Transcript Scientific Competition

Scientific Competition
Filling instructions
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Question 1
The classic location for an abdominal aortic aneurysm is inferior to the
renal arteries and extending to the bifurcation of the common iliac
arteries. Repair involves resecting the diseased portion of the aorta. Which
of the following visceral arteries would likely be resected along with the
diseased aortic tissue during this repair?
(A) Gastroduodenal artery
(B) Hepatic artery
(C) Inferior mesenteric artery
(D) Left gastric artery
(E) Superior mesenteric artery
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Question 2
A dysfunctional myocardial endothelium underlies ischemic heart disease
and its pathology is most often from severe narrowing of atherosclerotic
coronary vessels. Which of the following is a soluble metabolite that
mediates the compensatory coronary artery vasodilation during periods of
increased myocardial oxygen demand?
(A) Acetylcholine
(B) Adenosine
(C) Carbon dioxide
(D) Lactate
(E) Norepinephrine
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Question 3
Cardiac output is a function of stroke volume and heart rate. Stroke
volume increases when contractility increases, preload increases, or
afterload decreases. Which of the following variations would increase
cardiac output?
(A) β-Blocker treatment
(B) Aortic stenosis
(C) Cardiac glycoside administration
(D) Decreased intracellular calcium concentration
(E) Increased extracellular sodium concentration
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Question 4
A 50-year-old man presents to the emergency department because of
retrosternal chest pain that started four hours ago and is becoming severe.
After a thorough work-up he is diagnosed with an acute myocardial
infarction (MI). Which of the following laboratory test elevations is most
specific for MI?
(A) Alanine aminotransferase
(B) Aspartate aminotransferase
(C) Creatine kinase-MB fraction
(D) Lactate dehydrogenase
(E) Troponin I
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Question 5
A 62-year-old breast cancer survivor complains about weakness, fatigue,
fever, and weight gain 5 years following her radiation therapy. Physical
examination reveals hepatomegaly and jugular venous distention that fails
to subside on inspiration, with no evidence of hypotension or pulsus
paradoxus. An echocardiogram shows reduced end-diastolic volumes and
elevated diastolic pressures in both ventricles. Which of the following is
the most likely diagnosis?
(A) Cardiac tamponade
(B) Congestive heart failure
(C) Constrictive pericarditis
(D) Dilated cardiomyopathy
(E) Recurrence of breast cancer
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Question 6
A patient presents for treatment of his severe essential hypertension. He is
being treated with numerous medications for high blood pressure, and
hydralazine was recently added to his medication regimen. He has been
experiencing flushing and headaches since hydralazine therapy was started.
Which of the following is an adverse effect of Hydralazine?
(A) Angina
(B) Cardiotoxicity
(C) Cyanide toxicity
(D) Nephrotoxicity
(E) Pulmonary embolism
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Question 7
A 10-year-old boy presents with a low-grade fever, anorexia, nausea,
vomiting, and abdominal pain. The pain initially began periumbilically and
developed into severe right lower quadrant pain after several hours. The
child is diaphoretic and lies still; involuntary guarding and rebound are
present. Pain is elicited when the child is placed on his left side and the
right leg is raised against resistance. Which of the following provides
innervation to the muscle involved in this manoeuvre?
(A) Inferior gluteal nerve
(B) Lumbar plexus and femoral nerve
(C) Obturator nerve
(D) Sciatic nerve
(E) Superior gluteal nerve
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Question 8
A 51-year-old man has a lengthy history of medication-dependent reflux
esophagitis. Laboratory tests reveal a blood gastrin level three times the
upper limit of normal. His physician expresses concern that the patient is at
risk of developing atrophic gastritis. Which of the following medications is
this patient most likely taking?
(A) Aluminum hydroxide
(B) Bismuth
(C) Cimetidine
(D) Misoprostol
(E) Omeprazole
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Question 9
An obese 40-year-old multiparous woman comes to the physician because
she has been experiencing right upper quadrant pain with nausea and
vomiting precipitated by fatty foods. Results of a right upper quadrant
ultrasound show multiple gallstones. Laboratory studies show:
HDL cholesterol: 33 mg/dL
Total cholesterol: 280 mg/dL
Triglycerides: 420 mg/dL
LDL cholesterol: 170 mg/dL
Which of the following drugs is relatively contraindicated in this patient’s
treatment?
(A) Ezetimibe
(B) Gemfibrozil
(C) Niacin
(D) Pravastatin
(E) Simvastatin
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Question 10
A 27-year-old man presents to his family physician for an annual physical
examination. On rectal examination, masses are palpated. The patient is
referred for a colonoscopy, which reveals adenomatous polyps located
diffusely throughout the colon. The patient states that his father passed
away from colon cancer. Which of the following inheritance patterns is
characteristic of this condition?
(A) Autosomal dominant
(B) Autosomal recessive
(C) Autosomal trisomy
(D) Sex chromosome abnormality
(E) X-linked recessive
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Question 11
A 51-year-old man complains of recurrent vomiting and sometimes
throwing up blood. There is some lower extremity edema and tortuous
veins on the surface of his abdomen. He has had several recent sexual
partners, and has never been tested for sexually transmitted diseases. He
admits drinking a “few” drinks a night. Results of a liver biopsy are shown
in the image. Which of the following best describes the pathologic process
occurring in this patient’s liver?
(A) At this stage in disease, hepatocytes
fail to regenerate
(B) Lipid deposition is taking place
(C) Mallory bodies are commonly seen
(D) The architectural changes are
irreversible
(E) The liver will be enlarged
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Question 12
A 17-year-old girl who is being treated with antibiotics for recurrent sinus
tract infections presents to the physician with intractable watery diarrhea
and cramps. Which of the following is most often associated with this
patient’s condition?
(A) Clostridium difficile
(B) Clostridium perfringens
(C) Escherichia coli
(D) Staphylococcus aureus
(E) Vibrio cholerae
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Question 13
A 57-year-old woman comes to the physician 6 weeks after returning from
a trip to Greece. She has had a fever of 38.8 °C (101.8 °F) that rises during
the day and decreases at night. She feels tired and has lost weight. She
mentions she tried fresh goat cheese. Her physical examination is notable
for hepatosplenomegaly and generalized lymphadenopathy. Which of the
following organisms is most likely responsible for this patient’s symptoms?
(A) Bartonella henselae
(B) Brucella melitensis
(C) Pasteurella multocida
(D) Plasmodium malariae
(E) Plasmodium falciparum
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Question 14
The diagram below depicts the arterial network of the brain. Infarction of
the artery designated by arrow “A” would lead to which of the following
deficits?
(A) Contralateral motor deficits of the arm and hand
(B) Contralateral motor deficits of the face
(C) Contralateral motor deficits of the leg and foot
(D) Ipsilateral motor deficits of the face
(E) Ipsilateral motor deficits of the leg and foot
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Question 15
During the autopsy of a patient noted to have xanthochromia (on
cerebrospinal fluid examination), the pathologist removes the calvarium
and the attached dura. On the surface of the brain there is frank blood that
cannot be removed by rubbing or scraping the surface. Which of the
following most likely caused this finding?
(A) Ruptured aneurysm
(B) Intraparenchymal hemorrhage
(C) Intradural hemorrhage
(D) Tearing of bridging veins
(E) Temporoparietal bone fracture
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Question 16
A 76-year-old woman dies at home from sudden cardiac arrest after the
onset of ventricular fibrillation. The autopsy reveals several small infarcts
throughout the basal ganglia. Assuming that the defects arise from a single
vessel, pathology from which artery would be most consistent with this
finding?
(A) Anterior cerebral artery
(B) Anterior communicating artery
(C) Lateral striate artery or lenticulostriate arteries
(D) Posterior cerebral artery
(E) Vertebral cerebral artery
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Question 17
A researcher studying the function of the hypothalamus ablates the
supraoptic hypophyseal tract in laboratory rats. Which of the following
processes will be impaired in these animals?
(A) Concentration of urine
(B) Milk synthesis
(C) Ovulation
(D) Salt retention
(E) Spermatogenesis
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Question 18
A 33-year-old woman complains of pain behind her right ear since that
morning. Neurological examination is notable for paralysis of the right side
of her face, decreased taste sensation on the right side of her tongue, and
increased sensitivity to loud sounds in her right ear. In addition to the
symptoms described above, this patient may also develop:
(A) Decreased sensation over her right upper cheek
(B) Deviation of the uvula and soft palate to the left when the patient is
asked to say “Ahh”
(C) Deviation of the uvula and soft palate to the right when the patient is
asked to say “Ahh”
(D) Dryness in her left eye
(E) Dryness in her right eye
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Question 19
A 71-year-old woman is diagnosed with non-Hodgkin lymphoma. Soon
after starting her first cycle of chemotherapy, she reports severe nausea
and vomiting. Prochlorperazine is prescribed to control this adverse effect.
Upon which of the following labeled areas of the brain does
prochlorperazine act?
(A) 1
(B) 2
(C) 3
(D) 4
(E) 5
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Question 20
A 25-year-old man with a history of intractable seizures has recently been
switched to a new antiseizure medication. He subsequently develops a rash
on his body, which consists of maculopapular blistering lesions and
develops gum hyperplasia. Which of the following medication is most
likely to have resulted in the patient’s symptoms?
(A) Carbamazepine
(B) Gabapentin
(C) Phenytoin
(D) Valproic acid
(E) Topiramate
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Question 21
A physiologist divides the lung into three zones, with the apex being zone
1, the middle region being zone 2, and the base being zone 3. He applies a
small amount of positive pressure ventilation while studying blood flow in
different lung zones. Which of the following will be noted in this
experiment assuming the subject is standing?
(A) Blood flow in zone 3 will be driven by the difference between alveolar
and venous pressures
(B) Blood flow will be reduced in zone 1
(C) Blood flow will be continuous in zone 2
(D) Regional differences between blood flow will not be as great as
differences in ventilation
(E) Whether supine or standing, blood flow will remain uneven throughout
the lung zones
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Question 22
A 62-year-old woman underwent bilateral knee replacement and was
discharged without complications. Nine days after surgery she develops
severe respiratory distress and dies suddenly. Postmortem examination of
her pulmonary artery reveals the pathology seen in the image. What
medical condition could predispose to a similar pathology as observed in
this patient?
(A) Aspiration
(B) Factor V deficiency
(C) Factor VIII deficiency
(D) Protein C deficiency
(E) Thrombocytopenia
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Question 23
A 65-year-old man with an 80-pack-year history of smoking experiences
cough and increasing dyspnea over the past six weeks. A 2-cm mass in the
left lower lobe of the lung was biopsied, revealing squamous cell
carcinoma. A sample of non-neoplasic tissuefrom the lung biopsy is shown
in the image.
Which of the following types of epithelium
not normally present in the lung lines the
bronchus shown in this
image?
(A) Pseudostratified columnar
(B) Simple squamous
(C) Stratified columnar
(D) Stratified squamous
(E) Transitional
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Question 24
A 64-year-old retired shipyard worker has been experiencing shortness of
breath, a cough, and chest pain for five months. In that time he has lost
14.5 kg (32 lb). He develops progressive ascites, and ultimately dies due to
a pulmonary embolus. Autopsy results are shown in the image. Exposure
to which substance is a risk factor for this patient’s disorder?
(A) Aflatoxin B
(B) Asbestos
(C) Benzene
(D) Cadmium
(E) Silica
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Question 25
An 18-year-old man comes to the physician complaining of a runny nose,
sneezing, and difficulty breathing for the past 2 days. His younger sister
received a baby kitten 2 days ago. The response seen in this patient is
mediated by which of the following?
(A) Antigen-antibody complexes activating complement
(B) Antigen cross-linking IgE on presensitized mast cells and basophils
(C) IgM and IgG binding to antigens on enemy cells
(D) Sensitized T lymphocytes releasing lymphokines
(E) Serum sickness
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Question 26
An 8-year-old boy has had respiratory problems that have arisen since an
upper respiratory infection 4 months ago. The patient has attacks
characterized by wheezing and shortness of breath that usually resolve
after an hour. The doctor explained that the boy had an abnormally high
level of eosinophils in his blood. Which cytokine is involved in the
pathogenesis of this disease?
(A) Interferon-γ
(B) Interleukin-2
(C) Interleukin-4
(D) Interleukin-10
(E) Tumor growth factor−β
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Question 27
A 36-year-old woman with a history of leukemia receives a bone marrow
transplant. Two and a half weeks later, she experiences fever, cough, and
dyspnea. Bronchoalveolar lavage reveals large cells with prominent
intranuclear inclusions, as shown in the image. What is the most likely
cause of this patient’s infection?
(A) Candida albicans
(B) Cytomegalovirus
(C) Mycobacterium tuberculosis
(D) Pneumocystis jiroveci
(E) Toxoplasma gondii
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Question 28
Public health investigators are looking into a series of illnesses in a small
community. Many patients presented with acute-onset hyperpyrexia and a
particularly severe pneumonia. Gram staining of their sputum cultures
reveals neutrophils and very few organisms. Which of the following
organisms is most likely to have caused this outbreak?
(A) Bordetella pertussis
(B) Haemophilus influenzae type B
(C) Legionella pneumophila
(D) Mycobacterium tuberculosis
(E) Streptococcus pneumoniae
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Question 29
The following graph was obtained by collecting and assaying urine from a
healthy volunteer given varying amounts of glucose by intravenous
infusion. Which statement concerning the graph is most accurate?
(A) Glomerular filtration of glucose is saturated at 375 mg/dL
(B) Proximal convoluted tubule glucose reabsorption is saturated at 375
mg/dL
(C) Proximal convoluted tubule glucose
secretion begins at 200 mg/dL
(D) Proximal convoluted tubule glucose
secretion begins at 375 mg/dL
(E) Urine glucose begins to be detectable
at 375 mg/dL
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Question 30
A man accidentally chops into his arm, causing it to bleed profusely.
Although pressure is applied to the wound, there is continued blood loss.
Upon arrival to hospital, he appears lethargic and pale. Which of the
following set of vital signs would most likely be seen in this patient as he is
being transported to the hospital?
(A) A
(B) B
(C) C
(D) D
(E) E
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Question 31
A 63-year-old man measures his blood pressure at home and find it to be
168/100 mm Hg. The patient has had high blood pressure for the past 12
months that has not improved with dietary changes, exercise, or
medication. A physical examination is unremarkable except for a murmur
heard when auscultating the abdomen just to the left of the midline. What
is the most likely cause of the patient’s hypertension?
(A) Decreased levels of ADH
(B) Decreased levels of angiotensin II
(C) Elevated levels of aldosterone
(D) Excessive production of cortisol
(E) Increased levels of angiotensin-converting enzyme
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Question 32
A 67-year-old woman with osteoporosis is given a diuretic to treat her
hypertension. This particular diuretic has the adverse effect of limiting
calcium excretion by the kidney. Referring to the image, where along the
nephron does this drug act?
(A) A
(B) B
(C) C
(D) D
(E) E
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Question 33
A newborn with hypercalciuria and hypokalemic alkalosis is diagnosed with
neonatal Bartter’s syndrome, a rare inherited dysfunction of the thick
ascending limb of the nephron. Which diuretic may mimic these symptoms
by blocking a cotransporter found in this part of the nephron?
(A) Acetazolamide
(B) Furosemide
(C) Hydrochlorothiazide
(D) Mannitol
(E) Triamterene
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Question 34
A 5-year-old girl has generalized edema and laboratory testing reveals
proteinuria of 5 gm/day, and podocyte foot process effacement is seen on
electron microscopy of a kidney biopsy. Disruption of which of the
following components of the filtration barrier is contributing to this
patient’s proteinuria?
(A) Brush border
(B) Endothelial cell
(C) Heparan sulfate
(D) Integrin
(E) Type IV collagen
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Question 35
A 57-year-old woman is scheduled for elective hysterectomy. Severing
which of the following structures during surgery would most severely
disrupt blood flow to the ipsilateral ovary?
(A) Cardinal ligament
(B) Fallopian tube
(C) Round ligament
(D) Suspensory ligament
(E) Ureter
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Question 36
A 46,XY infant is born with a nonsense mutation in the SRY gene. The
product of the SRY gene is most directly responsible for which of the
following normal processes in the sexual development of male fetuses?
(A) Development of internal male genitalia from the mesonephric duct
(B) Development of testes from indifferent gonads
(C) Development of the genital tubercle into the glans penis
(D) Development of the urogenital sinus into the prostate gland
(E) Involution of paramesonephric ducts
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Question 37
A 26 year-old monogamous female presents with cyclic pelvic pain that has
been increasing over the last 6 months. She complains of significant
dysmenorrhea and dyspareunia. She uses condoms for birth control. On
physical examination her uterus is retroverted and non-mobile, and she has
a palpable adnexal mass on the left side. Her serum pregnancy test is
negative. Which of the following is the most likely diagnosis?
(A) Ovarian cancer
(B) Endometriosis
(C) Functional ovarian cyst
(D) Pelvic inflammatory disease
(E) Leiomyoma
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Question 38
A 29-year-old woman complains of a “fishy”-smelling vaginal odor
noticeable during intercourse. Pelvic examination reveals a homogenous
gray-white discharge, and a saline wet mount of vaginal epithelial cells is
obtained (see image). What is the morphology of the organism that is
causing this patient’s symptoms?
(A) Budding yeast and/or hyphae
(B) Gram-negative diplococci
(C) Gram-positive rod
(D) Obligate intracellular parasite
(E) Pleomorphic, gram-variable rod
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Question 39
A 24-year-old woman presents with severe right lower quadrant pain. She
has had multiple sexual partners but has been faithful to her husband for
the last three years. A urine β-human chorionic gonadotropin test is
positive, but no gestational sac is visualized on transvaginal ultrasound
imaging. During the examination, her pain increases and she is becoming
tachycardic. Which of the following best characterizes the organism most
likely predisposed this woman to her current clinical picture?
(A) It is a gram-negative bacillus
(B) It is a gram-variable bacillus
(C) It is a spirochete
(D) It is a teardrop-shaped trophozoite
(E) It is an obligate intracellular organism
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Question 40
A young couple is having trouble conceiving and decides to undergo in vitro
fertilization. The woman begins treatment to stimulate ovulation prior to
ova collection and fertilization. Which of the following hormones is most
directly responsible for ovulation?
(A) Estrogen
(B) Follicle-stimulating hormone
(C) Gonadotropin-releasing hormone
(D) Luteinizing hormone
(E) Progesterone
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