Biochemistry

1- Experiment to study the rate of LDL entry to the cell, what agent should be used in this study?
Clathrin
2- We injected a material that inhibits the function of Na/K -ATPase, what will happen?
a) Increased K inside
b) Decreased K outside
c) Increased Na inside the medium (intracellularly)***
3- COL3A1 mutation, what is the most likely affected? Blood vessels
4- Nucleus pulposus. Experiment to remove hydroxylated groups. Which will be the most or least
affected?
a) Collagen
b) Elastin
c) Proteoglycan

5- Viral infection(not HIV), what would we see? I answered D

6- Where is the most likely location? Thymus

7- What is the most likely cell? Immature thymocyte

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8- In Iceland, the BRCA gene mutation is 9%. The question mixed between Hardy-Weinberg
assumptions and BRCA being a tumor suppressor (double-hit-hypothesis) and two of the genetic
terminologies. Why is this the case here in Iceland or what will happen?
a) Bottleneck population due to cases of breast cancer
b) Heterogeneity at the locus
c) Heterogeneity at the allele
d) Geographically isolated (meaning no net migration)
e) Large population
f) Random mating
Note:

9- Patient can’t release hand after handshakes with an autosomal dominant pedigree. What is the
gene? DMPK (myotonic dystrophy)
10- Patient describing HOCM and S4 sound with an autosomal dominant pedigree. His grandpa died
at 30 while running a marathon. What is the diagnosis? HOCM
11- Question describing mitochondrial myopathy. What is the mode of inheritance? Mitochondrial

12- 6-domain transmembrane protein with ATPase. Most likely function? Transport of ions across
membrane
13- Very long-chain fatty acid. Organelle defect? Peroxisome
14- Labs : Palmitic acid high, linoleic acid low, linolenic acid low. Most likely deficient in this pateint?
Pancreatic lipase
15- Flat face, space between 1st and 2nd toes, duodenal atresia, enlarged abdomen. What’s the
diagnosis? Trisomy 21
16- Linoleic acid? Thromboxane A2
17- Old man with signs of scurvy. Process diminished? Hydroxylation

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18- Hydroxyproline is used a for lab quantification of collagen strength. Experiment is to be done to
increase hydroxyproline. What is the most appropriate to be done by the researcher?
a) Increase availability of hydroxyproline through diet***
b) Enhance post-transcriptional modification of hydroxyproline in rER

19- High ALT and AST?

a) Vitamin C
b) Vitamin E
c) High dose Niacin***
Note: no vitamin A in the options
20- Isoniazid? Vit B6
21- Postpartum lady follow up with her baby as shown. What prenatal
processes would most likely prevented this?
a) Acetylation
b) Phosphorylation
c) Methylation***
d) Glycosylation

22- Old man on a vegan diet. Which pathway is most likely decreased as a result of his diet?
23- Home-delivered baby with hemorrhagic disease of the newborn. What process is the most likely
cause? Carboxylation
24- Man eats 3 bites daily or 3 times weekly, he has diminished subcutaneous fat on physical exam.
Labs: Albumin 2, other labs were almost normal. What is the most likely deficient?
a) Complex carbohydrates
b) Essential amino acids***
c) Fat
d) Minerals
Note: I don’t remember mentioning edema
25- Postpartum lady who was diagnosed with gestational diabetes during her pregnancy and was
managed by diet. Her newborn has macrosomia and weighs 4 kgs. What is the most likely
cause?
a) High fetal cortisol
b) High fetal insulin***
c) High maternal cortisol
d) High maternal insulin
26- Child with pyruvate dehydrogenase deficiency (mentioned). What is the most appropriate diet
for him? (80% fat, 15% protein, 5% carbohydrates)
27- G6PD?
NADPH: decreased, Glutathione reductase: decreased, oxidized sulfahydryl group: present
28- Flapping tremor, somnolence, slurring speech and liver disease.
Treatment?
a) Acidification in colon***
b) Binding of excess ammonia in small intestine

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 29- African American presented with blue eyes and white curly hair and light skin. Most likely
cause?
a) Destruction of keratinocytes
b) Decreased synthesis of melanin***
c) Disrupted trafficking in melanosomes
30- Child with hypoglycemia. Labs: lactate high, uric acid high, triglycerides high. What’s the enzyme
deficient? Glucose-6-phosphatase

31- Cardiomegaly, hypotonia. What is the accumulated substance?

Glycogen

32- Child startle with mild noise (hyperacusis), red dot around white area (cherry-red spot on
macula), no hepatosplenomegaly. Enzyme deficiency?
a) Galactosidase
b) Glucocerebrosidase
c) Iduronidase
d) Hexosaminidase A***
e) Glucose-6-phosphatase
f) Myophosphorylase
33- 35 man presented with intermittent epigastric pain. His mother, sister, and
brother are being treated for hypercholestrolemia. What is cause?
a) High Triglycerides***
b) High LDL
c) Low VLDL

Immunology

34- Sigmoid? Inferior mesenteric lymph nodes

35- Labia minimus? Superficial inguinal lymph nodes
36- Macrophages under experiment are divided into 4 groups depending on the mutated receptor.
Which group is most likely unable to release cytokines?
a) TLR4***
b) ABC59
c) XYZ23
d) Wild-type
37- Neutrophils in pneumonia. Mechanism of defense? Myeloperoxidase-H2O2-halide
38- How anti Rh antibodies of the mother reach the baby in utero? Fc receptors on the placenta
39- Long question of recurrent meningitis with labs. Last line mentioned: gram-negative diplococci.
What deficiency predisposed to this? Complement 7
40- Purulent penile discharge and dysuria? Complement 8

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 41- Child with dark red urine especially in the morning. Cause? Complement inhibitors deficiency
42- What interleukin cause reduction in the inflammatory process?
a) TNF
b) IL-1
c) IL-10***
d) IFN
43- Rheumatoid arthritis ( morning stiffness that resolves after 1 hour with movement). Treatment
target? IL-2
44- Combination of cells in PPD?
a) T lymphocytes and macrophages***
b) B lymphocytes and macrophages
45- Deficiency in integrin. What will be the most likely defect in leukocytes? adhesion
46- Child with recurrent viral infections. What is the most likely cause?
a) Bruton agammaglobulinemia
b) Common variable
c) AIRE gene mutation
d) IgA deficiency
e) Vertically transmitted immunodeficiency (I answered this)
47- Mononuclear lymphocytic infiltration after transplant? Acute transplant rejection
48- Patient after transplant presented with (maculopapular) rash, diarrhea and
hepatosplenomegaly. What else you will find on physical examination? Jaundice
49- Patient on azathioprine for leukemia. As a prophylaxis of tumor lysis syndrome, he was given
allopurinol. What is most likely to occur? Increased 6-Mercaptopurine

Microbiology

50- Sepsis due to contaminated instruments with lipopolysaccharides? Release of cytokine

51- UTI, leukocyte esterase +, no nitrites. Irrelevant picture of the bacteria was shown. Most likely
causative agent? Staphylococcus saprophyticus
52- Patient with upper lobe lesion in the right lung. Picture of the kidney as
shown. Most likely causative agent? Mycobacterium tuberculosis
53- Patient has PPD with induration of 15mm in 72 hours? Mycobacterium
tuberculosis
54- Patient treated with cephalexin or cefazolin is not responding anymore. What
is the most likely cause?
a) VanA
b) MecA**
c) KatG
55- Normal flora of the vagina and their colonizers from uroepithelium. Which one is the right
combination?
Colonizer: Normal flora:
a) Proteus Lactobacillus
b) E. Coli. Klebsiella
c) Bacteroides Streptococcus agalactiae
56- Patient treated last week for sepsis and pneumonia presented today with abdominal pain and
diarrhea. Most likely mechanism? Release of toxin

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57- Female patient removed a tick of her leg few days ago developed lymphadenopathy and ulcer.
Gram stain showed gram-negative coccobacilli? Francisella tularenis
58- Child fully vaccinated developed a hoarse cough with shortness of breath and inspiratory
stridor?
a) Hemophilus influenza
b) Parainfluenza
59- Pregnant lady (Rh -ve) has cats in her home. Her husband is Rh +ve. Labs: toxoplasmosis IgG is
positive. On ultrasound the fetus is hydropic. What is the most likely cause?
a) Changing the cat feces litter
b) Rh status of husband
60- Pharyngitis, tonsillar exudate, pre-auricular lymphadenopathy, lymphocytes were 40% on labs?
a) Adenovirus
b) Mycoplasma
c) Coxsackievirus
d) Rhinovirus

61- Pharyngitis, posterior lymphadenopathy, splenomegaly. Heterophile test negative?

a) Adenovirus
b) CMV
c) Mycoplasma
d) EBV

62- Beard hair patches fall off. Studied with KOH? Microsporum
63- Patient returning from Africa. Vaccination is up-to-date. Elevated liver enzyme. Hepatitis workup
shown.
Anti HepA IgM: negative
Anti HepA IgG: positive
Anti HepB surface IgG: negative
Anti HepB core: negative
Anti HepC IgM: negative
Anti HepC IgG: negative
Anti HepE IgM: positive
Anti HepE IgG: positive
64- Patient developed lymphadenopathy at her hands, then spread to her arm
65- Patient ate berries while in Guatemala developed diarrhea. Stool culture showed no leukocytes
and no blood? Giardia
66- Hiker/camper drank water from a lake, developed watery foul-smelling fatty diarrhea. Under
microscope, the causative agent is teardrop-shaped with two eyes? Giardia
67- 30% of erythrocytes are affected. Which species of malaria is most likely involved?
a) Falciparum**
b) Vivax
c) Ovale
d) Malariae
68- Perianal pruritus in a child. Diagnosis by tape test. Mode of transmission ?
a) Direct Human contact
b) Walking barefoot
c) Ingestion of undercooked pork

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 69- Elderly in a 5-stars nursing home presented with burrows and itching between finger. Diagnosis?
Scabies
70- Child with swelling in anterolateral neck? Lymphoma
71- High fever resolved, then rash developed? HHV-6

72- HSV-1 encephalitis. MRI shown. What is the most likely complication?
Anterograde amnesia

73- Female smoker, alcoholic and multiple sex parters without protection, and with
abnormal pap smears. What is the strongest predisposing risk factor?
a) Alcohol
b) Smoking
c) HPV

74- Medical resident fully-vaccinated with needle-stick injury? Anti HepB surface
75- Elderly with signs and symptoms of pneumonia. Multiple medical history diseases. Most likely
cause? S. pneumonia
76- Infection required metronidazole. Site of MOA? DNA double helix
77- Patient on doxycycline presented with blistering rash on sun-exposed areas. Cause?
Non-immune
78- Patient on acyclovir not responding? Thymidine kinase
79- Patient on valacyclovir not responding? Thymidine kinase
80- Patient with AIDS is taking adefovir as anti-retroviral therapy. He presented with fractured ribs
although his diet was not changed and no history of trauma. What is the most likely cause?
Defect in the proximal renal tubules

Pathology

81- MI with high troponin C in serum? Plasma membrane rupture (repeated twice)
82- Apoptotic bodies removed by macrophages. How?
Phosphatidylserine
83- Picture shown? Coagulative necrosis
84- Acetaminophen? NAPQI
85- Redness, warmth, swelling, pain? Histamine
86- Tissue remodeling? Metalloproteinases
87- Metastasis? E-cadherin

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88- C-section one week follow up to remove staples from the Pfannenstiel incision. Scar is still not
healed completely at one end. Cause? Granulation tissue

89- Cell responsible?

a) Fibroblasts***
b) Tenocytes

90- Metastasis to bone. Bone uptake scan was increased. Where it’s
likely originated from? Kidney
91- Drug X is being developed to treat breast adenocarcinoma. Which is the most likely target of
drug X? Growth factor
92- Patient had a prophylactic thyroidectomy at age of 10, parathyroidectomy at age of 16, mother
had an adrenal tumor removed in the past? RET
93- Inactivation mutation with labs showing very high RBCs, WBCs, platelets. What is the most likely
defect?
a) Auto-inhibitory domain of JAK***
b) Tyrosine kinase domain of JAK

94- Retinoblastoma pic? G1 to S phase

95- Adult with lost red reflex? Cataracts

96- Patient with previous polyp (it has to be serrated), mother with endometrial cancer, sister with
ovarian cancer? Microsatellite instability
97- Renal tumor and aniridia? WT1
98- Osteoarthritis strongest risk factor? Age
99- Psammoma bodies? Papillary thyroid cancer

100- MRI shown. Histology findings? Laminated calcification

101- 80 years old woman lost 5kg within 2 months. She presented with limbic and truncal
ataxia. MRI shows cerebellar atrophy. What is the most likely cause?
a) AV malformation
b) Genetic
c) Chiari malformation
d) Malignancy***
102- Increased weakness with repetitive movements. Antibodies? Nicotinic receptors in the
neuromuscular junction
103- Delayed puberty and anosmia? Diencephalon

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Pharmacology

104- Drug with reduced potency with

equivalent efficacy? C

105- Drug that is given orally with food and without food. The experiment
showed that both had an oral availability of 10%. Why?
a) High water solubility
b) Intensive first-pass metabolism by the intestinal epithelium
106- Aspirin overdose. Treatment? Alkalinize the urine

107- What is the type of inhibition?

a) Competitive
b) Non competitive
c) Reversible
d) Irreversible
e) Suicidal

108- Drug X causes increased renal blood flow. What receptor does it work at? Dopamine
109- Erythema nodosum? OCPs
110- Lithium? Nephrogenic DI
111- Drug-induced AIN

Public health
112- Small group of rare disease to be studied for clinical findings? Case series
113- Two groups, each is given one drug. Results of the study were about survival and
remission/relapse? Randomized clinical trial
114- Drug trial of 80 healthy patients in which maximum tolerated dose and
pharmacodynamics are to be studied? Phase 1
115- Relationship between eating bats and Ebola infection. 3 groups; heavy consumption,
moderate, small. Relative risk was increasing with increasing consumption and all were
statistically significant. Bradford Hill? Dose-response or biological gradient
116- Without-treatment group: 3%. With-treatment group: 0.3%. ARR?
a) 0.27
b) 0.027
c) 0.0027

117- a+c / a+b+c+d would most likely represent? Prevalence

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118- Mortality rate in miners was 1 in every 10000. Mortality in the united states was
something. Mortality in coal mines outside the states was
something. What the standardized mortality rate in the
miners? Cannot be determined

119- Flip a coin? (Red dashed straight diagonal line)

120- Study of 100 participants heights has a mean of 170

cm. If one data measuring 220 cm was added. Which is the
most affected (by outliers)? Mean

121- Kaplan-meier graph as shown. What is the most

appropriate interpretation?
Drug A has better survival rates than drug B and is
statistically significant in 6 months

122- During a well-child exam, mother refused to wait outside? I’m curious why…
123- “Use telephone-based services” if the interpreter isn’t going to be available in that day.
124- Foreign old woman with her grandson (English-fluent) who came with her to help with
translation. In the clinic, there is a nurse who’s a verified credentialed interpreter?
a) Use the nurse as the interpreter and allow the grandson to stay
b) Use the nurse as the interpreter and ask the grandson to leave
125- Breaking bad news. The patient start crying?
Here’s some tissues! I will give you some time
126- OBGYN patient is going to have a surgery next week. You’re doing an assessment for her
for the surgery. When asked about her current medications she tells you “I am taking Garlic and
rice yeast supplement for my high cholesterol”. What the most appropriate initial response by
the physician?
a) You should stop them one week before your surgery
b) It doesn’t matter if you kept taking them
127- 90 years old man who is a retired soldier came to the clinic to be assessed by a young
resident. He had lost many friends throughout his life due to illnesses or wars. He tells the
resident: “you are probably are too young to understand”? I understand…

128- Secondhand-smoker asthmatic girlfriend arrived at the emergency department for an

asthma attack. She furiously says: “That’s the last time I’m going through this!”
a) Are you able to avoid your asthma triggers?
b) Have you considered telling him to stop smoking?
129- Smoking cessation visit?
a) Set a quit date with behavioral and pharmacologic therapies

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 b) Cut down gradually
c) Start with low-dose nicotine cigarettes first
d) Start with nicotine gum
130- Depressed old man. What is the most appropriate initial statement?
Do have access to guns?
131- 80 years old woman with her daughter and son in law. They seem loving and caring.
History differs from physical exam (petechiae)?
Ask separately about family relationships
132- Daughter presented with her mother for PCOS treatment. You starts explaining what
options she has. When you reached the option of OCPs, the mother interrupted you and says:
“those are going to make my daughter to gain weight”.
a) Tell me what is concerning you
b) Please let me complete all the options and I will let you both discuss your choice
c) You have a good knowledge! It’s your daughter’s decision at the end of the day
d) Please can you excuse us outside

Cardiovascular
133- PDA surgery? Recurrent laryngeal nerve
134- Left ascending artery origin? Left cusp of the aorta
135- 2 years old child presented with cyanosis. Physical exam reveals holosystolic murmur
between the apex and left sternal edge. Cause? VSD with shunt reversal

136- What causes a change from black loop to red loop? Increased
arterial resistance

137- Audio: Young patient with scoliosis and feet deformity. At apex?
MVP

138- Audio: Mitral stenosis. Cause? Chronic rheumatic heart disease

139- ECG: Irregularly irregular (mentioned). 12-leads ECG was shown. Cause? Abnormal foci
at the pulmonary vein

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140- Autopsy shown? Calcified mitral annulus

141- Cyanotic newborn with a murmur heard all over the

precordium. Cause?
a) Total anomalous of coronary artery
b) ASD
c) VSD
d) Tetralogy of Fallot***
142- 70% open left renal artery. Refractory HTN. Treatment will involve?
a) Myocardial contractility
b) Release of vasoconstrictor
143- Macrophages in atherosclerotic plaques contain?
a) Triglycerides
b) LDL**
144- AAA repair, then impotence? Pelvic ischemia
145- II, III, aVF? Right coronary artery
146- Patient had MI, then developed ventricular fibrillation. Couldn’t be resuscitated. Cause?
a) Long QT interval
b) Electrolytes imbalances
147- Sinus tachycardia, tachypnea with chest pain? Platelets and fibrin in pulmonary arteries
148- DVT? Factor V Leiden
149- Unmanaged hypertension with S4. Echocardiogram findings?
a) Biventricular
b) Eccentric left ventricle
c) Eccentric right ventricle
d) Concentric left ventricle ***
e) Concentric right ventricle
150- Heart failure treatment? Inhibition of reabsorption of Na and K from ascending loop
151- Orthopnea, paroxysmal nocturnal dyspnea, bilateral basilar crackles. Findings?
a) Fluid accumulation around the alveoli
b) Macrophages migrate to the alveoli***
152- Mitral regurgitation with pulmonary edema. Cardiogenic shock arrows ( cardiac output,
PCWP, SVR, SvO2)
153- Septic shock arrows
154- Patient has HepC and cirrhosis, with splinter hemorrhage (description), tricuspid
regurgitation? Candida (IV Drug abuse)
155- Friction rub, aggravated by inspiration and relieved by leaning forward. Diffuse ST
elevation? Acute pericarditis
156- ACh vasodilation How? Nitric oxide
157- Man who got gunshot 10 years ago, had a surgery joining his jejunum with the cecum.
Which enzyme activity is increased? HMG-CoA reductase

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 Endocrine

158- GH and IGF-1 at upper limits. Growth delay? IGF-1 resistance

159- Marathon runner? Increased urea absorption from collecting tubules
160- ADH? Supraoptic nucleus of the hypothalamus
161- Prolactinoma with bitemporal hemianopsia. Treatment? Full agonist
162- Normal blood glucose, low CSF glucose. Defect? Glucose-transporter-1
163- Androgen insensitivity case. Defect? DNA binding receptor
164- 26 years old girl with type 1 DM. She presented with signs and symptoms of
hypothyroidism and diffusely enlarged thyroid. Cause? Immune thyroiditis (other options: viral
thyroiditis)
165- Case of Graves? Thyroid-stimulating immunoglobulin

166- Diagnosis based on the graph? Secondary

hyperparathyroidism

167- Child with T1DM presented to the ER with nausea and vomiting. Labs show glucose of
400 and lymphocytosis. Cause of lymphocytosis? Ketones
168- Patient with duodenal ulcer and diarrhea (malabsorption). Secretin was administered to
confirm the diagnosis. What is abnormal? Gastrin (other options: Bicarbonate)
169- Anti-Diabetic therapy adverse effect
170- Metformin? Increased glucose uptake
171- Desmopressin for nocturnal enuresis? Increased water reabsorption

Gastrointestinal

172- Bilious vomiting? Duodenal atresia (other options: Annular pancreas)

173- Cells responsible for acid secretion? Parietal cells
174- Fever, RUQ pain, jaundice. Location of gallstone? Common bile (other options: common
hepatic, cystic duct, right hepatic duct)
175- Old woman with bulge inferior to inguinal
ligament? Femoral hernia

176- Duodenal ulcer with black stools. Label the artery

involved? Gastroduodenal artery (branch of the common
hepatic artery – celiac artery)

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177- Barret esophagus. Epithelium changes to? Columnar (asked twice)

178- Anti-Endomysial antibodies? Crypt hyperplasia

179- p-ANCA. Treatment? TNF-alpha inhibitors
180- Gastroparesis or ileus. Strongest predisposing risk factor?
a) Abdominal surgery
b) Diabetes
181- Polypectomy. After 3 years? Normal mucosa
182- Spider angioma in cirrhotic patient? Estrogen
183- SAAG less than 1.1? Malignancy
184- Splenomegaly without cirrhosis or hepatomegaly? Portal vein hypertension/ thrombosis
185-

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