Summative 1 Practice Exam GOOD LUCK EVERYONE ON MONDAY!

Student Name: _________________________________ Date: ___________________

Question #1: If the nerve that passes over the neck of the fibula were damaged, one would expect a
loss of each of the following EXCEPT
A) ability to dorsiflex the foot
B) ability to evert the foot
C) sensation between the first and second toes
D) sensation over the lateral leg and dorsum of the foot
E) sensation over the medial leg

Question #2: Cells from the yolk sac will form the structure labeled X , which fills the space between
the trophoblast externally and the amnion and yolk sac internally. What is the name of this structure.

A) Extraembryonic mesoderm
B) Extraembryonic dermatome
C) Extraembryonic coelom
D) Extra secondary mesoderm

Question #3: A 33-year-old male worker from the local newspaper has been admitted after accidentally
ingesting quantities of typemetal dust from the print room floor. His symptoms include headache,
vomiting and diarrhea. Since you recall that typemetal contains large amounts of arsenic as a
hardening agent you diagnose his condition as arsenic poisoning and he is started on a regimen of
Succimer, a chelating agent that removes arsenic from blood proteins. The arsenic metabolite
arsenate interferes with which of the following enzymes of glycolysis?
A) Enolase
B) Glyceraldehyde-3-phosphate dehydrogenase
C) Hexokinase
D) Phosphoglycerate kinase
E) Phosphoglycerate mutase
F) Pyruvate dehydrogenase complex

Page 1
Question #4: Which regulator inhibits carnitine-palmitoyl transferase I when fatty acid synthesis is
active?
A) Carnitine
B) Citrate
C) Fatty acyl CoA
D) Malonyl CoA
E) Pyruvate

Question #5: Which of the following tissues are best described as avascular?
A) Compact bone
B) Loose connective tissue
C) Hyaline cartilage
D) Dense regular connective tissue
E) Dense irregular connective tissue

Question #6: A 19-year-old woman comes to the physician because of a 5- day history of increasingly
severe right lower abdominal pain and bloody vaginal discharge. Her last menstrual period was 8
weeks ago. Abdominal examination shows exquisite tenderness of the right lower quadrant. A serum
pregnancy test result is positive. Ultrasonography shows no gestational sac in the uterus. Which of the
following is the most likely location of this patient’s fertilized egg?
A) Cervix
B) Peritoneum of the right lower abdominal wall
C) Rectouterine pouch (of Douglas)
D) Right fallopian tube
E) Right ovary

Question #7: The sputum (fluid coughed up from the lungs) of many smokers contain cells with
mutations (errors) in the genes for p53. The smoking induced mutations appear to be an early signal
showing that cancer of the lungs will follow. What is the likely relationship between early p53
mutation and the development of lung cancer?
A) Mutations in p53 would prevent abnormal cells from dying by apoptosis
B) Mutant p53 triggers the M phase of the cell cycle leading to abnormal cell division
C) p53 causes a cell to enter G2, blocking cell division
D) p53 with a mutation directly stimulates the growth of cancer cells

Question #8: Release of synaptic transmitter can be controlled by the:

1) state of polarization of presynaptic membrane

2) number of activated presynaptic Ca2+ channels
3) cyclic nucleotide cascade
4) open time of postsynaptic chemically gated channels

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Page 2
Question #9: A 48-year-old man has hepatic cancer that is unresponsive to standard therapy. He
enrolls in a clinical study of a novel chemotherapeutic agent that, as a side effect, blocks kinesin, a
component of the cellular microtubular transport system. One week later, he develops skeletal muscle
weakness. An alteration in which of the following components of the neuromuscular junction is the
most likely cause of the muscle weakness?
A) A decrease in the number of postsynaptic neurotransmitter receptors
B) A decrease in the number of presynaptic neurotransmitter vesicles
C) A decrease in the presynaptic neuron calcium permeability
D) Impaired alpha-motoneuron action potential conduction
E) Impaired skeletal muscle action potentail conduction

Question #10: The hormone Glucagon activate all of the following except:
A) Phosphorylase kinase
B) Protein kinase A
C) Glycogen phosphorylase
D) Glucogneogenesis
E) Glycogenesis

Question #11: A protein has one transmembrane domain composed entirely of alpha-helical secondary
structure. Which of the following amino acids would you expect to find in the transmembrane
domain?
A) Proline
B) Glutamate
C) Lysine
D) Leucine
E) Arginine

Question #12: A healthy, 32-year-old man lifts weights regularly as part of his workout. In one of his
biceps muscle fibers at rest, the length of the I band is 1.0 micrometers and the A band is 1.5
micrometers. Contraction of that muscle fiber results in a 10% shortening of the length of the
sarcomere. What is the length of the A band after the shortening produced by muscle contraction?
A) 1.5 micrometers
B) 1.35 micrometers
C) 1.0 micrometers
D) 0.9 micrometers
E) 0.45 micrometers

Question #13: A 35-year-old male wrestler is admitted to the emergency department with excruciating
pain in his right shoulder and proximal arm. During physical examination the patient clutches the arm
at the elbow with his opposite hand and is unable to move the injured limb. Radiographic studies
show that the patient has a dislocation of the humerus at the glenohumeral joint. Which of the
following conditions is the most likely?
A) The head of the humerus is displaced anteriorly
B) The head of the humerus is displaced posteriorly
C) The head of the humerus is displaced inferiorly
D) The head of the humerus is displaced superiorly
E) The head of the humerus is displaced medially

Page 3
Question #14: Diarrhea is an example of:
A) isosmotic volume expansion
B) isosmotic volume contraction
C) hyperosmotic volume expansion
D) hyperosmotic volume contraction
E) hyposmotic volume expansion
F) hyposmotic volume contraction

Question #15: The transfer of electrons from FADH2 group of succinate dehydrogenase to oxygen
through the electron transport chain
A) bypasses site II of ATP synthesis
B) involves cytochrome P450
C) involves the FMN group of the NADH dehydrogenase complex
D) involves the reduction and oxidation of ubiquinone
E) yields a P:O ratio of 3

Question #16: Cross-linking of collagen to form mature collagen fibrils occurs at which of the following
sites?
A) Cytoplasm
B) Extracellular space
C) Golgi apparatus
D) Rough endoplasmic reticulum
E) Smooth endoplasmic reticulum

Question #17: A 27-year-old male painter is admitted to the hospital after falling from a ladder.
Physical examination reveals that the patient is unable to abduct his arm more than 15° and cannot
rotate the arm laterally. A radiographic examination reveals an oblique fracture of the humerus. He
has associated sensory loss over the shoulder area. Which of the following injuries will most likely
correspond to the symptoms of the physical examination?
A) Fracture of the medial epicondyle
B) Fracture of the glenoid fossa
C) Fracture of the surgical neck of the humerus
D) Fracture of the anatomic neck of the humerus
E) Fracture of the middle third of the humerus

Question #18: The skeletal system develops via a process known as ossification, in which bones are
created from preexisting mesoderm. By which of the following processes do the long bones ossify?
A) Chondrocytes deposit minerals directly from the mesoderm
B) Osteoblasts deposit minerals directly from the mesoderm
C) Osteoblasts deposit minerals over a hyaline cartilage mold
D) Osteoclasts deposit minerals over a hyaline cartilage mold

Page 4
Question #19: A 2-year-old boy who recently emigrated from Somalia is brought to the physician
because of a 1-day history of pain of his arms and legs. Physical examination shows pale mucous
membranes and hepatosplenomegaly. Laboratory studies show a hemoglobin concentration of 8 g/dL.
A peripheral blood smear shows sickle cells. Genetic analyses show a point mutation in the
beta-globin gene leading to a change of a GAG codon (glutamate) to a GUG codon (valine). Which of
the following anticodons is most likely in the tRNA for valine?
A) CAC
B) CTU
C) CUC
D) GAC
E) GCC

Question #20: Although muscle cells synthesize and degrade glycogen, the glucose monomers released
cannot be exported to other tissues, because these cells lack:
A) Glycosyl-alpha 4,6-Transferase
B) Glucose-6-phosphatase
C) Glycogen synthase
D) Phosphoglucomutase
E) Pyrophosphorylase

Question #21: A 20-year-old woman presents at the emergency department with severe abdominal
pain on the right side with signs of internal bleeding. She indicated that she has been sexually active
without contraception and missed her last menstrual period. Based on this information, which of the
following disorders must be included as an option in the diagnosis?
A) Ovarian cancer
B) Appendicitis
C) Normal pregnancy
D) Ectopic tubal pregnancy
E) Toxemia of pregnancy

Question #22: When does formation of primary spermatocytes begin?

A) During week 4 of embryonic life
B) During month 5 of fetal life
C) At birth
D) During month 5 of infancy
E) At puberty

Question #23: A 50-year-old man with type 2 diabetes mellitus has a 1- week history of swelling and a
feeling “like electric shocks” in his right wrist and hand. He is a computer programmer, and the
shock-like feeling is worse with activity and at the end of the day. There is atrophy of the right thenar
eminence. With the hand hyperextended, pain radiates into the fingers when the examiner taps the
flexor surface of the distal wrist. Which of the following nerves is most likely compressed in this
patient?
A) Deep radial
B) Median
C) Musculocutaenous
D) Radial ulnar
E) Superficial radial

Page 5
Question #24: What single characteristic MOST clearly determines whether a neurotransmitter is
inhibitory or excitatory?
A) The total concentration of calcium ion intracellularly
B) The concentration of neurotransmitter at the post-synaptic site
C) The ion channel respond to neurotransmitter-receptor interaction
D) The intrinsic chemical nature of the neurotransmitter
E) The site of action of neurotransmitter on the post-synaptic target cell

Question #25: The concept of “learned helplessness” originates from animal experiments in which the
experimenter prevents
A) stimulus generalization
B) spontaneous recovery
C) extinction behavior
D) avoidance behavior
E) mother-infant bonding

Question #26: A 42-year-old woman comes to the physician for a follow-up examination after two
separate Pap smears have shown dysplastic epithelial cells. Results of a molecular diagnostic test
show DNA that encodes high-risk versions of the human papillomavirus E6 and E7 proteins. The viral
E6 protein binds to the cellular p53 tumor suppressor gene, causing it to be degraded. Which of the
following best describes the mechanism by which the E6 protein causes cervical cancer?
A) Arrests the cell cycle
B) Enhances tissue invasion and metastasis
C) Inhibits telomerase expression
D) Prevents apoptosis
E) Sustains angiogenesis

Question #27: If the amount of DNA in a cell during the G2 phase is 3, what is the amount of DNA in
the cell during metaphase?
A) 1.5
B) 2
C) 3
D) 6
E) 12

Question #28: The diagram below shows a Lineweaver-Burk plot obtained from in vitro experiments on
the enzyme HMGCoA reductase enzyme both without (-I) and with (+I) the inhibitor Lovastatin. What
type of inhibition is most likely to give plots like this? (Image on next page)
A) Competitive inhibition
B) Denaturation
C) Non-competitive inhibition
D) Suicide inhibition
E) Uncompetitive inhibition

Page 6
Question #29: A 15-year-old boy was diagnosed with pancreatic insufficiency caused by the gene
mutation in the CFTR protein. What changes do you expect in the intestine due to the defective
protein?
A) Decreased reabsorption of sodium and water
B) Decreased secretion of chloride
C) Increased hydration of pancreatic contents
D) Entry of diluted pancreatic secretions to intestine
E) Increased entry of bile acids to intestine

Question #30: The force developed in a muscle during voluntary contraction is normally graded by
varying the:

1) amount of acetylcholine liberated per impulse at each end-plate

2) discharge frequency of individual motor units
3) rate of hydrolysis of acetylcholine
4) number of active motor units

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Page 7
Question #31: A group of young scientists isolated eukaryotic DNA polymerases according to their
molecular weight and cellular location. Correctly match the different DNA polymerases with their
specific actions
A) Polymerase alpha: Proofreading activity
B) Polymerase beta: DNA repair
C) Polymerase alpha: DNA chain elongation
D) Polymerase gamma: Synthesizes primer
E) Polymerase epsilon: Replicates mitochondrial DNA

Question #32: Between which two layers is the extraembryonic mesoderm located?
A) Epiblast and hypoblast
B) Syncytiotrophoblast and cytotrophoblast
C) Synctiotrophoblast and endometrium
D) Exocoelomic membrane and syncytiotrophoblast
E) Exocoelomic membrane and cytotrophoblast

Question #33: In the adult, produces the renal proximal convoluted tubule
A) Ectoderm
B) Endoderm
C) Mesoderm
D) Yolk sac
E) Neural crest

Question #34: Loss of sympathetic innervation to one side of the head results in

1) partial ptosis
2) absence of a pupillary light reflex
3) loss of sweating
4) pupillary dilation

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Question #35: Membrane potential trajectory if membrane permeability increases for both sodium and
potassium
A) A B) B C) C D) D E) E

Page 8
Question #36: A prokaryotic operon codes for two enzymes and one regulatory protein. The operon is
expressed only in the presence of a particular sugar. Initial mapping of the operon has differentiated
the non transcribed sequences from the transcribed sequences. Deletion of 10 nucleotides from one
of the non transcribed sequences results in transcription of the operon in both the presence and
absence of the sugar. Which of the following sequences was most likely affected?
A) Activator binding site
B) Activator gene
C) Operator
D) Promoter
E) Repressor gene

Question #37: A 48-year-old white female secretary presents with progressive difficulty typing over the
past month. She also notes that her hands begin to feel numb and weak after typing for long periods
of time. Upon testing, which of the following deficits would be predicted?
A) Difficulty in abducting the fifth finger
B) Difficulty in adducting the thumb
C) Difficulty in flexing digits two and three at the metacarpophalangeal joints
D) Loss of sensation over the lateral half of the dorsum of the hand
E) Loss of sensation over the lateral half of the palm
F) Loss of sensation over the medial half of the dorsum of the hand
G) Loss of sensation over the medial half of the palm

Question #38: The following pedigree depicts the inheritance of a genetic disease in a family. How
many individuals are obligate carriers for the mutant gene in the generation II?
A) 1
B) 2
C) 3
D) 4
E) 5
F) 6

Page 9
Question #39: Lovastatin inhibits HMG CoA Reductase by binding to the active site of the enzyme, it is
classified as:
A) Competitive inhibitor
B) Non-Competitive inhibitor
C) Uncompetitive inhibitor
D) Allosteric inhibitor
E) Irreversible inhibitor

Question #40: Proteins synthesized on _______________ may become a lysosomal enzyme

A) Attached polyribosomes
B) Free polyribosomes
C) Both
D) Neither

Question #41: An increased concentration of fructose 2,6-bisphosphate in hepatocytes will have a

positive regulatory effect on which of the following?
A) Gluconeogenesis and glucose-6-phosphatase
B) Gluconeogenesis and phosphoenolpyruvate carboxykinase
C) Glycolysis and glucokinase
D) Glycolysis and phosphofructokinase 1

Question #42: A 16-year-old girl is brought into the orthopedic clinic because she fell off her bicycle
while riding down a steep hill. The orthopedic surgeon examines her left arm and palpates a displaced
mid-shaft break of her humerus. It is noted that she cannot extend her wrist, but there are no distal
broken bones. She has limited ability to extend and abduct her arm at the shoulder. Her left forearm
and hand feel slightly colder than her right arm and she seems to have lost some sensation on the
posterior lateral portion of her left hand, though she says she can feel with all her fingertips. The
physician is concerned that she has damaged which of the following?
A) Axillary nerve
B) Axillary nerve and posterior humeral circumflex artery
C) Radial nerve
D) Radial nerve and deep artery of the arm
E) Median nerve and brachial artery

Question #43: In a successful lumbar puncture, cerebrospinal fluid is withdrawn through a needle that
has penetrated the

1) dura mater
2) pia mater
3) arachnoid
4)anulus fibrosus

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Page 10
Question #44: Liver cells in culture were kept at 0 C (32.0 F) and treated with trypsin to digest the
receptors on the cell surface. The temperature was then raised to 37.0 C (98.6 F), and radioactive LDL
was added to the culture media. Several hours later, the labeled LD was found to be inside the cells.
This specific process of LDL uptake is
A) active transport
B) facilitated diffusion
C) phagocytosis
D) pinocytosis
E) receptor-mediated endocytosis

Question #45: A 50-year-old man with a 10-year history of alcohol abuse complains of pain in his left
big toe. Physical examination reveals erythmea and heat over the metatorsophalangial joints. A
complete blood cell count shows absolute neutrophilic leucocytosis, a strong sign for inflammatory
processes. A synovial fluid analysis showed needle shaped crystals. What is the mechanism of joint
inflammation?
A) Decreased activity of hypoxanthine-guanine phosphoribosyltransferase (HGPRT)
B) Decreased activity of xanthine oxidase
C) Decreased renal excretion of uric acid
D) Increased activity of phosphoribosyl-pyrophosphate synthetase
E) Increased degradation of pyrimidines

Question #46: The TCA cycle produces many high energy molecules, one of which is at the
substrate-level phosphorylation. This occurs through which of the following reactions?
A) Isocitrate --> alpha-ketoglutarate
B) Alpha-ketoglutarate--> Succinyl coA
C) Succinyl coA--> Succinate
D) Fumerate--> Malate
E) Malate--> Oxaloacetate

Question #47: A 29-year-old woman is brought to the emergency department with pain and injuries to
her left elbow. On examination, there is no sensation along the medial side of her palm. X-ray reveals
feature of medial epicondyle of the humerus. Which of the following movements is most likely
compromised due to the injury. (Image on next page)
A) Flexion of the thumb
B) Extension of the thumb
C) Abduction of the wrist
D) Adduction of the wrist
E) Extension of the wrist

Page 11
Question #48: A 35-year-old male body builder has enlarged his shoulder muscles to such a degree
that the size of the quadrangular space is greatly reduced. Which of the following structures would
most likely be compressed in this condition?
A) Axillary nerve
B) Anterior humeral circumflex artery
C) Cephalic vein
D) Radial nerve
E) Subscapular artery

Question #49: Which of the following statements about smooth muscle contraction is most accurate?
A) Ca2+ independent
B) Does not require an action potential
C) Requires more energy compared to skeletal muscle
D) Shorter in duration compared to skeletal muscle

Question #50: A 6-year-old boy was found to have irregular dark spots, excessive dryness and scaly
skin. The child’s mother also noticed the blistering in the skin after minimum exposure to sunlight. The clinical
presentation is most likely due to defect in
A) Vitamin C deficiency
B) Collagen synthesis
C) Failure to repair pyrimidine dimers in DNA
D) DNA synthesis
E) Defect in the RNA polymerase I

Page 12
Question #51: A 26-year-old man visits his physician with complaints of pain in his right shoulder that
developed after playing baseball one week ago. On examination, the patient experiences sharp pain
when the arm is abducted beyond 30 degrees. MRI scan of the shoulder reveals injury to the tendon
of the rotator cuff. The tendon fo which of the following muscles is most likely injured?
A) Infraspinatus
B) Latissimus dorsi
C) Supraspinatus
D) Teres minor
E) Teres major

Question #52: A polysome is actively involved in translation. The ribosomes are attached to which of
the following?
A) Single-stranded DNA
B) Double-stranded DNA
C) mRNA
D) rRNA
E) tRNA

Question #53: A 14-year-old high school freshman presents to her family doctor for a sports physical.
She has not played organized sports in the past but is in good physical shape. She mentions that she
experienced severe leg cramps after trying out for the soccer team last week. The night after the
tryouts, she noticed that her urine had a red- dish tinge. She has no other medical complaints. Her
physician orders an ischemic fore- arm exercise test, which reveals no increase in venous lactate.
Which of the following enzymes is most likely deficient in this patient?
A) Cystathionine synthase
B) Glucose-6-phosphatase
C) Alpha-1,6-Glucosidase
D) Glycogen phosphorylase
E) Lysosomal alpha-1,4-glucosidase

Question #54: After a night of fraternity parties, a 21-year-old college junior came to the ED the
following morning complaining that she could not raise her wrist. There is no history of trauma. On
examination, the patient cannot extend her fingers or wrist but an flex them. She can also both flex
and extend her elbow normally. There are no other motor deficits. The symptoms suggest damage to
which one of the following?
A) Median nerve
B) Ulnar nerve
C) Radial nerve
D) Axillary nerve
E) Musculocutatenous nerve

Question #55: A significant correlation has been established between a mutant fumarase enzyme which
is less active than normal, and increased incidence of rectal cancer. What is the product of fumarase
activity in the TCA?
A) Fumarate
B) Citrate
C) Oxaloacetate
D) L-Malate
E) Alpha-ketoglutarate

Page 13
Question #56: A 13-year-old boy is brought to the emergency department after losing control during a
motorbike race in which he was run over by several of the other racers. Physical examination reveals
several cuts and bruises. He is unable to extend the left wrist, fingers, and thumb, although he can
extend the elbow. Sensation is lost in the lateral half of the dorsum of the left hand. Which of the
following nerves has most likely been injured to result in these signs, and in what part of the arm is
the injury located?
A) Median nerve, anterior wrist
B) Median nerve, arm
C) Radial nerve, midhumerous
D) Ulnar nerve, midlateral forearm
E) Ulnar nerve, midpalmar region

Question #57: What is NOT a feature of apoptosis

A) Chromatic condensation
B) Nuclear swelling
C) Cell shrinkage
D) DNA fragmentation

Question #58: A mutation in p53 that causes a loss of its function can result in a(n)
A) Ability of cells to arrest in G1 phase after DNA damage
B) Increase in the production of an angiogenesis inhibitor
C) Decrease in induction of apoptosis of damaged cells
D) Increase in DNA repair
E) Decrease in DNA damage within cells

Question #59: The Paraxial mesoderm will give rise to which of the following.
A) Lateral mesoderm
B) Intermedial mesoderm
C) Somites
D) Median ectoderm
E) Ectoderm

Question #60: In the gastrocnemius muscle of a 400m runner, the following reaction is taking place
during exercise:
Glucose-6-P Glucose + Pi Delta G'o = -13.8 kJ/mol. Which of the following
statements best describes this system?
A) at 1M concentrations, the system would be at equilibrium
B) at equilibrium, Delta G'o = 0
C) the pH is 1.0
D) the reaction is exergonic
E) under standard conditions, reactants are favored
F) Delta S'o is negative

Question #61: Secretion of parathyroid hormone is increased by

A) an increase in extracellular concentration of magnesium
B) an increase in extracellular concentration of phosphate
C) high intake of dietary calcium
D) hypocalciuria
E) treatment with thiazide diuretics

Page 14
Question #62: In a normal, cycling cell in S phase, which of the following proteins will be active?
A) BRCA1
B) Cdk2
C) p21
D) p53
E) RB

Question #63: A 55-year-old male is examined in a neighbor- hood clinic after receiving blunt trauma
to his right axilla in a fall. He has difficulty elevating the right arm above the level of his shoulder.
Physical examination shows the inferior angle of his right scapula protrudes more than the lower part
of the left scapula. The right scapula protrudes far more when the patient pushes against resistance.
Which of the following neural structures has most likely been injured?
A) The posterior cord of the brachial plexus
B) The long thoracic nerve
C) The upper turn of the brachial plexus
D) The site of origin of the middle and lower subscapular nerves
E) Spinal nerve roots C7, C8, and T1

Question #64: A mother tugs violently on her male child’s hand to pull him out of the way of an
oncoming car and the child screams in pain. Thereafter, it becomes obvious that the child cannot
straighten his forearm at the elbow. When the child is seen in the emergency department,
radiographic examination reveals a dislocation of the head of the radius. Which of the following
ligaments is most likely directly associated with this injury?
A) Anular
B) Joint capsular
C) Interosseous
D) Radial collateral
E) Ulnar collateral

Question #65: Early in the morning you arise from bed and hurry off to the bathroom. On the way, you
stub your unprotected great toe on the stone mantle of your fireplace. The reflex that MOST
ACCURATELY accounts for your behavior is:
A) Reverse myotatic
B) Antigravity
C) Flexion/crossed extension
D) Reciprocal inhibitory
E) Muscle stretch

Question #66: A patient can abduct her arm no further than the 15 degree position. Which of the
following muscles is most likely affected?
A) Supraspinatus
B) Deltoid
C) Rhomboid minor
D) Subscapularis
E) Teres minor

Page 15
Question #67: Which of the following events is involved in the cleavage of the zygote during week 1 of
development?
A) A series of meiotic divisions forming blastomeres
B) Production of highly differentiated blastomeres
C) An increased cytoplasmic content of blastomeres
D) An increase in size of blastomeres
E) A decrease in size of blastomeres

Question #68: Which of the following is the correct sequence of events in the initiation of contraction of
a skeletal muscle fiber?
A) A
B) B
C) C
D) D
E) E

Question #69: As she fell from the uneven parallel bars, the 17- year-old female gymnast grasped the
lower bar briefly with one hand but then fell painfully to the floor. An MRI examination reveals an
injury to the medial cord of the brachial plexus. Which of the following spinal nerve levels would most
likely be affected?
A) C5, C6
B) C6, C7
C) C7, C8
D) C7, C8, T1
E) C8, T1

Question #70: The oxaloacetate formed for gluconeogenesis is transported

A) as malate from the cytosol to the mitochondria.
B) as malate from the mitochondria to the cytosol.
C) as NADHP from mitochondria to the cytosol.
D) as oxaloacetate from the cytosol to the ER.
E) as oxaloacetate from the ER to the cytosol.

Question #71: In muscle, pyruvate can be converted by a single enzyme (or enzyme complex) to each
of the following compounds EXCEPT
A) acetaldehyde
B) acetyl CoA
C) alanine
D) lactate
E) oxaloacetate
Page 16
Question #72: A 67-year old man has a restricted diet that includes no fresh citrus fruits or leafy green
vegetables. His teeth are loose and his gums bleed easily. This patient’s disorder most likely results from
a defect in collagen synthesis that involves which of the following amino acids?
A) Arginine
B) Cysteine
C) Histidine
D) Hydroxyproline
E) Leucine
F) Methionine
G) Serine

Question #73: A gene product through to be involved in the down regulation of fetal hemoglobin
expression is being investigated. Samples of primary tissue cultures of fetal, neonatal, and adult liver
and bone marrow, as well as adequate amounts of a DNA probe believed to contain the studied gene,
are provided. The best method for determining which of the tissue culture samples expresses the
studied gene is
A) DNA sequencing
B) Northern blot
C) Polymerase chain reaction (PCR)
D) Southern blot
E) Western blot

Question #74: A 50-year-old woman who works as a secretary comes to the physician because of
numbness and tingling in her hands. On examination, the patient is found to have decreased
sensation in all of her fingers except her fifth digit. Which of the following muscles is most commonly
weakened in patients with this condition?
A) Adductor pollicis
B) Dorsal interossei
C) Lumbricals (3 and 4)
D) Opponens digiti minimi
E) Opponens pollicis

Question #75: During week 2 of development, the embryoblast receives its nutrients via
A) diffusion
B) osmosis
C) reverse osmosis
D) fetal capillaries
E) yolk sac nourishment

Question #76: Glycolysis and gluconeogenesis share 7 of the 10 steps between glucose and pyruvate.
Which of the following steps is unique to gluconeogenesis?
A) 3-phosphoglycerate - 2-phosphoglycerate
B) fructose-6-phosphate - glucose-6-phosphate
C) glucose 6-phosphate - glucose + Pi
D) glyceraldehyde-3-phosphate - dihydroxyacetone
E) phosphoenolpyruvate + H2O - 2-phosphoglycerate

Page 17
Question #77: In the reflex examination, the patellar tendon is briskly tapped with a reflex hammer.
The pathway chiefly responsible for initiating this reflex is the:
A) I-B fibers
B) II fibers
C) Gamma motorneuron fibers
D) I-A fibers
E) Alpha motorneuron fibers

Question #78: 25-year-old lady had a severe vomiting and morning sickness and visited a
gynecologist. Upon examination doctor told her the good news that pregnancy test is positive and
prescribed the multivitamin tablets. Which one of the following vitamin to reduce the risk of a
pregnancy affected by spina bifida or other neural tube defects?
A) Cobalamin
B) Folic acid
C) Vitamin K
D) Thiamine
E) Riboflavin

Question #79: During meiosis, pairing of homologous chromosomes occurs, which permits large
segments of DNA to be exchanged. What is this process called?
A) Synapsis
B) Nondisjunction
C) Allignment
D) Crossing over
E) Disjunction

Question #80: Which of the following structures are best matched to their embryonic tissue?
A) Ectoderm: nervous system, epidermis
B) Endoderm: muscle and connective tissues
C) Hypoblast: amnion, endoderm
D) Mesoderm: epithelial linings of GI tract, respiratory and urinary systems
E) Epiblast: chorion, placenta

Question #81: A 27-year-old man receives a neurologic evaluation following a gunshot would received
5 days previously. A 9-mm bullet had passed through both the medial and lateral heads of the
gastrocnemius muscle. The exit wound on the lateral head of the muscle was somewhat deeper than
the entrance wound in the medial head. The bullet did not strike bone or significant arteries although
significant tissue damage, suppuration, and swelling were found around the exit wound. Neurologic
examination reveals losses of dorsiflexion and eversion of the left foot. The patient cannot feel
pinprick or touch on the dorsum of the left foot or anterolateral surface of the left leg. Which nerve
was most likely involved in the injury?
A) Sciatic nerve
B) Femoral nerve
C) Sural nerve
D) Common fibular (peroneal) nerve
E) Tibial nerve

Page 18
Question #82: The intermaxillary segment of the developing upper jaw contributes to the formation of
the

1) philtrum of the lip

2) primary or anterior palate
3) premaxillary part of the maxilla
4) posterior or secondary palate

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Question #83: Somites may differentiate into which of the following?

A) Urogenital ridge
B) Kidneys
C) Notochord
D) Epimeric and hypomeric muscles
E) Epithelial lining of the gastrointestinal tract

Question #84: Smooth muscle contraction is terminated by which of the following?

A) Dephosphorylation of myosin kinase
B) Dephosphorylation of myosin light chain
C) Efflux of Ca++ ions across the plasma membrane
D) Inhibition of myosin phosphatase
E) Uptake of Ca++ ions into the sarcoplasmic reticulum

Question #85: The release of epinephrine from the chromaffin granules of the adrenal medulla into the
bloodstream in response to neural stimulation is mediated by which of the following?
A) Acetylcholine
B) Gamma-Aminobutryic acid (GABA)
C) Cortisol
D) Dopamine
E) Serotonin

Question #86: A 12-year-old boy is brought to the ED by his mother after being pushed out of the
neighbor’s tree house, about 10 ft off the ground. He can walk but his right heel hurts every time he
puts weight on it. When his foot is examined, it is found to be tender to pressure on both the medial
and lateral aspects of the heel inferior to the tibia. Plain films of his right lower extremity are ordered
because of suspicion that he has fractured which one of the following?
A) Calcaneus
B) Fibula
C) Tibia
D) Navicular
E) Cuneiform

Page 19
Question #87: A laboratory researcher makes a solution containing D-glucose and ATP at
concentrations similar to those found in cells. Nothing happens. Next she adds a small amount of the
enzyme hexokinase, and the ATP reacts with the glucose forming glucose 6-phosphate. Which of the
following explains these observations? Relative to the uncatalyzed reaction, the enzyme
A) decreases Delta Gf for the reaction.
B) increases Delta Gf for the reaction.
C) provides a higher energy pathway from reactants to products.
D) provides a lower energy pathway from reactants to products.
E) shifts the equilibrium towards products.
F) shifts the equilibrium towards reactants

Question #88: Which one of the following statements is true for eukaryotic transcription?
A) Rifampicin binds to RNA polymerase and changes its conformation
B) RNA Polymerase III synthesizes tRNA
C) mRNA carries informations for more than one gene
D) 7-methylguanosine is attached at the 3’ end of the mRNA
E) Elongation of RNA is always in 3’ 5’ direction

Question #89: Which of the following intracellular signal molecules regulates the catalysis of the
conversion of GTP to cGMP?
A) cAMP
B) Ceramide
C) cGMP
D) Diacylglycerol
E) Malonyl CoA
F) Nitric oxide

Question #90: An adequate supply of purines and pyrimidines is supplied by normal metabolic
pathways rather than the diet. Which one of the following statements about purine and/or pyrimidine
biosynthesis is CORRECT?
A) Thymidine 5'-phosphate is formed in a reaction involving the direct participation of PRPP and
thymidine.
B) Only the de novo synthesis of pyrimidines is inhibited by methotrexate.
C) The ring structures of purines and pyrimidines are built first and then are attached to PRPP.
D) The committed step in pyrimidine biosynthesis is catalyzed by orotate decarboxylase.
E) AMP and GMP cross-regulate each other’s rate of synthesis.

Question #91: Which structure is derived from the same embryonic primordium as the kidney?
A) Gonads
B) Epidermis
C) Pineal gland
D) Liver
E) Adrenal medulla

Question #92: Enzyme reactions involving methylation

A) Biotin
B) Cyanocobalamin (vitamin B12)
C) Pyridoxine (vitamin B6)
D) Riboflavin (vitamin B2)
E) Thiamine (vitamin B1)

Page 20
Question #93: In which of the following nuclear structures is DNA actively transcribed to rRNA?
A) Envelope
B) Lamina
C) Matrix
D) Nucleolus
E) Pore

Question #94: Select the correct name of the sequence on a mRNA which is required in prokaryotes to
facilitate the binding to the 30S ribosomal subunit to correctly initiate protein synthesis.
A) Pribnow box
B) -35 sequence
C) Hogness box
D) TATA box
E) Shine-Dalgarno sequence

Question #95: A 26-year-old woman with a history of psychiatric problems has been brought to the
emergency room with high fever, sweating and tremors after ingesting approximately 100 aspirin
tablets in a suicide attempt. High fever associated with salicylate overdose is explained by
A) Excessive ADP phosphorylation
B) Excessive increase in proton concentration gradient
C) Rupture of mitochondrial membranes
D) Stimulation of thermogenin
E) Uncoupling of electron transport from ATP synthesis

Question #96: Consider adrenergic effects only. Select the INCORRECT match of tissue and response.
A) Skeletal muscle; lipolysis
B) Vascular smooth muscle; contraction
C) Kidney; Na+ reabsorption
D) Sweat glands; secretion
E) Liver; glycogenolysis

Question #97: Which of the following statements about smooth muscle contraction is most accurate?
A) Ca++ independent
B) Does not require an action potential
C) Requires more energy compared to skeletal muscle
D) Shorter in duration compared to skeletal muscle

Question #98: 39-year-old male farmer is brought to the emergency department. Three hours
previously he had been spraying fields with an insecticide called Fenoxycarb. He did not use any
respiratory protection and has inhaled the vapor. He shows rippling of the muscles under the skin,
blurred vision and complains of chest tightness. He is unable to walk. Fenoxycarb is a
non-competitive inhibitor of the enzyme acetylcholinesterase, an important mediator of
neurotransmitter action. Which of the following best describes the effect of this poison on the
enzyme?
A) Vmax is reduced, Km is unaltered
B) Vmax is unaltered, Km is increased
C) Both Vmax and Km are reduced
D) Both Vmax and Km are unaltered
E) The lineweaver-Burk plot becomes non-linear

Page 21
Question #99: In a patient with hereditary nonpolyposis colon cancer many small loops of unpaired
DNA were found. This is a result of a mutation affecting which of the following?
A) Chain break repair
B) Base excision repair
C) Depurination repair
D) Mismatch repair
E) Homologous recombination repair

Question #100: Select the correct statement regarding stabilization of tertiary structure in proteins
A) Ionic bonds in the proteins enhances the solubility of the protein
B) Methionine, a Sulphur containing amino acid is responsible for the covalent bonding in the side
chains
C) Lysine and aspartate contribute for the ionic interactions in the protein molecule
D) There dimensional stability of the structure mainly due to the presence of hydrogen bonds
E) Hydrogen bonds can be formed between glutamate and aspartate

Question #101: The glycolytic enzyme triose phosphate isomerase acts upon a phosphorylated triose
carbohydrate. Which of the following is an example of a ketotriose?
A) dihydroxyacetone
B) erythrose
C) glyceraldehyde
D) ribose
E) ribulose
F) threose

Question #102: In the reflex examination, the patellar tendon is briskly tapped with a reflex hammer.
The pathway chiefly responsible for initiating this reflex is the:
A) I-B fibers
B) II fibers
C) Gamma motorneuron fibers
D) I-A fibers
E) Alpha motorneuron fibers

Question #103: Cytotoxic T cells can elicit self-destruct mechanisms on target cells by interacting with
A) Ras ligand
B) Fas ligand
C) Fas receptors
D) adaptor proteins
E) procaspase

Question #104: In a normal adult, the conus medullaris is found at what vertebral level?
A) L3
B) T9
C) Tll
D) Ll
E) S1

Page 22
Question #105: During the synthesis of a daughter DNA molecule the chain elongation enzyme wrongly
inserts adenine instead of guanine in the daughter strand. Which activity of the DNA-synthesizing
enzyme removes the wrong base?
A) 5’ - 3’ DNA polymerase activity
B) 3’ - 5’ DNA polymerase activity
C) 3’ - 5’ exonulease activity
D) 5’ - 3’ proofreading activity
E) 3’ - 5’ endonulease activity

Question #106: A genetic code is degenerate when

A) a nucleotide triplet can code for more than one amino acid
B) a tRNA can be charged by more than one synthetase
C) an amino acid can be coded for by more than one nucleotide triplet
D) an aminoacyl tRNA synthetase can charge more than one tRNA species
E) the third base in an anticodon is not important for coding

Question #107: The lateral mesoderm is divided into two distinct layers by the formation of the
A) extraembryonic coelom
B) intraembryonic coelom
C) cariogenic region
D) notochrod
E) yolk sac

Question #108: Adrenal medullary chromaffin cells that secrete catecholamines (epinephrine and
norepinephrine) are innervated directly by:
A) pre-ganglionic sympathetic cholinergic fibers
B) pre-ganglionic parasympathetic cholinergic fibers
C) postganglionic sympathetic cholinergic fibers
D) postganglionic sympathetic noradrenergic fibers
E) hormones through the blood only - not by autonomic fibers

Question #109: A second-year medical student is under a lot of stress due to her impending
biochemistry examination. She knows that her psychological stress leads to the release of
endogenous glucocorticoid, which increases the glucose levels in her body. To raise glucose levels,
glucocorticoids act via the enzyme phosphoenolpyruvate carboxykinase to increase which of the
following?
A) Acetyl-CoA
B) Malate
C) Oxaloacetate
D) Phosphoenolpyruvate
E) Pyruvate

Question #110: Which of the following is the most energy-efficient precursor for gluconeogenesis?
A) Glucogenic amino acids
B) Glycerol from lipid catabolism
C) Ketogenic amino acids
D) Lactate from muscle and erythrocytes
E) Pyruvate from glycolysis

Page 23
Question #111: Which one of the following statements concerning the well-fed state is correct?
A) Most enzymes that are regulated by covalent modification are active in the phosphorylated form.
B) Hepatic fructose 2,6-bisphosphate is elevated.
C) Synthesis of gluconeogenic substrates concentrations are elevated.
D) Insulin stimulates the transport of glucose into hepatocytes.
E) The synthesis of glucokinase is repressed.

Question #112: Proteins synthesized on membrane-bound polyribosomes normally may undergo each
of the following EXCEPT
A) intracellular transport
B) release from polyribosomes into cytosol
C) secretion
D) sequestration in lysosomes
E) transfer to the cisternal space

Question #113: Which of the following best describes the glenohumeral joint?
A) Ball & socket
B) Condyloid
C) Hinge
D) Pivot
E) Saddle

Question #114: A 50-year-old woman is playing recreational basketball with her friends over the
weekend. She jumps up for a layup and makes the shot, but when she lands, she comes down on her
toes first and suddenly feels sharp pain at the posterior and distal portion of her leg. She was unable
to put weight on the foot, could not plantar flex but could dorsiflex (extend) her foot. Visual
inspection of bilateral feet shows the following (see image). Which of the following nerves supplies the
muscle of the tendon that is ruptured?
A) Deep fibular
B) Sciatic
C) Sural
D) Superficial fibular
E) Tibial

Page 24
Question #115: Most anti-neoplastic analogs of purine and pyrimidine bases are administered either as
the nucleoside or the base. Which of the molecules below represents a base without the ribose
attached?
A) Adenosine
B) Uridine
C) Inosine
D) Guanosine
E) Hypoxanthine

Question #116: Proteins synthesized on ______________ eventually become a cytoskeletal protein

A) Attached polyribosomes
B) Free polyribosomes
C) Both
D) Neither

Question #117: A 45-year-old woman has the sudden onset of severe headaches. During one of these
episodes, her blood pressure is 190/115 mm Hg. Her usual blood pressure is 130/90 mm Hg. Her
sister had similar episodes several years ago. Urinalysis shows increased concentrations of
metanephrine and vanillylmandelic acid. The patient is most likely to have a neoplasm that secretes
which of the following?
A) ACTH
B) Aldosterone
C) Cortisol
D) Epinephrine
E) Renin

Question #118: Concerning a 14 day old blastocyst, select the most appropriate structure in the
accompanying diagram which is the connecting stalk
A) A B) B C) C D) D E) E F) F G) G

Page 25
Question #119: A rapid way to purify proteins that are targeted to lysosomes would be to use affinity
chromatography. AN appropriate antibody to use on an affinity chromatography column would be one
directed against
A) acid hydrolyses
B) clathrin
C) glucose-6-phosphate
D) mannose-6-phosphate
E) sialic acid

Question #120: The right shoulder of a 78-year-old female had become increasingly painful over the
past year. Abduction of the right arm caused her to wince from the discomfort. Palpation of the
deltoid muscle by the physician produced exquisite pain. Imaging studies reveal intermuscular
inflammation extending over the head of the humerus. What structure was inflamed?
A) Subscapular bursa
B) Infraspinatus muscle
C) Glenohumeral joint cavity
D) Subacromial bursa
E) Teres minor muscle

Question #121: A 50-year-old man was admitted into the hospital of a leading research university with
a diagnosis of hepatitis and early cirrhosis of the liver. HIs past medical history is significant for heavy
smoking and only occasional consumption of alcohol. He did not use any drugs, and he had no viral
infections. DNA studies showed that he as homozygous for the Z allele of alpha1-antitrypsin,
produced by a missense mutation that prevents the proper folding of the protein. A liver biopsy would
most likely show accumulation of a proteinaceous substance in which of the following sub cellular
sites?
A) Endoplasmic reticulum
B) Extracellular matrix
C) Golgi apparatus
D) Inclusion bodies
E) Lysosomes

Question #122: Cyclin dependent kinases which control progression through cell cycle checkpoints are
fully activated by which of the following:
A) binding to cyclin, plus phosphorylation by a Cdk activating protein kinase
B) binding to cyclins
C) phosphorylation by a Cdk activating protein protein kinase
D) phosphorylation by a tyrosine kinase

Question #123: The reason why some glycosaminoglycans can act as lubricants in joints is that
A) They absorb a lot of water and the water gives ‘fluidity’ to the joint.
B) They are uncharged and hydrophobic thus acting as a kind of oil.
C) They are all negatively charged and hence repel and slide against each other
D) They are all positively charged and hence repel and slide against each other
E) They are amphipathic - having both nonpolar and polar moieties in their structure

Page 26
Question #124: A 49-year-old man is admitted to the emergency department complaining that he has
difficulties walking. Physical examination reveals that the patient suffers from peripheral vascular
disease. An ultrasound examination reveals an occlusion of his femoral artery at the proximal portion
of the adductor canal. Which of the following arteries will most likely provide collateral circulation to
the thigh?
A) Descending branch of the lateral circumflex femoral
B) Descending genicular
C) Medial circumflex femoral
D) First perforating branch of deep femoral
E) Obturator artery

Question #125: The retinoblastoma protein controls

A) Crossing-over
B) Centrosome duplication
C) Transition from G1 to S phase
D) Pairing of homologous chromosomes
E) Expression of cyclin D

Question #126: Residue(s) present in sphingomyelin

A) Choline
B) Glycerol
C) Both
D) Neither

Question #127: One of the following will not be needed during Glycogen degradation:
A) Phosphoglucomutase
B) Inorganic phosphate
C) Acid maltase
D) Lysosomal alpha 1,4 glucosidase
E) UDP-Glucose
F) Glucose-6-Phosphatase
G) Vitamin B6

Question #128: A 67-year-old man has a restricted diet that includes no fresh citrus fruits or leafy
green vegetables. His teeth are loose and his gums bleed easily. This patient's disorder most likely
results from a defect in collagen synthesis that involves which of the following amino acids?
A) Arginine
B) Cysteine
C) Histidine
D) Hydroxyproline
E) Leucine

Question #129: Which of the following proteins is not part of the apoptosome which initiates apoptosis
by the intrinsic pathway?
A) Apaf-1
B) Bcl-2
C) Cytochrome c
D) Procaspase 9
E) CARD

Page 27
Question #130: The following pedigree depicts the inheritance of a genetic disease in a family. With a
normal partner, what is probability of individual III-2 to have an affected son?
A) 0%
B) 25%
C) 50%
D) 100%

Question #131: Reinforcers have been found to be most effective when they
A) are concurrent with the behavior
B) follow the behavior
C) precede the behavior
D) sometimes precede and sometimes follow the behavior

Question #132: A 23-year-old male medical student fell asleep in his chair with Netter’s Atlas wedged into
his axilla. When he awoke in the morning, he was unable to ex- tend the forearm, wrist, or fingers. Movements of
the ipsilateral shoulder joint appear to be normal. Which of the following nerves was most likely compressed,
producing the symptoms described?

A) Lateral cord of the brachial plexus

B) Medial cord of the brachial plexus
C) Radial nerve
D) Median nerve
E) Lateral and medial pectoral nerves

Page 28
Question #133: A 22-year-old woman who is a professional tennis player presents to the physician
with pain on the lateral aspect of her elbow radiating down her forearm. Repetitive use of which of the
following muscles most likely lead to this patient’s condition?
A) Biceps
B) Extensor carpi radialis
C) Extensor carpi ulnaris
D) Flexor carpi ulnaris
E) Pronator teres

Question #134: A histologist is examining cells arrested at various stages of oogenesis. He discovers a
follicle within the storm of the ovary that has developed an antrum. This follicle would be classified as
A) Graafian
B) primary
C) primordial
D) secondary

Question #135: Which of the following best describes the tissue that develops from splanchnic
mesoderm?
A) Dermis of the limbs
B) Muscle of the GI tract
C) Muscle of the limbs
D) Bones of the limbs
E) Muscle of the abdominal wall

Question #136: Which of the following is most likely considered to be part of a mechanism involved in
the establishment and conduction of a normal action potential in an axon?
A) Declines in amplitude as it is conducted orthodromically
B) Is initiated by sodium efflux
C) Is terminated by potassium efflux
D) Is not associated with any net movement of sodium or potassium across the axonal membrane
E) Results in a transient reversal of the potassium concentration gradient

Question #137: When considering the common ways that sensory systems transduce stimulus
information into the code of the nervous system, which of the following makes each sensory system
unique from the other sensory systems?
A) Changes in membrane conductance in sensory receptors
B) Changes in membrane voltage (receptor potential)
C) Opening and closing of membrane ion channels in sensory receptors
D) Action potentials that travel from primary sensory neurons to the spinal cord or brain
E) The sensory receptor itself

Question #138: A workman accidentally lacerates his wrist as shown in the accompanying diagram. On
exploration of the wound, a vessel and nerve are found to be severed, but no muscle tendons are
damaged. From the indicated location of the laceration and loss of sensation, the involved nerve is
which one of the following? (Image on next page)
A) Median nerve
B) Recurrent branch of the median nerve
C) Superficial branch of the radial nerve
D) Ulnar nerve
E) Radial nerve

Page 29
Question #139: A 45-year-old woman is admitted to the hospital with neck pain. An MRI examination
reveals a herniated disk in the cervical region. Physical examination reveals weakness in wrist
extension and paraesthesia on the back of her arm and forearm. Which of the following spinal nerves
is most likely injured?
A) C5
B) C6
C) C7
D) C8
E) T1

Question #140: Proteins that are secreted from the cell in which they are synthesized
A) are cleaved prior to transport into the endoplasmic reticulum
B) are inserted into the membranes of the endoplasmic reticulum via their signal sequences
C) are post-translationally acetylated at their amino termini
D) are synthesized on mitochondrial membrane-bound ribosomes
E) have hydrophobic carboxylate termini

Question #141: A 25-year-old healthy man consumes a diet rich in carbohydrates. Following insulin
secretion, the process of glycogenesis in muscle is activated. Which of the following enzyme forms is
involved in this process?
A) Dephosphorylated glycogen phosphorylase
B) Dephosphorylated glycogen synthase
C) Phosphorylated glycogen phosphorylase
D) Phosphorylated glycogen synthase
E) Phosphorylated phosphorylase kinase

Page 30
Question #142: A patient presents to the emergency room with sever dehydration. In response, her
brain releases a peptide whose target cells are in her kidneys. Peptide biding gives rise to an increase
in cAMP to reduce the volume of urine produced. Which of the following best explains signaling by
this peptide?
A) Ligand binding activates opening of ion channels on endoplasmic reticulum membrane
B) Ligand biding to cell surface receptor leads to downstream activation of protein kinase A
C) Ligand diffuses through plasma membrane and activates transcription of adenylyl cyclase
D) Phosphorylation of the receptor leads to activation of intracellular signaling molecules
E) Receptor activation leads to activation and up regulation of protein kinase C

Question #143: A patient presents in her fifth pregnancy with a history of numbness and tinging in her
right thumb and index finger during each of her previous four previous four pregnancies. Currently,
the same symptoms are constant, although worse in the early morning. Symptoms could e somewhat
relieved by vigorous shaking of the wrist. Neurologic examination revealed atrophy and weakness of
the abductor pollicis braves, the opponens pollicis, and the first two lumbrical muscles. Sensation was
decreased over the lateral palm and the polar aspect of the first three digits. Numbness and tingling
were markedly increased over the first three digits and the lateral palm when the wrist was held in
flexion for 30 seconds. The symptoms suggest damage to which one of the following?
A) The radial artery
B) The median nerve
C) The ulnar nerve
D) Proper digital nerves
E) The radial nerve

Question #144: A mutation in the catabolite activator protein (CAP) that weakens its affinity for cAMP
would be expected to have which one of the following consequences?
A) Failure to fully induce the lac operon
B) No effect on the expression of lac operon
C) Constitute binding of the lac repressor to the lac operator
D) Constitute binding of CAP to the activator binding site of the operon
E) Failure of the lac repressor to bind the lac operator

Question #145: Which of the following is NOT a component of the spinal cord?
A) Lower motor neuron cell bodies
B) Pre-ganglionic autonomic cell bodies
C) Primary sensory cell bodies
D) Renshaw cells
E) Motor interneurons

Question #146: A specimen of muscle is examined under the microscope and the following tissue is
observed (see image). This specimen is from which of the following tissues? (Image on next page)
A) Bicep muscle of the arm
B) Intrinsic muscles of the back
C) Muscles of the eye
D) Wall of gastro-intestinal tract
E) Wall of the proximal aorta

Page 31
Question #147: A particular cytochrome enzyme normally has oxidoreductase activity and contains an
iron-based heme group. The enzyme is translated and folded before the heme group is incorporated.
An individual who has an iron malabsorption problem will produce only the protein without the heme.
Such a protein is referred to as a(n)
A) alloenzyme
B) apoenzyme
C) cofactor
D) holoenzyme
E) prosthetic group
F) translocase

Question #148: The condensation of chromatin into chromosomes

1) is accompanied by loss of histones on the DNA

2) occurs irreversibly in non dividing cells
3) requires a doubling of the histone content
4) occurs reversibly prior to each cell division

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct
Page 32
Question #149: A 40-year-old woman primarily subsists on fast foods, hotdogs and diet drinks.
Primary examination reveals bleeding gums, loosening of the teeth and perifollicular hemorrhages.
The mechanism of vascular instability in this patient is most closely associated with deficiency of
which of the following vitamins?
A) Vitamin C
B) Niacin
C) Folic acid
D) Vitamin D
E) Biotin

Question #150: When does a secondary oocyte complete its second meiotic division to become a
mature ovum?
A) At ovulation
B) Before ovulation
C) At fertilization
D) At puberty
E) Before birth

Question #151: A 34-year-old female skier was taken by ambulance to the hospital after she struck a
tree on the ski slope. Imaging gives evidence of a shoulder separation. Which of the following typically
occurs in this kind of injury?
A) Displacement of the head of the humerus from the glenoid cavity
B) Partial or complete tearing of the coracoclavicular ligament
C) Partial or complete tearing of the coracoacromial ligament
D) Rupture of the transverse scapular ligament
E) Disruption of the glenoid labrum

Question #152: A 28-year-old man is treated in the emergency department (ED) for a superficial gash
on his forehead. The wound is bleeding profusely, but examination reveals no fracture. While the
would is being sutured, he relates that while he was using an electric razor, he remembers becoming
dizzy and then waking up on the floor with “blood everywhere.” The physician suspects a
hypersensitive cardiac reflex. The patient’s epicranial aponeurosis (galea aponeurotica) is penetrated,
resulting in severe gaping of the wound. The structure overlying the epicranial aponeurosis is which
one of the following?
A) A layer containing blood vessels
B) Bone
C) The dura mater
D) The periosteum (pericranium)
E) The tendon of the epicranial muscle (occipitofrontalis)

Question #153: Fetal sex can be diagnosed by noting the presence or absence of the Barr body in cells
obtained from the amniotic fluid. What is the etiology of the Barr body?
A) Inactivation of both X chromosomes
B) Inactivation of homologous chromosomes
C) Inactivation of one Y chromosome
D) Inactivation of one X chromsome
E) Inactivation of one chromatid

Page 33
Question #154: The predominant energy store in mammals is
A) adipocyte triglycerides
B) blood ketone bodies
C) hepatic glycogen
D) muscle creatine phosphate
E) muscle glycogen

Question #155: The prochordal plate marks the site of the future
A) umbilical cord
B) heart
C) mouth
D) anus
E) nose

Question #156: Hypoglycemia is caused by a deficiency of each of the following EXCEPT

A) fructose 1,6-diphosphatase
B) glucose 6-phosphatase
C) phosphoenolpyruvate carboxykinase
D) pyruvate carboxylase
E) pyruvate dehydrogenase

Question #157: During the processing of particular N-linked glycoproteins, residues of mannose
6-phosphate are generated. Which of the following proteins is most likely to undergo this step in
processing?
A) Apo B receptor
B) The citrate transport protein of the inner mitochondrial membrane
C) IgG
D) Lysosomal alpha-fucosidase
E) Mitochondrial isocitrate dehydrogenase

Question #158: A doctor at the Internal Medicine Department of Brigham and Women’s Hospital in
Boston thought to have discovered a new variation of a human disease in a patient. She wanted to
investigate this new variation in more detail and asked the patient and his family for permission to
obtain blood and - if necessary - also tissue samples. Permission was granted and she started the
investigation with a series of different Southern Blot analyses to check the integrity of the gene
structure. It turned out that the gene structure was normal. Next she did an RFLP analysis, trying to
establish a link between a DNA polymorphism and the defective gene. Unfortunately, she was unable
to establish such a link. Finally she performed a Northern Blot analysis. The result of that analysis is
shown in the autoradiogram below. A control experiment for beta actin clearly demonstrated the
accuracy of her experimental setup (not shown). In this control, all samples (A to F) yielded a band
that was consistent with beta actin in terms of size and quantity. Explanations: “M” molecular size
marker in 1000 bp; Lane “A” control sample taken from a healthy individual; Lanes “B” to “F” samples
taken from individuals of the affected family. “1” to “6” indicates size of the respective molecular size
marker bands in 1000 bp. Which of the above individuals (B to F) would most likely be affected,
assuming that besides the absence of messenger RNA, any change in quantity and size of the
messenger RNA analyzed would also lead to expression of symptoms? (Answer Choices and Image on
Next Page)

Page 34
A) B only
B) B and E only
C) B, D, and E
D) C and E
E) C and F

Question #159: The orthopedic surgeon exposed the muscle in the supraspinous fossa so that she
could move it laterally, in repair of an injured rotator cuff. As she reflected the muscle from its bed,
an artery was exposed crossing the ligament that bridges the notch in the superior border of the
scapula. What artery was this?
A) Subscapular
B) Transverse cervical
C) Dorsal scapular
D) Posterior humeral circumflex
E) Suprascapular

Question #160: The diagram shows the length-tension relationship for a single sarcomere. Why is the
tension development maximal between points B and C? (Image on next page)
A) Actin filaments are overlapping each other
B) Myosin filaments are overlapping each other
C) The myosin filament is at its minimal length
D) The Z discs of the sarcomere abut the ends of the myosin filament
E) There is optimal overlap between the actin and myosin filaments
F) There is minimal overlap between the actin and myosin filaments

Page 35
Question #161: An Olympic runner participates in a 100-meter race. During this race, it is estimated
eta only 1/2 L oxygen will be consumed by the runner. However, more than 10 L oxygen would be
consumed if the metabolism in this interval were entirely aerobic. The majority of ATP generated
during this 100-meter race is derived from which of the following?
A) ATP stores
B) Creatine phosphate
C) Gluconeogenesis
D) Glycolysis
E) Lipolysis

Question #162: A child presents with low blood glucose, high plasma uric level, hepatomegaly, and
excess fat deposition in the cheeks. A liver biopsy reveals excess glycogen in hepatocytes. A
deficiency of which of the following enzymes might explain this phenotype?
A) Alpha-1,6-glucosidase
B) Glucose 6 phosphate dehydrogenase
C) Alpha-1,4 - alpha 1,6 trans glucosidase
D) Glucose 6-phosphatase
E) Alpha-1,4- alpha-1,4 glucan transferase

Question #163: Pyridoxal phosphate required

A) Oxidative deamination of glutamate
B) Transamination of glutamate
C) Both
D) Neither
Page 36
Question #164: A neonate has a prominent defect at the base of his spine through which his meninges
and spinal cord protrude. A failure of which of the following processes is the most common cause of
this type of defect?
A) Development of the body
B) Development of the pedicle
C) Development of primary vertebral ossification centers
D) Development of the superior articular process
E) Fusion of the vertebral arches

Question #165: Six healthy subjects participate in a study of muscle metabolism during which
hyperglycemia and hyperinsulinemia is induced. Muscle biopsy specimens obtained from the subjects
during the resting state show significantly increased concentrations of malonyl-CoA. The increased
malonyl-CoA concentration most likely directly inhibits which of the following processes in these
subjects?
A) Fatty acid oxidation
B) Fatty acid synthesis
C) Gluconeogenesis
D) Glycogenolysis
E) Glycolysis
F) Oxidative phosphorylation

Question #166: If you could selectively stimulate gamma motor neurons ONLY, in an otherwise intact
person, what effect would this have on the myotatic reflex?
A) Hyperreflexia
B) Hyporeflexia
C) Reflexes would be normal
D) Reflexes would not be observed because the muscle would be tonically contracted
E) Reflexes would not be observed because the muscle would be tonically relaxed

Question #167: The mitochondrial oxidations of alpha-ketoglutarate and of pyruvate both

1) are catalyzed by multi enzyme complexes

2) involve lipoid acid
3) involve thiamine pyrophosphate
4) involve FAD

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Question #168: Which of the following is an example of an anabolic process?

A) A marathon runner converts fatty acids to acetylCoA
B) A starving refugee loses muscle mass to maintain blood glucose levels
C) An athlete mobilizes muscle glycogen for glycolysis
D) An infant converts lactose to glucose and galactose
E) The liver converts lactate from anaerobic exercise into glucose

Page 37
Question #169: A 5-year-old boy is admitted to the emergency department after a car collision.
Radiographic examination reveals a fracture of the head of the femur. An MRI examination reveals a
large hematoma. Which of the following arteries is most likely injured?
A) Deep circumflex iliac
B) Acetabular branch of obturator
C) Descending branch of lateral circumflex femoral
D) Medial circumflex femoral
E) Radicular branches of circumflex artery

Question #170: Each of the following is a precursor of low molecular weight substances that function
as neurotransmitters EXCEPT
A) choline
B) glutamate
C) lysine
D) tryptophan
E) tyrosine

Question #171: Wrist-drop (flexion) results in a very weak hand grasp. The why self-defense classes
teach students to flex the wrist of an attacker holding an object to loosen their grip on that object.
The strength of the hand grasp is greatest with the wrist in the extended position for which one of the
following reasons?
A) Flexor digitorum superficialis and profundus muscles are stretched when the wrist and
metacarpophalangeal joints are extended
B) Lever arms of the interossei are longer when the metacarpophalangeal joints are extended
C) Lever arms of the lumbrical muscles are longer when the metacarpophalangeal joints are extended
D) Line of action of the extensor digitorum muscle is most direct in full extension
E) Radial half of the flexor digitorum profundus muscle is paralyzed because it is innervated by the
radial nerve

Question #172: A 17-year-old male suffered the most common of fractures of the carpal bones when
he fell on his outstretched hand. Which bone would this be?
A) Trapezium
B) Lunate
C) Pisiform
D) Hamate
E) Scaphoid

Question #173: Which of the following represents the correct steps in standard PCR?
A) Annealing, denaturation, extension
B) Extension, denaturation, annealing
C) Extension, annealing, denaturation
D) Denaturation, annealing, extension
E) Annealing, extension, denaturation

Page 38
Question #174: A 26-year-old basketball player presents to the emergency department complaining of
pain and swelling of his right knee. He feels wobbly and is unable to walk. He was fouled by a player
who accidentally ran into his knee. On physical exam of the knee, the leg (Tibia) can be pulled
anteriorly with reference to the thigh (Femur) (positive anterior drawer test) and the valgus stress test
is positive. Which of the following structures in the diagram is most likely injured?
A) A,B,C
B) A,E,F
C) B,C,F
D) D,E,F
E) D,B,C
F) E,F,C

Question #175: A 20-year-old woman presents to the emergency department with several deep
lacerations on the medial side of her wrist after a suicide attempt. She receives prompt psychiatric
evaluation. The function of which of the following muscles might be affected by these injuries?
A) Abductor pollicis brevis
B) Adductor pollicis
C) Flexor pollicis brevis
D) Lumbricals (1 and 2)
E) Opponens pollicis

Page 39
Question #176: A patient was diagnosed with one of the types of sphingolipidoses, which are
congenital diseases involving the inability to degrade sphingolipids. All sphingolipids have in common
which one of the following?
A) A glycerol backbone
B) Ceramide
C) Phosphorylcholine
D) N-acetylneuraminic acid (NANA)
E) A steroid ring structure to which sphingosine is attached

Question #177: Each of the following enzymes may function in the conversion of starch to glucose
EXCEPT
A) isomaltase
B) maltase
C) pancreatic amylase
D) salivary amylase
E) sucrase

Question #178: Which of the following is the correct sequence of the cell cycle in human cells?
A) G1 to G2 to S to M
B) G1 to M to G2 to S
C) G1 to S to M to G2
D) G1 to S to G2 to M

Question #179: Protein kinases phosphorylate proteins only at certain hydroxyl groups on amino acid
side chains. Which of the following groups of amino acids all contain side-chain hydroxyl groups?
A) Aspartate, glutamate, and serine
B) Serine, threonine, and tyrosine
C) Threonine, phenylalanine, and arginine
D) Lysine, arginine and proline
E) Alanine, asparagine, and serine

Question #180: A patient presents with numbness over his medial hand and atrophy of the hypothenar
muscles after an injury several days ago of his elbow at the medial epicondyle. Which of the following
nerves was mot likely injured
A) Anterior interosseous
B) Musculocutaneous
C) Recurrent branch of median
D) Superficial radial
E) Ulnar

Page 40
Question #181: Comparison of the ANS and the somatic motor system shows that both
A) utilize acetylcholine to stimulate epinephrine release from the adrenal medulla
B) have preganglionic neurons in the CNS
C) have cholinergic terminals that innervate nonvascular smooth muscle
D) have cholinergic neurons that originate in the spinal cord
E) are not tonically active

Question #182: Parathyroid hormone directly

A) controls the rate of 25-hydroxycholicalciferol formation
B) controls the rate of calcium transport in the mucosa of the small intestin
C) controls the rate of formation of calcium binding protein
D) controls the rate of formation of 1,25-dihydroxycholicalciferol
E) stimulates renal tubular phosphate reabsorption

Question #183: A 58-year-old woman presents to her physician with stiffness and pain in the left hip
that becomes worse at the end of the day. Physical examination reveals tenderness lateral to the joint
with pain on bending at the hip and limited mobility. An X-ray reveals loss of articular cartilage at the
left hip joint. The cartilage at the hip joint contains which of the following cells?
A) Chondrocyte
B) Fibroblast
C) Osteocyte
D) Osteoblast

Question #184: Replication errors are detected in a normal cell that has just completed S phase. The
usual cellular response to this DNA damage will include
A) Binding of cyclin D to Cdk2
B) Halting the cell cycle at the restriction point
C) Inactivation of cdc25 phosphatase
D) Inhibition of purine nucleotide biosynthesis
E) RB binding to transcription factor E2F

Question #185: A 52-year-old man is brought to the emergency department (ED) after being found in
the park, where apparently he had lain overnight after a fall. He complains of severe pain in the left
arm. Physical examination suggests a fractured humerus that is confirmed radiologically. The patient
can extend the forearm at the elbow, but supination appears to be slightly weak; the hand grasp is
very weak compared with the uninjured arm. Neurologic examination reveals an inability to extend the
wrist (wrist drop). Because these findings point to apparent nerve damage, the patient is scheduled
for a surgical reduction of the fracture. The observation that extension at the elbow appears normal,
but supination of the forearm appears weak, warrants localization of the nerve lesion to which one of
the following?
A) Posterior cord of the brachial plexus in the axilla
B) Posterior divisions of the brachial plexus
C) Radial nerve at the distal third of the humerus
D) Radial nerve in the midforearm
E) Radial nerve in the vicinity of the head of the radius

Page 41
Question #186: If there is alpha-gamma motoneuron co-activation during a movement, spindle
discharge will:
A) Rapidly increase then decrease
B) Increase
C) Decrease
D) Remain the same
E) Rapidly decrease and then increase

Question #187: Events occurring in the activation of glycogenolysis by glucagon include:

1) Glucagon binds to specific receptors in the plasma membrane

2) Adenylate cyclase is activated
3) A series of protein kinases is activated
4) Glycogen phosphorylase and glycogen synthetase are phosphorylated

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Question #188: Which of the following chromosome compositions in a sperm normally results in the
production of a genetic female if fertilization occurs?
A) 23 homologous pairs of chromosomes
B) 22 homologous pairs of chromosomes
C) 23 autosomes plus an X chromosome
D) 22 autosomes plus a Y chromsome
E) 22 autosomes plus an X chromosome

Question #189: Release of acetylcholine at the neuromuscular junction is dependent upon the influx of
which of the following ions to permit binding of synaptic vesicles to the pre-synaptic membrane?
A) Chloride
B) Calcium
C) Sodium
D) Potassium
E) Magnesium

Question #190: The conversion of dihydroxyacetone (DHAP) to glyceraldehyde-3-phosphate (GAP) is a

freely reversible reaction with an equilibrium constant close to 1. The interconversion is catalyzed by
the enzyme triose phosphate isomerase. The presence of this enzyme in a solution of
glyceraldehyde-3-phosphate will have the following effect compared with an identical solution with
no enzyme.
A) Decrease the amount of G-6-P at equilibrium.
B) Decrease the equilibrium constant.
C) Decrease the time taken to reach equilibrium.
D) Increase the amount of F-6-P present at equilibrium.
E) Increase the equilibrium constant.

Page 42
Question #191: Laboratory studies in the outpatient clinic on a 24-year-old female included
assessment of circulating blood chemistry. Which of the following arteries is most likely at risk during
venipuncture at the cubital fossa?
A) Brachial
B) Common interosseous
C) Ulnar
D) Anterior interosseous
E) Radial

Question #192: What is the usual receptor found at the parasympathetic end organ?
A) Cholinergic nicotonic
B) Muscarinic
C) Cholinergic alpha adrenergic
D) Beta adrenergic
E) Dopaminergic

Question #193: Which of the following basal ganglia are NOT derived from the prosencephalon?
A) Caudate nucleus
B) Globus pallidus
C) Subthalamus
D) Substantia nigra
E) None of the above. All basal ganglia are derived from prosencephalon

Question #194: If you wished to shut down pyrimidine synthesis without affecting purine synthesis, the
enzyme to inhibit would be
A) Carbamoyl phosphate synthetase I
B) Carbamoyl phosphate synthetase II
C) Glutamine: phosphoribosyl pyrophosphate amidotransferase
D) Ribose phosphate pyrophokinase
E) Xanthine oxidase

Question #195: If either the ulnar or radial arteries are occluded, which arteries ensure adequate
collateral arterial flow in the hand?
A) Anterior and posterior interosseous
B) Arcuate
C) Common and proper palmar digitals
D) Deep and superficial dorsalis pedis
E) Deep and superficial palmar arch

Question #196: A patient presents to the emergency department after sustaining a laceration of the
first web space of is hand in a rock-climbing accident. Which of the following structures is also likely
to be injured?
A) Deep branch of radial nerve
B) Opponens pollicis
C) Radial artery
D) Recurrent branch of median nerve
E) Superficial palmar arch

Page 43
Question #197: Fructose 2,6 Bisphosphate:
A) Is made from phosphorylated FBP2
B) It acts as an activator for PFK2
C) It is an intermediate of Glycolysis
D) It activated Pyruvate kinase
E) It increases when insulin is high

Question #198: Which one of the following statements about glucagon is correct?
A) High levels of blood glucose increase the release of glucagon from the alpha cells of the pancreas.
B) Glucagon levels decrease following ingestion of a protein-rich meal.
C) Glucagon increases the intracellular levels of cAMP in liver cells, causing an increase in glycogen
breakdown.
D) Glucagon is the only hormone important in combating hypoglycemia.
E) Glucagon depresses the formation of ketone bodies by the liver.

Question #199: Choose the correct answer regarding properties of amino acids:
A) Sidechain of the nonpolar amino acids cluster in the exterior of the protein molecule
B) Glycine is an optically active amino acid
C) Histidine is a basic amino acid
D) Valine is a polar amino acid
E) The side chain of methionine has a sulfhydryl group

Question #200: Hyaluronic acid is a

A) high molecular weight glycoprotein
B) high molecular weight, negatively charged polysaccharide
C) high molecular weight, positively charged polysaccharide
D) glycolipid
E) homopolysaccharide of galacturonic acid

Question #201: Concerning maturation of the female gamete (oogenesis), when do the oogonia enter
meiosis I and undergo DNA replication to form primary oocytes?
A) During fetal life
B) At birth
C) At puberty
D) With each ovarian cycle
E) Following fertilization

Question #202: A 52-year-old band director suffered problems in her right arm several days after
strenuous field exercises for a major athletic tournament. Examination in the orthopedic clinic reveals
wrist drop and weakness of grasp but normal extension of the elbow joint. There is no loss of
sensation in the affected limb. Which nerve was most likely affected?
A) Ulnar
B) Anterior interosseous
C) Posterior interosseous
D) Median
E) Superficial radial

Page 44
Question #203: In skeletal muscle contraction, the “power stroke” is initiated by which one of the following?
A) The initial binding of ATP to the myosin heads
B) Release of Pi form the myosin heads
C) Release of ADP and subsequent addition of an ATP molecule
D) Detachment of the myosin head from the actin
E) Phosphorylation of the myosin light chains

Question #204: The Extraembryonic mesoderm shows signs of clefts being developed which will fuse to
form one large space. What is the name of this space.
A) Extraembryonic amnion
B) Extraembryonic coelom
C) Extra trophoblast sinusoids
D) Extra trophoblast clefts

Question #205: Which of the following stimulates the secretion of parathyroid hormone (PTH)?
A) Increase in extracellular calcium ion activity above the normal value
B) Increase in calcitonin concentration
C) Respiratory acidosis
D) Increased secretion of PTH-releasing hormone from the hypothalamus
E) None of the above

Question #206: A new drug is developed that prevents the demyelinization occurring in the progress of
multiple sclerosis. The drug protects the cells responsible for the synthesis and maintenance of
myelin in the central nervous system. These cells are most likely which of the following?
A) Astrocyte
B) Ependymal cell
C) Microglial cell
D) Oligodendrocyte
E) Schwann cell

Question #207: A 50-year-old man is admitted to the emergency department after a car crash. An MRI
examination reveals an injured anterior cruciate ligament. Physical examination reveals a positive
drawer sign. Which of the following signs is expected to be present during physical examination?
A) The tibia can be slightly displaced anteriorly
B) The tibia can be slightly displaced posteriorly
C) The fibula can be slightly displaced posteriorly
D) The fibula can be slightly displaced anteriorly
E) The tibia and fibula can be slightly displaced anteriorly

Question #208: In order to determine the rate of DNA synthesis in various mammalian tissues, the
administration of which of the following labeled substances would be most specific in labeling DNA?
A) Adenosine
B) Cytosine
C) Guanosine
D) Thymidine
E) Uridine

Page 45
Question #209: A 27-year-old athlete is brought to the emergency department with an injury to his
arm. On examination, the patient is unable to extend his left wrist and thumb. X-ray of his arm
reveals fracture of the humerus. Which fo the following muscles most likely denervated?
A) Pronator teres
B) Pronator quadratus
C) Flexor digitorum profundus
D) Flexor carpi ulnaris
E) Extensor carpi radialis longus

Question #210: A 60-year-old man who lives alone came to the clinic with complaints of bleeding
gums. After investigation he was found to have vitamin C deficiency, which is required for which stage
of collagen biosynthesis?
A) Cleavage of pro-peptides
B) Glycosylation of selected hydroxylysines
C) Hydroxylation of proline and lysine residues
D) Synthesis of pre-pro alpha chain
E) Triple helix formation

Page 46
Question #211: Which one of the following events would usually NOT occur after the release of
norepinephrine from a postganglionic neuron? Norepinephrine:
A) Can undergo re-uptake presynaptically
B) Can be biodegraded chemically
C) Binds to an appropriate adrenoceptor
D) Can stimulate presynaptic autoreceptors
E) Interferes with the binding of co-released neurotransmitters

Question #212: A 60-year-old female is brought to the emergency department after a motor vehicle
collision. She complains of severe hip pain. On physical exam of the left hip, tenderness and reduced
range of motion are elicited. Radiographic examination reveals a fracture (see image). Which of the
following arteries will most likely be injured?
A) Deep femoral
B) External Iliac
C) Femoral
D) Lateral circumflex femoral
E) Medial circumflex femoral

Question #213: When the liver is actively synthesizing fatty acids, a concomitant decrease in beta
oxidation of fatty acids is due to:
A) inhibition of a translocation between cellular compartments
B) inhibition by an end product
C) activation of an enzyme
D) decrease in adipocyte lipolysis

Page 47
Question #214: A 65-year-old woman presents in the emergency department with severe muscle
spasms in her hands. She is being treated for arthritis by her primary care physician. Which of the
conditions described in the table is most likely to produce muscle spasms?
A) Condition A
B) Condition B
C) Condition C
D) Condition D
E) Condition E

Question #215: The following pedigree indicates nine individuals affected with a genetic disease. With a
normal partner what is the chance for individual IV-3 to have a normal daughter?
A) 0%
B) 25%
C) 50%
D) 75%
E) 100%

Page 48
Question #216: Removal of the parathyroid glands will result in
A) Increase Calcium and Increased Phosphorus
B) Increased Calcium and Decreased Phosphorus
C) Decreased Calcium and Increased Phosphorus
D) Decreased Calcium and Decreased Phosphorus
E) Decreased Calcium and Normal Phosphorus

Question #217: A demonstration is performed during a lecture on muscle physiology in which a student
is asked to fully extend his right arm with the palm up. Two large textbooks are placed on his palm,
one at a time. Which of the following facilitates the maximum amount of tension that allows the
student to keep his arm extended in place under the increasing weight of the books?

A) Amount of Ca2+ released from the sarcoplasmic reticulum

B) Amount of muscle phosphocreatine
C) Amplitude of the action potential
D) Number of motor units recruited
E) Rate of cross-bridge recycling

Question #218: A transmembrane protein that links the cytoskeleton to the extracellular matrix was
found to have undergone inadequate O-linked glycosylation. In which sub-cellular location was the
defect most likely to have occurred?
A) Cytoplasm
B) Golgi apparatus
C) Lysosome
D) Rough endoplasmic reticulum
E) Smooth endoplasmic reticulum

Question #219: Characteristics of all tRNAs include

1) a compact tertiary structure

2) proximity of 5’ and 3’ ends
3) interaction with aminoacyl tRNA synthetases, elongation factors and initiation factors
4) binding of amino acids at the 5’end

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Question #220: Glucose and galactose differ only in the configuration at the C-4 chiral center. These
two sugars are said to be
A) anomers
B) enantiomers
C) epimers
D) glycosides
E) tautomers

Page 49
Question #221: A one-year-old female baby is lethargic, weak, and anemic. Her urine contains an
elevated level of orotic acid. The administration of which of the following compounds is most likely to
alleviate her symptoms?
A) Adenine.
B) Guanine.
C) Hypoxanthine.
D) Thymidine.
E) Uridine.

Question #222: During a mastectomy, a surgeon removes lymph nodes from the axillary fat. Some time
thereafter, winging of the patient’s scapula occurs. Branches of which nerve were traumatized?
A) Axillary nerve
B) Dorsal scapular nerve
C) Lateral pectoral nerve
D) Long thoracic nerve to the serratus anterior muscle
E) Nerve to the subclavius muscle

Question #223: A 21-year-old man presents with a long history of increasing fatigue and muscle pain
in his legs after a short period of jogging. A blood test done immediately after exercise shows no
increase in lactate level. Which of the following enzyme deficiency is most likely to contribute to his
symptoms?
A) Alpha-ketoglutarate dehydrogenase
B) Glucokinase
C) Glucose 6-phosphatase
D) Glycogen phosphorylase
E) Pyruvate dehydrogenase

Question #224: A 29-year-old female is examined in the emergency department after falling from her
balcony. Radio- graphic examination reveals that she has suffered a broken clavicle, with associated
internal bleeding. Which of the following vessels is most likely to be injured in clavicular fractures?
A) Subclavian artery
B) Cephalic vein
C) Lateral thoracic artery
D) Subclavian vein
E) Internal thoracic artery

Question #225: A 17-year-old male has weakness of elbow flexion and supination of the left hand after
sustaining a knife wound in that arm in a street fight. Examination in the emergency department
indicates that a nerve has been severed. Which of the following conditions will also most likely be
seen during physical examination?
A) Inability to adduct and abduct his fingers
B) Inability to flex his fingers
C) Inability to flex his thumb
D) Sensory loss over the lateral surface of his forearm
E) Sensory loss over the medial surface of his forearm

Page 50
Question #226: Fractures of the humerus in different regions have the potential to damage different
nerves. What muscle innervation may be compromised by a fracture of the humerus at the “surgical
neck”?
A) Subscapularis
B) Pectoralis major
C) Teres major
D) Deltoid
E) Suprascapularis

Question #227: Select the feature which is characteristic of the sympathetic division of the ANS but NOT
the parasympathetic division.
A) Ganglia are usually located on or near the effector organ
B) Postganglionic neurons secrete norepinephrine and other neurotransmitters
C) Postganglionic neurons synapse on effector organs
D) Long preganglionic neurons
E) Preganglionic neurons originate in the dorsal horn of the thoracolumbar spinal cord

Question #228: Which effect is not seen in diarrhea?

A) Decreased ECF volume
B) Increased ECF osmolarity
C) Increased hematocrit
D) No change in ICF volume

Question #229: Mucopolysaccharidoses are inherited storage diseases. They are caused by
A) An increased rate of synthesis of proteoglycans.
B) The synthesis of polysaccharides with an altered structure.
C) The synthesis of abnormally small amounts of protein cores.
D) An insufficient amount of proteolytic enzymes.
E) Defects in the degradation of proteoglycans

Question #230: Incomplete penetrance:

A) underlies human height variation
B) is observed when the mutant genotype does not result in a mutant phenotype
C) causes late-onset diseases
D) a & b
E) a & c

Question #231: Which of the following is a major characteristic of meiosis I?

A) Splitting of the centromere
B) Pairing of homologous chromosomes
C) Reducing the amount of DNA to 1N
D) Achieving the diploid number of chromosomes
E) Producing primordial germ cells

Page 51
Question #232: Dual x-ray absorptiometric scanning shows decreased bone mineral density
(osteopenia) in the vertebral column of a postmenopausal woman. Her plasma 25-hydroxyvitamin D
and estradiol levels are low and testosterone level is high. Which of the following is the most likely
mechanism that explains her osteopenia?
A) High osteoblast activity
B) High osteoclast activity
C) Normal osteoblast activity
D) Low osteocyte activity
E) Low osteoclast activity

Question #233: A 53-year-old male cancer patient undergoing radiation therapy develops severe pain
in his right big toe. Laboratory analyses indicate an elevated serum uric acid level and urate crystals in
his urine. This patient's pain is caused by the overproduction of the end product of which of the
following metabolic pathways?
A) De novo pyrimidine biosynthesis.
B) Pyrimidine degradation.
C) De novo purine biosynthesis.
D) Purine salvage.
E) Purine degradation.

Question #234: Prevents myosin attachment to actin

A) Actin
B) Heavy meromyosin
C) Light meromyosin
D) Tropomyosin
E) Troponin

Question #235: The sarcoplasmic reticulum of skeletal muscle functions in which one of the following
ways?
A) Cellular Ca2+ storage
B) Cellular glycogen storage
C) Glycogen degradation
D) Transport of Ca2+ into the terminal cisternae during muscle contraction
E) Ca2+ release from the transverse tubules during muscle relaxation

Question #236: The Anaphase Promoting Complex is inhibited when:

A) Kinteochores are attached to the microtubules
B) Cdc20 activity is enhanced
C) Securing is bound to separin
D) Mad2 protein is active because spindles are not properly attached to kinetochores
E) p53 levels are low

Page 52
Question #237: A 30-year-old male with a BMI of 15 presents to the emergency department with severe
arm pain. Though intoxicated, he states he was at a bar and was challenged to an arm wrestling
match. Obliged to agree, he took on a 30-year-old bodybuilder with a BMI of 40. In his drunken state,
your patient began flailing his arms, when he heard a crack and immediately knew his arm was
broken. On examination, the patient is unable to extend his wrist. Additionally, there is an absent
triceps reflex. X-ray demonstrates a fracture of the humerus (see image). Which of the following
arteries is most likely injured?
A) Axillary
B) Brachial
C) Deep brachial
D) Radial
E) Subclavian

Question #238: Which of the following describes the number of chromosomes and amount of DNA in a
gamete?
A) 46 chromosomes, 1N
B) 46 chromosomes, 2N
C) 23 chromosomes, 1N
D) 23 chromosomes, 2N
E) 23 chromosomes, 4N

Page 53
Question #239: Compounds derived from tryptophan include

1) 5-hydroxyindoleacetic acid
2) serotonin (5-hydroxytrptamine)
3) NAD+
4) epinephrine

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Question #240: The inheritance of both chromosomes from the same parent is a condition called
________________.
A) displaced duplication
B) uniparental disomy
C) tandem duplication
D) unbalanced polymorphism
E) nondisjunction

Question #241: A young insulin-dependent diabetic woman in her first pregnancy is concerned that her
daily injection of insulin will cause a congenital malformation in her baby. What should the physician
tell her?
A) Insulin is highly teratogenic; discontinue treatment
B) Insulin does not cross the placental membrane
C) Insulin crosses the placental membrane but is degraded rapidly
D) Insulin will benefit her baby by increasing glucose metabolism
E) Insulin crosses the placental membrane but is not teratogenic

Question #242: Suppression of phosphofructokinase-2 causes a decrease in concentration of

fructose-2,6-bisphosphate. In the same metabolic state that causes this, which of the following
enzymes will also be inhibited?
A) adenylyl cyclase
B) aldolase
C) fructose 1,6-phosphatase
D) pyruvate carboxylase
E) pyruvate kinase

Question #243: A football player experiences an anterior dislocation of the shoulder. Cutaneous
sensation over the lower half of the deltoid muscle is impaired. These finding suggest damage to
which of the following nerves?
A) Axillary
B) Median
C) Musculocutaneous
D) Radial
E) Ulnar

Page 54
Question #244: Tetanic contraction of a skeletal muscle fiber results from a cumulative increase in the
intracellular concentration of which of the following?
A) ATP
B) Ca++
C) K+
D) Na+
E) Troponin

Question #245: Lymph has the highest protein concentration in the

A) brain
B) heart
C) liver
D) lung
E) thymus

Question #246: A 19-year-old man is brought to the emergency department after dislocating his
shoulder while playing soccer. Following reduction of the dislocation, he has pain over the dorsal
region of the shoulder and cannot abduct the arm normally. An MRI of the shoulder shows a torn
muscle. Which of the following muscles is most likely to have been damaged by this injury?
A) Coracobrachialis
B) Long head of the triceps
C) Pectoralis minor
D) Supraspinatus
E) Teres major

Question #247: Oligomycin interferes with synthesis of "high energy" compounds by

A) Blocking the transfer of electrons from cytochrome b to cytochrome c.
B) Uncoupling electron transport from oxidative phosphorylation.
C) Closing the proton channel through the stalk of ATP synthetase.
D) Inhibiting the adenine nucleotide carrier in the inner mitochondrial membrane.
E) Inhibiting the oxidation of NADH.

Question #248: In the production of male gametes, which of the following cells remains dormant for 12
years?
A) Primordial germ cell
B) Primary spermatocyte
C) Secondary spermatocyte
D) Spermatid
E) Sperm

Question #249: Interact(s) with tropomyosin in skeletal muscle

A) Actin
B) Myosin
C) Both
D) Neither

Page 55
Question #250: An 8-year-old boy returns to the pediatric clinic because he has a “pain in his butt” and
walks with a limp. He just visited the clinic a few days ago for a normal summer check up and an
update on his vaccinations. When the physician asks how this happened, the boy says that the pain
started when the nurse gave him his booster shot in his left buttock. When he walks, eh drops his
right hip as he places all the weight on his left leg and swings his right leg forward. When lying prone
on the examination table both legs flex normally with equal strength, and he can extend his thigh at
the high well, but there is facility of his muscles just under the iliac crest only on the left side. The
pediatrician tells the boy and his mother that the booster shot he received a couple of days ago likely
damaged which one of the following?
A) Lateral cutaneous nerve o fat thigh causing his pain
B) Superior gluteal nerve partially paralyzing his gluteus medius muscle
C) Superior gluteal nerve partially paralyzing his gluteus maximus muscle
D) Inferior gluteal nerve partially paralyzing his gluteus medius muscle
E) Sciatic nerve partially paralyzing his hamstring muscles

Question #251: A 45-year-old man comes to the physician because of right shoulder pain that began
after he chopped wood 2 days ago. Examination of the right upper extremity shows no obvious bone
deformities or point tenderness. The pain is reproduced when the patient is asked to externally rotate
the shoulder against resistance; there is no weakness. In addition to the teres minor, inflammation of
which of the following tendons is most likely in this patient?
A) Infraspinatus
B) Pectoralis
C) Subscapularis
D) Supraspinatus
E) Trapezius

Question #252: A mycologist has been accidentally poisoned with koningic acid extracted from the
fungus Trichoderma koningii. This poison blocks some enzymes that catalyze reactions that reduce
NAD+ to NADH. Which enzyme of glycolysis requires this cofactor reduction and will therefore be
unable to function in this patient?
A) aldolase
B) glyceraldeyde 3-phosphate dehydrogenase
C) phosphoglycerate kinase
D) pyruvate dehydrogenase
E) triose isomerase

Question #253: The axillary nerve enters the quadrangular space with the
A) radial nerve
B) axillary artery
C) anterior circumflex humeral artery
D) posterior circumflex humeral artery
E) scapular circumflex artery

Page 56
Question #254: Isocitrate -> alpha-ketoglutarate
alpha-ketoglutarate -> succinyl CoA
The above reactions of the tricarboxylic acid cycle are similar in that both involve

1) cleavage of a carbon-carbon bond

2) reduction of NAD+
3) release of CO2
4) addition of H2O

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Question #255: IN a controlled experiment, radiolabeled ATP is injected into an isolated muscle. The
muscle is stimulated and allowed to contract for 10 seconds. An autoradiogram from a biopsy of the
muscle will sow radiolabeled ATP bound to
A) actin
B) myosin
C) sarcoplasmic reticulum
D) tropomyosin
E) troponin C

Question #256: A 90-year-old woman is brought to the emergency department 30 minutes after she
fell while climbing the steps into her house. Physical examination shows tenderness over the right
shin area. An x-ray of the right lower extremity shows a fracture of the tibia. A DEXA scan shows
decreased bone density. Increased activity of which of the following cell types is the most likely cause
of the decrease in bone mass in this patient?
A) Chondrocytes
B) Osteoblasts
C) Osteoclasts
D) Osteocytes
E) Osteoprogenitor cells

Question #257: Which of the following amino acids is found in naturally occurring proteins?
A) Beta alanine
B) D-serine
C) Homoserine
D) Hydroxyproline
E) Ornithine

Question #258: Bind(s) calcium in skeletal muscle

A) Actin
B) Myosin
C) Both
D) Neither

Page 57
Question #259: When lipolysis is occurring at a high rate, compounds that inhibit the degradation of
glucose include

1) ketone bodies
2) citrate
3) malate
4) acetyl CoA

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Question #260: A 48-year-old female court stenographer is admitted to the orthopedic clinic with
symptoms of carpal tunnel syndrome, with which she has suffered for almost a year. Which muscles
most typically become weakened in this condition?
A) Dorsal interossei
B) Lumbricals III and IV
C) Thenar
D) Palmar interossei
E) Hypothenar

Question #261: The citric acid cycle serves as a source of building blocks for some biosynthetic
pathways in addition to its role in energy metabolism. An exit point from the citric acid cycle for the
synthesis of porphyrins is
A) Acetyl CoA
B) Citrate
C) Isocitrate
D) Alpha-ketoglutarate
E) Succinyl CoA

Question #262: A 62-year-old woman comes to the physician because of low back pain for 1 week.
Menopause occurred 10 years ago. Physical examination shows localized tenderness over the lumbar
spine after movement. X-rays of the spine show a compression fracture of L1-2. A DEXA scan shows
decreased bone mineral density. Serum calcium and phosphorus concentrations and serum alkaline
phosphatase activity are within the reference ranges. A bisphosphonate drug is prescribed. The
expected beneficial effect of this drug is most likely due to which of the following actions?
A) Decreased insulin-like growth factor-1 concentration
B) Decreased osteoclast activity
C) Decreased osteoprotegerin production
D) Increased 1,25-dihydroxycholecalciferol concentration
E) Increased osteoblast activity
F) Increased receptor activator of NF-kB ligand (RANKL) production

Page 58
Question #263: A man eats a low carbohydrate meal rich in proteins containing the amino acids that
stimulate insulin secretion. Which of the following responses accounts for the absence of
hypoglycemia?
A) Suppression of growth hormone
B) Suppression of somatomedin C secretion
C) Stimulation of cortisol secretion
D) Stimulation of glucagon secretion
E) Stimulation of epinephrine secretion

Question #264: A fracture of the surgical neck of the humerus causes weakness in abduction and
lateral rotation of the arm. The damage is to the
A) axillary nerve
B) long thoracic nerve
C) musculocutaneous nerve
D) radial nerve
E) suprascapular nerves

Question #265: Which one of the following is absent in smooth-muscle cells compared to skeletal
muscle cells?
A) Troponin
B) Calmodulin
C) Calcium
D) Myosin light-chain kinase
E) Actin and tropomyosin interactions

Question #266: Which of the following marked bone develops from intramembranous ossification
A) A
B) B
C) C
D) D

Page 59
Question #267: A linear biochemical pathway is given below, including the values for Delta G for each
reaction:
Delta G (kcal/mol) A. -0.5 --> B. -1.0 --> C. -0.4 --> D. -0.3 --> E. -0.2 --> F. +1.5 --> G.

The end product of this pathway, compound “G” is a waste product that is excreted and not used for a
subsequent reaction in another biochemical pathway. In this pathway shown above,
A) All reactions are in equilibrium
B) All reactions will proceed spontaneously
C) The first reaction is endergonic
D) The sum of the free energy of all reactions is positive
E) The terminal reaction will proceed only when coupled with hydrolysis of ATP or GTP

Question #268: Structural features that serve to identify eukaryotic mRNAs include a

1) 3’ terminal poly(A) sequence

2) high content of modified bases
3) 5’ terminal 7-methyl guanylate residue
4) cloverleaf secondary structure

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Question #269: Polypeptide chain elongation requires

1) initiation factors
2) peptidyl transferase
3) AUG codon in mRNA
4) GTP

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Question #270: Thiamine pyrophosphate is a required cofactor fo the oxidation of

1) pyruvate
2) isocitrate
3) alpha-ketoglutarate
4) succinate

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Page 60
Question #271: Under certain metabolic conditions, a hormone is released which suppresses
phosphofructokinase-2. In the same metabolic state that causes this, which of the following enzymes
will also be inhibited?
A) adenylyl cyclase
B) aldolase
C) fructose 1,6-phosphatase
D) pyruvate carboxylase
E) pyruvate kinase

Question #272: The developing embryo has a distinct human appearance by the end of
A) week 4
B) week 5
C) week 6
D) week 7
E) week 8

Question #273: How would the cell cycle be affected if you removed the phosphorylation sites in the Rb
protein?
A) The cell cycle would not be affected because Rb is not phosphorylated normally
B) The cell cycle would be blocked in G1
C) The cell cycle would be blocked in G2
D) The cell cycle would be shorter

Question #274: The transfer of electrons from fatty acyl CoA to O2 involves

1) FAD
2) NAD+
3) cytochrome c
4) glycerol 1-phosphate

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Question #275: A 16-month-old girl of middle eastern parents is admitted with growth retardation. Her
long bones show demineralization with bowing of both the arms and the legs. The patient avoided
dairy products due to a lactose intolerance and her diet was composed primarily of eggs, potatoes,
and other baked goods. When she was taken outside by her mother they were both heavily clad so as
to not expose any of their skin, effectively blocking exposure to the sun. What is the most likely
diagnosis from the choices below?
A) Niacin deficiency
B) Vitamin D deficiency
C) Thiamine deficiency
D) Vitamin A deficiency
E) Vitamin K deficiency

Page 61
Question #276: A 22-year-old woman is admitted to the emergency department in an unconscious
state. The nurse takes a radial pulse to determine the heart rate of the patient. This pulse is felt
lateral to which tendon?
A) Palmaris longus
B) Flexor pollicis longus
C) Flexor digitorum profundus
D) Flexor carpi radialis
E) Flexor digitorum superficialis

Question #277: Fluorescent in situ hybridization (FISH)

A) requires deoxynucleotides
B) requires a labeled probe
C) is used in genetic mapping of genomes
D) requires a DNA polymerase

Question #278: A 19-year-old man is struck by an automobile while crossing a road. He is brought to
the emergency department. On examination, the physician notes that the patient is having a high
stepping gait and is unable to dorsiflex his foot on the injured side. It is also noted that he is having
sensory loss on the dorsum of the foot. An X-ray reveals a fracture of the proximal fibula. Which of
the following nerves is most likely injured in this patient?
A) Common fibular
B) Femoral
C) Medial plantar
D) Superficial fubular
E) Saphenous
F) Tibial

Question #279: The dashed lines in the figure represent the changes from normal (solid lines) produced
by a particular procedure after metabolism of glucose and osmotic equilibration. That procedure is
most likely to be which of the following?
A) ingestion of NaCl tablets
B) intravenous infusion of isotonic saline (300 mOsm/kg water)
C) intravenous infusion of hypertonic saline (600 mOsm/kg water)
D) intravenous 5% glucose in water (300 mOsm/kg water)
E) sweating with fluid replacement

Page 62
Question #280: A cross-sectional view of a skeletal muscle fiber through the H zone would reveal the
presence of what?
A) Actin and titin
B) Actin, but no myosin
C) Actin, myosin, and titin
D) Myosin and actin
E) Myosin, but no actin

Question #281: Very often the first indication a woman has that she is pregnant is a missed menstrual
period. In which week of embryonic development will a woman experience her first missed menstrual
period?
A) Start of week 3
B) Start of week 4
C) Start of week 5
D) Start of week 8
E) End of week 8

Question #282: The 5’ cap on an mRNA is important for all the processes listed below except for the
______________ of an mRNA molecule.
A) transcription
B) intron removal
C) stability
D) initiation of translation

Question #283: The incidence of neural tube defects may be substantially reduced if the mother takes
which of the following vitamins prior to and during the pregnancy?
A) Thiamine
B) Vitamin A
C) Folic acid
D) Riboflavin
E) Vitamin B12

Question #284: Adrenal medullary chromaffin cells that secrete catecholamines (epinephrine and
norepinephrine) are innervated directly by:
A) pre-ganglionic sympathetic cholinergic fibers
B) pre-ganglionic parasympathetic cholinergic fibers
C) postganglionic sympathetic cholinergic fibers
D) postganglionic sympathetic noradrenergic fibers
E) hormones through the blood only - not by autonomic fibers

Question #285: How soon after fertilization occurs within the uterine tube does the blastocyst begin
implantation?
A) Within minutes
B) By 12 hours
C) By day 1
D) By day 2
E) By day 7

Page 63
Question #286: Which of the following is not a function of bone?
A) Initiate movement
B) Store calcium
C) Blood cell production
D) Protect brain and spinal cord
E) Support soft tissues

Question #287: A researcher is trying to identify a specific protein within a mixture. He subjects the
mixture to gel electrophoresis and then transfers the separation to nitrocellulose filters. The filters
are incubated with antibody to the specific protein, and the excess antibody is washed off. The
antibody-protein complex is then incubated with a radio labeled protein that binds to the antibody.
Autoradiography is performed to detect the presence of the protein. This technique represents
A) Northern blotting
B) Southern blotting
C) Southwestern blotting
D) Western blotting

Question #288: Associated with hepatic metabolism of bilirubin and drugs (e.g., alcohol and
barbiturates)
A) Rough endoplasmic reticulum
B) Smooth endoplasmic reticulum
C) Both
D) Neither

Question #289: Impulse conduction in axons can be blocked by

1) pressure
2) cold
3) tetrodotoxin
4) ischemia

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Question #290: Exocrine secretion might be expected following an increase in intracellular

1) pH
2) Ca2+
3) ATP
4) cyclic AMP

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Page 64
Question #291: A 22-year-old pregnant woman at 20 weeks of gestation comes to her ON/GYN for a
normal examination. During routine blood tests, her serum α-fetoprotein (AFP) concentration is
markedly increased for her gestational age. Ultrasonography reveals spina bifida in the fetus. At what
week of gestation did this defect most likely occur?
A) 1-2
B) 4-6
C) 9-11
D) 12-15
E) 16-19

Question #292: Which one of the following conditions would increase the catabolic activity of the citric
acid cycle
A) A high ATP/ADP ratio
B) A high GTP/GDP ratio
C) A low NADH/NAD+ ratio
D) A low concentration of AMP
E) High NADH due to slow electron transport activity

Question #293: The 58-year-old convenience store operator had received a superficial bullet wound to
the soft tissues on the medial side of the elbow in an attempted robbery. A major nerve was repaired
at the site where it passed behind the medial epicondyle. Bleeding was stopped from an artery that
accompanied the nerve in its path toward the epicondyle. Vascular repair was performed on this small
artery because of its important role in supplying blood to the nerve. Which of the following arteries
was most likely repaired?
A) The profunda brachii
B) The radial collateral artery
C) The superior ulnar collateral artery
D) The inferior ulnar collateral artery
E) The anterior ulnar recurrent artery

Question #294: Enzyme reactions involving transamination

A) BIotin
B) Cyanocobalamin (vitamin B12)
C) Pyridoxine (vitamin B6)
D) Riboflavin (vitamin B2)
E) Thiamine (vitamin B1)

Question #295: Sickle cell anemia is the clinical manifestation of an abnormal hemoglobin molecule.
The mutation in the Beta chain is known to produce a single amino acid change. The most likely
mechanism for this mutation is
A) Crossing over
B) Two-base insertion
C) Three-base deletion
D) Nondisjunction
E) Point mutation

Page 65
Question #296: Endoscopic examination of the shoulder of a 62-year-old female clearly demonstrated
erosion of the tendon within the glenohumeral joint. What tendon was this?
A) Glenohumeral
B) Long head of triceps
C) Long head of biceps
D) Infraspinatus
E) Coracobrachialis

Question #297: Alpha-ketoglutarate and pyruvate dehydrogenase have many features in common. In
comparing these two enzymes, which of the following characteristics is unique to pyruvate
dehydrogenase complex?
A) Positively regulated by Ca2+
B) Catalyzes the release of CO2
C) Is a multi-subunit enzyme complex
D) Regulated by phosphorylation and dephosphorylation
E) Requires lipoic acid as a cofactor

Question #298: Which of the following increases the rate of excretion of calcium ions by the kidney?
A) Decrease in calcitonin concentration in the plasma
B) Increase in phosphate ion concentration in the plasma
C) Decrease in the plasma level of parathyroid hormone
D) Metabolic alkalosis

Question #299: In order to have an adequate supply of precursors for nucleotide synthesis, the body
synthesizes its own nucleotides in addition to salvaging those produced from normal turnover in the
cell. In the biosynthesis of purines, the first purine derivative formed is
A) hypoxanthine
B) adenosine monophosphate
C) guanosine monophosphate
D) inosine
E) inosine monophosphate

Question #300: Which of the following components plays the most active role in invading the
endometrium during blastocyst implantation?
A) Epiblast
B) Syncytiotrophoblast
C) Hypoblast
D) Extraembryonic somatic mesoderm
E) Extraembryonic visceral mesoderm

Page 66
Question #301: An 85-year-old man is rushed to the emergency department from his primary care
physician’s office after his physician palpates a pulsating mass in his abdomen. The patient is
diagnosed with an abdominal aortic aneurysm. Instead of repairing the aneurysm by surgically
opening the abdomen, the surgeon decides to perform endovascular stenting and grafting. The stent
is inserted into the femoral artery and threaded up toward the aortic defect. To access the femoral
artery the surgeon must open the femoral sheath and expose its contents. Which of the following
structures is enclosed inside the femoral sheath?
A) Cooper’s ligament
B) Femoral canal
C) Femoral nerve
D) Obturator nerve
E) Tunica vaginalis
Question #302: A patient was diagnosed with a hypertriglyceridemia. This condition is named for the
high blood levels of lipids composed of which one of the following?
A) Three fatty acyl groups attached to a glycerol backbone
B) A glycerol lipid containing a phosphorylcholine group
C) A sphingolipid containing three fatty acyl groups
D) Three glycerol moieties attached to a fatty acid
E) Three glyceraldehyde moieties attached to a fatty acid

Question #303: A four-year-old boy is brought to your clinic. The parents tell you that he shows
strange gait and clumsiness which only seems to happen when he has consumed foods containing
sugar. His mother had the same problem from an early age, and has avoided carbohydrate rich foods
all her life. On administration of a test meal with a high carbohydrate content, he is found to develop
mild lactic acidosis in addition to the ataxia previously described. The enzyme which is most likely to
be deficient in this individual is
A) Alpha-Ketoglutarate dehydrogenase complex
B) ATP synthase
C) Citrate synthase
D) Pyruvate dehydrogenase complex
E) Succinate dehydrogenase

Question #304: Contributes to the formation of the choroid plexuses

A) Arachnoid
B) Dura mater, inner layer
C) Dura mater, outer layer
D) Pia mater

Question #305: Which of the following best describes the cells and/or structure that secretes human
chorionic gonadotrophin (hCG)?
A) Epiblast
B) Inner cell mass
C) Cytotrohphoblast
D) Syncytiotrophoblast
E) Hypoblast

Page 67
Question #306: A 20-year-old male visits the family physician complaining of difficulty to flex and
medially rotate his thigh while running and climbing. Which of the following muscles is most likely
damaged in this individual?
A) Rectus femoris
B) Tensor fasciae latae
C) Vastus intermedius
D) Semimembranosus
E) Sartorius

Question #307: A 29-year-old female had sustained a deep laceration in the proximal part of the
forearm. After the wound is closed, the following functional deficits are observed by the neurologist
on the service: The first three digits are in a position of extension and cannot be flexed. Digits 4 and
5 are partially flexed at the metacarpophalangeal joints and noticeably more flexed at the distal
interphalangeal joints. Sensation is absent in the lateral side of the palm and the palmar surfaces of
digits 1 to 3 and half of the fourth digit. Which of the following has (have) most likely been injured?
A) Median nerve
B) Ulnar and median nerve
C) Ulnar nerve
D) Radial and ulnar nerve
E) Radial nerve

Question #308: In target cells, stimulation of cyclic AMP by epinephrine

A) depends upon the internalization of epinephrine-receptor complexes
B) is amplified by prior long-term exposure of the cell to norepinephrine
C) is inversely related to the number of adrenergic receptors present on the cells
D) is mediated by a protein that binds GTP
E) requires translocation of epinephrine into the nucleus

Question #309: Collagen is an abundant protein in our body. Which amino acid gets glycosylated during
chain maturation?
A) Glycine
B) Proline
C) Hydroxyproline
D) Hydroxylysine
E) Arginine

Question #310: If you step on a tack with your left foot, the activity of the lower motor neurons in the
right lower limb flexors will:
A) Completely stop because of spindle unloading
B) Not change
C) Increase
D) Decrease
E) Decrease then increase

Question #311: Which of the following does the primitive node induce the formation of?
A) Bilaminar disc
B) Trilaminar disc
C) Notochord
D) Neural plate
E) Neural crest

Page 68
Question #312: A significant correlation has been established between a mutant fumarase enzyme
which is less active than normal, and increased incidence of rectal cancer. What is the product of
fumarase activity in the TCA?
A) Fumarate
B) Citrate
C) Oxaloacetate
D) L-Malate
E) Alpha-ketoglutarate

Question #313: In a polypeptide at physiologic pH, hydrogen bonding may occur between which of the
following?
A) The side chains of a leucine residue and a lysine residue
B) The side chains of an aspartyl residue and a glutamic residue
C) The terminal alpha-amino group and the terminal alpha-carboxyl group
D) The amide group in the peptide bond and an aspartyl side chain
E) The -SH groups of two cysteine residues

Question #314: During a routine neurological examination, the physician elicits a biceps tendon reflex
on the patient by tapping briskly with a reflex hammer on the tendon. The resident notes an
involuntary contraction of the biceps (positive response). The positive reflex confirms the integrity of
which of the following nerves?
A) Anterior interosseous
B) Musculocutaneous
C) Medial cutaneous
D) Posterior interosseous
E) Ulnar

Question #315: A person with a limp caused by injury to the superior gluteal nerve would most likely
have paralysis of which of the following muscles?
A) Gluteus maximus
B) Gluteus medius
C) Obturator internus
D) Piriformis
E) Quadratus femoris

Question #316: The major afferent fiber type responsible for eliciting the myotatic reflex is:
A) Ia fibers
B) Ib fibers
C) II fibers
D) gamma motor neurons
E) alpha motor neurons

Page 69
Question #317: When skeletal muscle contracts,

1) shortening increases with load

2) external work varies with shortening and load
3) velocity of shortening increases with load
4) the greatest force occurs with the slowest contractions

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Question #318: A 65-year-old man with severe atherosclerotic coronary artery disease comes to the
emergency department because of a 12-hour history of chest pain. Plasma activity of the MB isozyme
of creatine kinase (MB-CK) is markedly increased. Which of the following processes is the most likely
explanation for the increased plasma MB-CK?
A) Cell membrane damage
B) Endoplasmic reticulum dilation
C) Mitochondrial swelling
D) Polysome dissociation
E) Sodium pump dysfunction

Question #319: A 6-month-old boy has failed to thrive and is brought to you for evaluation. He suffers
severe fasting hypoglycemia, has hepatomegaly, signs of renal damage, hyperlacicacidemia and
hyperuricemia. Biopsy and further lab tests indicate that he has type Ia glycogen storage disease (von
Gierke’s Disease). This disorder affects both glycogen metabolism and gluconeogenesis in
gluconeogenic tissues due to a deficiency of an enzyme important to both. Which of the following is
the most likely enzyme to be found deficient in this patient?
A) Aldolase
B) Enolase
C) Fructose 1,6-bisphosphatase
D) Fructose 2,6-bisphosphatase
E) Glucose 6-phosphatase
F) Pyruvate carboxylase

Question #320: A 49-year-old man is admitted to the emergency department with a cold and pale foot.
Physical examination reveals that the patient suffers from peripheral vascular disease and his popliteal
artery is occluded and no pulse is felt upon palpation. What is the landmark to feel the pulse of the
femoral artery?

A) Adductor canal
B) Femoral triangle
C) Popliteal fossa
D) Inguinal canal
E) Pubic symphysis

Page 70
Question #321: Which of the following will DECREASE the rate of glycolysis? A drug which
A) inhibits adenylyl cyclase
B) inhibits fructose 2,6-bisphosphatase
C) inhibits phosphofructokinase-2
D) stimulates hexokinase
E) stimulates phosphofructokinase-1
F) stimulates phosphofructokinase-2

Question #322: A distinctive side chain determines the property of an amino acid. Which side chain
group of serine helps in the activity of an enzyme active site?
A) Aliphatic side chain
B) Aromatic side chain
C) Hydroxy group
D) Basic group
E) Imino group

Question #323: The lipid bilayer structure of cellular membranes provides for

1) insertion of protein through the lipid bilayer

2) rapid “flip-flop” of lipid molecules form one side of the bilayer to the other
3) ligand-induced movement of membrane components
4) fixed positions for proteins within a fluid-lipid matrix

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Question #324: Which of the following is a DNA nucleotide?

A) a phosphate group, adenine and ribose
B) a phosphate group, guanine and deoxyribose
C) cytosine and ribose
D) a phosphate group and adenine
E) none of the above

Question #325: The mutation shown in the illustration below is generated by

A) Amyl nitrite
B) Cigarette smoke
C) DNA replication error
D) DNA recombination
E) Ethidium bromide
F) Ultraviolet light

Page 71
Question #326: The neural folds approach each other and fuse converting the neural plate into a
structure that develop into the CNS. What is the name of this structure.
A) Notochord
B) Neural groove
C) Neural tube
D) Neural pit

Question #327: Dizygotic (fraternal) twins have

A) one placenta, one chorionic sac and one amniotic sac
B) one placenta, two chorionic sacs and two amniotic sacs
C) two placentae, one chorionic sac and one amniotic sac
D) two placentae, two chorionic sacs and one amniotic sac
E) two placentae, two chorionic sacs and two amniotic sacs

Question #328: Match the description to one of the points of the nerve action potential shown in the
diagram.
Point at which the membrane potential (Vm) is closest to the Na+ equilibrium potential.
A) A
B) B
C) C
D) D
E) E
F) F

Page 72
Question #329: Pulmonary surfactant material primarily consists of
A) cariolipin
B) dipalmitoylphosphatidylcholine
C) lysolecithin
D) lysophosphatidic acid
E) sphingomyelin

Question #330: If the axillary artery is ligated proximally as it passes over the first rib, blood will be
supplied to the distal axillary artery through the
A) brachial artery
B) internal thoracic artery
C) subclavian artery
D) subscapular artery
E) vertebral artery

Question #331: A normal person is given a large dose of insulin. Each of the following will occur in the
plasma EXCEPT
A) an increase in potassium concentration
B) an increase in epinephrine concentration
C) a decrease in concentrations of amino acids
D) a decrease in glucose concentration
E) an increase in glucagon concentration

Question #332: Select the INCORRECT statement.

A) All ANS ganglia are nicotinic
B) The receptor of the neuromuscular junction is a nicotinic type
C) Cardiac and smooth muscle have muscarinic and adrenergic receptors
D) Glandular cell receptors are either nicotinic or muscarinic
E) The receptors on the adrenal chromaffin cells which secrete epinephrine are nicotinic

Question #333: DNA binding proteins that recognize specific nucleotide sequences include

1) restriction endonuclease
2) histone HI
3) repressor proteins
4) DNA ligase

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Question #334: Which of the following best describes the tissue that gives rise to somites?
A) Intermediate mesoderm
B) Paraxial mesoderm
C) Endoderm
D) Lateral mesoderm
E) Ectoderm

Page 73
Question #335: The graph shown below is characteristic for which of the following types of reactions?
A) Antagonistic
B) Endergonic
C) Endothermic
D) Exergonic
E) Exothermic

Question #336: The mechanochemical enzyme that can be found on the surfaces of cellular organelles
where it mediates movement toward the plus end of the microtubules is which one of the following?
A) Myosin (myosin II)
B) Minimyosin (myosin I)
C) Dynein
D) Kinesin
E) Filamin

Question #337: The sensitivity of the smooth muscle contractile apparatus to calcium is known to
increase in the steady-state under normal conditions. This increase in calcium sensitivity can be
attributed to a decrease in the levels of which of the following substances?
A) Actin
B) Adenosine Triphosphate (ATP)
C) Calcium-calmodulin complex
D) Calmodulin
E) Myosin light chin phosphatase (MLCP)

Page 74
Question #338: A 19-year-old woman was dancing in clogs in an ethnic street festival when she
inverted her left foot. She presents to the clinic the next day with a swollen foot, but minaly complains
about tenderness on the lateral aspect of the foot along the plantar surface. Her foot is carefully
palpated and it is determined that she has tenderness over the tuberosity of the fifth metatarsal bone.
What muscle has avulsed from its insertion onto the tuberosity of the fifth metatarsal?
A) Abductor digiti minimi
B) Fibularis (peroneus) brevis
C) Fubularis (peroneus) longus)
D) Tibialis anterior
E) Tibialis posterior

Question #339: Reciprocal inhibition results when:

A) Renshaw cells disinhibit antagonist motor units
B) Ia afferents inhibit antagonist motor units though an inhibitory interneuron
C) Extensors are activated in one leg when the other leg is flexed
D) Ib afferents inhibit agonist motor units through an inhibitory interneuron Renshaw cells inhibit
E) synergist motor units

Question #340: Semi-conservative replication involves the separation of the strands of parent DNA.
Which one of the following statement is true for the initiation of replication?
A) DnaA protein binds to AT rich regions in the origin of replication
B) Activity of DNA helicase is energy independent process
C) Pre-priming complex proteins are involved in the removal of super coils
D) DNA helicase protect the ssDNA from nuclease attack
E) In prokaryotes replication begins at multiple sites along the DNA helix

Question #341: The cardiac muscle is critically dependent on the citric acid cycle for the provision of
energy during aerobic metabolism. Which of the following statements about the citric acid cycle are
correct?
A) The citric acid cycle is acting at its fastest rate when energy-rich intermediates like ATP and NADH
are at their highest concentrations.
B) The rate limiting step is catalyzed by pyruvate carboxylase.
C) The formation of citrate from acetyl CoA and oxaloacetate is irreversible.
D) Carbon dioxide is formed at the steps catalyzed by malate dehydrogenase and by succinate
dehydrogenase.
E) The citric acid cycle provides over 90% of the ATP requirement for erythrocytes

Question #342: A 35-year-old man has an adenoma of the parathyroid gland, with increased serum
concentrations of parathyroid hormone (PTH) and calcium. In this patient, PTH induces which of the
following processes to cause hypercalcemia?
A) Production of 25-hydroxycholecalciferol
B) Shift of Ca2+ from the intracellular to the extracellular fluid compartment
C) Stimulation of osteoclast activity
D) Suppression of renal production of 1,25-dihydroxycholecalciferol

Page 75
Question #343: A 61-year-old female was diagnosed with malignant cystosarcoma phyllodes (a breast
tumor), and she was admitted to the hospital for chemotherapy. She was started on a combination
chemotherapy consisting of Adriamycin, 5-fluorouracil and Doxorubicin. Doxorubicin is a
chemotherapeutic drug whose anticancer action is due to its ability to poison topoisomerase II. This
drug is effective mainly because it interferes with
A) DNA transcription
B) DNA replication
C) hormone signaling
D) proofreading
E) RNA translation

Question #344: A histologist examines a histological section of the tracheal cartilage. He identifies
chondrocytes and the structural proteins dispersed in the extracellular matrix. The extracellular
matrix is which of the following labelled structures?
A) A
B) B
C) C
D) D
E) E

Page 76
Question #345: Which one of the following is not required for Purine synthesis pathways?
A) THF
B) Glycine
C) CPSII
D) Glutamine
E) PRPP

Question #346: Where does the blastocyst normally implant?

A) Functional layer of the cervix
B) Functional layer of the endometrium
C) Basal layer of the endometrium
D) Myometrium
E) Perimetrium

Question #347: An inherited disorder of carbohydrate metabolism is characterized by an abnormally

increased concentration of hepatic glycogen with normal structure and no detectable increase in
serum glucose concentration after oral administration of fructose. These two observations suggest
that the disease is a result of the absence of which of the following enzymes?
A) Fructokinase
B) Glucokinase
C) Glucose-6-phosphatase
D) Phosphoglucomutase
E) UDP glucose

Question #348: During the later stages of pregnancy, maternal blood is separated from fetal blood by
the
A) syncytiotrophoblast only
B) cytotrophoblast only
C) syncytiotrophoblast and cytotrophoblast
D) syncytiotrophoblast and fetal endothelium
E) cytotrophoblast and fetal endothelium

Question #349: The heteropolysaccharide X has multiple uses in medicine that include its use in blood
transfusions to prevent the blood from coagulating before administration, as anticoagulant therapy in
prophylaxis and treatment of venous thrombosis and its extension, in pulmonary embolisms and in
other similar situations. According to the above, heteropolysaccharide X is:
A) Hyaluronic acid
B) Chondroitin- 4- Sulfate
C) Chondroitin- 6- Sulfate
D) Heparin
E) Dermatan Sulfate

Question #350: An elderly woman falls on her outstretched hand and fractures the surgical neck of her
humerus. Several weeks later she presents with significant weakness in abduction of her arm and
some weakened extension and flexion. Which of the following nerves is most likely injured?
A) Axillary
B) Spinal accessory
C) Radial
D) Subscapular
E) Thoracodorsal
Page 77
Question #351: The rate of conversion of 25-hydroxycholicalciferol is increased by

1) vitamin D intoxication
2) an increased circulating concentration of parathyroid hormone
3) hyperphosphatemia
4) hypocalcemia

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Question #352: The term “homologous chromosomes”

A) refers to replications of the same chromosome
B) is another name for sister chromatids
C) must be haploid
D) means a pair of chromosomes of the same kind, such as sex chromosomes

Question #353: In the gene for a given protein, a single nucleotide change can result in a

1) protein of normal molecular weight with a single amino acid substitution and normal
function
2) protein of normal molecular weight with normal amino acid composition
3) protein of normal molecular weight with a single amino acid substitution and altered
function
4) polypeptide of low molecular weight

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Question #354: The given pedigree displays the inheritance of mutant genes for Xeroderma
pigmentosum (an autosomal recessive disorder in a family. Totally, how many individuals are obligate
carriers for this mutant gene?
A) 1 B) 2 C) 3 D) 4 E) 5 F) 6

Page 78
Question #355: Deficiency of vitamin C results in defective collagen because of
A) activation of collagenase
B) decreased activity of lysol oxidase
C) incomplete glycosylation of hydroxylysine residues
D) incomplete hydroxylation of proline
E) lack of procollagen peptidase activity

Question #356: An 18-year-old male is brought to the emergency department after an injury while
playing rugby. Imaging reveals a transverse fracture of the humerus about 1 inch proximal to the
epicondyles. Which nerve is most frequently injured by the jagged edges of the broken bone at this
location?
A) Axillary
B) Median
C) Musculocutaneous
D) Radial
E) Ulnar

Question #357: Which of the following conditions described in the table is expected to occur in
exercising muscles during the contraction phase of an isometric exercise performed by a normal
healthy subject, compared to the conditions at rest?
A) Condition A
B) Condition B
C) Condition C
D) Condition D
E) Condition E

Question #358: In the gastrocnemius muscle of a 400m runner, the following reaction is taking place
during exercise:
Glucose-6-P Glucose + Pi Delta G'o = -13.8 kJ/mol.
Which of the following statements best describes this system?
A) at 1M concentrations, the system would be at equilibrium
B) at equilibrium, Delta G'o = 0
C) the pH is 1.0
D) the reaction is exergonic
E) under standard conditions, reactants are favored
F) Delta S'o is negative

Page 79
Question #359: A 34-year-old male runner visits the outpatient clinic complaining of pain in his foot
for the past week. Physical examination reveals inflammation of the tough band of tissue stretching
from the calcaneus to the ball of the foot. Which of the following conditions is characteristic of these
symptoms?
A) Pott fracture
B) Dupuytren fracture
C) Tarsal tunnel
D) Plantar fascitis
E) Rupture of spring ligament

Question #360: A laboratory researcher makes a solution containing D-glucose and ATP at
concentrations similar to those found in cells. Nothing happens. Next she adds a small amount of the
enzyme hexokinase, and the ATP reacts with the glucose forming glucose 6-phosphate. Which of the
following explains these observations? Relative to the uncatalyzed reaction, the enzyme
A) decreases Delta Gf for the reaction.
B) increases Delta Gf for the reaction.
C) provides a higher energy pathway from reactants to products.
D) provides a lower energy pathway from reactants to products.
E) shifts the equilibrium towards products.
F) shifts the equilibrium towards reactants

Question #361: The apolar central core of plasma lipoproteins primarily contains
A) apolipoproteins and cholesterol esters
B) apolipoproteins and phospholipids
C) phospholipids and cholesterol
D) phospholipids and triacylglycerols
E) triacylglycerols and cholesterol esters

Question #362: The passage of a cell through the stages of the cell cycle is controlled by protein
kinases that phosphorylate many different proteins at appropriate times. What are these protein
kinases called?
A) Cyclin-dependent kinases
B) Cdk activating kinases
C) Cyclins
D) Tyrosine kinases

Question #363: A 36-year-old man fell while playing soccer one week earlier. He fell on his left hand
and “didn’t think he broke anything” but he has a palmar mass, weakened ability to grasp with that
hand, and has tingling in his thumb and index finger. He has no pain when his physician presses on
the anatomical snuffbox. Which one of the following carpal bones is most likely dislocated anteriorly
and causing a form of carpal tunnel syndrome?
A) Capitate
B) Hamate
C) Lunate
D) Navicular
E) Scaphoid

Page 80
Question #364: Protein synthesis occurs on ribosomes that are associated with the rough endoplasmic
reticulum under which of the following conditions?
A) After cleavage of the signal recognition particle
B) For proteins destined for secretion outside of the cell
C) For proteins whose solubility is limited
D) From mRNA with a signal sequence at its 3’ terminus
E) On a special class of ribosomes with hydrophobic properties

Question #365: In the graph shown, (A) represents the normal action potential of an axon recorded with
intracellular microelectrodes; the electrical stimulus is indicated by the arrow.
The recording that would be expected if the extracellular concentration of K+ is increased would be
A) A
B) B
C) C
D) D
E) E

Question #366: An eight-year-old male attends elementary school. His teacher informs the parents that
the child does not like to complete his daily reading assignment. He leaves his seat and goes off
wandering in the play area. His parents set up the following program: If the student is able to sit and
complete his daily reading assignment, he is allowed to play with his video games after he returns
home that day. As soon as this program is implemented, the student’s completion rate of his reading
assignment increases to nearly 100%.
A) Positive Reinforcement
B) Positive Punishment
C) Negative Reinforcement
D) Negative Punishment
E) None of the above

Page 81
Question #367: A 2-year-old boy with mental retardation has chewed the tips of his fingers on both
hands and a portion of his lower lip. His serum uric acid concentration is increased, and he has a
history of uric acid renal calculi. His 5-year-old brother has similar findings. Which of the following
abnormal enzyme activities is the most likely cause of these findings?
A) Decreased adenine phosphoribosyltransferase
B) Decreased adenosine deaminase
C) Decreased hypoxanthine-guanine phosphoribosyl transferase
D) Increased phosphoribosyl pyrophosphate synthetase
E) Increased xanthine oxidase

Question #368: Which process establishes the three definitive germ layers?
A) Neurulation
B) Gastrulation
C) Craniocaudal folding
D) Lateral folding
E) Angiogenesis

Question #369: A 32-year-old woman is admitted to the emergency department after an automobile
collision. Radio- graphic examination reveals multiple fractures of the humerus. Flexion and
supination of the forearm are severely weakened. She also has loss of sensation on the lateral surface
of the forearm. Which of the following nerves has most likely been injured?
A) Radial
B) Musculocutatenous
C) Median
D) Lateral cord of brachial plexus
E) Lateral cutaneous nerve of the forearm

Question #370: Source of mitochondria acetyl CoA

A) ADP
B) Citrate
C) Malonyl CoA
D) Oxaloacetate
E) Pyruvate

Question #371: A 60-year-old woman, diagnosed with breast cancer undergoes a left sided
mastectomy. Postoperatively, she complains of shoulder pain and is unable to raise her arm above her
head to brush her hair. On physical examination, when she pushes her hands against a wall, the
medial border of the left scapula moves laterally and posteriorly away from the thoracic wall. Paralysis
of which of the following muscles most likely explains her postoperative clinical picture?
A) Deltoid
B) Infraspinatus
C) Latissimus dorsi
D) Serratus anterior
E) Supraspinatus

Page 82
Question #372: A mixture of bacterial DNA solution subjected to spectroscopic studies consists of 38%
of adenine base. What approximate percentage of the bases are guanine?
A) 76%
B) 24%
C) 12%
D) 38%
E) 68%

Question #373: Where do primordial germ cells initially develop?

A) In the gonads at week 4 of embryonic development
B) In the yolk sac at week 4 of embryonic development
C) In the gonads at month 5 of embryonic development
D) In the yolk sac at month 5 of embryonic development
E) In the gonads at puberty

Question #374: Which of the following is required to transport fatty acids across the inner
mitochondrial membrane?
A) Acyl carrier protein
B) Albumin
C) Carnitine
D) Chylomicrons
E) Creatinine
F) Lecithin-cholesterol acyltransferase

Question #375: Synthesis of RNA requires

1) reverse transcriptase
2) a free 3’ OH group
3) spermidine
4) ATP

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Question #376: Which one of the following activities is simultaneously stimulated by epinephrine in
muscle & inhibited by epinephrine in liver?
A) fatty acid oxidation
B) glycogenolysis
C) cAMP synthesis
D) glycolysis
E) activation of phosphorylate

Question #377: Which of the following statements correctly describes p53?

A) It is a membrane receptor that binds to a cell growth hormone
B) Cell division stops until p53 binds to DNA and repairs the damage
C) p53 is an example of an oncogene, and its expression causes uncontrolled cell division
D) activation of p53 leads to inhibition of the S-phase cyclin-Cdk complex

Page 83
Question #378: A woman comes to the physician for a prenatal visit. Examination reveals that her
uterus is considerably larger than her gestational age would predict. An ultrasound examination is
ordered and reveals that she has polyhydramnios. Which of the following congenital defects of the
fetus would be most likely to be associated with this abnormality?
A) Atrial septal defect
B) Esophageal atresia
C) Lung hypoplasia
D) Meckel diverticulum
E) Renal agenesis

Question #379: A 19-year-old male had suffered a deep laceration to an upper limb when he stumbled
and fell on a broken bottle. On examination of hand function it is observed that he is able to extend
the metacarpophalangeal joints of all his fingers in the affected limb. He cannot extend the
interphalangeal joints of the fourth and fifth digits, and extension of the interphalangeal joints of the
second and third digits is very weak. There is no apparent sensory deficit in the hand. Which of the
following nerves has most likely been injured?
A) Radial nerve at the elbow
B) Median nerve at the wrist
C) Ulnar nerve in midforearm
D) Deep branch of ulnar nerve
E) Recurrent branch of the median nerve

Question #380: A bacterial protein is encoded by the following mRNA sequence:

5’-AUGGUGCUCAUGCCCTAA-3’. The second methionine codon (AUG) in this mRNA sequence will:
A) serve as the initiation codon
B) encode N-formylmethionine
C) encode methionine that will eventually be removed
D) encode unformylated methionine

Question #381: Oxidation of glucose in muscle is reduced when mobilization of fatty acids is increased
because:
A) Utilization of fatty acid increases the cellular level of ATP, which decreases the activity of
hexokinase
B) Fatty acids compete with glucose for NAD+, which blocks formation of pyruvate
C) Fatty acids compete with glucose for transport across the cell membrane
D) Oxidation of fatty acids increases the formation of citrate, which blocks phosphofructokinase
E) Fatty acids inhibit the formation of pyruvate from lactate

Question #382: Mitosis is controlled at the _______________ checkpoint

A) G1
B) G0
C) M
D) S
E) G2

Page 84
Question #383: Refer the reaction shown below and select the appropriate statement related to the
reaction
Glucose---------X----------> Sorbitol-------Y--------> Fructose
A) The enzyme X requires NADH
B) The product of the enzyme X decreases in hyperglycemia
C) The enzyme X is aldose dehydrogenase
D) The absence of the enzyme Y may leads to cataract formation
E) The product of the enzyme Y is an aldohexose

Question #384: Which of the following decreases in length during the contraction of a skeletal muscle
fiber?
A) A band of the sarcomere
B) I band of the sarcomere
C) Thick filaments
D) Thin filaments
E) Z discs of the sarcomere

Question #385: Which Bcl2 proteins are considered anti-apoptotic?

A) Bcl2 & Bcl-XL
B) Bcl2 & Bax
C) Bcl-XL & Bak
D) Bax & Bak
E) Bid & Bad

Question #386: A healthy 26-year-old woman delivers a single chorion and placenta but two amniotic
sacs following a normal, full-term delivery. Which of the following is the most likely cause of these
findings?
A) Chorioamnionitis
B) Complete hydatidiform mole
C) Dizygotic twins
D) Monozygotic twins
E) Sheehan’s syndrome

Question #387: What is the usual receptor found at the parasympathetic end organ?
A) Cholinergic nicotinic
B) Muscarinic
C) Cholinergic alpha adrenergic
D) Beta adrenergic
E) Dopaminergic

Question #388: In the lactose operon, when glucose is the only sugar available, a protein that regulates
gene expression by binding to the operator region of the bacterial operon is called
A) An enhancer
B) A corepressor
C) A repressor
D) A promoter
E) An inducer

Page 85
Question #389: Glucose-mediated insulin release from pancreatic beta cells directly involves which of
the following actions?
A) Closing of potassium channels
B) Closing of calcium channels
C) Closing of magnesium channels
D) Opening of potassium channels
E) Opening of magnesium channels

Question #390: Alter(s) the equilibrium constant of the reaction

A) Nonregulatory enzyme
B) Regulatory enzyme
C) Both
D) Neither

Question #391: Of the following cell types, which would NOT be affected by inhibitors of transcription?
A) Cardiac muscle cells
B) Erythroblasts
C) Erythrocytes
D) Fibrocytes
E) Osteoclasts

Question #392: A 30-year-old woman comes to the physician for a routine health maintenance
examination. She takes no medications. Physical examination shows no abnormalities. Serum studies
show a calcium concentration of 12 mg/dL (Normal: 8.4-10.2 mg/dL). An increase in which of the
following substances is the most likely cause of the serum finding in this patient?
A) Bone morphogenic protein
B) Calcitonin
C) Integrins
D) Parathyroid hormone
E) Vitamin A

Question #393: Each of the following cells is innervated by sympathetic postganglionic nerve fibers
EXCEPT
A) brown adipocytes
B) cells of the sinoatrial node
C) enteric neurons
D) muscle of distributing arteries
E) striated muscle fo the esophagus

Question #394: Which of the following develops during the third week of embryo development?
A) Bilaminar embryonic disc
B) Syncytiotrophoblast
C) Blastocyst
D) Trilaminar embryonic disc
E) Hypoblast

Page 86
Question #395: ‘‘A four-year-old boy is brought to your clinic. The parents tell you that he shows
strange gait and clumsiness which only seems to happen when he has consumed foods containing
sugar. His mother had the same problem from an early age, and has avoided carbohydrate rich foods
all her life. On administration of a test meal with a high carbohydrate content, he is found to develop
mild lactic acidosis in addition to the ataxia previously described. The enzyme which is most likely to
be deficient in this individual is
A) Alpha-Ketoglutarate dehydrogenase complex
B) ATP synthase
C) Citrate synthase
D) Pyruvate dehydrogenase complex
E) Succinate dehydrogenase

Question #396: If you could selectively stimulate gamma motor neurons ONLY, in an otherwise intact
person, what effect would this have on the myotatic reflex?
A) Hyperreflexia
B) Hyporeflexia
C) Reflexes would be normal
D) Reflexes would not be observed because the muscle would be tonically contracted
E) Reflexes would not be observed because the muscle would be tonically relaxed

Question #397: After menopause, hormone replacement therapy with estrogen-like compounds is
effective in preventing the progression of osteoporosis. What is the mechanism of their protective
effect?
A) They stimulate the activity of osteoblasts
B) They increase absorption of calcium from the gastrointestinal tract
C) They stimulate calcium reabsorption by the renal tubules
D) They stimulate parathyroid hormone secretion by the parathyroid gland

Question #398: A 7-year-old girl comes to the dermatologist for the removal of a malignant melanoma.
Her face, legs, and arms are covered with freckles. She also suffers from severe persistent sunburns.
Which of the following is the most likely cause of these findings?
A) A defect in nucleotide excision repair
B) A defect in mismatch repair
C) A defect in proofreading enzymes
D) Exposure to ionizing radiation

Question #399: Which of the following muscle cell components helps spread the depolarization of the
muscle cell membranes throughout the interior of muscle cells?
A) Actin
B) Myosin
C) T tubule
D) Tropomyosin
E) Troponin
F) Z disk

Page 87
Question #400: A 22-year-old male construction worker is admitted to the hospital after he suffers a
penetrating injury to his upper limb from a nail gun. Upon physical examination the patient is unable
to flex the distal interphalangeal joints of digits 4 and 5. What is the most likely cause of his injury?
A) Trauma to the ulnar nerve near the trochlea
B) Trauma to the ulnar nerve at the wrist
C) Median nerve damage proximal to the pronator teres
D) Median never damage at the wrist
E) Trauma to spinal nerve root C8

Question #401: Select the correct statement regarding the characteristics of peptide bond
A) Occurs mostly in the cis configuration
B) Has double bond in between carbon and nitrogen atoms
C) The bond is unstable in the presence of weak acids
D) The bond is rigid and planar
E) The conventional reading of amino acid sequences in the C-terminal to N-terminal end.

Question #402: Which of the following is an example of a second messenger?

A) aldosterone
B) cAMP
C) G-protein
D) glucagon
E) JAK2 kinase
F) protein kinase A

Question #403: Cyclins inactivated by protein degradation during this phase?

A) Prophase
B) Prometaphase
C) Metaphase
D) Anaphase
E) Telophase

Question #404: A 34-year-old woman is brought into the ED following a car accident in which she hit a
patch of ice and slammed into the back of a trash truck. She is unable to walk because she has
intense pain in her left knee and hip. She thinks her knee hit the left side of the dashboard as she
twisted under the seat belt when she was thrown forward. She reports severe pain as the physician
moves her hip. A plain film of the leg up to the pelvis is ordered and it shows no broken bones, but
posterior displacement of the head of the femur out of the acetabulum. She is sedated in order to
forcefully relocate the femoral head back into the acetabulum. Despite successful relocation there is
concern that she has damaged which one of the following nerves, which may take several months to
regain function?
A) Obturator
B) Pudendal
C) Sciatic
D) Femoral
E) Superior gluteal

Page 88
Question #405: Which pair in the pedigree share the same mitochondrial DNA?
A) I-2 and III-1
B) II-2 and III-2
C) III-1 and III-2
D) II-2 and III-1
E) I-3 and II-6

Question #406: Consider the reaction coordinate diagram below where the vertical axis represents
energy, and the horizontal axis represents progress of the reaction. Which single labeled energy
value, can be used as a direct measure of the position of the equilibrium?
A) A
B) B
C) C
D) D
E) E

Page 89
Question #407: A 66-year-old man who lives alone has a severe myocardial infarction and dies during
the night. The medical examiner’s office is called the following morning and describes the man’s body
as being in rigor mortis. The state of rigor mortis is due to which one of the following?
A) Inhibition of Ca2+ leakage from the extracellular fluid and sarcoplasmic reticulum (SR)
B) Enhanced retrieval of calcium by the sarcoplasmic reticulum
C) Failure to disengage tropomyosin and troponin from the myosin active sites
D) Absence of ATP preventing detachment of the myosin heads from actin
E) Increased lactic acid production

Question #408: A 2-year-old girl is referred to a pediatric clinic for evaluation of lethargy, weakness,
and persistent anemia that has been unresponsive to treatment with iron, folic acid, and vitamins C
and B12. She is the third-born child of a healthy white couple; her mother had an uneventful
pregnancy and a eutopic delivery. Both brothers are healthy. On physical examination, she gives
evidence of low weight and height for age; marked pallor; flaccidity and lethargy; sleepiness. No focal
neurologic signs can be identified; lungs clear; heart sound with slight aortic systolic ejection murmur
(due to anemia); abdomen soft; no masses; no hepatomegaly; spleen barely palpable; no
lymphadenopathy. Complete blood count reveals megaloblastic anemia and elevated mean
corpuscular volume. Urinary analysis shows increased orotic acid excretion with formation of orotic
acid crystals. Which enzyme deficiency is likely to be responsible for this condition?
A) Hypoxanthine-guanine phosphoribosyl transferase
B) Orotate phosphoribosyl transferase
C) PRPP synthase
D) Thymidine kinase
E) Xanthine oxidase

Question #409: At what location does the amniotic cavity develop?

A) Between the cytotrophoblast and syncytiotrophoblast
B) Within the extraembryonic mesoderm
C) Between the endoderm and mesoderm
D) Within the hypoblast
E) Within the epiblast

Question #410: Which of the following amino acids has a side chain that can be involved in hydrogen
bond formation?
A) Alanine
B) Glycine
C) Histidine
D) Leucine

Question #411: Following several days of 12-hour daily rehearsals of the symphony orchestra for a
performance of a Wagnerian opera, the 52-year-old male conductor experienced such excruciating
pain in the posterior aspect of his right forearm that he could no longer direct the musicians. When
the maestro’s forearm was palpated 2 cm distal to, and posteromedial to, the lateral epicondyle, the
resulting excruciating pain caused the conductor to weep. Injections of steroids and rest were
recommended to ease the pain. Which of the following injuries is most likely?
A) Compression of the ulnar nerve by the flexor carpi ulnaris
B) Compression of the median nerve by the pronator teres
C) Compression of the median nerve by the flexor digitorum superficialis
D) Compression of the superficial radial nerve by the brachioradialis
E) Compression of the deep radial nerve by the supinator
Page 90
Question #412: ATPase
A) Actin
B) Heavy meromyosin
C) Light meromyosin
D) Tropomyosin
E) Troponin

Question #413: A 61-year-old man was hit by the cricket bat in the midhumeral region of his left arm.
Physical examination reveals an inability to extend the wrist and loss of sensation on a small area of
skin on the dorsum of the hand proximal to the first two fingers. What nerve supplies this specific
region of the hand?
A) Radial
B) Posterior interosseous
C) Lateral ante brachial cutaneous
D) Medial ante brachial cutaneous
E) Dorsal cutaneous of ulnar

Question #414: Paresthesia, hyperesthesia, or even painful sensation in the anterolateral region of the
thigh ay occur in obese persons. It results from an abdominal panniculus adiposis that bulges over
the inguinal ligament and compresses which one of the following underlying nerves?
A) Femoral branch of the genitofemoral nerve
B) Femoral nerve
C) Iliohypogastric nerve
D) Ilioinguinal nerve
E) Lateral femoral cutaneous nerve

Question #415: Select the CORRECT statement regarding protein structure:

A) The alpha-helix can be composed of more than one polypeptide chain
B) Secondary structure determines the amino acid sequence in the peptide chain
C) Domains are a type of secondary structure
D) Alpha-helix is rich in fibrous proteins
E) Beta sheet is stable during the heat treatment

Question #416: D-glucose and D-ribose are

A) aldoses
B) anomers
C) diasteromers
D) epimers
E) pyranoses

Question #417: Membrane potential trajectory if membrane permeability increases for potassium only
(Image on next page)
A) A
B) B
C) C
D) D
E) E

Page 91
Question #418: Which of the following is the MOST IMPORTANT component for maintenance of
blood-brain barrier integrity?
A) Astrocyte end-feet
B) Basal lamina
C) Endothelial tight junctions
D) Ependyma
E) Pia mater

Question #419: Which of the following best describes the stages of development following fertilization?
A) Bilaminar disc - trilaminar disc - morula - blastocyst
B) Blastocyst - morula - trilaminar disc - bilaminar disc
C) Morula - blastocyst - bilaminar disc - trilaminar disc
D) Trilaminar disc - bilaminar disc - blastocyst - morula
E) Blastocyst - morula - bilaminar disc - trilaminar disc

Question #420: Glycogen synthase, an enzyme involved in the biosynthesis of glycogen, may
A) Employ UDP-D-glucose as a glucosyl donor in both plants and animals
B) Be activated by the phosphorylation of a specific serine residue
C) Be activated by increased calcium levels
D) Be more specifically defined as UDP-glucose-glycogen glucosyl transferase
E) Synthesize glycogen without a polymer primer

Question #421: Whats the second messenger for muscarinic receptors?

A) IP3
B) cAMP
C) Both
D) Neither

Page 92
Question #422: A 23-year-old AUA medical student skipped his lunch and dinner due to his busy
working schedule. Which of the following enzymes is helping to maintain blood glucose level under
these conditions by releasing glucose from its storage form in the liver?
A) Acetyl co A carboxylase
B) Glucose 6 phosphate dehydrogenase
C) Glycogen phosphorylase
D) Glycogen synthase
E) Thiolase

Question #423: In oogenesis, which of the following events occurs immediately following the
completions of meiosis II?
A) Degeneration of the zona pellucida
B) Sperm penetration of the corona radiata
C) Formation of a female pronucleus
D) Appearance of the blastocyst
E) Completion of cleavage

Question #424: Which of the following best describes the tissue that gives rise to the vertebrae and
ribs?
A) Somatic mesoderm
B) Dermatome
C) Sclerotome
D) Splanchnic mesoderm
E) Myotome

Question #425: A 66-year-old man who lives alone has a severe myocardial infarction and dies during
the night. The medical examiner’s office is called the following morning and describes the man’s body as
being in rigor mortis. The state of rigor mortis is due to which one of the following?
A) Inhibition of Ca2+ leakage from the extracellular fluid and sarcoplasmic reticulum (SR)
B) Enhanced retrieval of calcium by the sarcoplasmic reticulum
C) Failure to disengage tropomyosin and troponin from the myosin active sites
D) Absence of ATP preventing detachment of the myosin heads from actin
E) Increased lactic acid production

Question #426: Which of the following is the origin of the mitochondrial DNA of all human adult cells?
A) Paternal only
B) Maternal only
C) A combination of paternal and maternal
D) Either paternal or maternal
E) Unknown origin

Question #427: Recall earlier lectures on macromolecules and the cell. For engagement of selectins,
which of the following is most likely to participate directly in the interaction?
A) Glycogen
B) Glycolipids
C) Integrins
D) Phosphatidylcholine
E) Pyruvate

Page 93
Question #428: A 23-year-old male basketball player is admitted to the hospital after injuring his
shoulder during a game. Physical and radiographic examinations reveal total separation of the
shoulder (Fig. 6-4). Which of the following structures has most likely been torn?
A) Glenohumeral ligament
B) Coracoacromial ligament
C) Tendon of long head of biceps brachii
D) Acromioclavicular ligament
E) Transverse scapular ligament

Page 94
Question #429: The epiblast is capable of forming which of the following germ layers?
A) Ectoderm only
B) Ectoderm and mesoderm only
C) Ectoderm and endoderm only
D) Ectoderm, mesoderm, endoderm
E) Mesoderm and endoderm only

Question #430: A 3-year-old girl with mild craniofacial dysmorphosis has profound hearing deficits.
Further evaluation indicates profound sensory auditory deficits and vestibular problems. Altered
development of which of the following is most likely to account for these observations?
A) Ectodermal placode
B) Intermediate mesoderm
C) Lateral plate mesoderm
D) Neural crest cell
E) Paraxial mesoderm
F) Prochordal mesoderm

Question #431: A 27-year-old male patient is admitted after eating Boletus mushrooms. He shows
profuse sweating, visual disturbances and irregular heart rate. Boletus contains the toxin muscarine
which is a competitive inhibitor of acetylcholine receptors in nerve cells. Under laboratory conditions
an in vitro neuron preparation has Km = 4.6 microM and Vmax = 2.0 nmol/mg/h for the
acetylcholine receptor in the absence of muscarine. In the presence of the Boletus toxin, the same
preparation would give apparent values closest to
A) A
B) B
C) C
D) D
E) E

Question #432: A patient with Bell palsy (paralysis of the facial (VII) nerve) experiences food collecting
in his oral vestibule. Paralysis of which of the following muscles would most likely cause this problem?
A) Buccinator
B) Masseter
C) Mentalis
D) Orbicularis oris
E) Zygomaticus major

Page 95
Question #433: To translate an mRNA requires two other types of RNA. These are:
A) tRNA and mRNA
B) tRNA and miRNA
C) tRNA and rRNA
D) rRNA and siRNA

Question #434: In the adult, produces the hepatocytes

A) Ectoderm
B) Endoderm
C) Mesoderm
D) Yolk sac
E) Neural crest

Question #435: A 15-year-old boy is brought to the emergency department because he has pain in his
hand following a fist fight. The physician tells the patient that he has broken his hand. Which of the
following is the most likely site of this patient’s fracture?
A) Distal radius
B) Hamate
C) Metacarpals
D) Phalanges
E) Scaphoid

Question #436: An infant receives an exchange blood transfusion due to severe neonatal jaundice. Red
blood cell transfusion is required monthly, and at 6 months of age, a splenectomy is performed.
Histologic examination of the spleen reveals marked hemosiderosis. Analysis of red cell glycolytic
intermediates indicates markedly elevated concentrations of 2,3-bisphosphoglycerate,
3-phosphoglycerate, 2-phosphoglycerate, and phosphoenolpyruvate. Which of the following is the
most likely diagnosis?
A) Glucose-6-phosphate dehydrogenase (G6PD)
B) Lead poisoning
C) Pyruvate kinase (PK) deficiency
D) Sickle cell anemia
E) Beta-Thalassemia

Question #437: After a forceps delivery of a male infant, the baby presents with his left upper limb
adducted, internally rotated, and flexed at the wrist. The startle reflex is absent on the ipsilateral side.
Which part of the brachial plexus was most likely injured during this delivery?
A) Lateral cord
B) Medial cord
C) Roots of the lower trunk
D) Root of the middle trunk
E) Roots of the upper trunk

Page 96
Question #438: A 45-year-old plumber presents in the clinic complaining of long standing pain in the
elbow. Subsequent examination reveals normal flexion/extension at both the elbow and the wrist, but
weakened abduction of the thumb and extension at the metacarpophalangeal joints of the finger.
Those symptoms are found to be caused by entrapment of the posterior interosseous nerve. Which
one of the following muscles could itself cause that entrapment?
A) Extensor carpi ulnaris
B) Extensor indices
C) Anconeus
D) Extensor digitorum
E) Supinator

Question #439: In humans, neuromuscular transmission in smooth muscle differs from that in skeletal
muscle in that:

1) There is closer apposition of nerve and muscle membranes in smooth muscle

2) The transmitter in smooth muscle may not be acetylcholine
3) Ca2+ is not required for neurotransmitter release from prejunctional terminals in smooth
muscle
4) Nerve stimulation may lead to relaxation of smooth muscle

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Question #440: A 22-year-old male football player suffered a wrist injury while falling with force on his
outstretched hand. When the anatomic snuffbox is exposed in surgery, an artery is visualized crossing
the fractured bone that pro- vides a floor for this space. What artery was visualized?
A) Ulnar
B) Radial
C) Anterior interosseous
D) Posterior interosseous
E) Deep palmar arch

Question #441: A 40-year-old man presents to the ED barely able to walk. He finds it painful to sit
down. He was water-skiing and was trying to learn to water ski backwards when his left ski caught the
water “wrong” and he fell. He has intense pain in the left gluteal region. Examining him in the prone
position, a ruling of the left hamstring muscles is noted with significant pain upon palpation of the
left ischial tuberosity. An avulsion of ht hamstring muscles from their origin on the ischial tuberosity
is suspected. Which three muscle origins most likely avulse a piece of bone form the ischial tuberosity
when his ski caught the water?
A) Adductor longus, adductor magnus, and biceps femoris
B) Adductor longus, adductor magnus, gracilis
C) Semitendinosus, semimembranosus, and adductor magnus
D) Semitendinosus, semimembranosus, and biceps femoris
E) Semitendinosus, semimembranosus, and gracilis

Page 97
Question #442: In the production of female gametes, which of the following cells can remain dormant
for 12 to 40 years?
A) Primordial germ cell
B) Primary oocyte
C) Secondary oocyte
D) First polar body
E) Second polar body

Question #443: In Non-Competitive inhibitors

A) Vmax increases
B) Km stays the same
C) Km increases
D) Vmax stays the same
E) Km decreases

Question #444: In the process of meiosis, DNA replication of each chromosome occurs, forming a
structure consisting of two sister chromatids attached to a single centromere. What is this structure?
A) A duplicated chromosome
B) Two chromosomes
C) A synapsed chromosome
D) A crossover chromosome
E) A homologous pair

Question #445: Which of the following is a universal characteristic of water-soluble organic

compounds?
A) They are composed of carbon and hydrogen atoms
B) They must contain a group that has a full negative charge
C) They must contain a group that has a full positive charge
D) They contain polar groups that can hydrogen bond with water
E) They contain aromatic groups

Question #446: Accumulation of citrate in vivo would

A) increase both glycolysis and fatty acid synthesis
B) decrease both glycolysis and fatty acid synthesis
C) decrease glycolysis and increase fatty acid synthesis
D) decrease the rate of both glycolysis and oxidation of fatty acids
E) do none of the above

Question #447: Following the ingestion of glyburide, a type 2 diabetic patient begins to experience
anxiety, diaphoresis, and hunger.. The patient subsequently ingests a health food bar containing
glucose. The glycolytic degradation of the ingested glucose commences with the action of which of
the following enzymes?
A) Aldolase
B) Hexokinase
C) Phosphofructokinase
D) Phosphoglucose isomerase
E) Pyruvate kinase

Page 98
Question #448: If a compound fracture of the humerus in the region marked Z on the accompanying
radiograph occurs, then there is likely to be a severe injury to a major nerve that passes on the dorsal
aspect of the bone. Which one of the following is most likely to occur as a result of such an injury?
A) Wrist-drop palsy
B) Total clawing of the hand
C) Waiter’s tip palsy
D) Clawing of digits 4 & 5
E) Dupuytren contracture

Question #449: A 67-year-old man presents with slurred speech, getting tired easily and feeling weak
especially in the evenings. On examination, the patient has ptosis and rapid muscle fatiguability on
repetitive movements, but normal tone and reflexes. Which of the following is the most likely site of
this man’s motor dysfunction?
A) Motor cortex
B) Muscle fibers
C) Neuromuscular junction
D) Peripheral nerve
E) Spinal cord

Page 99
Question #450: A 16-year-old girl presents on May 10 in obvious emotional distress. On questioning,
she relates that on May 1 she experienced sexual intercourse for the first time, without using any
means of birth control. Most of her anxiety stems from her fear of pregnancy. What should the
physician do to alleviate her fear?
A) Prescribe diazepam and wait to see if she misses her next menstrual period
B) Use ultrasonography to document pregnancy
C) Order a laboratory assay for serum hCG
D) Order a laboratory assay for serum progesterone
E) Prescribe diethylstilbestrol (“morning-after pill”)

Question #451: A needle correctly inserted for a lumbar puncture would penetrate each of the following
EXCEPT the
A) arachnoid mater
B) dura mater
C) interspinous ligament
D) ligamentum flavum
E) pia mater

Question #452: A patient experiences a prolonged stay in one position during a recent surgery and
postoperative recovery that results in compression of the common fibular (peroneal) nerve against the
fibular head. Which one of the following motor deficits would most likely occur?
A) Loss os extension at the knee
B) Loss of plantar flexion
C) Loss of flexion at the knee
D) Loss of eversion
E) Loss of medial rotation of the tibia

Question #453: Where in the lower motor neuron is the action potential generated?
A) Post-synaptic membrane
B) Axon hillock
C) Initial segment of the axon
D) First inter-nodal region of the axon
E) Dendritic membrane

Question #454: When a particular ligand binds to its receptor, there is an increase in the cleavage of
phosphatidylinositol biphosphate into inositol triphosphate and diacylglycerol. Both of these
substances have actions within the cell. Which of the following would be an example of a receptor that
functions in this manner?
A) Gamma-Aminobutyric acid receptor
B) Dopamine receptor
C) Insulin receptor
D) Muscarinic acetylcholine receptor
E) Serotonin receptor

Page 100
Question #455: A 48-year-old white female secretary presents with progressive difficulty typing over
the past month. She also notes that her hands begin to feel numb and weak after typing for long
period of time. On test, which of the following deficits would be predicted?
A) Difficulty in abducting the fifth finger
B) Difficulty in adducting the thumb
C) Difficulty in flexing digits two and three at the metacarpophalangeal joints
D) Loss of sensation over the lateral half of the palm
E) Loss of sensation over the medial half of the dorsum of the hand
F) Loss of sensation over the medial half of the palm
G) Loss of sensation over the lateral half of the dorsum of the hand

Question #456: Which of the following results from the action of parathyroid hormone (PTH) on the
renal tubule?
A) Inhibition of 1-alpha-hydroxylase
B) Stimulation of Ca2+ reabsorption in the distal tubule
C) Stimulation of phosphate reabsorption in the proximal tubule
D) Interaction with receptors on the luminal membrane of the proximal tubular cells
E) Decreased urinary excretion of cyclic adenosine monophosphate (cAMP)

Question #457: Concerning a 14 day old blastocyst, select the most appropriate structure in the
accompanying diagram which forms definitive structures found in the adult
A) A B) B C) C D) D E) E F) F G) G

Page 101
Question #458: Which of the following structures must degenerate for blastocyst implantation to occur?
A) Endometrium in progestational phase
B) Zona pellucida
C) Syncytiotrophoblast
D) Cytotrophoblast
E) Functional layer of the endometrium

Question #459: A 50-year-old patient is suffering from diabetes mellitus. This condition affects the
stimulation of which enzyme of the glycogenolysis regulation cascade:
A) Adenylate cyclase
B) cAMP dependent protein kinase
C) Glycogen synthase a
D) Active glycogen phosphorylase kinase a
E) Protein phosphatase 1

Question #460: Bone is a target tissue for

1) calcitonin
2) growth hormone
3) parathyroid hormone
4) testosterone

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Question #461: A 5-year-old boy has temporary weakness and cramping of skeletal muscle after
exercise. He has normal mental development. This child most likely has a deficiency of which of the
following enzymes.
A) alpha-1,4- Glucan transferase
B) Glycogen phosphorylase
C) Glycogen synthase
D) Phosphoglucomutase
E) UDP-glucose pyrophosphorylase

Question #462: Observation of a histologic preparation of muscle reveals cross striations and
peripherally located nuclei. The use of histochemistry shows a strong staining reaction for succinic
dehydrogenase. The same tissue prepared for electron microscopy shows many mitochondria in rows
between myofibrils and underneath the sarcolemma. Which one of the following is the best
description of this tissue?
A) White muscle fibers
B) Fibers that contract rapidly, but are incapable of sustaining continuous heavy work
C) Red muscle fibers
D) Cardiac muscle
E) Smooth muscle

Page 102
Question #463: Select the correct statement regarding the side chain properties of an amino acid
A) The amino acids with nonpolar side chains are involved in hydrogen bonding
B) The side chain of methionine consists of sulfhydryl groups
C) The amino acids aspartate and glutamate are proton donors at physiological pH
D) Glycine is an optically active amino acid
E) Proline has primary amino group in its structure

Question #464: A 27-year-old medical student is unable to eat lunch and dinner during her clinical
rotation. Which of the following enzymes is responsible for helping to maintain blood glucose levels
by releasing glucose from its storage form in the liver?
A) Acetyl-CoA carboylase
B) Glucose-6-phosphate dehydrogenase
C) Glycogen phosphorylase
D) Glycogen synthase
E) Thiolase

Question #465: In an enzyme that binds its substrate, acetate, through electrostatic interactions,
residues likely to be found within the active site include

1) glutamate
2) lysine
3) cysteine
4) arginine

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Question #466: A mixture of bacterial DNA solution was subjected to spectroscopic studies and was
found to consist of 29% of thymine base. What approximate percentage of the bases should be
purines?
A) 19%
B) 38%
C) 50%
D) 58%
E) 31%

Question #467: Which of the following findings best supports the idea that DNA is the genetic material?
A) DNA has transforming activity
B) DNA in chromosomes contains two complementary chains
C) DNA is present in the nuclei of all eukaryotic cells
D) RNA synthesis requires a DNA template
E) Viruses contain DNA

Page 103
Question #468: In a surgical opening of the ankle joint from the lateral side, structures passing behind
the lateral malleolus that should be preserved include the

1) tendon of the peroneus longus

2) great saphenous vein
3) tendon of the peroneus brevis
4) tendon of the peroneus tertius

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Question #469: The human papillomavirus promotes neoplasia through production of the viral proteins
E6 and E7, which interfere with the normal function of Rb and p53. What general function is common
to both Rb and p53?
A) Cell cycle regulation
B) Cellular adhesion
C) Direct transcriptional control
D) DNA repair
E) Inhibition of signal transduction

Question #470: The collagenous protein in bone subserves which of the following functions?
A) Growth factor
B) Binding of ionic calcium and physiologic hydroxyapatite
C) Formation of the three-dimensional lattice of the matrix
D) Cell attachment
E) Binding of mineral components to the matrix

Question #471: In the laboratory, you are preparing for microscopy of tissue samples taken from a
patient’s testis where a lipid hormone was actively being made. Which of the following in the cytosol would you
expect to be present in large amounts to aid in the synthesis of this hormone?
A) Free ribosomes
B) Lysosome
C) Proteasome
D) Rough endoplasmic reticulum
E) Smooth endoplasmic reticulum

Question #472: Damage to the radial nerve in the spiral groove causes
A) numbness over the medial side of the forearm
B) inability to oppose the thumb
C) weakness in pronating the forearm
D) weakness in abducting the arm
E) wrist drop

Page 104
Question #473: A25-year-old woman comes into your office complaining of “spotting” and having
“stomach pains” as she points to her lower abdominal area. She noted that she and her husband were
trying to have a baby and that she had her last period about 5 weeks ago. She said that after talking
with her girlfriends about her symptoms, she was a little afraid of what it could be, and so she
decided to see a physician. Her chart shows that she has had a history of pelvic inflammatory disease.
Relevant physical exam findings include a tender pelvic mass that was palpable, amenorrhea, light
vaginal bleeding, and lower abdominal pain. Relevant laboratory findings include elevated β-human
chorionic gonadotropin (hCG) levels but lower than expected for pregnancy, lower-than-normal
progesterone levels, and ultrasound that showed a mass in the ampulla of the left uterine tube. Which
of the following is the most likely diagnosis?
A) Choriocarcinoma
B) A bleeding corpus luteum
C) A spontaneous abortion
D) Ectopic tubal pregnancy
E) Appendicitis

Question #474: Two weeks into Jane's pregnancy , results indicates that she has extremely low HCG
levels. Which one of the following can explain this finding.
A) Multiple pregnancy
B) Hydatidiform mole
C) Choriocarcinoma
D) Ectopic pregnancy

Question #475: The enzyme ribonucleotide reductase is capable of directing synthesis to several
different products to maintain a balanced supply of nucleotides. This capability is due to
A) A catalytic activity site
B) Changes in gene expression
C) Feedback inhibition
D) Product inhibition
E) A substrate specificity site

Question #476: During a routine physical examination the physician notes an absent biceps tendon
reflex. Which spinal nerve root value is associated with this reflex?
A) C4-C5
B) C5-C6
C) C6-C7
D) C7-C8
E) C8-T1

Question #477: Of the following, the first to be affected by an increase in cyclic AMP concentrations in
the liver would be
A) stimulation of adenylate cyclase
B) conversion of phosphorylase b (inactive) to phosphorylase a (active)
C) conversion of glycogen synthetase I (inactive) to glycogen synthetase D
D) phosphorylation of phosphorylase b kinase
E) activation of protein kinase

Page 105
Question #478: Gout is an inborn errors of purine catabolism caused by increased plasma level of uric
acid. Which of the following is an intermediate of uric acid formation?
A) Carbamoyl phosphate
B) Orotate
C) Hypoxanthine
D) Ribose 1-Phosphate
E) Allopurinol

Question #479: A 49-year-old woman comes to the physician because of a 3-month history of waking
at night because of pain and numbness of her right hand. She reports that shaking her hand
decreases the severity of the pain. She has been cutting hair at a beauty salon 6 days weekly for 35
years. Examination of the right hand shows tenderness with palpation and distal tingling on
percussion of the volar wrist. Prolonged forcible palmar flexion of the right wrist produces tingling.
Which of the following is the most likely diagnosis?
A) Carpal tunnel syndrome
B) Early rheumatoid arthritis
C) Osteoarthritis
D) Stress fracture
E) Tendinitis

Question #480: Which one of the following events would usually NOT occur after the release of
norepinephrine from a postganglionic neuron. Norepinephrine:
A) Can undergo reuptake presynaptically
B) Can be biodegraded chemically
C) Binds to an appropriate adrenoceptor
D) Can stimulate presynaptic autoreceptors
E) Interferes with the binding of co-released neurotransmitters

Question #481: Which of the following is true of the ETC?

A) It occurs in the outer mitochondria membrane
B) It is activated by Glucagon to produce energy
C) Activated by AMP
D) Activated by ATP
E) Activated NADH

Question #482: Which fo the following best describes the cell type most active in bony callus formation
following a fracture?
A) Chondrocytes
B) Osteoblasts
C) CHondroblasts
D) Osteocytes
E) Osteoclasts

Question #483: The first indication of gastrulation in the embryo is

A) formation of the primitive streak
B) formation of the notochord
C) formation of the neural tube
D) formation of extraembryonic mesoderm
E) formation of tertiary chorionic villi

Page 106
Question #484: A patient presents to the emergency department with a crushing injury to her right
ankle. A medical student working there is told to evaluate the vascular integrity of the patient’s right
lower extremity. She feels for femoral, dorsalis pedis, and posterior tibial pulses and finds that they
are intact and symmetric bilaterally. In which of the following locations did the student palpate the
posterior tibial pulse?
A) Between the two heads of the gastrocnemius muscle
B) Deep in the popliteal fossa
C) Immediately anterior to the medial malleolus
D) Immediately posterior to the lateral malleolus
E) Immediately posterior to the medial malleolus
F) On the dorsal surface of the foot

Question #485: A young woman is doing intense aerobic exercise. Aerobic glycolysis is being used for
the source of energy for the muscle activity. In which of the following forms will the carbons derived
from glucose enter the citric acid cycle?
A) Acetyl-CoA
B) Citrate
C) Oxaloacetate
D) Pyruvate
E) Succinate

Question #486: A 72-year-old woman is admitted to the emergency department after an episode of
stroke. During neurologic examination the patient shows no response to the ankle reflex test. Which
of the following nerve roots is responsible for this reflex?
A) L2
B) L3
C) L4
D) L5
E) S1

Question #487: ON the way to the bathroom you stub your unprotected great toe in the stone mantle of
your fireplace. Which of the following reflexes most likely accounts for your response to this trauma?
A) Antigravity
B) Flexion/crossed extension
C) Reciprocal Inhibitory
D) Reverse Myotatic
E) Muscle stretch

Question #488: In the graph shown, (A) represents the normal action potential of an axon recorded with
intracellular microelectrodes; the electrical stimulus is indicated by the arrow. (Image on next page)

The recording that would be expected if an agent is added that reduces a change in the permeability
of the membrane to K+ would be
A) A
B) B
C) C
D) D
E) E

Page 107
Question #489: Innervation of the gracilis muscle
A) Femoral nerve
B) Obturator nerve
C) Both
D) Neither

Question #490: A transgenic mouse has been produced which has a mutation in the gene for
phosphofructokinase2 /Fructose bisphosphatase 2 that makes this enzyme incapable of
phosphorylation at its regulatory site. Which of the following effects would you most expect to see in
this mouse?
A) exercise intolerance
B) fasting hyperglycemia
C) fasting hypoglycemia
D) obesity
E) postprandial hyperglycemia
F) postprandial hypoglycemia

Question #491: Spermatogenesis, the process of forming spermatozoa, occurs in the seminiferous
tubules. As the cells proceed through the different stages of spermatogenesis, they contain varying
numbers of chromosomes and varying amounts of DNA. Spermiogenesis describes a particular stage
of spermatogenesis. When the cells are going through spermiogenesis, which of the following is the
amount of DNA and the number of chromosomes that exist in those cells?
A) 23, 1N
B) 23, 2N
C) 46, 1N
D) 46, 2N
E) 46, 4N
Page 108
Question #492: An experimental drug is being tested as a potential therapeutic treatment for asthma.
Preclinical studies have shown that this drug induces the relaxation of cultured porcine tracheal
smooth muscle cells pre-contracted with acetylcholine. Which of the following mechanisms of action
is most likely to induce this effect?
A) Decreased affinity of troponin C for Ca++
B) Decreased plasma membrane K+ permeability
C) Increased plasma membrane Na+ permeability
D) Inhibition of the sarcoplasmic reticulum Ca++-ATPase
E) Stimulation of adenylate cyclase

Question #493: Which of the following muscles is not part of the rotator cuff group?
A) Tere minor
B) Supraspinatus
C) Infraspinatus
D) Teres major
E) Subscapularis

Question #494: Enzyme reactions involving carboxylation

A) Biotin
B) Cyanocobalamin (vitamin B12)
C) Pyridoxine (vitamin B6)
D) Riboflavin (vitamin B2)
E) Thiamine (vitamin B1)

Question #495: The enzyme aldolase, if inhibited, causes a build-up of a metabolite which activates
pyruvate kinase. Aldolase is responsible for which of the following transformations?
A) fructose 1,6BP - glyceraldehyde 3-P + dihydroxyacetone-P
B) fructose 6-P + ATP - fructose 1,6-BP
C) glucose 6-P - fructose 6-P
D) glucose + ATP - glucose 6-P + ADP
E) glyceraldehyde 3-P + NAD+ Pi - 1,3-bisphosphoglycerate + NADH

Question #496: Characteristics of DNA replication include:

1) There is a different mechanism for the synthesis of each strand

2) It proceeds in a 3’ -> 5’ direction
3) A primer is required
4) There is conservative synthesis

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Page 109
Question #497: Which of the following events is usually associated with necrosis?
A) Nuclear lamina proteolysis
B) Membrane blebbing
C) Rapid lysis of the cell membrane followed by an inflammatory response
D) Cleavage and fragmenting of DNA by nucleases
E) Engulfment of the apoptotic cell body by macrophages

Question #498: The major afferent fiber type responsible for eliciting the myotatic reflex is:
A) Ia fibers
B) Ib fibers
C) II fibers
D) gamma motor neurons
E) alpha motor neurons

Question #499: Examination of a 21-year-old female athlete with an injury of the radial nerve in the
spiral groove would typically demonstrate which of the following physical signs?
A) Weakness of thumb abduction and thumb extension
B) Weakness of thumb opposition
C) Inability to extend the elbow
D) Paralysis of pronation of the hand
E) Paralysis of abduction and adduction of the arm

Question #500: While walking to his classroom building, a first-year medical student slipped on the wet
pavement and fell against the curb, injuring his right arm. Radiographic images showed a midshaft
fracture of the humerus. Which pair of structures was most likely injured at the fracture site?
A) Median nerve and brachial artery
B) Axillary nerve and posterior humeral circumflex artery
C) Radial nerve and deep brachial artery
D) Suprascapular nerve and artery
E) Long thoracic nerve and lateral thoracic artery

Question #501: The force produced by a single skeletal muscle fiber can be increased by which of the
following?
A) Decreasing extracellular K+ concentration
B) Increasing the amplitude of the depolarizing stimulus
C) Increasing the frequency of stimulation of the fiber
D) Increasing the number of voltage-gated Na+ channels in the sarcolemma
E) Increasing the permeability of the sarcolemma to K+

Question #502: A patient was diagnosed with a deficiency of the lysosomal enzyme alpha-glycosidase.
The name of the deficient enzyme suggests that it hydrolyzes a glycosidic bond, which is best
described as a bond formed via which of the following?
A) Through multiple hydrogen bonds between two sugar molecules
B) Between the anomeric carbon of a sugar and an O—H (or N) of another molecule
C) Between two anomeric carbons in polysaccharides
D) Internal bond formation between the anomeric carbon of a monosaccharide and its own fifth
carbon hydroxyl group
E) Between the carbon containing the aldol or keto group and the alpha-carbon of the sugar

Page 110
Question #503: The lower motor neurons of the pons are found in which groups of nuclei?
A) V, VI, and VII
B) VI, X, and N. Ambiguus
C) XII, N. Ambiguus, and VII
D) III, IV, and VI
E) V only

Question #504: Concerning a 14 day old blastocyst, select the most appropriate structure in the
accompanying diagram which is the primary chorionic villi
A) A B) B C) C D) D E) E F) F G) G

Question #505: A 32-year-old pregnant woman with a history of deep venous thrombosis associated
with oral contraceptive use is seen for her first prenatal visit. Her mother also had an episode of deep
vein thrombosis during pregnancy. DNA from the woman is tested for a potential mutation in the
factor V gene known to cause this condition. The DNA sequence to be amplified by PCR is shown
below. The dashed line indicates the internal sequence where the potential mutation is located. Which
answer choice represents the pair of primers that should be used in the PCR? TCCTGAGC ——————
AAATGTGT
A) AGGACTCG and TTTACACA
B) GCTCAGGA and AAATGTGT
C) GCTCAGGA and ACACATTT
D) TCCTGAGC and ACACATTT
E) TCCTGAGC and TTTACACA

Page 111
Question #506: In the branched-chain metabolic pathway in which a different single enzyme catalyzes
each of the individual steps, the enzyme that would be expected to be most severely inhibited by
compound V is enzyme
A) A
B) B
C) C
D) D
E) E

Question #507: A 27-year-old woman falls from her horse, sustaining a mid-shaft fracture of both her
forearm bones. Her arm is placed in a cast for 6 weeks and after removal, she is referred for physical
therapy. She is asked to open a lock with a key but experiences difficulty. Which of the following
movements is responsible for opening and locking a lock?
A) Flexion and extension of elbow
B) Supination and pronation of forearm
C) Flexion and extension of wrist
D) Abduction and adduction of wrist
E) Medial and lateral rotation of shoulder

Question #508: What is the principle method of inactivation of catecholamines released from nerve
terminals in the CNS?
A) Enzymatic hydrolysis
B) Postsynaptic uptake
C) Presynaptic reuptake
D) Uptake by astrocytes
E) Vascular washout for catabolism by the liver

Page 112
Question #509: A 72-year-old woman trips over the edge of the carpet and falls forward onto the floor.
A common reflex reaction to ripping and falling forward is to extend ones hands to ease the impact of
stoking the floor. She presents to the ER holding her left arm with her right hand. There is an obvious
posterior displacement of the left distal wrist and hand that looks like a dinner fork. Which bone(s)
is/are likely involved in a classic Colles fracture?
A) Always the ulna and sometimes the radius
B) Always the radius and sometimes the ulna
C) Always the ulan and sometimes the scaphoid
D) Always the radius and sometimes the trapezium
E) Only the ulna

Question #510: A pathologist is examining microscope slides of a skin biopsy from a patient with
malignant melanoma. The pathologist notes in the microscopic description of the report that almost
all of the melanoma cells have very large, visible nucleoli. This finding specifically suggests that these
cells are making large amounts of which of the following?
A) Cell surface markers
B) Golgi apparatus
C) Immunoglobulins
D) New DNA
E) Ribosomes

Question #511: A 42-year-old male is bitten superficially on his posterior thigh by a dog. The
superficial wound is sutured in the emergency department. Four days later the patient returns to the
hospital with high fever and swollen lymph nodes. Which group of nodes will first receive lymph from
the infected wound?
A) External iliac
B) Vertical group of superficial inguinal
C) Deep inguinal
D) Horizontal group of superficial inguinal
E) Internal iliac

Question #512: A lethal mutation occurs in a bacterium, rendering it incapable of replicating its
chromosome. Because of this mutation, DNA synthesis produces many short fragments of DNA that
have RNA sequences at their 5’ ends. The mutation is most likely in a gene encoding which of the following?
A) DNA gyrase
B) DNA helicase
C) DNA ligase
D) DNA polymerase I
E) Primase

Question #513: A patient develops a form of lung cancer that spreads to occlude the thoracic duct.
Edema involving which of the following sites might be expected as a potential complication?
A) Entire left side and right leg
B) Entire right side and left leg
C) Left arm only
D) Right arm and right half of head only
E) Right arm only

Page 113
Question #514: An otherwise healthy infant boy born via vaginal delivery has an abnormal appearance
of his right upper limb. His arm hangs by his side, pronated and medially rotated. Which of the
following muscles is still functioning in this patient?
A) Biceps
B) Deltoid
C) Infraspinatus
D) Supraspinatus
E) Triceps

Question #515: Constituents of normal plasma membrane include

1) phospholipids
2) proteins
3) glycolipids
4) cholesterol

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Question #516: Which of the following characterize alpha-helix regions of proteins?

A) They all have the same primary structure
B) They are formed principally by hydrogen bonds between a carbonyl oxygen atom in one peptide
bond and the amide hydrogen from a different peptide bond
C) They are formed principally by hydrogen bonds between a carbonyl atom in one peptide bond and
the hydrogen atoms on the side chain of another amino acid
D) They are formed by hydrogen bonding between two adjacent amino acids in the primary sequence
E) They require a high content of proline and glycine

Question #517: A 25-year-old butcher has had severe episodic pain in his right thumb and right
second and third digits for 2 months. The pain frequently awakens him from sleep. He has decreased
sensation over the palmar surface of the thumb and index and long fingers of the right hand and
atrophy of the thenar muscle mass. Compression of which of the following nerves is the most likely
cause?
A) Median
B) Musculocutaneous
C) Posterior interosseous
D) Radial
E) Ulnar

Question #518: The genetic code is said to be “degenerate” because:

A) there are more codons than amino acids
B) there are more amino acids than codons
C) different organisms use different codons to encode the same amino acid
D) some codons specify more than one amino acid

Page 114
Question #519: Approximately how many sperm will be ejaculated by a normal fertile male during
sexual intercourse?
A) 10 million
B) 20 million
C) 35 million
D) 100 million
E) 350 million

Question #520: Which of the following events does not occur during the first week of development?
A) Blastocyst formation
B) Implantation
C) Gastrulation
D) Cleavage of the zygote
E) Fertilization

Question #521: The sequence of amino acids at the amino terminal part of secretory proteins as first
synthesized serves to
A) enhance enzymatic activity
B) protect against proteolytic digestion
C) facilitate passage through membranes
D) speed transport through the ducts of glands
E) receive the addition of glucose in the Golgi complex

Question #522: At an enzyme active site, the amino acid most likely to be affected by changes in pH
between 5 and 7 is
A) arginine
B) asparagine
C) glutamine
D) histidine
E) lysine

Question #523: Attributes of allosteric effectors include

1) activation of enzymatic activity

2) inactivation of enzymatic activity
3) alteration of the apparent Km for substrate
4) competition with substrate for binding at the active site

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Page 115
Question #524: If the cytosolic concentration of malonyl CoA decreases, which of the following will
happen as a result of this change?
A) activity of lipoprotein lipase decreases
B) activity of lipoprotein lipase increases
C) beta-oxidation of fatty acids increases
D) fatty acid synthesis increases
E) transport of fatty acids out of mitochondria increases
F) transport of fatty acids out of mitochondria decreases

Question #525: Release of acetylcholine at the neuromuscular junction is dependent upon the influx of
which of the following ions to permit binding of synaptic vesicles to the pre-synaptic membrane?
A) Chloride
B) Calcium
C) Sodium
D) Potassium
E) Magnesium

Question #526: Which of the following individuals developed the MOST WIDELY used cerebral
cytoarchitectonic map?
A) Rexed
B) Broca
C) Geschwind
D) Brodmann
E) Gall

Question #527: A 47-year-old female tennis professional is in- formed by her physician that she has a
rotator cuff in- jury that will require surgery. Her physician explains that over the years of play a
shoulder ligament has gradually caused severe damage to the underlying muscle. To which of the
following ligaments is the physician most likely referring?
A) Acromioclavicular ligament
B) Coracohumeral ligament
C) Transverse scapular ligament
D) Glenohumeral ligament
E) Coracoacromial ligament

Question #528: In your laboratory you are studying a particular mutation which is thought to occur in a
region which is responsible for regulation of a specific gene's expression. You wish to examine the
level of activity of the gene by detecting the product of the transcription process in cultured
fibroblasts. The most common technique for making these measurements is
A) enzyme-linked immunosorbent assay (ELISA)
B) gas chromatography (GC)
C) Northern blot
D) polymerase chain reaction (PCR)
E) Southern blot
F) Western blot

Page 116
Question #529: A patient with a nerve injury to the gluteal region has difficulty rising from the seated
position and straightening his trunk, but he has no difficulty flexing his leg. This nerve injury affects
the
A) gluteus maximus muscle
B) gluteus minimus muscle
C) hamstring muscles
D) iliopsoas muscle
E) obturator interns muscle

Question #530: Glucokinase catalyzes the transfer of the γ – phosphate of ATP to glucose. What is the
ΔG°` of the reaction if the ΔG°` of ATP hydrolysis is -30.5 kJ/mol, and the ΔG°` of adding phosphate
to glucose is +14 kJ/mol
A) +16.5 kJ/mol
B) +44.5 kJ/mol
C) -16.5 kJ/mol
D) -44.5 kJ/mol
E) Approximately 2 kJ/mol

Question #531: The graph illustrates the effects of tetraethylamonium (TEA) on the action potential of
an axon. The most likely action of TEA is to
A) open K+ gates, causing membrane permeability to K+ to increase during the action potential
B) block K+ gates, preventing membrane permeability to K+ from increasing during the action
potential
C) open Na+ gates, causing membrane permeability to Na+ to increase
D) block the Na+/K+ active pump during the action potential
E) close Na+ gates, preventing membrane permeability to Na+ from increasing during the action
potential

Page 117
Question #532: A 35-year-old man attends your clinic for regular health checkup. He is sedentary in
his habits, a non-smoker and is 2.0 m in height. He weighs 132 kg. Based on his BMI, he would be
classified as
A) borderline obese
B) underweight
C) overweight
D) class III obese
E) obese

Question #533: A 34-year-old woman presents to her physician complaining of oral ulcers. A careful
history reveals that she is a strict vegetarian and does not eat meat, fish, poultry, eggs, or dairy
products. She is found to have a severe riboflavin deficiency. The function of which of the following
enzymes in the citric acid cycle would be most directly affected by the riboflavin deficiency?
A) Aconitase
B) Citrate synthase
C) Isocitrate dehydrogenase
D) Malate dehydrogenase
E) Succinate dehydrogenase

Question #534: A 25-year-old man, an intravenous drug abuser, had been injecting himself with
temazepam (a powerful intermediate-acting drug in the same group as Valium) and heroin for 5
years, leaving much residual scar tissue over points of vascular access. The patient is admitted to the
emergency department for a detoxification program requiring an intravenous infusion. The femoral
veins in his groin are the only accessible and patent veins for intravenous use. Which of the following
landmarks is the most reliable to identify the femoral veins?
A) The femoral vein lies medial to the femoral artery
B) The femoral vein lies within the femoral canal
C) The femoral vein lies lateral to the femoral artery
D) The femoral vein lies directly medial to the femoral nerve
E) The femoral vein lies lateral to the femoral nerve

Question #535: Constituents of the thin filaments of a relaxed skeletal muscle cell include

1) actin
2) tropomyosin
3) troponin
4) S1 fragments of myosin (heavy meromyosin)

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Question #536: Which of the following pairs of hormones and the corresponding action is incorrect?
A) Glucagon—increased glycogenolysis in liver
B) Glucagon—increased glycogenolysis in skeletal muscle
C) Glucagon—increased gluconeogenesis
D) Cortisol—increased gluconeogenesis
E) Cortisol—decreased glucose uptake in muscle

Page 118
Question #537: A screening study done on a couple indicates that the husband is affected with an
autosomal recessive disease. Although his wife is unaffected, her (wife’s) mother is found to be
affected with the same genetic disease. The couple wants to know about their chance of having child
with a mutant gene/s for this disease. What is the probability?
A) 0%
B) 25%
C) 50%
D) 100%

Question #538: During gel electrophoresis, large DNA fragments will ___________small DNA fragments.
A) migrate more rapidly than
B) migrate at the same speed as
C) migrate more slowly than
D) cause degradation of
E) separate into

Question #539: The release of epinephrine from the chromaffin granules of the adrenal medulla into
the bloodstream in response to neural stimulation is mediated by which of the following?
A) Acetylcholine
B) Gamma-Aminobutyric acid (GABA)
C) Cortisol
D) Dopamine
E) Serotonin

Question #540: The regulation of translation in eukaryotes can be accomplished through reversible
phosphorylation of
A) EF-2
B) eIF-2
C) eRF-1
D) eRF-2
E) eIF-5

Question #541: Individual blastomeres were isolated from a blastula at the 4-cell stage. Each
blastomere was cultured in vitro to the blastocyst stage and individually implanted into four
pseudopregnant foster mothers. Which of the following would you expect to observe 9 months later?
A) Birth of one baby
B) Birth of four genetically different babies
C) Birth of four genetically identical babies
D) Birth of four grotesquely deformed babies
E) No births

Question #542: A 15-year-old girl was brought to the emergency department with a tear of the
tendons in the first dorsal compartment of the wrist from a severe bite by a pit bull dog. The injured
tendons in this compartment would include which of the following muscles?
A) Extensor carpi radialis longus and brevis
B) Abductor pollicis longus and extensor pollicis brevis
C) Extensor digitorum
D) Extensor indicis proprius
E) Extensor carpi ulnaris

Page 119
Question #543: A 60-year-old man has tenderness in the region distally between the tendons of the
extensor pollicis longus and extensor pollicis brevis (anatomical snuffbox) after falling on the palm of
his right hand. A fracture of which of the following carpal bones is most likely in this patient?
A) Hamate
B) Lunate
C) Scaphoid
D) Trapezium
E) Triquetrum

Question #544: In order to determine the rate of DNA synthesis in various mammalian tissues, the
administration of which of the following labeled substances would be most specific in labeling DNA?
A) Adenosine
B) Cytosine
C) Guanosine
D) Thymidine
E) Uridine

Question #545: Intermediate mesoderm will give rise to the

A) neural tube
B) heart
C) kidneys and gonads
D) somites
E) notochord

Question #546: Refer the reaction given below and respond to the statements

Fructose-I-Phosphate --> Glyceraldehyde + Dihydroxyacetone Phosphate

A) The product dihydrocyacetone phosphate is an aldose sugar

B) The reaction is catalysed by aldolase A
C) The deficiency of the enzyme system in the reaction causes to essential fructosuria
D) The reaction bypasses the PFK-1 step of glycolysis
E) Feeding more of fructose rich diet is the treatment for the clinical condition caused by the
deficiency of the enzyme for the reaction

Question #547: The resting potential of a myelinated nerve fiber is primarily dependent on the
concentration gradient of which of the following ions?
A) Ca++
B) Cl-
C) HCO3-
D) K+
E) Na+

Question #548: Which one of the following statements regarding glycogen metabolism is true?
A) Glycogenin acts as a primer in the formation of glycogen molecule
B) Glycogen synthase is active in the phosphorylated form
C) Oligo alpha [1-4] -> alpha [1-4] glucan transferase is a branching enzyme in glycogenesis
D) Insulin inhibits protein phosphatase and activate glycogenolysis
E) Muscle glycogenolysis regulates the blood glucose level

Page 120
Question #549: Concerning a 14 day old blastocyst, select the most appropriate structure in the
accompanying diagram which is the chorion
A) A B) B C) C D) D E) E F) F G) G

Question #550: Calmodulin is most closely related, both structurally and functionally, to which of the
following proteins?
A) G-actin
B) Myosin light chain
C) Tropomyosin
D) Troponin C

Question #551: A 32-year-old man presents with abnormal phenotypic manifestation of Marfan
syndrome, an autosomal dominant genetic disorder. With an unaffected female partner, what is the
chance for him to have a normal child?
A) 0%
B) 25%
C) 50%
D) 75%
E) 100%

Page 121
Question #552: When NADH electrons need to be translocated into the mitochondrion for oxidative
phosphorylation, there are two possible shuttles, the glycerol phosphate shuttle and the
malate-aspartate shuttle. In comparing the two shuttles’ efficiency and the reason for the difference,
we find that the glycerol phosphate shuttle is
A) less efficient, electrons pass into FADH2
B) less efficient, electrons pass into NADH
C) less efficient, electrons pass into phosphate
D) more efficient, electrons pass into FADH2
E) more efficient electrons pass into NADH
F) more efficient, electrons pass into phosphate

Question #553: An infant born to an alcoholic mother had microcephaly and cardiac abnormalities and
died despite resuscitative efforts. During which of the following periods of pregnancy is alcohol most
teratogenic?
A) First 2 weeks
B) Third through ninth weeks
C) Ninth through twelfth weeks
D) Twelfth through sixteenth weeks
E) Sixteenth through twentieth weeks

Question #554: Synthesis of ATP in the mitochondria

1) involves expulsion of protons coupled to electron transport

2) is carried out by an ATPase specifically oriented in the membrane
3) is inhibited by antimycin
4) accounts for most of the O2 consumption in humans

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Question #555: PCR is used for

A) digesting proteins
B) digesting DNA
C) copying plasmids
D) amplifying DNA
E) amplifying proteins

Question #556: A 25-year-old male medical student presents in the health clinic complaining of a
painful, rigid muscle. Which of the conditions described in the table is most likely to be found in a
rigid muscle? (Image on next page)
A) Condition A
B) Condition B
C) Condition C
D) Condition D
E) Condition E

Page 122
Question #557: 20-year-old medical student met an accident and suffered from multiple injuries all
over the body with the bone fracture. Your surgeon colleague prefers to supplement patients with
ascorbic acid after surgery. The doctor trying to optimize which one of the following process?
A) The formation of desmosine in collagen
B) The formation of hydroxylysines in elastin
C) The hydroxylation of proline in tropocollagen
D) The cleavage of pro-peptides from pro-collagen
E) The addition of galactose to lysine in elastin

Question #558: A 36-year-old man is brought to the emergency department because of a deep knife
wound on the me- dial side of his distal forearm. He is unable to hold a piece of paper between his
fingers and has sensory loss on the medial side of his hand and little finger. Which nerve is most
likely injured?
A) Axillary
B) Median
C) Musculocutaneous
D) Radial
E) Ulnar

Question #559: Many metabolic reactions involve the transfer of electrons. Which of the following
statements concerning electron transfer is TRUE?
A) NADH reducing equivalents are used mainly in biosynthetic reactions.
B) A flavoprotein is an intermediate electron transport chain carrier between NADH and ubiquinone.
C) Both of the "high energy" phosphate linkages of ATP are added during oxidative phosphorylation.
D) NADPH is used as the primary electron carrier in electron transport.
E) Cyanide blocks the transfer of electrons from NADH to ubiquinone.

Page 123
Question #560: Nicotinic receptors are mainly found in or on:
A) Postganglionic sympathetic terminals
B) Smooth muscle of hollow viscera
C) Adrenal medulla
D) Postganglionic parasympathetic terminals
E) Sweat glands

Question #561: At the end of each phase of the cell cycle cyclins activating Cdks in that phase are
inactivated irreversibly by which of the following mechanisms?
A) Ubiquitinylation
B) Destruction by proteolysis in a proteasome
C) Dephosphorylation
D) Multiple phosphorylations

Question #562: Congenital absence of the parathyroids is most likely to be accompanied by absence or
poor development of the
A) lungs
B) anterior portion of the pituitary gland
C) thyroid gland
D) nasopharyngeal portions of the eustachian tubes
E) thymus

Question #563: Select the correct statement regarding the structure of glycoproteins
A) The length of the carbohydrate chain is longer than proteoglycans
B) The glycoprotein carbohydrate chains are often branched
C) They are mainly made up of repeating disaccharide units
D) Oligosaccharide attached to the protein by hydrophobic bond
E) Pentoses are the main carbohydrate units present in the structure

Question #564: Intramembranous ossification differs from endochondral ossification in which one of
the following ways?
A) Action of osteoblasts
B) Light microscopic appearance of the adult bone
C) Ultrastructural appearance of the adult bone
D) Presence of woven bone early in the ossification process
E) Microenvironment in which ossification occurs

Question #565: A 34-year-old man is pushing some heavy weights while doing squats. Unfortunately,
while maxing out, he drops the weight and immediately grabs at his upper thigh, writhing in pain. The
man is admitted to the emergency department and during physical examination is diagnosed with a
femoral hernia. What reference structure would be found immediately lateral to the herniated
structures?
A) Femoral vein
B) Femoral artery
C) Pectineus muscle
D) Femoral nerve
E) Adductor longus muscle

Page 124
Question #566: Which of the following is a characteristic of globular proteins?
A) Hydrophilic amino acids tend to be on the inside
B) Hydrophobic amino acids tend to be on the outside
C) Tertiary structure is formed by hydrophobic and electrostatic interactions between amino acid side
chains and by hydrogen bonds between peptide bonds
D) Secondary structures are formed principally hydrophobic interactions between amino acids
E) Covalent disulfide bonds are necessary to hold the protein in a rigid conformation

Question #567: A baseball pitcher delivers 97-mph fastball to a batter and suddenly feels a sharp pain
in his shoulder on release of the ball. The trainer examines the shoulder and concludes that the
pitcher has a rotator cuff injury. Which of the following muscles i most vulnerable and most likely torn
by this type of injury?
A) Infraspinatus
B) Subscapularis
C) Supraspinatus
D) Teres minor
E) Teres major

Question #568: Which of the following best describes the typical site of implantation?
A) Cervix
B) Ovary
C) Uterine tube
D) Vagina
E) Uterus

Question #569: A 25-year-old male athlete is admitted to the emergency department after a bad
landing in the pole vault. Radiographic examination of his hand reveals a fractured carpal bone in the
floor of the anatomic snuffbox (Fig. 6-1). Which bone has most likely been fractured? (Image on next
page)
A) Triquetral
B) Scaphoid
C) Capitate
D) Hamate
E) Trapezoid

Page 125
Page 126
Question #570: Which of the following best describes an attribute of visceral smooth muscle not shared
by skeletal muscle?
A) Contraction is ATP dependent
B) Contracts in response to stretch
C) Does not contain actin filaments
D) High rate of cross-bridge cycling
E) Low maximal force of contraction

Question #571: N-terminal and C-terminal polypeptides of collagen are cleaved in

A) Nucleus
B) Rough endoplasmic reticulum
C) Smooth endoplasmic reticulum
D) Ribosomes
E) Extracellular space

Question #572: Some forms of Ehlers-Danlos syndrome are characterized by abnormally elastic skin.
This is due to defective formation and function of
A) Alpha 1 antitrypsin
B) Collagen
C) Elastin
D) Elastase
E) Fibrillin

Question #573: The major source of ammonia excreted into the urine by the kidneys of most vertebrate
animals is
A) alanine
B) asparagine
C) glutamic acid
D) glutamine
E) glycine

Question #574: In a presurgical patient, the great saphenous vein is cannulated in the vicinity of the
ankle. During the procedure, the patient experiences severe pain that radiates along the medial
border of the foot. Which one of the following nerves was accidentally included in a ligature during
this procedure?
A) Medial femoral cutaneous nerve
B) Saphenous nerve
C) Superficial fibular nerve
D) Sural cutaneous nerve
E) Tibial nerve

Question #575: The length–tension diagram shown here was obtained from a skeletal muscle with
equal numbers of red and white fibers. Supramaximal tetanic stimuli were used to initiate an
isometric contraction at each muscle length studied. The resting length was 20 cm. What is the
maximum amount of active tension that the muscle is capable of generating at a preload of 100 gs?
A) 145-155 grams
B) 25-35 grams
C) 55-65 grams
D) 95-105 grams
E) Cannot be determined

Page 127
Question #576: Adenosine deaminase deficiency leads to deficiency of all deoxyribose nucleotides
because
A) Adenine activates adenine phosphoribosyltransferase
B) dATP accumulates and inhibits ribonucleotide reductase
C) Guanase is also usually deficient
D) Tetrahydrofolate is not properly cycled
E) Xanthine oxidase is inhibited

Question #577: Replication of the genome occurs in the _____________ phase of the cell cycle
A) G1
B) G)
C) M
D) S
E) G2

Question #578: Your patient has presented with a mild megaloblastic anemia. Urinanalysis reveals the
presence of orotic acid. Which one of the enzymes below is likely to be defective in this patient?
A) Hypoxanthine phosphoribosyltransferase.
B) Uridine monophosphate synthase.
C) Phosphoribosylpyrophosphate amidotransferase.
D) Aspartate transcarbamoylase.
E) Carbamoyl phosphate synthetase I.

Page 128
Question #579: Sphingomyelin is a phospholipid present mainly in the nervous tissue. Its synthesis
requires
A) Succinyl CoA
B) Phosphatidylcholine
C) NADH
D) N-Acetylneuraminic acid
E) Arachidonic acid

Question #580: Semiconservative replication involves the separation of parent DNA molecule. Which
one of the following protein is essential for the separation of the strands?
A) DNA helicase
B) DNA polymerase I
C) DNA polymerase III
D) DNA topoisomerase
E) DNA ligase

Question #581: Which of the following pairs of values will allow us to conclude that a reaction must be
spontaneous?
A) ΔG < 0 and exothermic
B) ΔG = 0 and at equilibrium
C) ΔG < 0 and exergonic
D) ΔG < 0 and endergonic
E) ΔG > 0 and exergonic

Question #582: Which one of the following statement regarding the synthesis and function of nitric
oxide is true?
A) Its synthesis requires NADP+
B) It is synthesized from citrulline
C) It helps in the relaxation of smooth muscle
D) It is a powerful vasoconstrictor
E) L-Alanine is the substrate for nitric oxide synthase

Question #583: Which of the following compounds does NOT contribute carbon or nitrogen to the
purine ring?
A) Arginine
B) Aspartate
C) Formate
D) Gluatmine
E) Glycine

Page 129
Question #584: The nerve supply of the tongue is derived, in part, from the nerve of the

1) first branchial arch (mandibular division of V)

2) second branchial arch (VII)
3) third branchial arch (IX)
4) fourth branchial arch (X)

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Question #585: Which one of the following is correct about protein?

A) Domain is a type of secondary structure
B) Silk structure is an alpha helical fibrous structure
C) Proline participates in hydrogen bond network
D) Lysine residues will hydrogen bond with Arginine
E) Lysine residues increase the protein solubility

Question #586: 5-Fluorouracil inhibits DNA synthesis by decreasing the cell’s supply of dTMP. This drug
A) activates uridine phosphorylase
B) activate uracil phosphoribosyl transferase
C) inhibits ribonucleotide reductase
D) inhibits thymidylate synthetase
E) inhibits thymidine kinase

Question #587: A 45-year-old man is admitted to the hospital after a car crash. Radiographic
examination reveals mild disk herniations of C7, C8, and T1. The patient presents with a sensory
deficit of the C8 and T1 spinal nerve dermatomes. The dorsal root ganglia of C8 and T1 would contain
cell bodies of sensory fibers carried by which of the following nerves?
A) Medial antebrachial cutaneous nerve
B) Long thoracic nerve
C) Lateral antebrachial cutaneous nerve
D) Deep branch of ulnar nerve
E) Anterior interosseous nerve

Question #588: Which of the following best describes the long, cylindrical, main region of a long bone?
A) Compact bone
B) Epiphysis
C) Metaphysis
D) Diaphysis
E) Spongy bone

Page 130
Question #589: Drugs that inhibit the action of DNA topoisomerase are effective agents for the
treatment of viral infections and are used in anticancer therapy, because they directly inhibit
A) A transient breakage and rejoining of N-glycosidic bonds in the double helix
B) The formation of telomeres
C) The initiation of replication
D) The formation of replication fork
E) The transient breakage and rejoining of phosphodiester bonds in the DNA double helix

Question #590: A clone of cells is grown on a tissue culture plate. It is known that the diploid amount
of DNA in this species is 2 units. The amount of DNA measured in a cell sorter for fours cells from
this culture is: Cell I - 2 Cell II - 2.5 Cell III - 4 Cell IV - 4
Cell I:
A) has just completed telophase
B) has just completed the S phase
C) is in mitosis
D) is in the same stage of the cell cycle as Cell II
E) will incorporate tritiated thymidine into its nucleus

Question #591: Which of the following parts of bone develop from the primary ossification center?
A) metaphysis
B) diaphysis
C) epiphysis
D) epiphyseal plate

Question #592: A 27-year-old man was admitted to the emergency department after an automobile
collision in which he suffered a fracture of the lateral border of the scapula. Six weeks after the
accident, physical examination reveals weakness in medial rotation and adduction of the humerus.
Which nerve was most likely injured?
A) Lower subscapular
B) Axillary
C) Radial
D) Spinal accessory
E) Ulnar

Question #593: Which of the following compounds is an allosteric activator of glycogen phosphorylase
b in muscle?
A) cAMP
B) ATP
C) Glucose
D) AMP
E) Glucose-6-Phosphate

Question #594: A 16-year-old gymnast presents to the emergency department after landing awkwardly
on her ankle. She is diagnosed with a sprained ankle. Which of the following ligaments is most
commonly injured in an ankle sprain?
A) Anterior talofibular ligament
B) Calcaneofibular ligament
C) Talonavicular ligament
D) Tibiocalcaneal ligament
E) Tibiotalar ligament

Page 131
Question #595: The contractile portions of the muscle spindle are directly supplied by which nerve
fibers?
A) Gamma motor neurons
B) Alpha motor neurons
C) Ia afferent fibers
D) II afferent fibers
E) Postganglionic sympathetic fibers

Question #596: A 54-year-old female marathon runner presents with pain in her right wrist that
resulted when she fell with force on her outstretched hand. Radiographic studies indicate an anterior
dislocation of a carpal bone (Fig. 6-3). Which of the following bones is most likely dislocated?
A) Capitate
B) Lunate
C) Schphoid
D) Trapezoid
E) Triquetrum

Question #597: Production of NH3

A) Oxidative deamination of glutamate
B) Transamination of glutamate
C) Both
D) Neither

Page 132
Question #598: A 13-year-old adolescent is brought to the family practice clinic by his mother,
because he can barely walk. He has been trying out for a soccer team for the last 2 weeks. but in the
last few days has developed right knee pain and swelling. Upon examination the pain is below the
knee joint along the tibia where the patellar tendon attaches. What is the most likely source of the
problem?
A) Anterior cruciate ligament (ACL) strain
B) Bursitis
C) Osteochondritits of the tibial tubercle
D) Prepatellar bursitis
E) Quadriceps tendonitis

Question #599: Activin is a protein that normally exists in a gradient within certain tissues in
developing embryos. Certain undifferentiated cells cultured without activin produce epidermal cells.
However, activin induces these same cells to adopt other fates (e.g., blood, muscle, heart), depending
on the concentration of activin. Based on these observations, activin acts as a:
A) transcription factor
B) cell surface receptor
C) morphogen
D) second messenger
E) activator

Question #600: A 21-year-old female softball pitcher is examined in the emergency department after
she was struck in the arm by a line drive (a ball hit very hard and low). Radiographic and MRI studies
show soft tissue injury to the region of the spiral groove, with trauma to the radial nerve. Which of the
following muscles would be intact after this injury?
A) Flexor carpi ulnaris
B) Extensor indicis
C) Brachioradialis
D) Extensor carpi radialis
E) Supinator

Question #601: Which enzyme is ONLY found in the Liver?

A) Glucokinase
B) Pyruvate Dehydrogenase
C) Glucose-6-Phosphatase
D) Glucose-6-P Dehydrogenase
E) CPSI

Question #602: A 35-year-old patient has a small but painful tumor under the nail of the little finger.
Which of the following nerves would have to be anesthetized for a painless removal of the tumor?
A) Superficial radial
B) Common palmar digital of median
C) Common palmar digital of ulnar
D) Deep radial
E) Recurrent branch of median

Page 133
Question #603: A dentist reports that years of poor dental hygiene, teeth grinding (bruxism) and
bushing technique has caused significant erosion of the gums (gingival) and bone loss in a
50-year-old man. The man is referred to a dental surgeon specializing in gingival and jaw (alveolar)
bone restoration. Which of the following is a mechanisms for increasing bone mineral density that
should help restore the alveolar bone?
A) High BMP activity
B) High osteocyte activity
C) High osteoclast activity
D) High sympathetic neural activity
E) Immobilization in a cast

Question #604: Which of the following best describes the cell type that digest the extracellular matrix
of bone?
A) Osteoclast
B) Chendrocyte
C) Osteoblast
D) Osteogenic
E) Osteocyte

Question #605: During cell division there are three types of check points, one of them (M checkpoint) is
to ensure
A) Chromosomes are attached to the spindle
B) Complete DNA replication
C) DNA is not damaged or broken
D) All of the above

Question #606: Which group of genes specifies the identities of body segments along the
anterior-posterior axis?
A) homeotic
B) gap
C) Hox
D) pair-rule
E) segment-polarity

Question #607: In a cell with only mutant versions of RB, which of the following actions will be
inhibited?
A) Activation of DNA synthesis
B) Arrest of the cell cycle in G1
C) Binding of cyclins to Cdks
D) Completion of nuclear division during mitosis
E) Removal of inhibitory phosphorylations from Cdks

Question #608: In case of starvation many metabolic changes takes place to meet the body’s metabolic
demands. Which of the following illustrates starvation-triggered changes in intermediary metabolism?
A) Increased dependence of liver on glucose for its energy supply
B) Increased synthesis of proteins in muscle tissue
C) Increased use of ketone bodies as energy source in brain
D) Decreased mobilization of triacylglycerol by adipose tissue
E) Adaptation of RBC to utilize ketone bodies for energy

Page 134
Question #609: Assuming there are no heteroplastic individuals but that people from different families
have different DNA, how many different mitochondrial DNAs are there in the pedigree?
A) 2
B) 4
C) 5
D) 6
E) 7

Question #610: What roles in regulating the intrinsic pathway of apoptosis are played by the Bcl-2
protein family members Bax and Bcl-2?
A) Bak stimulates apoptosis while Bcl-2 inhibits apoptosis
B) Bcl-2 stimulates apoptosis while Bak inhibits apoptosis
C) Both Bax and Bcl-2 inhibit apoptosis
D) Both Bax and Bcl-2 stimulate apoptosis

Question #611: In the adult, produces the primordial germ cells

A) Ectoderm
B) Endoderm
C) Mesoderm
D) Yolk sac
E) Neural crest

Question #612: A 24-year-old medical student was bitten at the base of her thumb by her dog. The
wound became infected and the infection spread into the radial bursa. The tendon(s) of which muscle
will most likely be affected?
A) Flexor digitorum profundus
B) Flexor digitorum superficialis
C) Flexor pollicis longus
D) Flexor carpi radialis
E) Flexor pollicis brevis

Page 135
Question #613: A married couple is screened to assess the risk for Gaucher disease in their children.
The activities of glucocerebrosidase in the sera of the mother and father are 45% and 55%,
respectively, of the reference value. The couple has one child. Which of the following is the probability
of the child possessing one or more alleles of the Gaucher mutation?
A) 0
B) 0.25
C) 0.5
D) 0.75
E) 1.0

Question #614: A 45-year-old garbage collector has sever neck pain and weakness in his eft upper
extremity. He has gotten no relief form over-the-counter medications. he denies any history of
trauma. ON examination the patient is thin and walks with his neck tilted to the left side. The patient
has limited neck flexion and extension secondary to pain. The patient has a normal motor and
sensory examination of all extremities, with the exception of the left upper extremity. His left radial
forearm and thumb are numb to the touch (decreased sensation to light touch). The patient has a
decreased brachioradialis reflex and slight weakness of his wrist extensors. Plain radiographs appear
normal. Which of the following is the most likely diagnosis?
A) Compression of this left C6 nerve root
B) Compression of this left thoracic first nerve root (T1)
C) Compression of his right T1 root
D) A tumor in his lumbar spine
E) A tumor in his sacral spine

Question #615: Cdks bind with __________, enabling the Cdks to function as enzymes
A) MPF
B) Cyclins
C) p53
D) APC/C
E) Cdc20

Question #616: A football player is examined by the team physician following a shoulder injury during a
game. Preliminary x-ray films show an inferior dislocation of the humerus. On further examination,
there is weakness in lateral rotation and abduction of the arm. The nerve most likely affected is the
A) axillary
B) dorsal scapular
C) radial
D) suprascapular
E) thoracodorsal

Question #617: A 54-year-old male cotton farmer visits the outpatient clinic because of a penetrating
injury to his forearm with a baling hook. After the limb is anesthetized, the site of the wound is
opened and flushed thoroughly to remove all debris. The patient is not able to oppose the tip of the
thumb to the tip of the index finger, as in making the OK sign. He is able to touch the tips of the ring
and little fingers to the pad of his thumb. What nerve has most likely been injured?
A) Median
B) Posterior interosseous
C) Radial
D) Recurrent median
E) Anterior interosseous
Page 136
Question #618: In a normal, healthy muscle, what occurs as a result of propagation of an action
potential to the terminal membrane of a motor neuron?
A) Opening of voltage-gated Ca++ channels in the presynaptic membrane
B) Depolarization of the T tubule membrane follows
C) Always results in muscle contraction
D) Increase in intracellular Ca++ concentration in the motor neuron terminal
E) All of the above are correct

Question #619: A 68-year-old female is examined by the senior resident in emergency medicine after
her fall on a wet bathroom floor in the shopping center. Physical examination reveals a posterior
displacement of the left distal wrist and hand. Radiographic examination reveals an oblique fracture
of the radius. Which of the following is the most likely fracture involved in this case?
A) Colles’ fracture
B) Scaphoid fracture
C) Bennett’s fracture
D) Volkmann’s ischemic contracture
E) Boxer’s fracture

Question #620: Concerning a 14 day old blastocyst, select the most appropriate structure in the
accompanying diagram which is the chorionic cavity
A) A B) B C) C D) D E) E F) F G) G

Page 137
Question #621: Actin is found in

1) neurons
2) platelets
3) erythrocytes
4) neutrophils

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Question #622: An antibiotic added to an in vitro translation reaction directed by AUGUUUUUU… allows
synthesis only of fMet-Phe. The intermediate event that is inhibited is
A) activity of peptidyl transferase
B) amino acid-tRNA ribosomal binding
C) initiation
D) termination of peptide chains
E) the GTP-requiring translocation event

Question #623: A 14-year-old female adolescent is having difficulty at home with her parents. When
one of her parents asks her to do something (Take out the trash, bring up the laundry, etc.) she flatly
refuses or ignores the request. Her parents tell her, “You are currently getting $20 a week for your
allowance. Every time you say “No” to a request from either parent, $1 will be deducted from your
allowance.” Within two weeks, the rate of refusing parental requests decreases to less than 5%.
A) Positive Reinforcement
B) Positive Punishment
C) Negative Reinforcement
D) Negative Punishment
E) None of the above

Question #624: A 45-year-old male is admitted to the hospital after accidentally walking through a
plate glass door in a bar while intoxicated. Physical examination shows multiple lacerations to the
upper limb, with inability to flex the distal interphalangeal joints of the fourth and fifth digits. Which
of the following muscles is most likely affected?
A) Flexor digitorum profundus
B) Flexor digitorum superficialis
C) Lumbricals
D) Flexor digitorum profundus and flexor digitorum superficialis
E) Interossei

Page 138
Question #625: A couple comes to the physician for advice about contraception and family planning.
The physician provides advice about various methods of birth control. While discussing the option of
using an intrauterine device, a discussion of the process of implantation comes up. At what stage of
embryonic development does an embryo normally begin to implant in the endometrium?
A) Blastocyst
B) Four-cell stage
C) Morula
D) Trilaminar embryo
E) Zygote

Question #626: Refer the structure shown below and respond to the statements (we don’t actually have
to know atom placement)
A) The source of nitrogen atom in the position 7 of the ring contributed by aspartate
B) The numbering of carbon atoms and nitrogen atoms in both the ring is clockwise
C) The carbon atoms in the position 4 and 5 of the ring are donated by glycine
D) Amino group attachment in the position 1 of the ring forms adenine
E) N10 formyl tetrahydrofolate is the source of carbon atom 6 in the ring

Question #627: Transection of a nerve supplying a skeletal muscle usually causes

1) muscle atrophy
2) chromatolysis of motor neurons
3) fibrillations in muscle fibers
4) appearance of new exntrajunctional acetylcholine receptors

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Page 139
Question #628: After a football injury, the femur can be pulled anteriorly in relation to the tibia. No
other abnormalities are seen. The damaged structure is the
A) anterior cruciate ligament
B) lateral collateral ligament
C) medial collateral ligament
D) medial meniscus
E) posterior cruciate ligament

Question #629: A patient was admitted to the hospital emergency room in a coma. Laboratory tests
found high levels of the compound shown below in her blood:
CH2OH—CH2—CH2—COO-
On the basis of its structure (and your knowledge of the nomenclature of functional groups), you
identify the compound as which one of the following?
A) Methanol (wood alcohol)
B) Ethanol (alcohol)
C) Ethylene glycol (antifreeze)
D) Beta-Hydroxybutyrate (a ketone body)
E) Gamma-Hydroxybutyrate (the “date rape” drug)

Question #630: Which factor influences elevation of plasma calcium levels most?
A) Calcitonin
B) Calcitriol
C) Calmodulin
D) Catecholamine
E) Cobalamine

Question #631: Which of the following are components of the definitive chorion?
A) Extraembryonic somatic mesoderm and epiblast
B) Extraembryonic somatic mesoderm and cytotrophoblast
C) Extraembryonic somatic mesoderm and syncytiotrophoblast
D) Extraembryonic somatic mesoderm, cytotrophoblast, and syncytiotrophoblast
E) Extraembryonic visceral mesoderm, cytotrophoblast, and syncytiotrophoblast

Question #632: Which germ layers are present at the end of week 3 of development (day 21)?
A) Epiblast only
B) Epiblast and hypoblast
C) Ectoderm and endoderm
D) Ectoderm, mesoderm and endoderm
E) Epiblast, mesoderm, and hypoblast

Question #633: What is the primary structure that promotes exchange between maternal and fetal
circulations?
A) Yolk sac
B) Amnion
C) Amniotic fluid
D) Umbilical cord
E) Chorionic villi

Page 140
Question #634: Processes that play a major role in the formation of a trilaminar embryo include the

1) migration of cells from the ectoderm (epiblast) to a position between the endoderm and
ectoderm
2) juxtaposition of the neurenteric canal along the allantois
3) formation of the primitive streak
4) expansion of the extraembryonic mesoderm

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Question #635: What is a normal amount of amniotic fluid at term?

A) 50 mL
B) 500 mL
C) 1000 mL
D) 1500 mL
E) 2000 mL

Question #636: Which of the following compounds will diffuse LEAST rapidly across a protein free lipid
bilayer?
A) Alanine
B) ATP
C) Glucose
D) Glycerol

Question #637: The major muscles that invert the foot are innervated by the

1) saphenous nerve
2) tibial nerve
3) superficial peroneal nerve
4) deep peroneal nerve

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Question #638: A 17-year-old male patient comes to you complaining of symptoms consistent with
pyruvate kinase (PK) deficiency. Glycolysis is carried out by cells of all tissues, but PK deficiency is
usually only clinically noticeable in
A) adipocytes
B) hepatocytes
C) lymphocytes
D) muscle cells
E) neurons
F) RBC’s

Page 141
Question #639: Which of the conditions described in the table is most consistent with a
lower-than-normal force of bladder smooth muscle contractions in a pregnant woman with high
residual bladder volume?

A) Condition A
B) Condition B
C) Condition C
D) Condition D
E) Condition E

Question #640: A 22-year-old man presents in the emergency room complaining of a fainting spell.
Which of the following sympathetic vascular smooth muscle contraction mechanisms is an
explanation for this patient’s fainting spell?
A) Activation of a Gs protein
B) Activation of a Gq protein
C) Inhibition of an alpha-1 adrenergic receptor
D) Inhibition of a muscarinic-1 acetylcholine receptor

Question #641: At which cell cycle checkpoint is the cell cycle halted if the cell’s DNA is damaged?
A) G2-M
B) G1-S
C) S-G2
D) G0-G1

Question #642: A 24-year-old woman is diagnosed with a laceration to the median nerve at the wrist.
Which of the following best describes the muscles most likely affected in this condition?
A) Dorsal interossei
B) Thenar
C) Palmar interossei
D) Extensor pollicis longus
E) Hypothenar

Page 142
Question #643: To account for his sneezing, a patient reported likely having inhaled a large quantity of
pollen. For his phagocytes to move towards and engulf these particles in his respiratory tract, which
of the following structures is responsible?
A) Cilia
B) Microfilaments
C) Microtubules
D) Mitotic spindle
E) Neurofilaments

Question #644: The cardiac muscle is critically dependent on the citric acid cycle for the provision of
energy during aerobic metabolism. Which of the following statements about the citric acid cycle are
correct?
A) The citric acid cycle is acting at its fastest rate when energy-rich intermediates like ATP and NADH
are at their highest concentrations.
B) The rate limiting step is catalyzed by pyruvate carboxylase.
C) The formation of citrate from acetyl CoA and oxaloacetate is irreversible.
D) Carbon dioxide is formed at the steps catalyzed by malate dehydrogenase and by succinate
dehydrogenase.
E) The citric acid cycle provides over 90% of the ATP requirement for erythrocytes

Question #645: A 3 month-old boy presents with poor feeding and growth, hypotonia, lactic acidemia,
and mild acidosis, the ratio of pyruvate to lactate in serum is elevated, and there is decreased
conversion of pyruvate to acetyl CoA in fibroblasts, which of the following compounds might be
considered for therapy?
A) Pyridoxine
B) Thiamine
C) Free fatty acids
D) Biotin
E) Ascorbic acid

Question #646: Albinism is an autosomal recessive disorder in which a deficiency in tyrosinase activity
leads to a lack of pigmentation in the hair, skin, and eyes. The cells most involved in this condition
are derived from which of the following germ cell layers?
A) Ectoderm
B) Endoderm
C) Mesoderm
D) Neuroectoderm, neural crest cells
E) Neuroectoderm, non-neural crest cells

Question #647: Acridine dyes produce single base pair insertions and deletions. Which of the following
would be the result of such a mutation?
A) A protein would be produced that would differ in more than one amino acid residue change from
the normal protein
B) A single amino acid residue change would occur, giving rise generally to a functional protein
C) A single amino acid residue change would occur, giving rise to a nonfunctional protein
D) No detectable change would result in the protein produced
E) No product would be generated from the mutant gene

Page 143
Question #648: Muscle spindles are
A) specialized sensory organs in tendons that function as strain gauges
B) specialized sensory receptors located within a portion of a striated muscle fiber
C) smooth muscle cells of fusiform shape
D) encapsulated groups of small specialized muscle fibers with special motor and sensory innervation
E) specially innervated spindle-shaped dilations of striated muscle fibers

Question #649: Identify the components of the death-inducing-signaling-complex (DISC)

A) NGF, Death receptor, FADD, procaspase-8
B) Ligand, Death receptor, FADD, procaspase-8
C) Ligand, Death receptor, FADD, procaspase-9
D) Ligand, Cdc20, Apaf-1, procaspase-9
E) APC/C, Cdc20, Apaf-1, procaspase-8

Question #650: The rate of RNA synthesis in a culture of cells could be most accurately determined by
measuring the incorporation of which of the following radioactive compounds?
A) Adenine.
B) Guanine.
C) Phosphate.
D) Thymidine.
E) Uridine.

Question #651: A 34-year-old woman had a direct blow to the patella during a car collision. The
woman is admitted to the emergency department and radiographic examination reveals
patellofemoral syndrome. This type of syndrome is characterized by lateral dislocation of the patella.
Which of the following muscles needs to be strengthened to prevent future dislocation of the patella?
A) Vastus lateralis
B) Vastus medialis
C) Vastus intermedius
D) Rectus femoris
E) Patellar ligament

Question #652: Innervation of the quadriceps femoris muscle

A) Femoral nerve
B) Obturator nerve
C) Both
D) Neither

Question #653: In a cell, a drug that acts as an H+ ionophore would be expected to

A) activate protein synthesis
B) cause the secretion of lysosoomes
C) increase the acidity of endosomes
D) stimulate secretion
E) uncouple oxidative phosphorylation

Page 144
Question #654: Muscles whose tendons pass through the carpal tunnel include the

1) flexor digitorum profundus

2) flexor digitorum superficialis
3) flexor pollicis longus
4) palmaris longus

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Question #655: Normal metabolism involves the salvage of purine bases produced during nucleic acid
digestion in the lysosomes. The reaction of adenine and 5'-phosphoribosylpyrophosphate produces
A) xanthine monophosphate
B) adenosine monophosphate
C) guanosine monophosphate
D) inosine monophosphate
E) hypoxanthine monophosphate

Question #656: The contractile portions of the muscle spindle are directly supplied by which nerve
fibers?
A) Gamma notor neurons
B) Alpha motor neurons
C) Ia afferent fibers
D) II afferent fibers
E) Postganglionic sympathetic fibers

Question #657: Similarities between smooth and cardiac muscle include which of the following?
A) Ability to contract in the absence of an action potential
B) Dependence of contraction on Ca++ ions
C) Presence of a T tubule network
D) Role of myosin kinase in muscle contraction
E) Striated arrangement of the actin and myosin filaments

Question #658: A pregnant woman comes to her physician with questions about the effect that
ingested substances may have on her unborn child. The physician explains that large molecules do
not pass between the mother and fetus because of the placental barrier. The physician adds that fetal
blood is in the fetal blood vessels of the villi of the placenta and the mother’s blood is in the maternal
blood vessels, and that these blood vessels do not connect. The placental villi are formed from which of the
following cells?
A) Cytotrophoblast
B) Embryoblast
C) Endometrium
D) Epiblast
E) Syncytiotrophoblast

Page 145
Question #659: During the second week of development, the inner cell mass gives rise to which of the
following structures?
A) Embyroblast
B) Syncytiotrophoblast
C) Cytotrohphoblast
D) Trilaminar disc
E) Bilaminar disc

Question #660: The police arrested a notorious terrorist in the city. As he was being taken to the police
station, he suddenly swallowed cyanide powder which was in his pocket and became unconscious. He
was taken to a nearby hospital where he was administered amyl nitrate. Which component of the
electron transport chain became nonfunctional in this case?
A) NADH dehydrogenase
B) Cytochrome oxidase
C) Coenezyme Q
D) Cytochrome C
E) Cytochrome b1

Question #661: A college student goes to a fraternity party and consumes large quantities of beer. The
alcohol in the beer is metabolized by the liver, with almost half the alcohol being oxidized to
acetaldehyde. In which of the following sites does this reaction occur?
A) Golgi bodies
B) Lysosomes
C) Mitochondrial matrix
D) Peroxisomes
E) Ribosomes

Question #662: An mRNA has the stop codon 5’ UAA 3’. What tRNA anticodon will bind to it?
A) 5’ ATT 3’
B) 5’ TTA 3’
C) 5’ AUC 3’
D) 5’ CUA 3’
E) None

Question #663: Without using the genetic code table, which of the following changes leads to a
nonsense mutation?
A) UAC to AAC
B) UAA to AAA
C) GGA to AGA
D) CGA to UGA
E) UAA to UGA

Question #664: The immediate product of the degradation of glycogen by phosphorylase is:
A) Glucose-1-phosphate
B) Glucose
C) Furctose-6-phosphate
D) Glucose-6-phosphate
E) UDP-Glucose

Page 146
Question #665: Pyruvate Dehydrogenase
A) Uses Acetyl CoA as a substrate
B) Active when phosphorylated
C) Uses biotin and 4 other cofactors
D) Inhibited by Acetyl CoA
E) Activated by Acetyl CoA

Question #666: A genetic test done on a couple indicates that their probability of producing a
heterozygous affected son or daughter is 100% (4 out 4). Which of the following are the most likely
genotypes and phenotypes of this couple?
A) Female is affected heterozygous, male is normal
B) Male is affected heterozygous, female is normal
C) Male is affected homozygous, female is normal
D) Male is affected homozygous, female is heterozygous
E) Both are unaffected heterozygous

Question #667: An mRNA has the codon 5’ UAC 3’. What tRNA anticodon will bind to it?
A) 5’ AUG 3’
B) 5’ GUA 3’
C) 5’ ATC 3’
D) 5’ CTA 3’

Question #668: During ovulation, the secondary oocyte resides at what specific stage of meiosis?
A) Prophase of meiosis I
B) Prophase of meiosis II
C) Metaphase of meiosis I
D) Metaphase of meiosis II
E) Meiosis is completed at the time of ovulation

Question #669: Polar and nonpolar amino acids are responsible for the hydrophobic interactions in the
tertiary structure of proteins. What is the most likely cause of destabilization of a protein when
aspartate is substituted for isoleucine?
A) Loss of hydrogen bond between isoleucine and neighboring side chain
B) Introduction of a site for N-linked glycosylation
C) Introduction of cis peptide bond
D) Disruption of the hydrophobic core by introducing charged side chain
E) Disruption of disulfide bond

Question #670: A 69-year-old man has numbness in the middle three digits of his right hand and finds
it difficult to grasp objects with that hand. He states that he retired 9 years earlier, after working as a
carpenter for 50 years. He has atrophy of the thenar eminence. Which of the following conditions is
the most likely cause of the problems in his hand?
A) Compression of the median nerve in the carpal tunnel
B) Formation of the osteophytes that compress the ulnar nerve at the medial epicondyle
C) Hypertrophy of the triceps muscle compressing the brachial plexus
D) Osteoarthritis of the cervical spine
E) Repeated trauma to the ulnar nerve

Page 147
Question #671: What is a feature of phosphatidylserine
A) The negative charged phospholipid is typically found on the inner leaflet of the plasma membrane
B) In apoptotic cells it flips to the outer leaflet of the plasma membrane
C) It acts as a signal for macrophages
D) All of the above
E) None of the above

Question #672: Contains R group with highest pK’

A) Arginine
B) Glutamate
C) Histidine
D) Serine
E) Tryptophan

Question #673: The graph shows the isometric length-tension relations before activation (passive) and
after maximal activation (active) of a striated muscle fiber. The dashed curve is the difference between
these two relations. If the passive muscle fiber is stretched to 2g of tension and then activated to
contract isometrically, the total tension (in g) developed will be approximately
A) 3
B) 5
C) 7
D) 9
E) 11

Page 148
Question #674: A 22-year-old man who belongs to a weekend football league was running with the ball
when a defender tackled him mid-lower limb from the side. After the tackle, his knee is injured and
he presents to the ED. From the MRI of the knee, the lateral meniscus is uniformly black; however, the
media meniscus has a tear (lucent area within the meniscus). Which one of the following is the reason
why the medial meniscus is more susceptible to damage than the lateral meniscus?
A) The medial meniscus is attached to the popliteus muscle tendon, making it more susceptible.
B) The medial meniscus is attached to the medial (tibial) collateral ligament, which holds it relatively
immobile, making it more susceptible
C) The medial meniscus is attached to the anterior cruciate ligament, which holds it relatively
immobile, making it more susceptible.
D) The only reason the medial meniscus is more susceptible to damage is that the knee usually gets
hit laterally, causing more torsion on the medial meniscus.
E) The medial meniscus is attached to the medial condyle of the femur

Question #675: A 25-year-old woman who is CEO of a new biotech company has been under
considerable stress this last year trying to negotiate a contract with a major drug company. She has
also been under a very rigorous exercise program because “she just can’t stand any fat on her body”
and ran in the Boston marathon 4 months ago. Due to her busy schedule, her eating habits have
radically changed, and sometimes “the sight of food just disgusts me.” She is not on any drug or
medication. She tells you that recently she met “the guy” and has been sexually active with him for
“about 2 months now.” She comes to you because her menstrual cycle is 2 weeks late and sometimes
she feels nauseated, especially in the morning. Relevant physical exam findings were unremarkable.
Relevant laboratory findings include a positive β-human chorionic gonadotropin (hCG) test. Which of
the following is the most likely diagnosis?
A) Secondary amenorrhea due to stress
B) Secondary amenorrhea due to anorexia nervosa
C) Pregnancy
D) Turner syndrome
E) Secondary amenorrhea due to antipsychotic drug therapy

Question #676: Refer the equation given below and respond to the statements
A) If an acid has larger pKa it is considered as a weak acid
B) At physiological pH all amino acids have COO- and NH3+ groups
C) In the case of bicarbonate buffer system an increase in base portion causes the pH to fall
D) At the low pH of the stomach the drug aspirin is largely charged
E) Increase in the carbon dioxide in the bicarbonate buffer system causes the pH to raise

Page 149
Question #677: The rate of a reaction depends upon the
A) change in entropy
B) change in enthalpy
C) change in free energy
D) energy of activation
E) total energy of the system

Question #678: Drug X applied to a nerve axon decreases the duration of the action potential without
affecting the resting potential or peak amplitude of the action potential. Which of the following is the
most likely mechanism of action of Drug X?
A) Block of voltage-dependent Na+permeability
B) Decrease in the rate of Na+ inactivation
C) Decrease in voltage-dependent Na+ permeability
D) Increase in the rate of voltage-dependent changes in K+ permeability
E) Inhibition of the Na+-K+ pump

Question #679: A 15-year-old boy visited the physician with the complaints of joint pain, bleeding of
the gums and loosening of the teeth. This is due to the defect in the post translational modification of
collagen molecule. This problem is corrected by supplying which compound in the diet of the patient?
A) Lysyl oxidase
B) Copper
C) Alpha-Ketoglutarate
D) Glycine
E) Ascorbic acid

Question #680: A cut in the palm causes absence of flexion of the distal interphalangeal joint of the
index finger and weakness in flexion of the proximal interphalangeal joint of the same finger. No
other abnormalities are noted. The damaged structure is
A) the median nerve
B) the radial nerve
C) the ulnar nerve
D) a tendon of the flexor digitorum profundus muscle
E) a tendon of the flexor digitorum superficialis muscle

Question #681: During post-transcriptional processing of tRNA which one is added at the end of tRNA?
A) CAAT
B) CCA
C) GAATTC
D) GU……AG
E) TATA
F) UAG
G) polyA

Question #682: If the concentration of glucose inside a patient’s muscle cells is lower than that of blood,
which of the following processes is most likely to be used for the transport of glucose into these cells?
A) Diffusion across lipid bilayer
B) Facilitated diffusion through a membrane protein
C) Uptake through a secondary active transporter
D) Uptake through aquaporins
E) Use of ATP to pump glucose into cells

Page 150
Question #683: An investigator is studying the effect of parathyroid hormone (PTH) in experimental
animals. During an 8-hour period, Animal X is infused with PTH and Animal Y is infused with 5%
dextrose in water. Which of the following sets of findings best describes the most likely serum
concentrations in Animal X compared with Animal Y at the end of the infusion?
A) A
B) B
C) C
D) D
E) E
F) F
G) G

Question #684: A 56-year-old male has severe pain secondary to a metastatic cancer. At this point he
is considered “end-stage” and will likely live just a few more weeks. He describes his daily “comfort score” as “1
to 2” every day. To help make him more comfortable, the patient is given very strong pain medication every four
hours. Despite this, he still describes his daily comfort score as “1 to 2”.
A) Positive Reinforcement
B) Positive Punishment
C) Negative Reinforcement
D) Negative Punishment
E) None of the above

Question #685: During childbirth, a major bony landmark used for a pudendal nerve block is the
A) greater sciatic nothc
B) ischial spine
C) lesser sciatic nothc
D) obturator foramen
E) pubic tubercle

Question #686: Bcl-2 family proteins undergo a direct battle with each other during apoptosis. Some
members of the family are pro-apoptotic and promote release of apoptotic factors from the
mitochondria, others are anti-apoptotic. From the options below which are the pro-apoptotic family
members?
A) Bax and Bcl-2
B) Bid and Bax
C) Bid and Bcl-2
D) Bcl-2 and Bcl-XL
E) Bcl-XL and Bid

Page 151
Question #687: Which of the following decreases the rate of urinary excretion of calcium ions by the
kidney?
A) Increase in calcitonin concentration in the plasma
B) Decrease in phosphate ion concentration in the plasma
C) Increase in the plasma level of parathyroid hormone
D) Metabolic acidosis
E) Increase in calcium ion activity in the plasma

Question #688: A 37-year-old woman requests diagnostic testing before her frozen embryos are
implanted. The physician requests a work-up for cystic fibrosis, as both the patient and her husband
are carriers. The laboratory isolates some of the DNA from each 8- to 10-cell embryo prior to
implantation and proceeds to run tests to determine the genotype of the embryos. Which of the
following procedures is the first step performed in determining the genotype of the embryos?
A) Enzyme-linked immunosorbent assay
B) Ligase chain reaction
C) Northern blot
D) Polymerase chain reaction
E) Southern blot

Question #689: Endoderm contributes to the formation of each of the following EXCEPT the
A) auditory (eustachian) tube
B) liver
C) parathyroid glands
D) tooth enamel
E) trachea

Question #690: A 34-year-old man is examined in the prison infirmary after sustaining a superficial
stab would to the superolateral aspect of the thoracic wall at the level of the third rib. There is little
bleeding and no difficulty breathing; however, the medial border of the scapular on the injured side
pulls away from the body wall when the arm is raised. In addition, the arm cannot be abducted above
the horizontal. Which of the following muscles is paralyzed?
A) Levator scapulae
B) Pectoralis minor
C) Rhomboid major
D) Serratus anterior
E) Supraspinatus

Question #691: A 50-year-old woman visits her physician with complaints of tingling and numbness
along the lateral three fingers of her hand. On examination, the patient has wasting of the thenar
muscles and is unable to touch the little finger with her thumb. Which of the following nerves is most
likely injured?
A) Anterior interosseous
B) Median
C) Posterior interosseous
D) Radial
E) Ulnar

Page 152
Question #692: A researcher is working with mice, on the role of thiamine in the metabolic pathways.
He feeds the rodents with glucose-rich, thiamine-free food. Which of the following most likely
accumulates in the cells of these mice?
A) Acetyl CoA
B) Carnitine
C) Lactate
D) Oxaloacetate
E) Fatty acid

Question #693: In a 25-year-old patient suffering from acute lymphoid lymphoma, which of the
following enzymes would be inhibited by the anticancer drug 5-Flurouracil?
A) Aspartate transcarbamoylase
B) Glutamine: PRPP amidotransferase
C) Ribonucleotide reductase
D) Thymidylate synthetase
E) Xanthine oxidase

Question #694: In an attempt to correct a specific genetic defect in the activity of pyruvate
dehydrogenase, the most effective treatment would involve the administration of large doses of
A) acyl carrier protein
B) biotin
C) cyanocobalamin (vitamin B12)
D) pyridoxine (vitamin B6)
E) thiamine (vitamin B1)

Question #695: A normal somatic cell contains a total of 46 chromosomes. What is the normal
complement of chromosomes found in a sperm?
A) 22 autosomes plus a sex chromosome
B) 23 autosomes plus a sex chromosome
C) 22 autosomes
D) 23 autosomes
E) 23 paired autosomes

Question #696: Among the triggers that lead to activation of p53 is damage to ____________. Upon
activation, p53 acts as a ____________, stimulating expression of the gene for the protein
______________. This protein then stops cell division by binding to and inactivating _______________.
A) DNA, an activator, p21, G1/S-Cdk
B) DNA, an inhibitor, p21, S-Cdk
C) DNA, an activator, p21, both G1/S-Cdk and S-Cdk
D) Cell membrane, an activator, p21, S-CDK
E) DNA, an inhibitor, p27, S-Cdk

Question #697: Which of the following is required to transport fatty acids across the inner
mitochondrial membrane?
A) Acyl carrier protein
B) Albumin
C) Carnitine
D) Chylomicrons
E) Creatinine
F) Lecithin-cholesterol acyltransferase

Page 153
Question #698: In the diagram, the shaded areas indicate the anesthetized areas after a nerve injury
caused by a cut on the ventral wrist as shown. Muscles that would be paralyzed by this nerve injury
include the

1) abductor pollicis brevis

2) flexor carpi ulnaris
3) opponens pollicis
4) pronator teres

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Page 154
Question #699: During a routine physical examination, the physician lifts a fold of skin to test its
mobility and the speed with which it returns into place. Which of the following is most directly being
assessed?
A) Cholesterol content of plasma membranes
B) Fibrillin-containing matrix macromolecules
C) Fibrinogen content
D) Keratin content
E) Large, osmotically active protein-polysaccharide complexes

Question #700: Match the description to one of the points of the nerve action potential shown in the
diagram.
Point at which the driving force for Na+ is the greatest.
A) A
B) B
C) C
D) D
E) E
F) F

Page 155
Question #701: Which of the following post-translational modifications is most likely to be found on a
cyclin B protein that is targeted for degradation?
A) Acetylated lysine residues
B) Phosphorylated serine residues
C) Phosphorylated threonine residues
D) Phosphorylated tyrosine residues
E) Ubiquitinated lysine residues

Question #702: A scientist takes a preparation of mammalian mitochondria in a medium with all the
requirements for TCA and oxidative phosphorylation. After adding low levels of carbonyl cyanide
p-[trifluoromethoxy]-phenyl-hydrazone (an uncoupling agent) the rate of ATP production is reduced
but not eliminated, and the temperature rises. She now adds sodium azide solution to the medium.
Which of the following immediate observations would you most expect?
A) Further decrease in ATP synthesis
B) Further increase in temperature
C) Increase in ATP synthesis
D) Increase in proton gradient
E) No effect at all

Question #703: At the end of week 2 of development (day 14), what is the composition of the
embryonic disk?
A) Epiblast only
B) Epiblast and hypoblast
C) Ectoderm and endoderm
D) Ectoderm, mesoderm, and endoderm
E) Epiblast, mesoderm, and hypoblast

Question #704: Blood is drawn from a child with severe anemia and the hemoglobin protein is
degraded for peptide and amino acid analysis. Of the results below, which change in the primary
structure is most likely to correlate with the clinical phenotype of anemia?
A) Ile-Leu-Val to Ile-Ile-Val
B) Leu-Glu-Ile to Leu-Val-Ile
C) Gly-Ile-Gly to Gly-Val-Gly
D) Gly-Asp-Gly to Gly-Glu-Gly
E) Val-Val-Val to Val-Leu-Val

Question #705: Iodoacetamide is a powerful inhibitor of aldolase A. A muscle tissue preparation which
is perfused with a glucose solution and stimulated electrically, is poisoned with iodoacetamide. Which
of the following glycolytic intermediates would you expect to accumulate most?
A) 2,3-bisphosphoglycerate
B) 3-phosphoglycerate
C) Fructose 1,6-bisphosphate
D) Glucose 6-phosphate
E) Phosphoenolpyruvate

Page 156
Question #706: After translation, eukaryotic proteins can be modified by:
A) acetylation
B) the addition of phosphate groups
C) the removal of amino acids
D) the addition of methyl groups
E) all of the above

Question #707: Native collagen is composed almost entirely of which of the following types of
structures?
A) Alpha-Helix
B) Beta-Pleated sheet
C) Random coils
D) Triple helix
E) Two peptides connected by a disulfide bond

Question #708: Around day 16 of the embryo development, mesodermal cells from the primitive node
migrate towards the head of the embryo between the ectodermal and endodermal layers of the
embryonic disc to reach the prechordal plate. Eventually a hollow tube of cells will be formed in the
midline. What is the name of this structure.
A) Notochord process
B) Neural crest
C) Neural plate
D) Neural groove

Question #709: The first branchial arch (pharyngeal arch) contributes to the formation of the

1) malleus and incus

2) maxilla and mandible
3) muscles of mastication
4) muscles of facial expression

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Question #710: During an experimental study, an investigator finds that the regulation of cell cycle and
programmed cell death may be initiated by the mitochondrion. The interaction of the mitochondrion
with the activation of the caspase family of proteases and subsequent apoptosis is most likely
mediated by which of the following?
A) Calcium release
B) cAMP production
C) Cytochrome c release
D) GTP binding
E) Nitric oxide release

Page 157
Question #711: A medical student examined a histological slide of cartilage under the microscope. He
observed cells located in a structure surrounded by matrix as seen in the photomicrograph attached.
Which of the following tissue specimen was being observed?

A) Epiglottis
B) Intervertebral disc
C) Nasal cartilage
D) Tracheal cartilage

Question #712: In which phase of the cell cycle are the chromosomes inactive, condensed, and not
transcribed to messenger RNA?
A) G1 phase
B) M phase
C) S phase
D) G2 phase

Question #713: Proteins synthesized on ______________ are secreted by exocytosis

A) Attached polyribosomes
B) Free polyribosomes
C) Both
D) Neither
Page 158
Question #714: A technician wants to determine whether cytomegalovirus (CMV) DNA is present in the
blood of a bone marrow transplant recipient. DNA purified from the leukocytes of the patient is
reacted in a mixture containing oligonucleotides specific for CMV DNA, thermostable DNA
polymerase, and nucleotides. Repetitive cycles of heating and cooling are performed, and the reaction
product is detected by gel electrophoresis. The technician most likely used which of the following
laboratory procedures on this patient's blood?
A) Northern blotting
B) Polymerase chain reaction
C) Reverse transcription
D) Southern blotting
E) Western blotting

Question #715: In GTP dependent regulatory proteins (G proteins) the effect of the active, dissociated
G-alpha unit is short-lived because it has its own
A) adenylyl cyclase activity
B) Gs and Gi proteins.
C) GTP-ase activity
D) tyrosine kinase activity
E) protein kinase activity

Question #716: Each of the following nerves supplies muscles derived from the branchial arches
EXCEPT the
A) facial (VII)
B) glossopharyngeal (IX)
C) hypoglossal (XII)
D) trigeminal (V)
E) vagus (X)

Question #717: Exposure to UV light directly facilitates which of the following?

A) Conversion of cholesterol to 25-hydroxycholicalciferol
B) Conversion of 25-hydroxycholicalciferol to 1,25-dihydroxycholicalciferol
C) Transport of calcium into the extracellular fluid
D) Formation of calcium binding protein
E) Storage of vitamin D3 in the liver

Question #718: Which of the following features correctly describes the nature of the peptide bond in
polypeptides?
A) They release protons in the pH range of 2-12
B) Mainly single bond character
C) Occurs between two amino groups
D) The peptide bond generally assumes the trans configuration
E) C=O and -NH groups of the peptide bonds are non-polar in nature

Question #719: Which of the following substance is least likely to be involved in the initiation of protein
synthesis in prokaryotes?
A) Sigma factor
B) Initiator codon
C) N-Formylmethionine
D) 30s ribosomal subunit
E) GTP

Page 159
Question #720: The fact that the kidneys of a 32-year-old female patient were failing required that she
be placed on dialysis. However, the search in her upper limb for a suitable vein was unexpectedly
difficult. The major vein on the lateral side of the arm was too small; others were too delicate. Finally,
a vein was found on the medial side of the arm that passed through the superficial and deep fascia to
join veins beside the brachial artery. Which of the following veins was this?
A) Basilic
B) Lateral cubital
C) Cephalic
D) Medial cubital
E) Medial antebrachial

Question #721: Close association with blood vessels passing into the cerebral cortex
A) Arachnoid
B) Dura mater, inner layer
C) Dura mater, outer layer
D) Pia mater

Question #722: A 45-year-old man without a history of bleeding or excessive bruising dies suddenly
due to rupture of an aortic dissection. Genetic analysis at autopsy shows a defect in the gene for
fibrillin. Which of the following events most likely occurs with defective fibrillin?
A) Elastic fibers in the extracellular matrix are not correctly formed
B) Hyaluronic acid in proteoglycans is not sulfated on the proper hydroxyl residues
C) Intermediate filaments are not assembled in the endothelial cells
D) Shorter side chains of chondroitin sulfate are present on proteoglycans
E) Tubulin is not polymerized correctly due to the lack of GTP in endothelial cells

Question #723: A cell cycle “check point” would be best described as:
A) a site in the cytoplasm where proteins are inspected for mutations
B) either G1, S, G2, prophase, metaphase, anaphase or telophase
C) specific stages where further progress of the cell cycle can be halted
D) any step where the cell cycle is blocked by a mutated protein

Question #724: A 54-year-old woman is brought to the emergency department with a complain of
severe pain in the right shoulder after a car accident. ON physical examination, there is a deep wound
above the clavicle. The wound is closed and the patient is sent home with pain medication. One week
later, she presents to the emergency department again complaining of hand weakness. She is unable
to move her shoulder and upper limb is adducted, internally rotated and forearm pronated. Which of
the following parts of the brachial plexus is most likely injured?
A) Lateral cord
B) Lower trunk
C) Medial cord
D) Middle trunk
E) Upper trunk

Question #725: Which of the following constitutes the 5’ terminus or cap of eukaryotic mRNA?
A) dUMP
B) Polyadenylate
C) Pseudoruidine
D) Ribothymidine
E) 7-Methyl guanylate

Page 160
Question #726: Match the description to one of the points of the nerve action potential shown in the
diagram.
Point at which the ratio of K+ permeability to Na+ permeability (PK/PNa) is the greatest.
A) A
B) B
C) C
D) D
E) E
F) F

Question #727: Concerning a 14 day old blastocyst, select the most appropriate structure in the
accompanying diagram for the future site of the mouth (Image on next page)
A) A B) B C) C D) D E) E F) F G) G

Page 161
Question #728: By the end of the third week, the lateral edges of the neural plate becomes elevated and
form which of the following structures.
A) Neural crest
B) Neural fold
C) Neural groove
D) Neural tube
E) Neural pit

Question #729: A 32-year-old man presents with abnormal phenotypic manifestation of Marfan
syndrome, an autosomal dominant genetic disorder. With an unaffected female partner, what is the
chance for him to have an unaffected child?
A) 0%
B) 25%
C) 50%
D) 75%
E) 100%

Page 162
Question #730: The maternal and fetal components of the placenta are
A) decidua basalis and secondary chorionic villi
B) decidua capsular and secondary chorionic villi
C) decidua parietali and tertiary chorionic villi
D) decidua capsularis and villous chorion
E) decidua basalis and villous chorion

Question #731: Small nuclear ribonucleoprotein particles are necessary for cell growth. They are
required for proper
A) DNA replication
B) Alignment of mRNA to the eukaryotic ribosomes
C) Activation of transcription
D) Modification of histones
E) RNA splicing

Question #732: An RFLP was found to be associated with the X-linked recessive disorder hemophilia A
in a particular family. A pedigree and Southern blot analysis are shown below. Individual II-1 is
affected. Assuming that no recombination has occurred, what is the status of the individuals in
generation III with respect to hemophilia A?
A) All individuals in generation III are normal
B) III-1 and III-3 are affected, III-2 is normal, and III-4 is a carrier
C) III-1 and III-3 are affected, III-2 and III-4 are normal
D) III-1, III-2 and III-3 are affected and III-4 is a carrier
E) III-1 and III-3 are normal, III-2 is affected and III-4 is a carrier

Page 163
Question #733: The following pedigree indicates nine individuals affected with a genetic disease. With a
normal partner, what would be the probability of individual IV-4 to have an affected son?
A) 0%
B) 25%
C) 50%
D) 75%
E) 100%

Question #734: D-galactose and L-galactose are distinct substances with differing optical properties.
D- and L galactose are
A) anomers
B) diasteriomers
C) enantiomers
D) epimers
E) tautomers

Page 164
Question #735: Without inhibitor Km= 1.8 x 10^-4M, Vmax= 20, Hill Constant= 1
With 5 mM inhibitor Km=3.6 x 10^-4M, Vmax= 20, Hill Constant = 1
From the above date it may be concluded that the
A) inhibitor binds at the active site
B) inhibitor binds at the allosteric site
C) inhibitor does not compete with the substrate at the active site
D) inhibitor produces irreversible inactivation of the enzyme
E) K is lower than 5 mM

Question #736: Which one of the following statements regarding acid-base properties of the amino
acid alanine is correct?
A) At low pH both functional groups of alanine are deprotonated
B) Minimum buffering occurs when pH=pKa
C) In the isoelectric form of alanine, the net charge is zero.
D) When pH is equal to pK1 equal amounts of Forms I and III of alanine are present
E) Form III of alanine in solution is fully protonated

Question #737: AAGCAA -> AACAA

Mutation?
A) Frameshift
B) Nonsense
C) Both
D) Neither

Question #738: A single contraction of skeletal muscle is most likely to be terminated by which of the
following actions?
A) Closure of the postsynaptic nicotinic acetylcholine receptor
B) Removal of acetylcholine from the neuromuscular junction
C) Removal of Ca++ from the terminal of the motor neuron
D) Removal of sarcoplasmic Ca++
E) Return of the dihydropyridine receptor to its resting conformation

Question #739: The intervillous space of the placenta contains

A) maternal blood
B) fetal blood
C) maternal and fetal blood
D) amniotic fluid
E) maternal blood and amniotic fluid

Question #740: Amino acids have the general structure shown below, and 19 out of the 20 encoded
amino acids are optically active, which means that they rotate polarized light either to the left or to
the right. Which of the following substitutions for the R side chain would yield an amino acid that is
optically inactive?
A) CH-(CH3)2
B) CH2-SH
C) (CH2)2-COOH
D) (CH2)4-NH3
E) H

Page 165
Question #741: A 39-year-old female farm worker is brought to the emergency department. Three
hours previously she had been spraying apple orchards with an insecticide called Fenoxycarb. She did
not use any respiratory protection and has inhaled the vapor. She shows rippling of the muscles under
the skin, blurred vision and complains of chest tightness. She is unable to walk. Fenoxycarb is a
non-competitive inhibitor of the enzyme acetylcholinesterase, an important mediator of
neurotransmitter action. Which of the following statements about the Lineweaver-Burk plots for the
inhibited (+I) and uninhibited (-I) enzyme reaction is correct?
A) Both plots will be hyperbolic in shape
B) The plots will be parallel
C) The plots will intersect on the X-axis
D) The plots will intersect on the Y axis
E) The (+I) plot becomes non

Question #742: Which of the following is NOT a component of the spinal cord?
A) Lower motor neuron cell bodies
B) Pre-ganglionic autonomic cell bodies
C) Primary sensory cell bodies
D) Renshaw cells
E) Motor interneurons

Question #743: Which one of the following statements does NOT apply to the sympathetic division the
ANS?
A) Thoracolumbar outflow
B) Preganglionic neurons are located in the intermediolateral column of the spinal cord
C) The neurotransmitter of preganglionic fibers is acetylcholine
D) Some postganglionic fibers secrete acetylcholine
E) Postganglionic fibers are short and non-myelinated

Question #744: Which would not be found on an mRNA molecule?

A) Protein-coding region
B) 3’ untranslated region
C) 5’ untranslated region
D) Promoter
E) Start and stop codons

Question #745: A 60-year-old male butcher accidentally slashed his wrist with his butcher knife,
partially dividing the ulnar nerve. Which of the following actions would most likely be lost as a result
of this injury?
A) Flexion of the proximal inerphalalngeal joint of the fifth digit (little finger)
B) Extension of the thumb
C) Adduction of the fifth digit
D) Abduction of the thumb
E) Opposition of the thumb

Page 166
Question #746: Beginning with protein synthesis in membrane-bound ribosomes, hepatocytes secrete
proteins into the circulation via which of the following mechanisms?
A) Active transport through the cell membrane
B) Diffusion through the cell membrane
C) Transport by microtubules and exocytosis
D) Transport in vesicles and exocytosis
E) Transport through pores in the cell membrane

Question #747: The mutation shown in the diagram below can best be described as a ________________
mutation.
A) missense
B) nonsense
C) silent
D) neutral
E) reverse

Question #748: Which of the following structural arrangements in a protein strongly suggests that it is
a DNA binding protein?
A) alpha helix
B) beta bend
C) beta pleated sheet
D) Triple helix
E) Zinc finger motif

Question #749: The substantia is implicated in Parkinson disease. The substantia is derived from which
of the following secondary brain vesicles?
A) Diencephalon
B) Mesencephalon
C) Metencephalon
D) Mylencephalon
E) Telencephalon

Page 167
Question #750: ATP is used directly for each of the following processes EXCEPT one. Which one is this
EXCEPTION?
A) Accumulation of Ca++ by the sarcoplasmic reticulum
B) Transport of glucose into muscle cells
C) Transport of H+ from the parietal cells into the lumen of the stomach
D) Transport of K+ from the extracellular to intracellular fluid
E) Transport of Na+ from the intracellular to extracellular fluid

Question #751: dTMP is formed from dUMP. This conversion requires

A) 5- Flurouracil
B) N10 formyl tetrahydro folate
C) N5N10 Methylene tetrahydrofolate
D) Thioredoxin
E) Glutamine

Question #752: A 21-year-old man presents to the emergency department following an injury to his
shoulder that he sustained while playing football. His shoulder appears flattened, and he is not able to
abduct his arm. He is found to have a fracture at the surgical neck of his humerus. The muscle that is
most likely injured in this patient receives innervation from which of the following nerve roots?
A) C3-5
B) C5-6
C) C6-7
D) C7-8
E) C8-T1

Question #753: A 45-year-old male arrived at the emergency department with injuries to his left elbow
after he fell in a bicycle race. Radiographic and MRI examinations show a fracture of the medial
epicondyle and a torn ulnar nerve. Which of the following muscles would be most likely to be
paralyzed?
A) Flexor digitorum superficialis
B) Biceps brachii
C) Brachioradialis
D) Flexor carpi ulnaris
E) Supinator

Question #754: A patient was born with a congenital mutation in an enzyme that severely affected its
ability to bind an activation-transfer coenzyme. As a consequence, which one of the following is most
likely to occur?
A) The enzyme will be unable to bind the substrate of the reaction
B) The enzyme will be unable to form the transition-state complex
C) The enzyme will normally use a different activation-transfer coenzyme
D) The enzyme will normally substitute the functional group of an active-site amino acid residue for
the coenzyme
E) The reaction may be carried out by the free coenzyme, provided the diet carries an adequate
amount of its vitamin precursor

Page 168
Question #755: All primary oocytes are formed by
A) week 4 of embryonic life
B) month 5 of fetal life
C) birth
D) month 5 of infancy
E) puberty

Question #756: Single amino acid substitution in protein

Mutation?
A) Frameshift
B) Nonsense
C) Both
D) Neither

Question #757: Parathyroid hormone influences plasma concentrations of calcium by

1) directly inhibiting the release of calcitonin

2) influencing the absorption of calcium in the distal renal tubule
3) regulating the intestinal absorption of cholecalciferol (vitamin D)
4) regulating the mobilization of calcium from bone

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Question #758: Excitation–contraction coupling in skeletal muscle involves all of the following events EXCEPT
one. Which one is this EXCEPTION?
A) ATP hydrolysis
B) Binding of Ca++ to calmodulin
C) Conformation change in dihydropyridine receptor
D) Depolarization of the transverse tubule (T tubule) membrane
E) Increased Na+ conductance of sarcolemma

Question #759: A 3-month-old child presents with hyperuricemia which responds to treatment with
allopurinol. Assay of a fibroblast culture shows increased levels of PRPP coupled with decreased IMP
and GMP. The most likely diagnosis is
A) Orotic aciduria
B) Purine nucleoside phosphorylase deficiency
C) Adenosine deaminase deficiency
D) Lesch-Nyhan syndrome
E) Gout

Page 169
Question #760: A twelve-year-old female is diagnosed with Type I diabetes. She has been taught to
take her blood glucose three times a day using a glucometer, however, she frequently either refuses
or “forgets” to do so. Currently, she averages about 50% compliance. In order to encourage her to be
more compliant, her mother informs her that she can spend an extra 30 minutes a day on social
media (supervised), something she really enjoys doing, if she checks all three times. Over the next
weeks, the following data are collected (note: the “treatment” is the extra social media time).

A) Positive Reinforcement
B) Positive Punishment
C) Negative Reinforcement
D) Negative Punishment
E) None of the above

Question #761: Which of the following best describes a sesamoid bone?

A) Humerus
B) Vertebrae
C) Scaphoid
D) Sternum
E) Patella

Question #762: Octreoside is a pharmaceutical product which, among other effects, inhibits the release
of glucagon by the pancreas. Assuming that this is the only relevant effect of this drug, which of the
following effects would you most likely see after administration of octreoside?
A) Decreased activity of phosphofructokinase-1
B) Increased activity of adenlyate cyclase
C) Increased activity of fructose-2,6-bisphosphatase-2
D) Increased activity of phosphofructokinase-2
E) Increased activity of protein kinase A

Page 170
Question #763: Which of the following best describes the placental components of dizygotic twins?
A) One placenta, two amniotic sacs, one chorion
B) One placenta, two amniotic sacs, two chorions
C) Two placentas, two amniotic sacs, one chorion
D) Two placentas, two amniotic sacs, two chorions
E) One placenta, two amniotic sacs, two chorions

Question #764: Oxaloacetate is a substrate for

1) citrate syntehtase
2) phophoenopyruvate carboxykinase
3) malate dehydrogenase
4) citrate lyase

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Question #765: A young woman enters puberty with approximately 40,000 primary oocytes in her
ovary. About how many of these primary oocytes will be ovulated over the entire reproductive life of
the woman?
A) 40,000
B) 35,000
C) 480
D) 48
E) 12

Question #766: We eventually stop growing taller because

A) sex steroid stimulate a growth spurt that exhausts ability of chondrocytes to proliferate
B) sex steroid stimulation of ossification overtakes chondrocyte proliferation to close the epiphysis
C) sex steroid stimulation of chondrocyte proliferation overtakes ossification to close the epiphysis
D) growth hormone decreases with age
E) if we didn’t, no one could fit through doorways without bending over

Question #767: Pyruvate kinase deficiency is one of the common causes of hemolytic anemia. Various
mutations can result in this enzyme having abnormal properties including abnormal response to
allosteric effectors. Which of the following substances is an allosteric effector of this enzyme?
A) cAMP
B) fructose-1,6-bisphosphate
C) fructose-2,6-bisphosphate
D) glucose-6-phosphate
E) lactate

Page 171
Question #768: Least soluble in water at neutral pH
A) Arginine
B) Glutatmate
C) Histidine
D) Serine
E) Tryptophan

Question #769: A 24-year-old man is unable to flex his right forearm at the elbow joint. Which of the
following best describes the nerve likely affected in this case?
A) Median
B) Axillary
C) Musculocutaenous
D) Radial
E) Ulnar

Question #770: How much DNA does a primary spermatocyte contain?

A) 1N
B) 2N
C) 4N
D) 6N
E) 8N

Question #771: Usain Bolt of Jamaica, the current world record holder for the 200-m sprint, runs 200 m
in about 19.3 seconds. He consumes some glucose to provide the energy necessary for this muscular
activity. Under these conditions, what will be the most probable final fate in his muscles of the
glucose used?
A) Converted to citrate for fatty acid synthesis
B) Converted to oxaloacetate
C) Decarboxylated to acetyl coenzyme A
D) Oxidized to lactate
E) Oxidized to ethanol and CO2
F) Reduced to ethanol and CO2
G) Reduced to lactate

Question #772: A 23-year-old female maid was making a bed in a hotel bedroom. As she straightened
the sheet by running her right hand over the surface with her fingers extended, she caught the end of
the index finger in a fold. She experienced a sudden, severe pain over the base of the terminal
phalanx. Several hours later when the pain had diminished, she noted that the end of her right index
finger was swollen and she could not completely extend the terminal interphalangeal joint. Which one
of the following structures within the digit was most likely injured?
A) The proper palmar digital branch of the median nerve
B) The vinculum longa
C) The insertion of the tendon of the extensor digitorum onto the base of the distal phalanx
D) The insertion of the flexor digitorum profundus tendon
E) The insertion of the flexor digitorum superficialis tendon

Page 172
Question #773: Total RNA extracted from hepatic cells hybridizes only 5-10% of the DNA sequences
present in that cell. Factors that contribute to this include:

1) Gene expression is controlled at the level of transcription

2) Gene expression is controlled at the level of translation
3) Many DNA sequences do not code for proteins
4) Some DNA sequence rearrangement occurs in the liver

A) 1,2,3 only
B) 1,3 only
C) 2,4 only
D) 4 only
E) All are correct

Question #774: A new drug, Drug X, relieves pain by interacting with a specific receptor in the body.
Drug X binds irreversibly to this receptor, resulting in a long duration of action. Which of the
following types of bonds is most likely formed between Drug X and its receptor?
A) Covalent
B) Hydrogen
C) Hydrophobic
D) Ionic
E) van der Waals

Question #775: The technique known as Northern Blot is based on the analysis of
A) DNA
B) Hydrothermal layers in currents of the Arctic Ocean
C) Messenger RNA
D) Protein
E) Protein-DNA interactions

Question #776: Which one is not a derivative of the middle trunk of the brachial plexus?
A) Median nerve
B) Ulnar nerve
C) Radial nerve
D) Axillary nerve

Question #777: Which of the following amino acids is most compatible with an alpha-helical structure?
A) tryptophan
B) alanine
C) proline
D) cysteine
E) lysine

Page 173