10
9.
During an experiment, a Southern blot analysis is done by digesting DNA samples with a single restriction endonuclease,
separating the digestion products by gel electrophoresis, and transferring them to a filter. The investigator probes the filter by
exposing it to a cDNA clone that encodes a single immunoglobulin-constant region. The figure shows the resulting pattern
with DNA samples isolated from different organs. Assuming there were no technical errors, the Southern blot analysis results
demonstrate which of the following processes?
(A) Affinity maturation
(B) Apoptosis
(C) Gene rearrangement
(D) RNA splicing
(E) Somatic hypermutation
10.
During a clinical study examining the effects of exercise, men between the ages of 20 and 30 years are evaluated during a 15-
minute session on a treadmill. The average pulse for the last 2 minutes of the session is 175/min. During the last minute of
exercise, various measurements are taken. Compared with the measurement before the session, which of the following is
most likely to be decreased?
(A) Cardiac output
(B) Oxygen consumption
(C) Pulse pressure
(D) Stroke volume
(E) Systolic blood pressure
(F) Total peripheral resistance
11
11.
A 26-year-old man is brought to the emergency department by ambulance 30 minutes after being shot in the leg. He is
unconscious and appears markedly pale. His pulse is 120/min, respirations are 16/min, and blood pressure is 80/60 mm Hg.
Compared with a healthy adult, which of the following findings is most likely in this patient?
Arterial Baroreceptor
Systemic Vascular
Pulmonary Vascular
Systemic Capillary
Firing Rate
Resistance
Resistance
Fluid Transfer
(A)
↑
↑
↑
filtration
(B)
↑
↓
↑
absorption
(C)
↑
↓
↓
filtration
(D)
↓
↑
↑
absorption
(E)
↓
↑
↓
filtration
(F)
↓
↓
↓
absorption
12.
A 17-year-old boy is brought to the emergency department 30 minutes after being found with a "blank stare" and flat facial
expression at a party. His pulse is 72/min, and blood pressure is 104/68 mm Hg. He is sitting upright and appears catatonic.
Physical examination shows rigidity. During the examination, he becomes hostile and attempts to assault the physician. This
patient most likely ingested which of the following drugs?
(A) Cocaine
(B) Diazepam
(C) Methamphetamine
(D) Oxycodone
(E) PCP (phencyclidine)
13.
A 26-year-old woman is brought to the emergency department because of an 8-hour history of severe back and abdominal
pain and mild but persistent vaginal bleeding. Ultrasonography of the abdomen shows a 2-cm ectopic pregnancy in the
ampulla. The ampulla has ruptured into the surrounding tissue. Fluid from this rupture will most likely be found in which of
the following locations?
(A) Lesser peritoneal cavity
(B) Mesometrium
(C) Pouch of Douglas
(D) Uterine cavity
(E) Vagina
14.
A 14-year-old girl has had nausea, intermittent diarrhea, and a 2.2-kg (5-lb) weight loss over the past 4 weeks. Examination
shows a migrating serpiginous pruritic perianal rash. Her leukocyte count is 8000/mm
3
with 20% eosinophils. Which of the
following tests is most likely to yield an accurate diagnosis?
(A) Blood smear
(B) Bone marrow biopsy
(C) KOH preparation
(D) Microscopic examination of the stool
(E) Skin snip
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15.
A 40-year-old woman comes to the physician because of a 6-month history of increased facial hair growth. Her last menstrual
period was 4 months ago. She is 165 cm (5 ft 5 in) tall and weighs 70 kg (154 lb); BMI is 26 kg/m
2
. Her pulse is 80/min, and
blood pressure is 130/82 mm Hg. Physical examination shows temporal balding and coarse dark hair on the upper lip and
chin. Pelvic examination shows clitoral enlargement. Her serum testosterone concentration is increased. Serum
concentrations of androstenedione, dehydroepiandrosterone, and urinary 17-ketosteroids are within the reference ranges.
Ultrasonography of the pelvis shows a 12-cm ovarian mass. Which of the following best describes this mass?
(A) Granulosa tumor
(B) Ovarian carcinoid
(C) Sertoli-Leydig tumor
(D) Teratoma
(E) Thecoma
16.
A 45-year-old woman with systemic sclerosis (scleroderma) comes to the physician because of a 3-week history of
progressive shortness of breath and nonproductive cough. Her temperature is 36.9°C (98.4°F), pulse is 82/min, respirations
are 20/min, and blood pressure is 136/85 mm Hg. Crackles are heard in both lower lung fields. Pulmonary function tests
show total lung capacity is 80% of predicted, and diffusing capacity for carbon monoxide, corrected for alveolar volume, is
65% of predicted. Histologic examination of a lung biopsy specimen is most likely to show which of the following findings?
(A) Diffuse interstitial fibrosis
(B) Intra-alveolar exudates
(C) Multiple thromboemboli
(D) Necrotizing vasculitis
(E) Non-necrotizing interstitial granulomas
17.
A new blood test to detect prostate cancer is evaluated in 300 male volunteers. A needle biopsy of the prostate gland is done
on all men with serum prostate-specific antigen concentrations greater than 5 ng/mL (N<4). One hundred men undergo
biopsy procedures; 90 are found to have prostate cancer, and five are found to have chronic prostatitis. Which of the
following is necessary to calculate the sensitivity of this test?
(A) Incidence of chronic prostatitis in the general population
(B) Number of men with test results greater than 5 ng/mL and a normal biopsy specimen
(C) Prevalence of chronic prostatitis in the general population
(D) Prostate biopsies of men with test results equal to or below 5 ng/mL
18.
A 62-year-old woman comes to the physician because of low back pain for 1 week. Menopause occurred 10 years ago.
Physical examination shows localized tenderness over the lumbar spine after movement. X-rays of the spine show a
compression fracture of L1-2. A DEXA scan shows decreased bone mineral density. Serum calcium and phosphorus
concentrations and serum alkaline phosphatase activity are within the reference ranges. A bisphosphonate drug is prescribed.
The expected beneficial effect of this drug is most likely due to which of the following actions?
(A) Decreased insulin-like growth factor-1 concentration
(B) Decreased osteoclast
activity
(C) Decreased osteoprotegerin production
(D) Increased 1,25-dihydroxycholecalciferol concentration
(E) Increased osteoblast activity
(F) Increased receptor activator of NF-κB ligand (RANKL) production