Section 1

Ravi & Mohan

1. B
2. D
3. E
4. A
5. E
6. H
7. C
8. A
9. F
10. A
11. B
12. D
13. C
14. E
15. D
16. C
17. E
18. B
19. ?
Question 19 couldn't really be answered since the screen shot only captured 2 of the possible
answer choices.
20. B
James Brittin & Mariu
21-C Bilateral lesion of the midbrain reticular formation cause loss of consciousness.
22-A. A is the superior ramus and contributes to all of the following movements that the man
has lost:
Arm abduction=deltoid=axillary (C5,6)
=Supraspinatus=suprascapular (C5)
Lat rotation=deltoid (c5,6)
Flexion=deltoid
=biceps short head=musculocutaneous=c5,6
Elbow flexion/supination=c5,6
23- A. PCO2 regulates cerebral blood flow.
24-A. C5 is most commonly injured during vaginal delivery (called Erb-Duchenne palsy).
25 E. X is the Substantia Nigra, which usually inhibits striatum in the extrapyramidal
pathways.

26-C. Blindness is caused by accumulation of formic acid, a toxic metabolite of methanol.

Formic acid accumulates within the optic nerve, which results in classic visual symptoms of
flashes of light and blurring. This may progress to scotomas and scintillations.
27-C. Neuroleptic malignant syndrome=fever, myoglobinuria, elevated CPK, and muscle
rigidity. Caused by haloperidol (other neuroleptics end in azine=thioridazine, fluphenazine,
chlorpromazine). Clozapine, olanzapine, risperidone are atypical antipsychotics.
28- (d)
29-A--common peroneal n injury causes foot drop.
30- C. Osteogenesis imperfecta is caused by abnormal collagen synthesis. It is characterized
by multiple fractures, blue sclerae, hearing loss, and dental imperfections (Type I). Type II is
fatal in utero.
31(b)
32- (e) Family history of dying young from lung disease is suggestive of genetic cause=alpha1-antitrypsin deficiency, which causes panacinar emphysema. FEV1/FVC<80% (1/3.3) so
this makes it obstructive, which is consistent with emphysema.
33-D. Non productive cough, wheezing, dyspnea are all symptoms of asthma. 5Lipoxygenase pathway converts arachidonic acid to leukotrienes, which cause
bronchoconstriction, mucus, and inflammation. Asthma drugs like Zileuton inhibit 5lipoxygenase.
34-E. Important formulas: Q=P/R, R=8*viscosity*(length of vessel)/(pi*r^4). From first
equation, since pressure is maintained, Q/R is constant. Increasing diameter twofold
increases the radius twofold. Increasing radius twofold decreases R 16fold so Q has to
increase 16fold. 100*16=1600.
35 C. Systolic murmurs can be Mitral Regurg or Aortic Stenosis (MR. ASS)
36 A
37 C Cholestyramine prevents resorption of bile salts. Liver will upregulate LDLr in order to
take up more cholesterol to make bile salts. The overall goal is to lower LDL.
38 D
39 C
40 E He has portal hypertension from chronic hepatitis and signs of esophageal varices
(circumferentially prominent tortuous veins). Increased pressure in submucosal esophageal
veins causes esophageal varices which likely ruptured and produced the clot seen by
endoscopy.

Bronwyn
41. B - remember parasympathetic is involved in urination
42. A - hydronephrosis is the distention and dilation of the renal pelvis, usually due to
obstruction - this matches the description that the mass has a "markedly dilated renal pelvic
and calyceal system."
43. J - Even though it may look like polycystic kidney disease, a big key is that it is unilateral
and the picture doesn't really show cysts, it is more dilation of the calyceal system.
Vesicoureteral reflux explains this.
44. D - Sounds like Schistosoma (blood fluke), which is a parasite.
45. D - Trichomoniasis is a single celled protazoan that can be visualized using a
microscope. Usually present with frothy, yellow-green vaginal discharge.
46. B - They are unsure of the MOA of amniotic fluid embolism, seems that something from
the baby gets into the mother's blood and triggers a severe allergic reaction. 50% die within 2
hours of symptoms.
47. C
48. B - Plasma renin activity will increase due to an increase in renal sympathetic nerve
activity, while renin activity would be increased with due to a decrease in atrial pressure or
sodium delivery.
49. D - patient is unable to concentrate urine and is constantly thirsty despite drinking more
than usual. Blurry vision is a rare symptom.
50. A 60-year old woman develop anemia several years after a subtotal gastrectomy. Which
of the following is the most likely finding on peripheral blood smear?
A. basophilic stippling - no, suggests toxic injury to bone marrow
B. helmet cells - no
C. Macrocystois of erythrocytes - this is the answer they have. I guess even a subtotal
gastrectomy you could have problems not producing enough intrinsic factor. but why would
you also not have E?
D. Microcytosis of erythrocytes - no duodenum is fine
E. Reticulocytosis

Section 2
Alan P.
1. A "methylation of Ecoli DNA"
2. A "Cysteine"
3. D "NADH"
Rapid Reveiw (E. Goljan) p. 111: "Laboratory findings in ETOH abuse: Fasting hypoglycemia Excess NADH causes pyruvate (substrate for gluconeogenesis) to convert to lactate."
4. C "phospholipase C"
http://en.wikipedia.org/wiki/Image:PIP2_cleavage_to_IP3_and_DAG.jpg
http://en.wikipedia.org/wiki/Phospholipase_C
Phospolipase C performs a catalytic mechanism, generating inositol triphosphate (IP3) and
diacylglycerol (DAG).
These molecules then go on to modulate the activity of downstream proteins important for
cellular signaling. IP3 is soluble, and diffuses through the cytoplasm and interacts with IP3
receptors on the endoplasmic reticulum, causing the release of calcium and raising the level
of intracellular calcium.
5. C "Hyperplasia"
Patient has psoriasis - see Rapid Review Path (Goljan) p. 552-554. I'm interpreting the
"hyperproliferative state" described in Up To Date "
Epidemiology, clinical manifestations, and diagnosis of psoriasis" as Hyperplastic.
From the article:
PATHOPHYSIOLOGY Historically, the understanding of the pathogenesis of psoriasis has
been affected by the treatments available at the time. Where previously psoriasis had been
viewed as primarily a disease of hyperproliferation, more recently it has come to be regarded
as an immune-mediated disease [14] . This view is supported by novel therapies that target
memory T-lymphocytes and related cytokines.
It appears that psoriasis is a complex immune-mediated disease in which T-lymphocytes play
a central role. Although drugs and infections may trigger psoriasis, the primary insult that
initiates psoriasis is not always clear.
The typical clinical findings of erythema and scaling are the result of hyperproliferation and
abnormal differentiation of the epidermis, plus inflammatory cell infiltrates and vascular
changes. This hyperproliferative state, when compared with normal epidermis, is
characterized by the following:
Increased numbers of epidermal stem cells
Increased numbers of cells undergoing DNA synthesis
A shortened cell cycle time for keratinocytes (36 hours compared with 311 hours in
normal skin)
A decreased turnover time of the epidermis (four days from basal cell layer to stratum
corneum, compared with 27 days in normal skin)

6. NO IDEA
7. E "Type IV Collegenase"
8. C
This seems best to me, but there may be something about the process of getting an
interpreter would take too long etc... so I'm not 100% sure.
9. 9. D is correct.
A The osmolality of edema fluid should be approximately 280 (isotonic) and the
concentration of Cl- should be no higher than necessary to balance the cations
present
B in patients with cirrhosis with ascites, GFR is normal to low
C a completely nonsensical answer
E serum globulin fraction may be increased in some types of liver disease, but this
has no impact on urinary sodium retention, as opposed to D which is the principle
mechanism by which edema results and is the reason spironolactone is an effective
diuretic in this population.
10. B "G6PD"
Sulfa drugs cause hemolyitic anemia in G6PD deficiency. See Up To Date "
Clinical manifestations of glucose-6-phosphate dehydrogenase deficiency"
Eve & Michelle L.
11. G
12. A
13. G
14. D
15. C
16. D
17. C
18. B
19. D
20. E
21. C
22. C (K+ efflux decreases membrane potential)
23. C
24. B

25. C
26. B or D? (BRS Pharm says that adverse effects of dopamine agonists include dyskinesias ("repetitive
involuntary gross movements affecting the face and limbs"), so maybe that would be an example of exaggerated
tremor? The dopamine hypothesis, though, says that increased dopamine is associated with psychosis.)

27. B
28. C
29. C
30. A

Fiona
31. C disseminated TB: most pple asymptomatic on primary infection; sx include fever,
night sweats, productive cough, wt loss, low grade fever.
32. A
33. A crescendo-decrescendo murmur
34. C mitral valve stenosis
35. C - norepinephrine
36. A pure alpha agonist (eg phenylephrine)
37. B jejunem (lactase in small intestine)
38. A alcohol dependence
39. C biliary cholic
40. E
41. D minimal change disease: proteinuria without hematuria, common in kids
42. D von hippel lindau dz: hemangioblastomas, cysts, incr incidence renal cell ca
43. D thiazides block Na-Cl symporter
44. E
45. B
46. F testo causes negative feedback inhibition of LH production test atrophy
47. B bind nuclear receptors gene transcription
48. A

49. A adrenal atrophy; abrupt cessation of prednisone may addisonian crisis (nausea,
vomiting, fatigue, mm weakness, joint aches/pains)
50. ? No question 50

Section 3
James W. & Jared O.
1. C All of the other methods deal with comparing for concordance in specific sections of the
genome. Nucleotide sequencing can demonstrate exact sequence equivalence between 2
bacteria.
2. C
3. A
ALA-synthetase is the rate limiting enzyme, which uses B6 to form dALA
4. C C is the I band which is non-overlapped thin filaments. It shrinks with contraction as
thick filaments overlap thin.
5. E
6. B Fragile X is a triple nucleotide repeat disease with anticipation
7. C Astrocytes are considered glial cells
8. J
9. C This is describing methemaglobinemia, a cyanotic syndrome. Nitrates are reducers
and they reduced the iron in his heme from 2+ to 3+ so it can no longer carry O2.
10. C Nalaxone = opiate competitive antagonist
11. C Tetracyclines would be the drug of choice for various intracellular bugs including
Rickettsia or Erlichia and it is a protein synthesis inhibitor
12. A You kinda had to know that bleomycin is used in the treatment of testicular carcinoma
b/c cyclophosphamide also can cause pulmonary fibrosis
13. D Phenolphthalein turns clear in acidic solution. H.Pylori Urease generating ammonia
has alkalized the solution causing the indicator to turn red.
14. B Crypto is very common in HIV and this picture looks similar to the one on Wiki for
crypto
15. C Fas/FasL is an important signaling pathway for the elimination of unwanted (autoactive) T-cells
16. E
17. C The increase in C02 will acidify the solution right shifting the oxy-hemaglobin
dissociation curve. In vivo this effect causes the release of 02 from hemoglobin in hypoxic
tissues
18. E
19. E
20. D
Courtney & Andrew Gore
21. E - All interosseous muscles of the hand are innervated by the deep branch of the ulnar
nerve.
22. B Leading cause of preventable blindness in the world (disease of poverty; HSV is most
common cause of infectious blindness in USA)
23. D common picture from Neuro
24. A see neuro headache definitions
25. F chronic syndrome; recurrent symptoms in many organ systems; onset before age 30
26. E likely OCA1a an alteration in tyrosinase gene produces no functional protein
27. C
28. F arthritis, mouth ulcers, low platelet count all consistent with SLE
29. E NSAID chronic use related to gastric ulcers

30. D an RSV infection; treat with Ribavirin (although not really preferable to use in kids)
31. D the description is consistent with sleep apnea; the motion of the wall during the
episodes is consistent with obstructive sleep apnea rather than central sleep apnea, in which
no attempts to breath are made during the episodes
32. C baby takes first breath and decreases PVR
33. C this is describing Raynauds phenomenon, which is vasospasm
34. A
35. A Ca channel dependent on slow response tissue; i.e. AV node
36. D
37. C most common cause of travelers diarrhea
38. E hepatocellular carcinoma leads to an increase in alpha-fetoprotein
39. B
40. E edema result of decreased capillary oncotic pressure; consistent with decreased
protein, likely from protein wasting in the urine
MJ & Dan Matthews
41. E Read about hydronephrosis http://www.merck.com/mmhe/sec11/ch148/ch148b.html.
Basically the bladder is distended (mass above pubis) so it has to be distal to the kidneys and
that makes urethral obstruction the only reasonable answer.
42. A CORRECTION: Bruit heard over flank suggests renal artery stenosis. This
causes secondary hyperaldosteronism and thus all arrows would be expected to point
upward.
43. D At least a week, which is closest to 8 days.
44. E This is premature ovarian failure. PCOS would have presented differently
patient would have infertility, amenorrhea PLUS some combination of obesity/insulin
resistance/diabeetus/hirsutism. Other answers are congenital and dont make since
because the patient has already had one baby.
45. D Raloxifene does stimulate breast or endometrial tissue, and thus is good for treating
osteoporosis in post-menopausal women
46. G ADH receptor cant respond to ADH so urine osmolality is low. Water is not conserved
so serum osmolality goes up. This causes ADH to go up (but this doesnt help the situation
because the receptor is mutated).
47. D All DKA patients have deficiency in whole body potassium.
http://www.emedicine.com/ped/topic582.htm.
48. E Primary hyperparathyroidism (see BRS). I dont think PTH is regulated by
hypothalamus at all. It is regulated by Ca++ levels and since these are up and PTH is still
high, that means feedback inhibition is not working. Increased urinary Ca++ is a little
confusing but BRS says that it is caused by increased filtered load or Ca++
49. A The distribution is not normal but that doesnt mean you cant calculate mean, median,
and mode.
50. B precision is reproducibility and accuracy is degree of veracity. The technique is
reproducible but does not give a true (accurate) value.

Section 4
MJ & Dan Matthews
1. C Pathologic Basis of Disease 7ed. p. 632-633. It says C or E, but C is most
common. I think this is a terrible question.
2. B Increasing K decreases affinity so a higher concentration would be needed to
reach the same Vmax (which doesnt change)
3. C just wiki I-cell disease
4. C Im pretty sure about this but didnt look it up. A is wrong. For D, its
electrochemical gradient, not just concentration gradient. B sounds silly to me.
5. E
6. C - Pathologic Basis of Disease 7ed. p. 56.
7. A Im going with common sense here. Could be wrong. Operation is too extreme.
Shes too young for hormonal therapy.
8. A http://en.wikipedia.org/wiki/Malignant_hyperthermia.
9. C 5 half lives?
10. B Cimetidine increases the INR. A is too extreme, because cimetidine needs time to
interact with warfarin.
Laura T. and Eli Z. (all answers same except questions 17 & 19 as indicated; first answer =
Eli; second = Laura)
11 C - An azole antifungal is a potent CYP inhibitor, increasing other drug concentrations (thus
increasing hypoglycemic effects of glipizide and anticoagulant effects of warfarin)
12 C - Lipid A is the component of endotoxin that would cause hypotension.
13 A - A serous exudate implies a viral conjunctivits. Adenovirus is a common (and easily
transmitted in places like daycares) cause of conjunctivitis
14 F - I think NK cells are the right answer. Since it can't be CD8+ T-cells, and CD4+ T-cells
wouldn't lyse cancer cells, NK cells make sense as powerful tumor-lysing cells.
15 E - Wiskott-Aldrich syndrome is an X-linked condition marked by eczema,
thrombocytopenia and immunodeficiency.
16 D - This is a classic cohort study. It is prospective, and it involves no randomization
17 C - High altitude plus exercise training would increase tissue delivery of oxygen.
B
18 E - These are classic plasma cells, and the vignette relays a history including a pathologic
fracture.
19 A - Cortisol, an immunosuppressive agent, would be increased in times of stress.
D
20 D - A right MCA stroke would cause ipsilateral weakness of the hand and forearm.
21 B - The femoral nerve is responsible for both knee extension and sensation of the medial
leg.
22 B - Hemophilus influenza is responsible for the symptoms in the vignette, is the only Gramnegative coccobacillus, and is routinely vaccinated against.
23 E - The lucid interval, and the shape on CT are suggestive of epidural hematomas. The
middle meningeal artery is the most common vessel involved in EDH.
24 A - This is Huntington's disease, an autosomal dominant disorder characterized by
choreiform movements, and progressive dementia and psychosis. It primarily affects the
caudate.

25 C - This is psychosis of short duration. A refers to behavior like truancy and theft, B
doesn't involve psychosis, it is too short of a timeframe to diagnose D, and the vignette rules
out the substance use in E.
26 D - A benzodiazepine overdose in a child would cause respiratory depression.
27 A - The closure of the epiphyseal cartilaginous plate marks the end of bone growth.
28 D - The history of septic arthritis in a healthy young adult, as well as the Gram-stain
suggest Neisseria meningitidis.
29 A? E? - No clue on this one. I think that since protein malabsorption will be impaired,
excretion of hydroxyproline (a component of collagen) will be decreased.
30 E - Kartagener's syndrome, which is described, predisposes patients to bacteria normally
cleared via the mucociliary route. Staph aureus is one such bacteria.
Kunal & Walter
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.

B (i am reasonably certain)
E
B (because the others don't make much sense to me)
A
D
E
A
D (I am not sure, but I feel in my heart this is correct)*
C
E
F
C
D
A
E
C
A
B
C
B

* this answer has since been verified by a GI path person