A 25-year-old male patient visits a local physician for non-productive cough for the past 2 months.

He smoked 2 packs of
cigarettes per day for 10 years before quitting 2 days ago. His blood and imaging studies did not revealed anything clinical
significant. The physician ordered the biopsy of his lung and trachea. Below is the histological image of his trachea. What
type of cell layer is most likely shown the image below?

a. Transitional epithelium
b. Columnar epithelium
c. Psuedostratified ciliated epithelium
d. Stratified ciliated cuboidal epithelium
e. Simple squamous epithelium
Identify organelle labeled 1 in the image below:

a. Golgi complex
b. Vesicles
c. Nuclear envelope
d. SER
e. RER
A 75-year-old male patient visits his primary care physician complaining of fatigue, mild fever, blood is stool and loss
of appetite for the past 9 months. He states that he often misses his wife who passed away 6 months ago due to
coronary heart disease. His physical exam and vitals are within the normal limits except for mildly elevated
temperature and low hemoglobin. A CT scan indicates a mass in his ascending colon. A colonoscopy is performed
which reveals an adenocarcinoma of the colon. Which of the following statements is the most accurate regarding this
patient’s finding?

a. Elevated heterochromatin-to-euchromatin ratio

b. Elevated euchromatin-to-heterochromatin ratio
c. Shrunken nucleus
d. Light-gray-colored nucleus observed under TEM
e. Increased number of lysosomes in the cytoplasm
A 68-year-old male patient visits a physician because of fatigue for the past 6 months. He states that he has
always been healthy before and was only once hospitalized after a car accident 25 years ago. He indicates
that he smokes 1 pack of cigarettes everyday for the past 25 years. Histology of his biopsy is shown in the
image below. This biopsy was most likely taken from which of the following organs?

a. Lung
b. Skeletal muscle
c. Skin
d. Bladder
e. Mucous membranes
A 45-year-old-female patient visits your office complaining of frequent headaches and loss of consciousness. An
MRI of the brain indicates a tumor. The patient was immediately scheduled for cancer treatment but dies before
receiving any therapy. Histology of her tumor is shown in the image below. Based on the statistics, what type of
neural cells most commonly give rise to brain tumors?

a. Microglia
b. Schwann cells
c. Oligiodendrites
d. Neurons
e. Astrocytes
Identify the tissue labeled A in the image below:

a. Gray matter (neural)

b. Loose connective (proper)
c. White matter (neural)
d. Dense connective
e. Adipose
Which cell myelinates more than one neuron at a time and
where is it located?

a. Schwann cell and CNS

b. Schwann cell and PNS
c. Astrocyte and CNS
d. Ogliodendrocyte and CNS
e. Ogliodendrocyte and PNS
A sample of a brain biopsy was examined by a pathologist. The sample was taken from a 70-
year-old male patient who died of old age. Below is the histological image. What types of
cells are most likely observed on the apical side of this sample?

a. Ependymal cells
b. Simple columnar epithelial
c. Astrocytes
d. Simple squamous epithelium
e. Oligodendrocytes
A 50-year-old-diabetic woman visits her primary care physician complaining of tingling sensation and sharp
pain in her lower limbs. She states that the pain is constant and no medication alleviates it. A histological
image of the nerve biopsy taken from her lower limb is shown below. Which of the following statements is
the most accurate regarding the items indicated by green arrows?

a. Intercalated disk
b. Gap junction
c. Schwann cell
d. Node of Ranvier
e. Reticular fiber
A 24-year-old formula one driver is brought to the Emergency Department after suffering an accident on Florida
Turnpike. He says that after the collision he lost consciousness for a short time but regained it quickly. His vitals are
within normal limits and he is oriented. A CT of his brain is shown below. Which of the following statements is the most
accurate regarding this patient’s condition?

a. Rupture of middle meningeal artery

b. Blood accumulation between the dura and arachnoid
c. Rupture of middle cerebral artery
d. Rupture of a venous sinus
e. Rupture of the jugular vein
Please identify the ester bond (using the red letters) and name the structure below.

a. A; adenosine monophosphate
b. A; deoxyadenosine monophosphate
c. E; deoxyadenosine monophosphate
d. E; adenosine monophosphate
e. D; adenosine monophosphate
 Which of the following best describes DNA replication?

a. tRNA, by complementary base pairing with mRNA, produces proteins

b. DNA nucleotides, by complemetary base paring with DNA, produce DNA
c. RNA nucleotides, by complementary base pairing with DNA, produce DNA
d. RNA nucleotides, by complementary base pairing with DNA, produce tRNA
e. RNA nucleotides by complementary base pairing with rRNA, produce DNA
During DNA replication, what would be the complementary sequence, synthesized by
PRIMASE, to the DNA parental strand below?

5’-TACCGTAAT-3’

a. 5’-ATGGCATTA-3’
b. 5’-AUGGCAUUA-3’
c. 5’-ATTACGGTA-3’
d. 5’-UACCGUAAU-3’
e. 5’-AUUACGGUA-3’
A transcript was prematurely released from RNA polymerase I during transcription (shown
below). What is the corresponding DNA sequence on the coding strand from which this
transcript was derived?

5’-AUCUCGGCU-3’

a. 5’-AGCCGAGAT-3’
b. 5’-TAGAGCCGA-3’
c. 5’-ATCTCGGCT-3’
d. 5’-TCGGCTCTA-3’
e. 5’-ACGGCACAA-3’
As a molecular biologist, you set up an experiment in the lab to monitor DNA replication. In this experiment, you
start with a completely radioactive double-stranded DNA molecule. You then provide a solution, FREE OF ANY
RADIOACTIVE LABEL, of all the factors needed for DNA replication. If allowed to undergo two rounds of
DNA replication, what would be the radioactive status of the resulting four double-stranded DNA molecules?

a. All should contain radioactivity

b. Half should contain radioactivity in both strands
c. One should contain radioactivity in both strands
d. None should contain radioactivity
e. Half should contain no radioactivity
If protein X is added to the DNA non-coding strand below, the transcript levels of “Gene” increase. If protein Y is
added instead, the transcript levels of “Gene” decrease. A mutation in region A (causing region A to become non-
functional) increases transcript levels even in the presence of protein Y. A mutation in region C completely prevents
transcription. Please identify regions A, B, and C in the DNA non-coding strand below.

a. A = Enhancer; B = Silencer; C = Promoter

b. A = Silencer; B = Promoter; C = Enhancer
c. A = Silencer, B = Enhancer, C = Promotor
d. A = Enhancer; B = Promoter; C = Silencer
e. A = Repressor protein; B = Transcription factor; C = Promoter
You are doing research on eukaryotic protein translation. You are trying to develop an in vitro assay to study the
formation of the initiation complex from the pre-initiation complex. You have all the known components that are
thought to be engaged in the transition from one stage to the other, but yet, you are getting no product. Instead of
doing some library research, you decide to add different gel-filtration fractions from a eukaryotic cell lysate to your
assay. Sure enough, one of the fractions made your reaction go. You later find that the missing component was most
likely eIF5 and it is known to have which of the following functions?

a. Position the capped mRNA molecule at the correct site of the 40S ribosomal subunit
b. Combine with the eIF3 to allow the binding of the 60S ribosomal subunit
c. Foster the disassociate of eIF3 from the 40S ribosomal subunit allowing the association of the 60s ribosomal
subunit
d. Combine with the initiation tRNA to help bind methionine
e. Combine with the 60S ribosomal subunit to help position it on the 40S ribosomal subunit
How would an inactivating mutation in RNA polymerase II adversely affect cell
function?

a. tRNA’s would not be synthesized, halting translation

b. mRNA synthesis would be reduced, slowing cellular processes
c. mRNA’s, microRNA’s, and snRNA’s would not be synthesized, leading to cell death
d. rRNA’s would not be synthesized, halting translation
e. mRNA’s, snRNA’s, and rRNA’s would not be synthesized, leading to cell death
You are given an assignment to reproduce the experiment that shows the direction in which polypeptides are
synthesized following the instructions contained in the mRNA. After an appropriate period of historical research in
the library, you decide to proceed. Your mentor wants to review your library research showing that.

a. Synthesis proceeds from carboxy to amino terminus; the ribosome does not detach from the mRNA until
synthesis is completed; there is a one-to -one correspondence between the mRNA codons and the amino
acids of the polypeptide
b. Synthesis proceeds from amino to carboxy terminus; the ribosome detaches from the mRNA before synthesis
is completed; there is a one-to -one correspondence between the mRNA codons and the amino acids of the
polypeptides
c. Synthesis proceeds from amino to carboxy terminus; the ribosome does not detach from the mRNA until
synthesis is completed; there is no correspondence between the mRNA codons and the amino acids of the
polypeptides
d. Synthesis proceeds from amino to carboxy terminus; the ribosome does not detach from the mRNA until
synthesis is completed; there is a one-to -one correspondence between the mRNA codons and the amino
acids of the polypeptides; the tRNA attach to the mRNA before the ribosome subunits do
e. Synthesis proceeds from amino to carboxy terminus; the ribosome does not detach from the mRNA until
synthesis is completed; there is a one-to-one correspondence between the mRNA codons and the amino
acids of the polypeptides
Which of the following protein chains will be produced by the
following sequence
5’-AUG-GCA-AGA-UGA-ACG-3’
a. Met-Ala-Arg-Ile-Met
b. Met-Ala-Ile-Met-Lys
c. Met-Ala-Arg-Thr
d. Met-Ala-Arg
e. Met-Arg-Val
Suppose a solution has a glucose concentration of 70 mmol/L and a CaCl2 concentration of 10 mmol/L. What
should be the NaCl concentration of the solution so that a cell placed in it would neither shrink nor swell? The
cell has a cytoplasmic osmolarity of 290 mOsm/L. Note: glucose does not dissociate in the aqueous
environment and none of the ions are permeable to the cell membrane.

a. 95 mmol/L
b. 80 mmol/L
c. 105 mmol/L
d. 190 mmol/L
e. 210 mmol/L
The transporter that moves one Na+ into the cell against its concentration
gradient and moves one H+ out of the cell against its concentration gradient
can be classified as a:

a. secondary active symporter.

b. facilitated passive antiporter.
c. primary active antiporter
d. primary active symporter.
e. secondary active antiporter.
The graph below shows the relationship between the concentration of a
molecule (A) outside a red blood cell and its rate of entry (Vo) into the cell

a. active transport.
b. facilitated diffusion
c. counter transport.
d. secondary active transport.
e. simple diffusion.
The action of which second messenger(s) is terminated by phosphodiesterases?

a. cAMP and cGMP

b. AMP
c. IP3
d. DAG
e. Ca2+
The breakdown of fats in fat cells is stimulated when such cells are exposed to epinephrine, which increases cAMP
levels in the fat cells. Fat breakdown is also stimulated by exposing the cells to the compound dibutyryl-cAMP, a
cAMP analog that readily traverses the cell membrane. Exposing the cells to the prostaglandin known as PGE1 blocks
the fat-breakdown effect of epinephrine, but not that of dibutyryl-cAMP. Thus, the most likely action of PGE1 is to:

a. inhibit CREB phosphorylation.

b. inhibit protein kinase A.
c. inhibit cAMP phosphodiesterase.
d. stimulate protein kinase A.
e. inhibit adenylyl cyclase
At which labeled point on the action potential is the K+ closest to electrochemical
equilibrium?

a. 1
b. 2
c. 3
d. 4
e. 5
 The equilibrium potential of an ion is:

a. the membrane potential at which the concentration gradient balances the electrical gradient.
b. the same as the resting potential.
c. the force which moves an ion across a cell membrane.
d. always equal to the extracellular concentration of the ion.
e. the membrane potential at which the electrical gradient balances the concentration gradient
If [X2+]i = 300 mM, [X2+]o = 30 mM, [Y2-]i = 150 mM, [Y2-]o = 15 mM, [Z-]i = 50 mM, [Z-]o = 5
mM, what is this cell’s resting membrane potential provided this cell is only permeable to ion Z?
a. 60 mV
b. 30 mV
c. -30 mV
d. -60 mV
e. Cannot calculate
The effect of temporal summation of EPSPs on the membrane potential of a dendrite will
be enhanced if the:

a. membrane resistance of the dendrite is increased.

b. diameter of the dendrite is decreased.
c. length constant of the dendrite is decreased.
d. membrane time constant of the dendrite is increased.
e. Internal resistance of the dendrite is increased.
Stimulation of neuron A results in the release of a neurotransmitter which acts on a ligand-gated
channel on postsynaptic neuron B, resulting in increased entry of chloride ions into
neuron B. What effect will this have on neuron B?

a. It will take the neuron to the threshold level making an action potential more likely to occur
b. Neuron B will develop a positive membrane potential
c. It will be more difficult for an action potential to depolarize this neuron (hyperpolarization)
d. Neuron B will become rapidly depolarized
e. Neuron B will remain unchanged electrochemically
Which of the following best describes immunity that protects a
newborn baby from getting infected with polio virus?

a. Passive adaptive immunity

b. Active innate immunity
c. Active adaptive immunity
d. Passive innate immunity
e. Acquired innate immunity
 After exiting the primary lymphoid organs, which of the following best
describes the path T cells take before killing an infected cell?

a. Tissue → afferent lymphatic vessel → lymph node → efferent lymphatic vessel → circulation → tissue
b. Circulation → tissue → efferent lymphatic vessel → lymph node → high endothelial venule → afferent lymphatic vessel
c. Lymph node → high endothelial venule → circulation → afferent lymphatic vessel → tissue → thoracic duct
d. Circulation → high endothelial venule → lymph node → efferent lymphatic vessel → circulation → tissue
e. Tissue → circulation → high endothelial venule → efferent lymphatic vessel → lymph node → afferent lymphatic vessel
Which of the following would be least likely found in the
lymphatic vessels?
a. Red blood cells
b. Dendritic cells
c. Extracellular antigen
d. Activated T cells
e. Naïve B cells
Which of the following is correct regarding the portion labeled “A”
in the image below?

Determines the
Is composed of two Is the same on every antibody
isotype of the
unique proteins expressed by a particular B cell
antibody
a. YES YES YES
b. NO YES YES
c. YES YES NO
d. YES NO NO
e. NO NO NO

a. a
b. b
c. c
d. d
e. e
 Which of the following is correct regarding an individual’s total
B cell repertoire?

a. Only maternal or paternal alleles of the heavy chain gene can be found in the total repertoire
b. Each B cell will express both maternal and paternal alleles of the heavy chain gene
c. Most B cells will have more than a single specificity per cell
d. Both lambda and kappa light chains can be found in the total repertoire
e. Most of the B cells will recognize the same antigen
Which of the following occurs in the germinal centers of
secondary lymphoid tissue?

a. V-D-J recombination
b. Allelic exclusion
c. Differentiation of stem cells into T cells
d. B cell proliferation
e. Phagocytosis of antigen by dendritic cells
Which of the following determines the anatomical site of the
body a particular immunoglobulin will go to when it is
secreted?

a. Its idiotype
b. The Fab portion
c. The variable portion of the light chain
d. The constant portion of the heavy chain
e. The variable portion of the heavy chain
Which of the following is a characteristic of the stage in B cell development where most
auto-reactive B cells are eliminated?

a. Highest level of RAG expression

b. Expression of IgM on the surface
c. Expression on mu chain alone on the surface
d. Expression of both IgM and IgD on the surface
e. Secretion of pentameric IgM
During B cell development, when one light chain gene rearranges to produce a functional
protein product, the cellular machinery that is involved in the recombination of the
immunoglobulin genes is shut off. The consequence of this is that only one specificity
immunoglobulin is produced. The process that ensures this is called:

a. Allelic exclusion
b. Somatic recombination
c. Somatic hypermutation
d. Affinity maturation
e. Isotype switching
 Which of the following best describes peptides that bind to MHC I?

a. Only self-peptides obtained from proteins processed by the proteosome

b. Only foreign peptides obtained from the phagolysosome as a result of low pH
c. Self and foreign peptides obtained from proteins processed by the proteosome
d. Only foreign peptides obtained from proteins processed by the proteosome
e. Self and foreign peptides obtained from the phagolysosome as a result of low pH
 A 79-year-old male is brought to the emergency department because of he experienced a seizure 1 hour ago. His wife
says that for the past month he has been experiencing mild headache, difficulty with balance, memory loss and
personality change. His vitals are within the normal limits. His Glasgow Coma Scale is 10. Below is the CT of his brain.

Which of the following statements is the most accurate regarding this patient’s current condition?

a. This patient’s balance loss is to accumulation of blood between the cranial bone and periosteal bone.
b. This patient’s personality changes are due to increased intracranial pressure due to accumulation of blood between the dura and arachnoid space.
c. This patient’s seizure could be the result of obstructing hydrocephalus
d. This patient’s seizure could be the result of nonobstructing hydrocephalus
e. This patient’s headaches are due to subarachnoid hemorrhage
A 60-year-old female is brought to the Emergency department after suffering a car accident. She is conscious
but in severe pain. She is oriented and her vitals are within the normal limits. After further investigation, it is
determined that her styloid process is damaged and she having otorrhea. Which of the following statements is
the most accurate regarding this patient’s condition?

a. This condition could be a result of fracture of her ethmoid bone

b. A fracture of her frontal bone
c. A fracture of her temporal bone
d. A fracture of her sphenoid bone
e. A fracture of her zygomatic bone
Superior sagittal sinus contains which of the following structures for the
absorption of CSF?

a. Arachnoid villi
b. Choroid plexus
c. Aqueduct of Sylvius
d. Lateral apertures
e. Medial aperture
A 21-year-old college student visits your office due to fever, headache, vomiting and neck stiffness for the past 2
days. She lives in the college and regularly swims at the college swimming pool. A few of her dorm mates also
experienced fever about a week ago. Her vitals are within the normal limits except elevated temperature (101.8
F). Her physical exam is positive for nuchal rigidity and photophobia. You ask your MERP student to perform a
lumbar puncture (LP). Which of the following locations on the spinal cord is the best place to perform the LP?

a. Above T12 and L1

b. Below L1 and L2
c. Between C2 and C3
d. At the level of medullary cone
e. Between L3 and L4
 A 75-year-old male is brought to the emergency department after having an episode of weakness in upper
arm and loss of speech for the past 2 hours. Patient has a history of hypertension, diabetes, myocardial
infarction and atrial fibrillation. Patient’s vitals are within the normal limit except his blood pressure which
is 142/89. A CT of the brain without the contrast is taken on day 1 is shown below.

Neurologic exam reveals increased reflexes and muscle weakness on right side. You perform a stroke with a
reflex hammer on planter surface of his right foot and you observe fanning of his toes. Which of the
following statements would be most accurate regarding the patient?
a. Patient could have decreased muscle tone
b. This patient could develop insignificant atrophy of his muscles in 1 year
c. This patient’s knee Jerk reflex would be decreased
d. Over the next year, this patient would develop significant twitching in lower limbs
e. Spasticity could be decreased in this patient
 The following image was taken from which of the following patients?

a. A 55-year-old women infected with untreated syphilis 20 years ago suffering from loss of touch and proprioception
b. A 8-year-old boy with polio suffering from loss of lower motor function
c. A 30-year-old male with history of Myasthenia Gravis suffering from weakness in lower limbs
d. A 17-year-old girl with Gullian-Barre Syndrome suffering from respiratory depression
e. A 22-year-old male with a normal spinal cord
Damage to the cerebellum would result in which of the following losses?

a. Loss of ipsilateral vibration sensation

b. Loss of contralateral pain and temperature sensation
c. Loss of ipsilateral spatial location sensation
d. Loss of contralateral vibration sensation
e. Loss of ipsilateral pain and temperature sensation
f. Loss of contralateral spatial location sensation
 Which of the following statements is the most accurate regarding the
corticospinal tract?

a. The body of the UMN is located in the medulla oblongata

b. Most the UMN decussate before they reach the spinal cord generally in the medulla oblongata
c. Damage to the UMN will most likely result in loss of motor function on the ipsilateral side
d. Damage to the LMN will most likely result in loss of motor function on the contralateral side
e. Body of the LMN is located in the dorsal horn of the spinal cord
A 24-year-old male MERP student is brought to the ER after being hit on the head by histology text book by another
MERP student after he was caught trying to steal her lunch. During the physical examination, the ER physician asks the
student to close his eyes and identify the object (coffee beans) by smell. After a few seconds, the student mentions
that she is not able to smell anything. Which of the following statements is the most accurate regarding this student’s
current condition?

a. After the incidence, the MERP student suddenly started to take keen
interest in histology and won a Nobel prize in the year 2050
b. The student suffered a damage to his Brodmann’s area 43
c. The student suffered a damage to his Brodmann’s area 17
d. The patient suffered a damage to his Brodmann’s area 42
e. The patient suffered a damage to his occipital lobe
A 24-year-old female, Ms. PREM is brought to the emergency department after being involved in an automobile accident.
She failed to yield to the incoming traffic from her left side at an interaction. On physical exam, she appears to be in a
state of shock but stable and she as bruises around her neck and shoulder. Patient mentions that she has been taking
Tylenol for the past 6 months to relieve her frequent headaches. Based on the MRI shown below, the patient would most
likely experiencing which of the following symptoms?

a. Loss of right and left vision

b. Loss of left vision
c. Loss of right vision
d. Loss of medial vision
e. Loss of lateral vision
While exploring the marshes of Lucayan National Park, you discover a new species of
fruit. To characterize this new fruit, you liquefy it and isolate a new protein—protein X. You
place protein X in a buffer solution and measure its properties using a spectrophotometer. You
measure a concentration of 5 moles/liter with an absorbance reading of 0.4. Based on this first
measurement, what absorbance reading would yield a concentration of 12 moles/liter? Assume
that the same cuvette is used for both readings.

a. 150
b. 0.88
c. 0.96
d. 9.6
e. 0.5
A new drug has a pKa of 5.4. What is the ratio of A¯ to HA in the blood (pH = 7.4) and
the stomach (pH = 1.4)?

a. 1,000; 0.001
b. 0.01; 10,000
c. 100; 0.0001
d. 4; -2
e. 10; 0.1
 Which of the following statements is the most accurate about an
amino acid whose pKa1 = 3.5 & pKa2 = 9.0; in a solution with pH=7?

a. The carboxyl groups will be mostly protonated while the amino groups will be mostly
protonated
b. Half carboxyl group will be deprotonated and half amino group will be protonated
c. The carboxyl groups will be mostly deprotonated while the amino groups will be mostly
deprotonated
d. The carboxyl groups will be mostly deprotonated while the amino groups will be mostly
protonated
e. The amino groups will be mostly deprotonated while the carboxyl groups will be mostly
protonated
Which of the following curves on Linewaver-Burk plot have the lowest “Vmax”
(enzyme reaction rate)?

a. “a”
b. “b”
c. “c”
d. “d”
Which of the following statements is most accurate about uncompetitive inhibitor?

a. It inhibits a reaction by preventing substrate from behind to enzyme

b. It inhibits a reaction by either prevent enzyme from binding to substrate or by
locking the enzyme-substrate complex and preventing formation of product
c. It locks the enzyme-substrate complex and prevent formation of product
d. It competes for the substrate binding site
As an aspiring pharmacologist, you have successfully designed the first reversible inhibitor that can inhibit
hepatitis B using two different mechanisms—“mechanism 1” involves the inhibitor binding to a distinct
pocket in the viral polymerase that is formed AFTER substrate binding and locks the enzyme in place;
“mechanism 2” involves the inhibitor binding to a separate allosteric site, in the absence or presence of
substrate, and preventing product formation. What kinetic parameter(s) would this new drug affect?

a. Km increases, Vmax decrease

b. Km is unaffected, Vmax decreases
c. Km increases, Vmax increases
d. Km decreases, Vmax decreases
e. Km increases, Vmax is unaffected
Which class of enzymes would be responsible for the reaction shown below?

a. Isomerases
b. Transferases
c. Lyases
d. Hydrolases
e. Ligases
A genetic mutation in the cell results in the loss of chromatin packaging, specifically the
characteristic “beads on a string” unravel, yet nucleosome cores remain intact. What protein is
most likely affected by this mutation?

a. Histone H4
b. Histone H3
c. Histone acetyltransferase
d. Histone H1
e. Chromatin filament
Histone deacetylase INHIBITORS are being considered as a treatment option for latent
HIV-1 infection. What would be the primary effect of this potential treatment?

a. Histone proteins contain less acetyl groups and close the chromatin for transcription
b. Histone proteins contain more acetyl groups and close the chromatin for transcription
c. Histone proteins contain more acetyl groups and open the chromatin for transcription
d. Histone proteins contain less acetyl groups and open the chromatin for transcription
e. Histone proteins contain less acetyl groups and chromatin would condense to
chromosome
The BRCA1 gene (BRCA1 = breast cancer susceptibility gene 1) is a tumor suppressor
gene; when mutated, this gene has been linked to hereditary breast cancer. BRCA1 has been
genetically mapped and assigned the following position: 17q21. At which chromosomal
location can this gene be found?

a. Region 1, band 7 on the long arm of chromosome 21

b. Region 1, band 7 on the short arm of chromosome 21
c. Region 2, sub-band 1 on the short arm of chromosome 17
d. Region 1, band 2 on the long arm of chromosome 17
e. Region 2, band 1 on the long arm of chromosome 17
 An EPSP is:

a. caused by an increase in permeability of the postsynaptic membrane to small molecules.

b. hyperpolarizing.
c. sufficient by itself to generate an action potential.
d. all or none in character.
e. a type of graded potential induced by more than one neuron.
At the peak of the action potential, the membrane
potential is:

a. the same as the resting membrane potential.

b. exactly at 0 mV.
c. exactly at the sodium ion equilibrium potential.
d. exactly the same as the resting membrane potential.
e. close to but less positive than the sodium ion equilibrium potential.
Why does hypokalemia reduce the possibility of an action
potential from occurring?

a. It decreases the membrane potential

b. It results in closure of the potassium channels
c. It prevents the sodium channels from resetting
d. It causes hyperpolarization of the membrane
e. It causes the chloride ions to enter the cell making it more negative
 Why does myelin increase conduction velocity?

a. It increases the length constant, increases Rm and decreases membrane capacitance (Cm)
b. It decreases the length constant, increases Rm and decreases membrane capacitance (Cm)
c. It decreases Rm and thus charges jump from node to node
d. It increases the length constant, increases Rm and increases membrane capacitance (Cm)
e. It increases Ri and thus charges jump from node to node
What effect would tetrodotoxin have on the electrical activity of
an excitable cell?

a. Repolarization rate will increase

b. Slow membrane depolarization to zero
c. Decrease in action potential amplitude
d. Sodium-potassium pump will be inhibited
e. Increase action potential amplitude
A 16-year-old, highly allergic girl who is stung by a bee gives herself an injection of
epinephrine using a syringe and needle prescribed by her physician. Because epinephrine
activates beta-receptors, it will relieve the distressing effects of the bee sting by decreasing:

a. the strength of her ventricular muscle contraction.

b. her heart rate.
c. contraction of her bronchiolar smooth muscle.
d. her salivary secretion.
e. the relaxation of her detrusor muscle.
The effect of sympathetic stimulation on the urinary bladder is to _____ the detrusor
muscle and _________ the _______ sphincter.

a. contract, relax, external

b. contract, contract, internal
c. relax, contract, external
d. contract, contract, external
e. relax, contract, internal
A 55-year-old man develops an impaired ability to view items that are close and to
accommodate to bright light after taking a plant extract containing atropine. The most likely
cause is a blockade of which of the following receptors?

a. α1-adrenergic
b. β2-adrenergic
c. Muscarinic 3
d. Nicotinic 1
e. Muscarinic 2
A 25-year-old man is running away from a bear. Which of the following symptoms is he likely to
exhibit?

a. Excessive salivation, diarrhea, tachycardia, bronchoconstriction

b. Urinary retention, constipation, excessive sweating
c. Dry mouth, bradycardia, constipation, bronchodilation
d. Excessive salivation, diarrhea, bradycardia, bronchoconstriction
e. Miosis, urination, dry mouth, bronchodilation
A 58-year-old woman being treated for hypertension is given a drug which causes
peripheral vasodilation by blocking an adrenoceptor. What is the most likely receptor being
blocked?
a. Alpha 1
b. Beta 1
c. Beta 2
d. M2
e. Alpha 2
Refer to the table below. Which line in the table below
correctly designates the properties
of a T cell receptor (TCR)?

Composed of two unique Recognizes the polymorphic

Binds antigen
proteins region of MHC
a. YES YES YES
b. YES YES NO
c. NO NO YES
d. NO YES YES
e. NO NO NO

a. a
b. b
c. c
d. d
e. e
Which of the following best describes the main purpose of
positive selection?

a. Ensuring the survival of T cells that recognize foreign peptides

b. Ensuring the survival of T cells that recognize self-peptides
c. Destroying T cells that are self-reactive
d. Destroying T cells that recognize self-MHC
e. Ensuring the survival of T cells that recognize self-MHC
The purpose of negative selection can best be summarized as: “Negative selection of T
cells ensures:

a. the survival of T cells which cannot recognize self-MHC.”

b. the death of T cells that express both CD4 and CD8 simultaneously.”
c. the death of T cells that have strong affinity for self-MHC with self-peptide.”
d. the survival of T cells that recognize foreign MHC.”
e. the survival of T cells that have weak affinity for self-MHC and peptide.”
An individual who has hyper-IgM syndrome due to a mutation in the
CD40L gene would likely:

a. have no immunoglobulins in the blood.

b. have only low affinity antibodies.
c. have a low amount of IgM and an elevated amount of IgG.
d. be unable to activate T cells.
e. have no immature B cells in the bone marrow.
A patient has been diagnosed with a genetic defect that specifically prevents him from
mounting an efficient Th1 response, without affecting other immune responses. Which of the
following are you also most likely to find in this patient?

a. Elevated levels of viral infection

b. Higher chances of having unresolved tuberculosis
c. A lack of CD4 T cells in the bloodstream
d. A severe reduction in the ability to produce CD8 T cells
e. A severe reduction in mature naive B cells
Regarding Th-1 and Th-2 cells, which one of the following is most accurate?

a. Th-2 cells produce interleukin-4 and -21 and promote antibody-mediated immunity
b. Th-1 cells produce IL-10 and promote cell-mediated immunity
c. Th-2 cells work best against intravesicular pathogens
d. Before T cells differentiate into Th-1 or Th-2 cells, these mature naive T cells express
both CD4 and CD8
e. Th-2 cells have a T cell receptor composed of 2 chains, whereas Th-1 cells have a T
cell receptor composed of 1 chain
 Which one of the steps below is usually required for a B cell to become activated and
secrete antibodies specific for a pathogen it has recognized?

a. The expression of B7 on the B cell

b. The presentation of a peptide derived from the pathogen on the MHC II of the B cell
c. The presentation of a peptide derived from the pathogen to an effector CD8 T cell
d. The presentation of a peptide derived from a pathogen on MHC I of a professional APC
e. The encounter of the pathogen by a B cell in the bone marrow followed by the
migration of the B cell to the lymph node
Which of the following mechanisms plays the most important
role in the effector/activation phase of Type II hypersensitivity?

a. IgE binding to mast cells follow by degranulation

b. Antibody-mediated complement activation
c. Activation of CD8 T cells
d. Activation of CD4 T cells
e. Attraction of eosinophils to the site of allergy
Which of the following complement components is common to
both the alternative and classical complement cascade and also
directly participates in pore formation?

a. C2
b. C9
c. C4b
d. C3
e. C5a
What is determined by the PPD test?

a. Presence of tuberculin purified protein derivative

b. Presence of tuberculin intravesicular bacteria
c. Presence of the anti-tuberculin interferon gamma
d. Presence of Th1 cells specific to tuberculosis-causing bacteria
e. Presence of antibodies specific to tuberculosis-causing bacteria
A 17-year-old male is brought to the emergency department after an attempted suicide from the roof of Seahorse plaza.
Patient is non-responsive and hemodynamically unstable. His skull suffered fractures. Below are the images of patient’s
skull. Which of the following symptoms will most likely be observed in this patient if the foramen immediately posterior
and inferior to the fissure that allows CN VI to cross the skull was damaged?

a. Significant atrophy of the zygomatic major and zygomatic minor muscles

b. Loss of pain sensation at the tip of the nose
c. Loss of ability to elevate the upper lips
d. Loss of pain sensation at the philtrum
e. Loss of touch sensation under the lower jaw
f. Loss of pain sensation at the nasal bridge
A 9-year-old boy was brought to the emergency department because of acute speech difficulties. 5 days ago,
he developed a low-grade fever, sore throat, and malaise. Last night, he was observed with difficulties in
articulation of speech and tongue movements. Below is the picture of his tongue when he is asked to protrudes
it. Damage to which of the following nerves would most likely be observed?

a. Left glossopharyngeal nerve

b. Right glossopharyngeal nerve
c. Left hypoglossal nerve
d. Right hypoglossal nerve
e. Right vagus nerve
A 58-year-old female, Ms. Barracuda was rushed to emergency department after she was
involved in an automobile accident. Upon further examination, it was discovered that her
left internal auditory meatus was damaged. Which of the symptoms will most likely be
observed in this patient?

a. Loss of taste in the anterior one-third of right tongue is

b. Loss of taste in the posterior two-third of left tongue
c. Loss of taste in the posterior one-third of right tongue
d. Loss of taste in the anterior two-third of left tongue
e. Loss of taste in the middle one-third of right tongue
What is the most likely function of the muscle indicated by red dot?

a. Retraction of the angle month

b. Depression of the angle of month
c. Elevation of the angle of the month
d. Presses checks
e. Closes lip
If the nerve indicated below by the forceps is damaged, which of the following symptoms would be most likely
observed?

a. Hoarseness due to paralysis of right vocal folds

b. Hoarseness due to paralysis of left vocal folds
c. Tachycardia
d. Loss of taste sensation in left half of tongue
e. Loss of right-sided gag reflex
Below is an MRI of the heart of a 28-year-old male patient. Based on the MRI,
which of the following is the most likely diagnosis?

a. Ventricular septal defect

b. Atrial septal defect
c. Normal Heart
d. Connection between left and right ventricles
e. Connection between your left atrium and right ventricle
Which of the followings is the most correct pathway of cardiac-impulse flow?
a. SA node  Bundle of His  AV node Right and left bundles  Purnkinje
fibers
b. SA node  AV node  Purnkinje fibers  Bundle of His  Right and left
bundles
c. SA node  AV node  Bundle of His  Right and left bundles  Purnkinje
fibers
d. SA node  AV node  Bundle of His  Purnkinje fibers  Right and left
bundles
e. SA node  AV node  Purnkinje fibers  Bundle of His  Right and left
bundles
A CT scan (shown below) of a 48-year-old female smoker was taken after bilateral pleural effusion was
suspected. She has a 3 month history of progressive dyspnea. Which of the following statements is the most
accurate regarding the structure indicated by green arrow?

a. It connects IVC and SVC

b. It drains lymphatic fluid from right side of the body
c. It receives blood from both IVC and SVC
d. It supplies blood to the right side of the heart
e. It collect blood from head, neck and shoulders
Which of the following muscles help with inhalation?
a. Innermost intercostal muscles
b. Internal intercostal muscles
c. External intercostal muscles
d. Masseter
e. Platysma
Manubriosternal joint is located at which level?
a. Between T3 and T4
b. Between T4 and T5
c. Between T5 and T6
d. Between T6 and T7
e. T9
In the graph below, what point represents the highest transition state
intermediate in the presence of enzyme? In the absence of enzyme?

a. C; B
b. D; C
c. A; C
d. D; B
e. B; C
 For successful cloning of the human gene “A” in E. coli cells, a bacterial promoter sequence has
to be attached to the fragment of human DNA containing gene A. Which of the following
conditions will best promote highest production of the required recombinant DNA?

a. If both DNA fragments (bacterial and human origin) are cleaved using the different restriction endonucleases (RE)
b. If both DNA fragments (bacterial and human origin) are flanked by 5’ or 3’ overhangs
c. If DNA fragments of both origins have blunt ends
d. If DNA fragments of both origin have poly AAA tails
e. If the cohesive ends of the 2 DNA fragments produced by same RE are joined by ligase
Which vitamin would not be made if someone was on a very
low protein diet?

a. Thiamine
b. Niacin
c. Biotin
d. Cobalamin
e. Pyridoxine
Which of the following organs or tissues is not associated with
vitamin D synthesis or function?

a. Skin
b. Pancreas
c. Intestines
d. Kidney
e. Bone
Overconsumption of antacids would affect which of the following reactions or
processes most?

a. Carboxylation
b. Redox
c. DNA synthesis
d. Hydroxylation of collagen
e. Bone remodeling
In treating a new disease, you administer a drug that DEPLETES ALL guanine-based
nucleotides in cells. Unfortunately, this drug also promotes mutations within the DNA,
indicated by arrows in the sequence below (single arrow = transition mutation; double arrow =
transversion mutation). In this treated individual, what would be the complementary sequence
of the daughter strand derived from the newly-mutated segment of DNA?

A. 5’-ACCGATCCG -3’
B. 5’-GCCTGTACT -3’
C. 5’-CCCACTTCA-3’
D. 5’-ACTTTACCT-3’
E. 5’-TCCATTTCA-3’
Please use the disease pedigree to identify the disease most likely
manifested in this family.

A. Sickle cell disease

B. Huntington’s disease
C. Fragile X syndrome
D. Turner syndrome
E. Chronic granulomatous disease
A segment of DNA has undergone a number of transition
mutations, indicated by arrows
and accompanying Roman numerals in the sequence
below. Using the given codon table,
please identify the types of base-pair substitutions that
occur in the amino acid sequence
derived from this newly-mutated DNA (assume the given
DNA strand is the non-coding
strand).

A. I = silent mutation; II = silent mutation; III = missense

mutation
B. I = silent mutation; II = nonsense mutation; III =
missense mutation
C. I = missense mutation; II = missense mutation; III =
silent mutation
D. I = missense mutation; II = missense mutation; III =
nonsense mutation
E. I = silent mutation; II = silent mutation; III = nonsense
mutation
What is the underlying cause of Fragile X syndrome?

A. One of the short arms of the X chromosome is deleted

B. One of the long arms of the X chromosome is deleted

C. It is a tri-nucleotide repeat (CGG) disease leading to repression of the FMR1 gene

D. It is a tri-nucleotide repeat (CGG) disease leading to overexpression of the FMR1 gene

E. It is a tri-nucleotide repeat (CAG) disease causing constriction of the X chromosome

What genetic defect or chromosomal abnormalities are indicated
by the following human
karyotype?

A. Double aneuploidy (two distinct genetic defects)

B. Monosomy
C. Trisomy
D. Triploidy
E. Robertsonian translocation
During the process of relaxation in skeletal and cardiac muscle, the most important cellular
event is:

a. a reduction in the amount of free intracellular calcium ions.

b. the consumption of all available fuels.
c. a nerve signal that begins the relaxation process.
d. the entry of chloride ions into the muscle fiber.
e. the entry of sodium ions into the muscle fiber.
When comparing IPSPs, EPSPs and MEPPs, which of the following characteristics is true
for all three?
a. Blocked by muscarinic receptor antagonists
b. Blocked by N1 receptor antagonists
c. Result from opening of ion-channels
d. Occur in ganglia
e. Produce an action potential in the effector cell
 In the absence of an adequate supply of ATP for skeletal muscle
contraction:

a. myofilament interaction ceases, and the muscle relaxes.

b. actin and myosin filaments cannot separate, and the muscle stiffens.
c. the muscle becomes paralyzed.
d. cyclic AMP becomes the main source of energy.
e. the lower energy form, ADP, can support contraction at a reduced rate.
In skeletal muscle, but not in cardiac muscle, the release of calcium from the sarcoplasmic
reticulum involves:

a. calcium-induced calcium release.

b. mechanical coupling between dihydropyridine and ryanodine receptors.
c. depolarization of the sarcoplasmic reticulum.
d. direct influx of extracellular calcium through ryanodine receptors.
e. primary active transport of calcium out of the sarcoplasmic reticulum.
 Why are atropine and neostigmine used to reverse the skeletal muscle paralysis induced by
curare?

a. Neostigmine inhibits AchE; atropine prevents the effects of AchE inhibition on beta receptors
b. Both drugs directly compete with curare on the nicotinic receptors
c. Both drugs chemically degrade curare
d. Neostigmine inhibits AchE; atropine prevents the effects of AchE inhibition on muscarinic receptors
e. Neostigmine inhibits monoamine oxidase; atropine prevents the effects of AchE inhibition on
muscarinic receptors
On the graph showing left ventricular volume and pressure,
isovolumetric relaxation occurs from point:

a. 41
b. 12
c. 23
d. 34
The aortic valve closes at point:

a. 1
b. 2
c. 3
d. 4
Which phase of the ventricular action potential coincides with
diastole?

a. Phase 0
b. Phase 1
c. Phase 2
d. Phase 3
e. Phase 4
Seven periods during a normal cardiac cycle are delineated in the graph
below. During which period is ventricular filling the most rapid?

A. 1
B. 2
C. 3
D. 4
E. 5
This figure depicts a series of pressure-volume loops obtained over time on a
normal individual. They begin with loop A and, because of an intervention, shift
over several cardiac cycles to a new steady state represented by loop B. An
INCREASE in which of the following parameters would produce the observed
shift in the loop?

A. Total peripheral resistance

B. Ventricular contracility
C. Venous return
D. Ventricular afterload
E. Ventricular preload
Which of the following is not a direct function of an antibody?

a. To kill virally-infected cells

b. To attract and bind complement
c. To neutralize bacterial toxins
d. To facilitate phagocytosis of antigen
e. To cross tissue barriers
Which of the following is correct about the immune response generated against a conjugated hapten-
carrier molecule?

a. A B cell’s MHC II must always present the exact same epitope recognized by this B cell’s antibody
b. The B cell and Th2 cell involved in the response must recognize the exact same epitope of the
molecule
c. The hapten epitope can only be recognized by the specific Th2 cell while the carrier protein
epitopes can be recognized by both specific B cells and Th2 cells
d. A B cell whose antibodies are specific for one epitope from this molecule, will be able to present a
different epitope from this molecule on MHC II
e. After generation of the immune response to this molecule, antibodies against the carrier protein
but not the hapten will be found
What could the offspring's blood type potentially be if the
mother is type O, Rh+ and the father is type A, Rh-?

a. A+, A-, O+, or O-

b. A+ or O+
c. A+ or O-
d. Only A+
e. A+ or A-
Which of the following hypersensitivity/hypersensitivities
has/have a complement-mediated effector phase and
attacks/attack a soluble, non-cell-associated antigen?

a. Type I
b. Type II
c. Type III
d. Type I and IV
e. Type II and III
The purpose of a desensitizing allergy shot is to:

a. Sensitize the patient to the allergen

b. Block the production of IL-2 and IL-4
c. Block the Fc epsilon receptors on the mast cells
d. Redirect isotype switching to IgG
e. Allow somatic hypermutation to take place, so the antibody
will not bind to the allergen
All of the following describe killed vaccines except:

a. very stable under different environmental conditions

b. may be composed of dead virus or viral particles
c. may be used to protect against either vial or bacterial
infections
d. less commonly used as viral vaccines of choice
e. more potent than live vaccine because they mimic infection
Linear, single-stranded DNA is the genetic
material of

A. Caliciviruses
B. Flaviviruses
C. Papillomaviruses
D. Parvoviruses
Non-enveloped viruses are usually released from the host
cell by ______.
a. Budding
b. Lysis
c. Exocytosis
You are participating in a rural health clinic in the mountains of Dominica
and a patient comes in with widespread vesicular skin lesions. You think it
looks like smallpox, but you know this disease was supposedly eradicated
worldwide. Unfortunately, light microscopy is the only tool you have to
quickly confirm or refute this diagnosis. What will you see that will confirm
this as smallpox?

a. Negri bodies in the epithelial cytoplasm

b. Negri bodies in the epithelial nuclei
c. Cowdry bodies in epithelial cytoplasm
d. Cowdry bodies in the epithelial nuclei
e. Guarnieri bodies in the epithelial nuclei
f. Guarnieri bodies in the epithelial cytoplasm
Which of the following viruses causes an acute febrile rash and
produces disease in immunocompetent children but has been
associated with transient aplastic crises in persons with sickle
cell disease?

a. Pox
b. Varicella-zoster
c. Parvovirus
d. Rubella
e. Herpes simplex
A 58-year-old male patient is rushed to the emergency department after an
episode of acute retrosternal chest pain which is radiating to his neck. He is
immediately taken for cardiac catheterization and a blockage is observed in the
circumflex. This blockage will most likely result in ischemia in which of the
following regions of the heart?
a. Anteriorly on the left ventricle
b. Posteriorly on the left ventricle
c. Anterior interventricular septum
d. Posterior interventricular septum
e. Anteriorly on the right ventricle
The autopsy picture presented below was most likely taken from the
_________________.

a. arteriole
b. conducting artery
c. distributing artery
d. large vein
e. spinal cord
A woman walks into the emergency room (ER) of a local hospital with her 9-year-old
son. She states her son fell out of a tree. The child’s chief complaints are difficulty in
breathing and intense sharp pain in his chest. The doctor in the emergency room
orders immediate X-rays. What is the doctor’s diagnosis shown by the arrows in the
image below?

a. Anterior rib fractures

b. Lateral rib fractures
c. Posterior rib fractures
d. Flail chest
e. Broken vertebrae
Which of the following is found in the posterior mediastinum?

a. Azygous Vein
b. Esophagus
c. Vagus nerve
d. Phrenic nerve
e. Manubrium
During your pediatrics rotation, your attending physician asks you to examine a 1-day-old neonate.
While you were examining the back, you notice a tuft of hair over his spine and recalled that it is
probably due to the outer part of vertebrae not being completely closed. You tell the newborn’s
mother your most likely diagnosis and further that people with this diagnosis most likely will have
which following symptom in the future?

a. Unable to abduct lower limbs

b. Unable to adduct lower limbs
c. Complete loss of sensation
d. Slight loss of sensation
e. Unable to control the heart rate
Which letter presents the left superior pulmonary vein in this view?

a. o
b. e
c. m
d. k
e. l
Which of the following structures are passing through the opening labeled by the
arrow in the image below?

a. Vagus nerves
b. Thoracic duct
c. Inferior vena cava
d. Phrenic nerves
e. Azygos vein
Identify the structures labeled 1 and 3 in the image below.

a. 1 – elastic arteries; 3 – adipose tissue

b. 1 – respiratory bronchiole; 3 – type two alveolar cells
c. 1 – inferior vena cava; 3 – adipose tissue
d. 1 – bronchi; 3 – alveoli
e. 1 – primary bronchi; 3 – secondary bronchi
A 59-year-old male was brought to the ER with acute chest pain and difficulty breathing. The CT that was
taken in the ER is presented below. In spite of the measures taken in the hospital, the patient passed away
two hours later. Please identify the pathology shown in the CT scan.

a. Left lung pneumothorax

b. Pulmonary embolism in right and left pulmonary arteries
c. Cardiac tamponade
d. Pleural effusion
e. Myocardial infarction
A 3-year-old girl was jumping on a trampoline when she suddenly experienced a cough attack. Her mother told her not to
eat while jumping and took the bag of baby carrots away from her. The girl got upset and was misbehaving during her
lunch. After lunch she had a nap and woke up even crankier. She soon developed tachypnea, sweating, weakness and was
brought to the ER in acute respiratory distress. During physical examination, percussion revealed tympanic sounds on the
right side. Auscultation revealed normal sounds on the left side but almost no sound on the right. It appears that a very
weak wheezing sound was heard on the right side during inspiration. Her chest X-ray is presented below. Which of the
following was most likely revealed by bronchoscopy?

a. Pleurisy of the right lung

b. Foreign body obstruction in right main bronchi
c. Tuberculosis in the left lung
d. Asthma in both lungs
e. Left side tension pneumothorax
The following pedigree represents the inheritance pattern of a specific genetic trait in humans. Assume the trait is common in the population.

This disorder could be inherited in which of the following ways?

A. Either as an Autosomal recessive trait or an X-linked recessive trait
B. As an X-linked recessive trait
C. As both an Autosomal dominant trait and an X-linked dominant trait
D. As an Autosomal dominant trait
E. As an X-linked dominant trait
F. As an Autosomal recessive trait
A 35-year-old male is brought to a physician by his wife for development of chorea,
cognitive decline and depression for the past year. Patient’s uncle died after developing
similar conditions at age 50. His 38-year-old sister also suffers from similar symptoms.
Which of the following statements is the most accurate regarding this patient’s condition?

a. Increased CGG repeats

b. Replacement of Glutamic acid with Valine
c. An extra X-chromosome
d. Increased CAG repeats
e. Missing X-chromosome
A 4-year-old male, George is brought to a physician for evaluation of possible behavioral
and development deficiencies. Patient has increased CGG repeat on X-chromosome.
Which of the following additional finding could most likely be observed in this patient?

a. Chorea
b. Anemia due to shorter lifespan of RBCs
c. 100 CGG
d. 4000 CAG
e. Larger than normal testicles after puberty
A-35-year-old female G1P0 visits her obstetrician for prenatal visit. She is
currently at 16 weeks of gestation. Her physical exam is within the normal limit.
An amniocentesis is performed which reveals an additional chromosome 21.
Which of the following statements is the most accurate regarding her child?

a. Her child will have normal cognitive abilities only if its gender is female
b. Her child is at increased risk of developing congenital heart disease
c. Her child could have streak gonads
d. Her child is at increase risk of developing chronic myelogenous leukemia
e. Her child could have decreased respiratory burst
Which of the followings in the most likely cause of NADPH oxidase deficiency?

a. Splice-sense mutation
b. Nonsense mutation
c. Missense mutation
d. Silent mutation
e. Splice-site mutation
A 45-year-old female is brought to the ER because she complained of severe chest
pain. She just returned from an 12-hour transatlantic flight on Spirit Air. Her ECG
and troponin levels are within normal limit. Upon further testing, she is suspected
of having a pulmonary embolism. Which of the following substances would be
most helpful in relieving her symptoms?
a. Chondroitin 4
b. Keratin sulfate
c. Heparin
d. Dermatan sulfate
e. Hyaluronic acid
Which of the following GAGs are the most abundant in our body?
a. Chondroitin
b. Keratin sulfate
c. Heparin
d. Dermatan sulfate
e. Hyaluronic acid
Why could alcohol consumption cause hypoglycemia?
a. It increases the NADH+H+ /NAD+ ratio making less pyruvate
available for glycogenesis
b. It increases the NADH+H+ /NAD+ ratio making less pyruvate
available for glycogenolysis
c. It increases the NADH+H+ /NAD+ ratio making less pyruvate
available for gluconeogensis
d. It decreases the NADH+H+ /NAD+ ratio making less pyruvate
available for gluconeogenesis
e. It increases the NADH+H+ /NAD+ ratio making less citrate
available for gluconeogenesis
Which of the following statements is the most accurate regarding
reducing sugars?
a. Anomeric OH is not free and it is part of a glycosidic bond
b. Anomeric OH is free and not involved in a glycosidic bond
c. Anomeric OH is not free and not involved in a glycosidic bond
d. Anomeric OH is free and it is part of a glycosidic bond
e. Sucrose is an example of reducing sugar
Which of the following effects will be most likely observed if glucagon is
increased in the blood?
a. Increased activation of PFK-2 leading to decrease blood glucose
b. Increased activation of Fructose Bisphophatase leading to
increase pyruvate
c. Increased activation of Fructose Bisphophatase leading to
increase blood glucose
d. Increased activation of Fructose Bisphophatase leading to
decrease blood glucose
e. Increased activation of PFK-2 leading to increase blood glucose
The figure below displays the same series of pressure-volume loops as in the
previous question. As a consequence of the shift in the pressure-volume loops,
which of the following parameters has INCREASED?

A. Duration of diastole
B. End diastolic volume
C. Ejection fraction
D. End systolic volume
E. Left atrial pressure
Seven periods during a normal cardiac cycle are delineated in the graph
below. Which periods correspond to ventricular systole?

A. 4, 5, & 6
B. 3 & 4
C. 4 & 5
D. 5 & 6
E. 4, 5, 6 & 7
The figure below is a stylized representation of a ventricular muscle action
potential. Which of the numbered arrows most closely corresponds to the
QRS complex in an ECG trace?

A. 3
B. 5
C. 4
D. 2
E. 1
If you were recording an ECG simultaneously with the left
ventricular pressure-volume loop shown below, the P-wave would
occur:

A. immediately before Point P.

B. immediately after Point M.
C. immediately before Point O.
D. late during Phase III.
E. early during Phase I.
Curve B in the figure represents:

a. Left atrial pressure

b. Ventricular pressure
c. Atrial pressure
d. Ventricular volume
A 50 year old male visited his physician when he developed a
headache. The blood pressure recorded in the patient was 180/100 mm
Hg and the pulse rate was 60 per minute. The physician told the
patient that he is suffering from high blood pressure. Select the TRUE
statement:

a. The baroreceptors were inhibited in this patient

b. The sympathetic nerves to the heart were stimulated in this patient
c. The afterload on the left ventricle was low in the patient
d. The reduction in heart rate was due to reflex stimulation of the
Vagus nerves to the SA node
When a person moves from a supine position to a standing position, which
of the following compensatory changes occurs?

a. Decreased heart rate

b. Increased contractility
c. Decreased total peripheral resistance
d. Decreased cardiac output
In a tissue capillary, the interstitial hydrostatic pressure is 2
mm Hg, the capillary hydrostatic pressure is 25 mm Hg, and
the interstitial oncotic pressure is 7 mm Hg. If the net
pressure across the capillary wall is 4 mm Hg favoring
filtration, what is the capillary oncotic pressure?

a. 20 mm Hg
b. 22 mm Hg
c. 24 mm Hg
d. 26 mm Hg
A 30 year old female presents to the emergency department with
severe diarrhea. When she is placed in the supine position (lying
down on her back), her blood pressure is 90/60 mm Hg and her
heart rate is 100 bpm. When she is moved to a standing position,
her heart rate further increases to 120 bpm. Which of the following
accounts for the further increase in her heart rate upon standing?

a. Decreased total peripheral resistance

b. Increased vasoconstriction
c. Decreased venous return
d. Increased afterload
During exercise, there is an increase in a
person’s:

a. Venous compliance
b. Total peripheral resistance
c. Diastolic pressure
d. Stroke volume
During your pediatrics rotation, you see a 6 year-old male with a rash. He has red
cheeks, circumoral pallor and a lacy, pink macular rash over the rest of his torso.
His mother reports that he has been irritable and “sick” for the past 2 weeks or so.
She is very concerned about him missing more school and wants to know the
appropriate course of action. What do you tell her?

a. He cannot go back to school for another week

b. He can go back to school today

c. He can go back to school, but cannot come into physical contact with other kids

d. He can go back to school in 2 weeks

A patient is sick with severe diarrhea. The examination of a
stool sample reveals an icosahedral-shaped virus with long
fibers protruding from the virus. What else is a likely
characteristic of this virus?

a. it is naked
b. it is enveloped
c. it is an RNA virus
d. it is a DNA virus
e. it is a retrovirus
Which of the following is true regarding viral pathogenesis?

A. Viruses that are acquired through respiratory route rarely

cause viremia
B. Humoral immunity but not cell mediated immunity (CMI)
acts
against viruses
C. Viruses that are acquired via skin contact can cause
viremia
D. RNA viral mutations can only occur in the cytoplasm
E. RNA viruses are more likely than DNA viruses to cause
persistent infections
Which of the following is the first synthetic event that occurs in the
replication cycle of
Coronaviridae?

a. Synthesis of a negative strand RNA

b. DNA synthesis
c. Translation
d. Budding from a cell
e. Synthesis of mRNA
While teaching a class, microbiology professor describes a small, enveloped virus
that has virion-associated enzyme activity. The replication cycle takes place exclusively
in the cytoplasm of infected cells. When purified genomic nucleic acid is added to cells, it
results in the production of low levels of infectious virus. A student is asked to describe the
most likely genome of the virus. What would be the correct answer?

A. Double-stranded DNA
B. Single-stranded, non-segmented, positive-sense DNA
C. Single-stranded, non-segmented, negative-sense RNA
D. Single-stranded, non-segmented, positive-sense RNA
E. Single-stranded, segmented, negative-sense RNA
You have been charged with developing a vector delivery system for a new HIV-1 vaccine (a vector is an engineered
microbe that can be used to deliver vaccine components to host cells). You decide to use a chimeric virus to deliver
HIV-1 genes into host cells. This vaccine MUST be delivered predominantly to B cells AND the HIV-1 genes must
be integrated into the host cell chromosome to work most effectively. Which composite virus would you use as a
vector to best achieve your goal (assume HIV-1 genes are genetically added to the composite virus’ DNA)?

a. Variola virus envelope + parvovirus B19 DNA

b. Epstein-Barr virus envelope + variola virus DNA
c. Epstein-Barr virus envelope + human papilloma virus-16 DNA
d. Parvovirus B19 capsid + herpes simplex virus-2 DNA
e. BK polyoma virus capsid + varicella-zoster virus DNA
 All of the following statements are true EXCEPT which one?

a. Epstein-Barr virus infection can yield heterophile antibodies and lead to nasopharyngeal carcinoma
b. Herpes simplex virus-1 infection can yield syncytia and cause encephalitis
c. Cytomegalovirus infection can cause heterophile-negative mononucleosis
d. Varicella-zoster virus infection can yield cytoplasmic inclusion bodies and cause shingles
e. Human papilloma virus-18 infection can result in cytopathic effects and lead to genital carcinoma
 How do human papilloma viruses promote DNA replication, thereby promoting cell cycle
progression?

a. They code for a viral protein (E6) which leads to E2F proteosomal degradation
b. They code for a viral protein (E6) that activates a host transcription factor (E2F)
c. They code for a viral protein (E6) which activates the cellular p53 pathway
d. They code for a viral protein (E7) which disrupts the cellular pRb-E2F complex
e. They code for a viral protein (E7) which sequesters/traps E2F, preventing its translocation to the nucleus
A young woman who received the Cervarix vaccine was later exposed to human papilloma virus-11. What
likely symptoms will arise from this virus?

a. She might develop benign genital warts

b. She might develop invasive cervical carcinoma
c. No symptoms will arise due to a vaccine-elicited antiviral memory response
d. She might develop plantar (sole of foot) warts
e. She might develop a systemic rash
A frantic mother calls you after her baby spiked a 104.6° fever this morning. You tell her to
bring the baby into your office for examination. While the mom is undressing the baby, she
exclaims that the baby now has a rash that wasn’t there previously. The rash is most
prominent on the trunk and thighs of the baby. What is responsible for the baby’s sickness?

a. Roseola
b. Rubella
c. Rubeola
d. Varicella
e. Mononucleosis
Identify the structure labeled by the orange box in the image below.

a. Left lung
b. Right lung
c. Right kidney
d. Left kidney
e. Spleen
Identify the pathologies evident in the pyelogram shown in the image below.

a. Pelvic kidney, peritonitis, polycystic kidney

b. Spina bifida, kidney stones, bifid ureter
c. Kidney stones, horseshoe kidney, bifid ureter
d. No pathologies present
e. Kidney stones, retrocaval ureter, bifid
A 34-year-old male visit his primary care physician for employment physical exam. A PPD test is performed which was
positive 48-hours later. A chest X-ray ordered is shown below. Which of the following statements the most accurate
regarding his chest X-ray?

a. Pleuritis
b. Normal inhalation
c. Lobar pneumonia
d. Pneumothorax
e. Pleural effusion
A 19-year-old tall thin basketball player is brought to the emergency room for sudden onset of pain in his chest. A CT scan of
his thorax is shown below. Which of the following statements is most accurate regarding this patient?

a. Pneumothorax
b. Lobar Pneumonia
c. Hemothorax
d. Pulmonary embolism
e. Pleural effusion
A 67-year-old male is brought admitted to the hospital because of the fever, chills and chest pain. Based on his x-
rays shown below, which of the followings is the most likely location of his pneumonia?

a. Right upper lobe

b. Right upper and middle lobes
c. Left inferior lobe
d. Left upper and middle lobes
e. Left upper lobe
Why is pancreatic cancer very deadly?
a. Its enzymes become hyperactive because of cancer
b. Once pancreatic cancer develop, the production of enzymes
completely stops making it impossible to digest any food
c. It causes the production of bile to increase
d. It shares blood supply with vital organs
e. The reason behind pancreatic cancer being so deadly is still under
investigation
Which of the following statements is true regarding the picture below?

a. Endocrine gland
b. Exocrine gland
c. Unicellular gland
d. Compound tubuloacinar gland
e. Compound tubular gland
f. Compound acinar
Which of the following statements is true regarding acini?
a. They are composed of goblet cells
b. They do not secrete in duct
c. They have a wide lumen
d. They are found in brain
e. They have a narrow lumen
Which of the following statement is true regarding Alveolar glands?
a. They have a narrow lumen
b. They are made of goblet cells
c. They are made of cuboidal cells
d. They are unicellular glands
Which of the following arteries is supplies the greater curvature of the
stomach?
a. Superior pancreaticoduodenal artery
b. Superior mesenteric artery
c. Splenic artery
d. Left gastric artery
e. Hepatic artery
For an undisclosed reason, a MERP student decided to run to Tampa, FL on a
scorching sunny day. After 30 minutes into his run and in the middle of nowhere,
he is totally exhausted and begin to doubt his not so clever decision. Which of the
following statements is the most accurate regarding his current condition?

a. Increase activity of pyruvate kinase leading increased levels NAD+

b. Increase activity of pyruvate kinase leading decreased levels NADH + H+
c. Increase activity of lactate dehydrogenase (LDH) leading increased levels
NAD+
d. Increase activity of pyruvate dehydrogenase (PDH) leading increased levels
NAD+
e. Increase activity of lactate dehydrogenase (LDH) leading increased levels
NADH + H+
A 29-year-old female nurse is admitted for sudden loss of consciousness and palpations. Her blood
glucose is 35 mg/dL (normal 70 – 110 mg/dL). She admits trying to lose weight by self- injecting with
insulin. Which of the following statements is the most accurate regarding this patient’s current
condition?
a. Decreased levels of Fructose 2,6 Bisphosphate leading to increased activities of PFK-1
b. Increased activity of Fructose Bisphophatase leading increased levels of Fructose 2,6
Bisphosphate
c. Decreased activity of Fructose Bisphophatase leading decreased levels of Fructose 2,6
Bisphosphate
d. Decreased activity of Fructose Bisphophatase leading increased levels of glucose
e. Increased levels of Fructose 2,6 Bisphosphate leading to increased activities of PFK-1
Which of the following statements is the most accurate regarding
Phosphofructokinase-1 (PFK-1)?
a. PFK-1 is inhibited by high levels of ADP leading to increase levels of Fructose-6-P
b. PFK-1 is inhibited by high levels of ATP leading to increase levels of Fructose-6-P
c. PFK-1 is inhibited by high levels of ATP leading to increase levels of Fructose-1,6-
Bisphosphate
d. PFK-1 activities is increased by high levels of Fructose 2,6 Bisphosphate leading
to increase levels of Fructose-6-P
e. PFK-1 activities is increased high levels of ATP leading to increase levels of
Fructose-6-P
Which of the following statements is most the accurate regarding the hexokinases?
a. Hexokinase IV has higher Km than Hexokinase III and is not inhibited by glucose-6-
phosphate
b. Hexokinase III has higher Km than Hexokinase II and is not inhibited by glucose-6-
phosphate
c. Hexokinase IV has lower Km than Hexokinase III and is not inhibited by glucose-6-
phosphate
d. Hexokinase I has higher Km than Hexokinase IV and is inhibited by glucose-6-
phosphate
e. Hexokinase I has lower Km than Hexokinase IV and is not inhibited by glucose-6-
phosphate
Which of the following statements is the most accurate regarding maltose?
a. It is found in starch and is composed of glucose-glucose
b. It is found in milk and is composed of glucose-galactose
c. It is found in sugar cane and is composed of glucose-fructose
d. It is found in starch and is composed of glucose-galactose
e. It is found in sugar cane and is composed of glucose-galactose
Glycogen synthase is activated by which of the followings?
a. Insulin
b. Glycogen
c. Glucagon
d. Phosphorylase kinase b
e. Calmodlium
Glycogen storage disorder Type V is due to deficiency of which of the following
enzymes?
a. Glycogen synthase
b. Glucose-6-phosphatase
c. Lysosomal acid glucosidase
d. Debranching enzyme
e. Branching enzyme
f. Muscle phosphorylase
g. Liver phosphorylase
In gluconeogenesis, which of the following enzymes is required to complete the final step to form
glucose?
a. Glycogen synthase
b. Phosphofructokinase
c. Glucokinase
d. Fructose 1,6 bisphosphatase
e. Glucose-6-phosphatase
Binding of insulin to its receptor will lead to which of the following actions?
a. Decrease transport of potassium into the cell
b. Hyperkalemia
c. Decrease in GLUT expression
d. Decrease in glycogenesis
e. Increase in glycogenolysis
f. Decrease in amino acid transport into the cell
g. Internalization of glucose to the cell
Glycogen storage disorder type Ib results from deficiency of which of the following enzymes?
a. Microsomal G6P translocase
b. Glucose-6-phosphatase
c. Lysosomal acid glucosidase
d. Debranching enzyme
e. Branching enzyme
f. Muscle phosphorylase
g. Liver phosphorylase
At the arteriolar end of the capillary the hydrostatic
pressure is 35 mm Hg; the colloid osmotic pressure
of the plasma is 25 mm Hg; both hydrostatic and
colloid osmotic pressures in the interstitial space are
zero mm Hg. The net pressure will be:

a. 5 mm Hg
b. 10 mm Hg
c. 12 mm Hg
d. 15 mm Hg
A 60-year old man undergoes a coronary angiogram as
one of the cardiac screening tests. The angiography shows
that the radius of the patient’s left coronary artery is
reduced by 50%. What is the expected change in blood
flow through the stenotic artery?

a. Decrease to ½
b. Decrease to ¼
c. Decrease to 1/8
d. Decrease to 1/16
Which of the following is the correct
relationship between mean arterial
pressure (MAP), cardiac output (CO), and
total peripheral resistance (TPR)?

a. MAP = CO/TPR
b. MAP = CO x TPR
c. CO = MAP x TPR
d. TPR = MAP x CO
1000 ml of fluid is flowing through a series of tubes of
varying diameters. The tube, A is of largest diameter,
tube B is of medium diameter, and tube C has the
smallest diameter. Tubes are connected in series in
order, A, B and C. Fluid flows from tube A to C. The
velocity of flow is the highest in:

a. Tube A
b. Tube B
c. Tube C
d. All tubes the same
 A 55-year-old man is constipated and straining in the bathroom. At the end of
the exertion and inhalation, his systolic pressure rises to 205 mmHg. How
will his cardiovascular center respond?

a. It will directly inhibit his baroreflex

b. It will block his alpha 2 receptors
c. Sympathetic outflow will be increased; parasympathetic outflow will be decreased
d. It will decrease his ESV
e. Sympathetic outflow will be inhibited; parasympathetic outflow will be activated
With time, blood stored in a blood bank tends to become relatively
depleted of 2, 3-diphosphoglycerate (2,3 DPG). What effect does this
have on the Hb-O2 dissociation curve?

a. Shifts the curve to the left, so that Hb has a decreased O2 affinity

b. Shifts the curve to the left, so that Hb has an increased O2 affinity
c. Shifts the curve to the right, so that Hb has an increased O2 affinity
d. Shifts the curve to the right, so that Hb has a decreased O2 affinity
In the case of Carbon monoxide poisoning, P50 is:

a. Increased and Hb has lesser affinity of O2

b. Increased and Hb has a greater affinity for O2
c. Decreased and Hb has a greater affinity for O2
d. Decreased and Hb has a lesser affinity for O2
Which of the following causes of hypoxia is
characterized by a decreased arterial PO2 and an
increased A-a gradient?

a. Hypoventilation
b. Right-to-left cardiac shunt
c. Carbon monoxide poisoning
d. Ascent to high altitude
A person with a ventilation/perfusion (V/Q) defect has
hypoxemia and is treated with supplemental O2. The
supplemental O2 will be most helpful if the person’s
predominant V/Q defect is:

a. dead space
b. shunt
c. high V/Q
d. low V/Q
Which of the following will decrease the O2 carrying
capacity of blood?

a. Increased PCO2
b. Increased temperature
c. Decreased pH
d. Decreased Hemoglobin
A childhood friend of yours calls you and is in tears. She knows you are basically already a doctor having gotten
to the halfway point of MERP and needs your help. She just received a call from her OBGYN and received her
Pap smear results. She wants to know what strains could possibly lead to cervical cancer.

a. HPV 2, 11
b. HPV 6,11
c. HPV 16,18
d. HPV 2, 18
e. HPV 6,18
A 40 year old dentist comes to your office because of a bump on his finger. She explains that the finger often
throbs and bothers him. What test would most accurately determine the etiology of this patient’s pathology?

a. Giemsa Stain
b. Culture on charcoal yeast agar
c. Culture on chocolate agar
d. Tzanck smear
e. Monospot Test
A 32 year old pregnant woman arrives to her baby shower. Her younger sister has a 4 year old boy who
was just recently diagnosed with erythema infectiousum. She begins to worry because her OBGYN
specifically told her to avoid any children with this illness. Her mother tries to comfort her by telling her
that she had it when she was younger, so she and her baby will be fine. Is the mother’s rationale
correct? Why or why not?
a. No, there is a 10% chance of fetal loss with maternal infection
b. Yes, If mom has parvovirus Ab after being infected, then the fetus will be
protected
c. No, any fetus exposed to B19 will die in utero
d. Yes, this baby will only have a mild form of fetal anemia because the mom was
only exposed to the disease for a short period of time
 A brainy yet handsome Microbiology professor hobbles to the clinic, complaining of severe arthralgia (joint
pain) and systemic pruritic erythema (itchy rash), symptoms which have persisted for the past 5 days. In
examining the patient, you suspect a virus infection is responsible and decide to GENTLY draw some blood
to send to the clinical laboratory for diagnostics (to measure free viral antigen or antiviral antibodies). The
results from the ELISA tests reveal:

a. low viremia, high antiviral IgM’s, and high antiviral IgG’s.

b. high viremia, low antiviral IgM’s, and low antiviral IgG’s.
c. low viremia, low antiviral IgM’s, and low antiviral IgG’s.
d. high viremia, high antiviral IgM’s, and high antiviral IgG’s.
e. low viremia, high antiviral IgM’s, and low antiviral IgG’s
You identify a new dsDNA, enveloped virus that is persistent and is found in all organs of the body, including
the basolateral lining of the GI tract. Which of the following means of transmission was most probably not
utilized by this virus?
a. Sexual contact
b. Fecal/oral
c. Contact with spit
d. Respiratory secretions
e. Blood
Which of the following best fits the descriptions for Virus A and Virus B?
a. A-HSV-1, B-HPV-4
b. A-Measles, B-Polio
c. A-Polio, B-Coxsackie A
d. A-Chicken pox, B-Adeno
e. A-Rhabdo, B-Hepatitis A
Which of the following infections by picornaviruses cannot be prevented by a
vaccine? (You may choose more than one)
a. Myocarditis
b. Hepatitis
c. Paralysis
d. Hand-foot-and-mouth
e. Common cold
Pick the correct match for the following rashes and their description:

Measles A. Starts with Koplik’s spots in the mouth

Chicken pox B. Infects erythroid precursors
Erythema infectiosum (B19) C. Uses reverse transcriptase
Roseola D. Rash follows fever, spares the face
E. can be reactivated from neurons as shingles
F. caused by a naked RNA virus

a. Measles→A; chicken pox→F; B19→C; roseola→B

b. Measles→C; chicken pox→B; B19→A; roseoa →E
c. Measles→E; chicken pox→F; B19→B; roseola→A
d. Measles →F; chicken pox→B; B19→E; roseola→D
e. Measles→A; chicken pox→E; B19→B; roseola→D
Refer to the serological data below, obtained from a patient recovering from Hepatitis B. The
x-axis indicates the number of months before and after acute symptoms (acute symptoms are
marked by month “0”). The y-axis indicates Hepatitis B specific antigens and antibodies detected
in the patient.
Which of the following letters point to the curve(s) that represent(s) the antibody(s) one use(s) as
a marker of Hepatitis B vaccination?

a. B
b. C and E
c. D and F
d. E
e. F
A 31-year-old man presents to your free clinic complaining that his urine is dark and
his stools are pale. On physical examination, you note icteric sclera and conclude
that he likely has hepatitis. A hepatitis serology panel is performed:

HBsAg: positive
anti-HBcIgM: positive
HBV DNA: 1010 copies/mL

You see the patient 5 months later, at which time a second hepatitis serology panel is performed:

HBsAg: negative
anti-HBs: IgG positive
anti-HBcIgG: positive
HBV DNA: not detectable

What is the most likely interpretation?

a. The man was vaccinated for HBV

b. The man has chronic HBV
c. The man has acute HBV and will become chronically infected
d. The man had acute HBV but cleared the infection
e. These results are inconclusive
f. The man had chronic HBV but cleared the infection
Below is the CT-scan on the abdomen of 48-year-old male patient. Which of the
following structures is most likely indicated by the arrow?

a. Renal Cortex
b. Renal Medulla
c. Adrenal Medulla
d. Minor Calyx
e. Major Calyx
From which part of the kidney was the biopsy presented below taken? What structures are identified by the numbers
1, 2 and 3 in the EM image below?

a. Kidney cortex; 1 – capillary endothelium, 2 – podocyte pedicels, 3 – basement membrane

b. Kidney medulla; 1 - collecting duct, 2 – peritubular capillary, 3 – thin loop of Henle
c. Kidney medulla; 1 - collecting duct, 2 - thin loop of Henle, 3 - peritubular capillary
d. Kidney cortex; 1 – capillary endothelium, 2 – podocyte pedicels, 3 – parietal layer of Bowman’s capsule
e. Kidney cortex; 1 – capillary endothelium, 2 – cuboidal epithelium of basement membrane, 3 – small calix.
From which organ was the biopsy presented below taken? What structure is identified by the letter A?

a. Kidney medulla; distal convoluted tubule

b. Kidney cortex; proximal convoluted tubule
c. Kidney cortex; collecting duct
d. Kidney cortex; glomerulus
e. Kidney cortex; distal convoluted tubule
Which of the followings is an intraperitoneal organ?
a. Right adrenal gland
b. 1st part of duodenum
c. 2nd part of duodenum
d. 3rd part of duodenum
e. Head of the pancreas
f. Body of the pancreas
g. Ascending colon
h. Descending colon
Which of the choices below best indicates the difference between
the kidneys?
a. The right kidney is larger in right handed patients
b. The right kidney is found at a lower level than the left kidney
c. The right kidney has a shorter renal artery than the left
d. The right kidney has a longer renal vein than the left kidney
e. The right kidney has a suprarenal gland and the left does not
Which of the following retroperitoneal organs is responsible for the
right paracolic gutter
a. Liver and the kidney
b. Transverse colon
c. Descending colon
d. Ascending colon
e. Duodenum
Which of the following statements is most accurate regarding macula densa?
a. Cells of the proximal convoluted tubule
b. Cells of the descending limb of the LOH
c. Cells of the distal convoluted tubule
d. Cells of the afferent arteriole
e. Cells found in both the afferent and efferent arteriole
There are two types of polycystic kidney disease, autosomal dominant and
autosomal recessive. Which of the following patients below is most likely
suffering from autosomal dominant type?
a. An infant that died shortly after birth
b. A 10-year-old healthy boy
c. A 16-year-old G1P0 female
d. A 40-year-male with increasing abdominal girth
e. A 40-year-old female with heartburn during sleep after having late dinner
Which of the followings is the most correct drainage pathway of urine?
a. Proximal convoluted tubule, ascending limb of LOH, distal convoluted tubule, collecting
duct
b. Ascending limb of the LOH, collecting duct, proximal convoluted tubule, distal convoluted
tubule
c. Proximal convoluted tubule, collecting duct, ascending limb of the LOH, distal convoluted
duct
d. Distal convoluted tubule, collecting duct, ascending limb of the LOH, proximal convoluted
tubule
e. Ureter, collecting duct, papillary duct, major calyces, minor calyces
Identify the pathologies evident in the pyelogram shown in the image below

a. Pelvic kidney, peritonitis, polycystic kidney

b. Spina bifida, kidney stones, bifid ureter
c. Kidney stones, horseshoe kidney, bifid ureter
d. No pathologies present
e. Kidney stones, retrocaval ureter, bifid pelvis
A postoperative patient on intravenous fluids develops Lesions in the mouth.
Urinalysis indicates an excretion of niacin, which is abnormally low. Which of the
following TCA enzymes is most likely to be affected first?

a. Citrate synthase
b. Isocitrate dehydrogenase
c. Fumarase
d. Succinate dehydrogenase
e. Malate dehydrogenase
An increased levels of which of the following substances would most
likely lead to inhibition of succinate dehydrogenase?
a. Arsenate
b. Malonate
c. Sodium fluoride
d. Succinyl CoA
e. NADH
Fluoroacetate most likely causes which of the following effects if it is introduced into human
body since it inhibits the formation of aconitate?
a. It can halt Glycolysis by inhibiting pyruvate dehydrogenase complex there by leading
to death
b. It can cause increase production of lactic acid resulting in high amounts of NAD+
c. It can halt citric acid cycle by inhibiting the reaction that leads to production of
isocitrate from citrate
d. It can halt TCA by inhibiting the reaction that leads to production of succinate from
citrate
e. It can halt TCA by inhibiting Fumarase
Which of the following control points of glycolysis does not use direct product
inhibition?

a. Enolase
b. Hexokinase
c. Phosphofructokinase 1
d. Phosphoglycerate Kinase
e. Pyruvate kinase
Which of the following statements would be correct in a fasting state?

a. Pyruvate dehydrogenase would be phosphorylated by pyruvate

dehydrogenase kinase
b. Pyruvate dehydrogenase would be dephosphorylated by pyruvate
dehydrogenase kinase
c. Pyruvate dehydrogenase would be phosphorylated by pyruvate
dehydrogenase phosphatase
d. Pyruvate dehydrogenase would be dephosphorylated by pyruvate
dehydrogenase phosphatase
e. Pyruvate dehydrogenase would be phosphorylated by NADH
Despite warning signs posted all over the area your patient decided to drink pond water
with high concentrations of fluoroacetate. Which of the following TCA cycle intermediates
would you expect your patient to be deficient in?

a. Glucose
b. Poryphorins
c. Amino acids
d. Fatty acids
e. CO2
You are working another late shift in the emergency room. One of your regulars
presents to you with altered mental status and slurred speech. You recognize this
patient as a known alcoholic who appears severely malnourished. What enzyme in
the TCA cycle would you expect to be directly affected?

a. Pyruvate dehydrogenase
b. Aconitase
c. Hexokinase
d. Malate synthase
e. Citrate synthase
Your patient has developed burning foot syndrome from a deficiency in a certain
vitamin. As a result which enzyme in the TCA cycle is likely to be inhibited?

a. Citrate synthase
b. Malate dehydrogenase
c. Dihydrolipoyl dehydrogenase
d. Aconitase
e. Dihydrolipoyl transacetylase
Which TCA enzyme is directly involved in the electron transport chain?

a. Malate synthase
b. Succinyl-CoA synthetase
c. Aconitase
d. Succinate dehydrogenase
e. Malate dehydrogenase
Your patient presents to you with anorexia and panic disorder. Because of her condition, her diet is
extremely poor and lacks many of the necessary vitamins. All of the following vitamins are required
as cofactors in the enzymes that are involved in the TCA cycle except?

a. B2
b. B6
c. B1
d. B5
e. B3
A person has a vital capacity (VC) of 5 L, a tidal volume (TV) of 0.5 L,
an inspiratory capacity of 3.5 L, and a functional residual capacity
(FRC) of 2.5 L. What is his expiratory reserve volume (ERV)?

a. 2.0 L
b. 1.5 L
c. 3.9 L
d. 2.5 L
Which of the following lung volumes or capacities can be
measured by spirometry?

a. Functional residual capacity (FRC)

b. Residual volume (RV)
c. Total lung capacity (TLC)
d. Vital capacity (VC)
An infant born prematurely in gestational week 25 has
neonatal respiratory distress syndrome. Which of the
following would be expected in this infant?

a. Increased lung compliance

b. Collapse of the small alveoli
c. Normal breathing rate
d. Normal arterial partial pressure of Oxygen
Which of the following is true during inspiration?
a. Intrapleural pressure is more negative than it is during expiration
b. The volume in the lungs is less than the functional residual capacity
(FRC)
c. Alveolar pressure equals atmospheric pressure
d. Alveolar pressure is higher than atmospheric pressure
Which volume remains in the lungs after a tidal volume (TV) is expired?

a. Vital capacity (VC)

b. Expiratory reserve volume (ERV)
c. Residual volume (RV)
d. Functional residual capacity (FRC)
A 150-lb patient scheduled for abdominal surgery is sent for preoperative evaluation and testing. His
chest x-ray is normal, and pulmonary function results on
room air show the following:

Inspiratory reserve volume = 2000 mL

Expiratory reserve volume = 2400 mL
Respiratory rate = 10/min
Vital capacity = 5000 mL
Alveolar volume = 5000 mL

The volume of the patient’s anatomical dead space equals which of the following?
a. 100 mL
b. 150 mL
c. 180 mL
d. 420 mL
e. 7200 mL
A 6′3″ tall, 140-lb, 20-year-old man was watching television when he felt pain in his shoulder
blades, shortness of breath, and fatigue. His father noticed how pale
he was and took him to the emergency department. The physical exam revealed decreased
tactile fremitus, hyperresonance, and diminished breath sounds. A chest xray
revealed a 55% pneumothorax of the right lung, which was attributed to rupture of a bleb on the
surface of the lung. What changes in lung function occur as a result
of a pneumothorax?

a. The chest wall on the affected side recoils inward.

b. The intrapleural pressure in the affected area equals greater than atmospheric pressure.
c. The trachea deviates away from the affected lung.
d. There is hyperinflation of the affected lung.
e. The FEV1/FVC ratio on the affected side increases above normal.
A 58-year-old woman experiences an acute exacerbation of asthma, which causes
her breathing to become labored and faster. As a result, which of the following
changes in airflow is expected?

a. Flow in the trachea and upper airways will become more laminar.
b. The pressure gradient required for airflow will increase.
c. The resistance to airflow will decrease.
d. The resistance to airflow will increase linearly with the decrease in airway
radius.
e. Reynolds number will decrease.
A healthy, 24-year-old man is prescribed sustained-release bupropion (Zyban) for smoking cessation.
Three weeks later, he presents to his family physician with
intermittent fever and a generalized rash, at which time the bupropion is discontinued. A month later, he
develops a dry, intermittent cough and dyspnea. Which of the
following pulmonary function results is consistent with allergic bronchospasm?

a. A decreased FEV1/FVC
b. A decreased residual volume
c. An increased diffusing capacity
d. An increased FVC
e. An increased lung compliance
A 48-year-old coal miner complains of shortness of breath and a productive cough. He
has smoked one to two packs of cigarettes per day since he was 16 years
old. Pulmonary function studies are ordered, including an esophageal balloon study to
measure intrapleural pressures. Normally, intrapleural pressure is negative
throughout a tidal inspiration and expiration because of which of the following?

a. The lungs have the tendency to recoil outward throughout a tidal breath.
b. The chest wall has the tendency to recoil inward throughout a tidal breath.
c. The lungs and chest wall recoil away from each other throughout a tidal breath.
d. The lungs and chest wall recoil in the same direction throughout a tidal breath.
e. A small volume of air leaves the pleural space during a tidal breath.
A young girl has had repeated infections with Candida
albicans and respiratory viruses since the time she was
3 months old. As part of the clinical evaluation of her
immune status, her responses to routine immunization
procedures should be tested. In this evaluation, the use
of which of the following vaccines is contraindicated?

a. DPT
b. Bordetella pertussis vaccine
c. Salk polio
d. Tetanus toxoid
e. MMR
Which outcome of polio infection has the highest rate of
mortality?

a. bulbar polio
b. flaccid paralysis
c. aseptic meningitis
d. abortive polio
Where is the RNA dependent RNA polymerase of the influenza virus active?

a. Golgi apparatus
b. Cytosol
c. Rough ER
d. Smooth ER
e. Nucleus
You are rotating in the ER when a 29 year-old male comes in complaining of chest pain. The pain is sharp in nature
and seems to get better when the patient leans forward. Since you happen to be rotating in Dubai and money is no
object you skip immediately to a CT scan. The results are:

What is the most likely causative agent?

a. Coxsackie A
b. Coxsackie B
c. Epstein-Barr virus
d. Poliovirus
e. Orthomyxovirus
Another patient presents to you in the ER with diarrhea and abdominal
pain for 2 weeks. You notice scleral icterus on physical examination so
you decide to check for hepatitis. Her HAV titer comes back as positive
along with elevated liver enzymes. Why are her liver enzymes elevated?

a. HAV lysing hepatocytes as it exits

b. Destruction of hepatocytes by marcophages
c. Destruction of hepatocytes by opsonization
d. Destruction of hepatocytes by cytotoxic T cells
What is the mechanism of action of oseltamivir (Tamiflu)?

a. It inhibits viral binding to the host cell via hemaglutinin

b. It inhibits acidification of the virion via M2 protein
c. It inhibits budding from the host cell via neuraminidase
d. It inhibits binding to the host cell via neuraminidase
What is the main factor that contributes to H5N1 influenza’s high mortality rate?

a. Viral affinity to the 2-6 sialic acid in lower human lung

b. Viral affinity to the 2-3 sialic acid in lower human lung
c. Viral affinity to the 2-6 sialic acid in the human oropharynx
d. Viral affinity to the 2-3 sialic acid in the human oropharynx
Which virus is the leading cause of the croup syndrome in young children
and, when infecting mammalian cells in culture, will absorb red blood
cells?

a. Coxsackie B
b. Rotavirus
c. Parainfluenza virus
d. Adenovirus
e. Rhinovirus
 Measles virus (rubeola), a common cause of exanthems in children, is best
described by which of the following statements?

a. Measles (rubeola) and German measles (rubella) are caused by the same
virus
b. Incubation time is approximately 3 to 4 weeks
c. Vesicular rashes are characteristic
d. Onset is abrupt with cough, coryza, and fever
e. Specific antibody in the serum does not prevent disease
A young mother brings her 5 year-old son in to your clinic. She reports that
he has been feeling unwell, with a fever, cough, runny nose and red, itchy
eyes. Upon physical exam, you see small, white lesions on the buccal
mucosa. She states that he is not up to date on his vaccines. How does this
virus spread from cell to cell?

a. Lysis via F protein

b. Exocytosis via M protein
c. Syncitial cell-to-cell via F protein
d. Membrane fusion via hemagglutinin
A 59-year-old male sustained the trauma shown below 3 months ago.
Function of which of the following nerves is most likely compromised now?

a. Median and radial

b. Ulnar and radial
c. Median and ulnar
d. Long thoracic and axillary
e. Radial and axillary
Which of the following is the correct labeling for the structures labeled below?

a. 8 – Ulna; 3 – Trochlea
b. 4 – Head of the radius; 3 – Radial fossa
c. 2 – Head of the ulna; 8 – Radius
d. 8 – Coronoid fossa; 7 – Radius
e. 3 – Capitilum; 7 – Trochlea
Identify the pathology based on the autopsy and X-ray presented below.

a. Achalasia
b. Peptic ulcer
c. H. pylori
d. Colorectal cancer
e. Pneumothorax
Identify the pathology shown in the image below.

a. Gastric ulcer
b. Barrett’s esophagus
c. Adenocarcinoma
d. Cirrhotic liver
e. Peptic ulcer
The biopsy presented below was taken from a polyp (tumor) discovered
during a colonoscopy. How would you describe this tumor?

a. Sarcoma
b. Carcinoma
c. Adenocarcinoma
d. High grade dysplasia
e. Adenoma
A 45-year-old female comes to her family physician for a routine examination. She mentions
during the history that she has been experiencing substernal burning pain following meals for
the past 13 years. Physical examination is completely benign. An upper GI endoscopy is
performed which reveals 2 to 3 cm long tongues of erythematous mucosa extending from the
gastroesophageal junction at the Z line upward into the lower esophagus. Biopsies of the
affected esophagus reveal gastric cardiac-type mucosa. Which of the following interpretations
is most appropriate for this patient’s findings?

a. Chronic flow back issues

b. Congenital anomaly
c. Squamous cell carcinoma
d. Crohn's disease
e. Achalasia
A 24-year-old female is admitted to the emergency department with the
diagnosis of appendicitis and peritonitis. After appendectomy the patient
undergoes exploratory laparoscopy. Which of the following features is most
helpful to distinguish the jejunum from the ileum during the laparoscopy?

a. The jejunum has more villi

b. The jejunum has more vascular arcades and shorter vasa recta
c. The jejunum has more submucosal glands
d. The jejunum is covered by serosa, but the ileum is covered by adventitia
e. The jejunum has less vascular arcades and longer vasa recta
A 59-year-old man is admitted to the emergency department with abdominal pain and a 3-day
history of vomiting. The patient looks exhausted and pale. Physical examination revealed a
colicky abdominal pain in the right lower quadrant, with abdominal distention. Upon auscultation
pain attacks were associated with rushes and tinkling sounds. During examination the patient
vomited again; his vomit contains bile but no blood. The CT scan revealed obstruction of the GI
tract. Which of the following is most likely obstructed in this patient?

a. Cardiac sphincter
b. Pyloric sphincter
c. Common bile duct
d. Ileocecal valve
e. Ampula of Vater
The image below shows the fluoroscopy of a patient with a bowel
obstruction. The fluorescent artificial food was given to the patient 11
hours before this X-ray image was taken. Identify organs A and B.

a. Duodenum and jejunum

b. Jejunum and ileum
c. Jejunum and descending colon
d. Transverse colon and descending colon
e. Stomach and jejunum
A 39-year-old woman is admitted to the hospital with severe abdominal pain,
nausea and vomiting. The pain is acute and started about 4 days ago; it began
in the epigastric region and radiated to the right shoulder. Now the pain is
localized in the right hypochondriac region. A CT scan revealed stones in the
gallbladder. During the laparoscopic cholecystectomy, the resident
accidentally clamped the right side of lesser omentum (hepatoduodenal
ligament) instead of the cystic artery. Which of the following vessels was
most likely occluded due to the resident’s mistake?

a. Middle colic artery

b. Splenic artery
c. Proper hepatic artery
d. Left gastric artery
e. Right colic artery
What is the role of dihydrofolate reductase in the purine synthesis pathway?

a. It carries and donates a formyl group

b. It carries and donates a methyl group
c. It becomes methylated in the pathway
d. It accepts a formyl group in the pathway
e. It activates PRPP
What condition in man, will a partial deficiency in the enzyme
HGPRT result in?

a. Immune deficiency
b. Lesch-Nyhan syndrome
c. Multiple myeloma
d. Decrease in allantoin synthesis
e. Gout
 In pyrimidine synthesis, the conversion of orotate to UMP involves the
addition of which molecule?

a. Fumarate
b. Aspartate
c. GTP
d. Glutamine
e. PRPP
A patient is brought to ER who recently suffered a seizure. Patient’s parent
says that this is the fourth time he had seizure within the past month. Patient
has a history of mental retardation. On physical exam, the patient appears to be
sedated and very fair skinned. Which of the following statements is most
accurate about this patient?

a. Deficiency of branched-chain alpha keto acid

b. Accumulation of Homogentisic acid
c. Treat with Tyrosine
d. Accumulation of cystine
e. Restrict methionine
Cystinuria is an autosomal recessive disorder of intestinal absorption and proximal
tubular reabsorption of dibasic amino acid. Which of the following statements is
true regarding Cystinuria?

a. Deficiency of branched-chain alpha keto acid

b. Accumulation of Homogentisic acid
c. Treat with Tyrosine
d. Accumulation of leucine
e. Restrict methionine
Which agent used in the long-term treatment of gout inhibits xanthine
oxidase?

a. Colchicine
b. Probenecid
c. Acetaminophen
d. NSAID’s
e. Allopurinol
In hepatic failure, brain neurons can die directly as a result of:

a. depletion of alpha-ketoglutarate stores

b. depletion of nitrogen stores.
c. depletion of glutamine stores.
d. depletion of glutamate stores.
e. depletion of alanine stores.
In alkaptonuria, why does the urine have a black appearance?

a. The dark pigment melanin is formed

b. Homogentisic acid is oxidized in the blood
c. Homogentisic acid is oxidized in the urine
d. The amount of sotolon increases in the urine
e. Precipitation of cystine in the urine
Which of the following describes the role of carbamoyl phosphate synthetase
I in the urea cycle?

a. It converts carbamoyl phosphate to orotic acid

b. It converts glutamine to glutamate
c. It catalyzes the condensation of bicarbonate and ammonium ions into carbamoyl phosphate
d. It converts L-arginine to L-ornithine and urea
e. It converts carbamoyl phosphate to uracil
. In which of the following steps is urea formed directly?

a. Arginine to ornithine
b. Argininosuccinate to L-arginine
c. Arginine to citrulline
d. Glutamate to N-acetylglutamate
e. L-ornithine to fumarate
When an inexperienced sailor is finally found by the Grand Bahama Coastguard,
his mucous membranes are dry, he appears pale and his skin is cool and clammy
to the touch. His blood pressure is 90/60 while supine and his heart rate is 120
beats/min. Which diagram most accurately describes the osmolarity and volume
of the sailor’s ECF & ICF compartments at the time he was rescued?

The boxes below illustrate the relationship between volume (X-axis) and
osmolarity (Y-axis) for the extracellular (ECF) and intracellular (ICF) fluid
compartments. In each diagram the boxes outlined with heavy black lines
represent normal
a. 1
b. 2
c. 3
d. 4
e. 5
A 63-year-old hospitalized woman becomes oliguric (little urine formation)
and confused. Her blood glucose is found to be only 35 mg/dL. She is given
an intravenous injection of a 50% glucose solution followed by a continuous
infusion of 10% glucose. Most of the glucose that is filtered through the
glomerulus undergoes reabsorption in which of the following renal tubules?

a. Descending limb of the loop of Henle

b. Ascending limb of the loop of Henle
c. Distal tubule
d. Proximal tubule
e. Collecting duct
An increase in efferent arteriolar resistance will result in:

a. an increase in filtration fraction

b. a decrease in peritubular capillary fluid reabsorption.
c. a decrease in efferent arteriolar blood osmolarity.
d. an increase in Bowman’s capsule hydrostatic pressure.
e. an increase in peritubular capillary hydrostatic pressure
A 35-year-old man with polycystic kidney disease has a decrease in
both GFR and RBF. The nephrologist wants to administer a drug
that will increase both GFR and RBF. GFR and RBF would both
increase if which of the following occurred?

a. The efferent and afferent arterioles are both constricted

b. The afferent arterioles are constricted
c. The efferent arterioles are constricted
d. The afferent arterioles are constricted and the efferent arterioles are dilated
e. The afferent arterioles are dilated
A drug of clinical relevance (drug Z) is being tested to determine its renal reabsorption
characteristics. Drug Z is freely filtered but it is not secreted, nor do the kidneys
metabolize or store drug Z. The following values were determined for drug Z:

GFR 100 ml/min

Plasma concentration of Z 1 mg/ml
Excretion rate of Z 25 mg/min

Given these values, what is the rate at which Z is reabsorbed by the tubule (in
mg/min)?

a. 25
b. 250
c. 75
d. 750
e. 2500
Various pressures recorded at the glomerulus are given below:
Glomerular capillary hydrostatic pressure = 47 mmHg
Bowman’s capsule hydrostatic pressure = 10 mmHg
Glomerular capillary oncotic pressure = 25 mmHg
In the above case, the filtration stops if the hydrostatic pressure in the Bowman’s
capsule becomes equal to:

a. 8 mmHg
b. 12 mmHg
c. 14 mmHg
d. 22 mmHg
A 30 year old male with a past medical history of diabetes mellitus was advised to
undergo evaluation of his renal function. The data collected from his renal function
studies are given below:
Glomerular capillary hydrostatic pressure = 48 mmHg
Bowman’s capsule hydrostatic pressure = 8 mmHg
Glomerular capillary oncotic pressure = 25 mmHg
Filtration coefficient = 8 ml/min mmHg
The glomerular filtration rate (GFR) of this patient is:

a. 100 ml/min
b. 110 ml/min
c. 120 ml/min
d. 125 ml/min
A substance that is filtered, but not secreted or reabsorbed (substance X), is infused into
a volunteer until a steady state plasma level of 0.1 mg/ml is achieved. The subject then
empties her bladder and waits one hour, at which time she urinates again. The volume
of urine in the second specimen is 60 ml and the concentration of substance X is 11
mg/ml. What is the glomerular filtration rate (GFR) of this patient?

a. 50 ml/min
b. 90 ml/min
c. 100 ml/min
d. 110 ml/min
In which of the following parts of the nephron is the percentage of Sodium reabsorption
the highest?

a. Proximal convoluted tubule

b. Distal convoluted tubule
c. Collecting duct
d. Thick ascending limb of the loop of Henle
The basic processes in a nephron are shown with numbered
items 1 to 4 in the figure below. Which of the following
processes is indicated by number 3?

a. Glomerular filtration
b. Tubular secretion
c. Tubular reabsorption
d. Excretion
A small percentage of untreated, HIV-infected people remain asymptomatic for the
duration of their life, with undetectable viremia (these individuals are called Long-Term
Non-Progressors). It appears that these persons are genetically more resistant to the
immune-evasion mechanisms of HIV. Which of the following mechanisms is NOT used
by HIV?

a. HIV gp120 undergoes significant antigenic drift during the course of HIV infection
b. HIV Tat recruits the DNA replication machinery to preferentially replicate the viral DNA
c. HIV Nef downregulates host MHC class I
d. HIV becomes latent in a certain subset of CD4+ T cells
e. Persistent antigen exposure induces an anergic state in various immune cells
 Each of the following statements regarding HIV is correct
except:

a. HIV can cause a latent infection by integrating its genome into the DNA of memory CD4+ T cells
b. HIV reverse transcriptase has DNA-dependent RNA polymerase activity
c. HIV requires two receptors to enter host cells and enters by receptor-mediated fusion
d. During the acute stage of HIV infection, the infected person can present with mononucleosis-like symptoms
e. Two different classes of anti-HIV drugs target reverse transcriptase
A 27-year-old man enters your clinic and complains of a recurring cough and chronic fatigue. The patient
explains to you he may have been sexually exposed to HIV about 2 ½ weeks ago. You draw blood and find he
has a depressed CD4+ T cell count (450 cells/µl). What test would you perform, on site, to initially determine if
this man is infected with HIV? Unfortunately, your clinic doesn’t have access to a PCR machine.

a. HIV RNA test

b. Anti-p24 antibody test
c. HIV DNA test
d. HIV p24 antigen test
e. Western blot for anti-p24 antibodies
At what point in the progression of HIV infection do you find clinical latency
(minimal symptoms associated with the chronic stage)?

a. A
b. B
c. C
d. D
e. E
You work in a new pharmaceutical company and have been instructed to design a new anti-
HIV drug that fits into one of the available drug classes. Specifically, the company would like
you to target the LATEST cytoplasmic event in the virus lifecycle. This new drug would be
marketed as a novel:

a. protease inhibitor
b. integrase inhibitor.
c. nucleoside inhibitor.
d. non-nucleoside inhibitor.
e. fusion inhibitor.
Which virulence factor for Neisseria gonorrhoeae is responsible
for bacterial survival after neutrophil phagocytosis?

a. Por
b. Pilin
c. Opa
d. LOS
e. Capsule
What type of bacteria are present in the culture?

a. Gram (+) staphylococci

b. Gram (-) streptacoccobacillus
c. Gram (-) streptococci
d. Gram (-) staphylococci
e. Gram (+) streptococci
A 22 year old female comes into your clinic complaining of intermenstrual
pain. Patient denies any vaginal discharge but complains of tenderness during
exam. You notice no visual abnormalities during inspection. You take a sample
of her mucus secreting epithelial cells and perform a cell culture. Results
indicate a gram (-) diplococcus bacteria. What other conditions can develop if
left untreated?

a. Infertility
b. Reite’s Syndrome
c. Fitz Hugh Curtis Syndrome
d. Ectopic pregnancy
e. Condylomalta
Your patient is an 86 year old male who visits your clinic. Your patient states
he sexually active and would like to have an STD test conducted. You
perform a blood test on your patient and confirm he is positive for Syphilis.
Upon further inspection you notice a copper colored rash on his hands. What
stage has his condition progressed to?

a. Primary stage
b. Primary latent period
c. Secondary stage
d. Secondary latent period
e. Tertiary stage
Your patient is a 26 year old female complaining of lower abdominal pain
with mild discharge. Patient states it has been two months since her last
menstrual cycle and that she is sexually active. You perform a pelvic exam
and notice tubule scarring. What is this patient at risk for?

a. Epidydymitis
b. Cervicitis
c. Bubues
d. Ectopic pregnancy
e. Proctitis
Identify the structure indicated by the yellow arrow.

a. Osteon
b. Volkmann’s canal
c. Harvesian canal
d. Lacuna
e. Lamella
Identify the cell indicated by the arrow in the image below.

a. Osteoclast
b. Osteocyte
c. Osteoblast
d. Erythrocyte
e. Chondroblast
 Identify the correct labeling for the structures in the image below.

a. A – hyaline cartilage; B – trabecula; C – red bone marrow; D – periosteum

b. A – periosteum; B – hyaline cartilage; C – red bone marrow; D – articular surface
c. A – perichondrium; B – hyaline cartilage; C – trabecular bone; D – articular surface
d. A – periosteum; B – compact bone; C – yellow bone marrow; D – articular surface
e. A – hyaline cartilage; B – trabecula; C – red bone marrow; D – articular surface
Kumayl was brought to the emergency department after he was hit by a mini
cooper in the MERP parking lot. On physical examination, he is unable to adduct his
left thigh. Which of the following Kumayl’s nerves is most likely damaged?

a. Femoral nerve
b. Obturator nerve
c. Sciatic nerve
d. Tibial nerve
e. Common peroneal nerve
Jason was brought to Miramar Hospital after he was hit on his right leg by Alyson
after he tried to steal her physiology notes. On physical exam, he was unable to
dorsiflex his right foot. Which of the following nerves is most likely damaged?

a. Superficial peroneal nerve

b. Common peroneal nerve
c. Tibial nerve
d. Femoral nerve
e. Radial nerve
Brian was brought to the emergency department by Besar after he complained of limitation of movement of his
right arm. Besar said that Brian was binge drinking last night and was unable to move his forearm today, which was
completely normal yesterday. His past medical history was negative for similar symptoms. During physical
examination, Brian had difficulty extending the elbow, the wrist and the digits. He also has sensory abnormalities on
the posterior part of his arm, forearm, and hand. Based on Brian’s symptoms, which of the followings is the most
likely location of his injury?

a. Radial nerve at elbow

b. Median nerve at wrist
c. Ulnar nerve at elbow
d. Ulnar nerve at wrist
e. Radial nerve at wrist
Eddie comes to the emergency department 2 hours after his failed motorcycle stunt attempt to
impress the MERP faculty. During physical examination, he is noted as having difficultly adducting,
abducting the digits and weakness for wrist flexion. Based on his symptoms, which of the followings is
the most likely location of his injury?

a. Musculocutaneous at the axilla

b. Radial nerve at the elbow
c. Long thoracic nerve
d. Ulnar nerve at the elbow
e. Ulnar nerve at the wrist
The lateral end of the clavicle articulates with which of the
following structures?

a. Infraglenoid tubercle
b. Coracoid process
c. Acromion process
d. Manubrium
e. Glenoid fossa
Which of the followings are the roots of Musculocutaneous
nerve?

a. C5 -TI
b. C6 - C8
c. C8 & T1
d. C7 - TI
e. C5 - C7
A very talented MERP student, Manavi decided to challenge Olga for a one-on-one at MERP
parking lot. Olga , a secret Russian spy, immediately took a shot at her left upper arm that
resulted in a “click” sound. Damage to which of the following structures could be associated
with the damage to Manavi’s median nerve?

a. Medial epicondyle
b. Surgical neck of the humerus
c. Shaft of the humerus
d. Supracondylar fracture
e. Fracture of the ulna
Normal levels of which of the following enzymes would be
most helpful in ruling out acute pancreatitis in this patient?
a. Amylase
b. GGT
c. Albumin
d. Alkaline Phosphatase
e. Lipase
A 96-year-old male, D. Horn, PhD arrives to emergency department with left-side chest pain radiating
to his neck. His pain start 4-hours ago after he was grilled by his beloved MERP class on a few
controversial biochemistry questions. Along with EKG, which of the following tests will be most
valuable in pointing towards myocardial infarction?
a. CK-MB
b. Troponin-T
c. LDH-5
d. Myoglobin
e. LDH-1
D. Horn, PhD is admitted to the hospital and treated appropriately. On day
5 of his admission, he begins to experience left-sided chest pain. Which of
the following the following tests will be most valuable in pointing towards
new myocardial infarction?

a. CK-MB
b. Troponin-T
c. LDH-1
d. Myoglobin
e. CK
 In patients who have deep vein thrombosis, why is warfarin administered after
heparin?

a. Warfarin will cause a rapid decrease in clotting factors whereas heparin will induce synthesis of antithrombin
b. Warfarin will gradually cause a decrease in clotting factors whereas heparin will induce activation of antithrombin
c. Warfarin will cause a rapid decrease in clotting factors whereas heparin will induce synthesis of thrombin
d. Warfarin will gradually cause a decrease in clotting factors whereas heparin will induce synthesis of thromboplastin
e. Warfarin will gradually cause a decrease in clotting factors whereas heparin will induce synthesis of prothrombin
Which of the following can increase the binding affinity of
plasminogen for tPA and what would the consequence be?

a. Vitamin K; enhances thrombin formation

b. Fibrin; degradation of the fibrin clot by plasmin
c. Protein S; facilitates clot resolution
d. Protein C; facilitates clot resolution
e. Fibrin; decreased formation of protein C
 A patient on warfarin takes aspirin for a headache and later develops signs of bleeding.
What is the underlying reason for this?

a. Aspirin binds irreversibly to COX whereas warfarin acts by opposing the effect of aspirin
b. Aspirin activates the formation of thromboxane A2 whereas warfarin is a vitamin K antagonist
c. Aspirin inhibits the formation of thromboxane A2 whereas warfarin is a vitamin K antagonist
d. Aspirin inhibits conversion of prothrombin to thrombin whereas warfarin is a vitamin K antagonist
e. Warfarin inhibits conversion of fibrinogen to fibrin whereas aspirin inhibits thromboxane A2 formation
As a biomedical researcher, you have identified a new set of diagnostic markers for acute renal failure—Protein Blue,
Protein Red, and Protein Green. Based on protein sizes (kDa = kilodalton) and their circulating half-lives (half-life = how
long the protein is detectable in the blood), please identify the diagnostic chart of blood enzyme levels which best
represents acute renal failure.
Marker Molecular Weight Half-Life
Protein Red 135 kDa 24 h
Protein Blue 90 kDa 5 days
Protein Green 75 kDa 72 h

a. A
b. B
c. C
d. D
e. E
Which of the following would be MOST indicative of acute
myocardial infarction?

a. Elevated AST
b. Elevated total LDH
c. Elevated creatine kinase-MM isoenzyme
d. Elevated total creatine kinase
e. LDH-1 > LDH-2
As a new lab technician in the field of enzyme diagnostics, you run your first LDH isoenzyme test (shown
below). However, you inadvertently mix up the patient samples. Knowing that sample #8 represents normal
LDH isoenzyme levels, please match Patient A and Patient B with their appropriate sample numbers based on
their symptomatic disease,

Patient A: Chronic liver cirrhosis (viral hepatitis)

Patient B: Acute myocardial infarction + a crushing muscle injury

a. Patient A: #7; Patient B: #3

b. Patient A: #4; Patient B: #1
c. Patient A: #4; Patient B: #7
d. Patient A: #6; Patient B: #7
e. Patient A: #7; Patient B: #4
A 65 year old patient comes to you complaining of dull pain all
over this body. His urinalysis shows high calcium content. On
his X-ray of long bones and skull you see many lytic regions.
What is your most likely diagnosis?

a. Monoclonal gammopathy of undermined significance (MGUS)

b. Alzheimer’s disease
c. Parkinson’s disease
d. Multiple sclerosis
e. Multiple myeloma
The alphabets A to E show the different parts of the nephron in the figure below.
Which parts of the nephron does the potassium secretion take place?

a. A and B
b. A, C, and D
c. B, D, and E
d. C, D, E
Which of the following is TRUE regarding the role of the respiratory
system in acid-base balance?

a. Respiration becomes rapid and deep during metabolic alkalosis

b. Addition of acid by the formation of excess CO2 in the body is
compensated by hypoventilation.
c. Addition of non-volatile acids into the ECF results in increased rate and
depth of breathing
d. By hypoventilation, lungs increase plasma bicarbonate level when non-
volatile acids are added into the ECF
Which of the following blood gas values is consistent
with metabolic acidosis?

a. PCO2 of 25, HCO3 of 30, pH 7.7

b. PCO2 of 35, HCO3 of 20, pH 7.3
c. PCO2 of 40, HCO3 of 25, pH7.4
d. PCO2 of 50, HCO3 of 30, pH7.1
A 30 year old Female is admitted to the Emergency Department for
Acute Respiratory Failure. Her arterial blood gas analysis shows the
following data:
PaCO2=64mmHg
Arterial pH=7.2
Arterial bicarbonate concentration = 26 mEq/L
The above patient must be having:

a. Respiratory acidosis with no compensation

b. Respiratory acidosis with partial renal compensation
c. Mixture of metabolic and respiratory acidosis
d. Metabolic acidosis with partial respiratory compensation
A 66 year old male has a cardiopulmonary arrest, and is transported
to the hospital by paramedics. The data shown below are derived
from an arterial blood sample obtained upon admission.
Arterial pH=7.09
Arterial Bicarbonate=15mEq/L
Arterial Carbon Dioxide=50 mmHg
What type of acid-base abnormality is present?

a. Metabolic acidosis
b. Metabolic alkalosis
c. Mixed Alkalosis
d. Mixed Acidosis
Renal correction of hyperkalemia will result in:
a. Alkalosis
b. Acidosis
c. Increased secretion of HCO3-
d. Increased secretion of H+
Metabolic acidosis is caused by:

a. Hypoaldosteronism
b. Hypokalemia
c. Hypercalcemia
d. Hyperventilation
The figure below gives the relationship between the arterial pH and bicarbonate at various
arterial PCO2 (Davenport diagram). The point indicated by the letter “N” denotes the values
for a normal adult. The letters A to F represent various acid-base disturbances. Which letter
indicates uncompensated metabolic alkalosis?

a. A
b. B
c. C
d. D
e. E
f. F
The figure below gives the relationship between the arterial pH and bicarbonate at various arterial
PCO2 (Davenport diagram). The point indicated by the letter “N” denotes the values for a normal
adult. The letters A to F represent various acid-base disturbances. Which letter indicates
uncompensated respiratory acidosis?

a. A
b. B
c. C
d. D
e. E
f. F
The figure below gives the relationship between the arterial pH and bicarbonate at various arterial PCO2
(Davenport diagram). The point indicated by the letter “N” denotes the values for a normal adult. The
letters A to F represent various acid-base disturbances. Which letter indicates completely compensated
metabolic alkalosis or completely compensated respiratory acidosis?

a. A
b. B
c. C
d. D
e. E
f. F
Use the image below to answer this question. Which of the following letters in the table best describes
toxic shock syndrome toxin 1 (TSST-1)? APC: Antigen presenting cell.

Number(s) on the image

Structure Function
representing TSST-1 binding site
a. 3 and 4 Protein Induces cytokine secretion
b. 5 Protein Induces cytokine secretion
c. 3 and 4 Sugar and lipid Direct T cell and APC death
d. 1 and 2 Protein Direct T cell and APC death
e. 5 Sugar and lipid Direct T cell and APC death

a. A
b. B
c. C
d. D
e. E
A six-day-old newborn was admitted to the hospital with exfoliating erythematous lesions over the face, of
two days duration. The lesions spread to the rest of the body during the next two days. Which of the
following is most likely regarding the infection?

a. The child will subsequently develop food poisoning

b. Skin lesions will yield no bacteria when cultured
c. The infection involves deep dermis and subcutaneous layer
d. A blood culture will grow an obligate anaerobe
e. The child was infected with the organism in-utero (while in the womb)
A patient comes to your office complaining of a rapid onset of diarrhea and vomiting which she has experienced
for the last 3 hours. She has no fever and is alert. Her history reveals that she just flew in from Poland, and a few
hours before landing the passengers were served a crème-filled Pączki - a Polish national dish. A passenger next to
her was experiencing similar symptoms on the flight. You inform the patients that most likely:

a. she needs to take antibiotics for 10 days and her symptoms will resolve.
b. she is having an allergic reaction to the Pączki, and will imminently develop anaphylactic shock.
c. she is not contagious and the culture of her stool will reveal no pathogenic bacteria.
d. she has a liver infection and should get her blood drawn for further analysis.
e. her infection is highly contagious and she may pass it to close contacts.
Which of the following conditions would be best to isolate and
differentiate Staphylococcus aureus, from other bacteria?

a. Absence of oxygen, media containing red blood cells

b. Atmospheric oxygen, media containing mannitol and low salt
c. Atmospheric oxygen, media containing mannitol and high salt
d. Absence of oxygen, media containing chocolate agar and low salt
e. Presence of oxygen, media containing red blood cells
An 80‐year‐old female with cellulitis of her lower left leg is seen in the emergency room. She has a history of
diabetes. The toes, heel, and ankle were swollen and there was a bluish hematoma and blister located medially at
the heel. The ankle was tender to the touch and released a foul smelling gas. A CBC was notable for an elevated
white cell count of 30,000/mm3 with a left shift. The blister was drained for gram stain and culture. The gram stain
was significant for gram‐positive "box car" shaped rods with an absence of neutrophils. The cultures were
significant for anaerobic gram‐positive rods that were lecithinase positive, nonmotile, and produced a double zone
of hemolysis on anaerobic blood agar

What infection does this patient have?

a. Clostridium perfringens
b. Staph aureus
c. Bacillus anthracis
d. Group A strep
e. Clostridium Tetani
Which one of the following bacteria is carried by about 20% of women of child‐
bearing age and is a cause of sepsis and meningitis of the newborn?

a. Lactobacilli species
b. Group A streptcocci
c. Streptococcus pneumoniae
d. Group B streptococci
e. Staphylococcus species
The alpha‐toxin (lecithinase) produced by a certain Clostri
dium species causes

a. Gas gangrene
b. Botulism
c. Pseudomembranous colitis
d. Tetanus
e. Anthrax
6 hours after eating fried rice at a restaurant, a 30‐year‐old female, her husband,
and his sister developed nausea, vomiting, and diarrhea. Which one of the
following organisms is the most likely to be involved?

a. Bacillus anthracis
b. Bacillus cereus
c. Clostridium perfringens
d. Staphylococcus aureus
e. Clostridium botulinum
A Gram stain has been performed on a bacterial isolate taken from a sheep blood agar plate. Upon observation,
the cells appear to be red to pink rods. The organism is presumptively identified as Citrobacter koseri . The most
likely reason for the red color of the cells in the stain is that the

a. Peptidoglycan layer of the cell wall is relatively thin

b. Peptidoglycan layer of the cell wall is relatively thick
c. Organisms in this genus have a lipopolysaccharide outer membrane
d. Organisms in this genus have only a cytoplasmic membrane
e. Capsule tends to capture the safranin from the Gram stain reagent
Scarlet fever is a complication of streptococcal infection
and is preceded by

a. Pharyngitis
b. Toxic Shock Syndrome
c. Rheumatic fever
d. Glomerulonephritis
e. Pneumonia
Which nerve innervates gluteus maximus?

a. Superior gluteal
b. Inferior gluteal
c. Obturator
d. Femoral
What is the innervation of psoas major?

a. Anterior rami L1-L3

b. Anterior rami L2-L4
c. Femoral nerve
d. Obturator nerve
Which of the following is the correct classification of the
knee joint?

a. Hinge type synovial

b. Plane type synovial
c. Pivot type synovial
d. Ball and socket
Which of these muscles flexes at the knee and
plantarflexes at the ankle?

a. Soleus
b. Popliteus
c. Gastrocnemius
d. Tibialis posterior
Which of the four muscles in this compartment
cause eversion at the ankle?

a. Tibialis anterior
b. Extensor halluces longus
c. Extensor digitorum longus
d. Fibularis tertius
In the diagram below, which hormones play a role in steps 1 and
2 respectively?

a. TH and CRF
b. T3 and T4
c. CRF and ACTH
d. Cortisol and ACTH
e. ACTH and cortisol
In individuals on a normal iodine content diet, which amino acid residues in
thyroglobulin will become iodinated and which protein will transport iodine
out of the cuboidal cells?

a. Tyrosine residues; pendrin

b. Phenylalanine residues; iodine binding globulin
c. Tryptophan; iodine binding globulin
d. Tyrosine residues; TSH pentamer
e. Glutamine residues; pendrin
What is the role of 11 beta-hydroxysteroid dehydrogenase type
II?

a. It converts testosterone to estrogen

b. It converts testosterone to dihydrotestosterone
c. It converts cortisol to cortisone
d. It converts cortisone to cortisol
e. It converts dihydrotestosterone to testosterone
A 22-year-old female presents to her family physician with complaints of amenorrhea (irregular periods). She says that she
feels otherwise fine but lately has noticed that that has to get a facial waxing done too often then she did in the past. Her
boyfriend often comments about her facial hairs which is embarrassing to her. She has also noticed few stands of hairs on
her chest, just above her breasts. Physical examination reveals normal blood pressure, body temperature and hear rate and
genitalia. Blood tests reveal moderately high levels of DHEA, androstenedione and testosterone. Based on the physical
examinations and blood tests, what might your preliminary diagnosis for the patient’s condition.

a. Classical congenital adrenal hyperplasia due to deficiency of 21-hydroxylase (21-alpha hydroxylase)

b. Non-classical congenital adrenal hyperplasia due to deficiency of 21- hydroxylase (21-alpha hydroxylase)
c. Salt wasting disease due to lack of aldosterone production
d. Classical congenital adrenal hyperplasia due to deficiency of 17-alphahydroxylase (17-alpha hydroxylase)
e. Non-classical congenital adrenal hyperplasia due to deficiency of 17-alphahydroxylase (21-alpha hydroxylase)
While working on a cell culture experiment you have by mistake administered a chemical X
that inhibits endopeptidase present in the plasma membrane of the human beta cell clones.
How will the chemical X effect the function of these beta cells

a. Inhibit synthesis of insulin in the RER of the beta cells in

culture
b. Prevent maturation of pre-proinsulin into proinsulin in the
golgi apparatus of the beta cells
c. Prevent release of mature insulin by exocytosis into the
medium.
d. Prevent proteolytic cleavage of proinsulin into mature
insulin in the secretory vesicles of the beta cells
A 45 year old male presents to your clinic with recent weight gain,
fatigue, and joint pain. During your exam you note the patient has
thinning of the hair, slow memory, and bradycardia. You perform a blood
serum test on the patient. What is your diagnosis for this patient and
what lab values would you expect to find?

a. Graves’ disease; low T3/T4, high TSH

b. Hashimoto’s hypothyroidism; high T3/T4, low TSH
c. Graves’ disease; high T3/T4, low TSH
d. Hashimoto’s hypothyroidism; low T3/T4, high TSH
A 43-year-old male is admitted to the emergency room for severe pain in his left flank radiating to the
groin. The pain is intermittent and initiated after running a marathon on a hot summer day. The patient is
asked for a urine specimen and blood is detected in his urine. Additional diagnostic procedures reveal high
serum calcium level and high PTH levels. The most likely mechanism underlying the hypercalcemia in this
patient is:

a. Increased calcitonin release

b. Decreased 25 hydroxylase activity in the kidneys
c. Increased osteoclast activity
d. Loss of negative feedback regulation of PTH
X is a drug that inhibits diffusion of substances into the hypophyseal portal
blood vessels. What will be the direct effect of this drug on the endocrine
system?

a. Block the release of oxytocin and vasopressin from post. pituitary

b. Block the transport of oxytocin and vasopressin from hypothalamus to post. pituitary
c. Inhibit transport of hypothalamic releasing/inhibiting factors to the adenohypophysis
d. Inhibit release of all peripheral hormones
e. Inhibit receptor mediated downstream signaling by peripheral hormones
Menorrhagea (prolonged menstrual periods) and secondary amenorrhea (absence
of menstrual cycles may occur due to misbalance of which hormone?

a. HCG
b. Progesterone
c. Prolactin
d. Estrogen
If you were to block testosterone receptors on Sertoli cells, spermatogenesis would come to a
halt. What is the most likely cause behind the inhibition of spermatogenesis?

a. Loss of blood-testis barrier

b. Inhibition of testosterone production by Leydig cells
c. Loss of Sertoli cell population in the seminiferous tubules
d. Decrease in concentration of active testosterone in seminiferous tubules
Which is the most likely scenario in which a PPD skin test would yield a FALSE-
NEGATIVE result (PPD test involves injecting proteins from M. tuberculosis into the
dermis of the skin to measure a memory immune response)?
a. An individual co-infected with HIV-1 and has progressed to AIDS
b. An individual who received two PPD skin tests within 1 week from each other
c. An individual harboring a latent/dormant M. tuberculosis infection
d., An individual who is currently taking long-term antibiotics to suppress his/her tuberculosis
e. An individual who has received the BCG vaccine as a child (BCG vaccine is a
live-attenuated, non-virulent mycobacteria derived from cattle)
The Gram stain and acid-fast stain share similarities in their protocols for
differentiating bacteria. What is the most likely step omitted if Mycobacterium
leprae appears blue at the conclusion of the acid-fast staining procedure
(assume all other steps were done correctly)?

a. Addition of carbol fuchsin

b. Heating the slide for 5 min
c. Addition of acid-alcohol
d. (a) or (b)
e. (b) or (c)
What is NOT a unique characteristic of the Neisseria genus?

a. Gram-negative diplococci
b. Acid production via fermentation
c. Growth in Thayer-Martin medium
d. High levels of a specialized endotoxin
e. Possesses catalase, superoxide dismutase, and oxidase
A 3 year old child comes to the emergency room with a sore throat, difficulty
swallowing, and difficulty breathing. On exam there is obvious difficulty each time the
child tries to take in a breath with sounds suggesting obstruction. A lateral neck x-ray
shows a swollen epiglottis. Which of the following is the most likely characteristic of this
organism?

a. Causes a severe destruction of ciliated respiratory epithelium

b. Can only reproduce inside host cells
c. Require NAD and hemin to grow
d. Secrete super antigen exotoxin
e. Gram-negative diplococci; oxidase positive
Most common symptom of reactivation of tuberculosis is

a. Hypotension
b. Weight loss
c. Rash
d. Head ache
e. Nausea and vomiting