueandirritabilityduringthisperiod,andshehashadnointerestinengagingin
activitiessheusedtoenjoypriortothebirthofthebaby.Shealsohashaddifficultysleepingbecausesheisalwayslisteningforsoundsindicatingthatherbabyisawake.Shesays,''Myhusbanddoesn'thelpmeatallwiththebaby.Weargueallthetime
now."Shethensays
:"IfeelguiltybecauseI’mnotenjoyingmybabymore.Idon'tknowifIwillbeagoodmotherornot.
'
1
Physicalexaminationshowsnoabnormalities.Whichofthefollowingstatementsbythephysicianismostappropriate?
A)"Hasitcomeasasurprisetoyouhowhardparentingis?Manypeoplefeelthatway"
3B)"Tmconcernedabouthowbadyou'vebeenfeelinglately.Haveyouhadanythoughtsaboutdeathorwantingtobedead?
"
oC)"lrmsurethatyou'llfeelbettersoon.AfteralE
:lookatyourbeautifulbaby.
'
1
30)"Mostnewmothersfeelthisway,andsometimesithelpstoseeatherapist.Wouldyoulikemetogiveyouareferral?"
E}"Yourrelationshipwithyourhusbandsoundsstrained.\don'tblameyouforbeingangrywithhim."
O m O m
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