Board Review Week 1 Test

Good luck!!

Question 1 of 40

A 20-year-old man arrives at the emergency room asking for a strong pain killer because he is in serious pain. The attending physician notices that he is very anxious and is sweating. The man states that he has no appetite, he has a runny nose, nausea, stomach cramps and diarrhea. He said that he took his temperature at home at it was 100F. While he talks he is continuously yawning and restless. The attending physician recognizes that he is abusing a certain substance and is experiencing withdrawal. Which substance is it?

(A) Alcohol

(B) Cocaine

(C) Amphetamines

(D) Barbiturates

(E) Opioids

E   Opioids

The patient is experiencing the classic symptoms of withdrawal from opioids which are anxiety, insomnia, anorexia, sweating, piloerection, fever, rhinorrhea, nausea, stomach cramps, diarrhea, yawning. Symptoms usually appear within 8 to 10 hours after abstinence. The onset is longer if methadone has been withdrawn. These symptoms peak within 48 to 72 hours and then disappear in 7 to 10 days. Methadone lessens the effects of withdrawal. It should be given no more than 20-50mg/day. Alcohol withdrawal appears within a few hours of stopping or decreasing alcohol consumption. It lasts for three to four days and sometimes as long as a week. The patient experiences tachycardia, tremulousness, diaphoresis, nausea, orthostatic hypotension, malaise, anxiety, and irritability. Benzodiazepine should be administered in a tapering dose over three days. Cocaine withdrawal is classified by psychological symptoms such as increased sleep, REM rebound causing nightmares, lassitude, increased appetite, depression, and suicide attempts. Treatment would consist of an antidepressant such as bupropion. Amphetamine withdrawal would include a post use crash, including anxiety, lethargy, headache, stomach cramps, hunger, severe depression, dysphoria mood, fatigue, and insomnia or hypersomnia. Barbiturate withdrawal is characterized by anxiety, seizures, delirium, and life threatening cardiovascular collapse.

Question 2 of 40

A 42-year-old white female delivers her third child while you are on call at a local hospital on the Atlantic coast. She thanks you for your help and mentions that she is grateful that her baby was on time. She states that the family is planning on taking their newest with them to Colorado in 2 weeks. You advise her not to attempt the trip, as the baby will have difficulty adjusting to the high altitudes. Which of the following factors is a major component in closure of the ductus arteriosus?

(A) Increase in pulmonary arterial pressure associated with increase in blood flow to the lungs

(B) Reduction of aortic arterial pressure due to reduction in systemic resistance

(C) Decrease in carbon dioxide levels in the blood

(D) Increase in oxygen tension within the blood

(E) Presence of prostaglandin E2 in the wall of the ductus arteriosus

D   Increase in oxygen tension within the blood

To state that increase in pulmonary arterial pressure associated with increase blood flow to the lungs is the major component in closure of the ductus arteriosus is to state the opposite of actual events. Pulmonary pressure and pulmonary blood pressure decreases, resulting in a decrease flow from the pulmonary circuit to the systemic circuit. To state that reduction of aortic arterial pressure due to reduction in systemic resistance is a major component in closure of the ductus arteriosus is to state the opposite of actual events. After birth, systemic blood pressure rises as a result of increased effective blood volume and decreased pulmonary resistance. The ductus no longer serves as a shunt from pulmonary to systemic circulation. As gas exchange increases, the amount of carbon dioxide in the neonate will decrease. However, this does not initiate vasoconstriction and closure of the ductus arteriosus. Increase in oxygen tension is thought to be the primary initiator of closure of the ductus arteriosus. The pO2 increases from 15 to 20 mm Hg to around 100 mm Hg in a few hours. Prostaglandins are thought to be responsible for maintaining patency of the ductus arteriosus.

Question 3 of 40

The nucleated cell as seen in this photomicroscopic image is best described as which cell type?

(A) Neutrophil

(B) Basophil

(C) Eosinophil

(D) Lymphocyte

(E) Monocyte

E   Monocyte

This cell represents a mononuclear leukocyte and is regarded as agranular, even though small, faintly staining granules may be seen in the cytoplasm. The monocyte is a large cell with a diameter of 10-15mm. The nucleus is never segmented, but it usually stains less dense than a lymphocyte and appears rounded, kidney or horseshoe-shaped. Several nucleoli may be visualized. The "agranular" appearance of the cytoplasm is due to the presence of fine, abundant azurophil granules. These cells differentiate in the tissue into macrophages.

Question 4 of 40

The city of Cancerville had a population of 10,000,000 (50% women) in 1995. In 1995, there were 80,000 women with previously diagnosed ovarian cancer in Cancerville. Twenty thousand new cases of ovarian cancer were diagnosed in 1995. What was the incidence rate of ovarian cancer in Cancerville in 1995?

(A) 2000 per One hundred thousand population

(B) 4000 per One hundred thousand population

(C) 200 per One hundred thousand population

(D) 400 per One hundred thousand population

(E) 1,000 per One hundred thousand population

D   400 per One hundred thousand population

The incidence rate is the number of new cases of a disease during a specific period per population at risk. Twenty thousand divided by 5 million women gives a rate of 1 case per 250 women, or 400 cases per One hundred thousand populations.

Question 5 of 40

The glossopharyngeal nerve, the stylopharyngeus muscle, and the lower part of the body of the hyoid bone arise from this branchial arch

(A) First branchial arch

(B) Second branchial arch

(C) Third branchial arch

(D) Fourth branchial arch

(E) Fifth branchial arch

(F) Sixth branchial arch

C   Third branchial arch

Arch* Nerve Muscles Skeletal structures Ligaments

First TrigeminalMuscles of mastication, Mylohyoid, anterior belly of digastric, tensor tympani, tensor veli palatini

Malleus, incus

Anterior of malleus, sphenomandi-bular

Second

FacialMuscles of facial expression, stapedius, stylohyoid, posterior belly of digastric

Stapes, styloid process, lesser cornu of hyoid, upper part of body of hyoid bone

Stylohyoid

Third Glosso-pharyngeal Stylo-pharyngeusGreater cornu of hyoid, lower part of body of hyoid bone

 

Fourth and Sixth

Superior and recurrent laryngeal branches of vagus

Cricothyroid, Levator veli palatini, constrictors of pharynx, intrinsic muscles of larynx, striated muscles of esophagus

Thryoid, cricoid, arytenoid, corniculate, and cuneiform cartilages

 

The fifth arch is often absent, and when present, it is rudimentary.

Question 6 of 40

The cell found in the peripheral blood associated with secretion of the vasoactive agent referred to as slow-reacting substance (SRS) of anaphylaxis is the

(A) Neutrophil

(B) Eosinophil

(C) Lymphocyte

(D) Basophil

(E) Monocyte

D   Basophil

The basophil as found in the peripheral blood contains large, darkly staining, membrane-bound granules that contain a variety of substances, including SRS, heparin sulfate and histamine. Upon stimulation, the release of histamine and SRS will induce the dilation of small blood vessels. The basophil, as found in the peripheral blood, may be related, at least functionally, to the tissue mast cell.

Question 7 of 40

One of blood cells in a blood smear taken from a female subject showed a drumstick-like appendage on one of the lobes of its nucleus. To which one of the following types of blood cells does this cell belong?

(A) Acidophils

(B) Basophils

(C) Neutrophils

(D) Monocytes

     

(E) Lymphocytes

C   Neutrophils

In females, the inactive X chromosome appears as a drumstick-like appendage on one of the lobes of the nucleus. This is not obvious in all neutrophils, however. Acidophils, basophils, monocytes, and lymphocytes do not show such structures.

Question 8 of 40

A laboratory has developed a new test for rapid ascertainment of serum parathyroid hormone levels. The test is repeated twenty times on the same sample with a resulting coefficient of variation of one percent. This is a measure of

(A) Accuracy

(B) Reliability

(C) Precision

(D) Validity

(E) Mode

B   Reliability

The mode is the most commonly occurring value in a series of data. Reliability is a measure of the reproducibility of a test over different conditions. The four most common types are inter-observer reliability, intra-observer reliability, split-sample reliability, and repeat testing reliability. Accuracy is a measure of the extent to which a test approximates the real value of that which is measured. New tests are measured against the gold standard, if one exists. Validity is the assessment of the degree to which a test measures that for which it was designed. In other words, you need to determine whether it reflect the outcome of interest or other outcomes. Precision is the degree to which a measurement is not subject to random variation.

Question 9 of 40

Which of the following is true

(A) The umbilical vein becomes the ligamentum venosum

(B) The ductus venosus becomes the ligamentum teres

(C) The foramen ovale closes during late childhood

(D) The ductus arteriosus becomes the ligamentum arteriosum

(E) Patent ductus arteriosus is associated with mumps during early pregnancy

D   The ductus arteriosus becomes the ligamentum arteriosum

The umbilical vein becomes the ligamentum teres and the ductus venosus becomes the ligamentum venosum. The foramen ovale closes at birth in 75% of the population. The patent ductus arteriosus is the most common congenital malformation associated with maternal rubella infection during pregnancy.

Question 10 of 40

At a large university, a study of pulse rates at rest was conducted on 5000 students. The mean pulse rate was 70, with a standard deviation of 10. Which of the following statements is true?

(A) Approximately 95% of the students had pulses between 60 and 80

(B) Approximately 68% of the students had pulses between 60 and 80

(C) Approximately 99.7% of the students had pulses between 50 and 90

(D) Approximately 95% of the students had pulses between 40 and 100

(E) Approximately 68% of the students had pulses between 50 and 90

B   Approximately 68% of the students had pulses between 60 and 80

When a test is conducted on a normally distributed population, 68% of the population will have values within one standard deviation of the mean, 95% of the population will have values within two standard deviations of the mean, and 99.7% of the population will have values within three standard deviations of the mean. Therefore, in this population, 68% of the pulses will be between 60 and 80, 95% between 50 and 90, and 99.7% between 40 and 100.

Question 11 of 40

Simon is an active, physically strong 10-year-old who stays out late at night with his friends despite his parents forbidding it. He has run away from home several times and is truant from school frequently. When he attends school, he takes other children's lunch money from them, threatens and intimidates them, and seems to enjoy getting into fights. He has attacked one student with a brick and has destroyed library books just for the fun of it. A good talker, he often has a good "cover story" for where he has been when something has been stolen or is broken. A favorite weekend activity in which Simon has been engaging for the past six months is shoplifting. Your diagnosis would be

(A) Oppositional Defiant Disorder

(B) Conduct Disorder

(C) Antisocial Personality Disorder

(D) Disruptive Behavior Disorder Not Otherwise Specified

(E) Attention-Deficit/Hyperactivity Disorder NOS

B   Conduct Disorder

Conduct Disorder, which may develop as early as 5-6, is seen more frequently in physically strong males and the symptoms frequently include lying, truancy, running away from home, theft, fighting and intimidation, cruelty, and destruction of property. One symptom of the disorder must be present for at least six months and in this instance it is shoplifting. The disorder may continue to increase in seriousness until the adult years, when crimes of burglary and sexual misconduct are seen and the diagnosis may be that of Antisocial Personality Disorder. The behavioral symptoms provided in this illustration are classic Conduct Disorder. Antisocial Personality Disorder is not diagnosed before age 18. Disruptive Behavior Disorder NOS would not be appropriate since the criteria for Conduct Disorder are fully met. Attention-Deficit/Hyperactivity Disorder NOS is not adequate because the illustration fails to provide evidence of inattention or hyperactivity-impulsivity. Oppositional Defiant Disorder would not be given because it fails to meet the criteria for frequent loss of temper, arguing with adults, refusing to comply with requests, blaming, vindictiveness, and hostility. Simon may engage in some of these, but his prominent symptoms are clearly in the area of how he conducts himself.

Question 12 of 40

Components of the face are derived in part from which pharyngeal arch?

(A) First

(B) Second

(C) Third

(D) Fourth

(E) Fifth

(F) Sixth

A   First

The first pharyngeal (branchial) arch gives rise to the endochondral and dermal bones of the upper and lower jaw. As it develops, the maxillary and mandibular swellings form. They will give rise to the upper and lower jaws, respectively. In short, the first arch gives rise to the bottom half of the face, including the mastication muscles (temporalis, masseter, and pterygoids).

Question 13 of 40

A statistician analyzes data for several academic departments. She is free to choose the appropriate methodology to her perform her analyses. Which of the following data would best be analyzed by non-parametric statistical methods?

(A) Results of a study on the effect of a new lipid-lowering drug on LDL cholesterol

(B) Results of a study on the effect of asbestos exposure on forced vital capacity

(C) Results of a study on the relationship between gender and lung cancer

(D) Results of a study on the differences in weight distributions between children in different countries

(E) Results of a study on the relationship between hemoglobin and reticulocyte count

C   Results of a study on the relationship between gender and lung cancer

Parametric techniques can be used to analyze data where at least one of the variables is quantitative (interval or ratio) and where the data is distributed normally. If the data is not distributed normally or both variables are qualitative (nominal or ordinal), non-parametric techniques must be used. Gender and lung cancer are both qualitative variables, so non-parametric techniques, such as chi-square, are used to determine the relationship between them. LDL cholesterol, forced vital capacity, hemoglobin, and reticulocyte count are quantitative ratio variables, so studies involving them can be analyzed using parametric techniques, assuming they are normally distributed. The use of a new lipid-lowering drug and the presence or absence of asbestos exposure is qualitative nominal variables. Weight is a quantitative ratio variable, and various parametric techniques can be used to compare the means, ranges, and variances of distributions between populations.

Question 14 of 40

A 50-year-old female has trouble making any decisions in her life without asking others what she should do. She cannot assume responsibility for anything in her life. She fears disagreeing with others because she will lose their approval. She has trouble doing things on her own because she feels she is incompetent and stupid. She will volunteer to do things that hurt her so that she can get nurture and support. She cannot be alone because she feels she needs someone to take care of her. When she got sick and was in the hospital the nurses complained that she was very demanding and complaining all the time. What type of personality disorder does this female have?

(A) Dependent personality disorder

(B) Avoidant personality disorder

(C) Narcissistic personality disorder

(D) Borderline personality disorder

(E) Antisocial personality disorder

A   Dependent personality disorder

Passive individuals characterize Dependent personality disorder. They let others guide their lives because they feel they are unable to guide their own lives. Spouses or parents make all the major decisions of their lives, including where they should live and what type of employment they should obtain. Their needs are secondary to the people on whom they depend. They see themselves as helpless or stupid and they avoid having to be self-reliant. They have an extreme need to be taken care of, which is shown through their clinging behavior and fear of separation. Their personality is shown through their inability to make everyday decisions without advice from others. They need others to take responsibility for their lives, they do not initiate projects because of a lack of self-confidence, and they go to the extreme to get nurturing. In addition, they have exaggerated fears of being helpless, they seek close relationships quickly when the one before has ended, and they have an extreme fear of having to take care of oneself. In the medical setting, their fear of abandonment increases and they become needier and therefore complain and demand a lot. The physician in this case must plan, along with the nurses and staff, what kind of care should be given. They should advise the patient how often, and when, they will check on them so that the patient has set limits. If limits are not set, the patient can become extremely demanding and then the caretakers will react in a very punitive way. An individual who is shy and timid, but wants to have friends characterizes Avoidant personality. They fear rejection and therefore avoid social contact. If given strong guarantees that they are truly accepted, they will make friends. They have low self-esteem, are hypersensitive to criticism and feel inadequate (these feelings usually begin by early adulthood). In addition, they avoid activities in which they may be ridiculed or rejected, do not want to get close to anyone unless they are certain they will be liked, and keep away from close relationships so they will not be shamed. They are preoccupied with worrying about being criticized, or rejected in social situations. They are also withdrawn in new social situations due to feelings of inadequacy, and believe that they are inferior to others. They are unwilling to take risks because they do not want to get embarrassed. In the medical setting, these patients are good patients because they are undemanding and cooperative. They allow others to take care of them but they are very sensitive to criticism and they can interpret remarks as being hurtful and then withdraw emotionally. A person who thinks of himself or herself highly, but is at the same time sensitive to criticism characterizes narcissistic personality disorder. They cannot empathize with others and they are more interested in the superficial. They see themselves as superior and therefore exaggerate their achievements. They have fantasies of unlimited power, success, beauty, or ideal love. In addition, they believe they should only associate with certain people of high status or from certain institutions, and they require admiration. They believe people should go with their expectations and they take advantage of others to achieve something for themselves. They do not consider the needs of others or their feelings. They are usually jealous of others or think others are jealous of them and they are arrogant. In the medical setting, the patient sees illness as destroying their perfection. They demand special attention. They see the physician as all good or all bad. They have a tendency to show anger or boredom in a hospital setting. This disorder is more characteristic of physicians rather than their patients. A person who is on the border between neurosis and psychosis characterizes borderline personality disorder. This person has unstable personal relationships and unstable moods. They have an identity crisis; they are confused about their sexual orientation, goals, self-image, and friends. These symptoms begin in early adulthood. They try to avoid abandonment and have intense relationships, which go from idealization to devaluation. They have a distorted sense of self and are reckless in 2 areas that are self-damaging such as sex, substance abuse, reckless driving, and binge eating. They have recurrent suicidal threats or self-mutilating behavior. In addition, they have intense feelings such as euphoria, irritability, or anxiety lasting only a few hours or a few days. They feel very empty and can display intense anger or lack of control of anger. They can display paranoia under stress or severe dissociative symptoms. This disorder is seen twice as much in females then in males. Ninety percent of those diagnosed with this disorder also have a psychiatric disorder. It can be caused by severe physical, verbal, or sexual abuse in childhood. They also have decreased levels of serotonin. In the medical setting, the patient has extreme amounts of stress, which can lead to paranoia, and other symptoms this disorder entails. They become even more emotionally unstable. They will cause the physicians and nurses to take sides and see things as either all good or all bad. This is called splitting because they cannot see a person as having both, they have to label people into categories, and certain people are all good and certain others are all bad. An individual who continually violates the rights of others characterizes the antisocial personality disorder. They are unable to control their impulses or to postpone immediate gratification. They are insensitive, usually selfish and demanding, and are free of fear and guilt. They start showing symptoms before the age of 15. They fail to conform to social norms and they are irritable and aggressive. They are irresponsible in finances or in work behavior because they do not plan. In addition, they deceive others by lying for pleasure or personal gain, do not care about their safety or others around them, and are indifferent to having hurt someone. This disorder is more common in males. Family problems with alcoholism increase the risk of antisocial personality coming out in their sons and daughters. It can be caused by head trauma or encephalitis and inconsistent and impulsive parenting is also a factor. In the medical setting, it is possible to see fights, suicides, or other injuries done by these types of people. They usually are charming when under stress, but then they become manipulative if given a chance. They usually have difficulty with authority figures and therefore may be noncompliant in taking their medicine and following the doctor's orders. They usually leave the hospital when they feel like it.

Question 15 of 40

You are doing a research project on comparing the effectiveness of cognitive-behavioral versus psychoanalytic therapy in depressed patients. Your subjects consist of 60 outpatient females being seen at the local college clinic. They are randomly assigned to three groups: those who will receive cognitive-behavioral therapy, those receiving psychoanalytic therapy, and a third group that receives no therapy to serve as a control group. In your study what is the independent variable?

(A) the subjects participating in the different therapy groups

(B) the therapies being compared in the study

(C) the subjects receiving no therapy

(D) the level of depression in the participants at the end of the study

(E) the assignment of the participants into the separate groups

B   the therapies being compared in the study

The independent variable is defined as the variable that is to be manipulated or controlled, or that has been selected by the researcher. In the study, as the researcher you are controlling the type of therapy to be utilized in the study. You are also controlling whether or not the participants are receiving any therapy at all. The subjects that are participating in the different therapy groups and that have been assigned to serve as the control group are the sample being used in this study. The sample simply means the participants chosen to represent the larger population. The level of depression in the participants at the end of the study is considered to be the dependent variable. The dependent variable is defined as the response to the independent variable (or therapy), the observed or measured behavior, or the outcome of the study.

Question 16 of 40

Which of the following events occurs first during the development of the heart

(A) Appearance of the sulci

(B) Formation of the foramen ovale

(C) Formation of the septum primum

(D) Initiation of cardiac folding

(E) Secretion of cardiac jelly

A   Appearance of the sulci

Appearance of the sulci occurs on day 21. Secretion by the developing myocardium of cardiac jelly starts on day 22. Cardiac folding starts on day 23. The septum primum is formed on day 26. The foramen ovale is formed on day 43.

Question 17 of 40

The nucleated cell as seen in this photomicroscopic image is best described as which cell type?

(A) Neutrophil

(B) Basophil

(C) Eosinophil

(D) Lymphocyte

(E) Monocyte

C   Eosinophil

The eosinophil is one of the granulated leukocytes having a lobulated nucleus. The nucleus of the eosinophil is frequently bi-lobed, as seen in this image, but may have three or four nuclear lobules. The distinctive feature of this cell is the presence of large brilliant, red-staining cytoplasmic granules that are so closely packed they tend to obscure the nucleus.

Question 18 of 40

The granules in the nucleated cell as depicted in this image contain a high content of what enzyme?

(A) Phagocytin

(B) Peroxidase

(C) Lactase

(D) Lipase

(E) Nuclease

B   Peroxidase

This cell depicted in this photomicroscopic image is an eosinophil demonstrating the characteristic bi-lobed nucleus and the distinctive closely packed brilliant red granules. These granules are lysosomes, and contain a high content of peroxidase. They differ from the azurophil granules of the neutrophil in that they do NOT contain phagocytin. Eosinophil granules also contain histaminase and other hydrolytic enzymes. Lactase, lipase and nucleases are located within lysosomes of cells, but do not constitute a high content in eosinophils.

Question 19 of 40

On your pediatric rotation, you auscultate a 3-hour-old infant and hear the murmur of a patent ductus arteriosus. You understand that in the neonate, systemic changes in circulatory patterns must occur to adapt from life in utero to relying upon oxygenation from lungs. One important change is the closure of the ductus arteriosus. The attending attempts to stump you and asks "When is ductus arteriosus functionally closed?" You answer

(A) "One to eight minutes after first breath"

(B) "One to eight hours after first breath"

(C) "One to eight days after first breath"

(D) "One to eight weeks after first breath"

(E) "One to eight months after first breath"

C   "One to eight days after first breath"

As oxygen tension in the blood increases, the ductus arteriosus begins to close. However, this The ductus may begin to show signs of closure, but it is still shunting blood away from pulmonary circulation and toward systemic circulation. process is relatively slow and the ductus is still open at this stage. The ductus arteriosus constricts and is functionally closed within the first eight days of life. The ductus becomes occluded and structurally closed within the first four months of life. If a ductus is still shunting blood at this stage, it is considered to be patent.

Question 20 of 40

Dysphoric mood, insomnia, irritation, frustration, anger, anxiety, and decreased heart rate together account for which of the following DSM-IV diagnoses?

(A) Nicotine withdrawal

(B) Opioid intoxication

(C) Opioid withdrawal

(D) Nicotine dependence

A   Nicotine withdrawal

Dysphoric mood, insomnia, irritation, frustration, anger, anxiety, difficulty concentrating, restlessness, increased appetite, weight gain and decreased heart rate are all symptoms which represent diagnostic criteria for a DSM-IV diagnosis of nicotine withdrawal. Symptoms must cause clinically significant distress or impairment in social, occupational, or other essential areas of functioning. Furthermore, symptoms cannot be due to a general medical disorder and cannot be better accounted for by another mental disorder. At least four of the above mentioned symptoms or complaints must be present for this diagnosis.

Question 21 of 40

You are doing a study on the distribution of IQ scores in 15-year-old adolescent males in a standard high school classroom. You have chosen one school from Los Angeles, Seattle, Dallas, Miami, Chicago and New York. The WISC-III is administered to all 15-year-olds in the schools selected. After all tests have been administered, the scores are collected and the distribution of the scores is analyzed. The IQ scores represent what type of statistical measurement scale?

(A) Nominal

(B) Ordinal

(C) Interval

(D) Ratio

(E) Correlational

C   interval

In statistical measurements, IQ is considered an interval scale because the difference between an IQ of 90 and 100 is indistinguishable from the difference in an IQ of 100 and 110. In interval scales, the difference between intervals is relative. The difference between 1 and 2 is relative to the difference between 3 and 4. Nominal measurements are used for variables in which there are no numerical values that can be compared, such as gender or ethnic background. Ordinal scales are used for rank ordering. Ordinal scales can be used for such variables as attractiveness, or grades in school. In each case one can state that s/he is more attractive then, or an A or B is better than a C or D. Ratio scales are based in measurements where there is an absolute 0. In IQ's there are no absolute zeros, and one cannot state that an IQ of 50 is half as good as an IQ of 100. Ratio scales can be used for variables such as the number of hours a student spends studying, 2 hours of studying would be half as many hours as 4 hours of study. Correlations are not used as a method of statistical measurements, but are used in research and statistics to define a relationship between two variables.

Question 22 of 40

A 1-month-old child is brought to the clinic for a regular checkup. The child appears healthy and the mother does not report any problem. On auscultation of his chest there is a loud pansystolic murmur over the left sternal edge. There is also an associated thrill. What is the likely diagnosis?

(A) Atrial septal defect

(B) Coarctation of the aorta

(C) Patent ductus arteriosus

(D) Tetralogy of Fallot

(E) Ventricular septal defect

E   Ventricular septal defect

A small to moderate ventricular septal defect produces a loud 'tearing' pan systolic murmur and a systolic thrill over the lower left sternal edge. There is usually no cyanosis. There may be a prominent apex beat and cardiac enlargement.

Atrial septal defect: This is often diagnosed only in adulthood and is more common in females. Patients are usually asymptomatic, though occasionally they may experience palpitations. The murmur is usually an ejection systolic, pulmonary flow murmur.

Coarctation of aorta: Increased incidence in patients of Turner's syndrome. It is often asymptomatic. Examination reveals a radio femoral delay and hypertension in the upper limbs.

Patent ductus arteriosus: Often seen in pre mature babies. The continuous murmur is classically described as a 'machinery' murmur, and is best heard in the first intercostal space on the left.

Tetralogy of Fallot: Consists of 1. ventricular septal defect2. overriding of the aorta3. right ventricular outflow obstruction4. right ventricular hypertrophy

Children present with dyspnea and a history of Fallot's spells and squatting. Central cyanosis is usually present since birth. There is a systolic ejection murmur with a thrill, in the second left intercostal space close to the sternum.

Question 23 of 40

The blood is carried from the placenta to the fetus by the

(A) Right umbilical vein

(B) Left umbilical vein

(C) Ductus venosus

(D) Inferior vena cava

B   Left umbilical vein

The umbilical veins are transformed as follows: (1) the right umbilical vein and the part of the left umbilical vein between the liver and the sinus venosus degenerate; and (2) the persistent part of the left umbilical vein carries all the blood from the placenta to the fetus. Concurrently, a large shunt called the ductus venosus develops within the liver and connects the umbilical vein with the inferior vena cava. The ductus venosus forms a bypass through the liver, enabling some blood from the placenta to pass directly to the heart. After birth the umbilical vein and ductus venosus become the ligamentum teres and ligamentum venosum, respectively. The right cardinal vein and the right common cardinal vein become the superior vena cava.

Question 24 of 40

A researcher studied the levels of serum calcium in the U.S. and Panama. The null hypothesis was proven. What does the null hypothesis state?

(A) There is a significant difference between populations tested

(B) Difference between populations is not attributable to chance

(C) Difference between populations is due to a particular factor

(D) There is no significant difference between populations tested

(E) Power of a study to detect a significant difference between populations is nil

D   There is no significant difference between populations tested

The null hypothesis states that there is no significant difference between the populations being tested, and that any difference that is found is attributable to chance. It is tested against the alternative hypothesis, which is that there is a significant difference between the populations tested.

Question 25 of 40

The following branchial arch gives rise to the facial nerve, the stapedius muscle, and the stapes

(A) First branchial arch

(B) Second branchial arch

(C) Third branchial arch

(D) Fourth branchial arch

(E) Fifth branchial arch

(F) Sixth branchial arch

B   Second branchial arch

Arch* Nerve Muscles Skeletal structures Ligaments

First TrigeminalMuscles of mastication, Mylohyoid, anterior belly of digastric, tensor tympani, tensor veli palatini

Malleus, incus

Anterior of malleus, sphenomandi-bular

Second

FacialMuscles of facial expression, stapedius, stylohyoid, posterior belly of digastric

Stapes, styloid process, lesser cornu of hyoid, upper part of body of hyoid bone

Stylohyoid

Third Glosso-pharyngeal Stylo-pharyngeusGreater cornu of hyoid, lower part of body of hyoid bone

 

Fourth and Sixth

Superior and recurrent laryngeal branches of vagus

Cricothyroid, Levator veli palatini, constrictors of pharynx, intrinsic muscles of larynx, striated muscles of esophagus

Thryoid, cricoid, arytenoid, corniculate, and cuneiform cartilages

 

The fifth arch is often absent, and when present, it is rudimentary.

Question 26 of 40

Platelets are derived from which of the following cell types?

(A) Lymphocytes

(B) Plasma cells

(C) T cells

(D) Neutrophils

(E) Megakaryocytes

E   Megakaryocytes

The plasma cells are derived from resting B lymphocytes and are responsible for antibody secretion. They occur mainly in secondary lymphoid tissue. The plasma cells are characterized by an abundance of rough endoplasmic reticulum that is required for antibody synthesis and secretion. Megakaryocytes are giant cells found in the bone marrow and are the source of circulating platelets. The megakaryocyte undergoes many rounds of DNA replication without undergoing cell division. Once DNA synthesis has stopped, the cytoplasm of the cell matures. Platelets bud from the main cell body of the megakaryocyte. Platelets lack nuclei and function in hemostasis, coagulation, and inflammation. The release of histamine and/or serotonin occurs to mediate inflammation. The cytoplasm of the small or "resting" lymphocyte is taken up mostly by the nucleus. When lymphocytes contact antigen, activation signals trigger development into large lymphocytes or plasma cells in the case of B lymphocytes. Neutrophils are phagocytic cells which are recruited to the sites of inflammation. Histamine is secreted by mast cells, basophils and platelets.

Question 27 of 40

A 17-year-old female is brought to the emergency department in the late stages of labor. Her vital signs are normal, but she appears emaciated. She relates that she is nine months pregnant and reports that she has experienced no medical problems during her pregnancy. Two hours after admission she gives birth by vaginal delivery to a male infant weighing 3100 grams (6.8 pounds). Despite his low but normal birth weight, the neonate shows signs of cyanosis shortly after birth. Which of the following is the most likely explanation for this condition?

(A) Coronary arteriovenous fistula

(B) Tetralogy of Fallot

  (C) Patent ductus arteriosus

(D) Atrial septal defect

     

(E) Ventricular septal defect

B   Tetralogy of Fallot

Cyanosis occurs when there is significant right-to-left shunting of blood in the heart, mixing de-oxygenated blood, returning from the body to the right atrium and right ventricle, with oxygenated blood returning from the lungs to the left atrium and left ventricle. Of the available answers, only Tetralogy of Fallot, a congenital malformation consisting of overriding aorta, pulmonary stenosis, ventricular septal defect, and right ventricular hypertrophy, causes right-to-left shunting. Atrial and ventricular septal defects are left-to-right shunts because of higher pressures in the left heart. Similarly, a patent ductus arteriosus conducts oxygenated blood from the aorta to the pulmonary trunk, thus effecting redundant oxygenation but producing no cyanosis. A fistula between a coronary artery (off the aorta) and coronary vein (draining into the right atrium) acts to deprive heart muscle of oxygenated blood, but does not cause cyanosis.

Question 28 of 40

Which of the branchial arches is a main contributor to thyroid cartilage

(A) The first branchial arch

(B) The second brachial arch

(C) The third branchial arch

(D) The fourth branchial arch

D   The fourth branchial arch

The cartilaginous components of the fourth pair of branchial arches give rise to large parts of the thyroid cartilage. The cartilages of the sixth arches are other contributors. The fifth arches, if present, are rudimentary and probably contribute little to these cartilages.

Question 29 of 40

The public health officials of a particular city wish to evaluate the lead levels of its constituents. In order to develop a sample population, they choose every 10th family in the city for the study. This is an example of what kind of population sample?

(A) Stratified selected sample

(B) Cluster selected sample

(C) Simple random sample

(D) Systematically selected sample

(E) Nonrandom selected sample

B   Cluster selected sample

In cluster selected samples, the population of interested is divided into subunits, such as families, and a random sample of these units is used. In simple random samples, each individual member of a population has an equal probability of being chosen. In stratified selected samples, individuals are chosen randomly from within stratified groups, such as age groups. In systematically selected samples, the population is ordered by some characteristic, such as age, a starting point for selection is randomly selected, and then the remainder of the sample is collected by a predetermined scheme, such as choosing every x number of people. In nonrandom selected samples, some predetermined scheme is used, such as the first x number of people presenting for a certain disease to a clinic.

Question 30 of 40

Which of the following is the correct position for the fetal heart?

(A) Apex of the heart to the left anterior chest, right ventricle more anterior and the left ventricle closest to the spine, atria cephalad to the ventricles.

(B) Apex of the heart to the right anterior chest, right ventricle more anterior and the left ventricle closest to the spine, atria cephalad to the ventricles.

(C) Apex of the heart to the left anterior chest, left ventricle more anterior and the right ventricle closest to the spine, atria cephalad to the ventricles.

(D) Apex of the heart to the left anterior chest, right ventricle more anterior and the left ventricle closest to the spine, atria caudal to the ventricles.

(E) Apex of the heart to the right posterior chest, right ventricle more anterior and the left ventricle closest to the spine, atria cephalad to the ventricles.

A   Apex of the heart to the left anterior chest, right ventricle more anterior and the left ventricle closest to the spine, atria cephalad to the ventricles.

The apex of the heart is to the left anterior chest with the right ventricle more anterior and the left ventricle close to the spine. The atria are cephalad to the ventricles.

A physician wants to learn more about prevalence rates for diabetes mellitus in his local community. He has raw data from his town public health department, but he is not sure how to determine the prevalence rates. Which of the following comments is true of prevalence rates?

(A) Reflect a portion of specific illnesses in a population

(B) Include new and existing cases during a specific time period in the numerator

(C) Denominator is the entire population, both those at risk and those not at risk

(D) Include only cases prevalent at the start of the time period in the numerator

(E) Are not influenced by the duration of disease

Question 31 of 40

B   Include new and existing cases during a specific time period in the numerator

Prevalence rates are determined as the number of new and existing cases of disease during a specific time period in the numerator divided by the population at risk in the denominator. They are influenced by both the duration of disease and the incidence of new cases. By measuring both existent and new cases of illness, they reflect the total amount of specific illnesses in a specific population.

Question 32 of 40

The nucleated cell in this photomicroscopic image may be best described as what cell type?

(A) Basophil

(B) Eosinophil

(C) Monocyte

(D) Neutrophil

D   Neutrophil

The granulated neutrophil in peripheral blood is commonly characterized by the lobulated shape of the nucleus (four, in this specimen), which are connected by thin filaments. As in this cell, a nuclear appendage (drumstick) can be visualized, representing the female sex chromatin. The cytoplasm contains two types of granules, specific granules which can be seen as the smaller, pinkish granules, and the larger azurophil granules that stain a reddish-purple.

Question 33 of 40

A male goes to the clinic for follow-up treatment. He states that he takes his medicine exactly every 8 hours and keeps a record of how many pills he takes, and at what time, and shows this to his doctor. He even wakes up in the middle of the night worrying if he missed a time. He is worried that maybe the medicine is not going to take effect because he took one of the pills 15 minutes late. What kind of disorder does this male have?

(A) Schizophrenia

(B) Post traumatic stress disorder

(C) Obsessive-compulsive personality disorder

(D) Schizoid

(E) Histrionic

C   Obsessive-compulsive personality disorder

Obsessive-compulsive personality disorder is characterized by being a perfectionistic, inflexible, and unable to express warm and tender feelings. They are too concerned about trivial details and rules, and do not appreciate changes in routine. They have a preoccupation with details, rules, lists, order, organization, or schedules to the extent that the major point of the activity is lost. Any illness is perceived as a threat to their control and they may therefore struggle with their physician for control. In this case, the physician is handling the patient properly, by allowing him to take part in the decisions and details of his medical care (like charting medication times). Schizophrenia is a disorder that consists of both positive and negative symptoms. Positive symptoms are delusions, hallucinations, and agitation. Negative symptoms are characteristics of the patient that are subtracted from the clinical picture including affective flattening, social withdrawal, apathy, anhedonia, and poverty of thought and content of speech. The diagnosis requires that symptoms be present for at least 6 months, although the course varies widely among individuals. Posttraumatic stress disorder describes a syndrome of distress, re-experiencing, avoidance, and arousal. These symptoms develop after exposure to events that involved actual death or injury, or a threat to the physical integrity of oneself or others and that brought on fear, helplessness, or horror. The symptoms may appear immediately after the trauma, or they may be delayed for 6 months or more. Symptoms can be re-experiencing the trauma through memories or dreams, avoidance of stimuli associated with the trauma and numbing of overall responsiveness, excessive arousal such as insomnia, angry outbursts, hypervigilance, exaggerated startle response, and difficulty concentrating. Schizoid personality describes a person who has a pattern of detaching from social relationships and shows a restricted range of emotions that begins by early adulthood. They usually do not desire or enjoy close relationships, they choose solitary activities, take pleasure in few activities, lack close friends, are indifferent to praise or criticism, and emotionally cold. Histrionic personality represents people who are flamboyant, attention seeking, and demonstrate an excess emotionality. Their emotions are shallow and shift rapidly. Typically, they are attractive, seductive, and overly concerned about their appearance.

Question 34 of 40

Following their maturation in the thymus gland and release into the vascular system, T-lymphocytes preferentially migrate to which one of the following tissues?

(A) Paracortex of lymph nodule

(B) Cortical lymphoid nodules of lymph nodes

(C) Lymphoid nodules of the spleen

(D) Hilus of lymph nodes

(E) Lymphoid nodules of the lingual tonsils

A   Paracortex of lymph nodule

T-lymphocytes generally re-circulate through the deep cortex or paracortical regions of lymph nodes and the periarterial sheaths in the white pulp of the spleen. The B-lymphocytes, on the other hand, are found in lymphoid nodules (a part of the lymph nodes, tonsils, and the spleen).

Question 35 of 40

Views of the fetal face and profile aid in the bonding of the parents to the unborn child. While views of recognizable anatomy are gratifying for parents, there is a diagnostic basis for these views. Which of the following is the most common facial defect identified during a sonographic examination?

      (A) Cleft lip, palate

(B) Micrognathia

(C) Mandibulofacial dysostosis

(D) Microsomia fetalis

(E) Pterygium colli

A   Cleft lip, palate

Cleft lip and palate can be visualized with a modified coronal view of the fetal nose and lips. Another view that can visualize cleft palate is an axial transverse view of the soft palate. This defect is the most common facial defect that can be identified through a sonographic examination of the fetal face. If a cleft defect is identified, there may not be fluid in the stomach due to fetal inability to swallow. Microsomia fetalis is an abnormally small fetus. A thick fold of skin found on the lateral aspect of the neck is termed a pterygium colli. This webbing extends from the mastoid region to the acromion and is considered a congenital process. Mandibulofacial dysostosis is a hereditary disorder characterized by micrognathia, hypoplasia of the zygomatic arches, microtia, mongoloid slant of the palpebral fissures, and colomba of the lower lid. Micrognathia or a small jaw can be seen on a profile view of the fetus.

Question 36 of 40

You are conducting an experiment on the effectiveness of behavioral therapy in treating social anxiety. Your research hypothesis is that behavioral therapy is effective in reducing social anxiety. The participant's in your study are 30 individuals who have been diagnosed with social anxiety. Each individual is independently evaluated for social anxiety to confirm the diagnosis. After the evaluation, 6 participants are found to not meet the set criteria for social anxiety and are dropped from the study. The remaining 24 participant's are broken up into two separate groups. Group A receives behavioral therapy and group B is put on a wait-list to receive therapy after the experiment is over. At the end of the experiment, you find that behavioral therapy was effective in treating social anxiety. In your study what is the independent variable?

(A) The subjects participating in the treatment group

(B) The treatment administered to group A

(C) The subjects in the no treatment group

(D) The level of social anxiety in the participants at the end of the study

(E) The assignment of the participants into the separate groups

B   The treatment administered to group A

The independent variable is defined as the variable that is to be manipulated or controlled, or that has been selected by the researcher. In this study, as the researcher, you are controlling whether or not participants receive therapy. The subjects that are participating in therapy and those that have been assigned to serve as the control group are the sample being used in this study. The sample simply means the participants chosen to represent the larger population. The level of social anxiety in the participants at the end of the study is considered to be the dependent variable. The dependent variable is defined as the response to the independent variable (or therapy), the observed or measured behavior, or the outcome of the study.

Question 37 0f 40

Which one of the following blood cells arises from the monocytes?

(A) Plasma cells

(B) Lymphocytes

(C) Acidophils

(D) Neutrophils

(E) Macrophages

E   Macrophages

Macrophages derive mainly from precursor cells from the bone marrow that divide, producing monocytes that circulate in the blood. In a second step, these cells migrate into the connective tissue where they mature and are called macrophages. Tissue macrophages can proliferate locally, producing more macrophages. Plasma cells originate from B-lymphocytes, while eosinophils (= acidophils) and neutrophils arise from myeloblasts in the myeloid tissue.

Question 38 of 40

A 20-year-old man walks into the emergency room and asks to see a doctor because he is feeling nervous, he can't sleep at night, has a loss of appetite, a low grade fever, a runny nose, and stomach cramps. When the nurse examines him she asks him if he feels cold because the hair on his arms is standing on end but she is confused because she sees that he is sweating. She also notes that his pupils are dilated. He tells her that he is accustomed to taking a certain drug but recently he can't get hold of it. What type of drug is this patient withdrawing from?

(A) Barbiturate

(B) Benzodiazepine

(C) Opiate

(D) Nicotine

(E) LSD

C   Opiate

This patient is experiencing classic withdrawal symptoms of an opiate which include flu like symptoms, nausea or vomiting, yawning, piloerection, fever, insomnia, and pupilary dilation. The medicine to be used in this case would be clonidine. Barbiturate withdrawal is not possible in this case because it is deadly. The findings would include hyperactivity, hallucinations, anxiety, and grand mal seizures. Benzodiazepines produce seizures upon withdrawal and anxiety, delirium, and tremor, and insomnia. Nicotine has less severe withdrawal including weight gain, anxiety, headache and irritability. LSD has no withdrawal symptoms.

Question 39 of 40

Which of the following congenital malformations is the most common in liveborns?

     (A) Atrial septal defect

(B) Persistent truncus arteriosus

(C) Tetralogy of Fallot

(D) Transposition of great vessels

     (E) Ventricular septal defect

E   Ventricular septal defect

The incidence in liveborns for the listed malformations is: ventricular septal defect = 12/10,000, Tetralogy of Fallot = 10/10,000, atrial septal defect = 6/10,000, transposition of great vessels = 5/10,000, and persistent ductus arteriosus = 1/10,000.

Question 40 of 40

A researcher studied the relationship between childhood exposure to lead and stature. The heights of the children measured at age 12 range from 4'8" to 5'9", with a standard deviation of 5", a mean of 5'3", a mode of 5'2", and a coefficient of variation of 7.9%. Which of the following statements is true?

(A) Variance is the square root of the standard deviation

(B) Range of a series of data provides information about the distribution of the data

(C) Coefficient of variation is a measure of the spread of the data in regard to the mean

(D) Standard deviation is an estimate of the standard error of a population

(E) Mode is a measure of central tendency of a data series

C   Coefficient of variation is a measure of the spread of the data in regard to the mean

The coefficient of variation is defined as the standard deviation divided by the mean, expressed as a percentage. It is a measure of the spread of the data with regard to the mean. The standard deviation is the positive square root of the variance. The standard error is an estimate of the standard deviation of a population. The range of a series of a data is calculated as the highest value in the series minus the lowest value, and it provides no information about the distribution of data within the series. The mode is the most commonly occurring value in a data series and does not provide any information about the central tendency of a data series.