Brain & Behavior
An otherwise healthy 27-year-old man is referred to a cardiologist because of three episodes of severe palpitations, dull chest discomfort, and a choking sensation. The episodes occur suddenly and are associated with nausea, faintness, trembling, sweating, and tingling in the extremities; he feels as if he is dying. Within a few hours of each episode, physical examination and laboratory tests show no abnormalities. He does not abuse drugs or alcohol and has no history of interpersonal problems. Which of the following is the most likely diagnosis?
(A) Delusional disorder (B) Generalized anxiety disorder (C) Hypochondriasis (D) Panic disorder (E) Somatization disorder
(D) Panic disorder
A fourth-year medical student is reviewing antibiotic agents during an infectious disease rotation. When looking up the treatment of Toxoplasma gondii, a parasite, she learns that it is treated by the antimicrobial combination of sulfadiazine and pyrimethamine, which she thought was antibacterial. She becomes confused about the difference between “antibacterials” and “antimicrobials.” Which of the following best defines this difference?
(A) All antibacterials are antimicrobials, but not all antimicrobials are antibacterial. (B) All antimicrobials are antibacterials, but not all antibacterials are antimicrobials. (C) All antimicrobials target bacteria, parasites, and fungi. (D) Antibacterials target only bacteria. (E) They are direct synonyms.
(A) All antibacterials are antimicrobials, but not all antimicrobials are antibacterial.
Which of the following patients has the least risk for iron deficiency?
(A) A 60-year-old male with heme-positive stools (B) An asymptomatic postmenopausal female (C) An asymptomatic premenopausal female (D) A patient with peptic ulcer disease taking large doses of oral antacids (E) A pregnant patient who consumes a vegan diet
(B) An asymptomatic postmenopausal female
A 69-year-old man comes to the clinic because of bleeding after brushing his teeth. He tells you that he recently came back from a 7-month long voyage at sea and his fruit and vegetable supply rotted a month into his journey. On observation of his skin, small pinpoint hemorrhages are observed. What vitamin is most likely deficient in this patient?
(A) Niacin (B) Thiamine (C) Vitamin B7 (D) Vitamin C
(D) Vitamin C
What was another name for the famous Jewish physician Moses Ben Maimon, who lived in the Golden age of Islam?
(A) Avicella (B) Maimonides (C) Paracelsus (D) Leannoc
(B) Maimonides
An investigator is studying normal sleep patterns in healthy men and women. Saccadic motions of the eyes are seen approximately 90 minutes after the volunteers fall asleep. Which of the following is most likely to be observed in the volunteers during this period of saccadic eye movements?
(A) Difficulty awakening (B) An EEG pattern resembling that of the walking state (C) Hyperactive muscle tone (D) Increased movements (E) Irregular respiratory rhythm
(B) An EEG pattern resembling that of the walking state
What is the function that differentiates retroviruses from RNA viruses?
(A) Ability to synthesize DNA from RNA (B) Ability to synthesize RNA from DNA (C) Mode of transmission (D) Presentation of fever and lymphadenopathy (E) Use of genetic code in replication
(A) Ability to synthesize DNA from RNA
A 52-year-old woman visits her physician and reports vaginal spotting after intercourse. She has smoked a half-pack of cigarettes a day for most of her adult life. Her last gynecologic exam was the postpartum follow-up visit after her 17-year-old son was born. She used oral contraceptives for many years until her husband had a vasectomy. She is eventually diagnosed with advanced cervical carcinoma that has spread to her lymph nodes. Which of the following is most responsible for her advanced disease at diagnosis?
(A) Age (B) Smoking History (C) Lack of cervical cancer screening (D) History of Oral Contraceptives (E) Late age at Childbirth
(C) Lack of screening
If your right thumb is facing outward, what is the relationship of your right pinkie finger to your right index finger?
(A) Distal (B) Inferior (C) Lateral (D) Medial (E) Proximal
(D) Medial
Which of the following is something Marie Curie is known for?
(A) Invention of the stethoscope (B) Discovery of antibodies (C) Discovery of Radium (D) Invention of the scalpel
(C) Discovery of Radium
A 27-year-old woman is brought to the emergency department 1 hour after a friend found her barely arousable in her disorderly apartment with a nearly starving cat. The patient appears extremely thin. Her pulse is 90/min, respirations are 6/min, and blood pressure is 90/60 mm Hg. Physical examination shows small pupils, cracked lips, and bruises and scratches over the upper extremities. Mental status examination shows mild obtundation, blunted affect, and slow, incoherent speech. Which of the following is the most appropriate next step in management?
(A) Observation in a quiet darkened room (B) Oral administration of chlorpromazine (C) Intramuscular administration of naloxone (D) Intravenous administration of haloperidol (E) Intravenous administration of lorazepam
(C) Intramuscular administration of naloxone
Gram-positive bacteria were isolated and determined to have an altered penicillin-binding protein encoded in the genome. What new ability has the bacteria acquired as a result of these altered genes?
(A) β-Lactam antibiotic resistance (B) Capsule Production (C) Exotoxin production (D) Sporulation capability (E) Superantigen production
(A) β-Lactam antibiotic resistance
Which of the following features of cancer most likely confers the worst prognosis?
(A) 10-cm primary tumor size (B) Grade 3 anaplasia (C) Involvement of two lymph nodes (D) Involvement of five lymph nodes (E) Metastasis to a distant organ
(E) Metastasis
Which of the following is most useful in cushioning ball-and-socket joints?
(A) Fascia (B) Fibrocartilage (C) Ligaments (D) Synovial Fluid (E) Tendons
(D) Synovial Fluid
True or false: the first doctor strike in North America was focused on Medicare.
False
A 47-year-old man with Down syndrome is brought to the physician by his sister because of an 8-month history of regression in his abilities. The sister describes a gradual decline in his language skills and progressive fearfulness. The patient no longer remembers songs that he has known for years, and he does not wish to participate in family activities anymore. Pathologic examination of the brain would most likely show which of the following in this patient?
(A) Deposits of long-chain fatty acids (B) Intracellular arylsulfatase A (C) Lewy bodies and nigral atrophy (D) Neuronal plaques and tangles (E) Perivenular inflammatory cells
(D) Neuronal plaques and tangles
Which of the following is not an example of a human parasite?
(A) Ascaris worms (B) Head lice (C) Liver flukes (D) Plasmodium vivax (E) Pneumocystis jiroveci
(E) Pneumocystis jiroveci
In relation to other abdominal organs, where is the spleen located?
(A) Anterior to the stomach, anterior to the kidney, lateral to the pancreas (B) Anterior to the stomach, posterior to the kidney, lateral to the pancreas (C) Posterior to the stomach, anterior to the kidney, lateral to the pancreas (D) Posterior to the stomach, anterior to the kidney, medial to the pancreas (E) Posterior to the stomach, posterior to the kidney, medial to the pancreas
(C) Posterior to the stomach, anterior to the kidney
Which of the following causes sodium channels to transition from the closed to the inactivated state in nonpacemaker cardiac cells?
(A) Acidosis (B) Alkalosis (C) Depolarization (D) Hyperpolarization (E) Sodium ion influx
(C) Depolarization
Which of the following was a major driving force in the desegregation of American hospitals?
(A) Medicare (B) The AMA (C) The Cone Moses Hospital Administration (D) Jerry
(A) Medicare
One day after admission to the hospital for agitation and hallucinations, a 19-year-old man has the onset of severe muscle stiffness that prevents him from rising out of bed. At the time of admission, treatment with haloperidol was begun. Today, he appears lethargic and diaphoretic. His temperature is 39.7°C (103.5°F), pulse is 120/min, and blood pressure is 160/110 mm Hg. Physical examination shows generalized severe rigidity of the upper extremities bilaterally. On mental status examination, he is not oriented to person, place, and time. Which of the following is the most appropriate next step in management?
(A) Observation only (B) Add fluoxetine (C) Add lithium carbonate (D) Discontinue haloperidol (E) Increase the dosage of haloperidol
(D) Discontinue haloperidol
A 65-year-old male presents at his doctor’s office complaining of intense pain down the back of his right leg. The pain began 3 days ago and is described as burning or electric. On further examination, the physician finds an erythematous rash with grouped vesicles located along the S1 dermatome. Which of the following best explains the pattern of the patient’s pain?
(A) There is postinfectious inflammation of peripheral nerves. (B) VZV has disseminated, traveling through the bloodstream to remote locations. (C) VZV has invaded an intervertebral disc, causing nerve root pain. (D) VZV has reactivated and traveled down a spinal nerve root. (E) VZV is infecting the skin epithelium
(D) VZV has reactivated and traveled down a spinal nerve root.
Which of the following causes of megaloblastic anemia will respond best to oral folate supplements?
(A) Chronic pancreatitis (B) Crohn disease (C) Gastritis (D) Pernicious anemia (E) Pregnancy
(E) Pregnancy
How does venous drainage differ between the right and left adrenal gland?
(A) The venous drainage from the adrenal glands does not differ between sides. (B) The venous drainage from the right adrenal gland empties directly into the hepatic vein; the left adrenal gland empties into the inferior vena cava. (C) The venous drainage of the right adrenal gland empties directly into the inferior vena cava; the left adrenal gland empties into the hepatic vein. (D) The venous drainage of the right adrenal gland empties directly into the inferior vena cava; the left adrenal gland empties into the left renal vein. (E) The venous drainage of the right adrenal gland empties directly into the right renal vein; the left adrenal gland empties into the inferior vena cava.
(D) The venous drainage of the right adrenal gland empties directly into the inferior vena cava; the left adrenal gland empties into the left renal vein.
What was initially used by Leannoc which would become the modern stethoscope?
(A) A funnel (B) Two cups connected by a string (C) Tube of paper (D) His ear