An obese 45 year old female pateint with an elevated temperature comes to the physicians

office complaining of nausea and intermittent, acute pain in the right upper quadrant of the
abdomen during the past 2 days. She has a 24 hour history of gallstones. Which of the following
structures has most likely been obstructed by a gallstone?
a. Cystic Duct 
b. Left Hepatic Duct 
c. Common Bile Duct 
d. Pancreatic Duct 
e. Right Hepatic Duct 

. A 22 year old primigravida recently emigrated from the Dominican Republic has a normal
vaginal delivery. The infant is phenotypically male but has hypospadias and a small phallus. The
testes are well developed but reisde in the inguinal area. His physical exam including blood
pressure is otherwise normal. Serum testosterone level is within normal limits. A karyotype is
performed and shows 46 XY. Which of the following enzymes is most likely deficient in this
patient? 
a. Aromatase
b. 5a-reductase 
c. DHEA sulfatase 
d. 17-hydroxylase 
e. 21-hydroxylase

 As part of her twice a week workout routine, a 26 year old woman does an exercise in which
she sits in a machine with her legs together and then opens her legs against lateral resistance
provided by the machine. The nerve responsible for this type of movement is the:
a. Superior Gluteal Nerve 
b. Obturator Nerve
c. Deep Peroneal Nerve
d. Sciatic Nerve
e. Femoral Nerve

 A young couple presents with concerns that they have not been able to conceive a child.
Physical exam of the 22 year old husband reveals mild obesity, gynecomastia, and decreased
facial and axillary hair. He has male genitalia, but penile length is decreased and the testes are
small. Chromosomal analysis reveals the XXY pattern of Kleinfetler syndrome. Which of the
following is the principal androgen responsible for transforming undifferintiated external genitalia
in the fetus into male external genitalia?
a. Andeostenedione 
b. Testosterone 
c. Androsterone 
d. Mūllerian-inhibiting substance (MIS)
e. Dihydrotestosterone 
47. A male gubernaculum helps to pull the testes from the posterior abdominal wall to the
labioscrotal swelling, in the female what does the gubernaculum become? 
a. Broad ligament and round ligament 
b. Round ligament of uterus and round ligament of ovary 
c. Mesosalpinx and mesovarium 
d. Round ligament of ovary and mesosalpinx 
e. Round ligament of uterus and mesometrium 

48. A 30 year old woman presents to her physician’s office with swelling in her right cheek and
increased salvation. She is diagnosed with a parotid gland tumor. The increased salivary flow
rate caused by the tumor would cause what changes in salivary electrolyte levels?

a. A
b. B?
c. C
d. D
e. E

 A 68 year old woman with hematemesis has heartburn and stomach acid pain. An endoscopy
showed inflammation involving the gastric body and antrum as well as a small gastric ulcer.
Biopsies were positive for H pylori. H pylori damages the gastric mucosa primarily by increasing
mucosal levels of which of the following?
a. NSAIDs
b. Gastrin 
c. Ammonium 
d. Pepsin 
e. Bile Salts 

 A 56 year old woman slipped and fell on her outstretched hand on a wet floor. She experienced
a severe pain at the wrist, and over her right collar bone. On examination at the ER, there were
both swelling and tenderness in her right anatomical snuffbox, dorsal deviation of the distal part
of her right forearm and tenderness and swelling over her right clavicle with the ipsilateral upper
limb hanging limply by her side. The anatomical snuffbox tenderness is due to: 
a. Transection of the median nerve 
b. Bennet’s fracture 
c. Fracture of pisiform 
d. Fracture of scaphoid 
e. Dislocation of lunate 

51.  10 days after a D & C, a 23 year old woman developed pelvic abscess. The physician
elicited tenderness and rebound tenderness in her left lower quadrant. Rectal exam revealed an
anterior fullness, and vaginal palpation revealed posterior fullness. Culdocentesis drew pus
through the posterior fornix. The abscess is most likely located in.. 
a. Retropubic pouch 
b. Vesicouterine pouch 
c. Rectouterine pouch 
d. Retrorectal pouch 
e. Urogenital diaphragm 

 A 52 year old postmenopausal woman sees her physician because she is worried about
osteoporosis. Her physician decides that he should investigate her calcium reabsorption in the
thick ascending limb of henley. Which of the following interventions would most likely effectively
increase her calcium reabsorption in the thick ascending limb of the loop of henley?
a. Maintenance of negative charge in the lumen 
b. Discontinuation of her loop diuretic 
c. Administration of exogenous parathyroid hormone 
d. Increasing serum calcium by administration of a vitamin supplement
e. Discontinuation of her thiazide diuretic 

53. An 83 year old man visits his doctor for a checkup, and he is found to have hypertension.
The physician wants to avoid the use of ꞵ-blockers and α blockers with this patient because of
an unpleasant adverse effects of these medications on the elderly, so he prescribes an
angiotensin-converting enzyme inhibitor instead. This drug is known to decrease the formation
of angiotensin II in the body. Aside from increasing aldosterone levels. How else does
angiotensin II directly act?
a. Increases acid reabsorption in the proximal tubule 
b. Increases level of bradykinin
c. Increases renal plasma flow 
d. Increases GFR
e. Increases Na reabsorption in the DCT 
A 44 year old man presents to the outpatient clinic complaining of a lesion on his penis. His
medical history indicates multiple instances of recent unprotected sex. On physical exam, a
penile shaft lesion resembling a cancer is noted. Blood tests reveal a positive rapid plasma
region. An intramuscular injection of penicillin G is administered. The patient comes back for a
follow up visit a week later, and when he walks into the room, his right hip drops  when his right
foot is raised off the ground. The injured nerve provides innervation to muscles that perform
what action?
a. Lateral rotation of the thigh 
b. Medial rotation of the thigh 
c. Abduction of the thigh 
d. Adduction of the thigh 
e. Extension of the thigh 

55. A 40 year old woman is having significant uterine bleeding from uterine fibroids. The
radiologist performs an embolization procedure of the uterine arteries. Through which of the
following structures do the uterine arteries transverse?
a. Cardinal Ligament 
b. Vesicouterine Ligament 
c. Hypogastric Sheath 
d. Uterosacral Ligament 
e. Posterior Fornix 

56. A 69 year old man with a history of gastroesophageal reflux develops a pulmonary saddle
embolus and expires. The patient’s esophagus is examined at autopsy, which of the following
types of epithelium lines the proximal portion of the autopsy specimen? 
a. Pseudostratified columnar with cilia and goblet cells 
b. Pseudostratified columnar and goblet cells 
c. Simple columnar with goblet cells 
d. Stratified squamous, nonkeratinized 
e. Stratified squamous, keratinized 

. A 54 year old missionary travelling alone in southern asia loses his bag of supplies. After 24
hours without food or water, due to increased secretion of ADH from the posterior pituitary, his
urine osmolarity is 1100 mOs.L. The fluid filtered by the glomerulous is primarily reabsorbed by
which part of the nephron?
a. PCT
b. DCT
c. Loop of Henle, Desc Limb 
d. Collecting Tubule 
e. Loop of Henle, Asc. Limb 

59. The research division of a large pharmaceutical company focuses their efforts on studying
renal tubular transport proteins. A substance is identified that specifically and completely inhibits
glucose transport in the proximal renal tubules. In a healthy volunteer receiving this substance,
glucose clearance will best approximate the clearance of which of the following?
a. Sodium 
b. Urea 
c. Alanine 
d. Inulin 
 e. Para - amino hippuric acid (PAH)

60. An otherwise healthy 20 year old woman presents to the emergency department
complaining of pain in her left lower quadrant that started 1 day ago. She denies vomitus, fever,
or chills. Her last menstrual period was about 2 weeks ago. On physical exam, her lower left
abdominal is tender to palpation, with involuntary guardian, urine β-human chorionic
gonadotropin is negative. Ultrasound imaging reveals no adrenal masses and grossly normal
ovaries. What is the most likely cause of this patient’s abdominal pain?
a. Serous cystadenoma 
b. Mittelschmerz 
c. Ectopic pregnancy 
d. Ruptured ovarian cyst 
e. Pelvic inflammatory disease 

61. A 28 year old woman suffered a right nondisplaced tibial fracture 2 weeks ago in a motor
vehicle accident and received a long leg cast. Today she presents to an outpatient health clinic
with a chief complaint of hand tingling and difficulty extending his wrist and extending her elbow.
On physical exam, the physician actively extends her wrist and notices that it drops when he
stops applying pressure. Which of the following nerves is most likely affected?

RADIAL
Median 
a. Ulnar 
b. Musculocutaneous 
c. Axillary 

 A healthy 46 year old man undergoes treatment of a kidney stone. He is in the lithotomy
position for two hours for his procedure and awakens from surgery without difficulty. However,
when he gets out of bed, he notices an inability to dorsiflex his foot. The damageto this nerve
was likely due to pressure at which site during surgery?

a. Greater trochanter 
b. Fibular head
c. Acetabulum 
d. Anterior superior iliac spine 
e. Medial malleolus 
63. You are investigating the activation of smooth muscle is the muscularis mucosae of the
stomach and its tole in assisting outflow from gastric glands. The cell bodies for visceral motor
fibers that innervated the muscularis mucosae are present in which of the following anatomic
locations?
a. Sympathetic trunk 
b. Nucleus ambiguus of the CNS
c. Meissner plexus 
d. Auberback plexus 
e. Celiac Ganglion 

64. If the musculocutaneous nerve is severed at its origin from the brachial plexus, flexion at the
elbow is greatly weakened but not abolished. What muscle remains operative and can
contribute to flexion? 
a. Short head of bicep brachii 
b. Coracobrachialis 
c. Brachialis 
d. Brachioradialis 
e. Long head of bicep brachii 

65. A 64 tear old man with type 2 diabetes mellitus comes to the physician for a routine follow
up appt. He was started on oral hypoglycemic medication 12 years ago but was recently
switched to long acting insulin due to inadequate blood sugar control. His serum creatinine level
was 2.1 mg/dL. This patient is concerned about his elevated creatinine level and how it relates
to his kidney function. Which of the following graphs most accurately represents the relationship
between serum creatinine and GFR?

a.
b.  

c.
 d.

66. A middle aged woman presents with flushing, severe headaches and a feeling that “my
head is going to explode” and a jump of her BP from 130/85 → 200/135 mm Hg immediately
after palpation of her abdomen. A CT scan is likely to confirm a diagnosis of what condition?
a. Adrenal cortical tumor 
b. Renal failure 
c. Pre renal abscess 
d. Adrenal medullary tumor 
e. Renal tumor 

67. A healthy human volunteer is given a slow intravenous infusion of a PAH solution. In which
of the following nephron segments is the PAH conc. Lowest?
a.  Bowman's space 
b. DCT
c. Loop of Henle 
d. PCT
e. Collecting duct 

68. A 69 year old man with hypertension and congestive heart failiure is brought to the ED bc of
a 9 day history of worsening SOB and swelling of his legs. His resp. Are 25/min and BP is
160/98 mm Hg, Pulse oximetry is 5 L O2 via nasal cannula shows an oxygen saturation of 92%.
Exam shows 2+ pretibia edema bilaterally. Crackles are head at both lung bases. The patient’s
symptoms are due in part to an increase in the rate of bradykinin breakdown. Bradykinin is
degraded by ACE, a component to the RAAS. The substance responsible bradykinin breakdown
is primarily produced by which of the following?
a. Atria 
b. Liver 
c. Zona Glomerulosa 
d. Pulmonary Endothelium 
e. Juxtaglomerular cells 

69. A 68 year old man presents with a 2 week history of abdominal discomfort. A CT scan
reveals a dilated and calcified segment to the abdominal aorta is examined at autopsy. Loss of
which of the following cellular/biochemical components of the aortic media contributed the most
to the development of this patient’s abdominal aneurysm. 
a. Heparin sulfate proteoglycans 
b. Reticular (type II collagen) fibers
c. Elastic Fibers / lamellae 
d. Collagen type I fibers 
e. Smooth muscle bundles 
70. Deuterium oxide and inulin are injected into a normal 30 year old man. The volume of
distribution of deuterium oxide is found to be 42 L and that of inulin 14 L. 
a. The man’s intracellular fluid vol is about 14 L 
b. The man’s plasma vol is about 7 L
c. The man’s ICF vol is about 28 L
d. The man’s interstitial fluid is about 9 L 
e. The man’s total body water cannot be determined from these data. 

71. A 34 year old man with type 1 diabetes mellitus comes to the office to achy pain in the
shoulders, elbows, and thighs over the past several months. The patient was diagnosed with
diabetes mellitus 15 years ago and has had difficulty adequately  controlling it. He currently
takes multiple daily injections of insulin. Vital signs are within normal limits. Physical exam
shows mild pedal edema. Serum creatinine is 2.2 md/dL up from 1.6 mg/dL six months ago.
Additional lab results show low serum calcium and elevated parathyroid hormone levels.
Inhibition of which of the following enzymatic steps is most likely responsible for this patient’s
current symptoms? 

a. A 
b. B
c. C
d. D
e. E 

72. A cross section of the penis is examined in the histo lab (shown in image) Identify the
structure indicated by the arrow 

a. Tunica Albuginea 
b. Corpus spongiosum 
c. Corpus carvemosum 
 d. Tunica vascularis 
e. Tunica vaginulas 

73. During a small group seminar, you are asked to discuss the physiology of muscle
contraction. The sarcomere is the basic contractile unit of the skeletal muscle. It lies between
which of the following paired structures in myofibrils? 
a. Adjacent I bands 
b. Adjacent M lines
c. Z line and M line
d. Adjacent Z line 
e. Adjacent A bands

74.  A 22 year old mother of one is brought to the ER with a complaint of lower quadrant pain,
with positional hypotension. Her last menstrual period, LNMP, was 2 months prior. A urine
dipstick and ultrasound confirmed an ectopic pregnancy. What is the most likely site of this
pregnancy?
a. Urinary Bladder
b. Peritoneal 
c. Interstitial 
d. Tubal 
e. Ovarian 

75.  A 23 year old man is brought to the emergency department by paramedic following a motor
vehicle accident. He was an unrealistic passenger in the front seat. Several days after
hospitalization, his fluid volume and plasma osmolarity are measured and illustrated in the
image bellow, (solid line, normal, dotted line, patient) 

a. Diabetes insipidus 
b. Adrenal insufficiency 
c. Acute gastrointestinal hemorrhage 
d. Primary polydipsia 
e. Hypertonic saline infusion 

76. Mrs. Jones is undergoing a routine colonoscopy for colon cancer prevention. The
gastroenterologist finds a Meckel’s diverticulum. Which of the following statements is true about
the diverticulum?
a. It is a persistent remnant of of the embryonic yolk sac 
b. It occurs in about 20% of the population 
c. It is located on the mesenteric side of the ileum 
d. It may contain renal and suprarenal tissues 
e. It is found 2 feet distal to the ileocecal junction 

77. A 64 year old with coronary artery disease and hypertension comes to the physician for a
follow up exam. His blood pressure ranges from 160/100 to 150/94 mm / Hg on his previous 3
visits over the past 4 months. Current medications include aspirin, atorvastatin,
hydrochlorothiazide, and metoprolol. Three weeks ago, he was also started on amlodipine. His
blood pressure today is 158 / 98 mm / Hg. Physical exam shows no other abnormalities. Renal
duplex ultrasonography shows 90% occlusion of the right renal artery. Decreased renal blood
flow is most likley to cause which of the following?
a. Dec reabsorption of bicarb at pct 
b. Dec prostaglandin synthesis by macula densa
c. Dilation of efferent arteriole 
d. Mesengial expansion and glomerular basement membrane thickening 
e. Hyperplasia of juxtaglomerular cells 

78. A 20 gauge spinal needle is placed through the vaginal to assess whether there is blood in
the peritoneal cavity. Which of the following describe the most dependent part of the peritoneum
or pelvis?
a. Pararectal space 
b. Fascia of denonvilliers 
c. Vesicouterine pouch 
d. Rectouterine pouch 
e. Paravesical space 

79. A 30 year old para 4 gravida 5 is in her first stage of labor and wants vaginal delivery with a
pudendal block in the second stage. The duty obstetrician asked the rotating medical student to
name the three structures attached to the ischial spine which are..
a. Interosseous sacroiliac ligament 
b. Anterior sacroiliac ligament 
c. Sacrospinous ligament 
d. Posterior sacroiliac ligament 
e. Sacrotuberous ligament 

80. A 42 year old mother of five comes to a primary care physician complaining of acute pain in
her abdomen for 3 days that is most pronounced after meals. She is afribile, her vital signs are
stable, and her body mass index is 34 kg/㎡. On physical exam she has tenderness to palpation
with voluntary guarding under the ribcage on the right side. Ultrasound confirms the diagnosis of
gallstones. The patient is counseled on surgical options as well as lifestyle modifications. Which
pair correctly matched the type of food this patient should avoid with the function of the hormone
that causes abdominal pain?
a. High carbohydrate foods stimulates gastric acid secretion 
b. High fat foods increase gastric motility 
c. High carbohydrate foods inhibit gastric acid secretion 
d. High protein foods inhibit gastric emptying 
e. High fat food stimulate gallbladder contractions

81.  A woman with a 2 year old son comes to her physician because she has been unable to
conceive a second child for more than a year. The woman is currently breastfeeding her son.
Which of the following best explains the physiological mechanism currently preventing her from
getting pregnant?
a. Prolactin inhibits secretion of estrogen from the ovaries 
b. Prolactin inhibits secretion of progesterone from the corpus luteum 
c. Prolactin inhibits secretion of LH from the ant pit gland 
d. Prolactin inhibits secretion of GnRH from the hypothalamus 
 e. Prolactin inhibits secretion of FSH from the ant pit gland 

83. An 89 yro man in a nursing home was seen by his primary care physician about his ongoing
struggles with his BP, which has constantly reas 180/100 or above. He also complained of not
feeling hungry, a sense of fullness in his abdomen and back, loss of about 10 pounds weight in
2 weeks. He also has a history of smoking for more than 30 years, on physical exam, the
physician notes a midline pulsating mass in the patient’s abdomen, which he has consistently in
the past mistaken for a heartbeat, but slightly delayed. The physician ordered a CT scan with IV
contrast, which confirmed what the physician was thinking about. What is it?
a. Retroperitoneal adenitis 
b. Abdominal aortic aneurysm 
c. Mesenteric angina 
d. Adrenal medullary tumor 
e. Acute colitis 

84. A prostate needle biopsy is obtained from a 70 year old man with elevated serum levels of
prostate specific antigen (PSA, 10.5 ng/mL.) The specimen is embedded in paraffin, stained
with H&E and examined in the path dept. (shown in image) identify the structure indicated by
the arrow. 

a. Corpora amylacea 
b. Residual body 
c. Cluster of malignant cells 
d. Glassy membrane 
e. Multinucleated giant cells 

87. A man injures his wrist on broken glass. Which of the following structures entering the palm
superficial to the flexor retinaculum may be damaged?
a. Ulnar nerve and median nerve 
b. Median nerve and flexor digitorum profundus 
c. Median nerve and flexor pollicis longus 
d. Ulnar artery and ulnar nerve
e. Ulnar nerve and flexor digitorum superficialis 

91. What is the explanation for the slightly pigmented and wrinkled appearance of the scrotum 
a. Hyperkeratinized squamous epithelium 
b. Dartos fascia 
c. Pampiniform plexus  
 d. Tunica albuginea 
e. Increased number of melanocytes 

92. Mr. Jones had type 1 diabetes mellitus and forgot to take his insulin. Although his serum
glucose level begins to rise rapidly, glucose only becomes detectable in his urine several hours
later. Which answer choice best explains why glucose does not immediatley become detectable
in Mr. Jones urine?
a. Impermeability of occluding proteins in the tight junction of glomerular capillary
endothelium cells 
b. Kinetics of the sodium potassium exchange pump in the DCT 
c. Kinetics of the sodium dependent glucose symporter in the DCT 
d. Kinetics of the sodium potassium exchange pump in the PCT 
e. Kinetics of the sodium dependent glucose symporter in the proximal convulated tubule 

93. A 26 year old pregnant woman visits her gynecologist for a routine checkup. Ultrasound
examination reveals that the patient has a normal pregnancy but that she also has two uteri.
What is the most likely embryologic explanation of this condition?
a. An incomplete fusion of the paramesonephric ducts 
b. Regression of the pronephrons 
c. A complete fusion of the parasympathetic ducts 
d. A complete fusion of the mesonephric ducts 
e. An incomplete fusion of the mesonephric ducts 

94. A painful and fluctant swelling that is located at 5 and 7 oclock in the female perineum is.
a. Bulboretheral gland 
b. Lesser vestibular gland 
c. Greater vestibular gland 
d. Bulb of vestibule 
e. Digital process 

95. During your lecture, a student asks about the significance of urine production during
intrauterine development. Which of the following is the most important function of the kidneys
during embryonic and fetal life 
a. Regulation of blood pH
b. Regulation of fetal BP
c. Removal of nitrogenous waste (blood urea nitrogen) 
d. Generation of amniotic fluid 
e. Maintance of electrolyte balance 

97. The parents of the 8 week old girl complain that the child is apathetic and sluggish. Further
tests reveal mental and physical retardation. The child is diagnosed with creatinism. Hormone
replacement therapy is initiated. Agenesis during development of which of the following organs
would explain the pathogenesis of physical and mental retardation in this infant?
a. Parathyroid gland 
b. Adrenal gland 
c. Pituitary gland 
d. Pineal gland 
e. Thyroid gland 
98. A person skiing for the first time goes too fast and grabs hold of tree with one arm to stop
himself. In doing so, he is most likely to injure which of the following? 
a. Median Nerve 
b. Lower part of the brachial plexus 
c. Radial nerve 
d. Upper part of the brachial plexus 
e. Ulnar nerve 

99. A 32 yro woman who is the mother of a 5 yro girl is being investigated for second infertility.
As most of her tests showed normal, the gynecologist decided to investigate her for
endometriosis by performing a laparoscopic exam of her abdominopelvic cavity. The physician
is carefully placed the trocar on the linea semilunaris. But away from the major and landmark
artery. What is the name of this artery?
a. Superior gluteal artery 
b. 7th intercostal artery 
c. Internal thoracic artery 
d. Inferior epigastric artery 
e. Lateral thoracic artery