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Board Review Week 2 Test
Good luck!!
Question 1 of 40
During a premarital examination, you note that your 32-year-old patient has an
anomaly that might be attributed to aberrant differentiation of the Müllerian ducts
during embryonic development. The Müllerian ducts normally differentiate into two
systems. Of the following, which most accurately names one of these systems?
(A) the uterus
(B) the ovary
(C) the cervix
(D) the urethral opening
(E) the seminiferous tubules
A the uterus
Müllerian ducts in the female differentiate into the Fallopian tubes, the uterus and the vagina. In most mammals,
uterus horns remain distinct. In primates and man they fuse to form a simplex type uterus.
The cervix is actually a part of the uterus itself, the neck that extends downward into the vagina.
The primitive gonads of both the male and the female embryo are composed of three components, including the
primordial germ cells that give rise to parts of the ovarian structure, the mesenchyme of the genital ridge and the
epithelial covering.
The primitive sex cords develop into the seminiferous tubules in the male.
The external genitalia, including the urethral opening in the female, arise from the area of the genital fold and the
genital swelling that is common to both sexes at the indifferent stage of development.
Question 2 of 40
A researcher is preparing a paper for publication on characteristics of hepatitis C
infection in her local population. It includes exposure and treatment information. She
reports that female sexual partners of men with hepatitis C virus are twice as likely
than other women in the same population to contract the hepatitis C virus. This is a
measure of
(A) Type I (alpha) error
(B) Odds ratio
(C) Prevalence
(D) Attributable risk
(E) Bias
D Attributable risk
Attributable risk, which can be determined from cohort studies, is a measure of the difference in occurrence of
disease between exposed and unexposed populations. The likelihood that a positive result is due to chance is a
measure of type I (alpha) error.
Prevalence is the amount of disease existing in a population at a certain point in time.
The odd ratio is a measure of the estimated relative risk occurring due to certain factors. Confounding variables
may cause bias in studies.
Question 3 of 40
You have been working with a 25-year-old married female for approximately one
month. The reason she came to see you, is that she believes that wherever she goes
men are coming on to her. She denies any sexual attraction to these men and states
that she loves her husband. Upon further questioning, you find that the woman has
only had sexual intercourse with her husband, and is curious what sex with another
man would be like. According to Freud, the woman's contention that other men keep
coming on to her is what type of ego-defense mechanism
(A) Introjection
(B) Projection
(C) Displacement
(D) Repression
(E) Compensation
B projection
According to Freud, projection occurs when a person attributes his or her own unacceptable desires to others.
This woman is wondering what it would be like to be with another man, but that is unacceptable for her to admit to
her husband, so instead she tells her husband that other men are coming on to her. Introjection involves
incorporating the standards and values of others so that they are not dissonant with their own beliefs.
Displacement occurs when a person takes out their aggression on an involvement "safe" target. For example, a
woman who is angry towards her husband may yell at the dog instead of yelling at her husband. Repression
occurs when a person ignores or removes from consciousness a painful event or memory. One example would be
in repressed memories of sexual abuse. It is assumed that some people will erase from their memory events of
sexual abuse in order to protect themselves. With compensation, a person will build up other aspects of himself or
herself to adjust for any perceived weaknesses. For example, a person who believes that they are not good at
sports may throw him or herself into studying to develop their intellect.
Question 4 of 40
A 53-year-old male presents to the emergency room accompanied by a family friend who states
that for approximately the last two hours the man has been acting "spaced out and strange."
The history reveals that this man has no personal or family history of mental disorders and that
his symptoms have occurred on a daily basis over the past several weeks, that they occurred
for the first time "out of the blue," and that the symptoms "come and go" in the course of a
typical day. Upon examination the man appears to be in no apparent distress, but his speech is
obviously rambling and at times it is incoherent. His attention wanders, he periodically nods off
during the short interview, and the man seems to be responding to visual stimuli. He is agitated
and reports that he has had little sleep during the past several weeks and that he attributes his
condition to this fact. There is no indication that substance use is involved, and the only
significant laboratory finding is that of a thiamin deficiency. The most likely diagnosis for this
man, given this information, is:
(A) Delirium.
(B) Dementia.
(C) Amnesia.
(D) Mental disorder due to a medical condition.
(E) HIV-related psychiatric disorder.
A Delirium.
Delirium is characterized by a sudden onset of symptoms. Patients often have multiple cognitive deficits such as an inability to maintain attention to external
stimuli and/or perseveration, disorganized thinking (e.g., rambling, irrelevant, or incoherent speech), and reduced levels of consciousness (e.g., perhaps having
difficulty staying awake during the examination), and they may have disturbed sleep patterns, psychomotor agitation or retardation, disorientation, and/or
memory impairment. Symptoms usually develop over a short period of time (spontaneously in many cases), and they fluctuate throughout the course of the day.
There is either evidence of a specific organic factor (e.g., intracranial trauma, the effects of drugs, nonendocrine organ disease, endocrine dysfunction, a
deficiency disease such as a thiamin deficiency, systemic infection, electrolyte imbalance, or a postoperative state) or in the absence of a known organic factor,
one or more can normally be presumed.
In contrast to delirium, dementia occurs most often in old age and in most cases it is caused by a primary, permanent, degenerative process affecting an
individual's orientation, memory, perception, intellectual function, reasoning, and judgment. Frequently, individuals with dementia have poor impulse control and
lability of mood that are not characteristic of the individual's premorbid personality. Early signs of dementia include difficulties in mental performance (e.g.,
memory), fatigue, and an inability to perform new or complex tasks. As the disorder progresses, everyday and familiar tasks become difficult to perform
successfully, and taking care of basic needs eventually becomes impossible. Language may or may not be affected, and affected individuals often will attempt to
compensate for deficits by joking, changing the subject, or by diverting the interviewer's attention.
Amnestic disorders are also characterized by an impairment of memory, but in contrast to delirium and dementia, amnestic disorders are not characterized by
global deficits in intellectual and cognitive functioning. Short-term memory and recent memory are affected, and the individual usually lacks insight into these
memory deficits and will try to minimize, deny, or rationalize them. Like delirium (and in contrast to dementia) the onset of amnestic disorders is usually sudden.
If symptoms are of a global nature, therefore, and/or of gradual onset, an underlying dementia or possibly a brain tumor should be suspected. Amnestic
disorders are not well known, however they are commonly seen among individuals with alcohol use disorders, and occasionally amnestic disorders will follow
trauma such as a head injury or electroconvulsive therapy.
Several medical conditions can cause psychiatric symptoms, but for a diagnosis of Mental Disorder Due to a General Medical Condition to be made, the
symptoms must be assumed to be caused by the direct physiological effects of a general medical condition. Examples of disorders falling into this category
include Mood Disorder Due to a General Medical Condition (e.g., HIV or AIDS), Anxiety Disorder Due to a General Medical Condition (e.g., cancer), Catatonic
Disorder Due to a General Medical Condition (e.g., head trauma, encephalitis, cerebrovascular disease, metabolic conditions), Psychotic Disorder Due to a
Medical Condition (e.g., an electrolyte imbalance), and Personality Change Due to a General Medical Condition (e.g., head trauma). It is important to note than
when choosing this type of diagnosis there must be evidence from the individual's history, physical examination, or laboratory tests that the mental disturbance
is a direct physiological consequence of a general medical condition, that the mental disturbance cannot be better explained by another mental disorder, and
that the mental symptoms cannot occur solely in the course of delirium—unless a diagnosis of Delirium due to a General Medical Condition is appropriate. It is
important to consider whether the onset of the medical condition and mental symptoms occur closely in time (they usually, but not always, do, whether the signs
of the mental disorder are typical or atypical (they will often be atypical), and whether the known medical condition usually produces symptoms similar to those
that the individual is experiencing.
HIV disorder is often accompanied by psychological changes that will vary with the stage of illness. Whereas depression and anxiety may occur early on, more
pervasive changes such as personality changes and dementia may occur later. A diagnosis of an HIV-related psychiatric disorder is made when an individual
qualifies for a psychiatric diagnosis and it is believed that the disorder is a direct result of having HIV illness. In some cases it can be shown that the disorder is
the direct physiological consequence of HIV infection, such as in the case of HIV-related dementia. The correct diagnosis in this case would be Dementia Due to
a General Medical Condition, and HIV Disease or similar would be noted as the cause. In other cases mental symptoms may be due to a reaction to having HIV
Disease, such as depression or anxiety, but not directly due to any HIV-related physiological changes. The correct diagnosis in this case would be the
appropriate psychiatric disorder for which the diagnostic criteria are met, and HIV Disease would be noted as a stressor or otherwise contributing factor.
Question 5 of 40
The type of bone growth as typified by the attached photomicrographic image is best
described as
(A) Endochondral
(B) Interstitial
(C) Appositional
(D) Intramembranous
(E) Callus formation
A Endochondral
This image typifies bone growth that occurs along a metaphysis ossification center of a long bone cut in
longitudinal section. Note the formation of a marrow cavity (diaphyseal marrow cavity) which enlarges as it
expands into the epiphyseal cartilage. During this process, a cartilaginous model of the bone is transformed
through a dynamic process into the "adult" bone. It is important to note, that the formation of bone by
endochondral bone formation, is NOT the result of calcification of cartilage. Intramembranous bone formation, by
contrast, is the development of bone from condensation of mesenchymal cells in the region of the bone to be
formed. In this situation, the aggregated mesenchymal cells differentiate into osteoblasts, which then form the
bone matrix as non-calcified bone, called osteoid. The osteoid is subsequently calcified.
Question 6 of 40
In reporting the results from a clinical study of a new anti-inflammatory drug for the
treatment of post-operative pain, the study's authors present data comparing the
total days of hospitalization for comparable groups of patients who have received
either the investigative anti-inflammatory drug or a placebo. The attached table
appears in their report. Which of the following would be a valid interpretation of the
data presented in this table?
(A) The p-value is greater than 0.05, indicating that there is no true treatment effect upon total days of post-operative
hospitalization
(B) The treatment group and placebo groups have unequal numbers of participants, and therefore the statistical test
results are not interpretable
(C) The results are suggestive of a true treatment effect, but the study has limited power to detect the effect due to
the relatively small number of study subjects
(D) Statistical testing of two group means yields a t-value, not a p-value
C The results are suggestive of a true treatment effect, but the study has limited power
to detect the effect due to the relatively small number of study subjects
While the p-value for the differences between the mean days of post-operative hospitalization is not below the
conventional level of 0.05, it is relatively close to that value. The values of the treatment group and placebo group
means (3.0 and 4.5 days, respectively) do suggest that there is an effect of treatment. It is likely that the statistical
power of the study is rather limited, given the modest number of people enrolled in each group. Ideally, this study
would be repeated with larger numbers of study subjects in each of the two groups. While it would be a mistake to
conclude that there was definitively a treatment effect, it would also be a mistake to conclude that there was no
evidence for a treatment effect, as well.
In clinical trials, it is not necessary that the comparison groups have identical numbers of subjects, although there
should be a sufficient number of participants in each study group to effectively evaluate the treatment being
considered. While statistical testing of two group means may use the t-test, it is possible to derive a p-value from
the use of this test.
Question 7 of 40
A news item in the paper carries information about a man who was startled to learn
that he has fully developed male sexual ducts and also, additionally, recognizable
uterine tubes. Genetically he is male. Which of the following processes was most
likely disturbed during the embryonic period?
(A) Production of estrogen by the embryonic testes
(B) Production of müllerian-inhibitory substance by the embryonic testes
(C) Production of testosterone by the embryonic testes
(D) Response of the paramesonephric (müllerian) ducts to estrogen
(E) Response of the paramesonephric (müllerian) ducts to testosterone
B Production of müllerian-inhibitory substance by the embryonic testes
The uterine tubes develop from the cranial portions of the müllerian (paramesonephric) system. In the males these
ducts regress under the influence of müllerian-inhibitory substance (MIS). MIS is secreted by the Sertoli cells of
the embryonic testes. If the MIS is not secreted in adequate quantities by the embryonic testes, the müllerian
ducts will develop into the female genitals. This does not disturb the development of the male genitalia. So, failure
to secrete MIS (or an abnormality in the receptor for MIS) can result in a genetic male with testes and normal male
phenotypic development, but additionally, uterine tubes, a uterus, and an upper vagina.
Production of testosterone by the embryonic testes is necessary for the development of the wolffian duct system
derivatives (e.g., vas deferens) in the male. Testosterone however, does not cause regression of the müllerian
system.
Question 8 of 40
Chronic constipation leads a teenage patient to seek medical help. A barium enema
revealed a megacolon involving the rectum and sigmoid colon. The differential for
this problem included Hirschsprung's Disease. What is the embryologic process
that is lacking for Hirschsprung's Disease?
(A) Failure of neural crest cells to migrate to the wall of the colon
(B) Failure of mesoderm cells to migrate to the wall of the colon
(C) Increased migration of the neural cells into the wall of the colon
(D) Arrest of the notochord development at the level of L 1
(E) Arrest of the notochord development at the level of L 4
(F) increased folding of the rostral neuropore
A Failure of neural crest cells to migrate to the wall of the colon
Congenital aganglionic megacolon is also known as Hirschsprung's Disease. This rare dilatation of the colon is
due to the absence of ganglion cells of the myenteric plexus. Incomplete migration of the neural crest cells into the
wall of the colon results in congenital megacolon. The internal anal sphincter is always involved including the
rectum.
Question 9 of 40
Suppose that a researcher is using hypothesis testing to determine whether two
treatments are equally effective. The hypotheses being tested are given below.
H0: Treatment A and Treatment B are equally effective
Ha: Treatment B is more effective than Treatment A
The study used an a-level of a = 0.05. The power of the test was 0.80. What is the
probability that H0 will be rejected if in fact the two treatments are equally effective?
(A) 0.05
(B) 0.20
(C) 0.80
(D) 0.95
(E) It is impossible to tell from the information given
A 0.05
When a researcher uses hypothesis testing, the researcher can never be certain that the conclusion he/she draws
is correct. The decisions a researcher makes versus the truth can be portrayed by the following table.
TRUTH
Ho True
RESEARCHER
Correct Decision
ACCEPTS Ho
RESEARCHER
ACCEPTS Ha
Type II Error
(Probability a)
Ha True
Type II Error
(Probability b)
Correct Decision
If H0 is true, but by chance the data suggested strong enough evidence against H0 to reject H0, then a type I
Error has been committed. The probability of a Type I Error is the a-level of the test. Therefore, if a = 0.01, then
only 1% of the time will data be strong enough to reject H0 when H0 is true, resulting in a Type I Error.
If Ha is true, but the evidence against H0 was not strong enough to reject H0, then a Type II Error has been
committed. The power of a test is defined as the probability of rejecting H0 when Ha is in fact true (the ability of
the test to correctly identify a significant difference). The power of a test is directly related to the probability of
committing a Type II Error. The probability of a Type II Error is b and the power of a test is given by (1 - b). One of
the most common reasons for a Type II Error is due to sample size being too small. In general, the larger the
sample size, the greater the power of the test.
Question 10 of 40
A 17-year-old African-American female comes to your clinic because she has trouble with public speaking. She is
close to graduating high school but has been hampered in class by her inability to give effective oral presentations.
She has always been regarded as "shy," but recently opted to receive an F for a class presentation instead of
delivering the speech. She was a healthy child, received all of her vaccinations, and did well in grade school. She
rarely goes on dates, but does have several close friends with whom she spends time.
Past medical history is significant for sporadic migraine headaches, a condition she has used on numerous occasions
to avoid social gatherings where unfamiliar people might be present. She has never been admitted to the hospital.
She has no psychiatric history. She has never had any surgery. She is not taking any prescription medications, but
does take a multivitamin daily. She is not allergic to any medications. Family history is significant for "shyness". She
does not smoke, drink alcohol, or use any illicit substances. On review of systems, she does report occasional
palpitations, subjective shortness of breath, and diaphoresis when confronted with public scrutiny. There was a time
in high school when she panicked after being asked to take a speed test during her typing course in front of
classmates. Physical examination is unremarkable. She appears to be a healthy young woman. Screening laboratory
tests were normal, including glucose and thyroid function. The finding, which would be most consistent with a
diagnosis of social anxiety disorder, is
(A) The patient reports that her father makes her anxious when he drives her to school
(B) That she had a lead role in the school play, has good grades, and plans for college
(C) The patient discovers that public speaking only bothers her when she drinks coffee
(D) The patient feels that her fear is irrational and her anxiety is needlessly excessive
(E) The patient reports that the symptoms started 4 months ago and are getting worse
D The patient feels that her fear is irrational and her anxiety is needlessly excessive
Social anxiety disorder is the third most common psychiatric disorder in the United States (after major depression
and alcohol dependence), yet it is often overlooked. Patients with this condition tend to be young, single, and of
low socioeconomic status. It is somewhat more common in females. There are two types of social anxiety
disorder: generalized (fear of many kinds of social situations) and specific (symptoms limited to public speaking,
etc). The cause of the condition is not completely known, but some researchers believe it may be linked to GABA,
dopamine, and/or serotonin imbalance. Treatment can include serotonin selective reuptake inhibitors such as
paroxetine, benzodiazepines such as lorazepam, or beta-blockers such as propanolol.
The diagnosis is usually suspected when the patient is overly concerned about being humiliated, is very selfconscious, and has symptoms such as sweating, blushing, trembling or palpitations. Onset is often in the teen
years and rarely is after age 25. Significant debility can result from avoidance, including unmet goals in education,
employment, or relationships with others. These diagnostic criteria are summarized in the following table.
Summary of DSM-IV Criteria for Social Phobia
Fear of one or more social situations where there may be scrutiny by strangers
The social situation causes anxiety symptoms
The patient realizes that the fear is excessive or irrational
The social situation is avoided or endured only with distress
The symptoms cause impairment of functioning
Symptoms have lasted 6 months if the patient is under 18 years of age
The symptoms are not being caused by a pharmaceutical or another medical condition
If there is comorbidity, the fear has nothing to do with comorbidity (ie. fear of heart attack in someone with coronary disease)
The anxiety of social phobia must come from scrutiny by strangers, not in-laws. The symptoms must cause
impairment of functioning, not evidenced by reported plans for marriage and high job satisfaction. The symptoms
cannot be due to a medication such as caffeine or some other medical condition. The symptoms must have
persisted for at least 6 months if the patient is under 18 years of age. A patient with social phobia has the insight to
realize that the fear and anxiety are excessive or irrational.
Question 11 of 40
A trial is carried out to determine the impact of a new diet combined with exercise in addition to conventional therapy
to further reduce the risk of dying in patients recovering from heart surgery. Patients are assigned to one of the two
study arms:
1- Conventional therapy only
2- Conventional therapy plus new diet plus new exercise program.
Patients are followed up every two months for the first year and then every six months for the next four years. Among
other factors, the following information is collected:
1) Sex
2) Age at time of surgery
3) Weight (at entry into trial and at each visit)
4) Percentage of body fat (at entry and at each visit)
5) Survival status and date of death where applicable
6) Need for further surgery and date where applicable
7) A grading for actual activity level (1 to 5 with 1=Sedentary & 5=Very Active)
Refer to the attached trial description. What study design is this?
(A) Case-Control study
(B) Cohort Study
(C) Randomized Clinical Trial
(D) Cross Over Study
(E) Cross Sectional
C Randomized Clinical Trial
Two study arms are present. In the first one, only the conventional therapy is present. In the second, diet and
exercise are added to conventional therapy. This is, therefore, an experimental study. The patients are assigned to
only one of the two study arms. Due to the nature of the intervention (diet plus exercise), patients are unblinded to
their study group. This is a Randomized Clinical Trial.
In a cross-over study, patients are assigned to one of the study arms for a period of time and then assigned to the
other study arm for the same length of time.
The other study designs mentioned are all observational studies. In case-control studies, people with and without
a specific outcome are chosen. Then, looking backward in time, one tries to detect possible causes or risk factors.
In cross sectional studies, data is collected at one time. Large governments surveys are good examples of cross
sectional studies. In a cohort study, people are selected and followed over a period of time. At the beginning of the
study, people are defined as being exposed or not exposed to certain risk factors. They are observed over time for
the development of outcome. The outcome is then compared to exposure to risk factors.
Question 12 of 40
A 36-year-old female states to her doctor that she has been feeling really tired and
not happy for the past three years. She thinks that she has no hope of better days in
the future. She thinks its amazing her boss hasn't fired her yet because as she
states," she is one of the worst employees." What is the diagnosis of this patient?
(A) Major depressive disorder
(B) Dysthymic disorder
(C) Bipolar I disorder
(D) Bipolar II disorder
(E) Kindling
B Dysthymic disorder
Dysthymic disorder is diagnosed when a patient presents with chronic depression for at least 2 years in duration that has
not been severe enough to be major depressive disorder. The patient must present with two of the following symptoms:
increased or decreased appetite, increased or decreased sleep, low energy, low self-esteem, poor concentration or
decision-making ability, and hopelessness.
Major depressive disorder is characterized by a more severe depression for at least 2 weeks and it presents with at least 5
of the following symptoms: depressed mood most of the day felt by the patient, or observed by others, lack of interest in all
activities(anhedonia-inability to experience pleasure), significant weight loss or gain or an increase or decrease in appetite,
insomnia or hypersomnia every day, psychomotor agitation or retardation every day, fatigue or loss of energy every day,
feelings of worthlessness or inappropriate guilt, diminished ability to think or concentrate, recurrent thoughts of death with
a suicidal attempt or a specific plan for committing suicide.
A single pole in which the patient experiences manic, hypomanic, or depressive symptoms characterizes Bipolar I
disorder. If the first episode is not manic, sometimes the diagnosis is not made until a manic episode arises. If the
symptoms arise due to the use of substances such as antidepressive medicines than it is not considered bipolar I disorder.
Attempted and successful suicides are common in patients with bipolar I disorder. Sexually transmitted diseases are more
frequent in this population when they are in the manic stage. There is also poor compliance in taking medicines due to
impaired judgment. Bipolar I disorder is associated with eating disorders, anxiety disorders, and attention deficit
hyperactivity disorder. The mean age in which it occurs is 21 years old.
Bipolar II disorder is diagnosed when a patient has had at least one episode of major depression and one hypomanic
episode without the presence of any manic or mixed episodes. Suicide is common during the depressive episodes. It is
seen in association with substance abuse or anxiety disorders as in the case of the bipolar I disorder. The lifetime risk of
getting the disease is .5%, which is higher in females than in males. Unlike the bipolar I disorder, which presents with
mania or mixed syndromes, the bipolar II disorder has no presence of mania or mixed syndromes.
Kindling is a phenomenon characterized by repeated subthreshold stimulations of the brain that result in seizure activity. It
seems that bipolar disorders follow the same scenario. For example, a person may experience a certain stress that sets of
their first episode of mania, then mania will appear with a lower grade of stress, and then eventually it will appear all by
itself. Anticonvulsants such as valproic acid and carbamazepine are useful in treating patients with seizures, as well as
patients with bipolar disorders.
Question 13 of 40
During a sonographic examination a fetus is shown to have oligohydramnios making
organ visualization difficult. It is suspected this fetus has early metanephric
degeneration resulting in which of the following malformations?
(A) Bilateral renal agenesis
(B) Unilateral renal agenesis
(C) Horseshoe kidney
(D) Ectopic kidneys
(E) Pancake kidney
(F) renal ectopia
A Bilateral renal agenesis
Bilateral renal agenesis occurs in approximately 0.3 of 1000 births. This malformation is incompatible with life, with
the infant living in utero, due to placental support. Oligohydramnios is seen since there is no excretion of urine
during pregnancy. Early metanephric diverticulum degeneration, or failure to form, results in the agenesis.
Question 14 of 40
A researcher wishes to compare the efficacy of a COX-2 inhibitor to that of ibuprofen
for treatment of pain in patients with osteoarthritis. Using a visual analogue scale of
1-100, a difference of 15 points between the mean values of the treatment arms is
considered to be clinically significant. Given that a true clinically relevant difference
exists between the two therapies, which of the following is most true about the
probability that the statistical test used in the study will fail to detect the difference?
(A) The probability decreases as a decreases
(B) The probability is determined by the type-II error of the study
(C) The probability decreases as the b increases
(D) The probability is impossible to determine without knowing the true mean
(E) The probability decreases as the power decreases
B The probability is determined by the type-II error of the study
Before a study is conducted, the researcher must select the significance level (a), which is the value used to
interpret the result of the statistical test. The a level represents the probability that the statistical test used will
detect a clinically significant difference due to chance alone. This is the chance of a type-I error. The a level does
not predict the response of an individual patient, or the proportion of a sample that will have a particular
therapeutic outcome.
The probability of a statistical test failing to detect a difference between means of two samples when such a
difference truly exists, is the b or type-II error. As the level of significance increases, there is a greater chance of a
type-I error, but less chance of a type II error, therefore, b decreases as a increases.
The ability of a statistical test to detect a difference between two means is the power of the test. Power is the
probability that a statistical test will detect a difference when such a difference truly exists and is not due to
chance. Power is the complement of b, and is equal to 1-b. Therefore, b decreases as power increases. As the
level of significance, and the chance of a type-I error decreases, b increases. Power differs from a and b in that it
is not a measure of error.
Question 15 of 40
A 36-year-old woman seeks treatment in a hospital emergency room. She complains
of severe tightness in her chest, feeling "like I'm suffocating," and asks if she is going
to die. Her pulse rate is 119, her breathing is rapid and shallow, her pupils are
somewhat constricted, and her speech is fast and tense. She says that her
symptoms began 2 or 3 hours ago, that they appeared suddenly, but that they didn't
seem to be associated with any trauma, physical exertion, or unusually stressful
circumstance. After eliminating gross cardiopulmonary pathology, you might suspect
that her symptoms are related to a psychological factor of
(A) Disassociation
(B) Rationalization
(C) Regression
(D) Anxiety
(E) Repression
D Anxiety
Refer to the image. Intense fear reactions that are far out of proportion to the present situation define a state of
anxiety. In this case, the symptoms of panic do not seem related to any actual event, object, or person, as would
be in a phobia. The other choices given as possible answers are all defense mechanisms used by the ego to
defend itself against the discomfort of anxiety and the sense of being overwhelmed. If the patient had used any or
all of these previously, they would now appear to be failing in their functions of warding off and reducing this
experience of anxiety.
Question 16 of 40
The parafollicular cells associated with the thyroid gland arise from what
embryological source?
(A) Endoderm
(B) Mesoderm
(C) Ectoderm
(D) Neural ectoderm
(E) Neural crest cells
E Neural crest cells
The thyroid follicular cells arise embryologically from endoderm that migrates downward from the floor of the
foregut, in the midline area near the base of the developing tongue. However, the parafollicular cells are derived
from the neural crest cells that migrate into the thyroid gland during development.
Question 17 of 40
In a study of the effects of a new treatment for ovarian cancer on mortality, the a
level is 0.05 and the b level is 0.20. What is the power of the study to detect a
change in mortality from this new treatment?
(A) 5%
(B) 20%
(C) 25%
(D) 80%
(E) 95%
D 80%
The power of a study is the ability of the study to detect a significant change when one exists. It is calculated as
1 - b, where b is the Type II error. In this case, 1 - b = 0.80, or 80%. Therefore, there is an 80% surety that this
study has detected a change in mortality with this new treatment when one exists. Or, in other words, 20% of the
time it will have missed a significant difference when one exists.
Question 18 of 40
A 19-year old female presents to the Diagnostic Imaging Department with complaints of pelvic pain. She is G 1 P 0. The patient
is estimated to be 14 weeks pregnant by LMP and physical exam. The serum pregnancy test was positive 4 weeks ago. The
bladder was not adequately filled and a transvaginal sonogram was performed.
Refer to the attached case and film. Which of the following is the most probable cause for the uterine shape seen on the
sonogram?
(A) Bicornuate uterus
(B) Unicornis
(C) Didelphic uterus
(D) Leiomyomata
(E) Hydrometrocolpos
(F) Hematometrocolpos
(G) Diethylstilbestrol exposure
(H)Thalidomide exposure
A Bicornuate uterus
The bicornate uterus is the most common developmental malformation that is caused by the failure of the
mullerian ducts to fuse. Renal agenesis on the same side as the uterine anomalies can coexist with a bicornate
uterus.
Question 19 of 40
A 25-year-old female patient presents with amenorrhea. History includes heavy
athletic training for the past year for a 25-mile marathon. She has lost 16 lbs. in the
past 3 months, and says she feels very fit, but she wonders why she is amenorrheic.
You explain that the layer on the inside of the uterus is not being built up in a normal
manner, most likely due to a paucity of estrogen caused by her strenuous physical
activity. She asks about the anatomical details of the uterus. How many layers are
associated with the uterus?
(A) 1
(B) 2
(C) 3
(D) 4
(E) 5
C 3
The uterus is defined by three distinct layers. The layers are the serosa, the myometrium, and the endometrium.
The serosa is the outer connective tissue cover and is shiny and tough. It also gives strength and shape. The
myometrium is the inner layer that is composed of muscle fibers that run longitudinally. These fibers act under the
influence of estrogen to contract and relax (peristaltic motion) to move the sperm up the reproductive tract. The
third and innermost layer, the endometrium, is composed of several parts; the stroma, glands and epithelium. The
epithelium lines the innermost part of the endometrium. The glands and stroma compromise the area beneath the
epithelium and are important to the proper function of the uterus.
Question 20 of 40
You and your colleagues are conducting a small clinical trial concerning the
management of pediatric asthma. The clinical trial involves three different treatment
arms and one placebo arm. The outcome of interest is hospitalization for respiratory
distress. In one treatment arm (n=31), there are no patients that require
hospitalization during the follow-up period (i.e., 0 events). What is the upper 95%
confidence bound for the rate of hospitalization for the 31 subjects in this treatment
arm?
(A) The upper 95% confidence bound cannot be calculated from the data provided
(B) 0
(C) 0.10
(D) 0.15
(E) 0.22
C 0.10
The answer to this question is derived using the "rule of three" (as explained by Hanley and Hand, JAMA, 1983).
When there are no events of interest observed in a particular group, the upper 95% confidence bound can be
calculated by dividing 3 by the number of subjects in the group (i.e., n). In the question, 3/n is equivalent to 3/31 or
0.097. Rounding up produces the answer 0.10, and thus the largest rate that we would expect (with 95%
confidence) would be 0.10 or approximately 3.0 events in this group of 31 study subjects. The 99% confidence
bound can be obtained by using the "rule of 4.6" (i.e., 4.6/n), and the 99.9% confidence bound can be obtained
using the "rule of 6.9" (i.e., 6.9/n). While this explanation will not go into the derivation of this rule, the calculations
underpinning the convenient statistical device are sound and well-tested.
Question 21 of 40
A 20-year-old woman is well-known to your practice. On this visit she complains of
abdominal pain. In the past she has sought treatment for head, back, joint, and chest
pain, she has complained of nausea and vomiting, she has a history of irregular
menses, and she has complained of localized weakness to her right leg. Her
symptoms have never been fully explained and you rule out such diagnoses such a
Factitious disorder and Malingering. This woman most likely suffers from (a):
(A) Somatization disorder
(B) Body dysmorphic disorder
(C) Conversion disorder
(D) Hypochondriasis
(E) Somatoform pain disorder
A Somatization disorder
The Somatoform disorders are a complex group that is characterized by physical symptoms that suggest a
medical condition in the absence of other evidence to support a medical diagnosis. Unlike individuals with a
Factitious disorder or Malingering, the symptoms experienced by individuals with Somatoform disorder are not
under voluntary control. There are 7 general types of Somatoform disorder, and each has a characteristic feature
or features:
Somatization disorder usually begins before age 30 and is characterized by a history of complaints related to pain,
gastrointestinal symptoms, sexual problems, and psychoneurological symptoms. Undifferentiated Somatoform
disorder, on the other hand, while similar, is characterized by symptoms that are below the threshold in severity or
number for a diagnosis of Somatization disorder. The symptoms that characterize Conversion disorder include
unexplained problems involving voluntary motor or sensory functioning. Pain disorder is characterized by
symptoms predominately related to pain. Hypochondriasis refers to a preoccupation with the fear of having a
serious disease. Body Dysmorphic disorder is characterized by a preoccupation with an imagined physical defect;
and Somatoform disorder Not Otherwise Specified is used to describe an individual with symptoms of Somatoform
disorder that do not fully meet the criteria for a diagnosis with any specific Somatoform disorder.
Question 22 of 40
The acrosome reaction is required for sperm to be able to fertilize ova. Which
organelle does the acrosome originate from?
(A) Rough endoplasmic reticulum
(B) Nucleus
(C) Lysosome
(D) Cell membrane
(E) Golgi
E Golgi
The acrosome arises from the Golgi. There are at least 16 different enzymes that have been documented to be
contained in the acrosome. Which part each one plays in breaking down the membrane of the ova has yet to be
fully elucidated.
Question 23 of 40
A rat is trained to press a lever to receive food. This is an example of
(A) Classical conditioning
(B) Operant conditioning
(C) Pavlovian conditioning
(D) Disinhibition
B Operant conditioning
Operant (or instrumental) conditioning involves behaviors that are instrumental in producing the presentation of
certain stimuli (as with a rat pressing a lever for food reinforcement). Classical and Pavlovian conditioning are
synonymous and simply involves the pairing of an unconditioned stimulus (that elicits an unconditioned response)
with a conditioned stimulus until the conditioned stimulus elicits the unconditioned response. disinhibition is the
recovery of a conditioned response by novelty.
Question 24 of 40
A 12 year old female presents with a one day history of right lower quadrant pain and
temperature. She complains of nausea but no vomiting. Physical examination is
notable for right lower quadrant pain and tenderness with guarding. She is taken to
the operating room with the presumptive diagnosis of appendicitis. Using a
McBurney incision in the right lower quadrant you mobilize the cecum and find the
appendix to be normal in appearance. This patient had a Meckel's diverticulum. The
most common location for a Meckel's diverticulum is the
(A) Proximal jejunum
(B) Distal jejunum
(C) Proximal ileum
(D) Terminal ileum
(E) Colon
D Terminal ileum
Even though the patients presentation was consistent with appendicitis, finding a normal appendix should not end
the search. Running the small bowel is necessary to rule out a Meckel's diverticula or evidence of terminal ileitis.
Closing the abdomen and observing or starting steroids would only cause more harm. A right hemicolectomy is not
indicated in this situation.
The most common complication from Meckel's diverticulum is bleeding secondary to ulceration of the heterotopic
gastric tissue. It is the most commonly encountered diverticulum of the small intestines and represents a true
diverticulum. It is the direct result of persistence of the omphalomesenteric duct. Technetium scans can be used to
identify diverticula with heterotopic gastric tissue. acute diverticulitis although not the most common presentation
can mimic acute appendicitis clinically . There is much controversy about the treatment of an incidentally found
Meckel's diverticulum. The general principles are that it should be removed if there is evidence of heterotopic
tissue and/or there is a narrowed neck. Other relative indications include unexplained abdominal symptoms and
evidence of prior inflammation. The location on the antimesenteric border is normal and is not an indication for
surgical resection. The most common location of a Meckel's is the terminal ileum usually located 45-90 cm. from
the ileocecal valve.
Question 25 of 40
In evaluating a female patient, you find that although she continues to complain of
significant pain several months after undergoing abdominal surgery, there is no
physiological basis for her symptoms; all tests are negative. In the absence of
perhaps a Mood disorder or an Anxiety disorder to explain the symptoms, you
conclude that she might be suffering from a
(A) Somatization disorder
(B) Body dysmorphic disorder
(C) Hypochondriasis
(D) Conversion disorder
(E) Somatoform pain disorder
E Somatoform pain disorder
The Somatoform disorders are a complex group that is characterized by physical symptoms that suggest a
medical condition in the absence of other evidence to support a medical diagnosis. Unlike individuals with a
Factitious disorder or Malingering, the symptoms experienced by individuals with Somatoform disorder are not
under voluntary control. There are 7 general types of Somatoform disorder, and each has a characteristic feature
or features:
Somatization disorder usually begins before age 30 and is characterized by a history of complaints related to pain,
gastrointestinal symptoms, sexual problems, and psychoneurological symptoms. Undifferentiated Somatoform
disorder, on the other hand, while similar, is characterized by symptoms that are below the threshold in severity or
number for a diagnosis of Somatization disorder. The symptoms that characterize Conversion disorder include
unexplained problems involving voluntary motor or sensory functioning. Pain disorder is characterized by
symptoms predominately related to pain. Hypochondriasis refers to a preoccupation with the fear of having a
serious disease. Body Dysmorphic disorder is characterized by a preoccupation with an imagined physical defect;
and Somatoform disorder Not Otherwise Specified is used to describe an individual with symptoms of Somatoform
disorder that do not fully meet the criteria for a diagnosis with any specific Somatoform disorder.
Question 26 of 40
A 70-year-old lady is referred to you by the primary physician of the nursing home
where she resides. The patient presents with mild memory impairment and she is
very upset about her declining cognitive abilities. She cries and says she does this
because her husband still lives at home and she is very upset that she can not live at
home with him. She says that he only visits once a week and is now developing
some health problems too. Based on your findings, you believe she is experiencing a
major depressive disorder, your first step in management of her would be?
(A) Hospitalization
(B) Obtain history of the patient and family
(C) Begin antidepressant therapy
(D) Individual therapy referral
(E) Family therapy referral
B Obtain history of the patient and family
Based on DSM-IV criteria, a major depressive disorder must consist of at least five of the following symptoms and they must have lasted for at least
2 weeks. These are: depressed mood, decreased interest or pleasure in previous activities, insomnia, or hypersomnia, psychomotor retardation or agitation;
fatigue, loss of energy; feelings of worthlessness; poor concentration, and recurrent thoughts of suicide or suicidal ideation. At least one of the above symptoms
must be depressed mood or loss of interest. And for a differential diagnosis, this depressed mood can not be attributable to a general medical condition or
bereavement.
Overall, the risk factors for a major depressive episode include the following: female, especially post partum, a history of depression, first degree relatives with a
history of depression, prior suicide attempts, over age 40, medical problems, decreased social supports, stress, and current substance or alcohol abuse.
Obtaining a history of the patient and family is extremely crucial in the treatment of mood disorders. Often, there seems to be a genetic link. History
must be taken before any treatment begins. It is very important to find out both from the family and patient if there has ever been any history of prior episodes of
depression and the level of recovery; any history of mania, any other psychiatric problems, any hospitalizations, or suicide attempts. Often geriatric patients are
reluctant to discuss their mental health problems, and therefore, you must obtain an accurate history from the immediate family.
Depression may present with similar or the same symptoms as dementias, but are due to other medical or neurological diseases such as head trauma,
Parkinson's disease, Picks disease, Huntington's disease, HIV disease, multiple sclerosis, a lateral sclerosis, vitamin deficiencies, and numerous other medical
conditions.
Some patients with loss of memory and other cognitive deficits have a major depression or other mood disorder which is causing their memory loss or cognitive
deficits and this is said to be the false or pseudodementia. Many elderly patients suffer from a major depression, which may even present itself with some of
the same symptoms as dementia of the Alzheimer's type or even multiinfarct dementia. These symptoms include short term or recent memory loss, fatigue,
insomnia or hypersomnia, low appetite, weight loss, overeating, and an inability of handling activities of daily living.
Substance induced depression includes cognitive and emotional effects caused by inhalants, sedative drugs, hypnotic drugs, prescription side effects,
overdoses of prescription drugs, or other substances. This is common in the elderly.
Bi-polar affective disorders also exist in geriatric patients but usually began in their earlier life. The symptoms of bi-polar disorder consist of the
following: grandiosity, decreased need for sleep, pressured speech, racing thoughts or flight of ideas, psychomotor agitation, excessive involvement of
pleasurable activities such as spending, sex, trips, loss of control, and substance abuse.
Supportive based therapy on an individual basis has proven to be more successful with the geriatric population rather than family therapy or group therapy.
Also, it is very crucial to have lab testing and a complete examination of the older patient before beginning any course of treatment. Psychotherapy plus
antidepressant therapy combined has proven to be the most successful in treatment of geriatric patients. But before beginning any antidepressant medication it
is very crucial to have an EEG AND AN EKG to rule out any superimposed brain diseases or cardiac problems.
Question 27 of 40
Recent research by Partsch, Aukamp, and Sippell has demonstrated a correlation
between increased scrotal temperatures in male infants wearing plastic-lined
disposable diapers and a decline in their fertility as adults. Testicular hyperthermia
during the post-natal period would most likely affect
(A) Meiosis of primary germ cells
(B) Mitosis of primary germ cells
(C) Spermiogenesis
(D) Spermatogenesis
(E) Mesonephric duct differentiation
(F) Paramesonephric duct degeneration
B Mitosis of primary germ cells
Primary germ cells (prespermatogonia) differentiate and have migrated to the embryonic gonads by the fifth
intrauterine week. Before the onset of puberty at between 13 and 16 years of age, spermatogonia within the
seminiferous tubules of the testis undergo some 30 mitotic divisions. Increased temperature in the testis would be
expected to affect this stage of development. The exact mechanism is unknown, but testicular hypothermia is
known to be important in normal development of spermatogonia in primates and most other mammals.
Meiosis does not occur until after puberty, when spermatogonia have already differentiated into primary
spermatocytes under the influence of testosterone produced by the interstitial cells of the testis. The first meiotic
division then produces secondary spermatocytes - haploid cells (1N) but with doubled chromatids (2C). The
second meiotic division produces spermatids - haploid cells with single chromatids (1C).
The process of spermiogenesis is the differentiation of spermatids into cells with flagellae and heads, known as
spermatozoa or sperms. The term spermatogenesis refers to the entire process of differentiation of spermatogonia
into spermatozoa, beginning at puberty.
Differentiation of the mesonephric (Wolffian) ducts into such important male reproductive tract structures as the
ductus deferens, ejaculatory duct, and epididymis occurs at the eighth intrauterine week, thus much earlier than
the insult in this case.
Degeneration of the paramesonephric (Mòllerian) ducts in the male embryo occurs at the same time, and in any
event would have little, if any, effect on male fertility.
Question 28 of 40
Which of the following defense mechanisms involves the re-channeling of the libido
into an object other than the object of the individual's instinctual desire?
(A) Displacement
(B) Replacement
(C) Projection
(D) Symbolization
(E) Substitution
A Displacement
Displacement is a term used to define a defense against anxiety. According to psychodynamic theory, when the
ego is threatened with frustration, it aims to find a substitute that resembles the original desired object to satisfy
the drive.
Question 29 of 40
Which one of the following external genitalia structures of the female is
embryologically homologous to the skin of the scrotum?
(A) Mons pubis
(B) Labia majora
(C) Labia minora
(D) Clitoris
(E) Vestibule
B Labia majora
The mons pubis is the prominence of subcutaneous tissue covered by stratified squamous epithelium overlying
the female pubic symphysis. The labia majora are two large folds of skin that extend posteriorly from the mons
pubis. These form the lateral boundaries of the vaginal opening and are covered with hair on the exterior surface,
but are devoid of hair on the smooth inner surface. Sebaceous and sweat glands are associated with each surface
and the folds contain various amounts of subcutaneous adipose tissue.
The labia majora are homologous to the skin of the scrotum in the male. The labia minora are smaller, paired folds
of skin that underlie the labia majora and boarder the vaginal vestibule. These hairless folds of skin have a core of
richly vascularized connective tissue and possess large sebaceous glands.
The clitoris is homologous to the penis and consists of erectile tissue covered by stratified squamous epithelium.
Similar to the structure of the penis, the body of the clitoris is composed of paired erectile bodies referred to as
corpora cavernosa. The clitoris ends with a small, round tubercle of tissue called the glans clitoris. The vestibule
represents the opening of the vagina and is lined with stratified squamous epithelium. Vestibular glands are
present in the underlying connective tissue, and provide mucus secretions near the vaginal opening.
Question 30 of 40
Adoptive studies have revealed that some psychopathology is genetically inherited.
The mental disorder that most commonly runs in families is
(A) Pedophilia
(B) Gender Identity Disorder
(C) Factitious Disorder
(D) Pica
(E) Schizophrenia
E Schizophrenia
Of the choices, Schizophrenia is the most prevalent mental disorder that is considered to be genetically
inheritable. Early adoptive studies showed that children of schizophrenics raised by adoptive parents were far
more likely to become schizophrenics. Within the general population, schizophrenic parents are 10 times more
likely to produce schizophrenic children.
Pedophilia is an adult's sexual attraction to children. There is no recognized familial pattern.
Gender Identity Disorder is diagnosed when a person has an overwhelming desire to live as a member of the
opposite sex. There is no recognized familial pattern.
Factitious Disorder is diagnosed when one pretends to have physical or psychological symptoms in order to adopt
the sick role. There is no recognized familial pattern.
Pica is the eating of nonnutritive substances. It is usually associated with mental retardation. There is no
recognized familial pattern for Pica.
Question 31 of 40
Which of the following events occurs second during the development of the thyroid?
(A) Appearance of the thyroid follicles
(B) Breakdown of the thyroglossal duct
(C) Formation of epithelial cords
(D) Formation of the thyroid diverticulum
(E) Secretion of thyroid hormones
B Breakdown of the thyroglossal duct
The thyroid is the first endocrine gland to appear in embryonic development, during week 4. The endoderm of the
floor of the primitive pharynx thickens in its medial part, with a downgrowth giving origin to the thyroid diverticulum.
The developing thyroid continues its descent, reaching the level of the hyoid bone by week six. At this point the
thyroid is connected to the tongue by the thyroglossal duct, which opens in the tongue at the foramen cecum. The
thyroid diverticulum is originally hollow, but soon becomes solid and divides. By week seven, the thyroid reaches
its final position, and the thyroglossal duct starts to degenerate. The thyroid primordium starts to breakdown into a
network of epithelial cords or plates, due to the invasion of the surrounding vascular mesenchyme. By week ten,
the cords divide into small cellular groups, and then a lumen forms in each of these. The cells organize
themselves into a single layer, and by week eleven colloid begins to appear within these structures, the thyroid
follicles. By week twelve, thyroid hormones are being synthesized.
Question 32 of 40
During a research rotation as a medical student, you spend several months
gathering data on the use of a new oral vaccine to prevent a serious gastrointestinal
disease in primates. Your research generates the attached table of data, and you are
interested in using the c2 test to statistically test the association between vaccination
status and the subsequent development of this particular gastrointestinal disease.
After calculating the c2 value, you are interested in looking at a table of c2 values to
determine the p-value that is associated with the c2 value that you obtained with the
numbers shown in the table above. What would be the correct "degrees of freedom"
associated with this table
(A) 1 degree of freedom
(B) 2 degrees of freedom
(C) 3 degrees of freedom
(D) 4 degrees of freedom
(E) 5 degrees of freedom
A 1 degree of freedom
The shape of the c2 distribution changes according to the number of degrees of freedom (df) involved in a
particular testing situation. Thus, in order to determine the correct p-value associated with a particular c2 value, it
is necessary to know the correct degrees of freedom. For contingency tables, the correct degrees of freedom is
obtained with the following formula: df = (r-1)(c-1), where r is the number of rows, and c is the number of columns.
In a table with 2 rows and 2 columns, the c2 test will have 1 degree of freedom.
Question 33 of 40
A 30-year-old resident is noted to be especially frugal, rigid and punctual. In most
areas of his life he is meticulous, but his desk and bedroom is messy. He tends to be
obsequious with superiors and rather sadistic with the medical students in his
control. Occasionally he has temper tantrums. From a psychodynamic point of view,
these characteristics are derivatives of which of the following stages of
development?
(A) Oral
(B) Anal
(C) Phallic
(D) Oedipal
(E) Latency
B Anal
Frugality, punctuality, meticulousness, sadistic rage, problems with control, submission, and defiance are common
in people fixated at the anal stage. Because of their use of reaction formation, these characteristics may exist
side-by-side with their opposites. In psychoanalytic theory, fixation at any stage of early development is believed
to lead to particular personality characteristics. The fixation may occur either because of excessive gratification or
because of deprivation, as experienced by the child in terms of his individual needs.
Freudian theory is a set of propositions about human personality and behavior derived from observations of
patients engaged in FREE ASSOCIATION at a time in history when the expression of sexuality was normally
repressed. Such expression, often in symbolic form, convinced Freud that sex was at the basis of most
psychopathology. He asserted that the uncovering of repressed unpleasant early experiences would disperse the
psychopathology, which he claimed they had caused. He proposed arbitrary divisions of the mind into
SUPEREGO, EGO, and ID. He asserted that infants pass through three stages- oral (birth to 18 months), anal (25 years) and phallic (5 years onward), and that the personality could be fixed at any of these stages with serious
consequences, curable only by psychoanalysis. He proposed the OEDIPUS COMPLEX and the castration
complex. Freud's ideas and discoveries continue to have wide influence, but are not now generally believed to
have any scientific basis. There is little convincing evidence that the application of his theories in psychoanalysis
has any specific value in the treatment of psychological disturbance.
Question 34 of 40
Which of the following is true in relation to fetal kidneys?
(A) They do not function before birth
(B) Polyhydramnios is due to renal obstruction
(C) A two vessel cord is always a sign of renal agenesis
(D) Renal obstruction or renal agenesis may cause oligohydramnios
(E) Renal function cannot be determined during a sonographic examination
D Renal obstruction or renal agenesis may cause oligohydramnios
Renal obstruction or agenesis causes oligohydramnios due to the fact that the fetus cannot excrete urine. During
fetal life the fetus swallows the amniotic fluid and excretes through the kidneys and bladder. This is not necessary
since the placenta removes waste from the fetus. Some urinary function can be observed during a sonographic
examination. The bladder will fill and empty, ureters will be small and no hydronephrosis will be seen.
Question 35 of 40
Eugene is very scared of being seen in the public. He thinks that everybody was
looking at him in a social scene. What is Eugene's condition?
(A) Panic Disorder
(B) Social Phobia
(C) Simple Phobia
(D) Agoraphobia
(E) Post-traumatic stress disorder
B Social Phobia
The preclusive concern of the social phobias is being seen or watched. People with social phobias would avoid
being noticed in the public or performing a task while being watched.
Simple Phobia is the fear of a specific object or situation such as fear of darkness, heights, spiders, butterflies, or
disease. The phobia's response is extreme.
Agoraphobia is the fear of the marketplace. Often, a panic attack accompanies the individual when he/she is in a
crowd, in an open space, when traveling, or even on the street. A typical symptom during the panic disorder attack
is shortness of breath, heart palpitations, profuse sweating, dizziness, and wild fear of dying or going crazy.
Almost everyone would show some Post-traumatic stress disorder after military combat, rape, being held hostage,
captivity in a concentration camp or natural disasters. The symptoms of PTSD include numbness to outside
events or withdrawal from such events; cognitive and emotional symptoms such as memory impairment, feelings
of guilt, inability to concentrate, and exaggerated alarming response; and reliving the event through nightmares or
sharp periodic recollections or feelings of the event.
Question 36 of 40
While doing morning rounds on the pediatric bone marrow transplantation unit at a
large university-affiliated medical center, the attending hematologist-oncologist asks
you about the allocation of patients to treatment groups in pediatric marrow
transplantation clinical trials. How should you answer her question most correctly?
(A) Patients are allocated based on prognosis
(B) Patients are allocated based on parental preference
(C) Patients are allocated by random assignment
(D) Patients are allocated based on the attending physician's clinical judgment
(E) Clinical trials cannot be done with pediatric subjects
C Patients are allocated by random assignment
To effectively evaluate experimental agents or procedures, randomized clinical trials must be performed.
Randomized clinical trials should be double-blinded in all but the most exceptional circumstances, and patient
allocation should be achieved by a random process in which each patient has the same probability of being
allocated to a specific treatment or control arm. Allocation based on prognosis, parental preference, or clinical
judgment can lead to seriously biased results and flawed conclusions about the efficacy of the experimental
treatment.
Question 37 of 40
Steve is a veteran of the Vietnam War. Often times he would wake up in the middle
of the night screaming and sweating. When asked, Steve said that the panics were
due to his dreams that he is still in the Vietnam War, and that in his dreams he saw
his comrades being killed. What is Steve experiencing?
(A) Panic Disorder
(B) Social Phobia
(C) Simple Phobia
(D) Agoraphobia
(E) Post-traumatic stress disorder
E Post-traumatic stress disorder
The preclusive concern of the social phobias is being seen or watched. People with social phobias would avoid
being noticed in the public or performing a task while being watched.
Simple Phobia is the fear of a specific object or situation such as fear of darkness, heights, spiders, butterflies, or
disease. The phobia’s response is extreme.
Agoraphobia is the fear of the marketplace. Often, a panic attack accompanies the individual when he/she is in a
crowd, in an open space, when traveling, or even on the street. Typical symptoms during the panic disorder attack
is shortness of breath, heart palpitations, profuse seating, dizziness, and wild fear of dying or going crazy.
Almost everyone would show some Post-traumatic stress disorder after military combat, rape, being held hostage,
captivity in a concentration camp or natural disasters. The symptoms of PTSD include numbness to outside
events or withdrawal from such events; cognitive and emotional symptoms such as memory impairment, feelings
of guilt, inability to concentrate, and exaggerated alarming response; and reliving the event through nightmares or
sharp periodic recollections or feelings of the event.
Question 38 of 40
When the male urethral orifice is on the ventral surface of the penis it is called
(A) Testicular feminization
(B) Mixed gonadal dysgenesis
(C) Hypospadias
(D) Epispadias
(E) Micropenis
C Hypospadias
Hypospadias is the condition where the urethral opening is on the ventral side of the penis. The penis may be
small and curve downward in a condition referred to as chordee. This abnormality is due to inadequate androgen
production in the fetus
Question 39 of 40
A 38-year-old, white, married woman comes to her family physician with a history of vague
abdominal pains. She is certain she has cancer. Exhaustive medical examinations and general
hospitalizations have failed to reveal any abnormality other than 'spasmodic colitis'. Yet, she
continues to believe she has cancer, but "the doctors just haven't found it yet". She wakes up
early in the morning (about 4 am). She has lost at least 15 pounds in the last six weeks (a fact
she attributes to cancer). Her speech is monotonous and slow. Tears come to her eyes as she
begins to talk about the fact that her youngest child joined the Navy five months ago. Since
then she has felt useless, and has found no pleasure in anything. Although she never feels
good, she believes she feels worse in the morning. She previously had been well. She denies
any previous history of similar symptoms. She has received no prior psychiatric help. Which of
the following would allow the therapist to be less concerned about suicide?
(A) Family history of suicide
(B) Patient's mood improves
(C) Patient tells about her suicidal ideas
(D) Patient made a suicidal gesture two weeks ago
(E) She is married with children
E She is married with children
Male, Caucasian, divorced, widowed, separated, older age, poor health in the past 6 months, loss of job, presence
of depression, schizophrenia, organic brain disease, and history of suicide attempt are some of the risk factors for
suicide.
In general, suicide rates increase with age. In the men, the rates peak around age 45 then continue to rise slowly.
Suicide rates for men over 75 are twice that for men aged 45-54. In women, suicide rates peak after age 55.
Men commit suicide three times more often than women. Women attempt suicide four times more often than men.
Women are also more likely to ingest drugs than men.
Married individuals with children have the lowest suicide rates. Individuals who have never married have almost
double the suicidal rates of married individuals. The highest suicide rates occur in previously married (especially
divorced) men. As many as 70% of individuals who commit suicide have some active, usually chronic, illness.
Approximately 50% of patients who commit suicide have sought medical help within 1 month or less of their
deaths, and 80% have seen their physicians within 6 months of their deaths.
Depression is present in over 50% of suicide victims. Patients with delusional depression are at the highest risk.
Suicidal risk increases with depressed mood, especially if vegetative signs are present, as in this case. The risk
will become even greater as she improves, and becomes more energetic. Indeed, if she decides to kill herself, her
mood may improve remarkably. The fact that she is married and has other children gives an indication that she
has family support to cope with the bereavement that has led to her depression. Along with therapeutic support,
psychological support and the medications, this factor will make suicide less probable. However, like with any
other patient suffering depression, she should be directly asked and probed about the possibility of suicide in her
mind, and therapeutic support provided accordingly.
Question 40 of 40
A 60-year-old man is referred to you by his primary physician for constantly going to
emergency rooms and asking for pain pills to assist him in his painful legs. After
extensive testing, the health care professionals find nothing wrong and after looking
at his medical charts, it becomes suspicious that he is addicted on pain medications.
He has no other mental health history or medical history that would explain the
requests for medications. What would be your provisional diagnosis?
(A) Pseudocyesis
(B) Factitious disorder
(C) Factitious disorder by proxy
(D) Malingering
(E) Hypochondriasis
D Malingering
A client with a factitious disorder make up physical and or mental health signs and symptoms in order to assume
the "sick" role and gain attention. They consciously fabricate symptoms in order to get attention from health care
professionals. This disorder is also known as Munchausen syndrome.
In malingering, the patient fabricates mental and or physical symptoms for the motive of material gain like avoiding
punishment, avoiding work, or obtaining money or drugs.
In hypochondriasis, the patient becomes preoccupied that he or she has a very serious illness and appropriate
medical testing reveals no findings. In addition, the disorder has lasted for longer than six months. The patient
becomes so fixated on having a serious disease that it impairs his or her personal or work life.
Clients with pseudocyesis have a false pregnancy; however, have convinced everyone else that they are truly
pregnant.
Clients with factitious disorder by proxy, gains attention by health care professionals by producing physical
symptoms in someone else, usually a child or parent. This disorder is also known as Munchausen syndrome by
proxy.