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Scientific Competition Filling instructions Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 1 The classic location for an abdominal aortic aneurysm is inferior to the renal arteries and extending to the bifurcation of the common iliac arteries. Repair involves resecting the diseased portion of the aorta. Which of the following visceral arteries would likely be resected along with the diseased aortic tissue during this repair? (A) Gastroduodenal artery (B) Hepatic artery (C) Inferior mesenteric artery (D) Left gastric artery (E) Superior mesenteric artery Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 2 A dysfunctional myocardial endothelium underlies ischemic heart disease and its pathology is most often from severe narrowing of atherosclerotic coronary vessels. Which of the following is a soluble metabolite that mediates the compensatory coronary artery vasodilation during periods of increased myocardial oxygen demand? (A) Acetylcholine (B) Adenosine (C) Carbon dioxide (D) Lactate (E) Norepinephrine Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 3 Cardiac output is a function of stroke volume and heart rate. Stroke volume increases when contractility increases, preload increases, or afterload decreases. Which of the following variations would increase cardiac output? (A) β-Blocker treatment (B) Aortic stenosis (C) Cardiac glycoside administration (D) Decreased intracellular calcium concentration (E) Increased extracellular sodium concentration Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 4 A 50-year-old man presents to the emergency department because of retrosternal chest pain that started four hours ago and is becoming severe. After a thorough work-up he is diagnosed with an acute myocardial infarction (MI). Which of the following laboratory test elevations is most specific for MI? (A) Alanine aminotransferase (B) Aspartate aminotransferase (C) Creatine kinase-MB fraction (D) Lactate dehydrogenase (E) Troponin I Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 5 A 62-year-old breast cancer survivor complains about weakness, fatigue, fever, and weight gain 5 years following her radiation therapy. Physical examination reveals hepatomegaly and jugular venous distention that fails to subside on inspiration, with no evidence of hypotension or pulsus paradoxus. An echocardiogram shows reduced end-diastolic volumes and elevated diastolic pressures in both ventricles. Which of the following is the most likely diagnosis? (A) Cardiac tamponade (B) Congestive heart failure (C) Constrictive pericarditis (D) Dilated cardiomyopathy (E) Recurrence of breast cancer Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 6 A patient presents for treatment of his severe essential hypertension. He is being treated with numerous medications for high blood pressure, and hydralazine was recently added to his medication regimen. He has been experiencing flushing and headaches since hydralazine therapy was started. Which of the following is an adverse effect of Hydralazine? (A) Angina (B) Cardiotoxicity (C) Cyanide toxicity (D) Nephrotoxicity (E) Pulmonary embolism Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 7 A 10-year-old boy presents with a low-grade fever, anorexia, nausea, vomiting, and abdominal pain. The pain initially began periumbilically and developed into severe right lower quadrant pain after several hours. The child is diaphoretic and lies still; involuntary guarding and rebound are present. Pain is elicited when the child is placed on his left side and the right leg is raised against resistance. Which of the following provides innervation to the muscle involved in this manoeuvre? (A) Inferior gluteal nerve (B) Lumbar plexus and femoral nerve (C) Obturator nerve (D) Sciatic nerve (E) Superior gluteal nerve Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 8 A 51-year-old man has a lengthy history of medication-dependent reflux esophagitis. Laboratory tests reveal a blood gastrin level three times the upper limit of normal. His physician expresses concern that the patient is at risk of developing atrophic gastritis. Which of the following medications is this patient most likely taking? (A) Aluminum hydroxide (B) Bismuth (C) Cimetidine (D) Misoprostol (E) Omeprazole Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 9 An obese 40-year-old multiparous woman comes to the physician because she has been experiencing right upper quadrant pain with nausea and vomiting precipitated by fatty foods. Results of a right upper quadrant ultrasound show multiple gallstones. Laboratory studies show: HDL cholesterol: 33 mg/dL Total cholesterol: 280 mg/dL Triglycerides: 420 mg/dL LDL cholesterol: 170 mg/dL Which of the following drugs is relatively contraindicated in this patient’s treatment? (A) Ezetimibe (B) Gemfibrozil (C) Niacin (D) Pravastatin (E) Simvastatin Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 10 A 27-year-old man presents to his family physician for an annual physical examination. On rectal examination, masses are palpated. The patient is referred for a colonoscopy, which reveals adenomatous polyps located diffusely throughout the colon. The patient states that his father passed away from colon cancer. Which of the following inheritance patterns is characteristic of this condition? (A) Autosomal dominant (B) Autosomal recessive (C) Autosomal trisomy (D) Sex chromosome abnormality (E) X-linked recessive Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 11 A 51-year-old man complains of recurrent vomiting and sometimes throwing up blood. There is some lower extremity edema and tortuous veins on the surface of his abdomen. He has had several recent sexual partners, and has never been tested for sexually transmitted diseases. He admits drinking a “few” drinks a night. Results of a liver biopsy are shown in the image. Which of the following best describes the pathologic process occurring in this patient’s liver? (A) At this stage in disease, hepatocytes fail to regenerate (B) Lipid deposition is taking place (C) Mallory bodies are commonly seen (D) The architectural changes are irreversible (E) The liver will be enlarged Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 12 A 17-year-old girl who is being treated with antibiotics for recurrent sinus tract infections presents to the physician with intractable watery diarrhea and cramps. Which of the following is most often associated with this patient’s condition? (A) Clostridium difficile (B) Clostridium perfringens (C) Escherichia coli (D) Staphylococcus aureus (E) Vibrio cholerae Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 13 A 57-year-old woman comes to the physician 6 weeks after returning from a trip to Greece. She has had a fever of 38.8 °C (101.8 °F) that rises during the day and decreases at night. She feels tired and has lost weight. She mentions she tried fresh goat cheese. Her physical examination is notable for hepatosplenomegaly and generalized lymphadenopathy. Which of the following organisms is most likely responsible for this patient’s symptoms? (A) Bartonella henselae (B) Brucella melitensis (C) Pasteurella multocida (D) Plasmodium malariae (E) Plasmodium falciparum Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 14 The diagram below depicts the arterial network of the brain. Infarction of the artery designated by arrow “A” would lead to which of the following deficits? (A) Contralateral motor deficits of the arm and hand (B) Contralateral motor deficits of the face (C) Contralateral motor deficits of the leg and foot (D) Ipsilateral motor deficits of the face (E) Ipsilateral motor deficits of the leg and foot Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 15 During the autopsy of a patient noted to have xanthochromia (on cerebrospinal fluid examination), the pathologist removes the calvarium and the attached dura. On the surface of the brain there is frank blood that cannot be removed by rubbing or scraping the surface. Which of the following most likely caused this finding? (A) Ruptured aneurysm (B) Intraparenchymal hemorrhage (C) Intradural hemorrhage (D) Tearing of bridging veins (E) Temporoparietal bone fracture Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 16 A 76-year-old woman dies at home from sudden cardiac arrest after the onset of ventricular fibrillation. The autopsy reveals several small infarcts throughout the basal ganglia. Assuming that the defects arise from a single vessel, pathology from which artery would be most consistent with this finding? (A) Anterior cerebral artery (B) Anterior communicating artery (C) Lateral striate artery or lenticulostriate arteries (D) Posterior cerebral artery (E) Vertebral cerebral artery Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 17 A researcher studying the function of the hypothalamus ablates the supraoptic hypophyseal tract in laboratory rats. Which of the following processes will be impaired in these animals? (A) Concentration of urine (B) Milk synthesis (C) Ovulation (D) Salt retention (E) Spermatogenesis Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 18 A 33-year-old woman complains of pain behind her right ear since that morning. Neurological examination is notable for paralysis of the right side of her face, decreased taste sensation on the right side of her tongue, and increased sensitivity to loud sounds in her right ear. In addition to the symptoms described above, this patient may also develop: (A) Decreased sensation over her right upper cheek (B) Deviation of the uvula and soft palate to the left when the patient is asked to say “Ahh” (C) Deviation of the uvula and soft palate to the right when the patient is asked to say “Ahh” (D) Dryness in her left eye (E) Dryness in her right eye Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 19 A 71-year-old woman is diagnosed with non-Hodgkin lymphoma. Soon after starting her first cycle of chemotherapy, she reports severe nausea and vomiting. Prochlorperazine is prescribed to control this adverse effect. Upon which of the following labeled areas of the brain does prochlorperazine act? (A) 1 (B) 2 (C) 3 (D) 4 (E) 5 Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 20 A 25-year-old man with a history of intractable seizures has recently been switched to a new antiseizure medication. He subsequently develops a rash on his body, which consists of maculopapular blistering lesions and develops gum hyperplasia. Which of the following medication is most likely to have resulted in the patient’s symptoms? (A) Carbamazepine (B) Gabapentin (C) Phenytoin (D) Valproic acid (E) Topiramate Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 21 A physiologist divides the lung into three zones, with the apex being zone 1, the middle region being zone 2, and the base being zone 3. He applies a small amount of positive pressure ventilation while studying blood flow in different lung zones. Which of the following will be noted in this experiment assuming the subject is standing? (A) Blood flow in zone 3 will be driven by the difference between alveolar and venous pressures (B) Blood flow will be reduced in zone 1 (C) Blood flow will be continuous in zone 2 (D) Regional differences between blood flow will not be as great as differences in ventilation (E) Whether supine or standing, blood flow will remain uneven throughout the lung zones Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 22 A 62-year-old woman underwent bilateral knee replacement and was discharged without complications. Nine days after surgery she develops severe respiratory distress and dies suddenly. Postmortem examination of her pulmonary artery reveals the pathology seen in the image. What medical condition could predispose to a similar pathology as observed in this patient? (A) Aspiration (B) Factor V deficiency (C) Factor VIII deficiency (D) Protein C deficiency (E) Thrombocytopenia Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 23 A 65-year-old man with an 80-pack-year history of smoking experiences cough and increasing dyspnea over the past six weeks. A 2-cm mass in the left lower lobe of the lung was biopsied, revealing squamous cell carcinoma. A sample of non-neoplasic tissuefrom the lung biopsy is shown in the image. Which of the following types of epithelium not normally present in the lung lines the bronchus shown in this image? (A) Pseudostratified columnar (B) Simple squamous (C) Stratified columnar (D) Stratified squamous (E) Transitional Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 24 A 64-year-old retired shipyard worker has been experiencing shortness of breath, a cough, and chest pain for five months. In that time he has lost 14.5 kg (32 lb). He develops progressive ascites, and ultimately dies due to a pulmonary embolus. Autopsy results are shown in the image. Exposure to which substance is a risk factor for this patient’s disorder? (A) Aflatoxin B (B) Asbestos (C) Benzene (D) Cadmium (E) Silica Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 25 An 18-year-old man comes to the physician complaining of a runny nose, sneezing, and difficulty breathing for the past 2 days. His younger sister received a baby kitten 2 days ago. The response seen in this patient is mediated by which of the following? (A) Antigen-antibody complexes activating complement (B) Antigen cross-linking IgE on presensitized mast cells and basophils (C) IgM and IgG binding to antigens on enemy cells (D) Sensitized T lymphocytes releasing lymphokines (E) Serum sickness Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 26 An 8-year-old boy has had respiratory problems that have arisen since an upper respiratory infection 4 months ago. The patient has attacks characterized by wheezing and shortness of breath that usually resolve after an hour. The doctor explained that the boy had an abnormally high level of eosinophils in his blood. Which cytokine is involved in the pathogenesis of this disease? (A) Interferon-γ (B) Interleukin-2 (C) Interleukin-4 (D) Interleukin-10 (E) Tumor growth factor−β Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 27 A 36-year-old woman with a history of leukemia receives a bone marrow transplant. Two and a half weeks later, she experiences fever, cough, and dyspnea. Bronchoalveolar lavage reveals large cells with prominent intranuclear inclusions, as shown in the image. What is the most likely cause of this patient’s infection? (A) Candida albicans (B) Cytomegalovirus (C) Mycobacterium tuberculosis (D) Pneumocystis jiroveci (E) Toxoplasma gondii Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 28 Public health investigators are looking into a series of illnesses in a small community. Many patients presented with acute-onset hyperpyrexia and a particularly severe pneumonia. Gram staining of their sputum cultures reveals neutrophils and very few organisms. Which of the following organisms is most likely to have caused this outbreak? (A) Bordetella pertussis (B) Haemophilus influenzae type B (C) Legionella pneumophila (D) Mycobacterium tuberculosis (E) Streptococcus pneumoniae Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 29 The following graph was obtained by collecting and assaying urine from a healthy volunteer given varying amounts of glucose by intravenous infusion. Which statement concerning the graph is most accurate? (A) Glomerular filtration of glucose is saturated at 375 mg/dL (B) Proximal convoluted tubule glucose reabsorption is saturated at 375 mg/dL (C) Proximal convoluted tubule glucose secretion begins at 200 mg/dL (D) Proximal convoluted tubule glucose secretion begins at 375 mg/dL (E) Urine glucose begins to be detectable at 375 mg/dL Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 30 A man accidentally chops into his arm, causing it to bleed profusely. Although pressure is applied to the wound, there is continued blood loss. Upon arrival to hospital, he appears lethargic and pale. Which of the following set of vital signs would most likely be seen in this patient as he is being transported to the hospital? (A) A (B) B (C) C (D) D (E) E Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 31 A 63-year-old man measures his blood pressure at home and find it to be 168/100 mm Hg. The patient has had high blood pressure for the past 12 months that has not improved with dietary changes, exercise, or medication. A physical examination is unremarkable except for a murmur heard when auscultating the abdomen just to the left of the midline. What is the most likely cause of the patient’s hypertension? (A) Decreased levels of ADH (B) Decreased levels of angiotensin II (C) Elevated levels of aldosterone (D) Excessive production of cortisol (E) Increased levels of angiotensin-converting enzyme Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 32 A 67-year-old woman with osteoporosis is given a diuretic to treat her hypertension. This particular diuretic has the adverse effect of limiting calcium excretion by the kidney. Referring to the image, where along the nephron does this drug act? (A) A (B) B (C) C (D) D (E) E Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 33 A newborn with hypercalciuria and hypokalemic alkalosis is diagnosed with neonatal Bartter’s syndrome, a rare inherited dysfunction of the thick ascending limb of the nephron. Which diuretic may mimic these symptoms by blocking a cotransporter found in this part of the nephron? (A) Acetazolamide (B) Furosemide (C) Hydrochlorothiazide (D) Mannitol (E) Triamterene Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 34 A 5-year-old girl has generalized edema and laboratory testing reveals proteinuria of 5 gm/day, and podocyte foot process effacement is seen on electron microscopy of a kidney biopsy. Disruption of which of the following components of the filtration barrier is contributing to this patient’s proteinuria? (A) Brush border (B) Endothelial cell (C) Heparan sulfate (D) Integrin (E) Type IV collagen Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 35 A 57-year-old woman is scheduled for elective hysterectomy. Severing which of the following structures during surgery would most severely disrupt blood flow to the ipsilateral ovary? (A) Cardinal ligament (B) Fallopian tube (C) Round ligament (D) Suspensory ligament (E) Ureter Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 36 A 46,XY infant is born with a nonsense mutation in the SRY gene. The product of the SRY gene is most directly responsible for which of the following normal processes in the sexual development of male fetuses? (A) Development of internal male genitalia from the mesonephric duct (B) Development of testes from indifferent gonads (C) Development of the genital tubercle into the glans penis (D) Development of the urogenital sinus into the prostate gland (E) Involution of paramesonephric ducts Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 37 A 26 year-old monogamous female presents with cyclic pelvic pain that has been increasing over the last 6 months. She complains of significant dysmenorrhea and dyspareunia. She uses condoms for birth control. On physical examination her uterus is retroverted and non-mobile, and she has a palpable adnexal mass on the left side. Her serum pregnancy test is negative. Which of the following is the most likely diagnosis? (A) Ovarian cancer (B) Endometriosis (C) Functional ovarian cyst (D) Pelvic inflammatory disease (E) Leiomyoma Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 38 A 29-year-old woman complains of a “fishy”-smelling vaginal odor noticeable during intercourse. Pelvic examination reveals a homogenous gray-white discharge, and a saline wet mount of vaginal epithelial cells is obtained (see image). What is the morphology of the organism that is causing this patient’s symptoms? (A) Budding yeast and/or hyphae (B) Gram-negative diplococci (C) Gram-positive rod (D) Obligate intracellular parasite (E) Pleomorphic, gram-variable rod Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 39 A 24-year-old woman presents with severe right lower quadrant pain. She has had multiple sexual partners but has been faithful to her husband for the last three years. A urine β-human chorionic gonadotropin test is positive, but no gestational sac is visualized on transvaginal ultrasound imaging. During the examination, her pain increases and she is becoming tachycardic. Which of the following best characterizes the organism most likely predisposed this woman to her current clinical picture? (A) It is a gram-negative bacillus (B) It is a gram-variable bacillus (C) It is a spirochete (D) It is a teardrop-shaped trophozoite (E) It is an obligate intracellular organism Scientific Competition 0:10 0:20 0:30 0:40 0:50 1:00 Question 40 A young couple is having trouble conceiving and decides to undergo in vitro fertilization. The woman begins treatment to stimulate ovulation prior to ova collection and fertilization. Which of the following hormones is most directly responsible for ovulation? (A) Estrogen (B) Follicle-stimulating hormone (C) Gonadotropin-releasing hormone (D) Luteinizing hormone (E) Progesterone Scientific Competition