PBL Spring 2019 Exam 2 Practice Questions

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aortic, pulmonic

(aortic/pulmonic) valve closes followed by (aortic/pulmonic) valve, creating the S2 sounds during isovolumetric ventricular relaxation

(increases/decreases) in blood volume or (increases/decreases) in venous compliance → decrease in mean systemic P → venous return curve shifts L in parallel fashion → new equilibrium where (A) increases, increases, both cardiac output & R atrial pressure are increased (B) increases, decreases, both cardiac output & R atrial pressure are increased (C) decreases, increases, both cardiac output & R atrial pressure are decreased (D) decreases, decreases, both cardiac output & R atrial pressure are decreased

(increases/decreases) in blood volume or (increases/decreases) in venous compliance → increased mean systemic pressure → venous curve shifts to the R in parallel fashion → new equilibrium at which (A) increases, increases, both cardiac output & R atrial pressure are increased (B) increases, decreases, both cardiac output & R atrial pressure are increased (C) decreases, increases, both cardiac output & R atrial pressure are decreased (D) decreases, decreases, both cardiac output & R atrial pressure are decreased

(increasing/decreasing) TPR → decrease in cardiac output & venous return → new equilibrium point where (A) increasing, both cardiac output & venous return are decreased but R atrial pressure is the same (B) increasing, both cardiac output & venous return are increased but R atrial pressure is the same (C) decreasing, both cardiac output & venous return are decreased but R atrial pressure is the same (D) decreasing, both cardiac output & venous return are increased but R atrial pressure is the same

(increasing/decreasing) TPR → increase in both cardiac output & venous return → new equilibrium point where (A) increasing, both cardiac output & venous return are decreased but R atrial pressure is the same (B) increasing, both cardiac output & venous return are increased but R atrial pressure is the same (C) decreasing, both cardiac output & venous return are decreased but R atrial pressure is the same (D) decreasing, both cardiac output & venous return are increased but R atrial pressure is the same

volume, pressure, pressure

(pressure/volume) work predominates during strenuous exercise (pressure/volume) work predominates during aortic stenosis (pressure/volume) work is more costly

- < 1% of blood antibodies -Mediate anaphylatic, type I hypersensitivity by binding to basophils & mast cells -Activates histamine secretion → allergy symptoms -Protect against parasitic infections (A) IgG (B) IgA (C) IgM (D) IgE (E) IgD

-0.95 kg/L density -TG = main component -B48 (A, C, E) -75 to 1200 nm (A) chylomicrons (B) VLDL (C) IDL (D) LDL (E) HDL

-0.95 to 1.006 kg/L density -TG = main component -B100 (A, C, E) -30 to 80 nm (A) chylomicrons (B) VLDL (C) IDL (D) LDL (E) HDL

-1.006 to 1.019 kg/L density -TG & cholesterol = main component -B100, E -25 to 35 nm (A) chylomicrons (B) VLDL (C) IDL (D) LDL (E) HDL

-1.019 to 1.063 kg/L density -cholesterol = main component -B100 -18 to 25 nm (A) chylomicrons (B) VLDL (C) IDL (D) LDL (E) HDL

-1.063 to 1.210 kg/L density -protein = main component -AI, AII (C, E) -5 to 12 nm (A) chylomicrons (B) VLDL (C) IDL (D) LDL (E) HDL

-10 to 15% of all renal cancers -Frequently multifocal & bilateral & appear as early-stage tumors -MET proto-oncogene on chromsome 7q (A) Oncocytoma (B) Clear cell carcinoma (C) Papillary renal cell carcinomas (D) chromophobe renal carcinoma

-5 to 10% of blood antibodies -Pentameric structure w/ 5 Ig units connected via sulfhydryl bonds & a J chain -5 day half-life -1st class produced during primary immune response -Found on B cells (A) IgG (B) IgA (C) IgM (D) IgE (E) IgD

-5 to 15% of blood antibodies -6 day half-life -Found in blood, tears, colostrum, intestinal, & respiratory secretions, & saliva -Consists of 2 antibodies joined by a J chain & secretory component (A) IgG (B) IgA (C) IgM (D) IgE (E) IgD

-5% of renal cell carcinomas -Arise from intercalated cells of collecting ducts -Tumor cells stain more darkly (i.e. less clear) -Extreme hypoploidy (A) Oncocytoma (B) Clear cell carcinoma (C) Papillary renal cell carcinomas (D) chromophobe renal carcinoma

-65% of renal cell cancers -Histologically - cells with clear cytoplasm -Abnormalities of chromsome 3 -Sporadic, familial, or in association with VHL disease (A) Oncocytoma (B) Clear cell carcinoma (C) Papillary renal cell carcinomas (D) chromophobe renal carcinoma

-75 to 85% of blood antibodies -longest half-life -opsonize antigens, activate complement, & cross placenta during pregnancy -Mediates antibody-dependent cellular cytotoxicity (A) IgG (B) IgA (C) IgM (D) IgE (E) IgD

-Atria contract -Final phase of ventricular filling -P wave -S4 heart sound (A) Atrial Systole (B) Isovolumetric Ventricular Contraction (C) Rapid Ventricular Ejection (D) Reduced Ventricular Ejection (E) Isovolumetric Ventricular Relaxation (F) Rapid Ventricular Filling (G) Reduced Ventricular Filling or Diastasis

-Atypical chest pain (not related to exertion & worse in recumbency) & prominent friction rub -Cardiac tamponade if fluid accumulation (A) restrictive cardiomyopathy (B) rheumatic fever heart disease (C) myocarditis (D) pericarditis

-Autosomal dominant disorder -Classically manifests w/ R-sided heart failure & rhythm disturbances that can cause sudden cardiac death -Causative mutations involve genes encoding desmosomal junctional proteins (A) Dilated cardiomyopathy (B) Hypertrophic cardiomyopathy (C) Restrictive cardiomyopathy (D) arrhythmogenic right ventricular cardiomyopathy

-BP > 180/110 -No organ damage - Tmt w/i 1 week (A) severe uncontrolled HTN (B) acute HTN (Hypertensive crisis) (C) Malignant HTN (D) Isolated HTN

-BP > 180/120 -Organ damage -early treatment & f/u within 1 to a few days (A) severe uncontrolled HTN (B) acute HTN (Hypertensive crisis) (C) Malignant HTN (D) Isolated HTN

-Basal medium (tryptic soy agar & sheep blood) -Identify β-hemolytic bacteria (strep pyogens) (A) blood agar (B) chocolate agar (C) buffered charcoal yeast extract (BCYE) (D) Mueller-Hinton Agar

-Block conversion of angiotensin I to angiotensin II -Maintain lowered BP by elevating bradykinin in blood (A) diuretics (B) ACE inhibitors (C) Angiotensin receptor agonists (D) CCBs

-Blood flow to an organ is proportional to its metabolic activity -Example: metabolic activity in skeletal muscle increases b/c of strenuous exercise → blood flow to muscle will increase proportionately to meet metabolic demands (A) Autoregulation (B) Active hyperemia (C) Reactive hyperemia (D) Hormonal (extrinsic) control of blood flow

-Blood flow to an organ remains constant over a wide range of perfusion pressures -Heart, Brain, & Kidney -Example: perfusion P to heart suddenly decreased → compensatory vasodilation of arterioles to maintain constant flow (A) Autoregulation (B) Active hyperemia (C) Reactive hyperemia (D) Hormonal (extrinsic) control of blood flow

-Caused by an autoimmune response, most often directed against the PLA2R on podocytes -Characterized by granular subepithelial deposits of antibodies w/ GBM "spike" formation, thickening, & loss of foot processes (A) Minimal-change disease (B) Focal Segmental Glomerulosclerosis (C) Membranous Nephropathy (D) Membranoproliferative GN Type I

-Caused by mutations in genes encoding GBM collagen -Manifests as hematuria & slowly progressing proteinuria & declining renal function (A) Hereditary Nephritis (Alport) (B) IgA nephropathy (C) Membranous Nephropathy (D) Membranoproliferative GN Type I

-Causes arteriolar constriction -Released in response to blood vessel damage to help prevent blood loss -Implicated in vascular spasms of migraine headaches (A) Histamine (B) Bradykinin (C) Serotonin (5-hydroxytryptamine) (D) Prostaglandins

-Causes arteriolar dilation & venous constriction → increased Pc & increased filtration OUT of capillaries → local edema -released in response to tissue trauma (A) Histamine (B) Bradykinin (C) Serotonin (5-hydroxytryptamine) (D) A & B

-Characterized by multiple expanding cysts affecting both kidneys that ultimately destroy the intervening parenchyma -Usually mutation in PKD1 on chromosome 16 short arm that alters mechanosensation by tubular cilia (A) Alport syndrome (B) Goodpasture syndrome (C) Autosomal dominant (adult) polycystic kidney disease (D) Autosomal recessive (childhood) polycystic kidney disease

-Conjugate vaccine -Cleared by FDA in 2010 -Age 2 to 55 (A) Menomune (MPSV-4) (B) Menactra (MCV-4) (C) Menveo (CRM197)

-Controlled by extrinsic sympathetic innervation of blood vessels in skeletal muscle AND by local metabolic factors -Important local vasodilators are lactate, adenosine, & K+ (A) skeletal muscle (B) pulmonary circulation (C) coronary circulation (D) cerebral circulation

-Coolness -Syncope -Chest pain -Hyperventilation The above signs point towards (A) ischemia (B) necrosis (C) infarction (D) all of the above

-Defense against parasitic infections -1 to 3% of WBCs (A) neutrophils (B) monocytes (C) basophils (D) eosinophils

-Depolarization of atria -Correlates with conduction time through atria (A) P wave (B) PR interval (C) QRS complex (D) T wave (E) QT interval

-Detects DNA (ds) -Agarose gel electrophoresis -DNA, radioactive, or nonradioactive probe used -DNA-DNA hybridization (A) Southern blot (B) Northern blot (C) Western blot (D) Eastern blot

-Detects mRNA (ss) -Formaldehyde agarose gel electrophoresis -cDNA, cRNA, radioactive or nonradioactive probe used -DNA-RNA hybridization (A) Southern blot (B) Northern blot (C) Western blot (D) Eastern blot

-Detects proteins -Polyacrylamide gel electrophoresis -Primary antibody probe used (A) Southern blot (B) Northern blot (C) Western blot (D) Eastern blot

-Dilation of the renal pelvis & calyces, w/ accompanying atrophy of the parenchyma, caused by obstruction to outflow or urine -Central stellate scar -Plethora of MT (A) Oncocytoma (B) Clear cell carcinoma (C) Papillary renal cell carcinomas (D) chromophobe renal carcinoma

-Diphtheria toxoid conjugate vaccine -Cleared by FDA in Jan 2005 -Age 2 to 55 -Recommended for all kids age 11 to 18 (A) Menomune (MPSV-4) (B) Menactra (MCV-4) (C) Menveo (CRM197)

-Enzyme activators & inhibitors -Extensively exchanged b/w different lipoprotein classes (A) ApoAI (B) ApoE (C) ApoC (D) Apo(a)

-Exhibits autoregulation -Exhibits active & reactive hyperemia -Most important local metabolic factor is CO2 (A) skeletal muscle (B) pulmonary circulation (C) coronary circulation (D) cerebral circulation

-Exhibits autoregulation -Exhibits active & reactive hyperemia -Most important local metabolic factors are hypoxia & adenosine (A) skeletal muscle (B) pulmonary circulation (C) coronary circulation (D) cerebral circulation

-Follows ARP -Possible to generate another action potential if greater than normal stimulus (A) Absolute Refractory Period (ARP) (B) Effective Refractory Period (ERP) (C) Relative Refractory Period (RRP) (D) Supranormal Period (SNP)

-Follows RRP -Starts when MP = -70 mV and ends when MP = -85 mV -Cell more excitable than normal because Na+ channels are recovered (A) Absolute Refractory Period (ARP) (B) Effective Refractory Period (ERP) (C) Relative Refractory Period (RRP) (D) Supranormal Period (SNP)

-Gram negative diplococci with pili -nonmotile -metabolize glucose oxidatively (A) N gonorrhea (B) N meningitidis (C) E corrodens (D) M catarrhalis

-Gram-negative Rods -Infections associated with human bite wounds -Causes subacute endocarditis with gradual onset of low fever, chills, & night sweats (A) N gonorrhea (B) N meningitidis (C) E corrodens (D) M catarrhalis

-Gram-negative bacteria -Can differentiate b/w lactose fermenters (turn indicator RED) & non-fermenters (A) MacConkey agar (B) Xylose lysine deoxycholate agar (C) Löwenstein-Jensen medium & Middlebrook agar (D) Mannitol salt agar

-Includes ARP -Na+ channels start to become unavailable to carry inward current -Conducted action potential cannot be generated (A) Absolute Refractory Period (ARP) (B) Effective Refractory Period (ERP) (C) Relative Refractory Period (RRP) (D) Supranormal Period (SNP)

-Increase in blood flow to an organ that occurs after a period of occlusion of flow -The longer the period of occlusion → the greater the increase in blood flow above preocclusion levels (A) Autoregulation (B) Active hyperemia (C) Reactive hyperemia (D) Hormonal (extrinsic) control of blood flow

-Initial depolarization of atria → initial depolarization of ventricles (A) P wave (B) PR interval (C) QRS complex (D) T wave (E) QT interval

-Injury to podocytes thought to present initiating event -affected glomeruli exhibit increased mesangial matrix, obliterated capillary lumina, hyalinosis, & foamy macrophages -Collapsing glomerulopathy (A) Minimal change Disease (B) Focal Segmental Glomerulosclerosis (FSGS) (C) Membranous Nephropathy (D) Membranoproliferative GN

-Iron & L-cysteine in medium -Legionella bacteria -Addition of antibiotics can make it selective for Brucella (A) Sabouraud dextrose agar (B) chocolate agar (C) buffered charcoal yeast extract (BCYE) (D) Mueller-Hinton Agar

-Isolation & growth of fungi -Add antibacterial agents & use low pH to make it selective for fungi (A) Sabouraud dextrose agar (B) chocolate agar (C) buffered charcoal yeast extract (BCYE) (D) Mueller-Hinton Agar

-Kidney failure - ESRD -Loss of ≥ 75% of normal renal function -GFR < 15 (or dialysis) (A) stage 1 (B) stage 2 (C) stage 3 (D) stage 4 (E) stage 5

-Light passing through condenser to specimen -Total magnification = objective lens x ocular lens -Resolving power about 0.2µm (A) bright-field microscopy (B) dark-field microscopy (C) phase contrast microscopy (D) fluorescence microscopy

-Mainly cortical -Simple cuboidal cells w/ long microvilli in lumen -Abundant mitochondria -Large interdigitating basolateral folds (A) renal corpuscle (B) PCT (C) Loop of Henle (D) DCT

-Marked limitation of activity -Less than ordinary physical activity results in symptoms, but patients are comfortable at rest (A) class I (B) class II (C) class III (D) class IV

-Mineralocorticosteroid produced in adrenal cortex -regulates sodium & potassium homeostasis (A) Renin (B) Aldosterone (C) ACE (D) angiotensin II

-Mitogen for all erythroid progenitor & precursor cells, also promoting their differentiation -source - peritubular endothelial cells of kidney/hepatocytes (A) stem cell factor (SCF) (B) Erythropoietin (EPO) (C) Thrombopoietin (TPO) (D) Granulocyte Colony-Stimulating Factor (G-CSF) (E) Monocyte Colony-Stimulating (M-CSF) (F) IL-1

-Mitogen for all hemopoietic progenitor cells -source - stromal cells of bone marrow (A) stem cell factor (SCF) (B) Erythropoietin (EPO) (C) Thrombopoietin (TPO) (D) Granulocyte Colony-Stimulating Factor (G-CSF) (E) Monocyte Colony-Stimulating (M-CSF) (F) IL-1

-Mitogen for megakaryoblasts & their progenitor cells -source - kidney & liver (A) stem cell factor (SCF) (B) Erythropoietin (EPO) (C) Thrombopoietin (TPO) (D) Granulocyte Colony-Stimulating Factor (G-CSF) (E) Monocyte Colony-Stimulating (M-CSF) (F) IL-1

-Mitogen for monocyte precursor cells -source - endothelial cells of marrow & macrophages (A) stem cell factor (SCF) (B) Erythropoietin (EPO) (C) Thrombopoietin (TPO) (D) Granulocyte Colony-Stimulating Factor (G-CSF) (E) Monocyte Colony-Stimulating (M-CSF) (F) IL-1

-Mitogen for neutrophil precursor cells -source - endothelial cells of bone marrow & macrophages (A) stem cell factor (SCF) (B) Erythropoietin (EPO) (C) Thrombopoietin (TPO) (D) Granulocyte Colony-Stimulating Factor (G-CSF) (E) Monocyte Colony-Stimulating (M-CSF) (F) IL-1

-Mitral valves show leaflet thickening, commissural fusion & shortening, & thickening & fusion of the chordae tendinae → valvular stenosis & regurgitation (A) SCD (B) chronic MI (C) chronic rheumatic heart disease (D) unstable angina

-Moderate ↓ in GFR w/ loss of 50% or more of normal renal function -GFR = 30 to 59 -at higher risk for CKD (A) stage 1 (B) stage 2 (C) stage 3 (D) stage 4 (E) stage 5

-Most common congenital cardiac anomaly at birth -Associated w/ large L-to-R shunt → R ventricular hypertrophy & dilation -can cause pulmonary HTN & CHF (A) ASD (B) VSD (C) PDA (D) Tetralogy of Fallot

-Mutations in genes encoding apoA1, ABCA1 transporter, & LCAT -Corneal clouding, arteriosclerosis, & xanthelasma The above are related to conditions causing (A) low HDL concentration (B) low LDL concentration (C) high HDL concentration (D) high LDL concentration

-No limitation of physical activity -No dyspnea, fatigue, or palpitations w/ ordinary physical activity (A) class I (B) class II (C) class III (D) class IV

-Normal or slightly increased GFR associated w/ some degree of kidney damage -GFR ≥ 90 -Asymptomatic w/ slight decline in renal function (A) stage 1 (B) stage 2 (C) stage 3 (D) stage 4 (E) stage 5

-Polysaccharide vaccine -Cleared by FDA in 1981 -Used for age 9 months to 55 years + older people at risk (A) Menomune (MPSV-4) (B) Menactra (MCV-4) (C) Menveo (CRM197)

-Premature occurrence of abnormally shaped QRS complex (ventricular contraction) followed by a pause -Provoked by medications; electrolyte imbalance; tension states; & excessive use of tobacco, caffeine, & alcohol (A) Premature Ventricular Complexes (PVCs) (B) Ventricular tachycardia (VT) (C) Ventricular flutter (D) VFIB

-Rapid, regular atrial rate of 250 to 350 beats/min -Often in association w/ septal defects, pulmonary emboli, obstructive lung disease, mitral or tricuspid valve stenosis or regurgitation, or chronic ventricular failure (A) Atrial Premature beats (APBs) (B) Atrial flutter (C) AFIB (D) Atrial tachycardias

-Reduce plasma volume by increasing Na+ & water excretion -Decrease BP by decreasing CO initially then by reduction in peripheral resistance (A) diuretics (B) ACE inhibitors (C) Angiotensin receptor agonists (D) CCBs

-Regulates activities & cytokine secretion of many leukocytes & other cells -source - Macrophages & T helper cells (A) stem cell factor (SCF) (B) Erythropoietin (EPO) (C) Thrombopoietin (TPO) (D) Granulocyte Colony-Stimulating Factor (G-CSF) (E) Monocyte Colony-Stimulating (M-CSF) (F) IL-1

-Severe ↓ in GFR (15 - 29) (A) stage 1 (B) stage 2 (C) stage 3 (D) stage 4 (E) stage 5

-Slight limitation of physical activity -Patients experience fatigue, palpitations, & dyspnea with ordinary physical activity but are comfortable at rest (A) class I (B) class II (C) class III (D) class IV

-Stabilized by disulfide bridges & kringles -synthesized in liver -binds to LDL receptor -component of Lp(a) (A) ApoAI (B) ApoE (C) ApoC (D) Apo(a)

-Staphylococci bacteria -Turn phenol red-yellow in presence of staph aureus (A) MacConkey agar (B) Xylose lysine deoxycholate agar (C) CandiSelect 4 agar & CHOMagar (D) Mannitol salt agar

-Stimulates LPL, hepatic triglyceride lipase (HGLT) & LCAT -In HDL, contributes to cholesterol removal from cells -Synthesized in brain by astrocytes & microglia - affects growth & repair of CNS cells (A) ApoAI (B) ApoE (C) ApoC (D) Apo(a)

-Symmetrically atrophic kidneys -Hyaline arteriosclerosis -Fibroelastic hyperplasia (A) Hereditary Nephritis (Alport) (B) IgA nephropathy (C) Nephrosclerosis (D) Acute Tubular Injury

-Symptoms are present with the patient at rest -Any physical exertion exacerbates the symptoms (A) class I (B) class II (C) class III (D) class IV

-Synthesized in enterocytes -Plasma concentration reflects sum of chylomicrons & chylomicron remnants (A) ApoAI (B) ApoAII (C) ApoB100 (D) ApoB48

-Synthesized in liver -Inhibits lipoprotein lipase (LPL) & serves as cofactor for LCAT & cholesterol ester transfer (CETP) (A) ApoAI (B) ApoAII (C) ApoB100 (D) ApoB48

-Synthesized in liver -VLDL, IDL, & LDL -Controls metabolism of LDL -Mutation → familial defective apoB (A) ApoAI (B) ApoAII (C) ApoB100 (D) ApoB48

-Synthesized in liver & intestine -Activates cholesterol-esterifying enzyme, LCAT -Marker of HDL concentration in plasma (A) ApoAI (B) ApoAII (C) ApoB100 (D) ApoB48

-Systolic 120-139 or diastolic 80-89 -Recheck in 1 year (A) Normal (B) Prehypertension (C) Stage 1 HTN (D) Stage 2 HTN

-Systolic 140-159 OR diastolic 90-99 -Confirm w/i 2 months (A) Normal (B) Prehypertension (C) Stage 1 HTN (D) Stage 2 HTN

-Systolic BP <120 & diastolic < 80 -Recheck in 2 years (A) Normal (B) Prehypertension (C) Stage 1 HTN (D) Stage 2 HTN

-Systolic ≥ 160 OR diastolic ≥ 100 -Evaluate & refer w/i 1 month (A) Normal (B) Prehypertension (C) Stage 1 HTN (D) Stage 2 HTN

-Tissue source - Heart, skeletal muscle, liver, brain -Diagnostic use - liver disease (A) AST (B) ALT (C) CK (D) LDH

-Tissue source - heart, liver, RBCs -Diagnostic use - lymphoma, hepatitis (A) AST (B) ALT (C) CK (D) LDH

-Tissue source - liver -Diagnostic use - liver disease (A) AST (B) ALT (C) CK (D) LDH

-Ventricles contract -Ventricular P increases -Ventricles eject blood into arteries -Ventricular V decreases -Aortic valve opens -Ventricular V reaches maximum (A) Atrial Systole (B) Isovolumetric Ventricular Contraction (C) Rapid Ventricular Ejection (D) Reduced Ventricular Ejection (E) Isovolumetric Ventricular Relaxation (F) Rapid Ventricular Filling (G) Reduced Ventricular Filling or Diastasis

-Ventricles contract -Ventricular P increases -All valves closed -QRS complex (A) Atrial Systole (B) Isovolumetric Ventricular Contraction (C) Rapid Ventricular Ejection (D) Reduced Ventricular Ejection (E) Isovolumetric Ventricular Relaxation (F) Rapid Ventricular Filling (G) Reduced Ventricular Filling or Diastasis

-Ventricles eject blood into arteries (slower rate) -Ventricular V reaches minimum -Aortic P starts to fall as blood runs off into arteries (A) Atrial Systole (B) Isovolumetric Ventricular Contraction (C) Rapid Ventricular Ejection (D) Reduced Ventricular Ejection (E) Isovolumetric Ventricular Relaxation (F) Rapid Ventricular Filling (G) Reduced Ventricular Filling or Diastasis

-Ventricles relaxed -Final phase of ventricular filling (A) Atrial Systole (B) Isovolumetric Ventricular Contraction (C) Rapid Ventricular Ejection (D) Reduced Ventricular Ejection (E) Isovolumetric Ventricular Relaxation (F) Rapid Ventricular Filling (G) Reduced Ventricular Filling or Diastasis

-Ventricles relaxed -Ventricles fill passively w/ blood from atria -Ventricular V increases -Ventricular P is low and constant -Mitral valve opens (A) Atrial Systole (B) Isovolumetric Ventricular Contraction (C) Rapid Ventricular Ejection (D) Reduced Ventricular Ejection (E) Isovolumetric Ventricular Relaxation (F) Rapid Ventricular Filling (G) Reduced Ventricular Filling or Diastasis

-Ventricles relaxed -Ventricular pressure decreases -Ventricular V is constant (all valves closed) (A) Atrial Systole (B) Isovolumetric Ventricular Contraction (C) Rapid Ventricular Ejection (D) Reduced Ventricular Ejection (E) Isovolumetric Ventricular Relaxation (F) Rapid Ventricular Filling (G) Reduced Ventricular Filling or Diastasis

-caused by mutation in apoB100 molecule that impairs its binding to the receptor -high plasma cholesterol (A) familial hypercholesterolemia (B) familial defective apolipoprotein B (FDB) (C) familial combined hyperlipidemia (D) Familial dysbetalipoproteinemia

-caused by mutation in apoE gene → apoE isoform w/ low affinity for LDL receptor → accumulation of remnant particles → increase in plasma cholesterol & triglycerides -palmar xanthomata (A) familial hypercholesterolemia (B) familial defective apolipoprotein B (FDB) (C) familial combined hyperlipidemia (D) Familial dysbetalipoproteinemia

-characterized by myocardial hypertrophy, defective diastolic filling, & - in 1/3 of cases - ventricular outflow obstruction -caused by missense mutations in 1 of several genes encoding proteins that form the contractile apparatus (A) Dilated cardiomyopathy (B) Hypertrophic cardiomyopathy (C) Restrictive cardiomyopathy (D) arrhythmogenic right ventricular cardiomyopathy

-limited to inner 1/3 of myocardium -caused by transient decreases in O2 delivery or increases in O2 demand (A) transmural infarction (B) subendocardial infarction (C) microscopic infarction (D) general MI

-most common cause of aortic stenosis -hypertrophied myocardium prone to ischemia & angina -calcified masses on outflow side of cusps protrude into sinuses of valsalva to impede valve opening (A) Calcific aortic stenosis (B) Myxomatous Mitral Valve (C) Rheumatic Valvular disase (D) infective endocarditis

-overproduction of apoB100 rather than receptor impairment -increased production of VLDL → increased generation of LDL -variable plasma lipid patterns (A) familial hypercholesterolemia (B) familial defective apolipoprotein B (FDB) (C) familial combined hyperlipidemia (D) Familial dysbetalipoproteinemia

-presents early as cyanosis localized to lower ½ of body -R ventricular hypertrophy -hypoplasia of aortic arch proximal to PDA (A) tetralogy of fallot (B) transposition of the great arteries (C) preductal aortic coarction (D) postductal aortic coarction

-protease produced by juxtaglomerular apparatus of kidney -released in response to decreased renal perfusion pressure (A) Renin (B) Aldosterone (C) ACE (D) angiotensin II

-results in extremely high VLDL, chylomicrons, & plasma triglycerides -rash-like skin xanthomata -associated with risk of pancreatitis (A) lipoprotein lipase deficiency (B) familial defective apolipoprotein B (FDB) (C) familial combined hyperlipidemia (D) Familial dysbetalipoproteinemia

-unexpected death due to a lethal arrhythmia such as asystole or sustained ventricular fibrillation -leading cause = coronary artery disease (A) angina pectoris (B) acute myocardial infarction (C) chronic IHD (D) sudden cardiac death (SCD)

-upper extremity HTN paired w/ weak pulses & relative hypotension in lower extremities -Notching of ribs on radiograph -L ventricle hypertrophy -discrete ridge-like infolding of aorta adjacent to ligamentum arteriosum (A) tetralogy of fallot (B) transposition of the great arteries (C) preductal aortic coarction (D) postductal aortic coarction

-↑ pCO2 -compensated by ↑ renal bicarbonate generation & ↑ in plasma bicarbonate (A) metabolic acidosis (B) metabolic alkalosis (C) respiratory acidosis (D) respiratory alkalosis

-↑ plasma bicarbonate -compensated by ↑ in pCO2 (hypoventilation) (A) metabolic acidosis (B) metabolic alkalosis (C) respiratory acidosis (D) respiratory alkalosis

-↓ pCO2 -compensated by ↓ renal bicarbonate reabsorption & ↓ plasma bicarbonate (A) metabolic acidosis (B) metabolic alkalosis (C) respiratory acidosis (D) respiratory alkalosis

-↓ plasma bicarbonate -compensated by ↓ pCO2 (hyperventilation) (A) metabolic acidosis (B) metabolic alkalosis (C) respiratory acidosis (D) respiratory alkalosis

1-D, 2-B, 3-C, 4-E, 5-A

1. Volume Contraction 2. Volume Expansion 3. Isosmotic disturbance 4. Hyperosmotic disturbance 5. Hyposmotic disturbance A. ↓ in ECF osmolarity B. ↑ in ECF volume C. no change in ECF osmolarity D. ↓ in ECF volume E. ↑ in ECF osmolarity

1-C, 2-B, 3-D, 4-A

1. fast HR 2. slow HR 3. irregular rhythm w/ normal ventricular contraction 4. chaotic depolarization w/o functional ventricular contraction A. asystole B. bradycardia C. tachcardia D. VFIB

65% of Americans 60 & older have HTN. Which of the following specifically becomes more prevalent pattern after age 60? (A) Isolated diastolic (B) Isolated systolic (C) primary HTN (D) secondary HTN

67% of Na+ is reabsorbed in the _____ (isosmotic reabsorption) (A) PCT (B) thick ascending limb of loop of Henle (C) Early DCT (D) Late DCT & collecting ducts

E (acute rheumatic fever)

A 10-year-old boy presents with migratory polyarthritis involving several large joints, fever, and malaise. Physical examination reveals a new heart murmur and friction rub on auscultation, and a painless nodule is detected on the extensor surface of the elbow. He had a severe sore throat approximately 2 weeks ago, apparently recovering without antibiotic therapy. The anti-streptolysin O (ASO) titer is elevated. Which of the following describes the most likely outcome for this patient? (A) Development of mitral valve stenosis over many months to years (B) Development of mitral valve stenosis over the next few months (C) Increasing severity of the current symptoms and findings over the next few decades (D) Persistence of the current symptoms and signs over the patient's lifetime (E) Total recovery after 1 to 2 months with no further complications or sequelae

A 10-year-old boy presents with vomiting, sweating, drooling, and a decreased heart rate. His friends state that he was in a corn field when it was sprayed by a crop duster. The chemical being sprayed was an organophosphate derivitive that covalently binds to acetylcholinesterase and inactivates the enzyme. What type of inhibition is being displayed? (A) Competitive (B) Noncompetitive (C) Irreversible (D) Feedback (E) Allosteric

A 12-year-old boy was admitted to a local hospital with a known history of heart problems. His left ventricular hypertrophy could result from which of the following conditions? (A) A constricted pulmonary trunk (B) An abnormally small left AV opening (C) Improper closing of the pulmonary valves (D) An abnormally large right AV opening (E) Stenosis of the aorta

A 14-year-old patient presents in the nephrology clinic with fatigue, malaise, anorexia, abdominal pain, and fever. She reports a loss of 6 lb in the past 2 months. Serum gamma globulin and the immunoglobulins IgG, IgA, and IgM are all elevated. Her serum creatine is 1.4 mg/dL (normal 0.6-1.2 mg/dL) and urinalysis of glucose and protein are 2+ on a dipstick test, confirmed by laboratory at 8.0 g/dL and 0.95 g/dL, respectively. A renal biopsy is prepared for light microscopy, and an infiltrate containing lymphocytes, plasma cells, and eosinophils is found among tubules having cells with prominent brush borders. Which one of the following statements correctly pertains to these epithelial cells? (A) Impermeable to water despite presence of ADH (B) The primary site for the reduction of the tubular fluid volume (C) The site of the countercurrent multiplier (D) The site of action of aldosterone (E) Indirectly involved in the release of renin

A 15-year-old male presents with hematuria, hearing loss, lens dislocation, and the onset of cataracts. Genetic analysis reveals a mutation in the COL4A5 gene. Transmission EM examination of a renal biopsy confirms that the disorder has affected a component of the renal corpuscles in which damage disrupts normal glomerular filtration. Which one of the following structures would most likely be abnormal in the TEM of this patient's biopsy? (A) Pedicels (B) Filtration slits (C) Slit diaphragms (D) Glomerular basement membranes (E) Fenestrated endothelium of glomerular capillaries

A 16-year-old boy is brought to the hospital by ambulance following a car accident causing serious head injuries. His blood pressure is 220/170 mmHg. Fundoscopy reveals retinal damage, and you administer nitroprusside via infusion. Control of the hypertension requires 72 hours and you notice the patient becoming increasingly fatigued and nauseous. The mostly likely cause of these symptoms is (A) Production of thiocyanate from nitroprusside (B) Negative inotropic activity of nitroprusside (C) Renal precipitation of nitroprusside (D) Accumulation of nitroprusside because of its long half-life (E) Production of hydroxocobalamin

A 19-year-old man came to the emergency department, and his angiogram exhibited that he was bleeding from the vein that is accompanied by the posterior interventricular artery. Which of the following veins is most likely to be ruptured? (A) Great cardiac vein (B) Middle cardiac vein (C) Anterior cardiac vein (D) Small cardiac vein (E) Oblique veins of the left atrium

A 2-year-old boy with visible abdominal distention is found to have an enormous left-sided flank mass apparently arising from, but dwarfing, the left kidney. The most likely diagnosis is (A) angiomyolipoma. (B) polycystic kidney. (C) renal cell carcinoma. (D) transitional cell carcinoma. (E) Wilms tumor.

A 20-year-old woman with the nephrotic syndrome and slowly progressive impairment of renal function marked by azotemia undergoes a renal biopsy. The patient's response to corticosteroid medication has been unimpressive. The biopsy shows diffuse thickening of the walls of the capillary loops. The most likely diagnosis is (A) focal segmental glomerulosclerosis. (B) membranous glomerulonephritis. (C) minimal change disease. (D) poststreptococcal glomerulonephritis. (E) rapidly progressive glomerulonephritis.

A 21-year-old patient with a stab wound reveals a laceration of the right vagus nerve proximal to the origin of the recurrent laryngeal nerve. Which of the following conditions would most likely result from this lesion? (A) Contraction of bronchial muscle (B) Stimulation of bronchial gland secretion (C) Dilation of the bronchial lumen (D) Decrease in cardiac rate (E) Constriction of coronary artery

A 22-year-old woman presents with fever, malaise, generalized arthralgias, and a skin rash over the nose and malar eminences. Which one of the following possible findings has the greatest relative significance in the overall prognosis for the patient? (A) Atypical verrucous vegetations of the mitral valve (B) Glomerular subendothelial immune complex deposition (C) Immune complexes at the dermal- epidermal junction in skin (D) Perivascular fibrosis in the spleen (E) Pleuritis

A 24-year-old woman presents to the emergency department with severe diarrhea. When she is supine (lying down), her blood pressure is 90/60 mm Hg (decreased) and her heart rate is 100 beats/min (increased). When she is moved to a standing position, her heart rate further increases to 120 beats/ min. Which of the following accounts for the further increase in heart rate upon standing? (A) Decreased total peripheral resistance (B) Increased venoconstriction (C) Increased contractility (D) Increased afterload (E) Decreased venous return

A 25-year-old man presents with generalized edema. Blood tests reveal severe proteinuria, hypoalbuminemia, and hyperlipidemia. The patient does not respond well to a course of corticosteroids. A renal biopsy demonstrates findings indicative of focal segmental glomerulosclerosis. Which of the following best describes the histologic findings in this disorder? (A) Crescentic formation in glomeruli on light microscopy (B) Intramembranous and epimembranous immune complex deposits in the glomerular basement membrane on electron microscopy (C) Nodular accumulations of mesangial matrix material on light microscopy (D) Sclerosis within capillary tufts that involves only some glomeruli and only parts of affected glomeruli on light microscopy (E) Wire-loop abnormalities from immune complex deposits and thickening of the glomerular basement membrane on light microscopy

A (Goodpasture syndrome)

A 25-year-old man presents with hematuria, periorbital edema, hypertension, and hemoptysis. He has also experienced nausea, vomiting, fever, and chills. Serologic testing is positive for antiglomerular basement membrane antibodies. Which of the following is the classic histologic finding in this renal disease? (A) Linear immunofluorescence (B) "Lumpy-bumpy" immunofluorescence (C) "Spike and dome" appearance of the glomerular basement membrane (D) Subendothelial immune complex deposition (E) Tram-track appearance of the glomerular basement membrane on electron microscopy

A 27-year-old cardiac patient with an irregular heartbeat visits her doctor's office for examination. Where should the physician place the stethoscope to listen to the sound of the mitral valve? (A) Over the medial end of the second left intercostal space (B) Over the medial end of the second right intercostal space (C) In the left fourth intercostal space at the midclavicular line (D) In the left fifth intercostal space at the midclavicular line (E) Over the right half of the lower end of the body of the sternum

A 27-year-old patient with Marfan syndrome has an aneurysm of the aortic arch. This may compress which of the following structures? (A) Right vagus nerve (B) Left phrenic nerve (C) Right sympathetic trunk (D) Left recurrent laryngeal nerve (E) Left greater splanchnic nerve

A 28-year-old woman presents with fever, dysuria, urinary frequency, and flank tenderness. The urine contained numerous neutrophils and many white cell casts. Urine protein was moderately increased. A quantitative urine culture revealed more than 105 bacteria per milliliter. The most likely causative organism is (A) Escherichia coli. (B) Haemophilus influenzae. (C) Neisseria gonorrhoeae. (D) Proteus vulgaris. (E) Pseudomonas aeruginosa.

A 3-year-old boy in good health began having generalized seizures consisting of a sudden turning of the head to the left, tonic posturing of the left arm, and loss of awareness for 1 to 2 minutes. The patient was successfully treated with the anticonvulsant phenytoin (dilantin). Dilantin is a substrate that binds to and is metabolized by an enzyme in the liver. Which one of the following statements best describes the relationship between an enzyme, substrate, and product? (A) Enzyme-product complexes enhance substrate binding. (B) All the active sites of the enzyme are saturated with substrate at high substrate concentrations. (C) At high substrate concentrations, substrate-substrate interactions interfere with enzyme activity. (D) At low substrate concentrations, none of the enzyme is found in the ES complex. (E) Significant product formation results in activation of the reaction.

A 3-year-old boy presents with cyanosis and shortness of breath that develops when he plays with friends. According to his mother, the boy was born cyanotic. The boy is very small and short for his age, and he squats on the floor next to his mother. Chest radiography reveals a boot-shaped heart, normal heart size, and a right aortic arch. Echocardiography reveals a large ventricular septal defect with an overriding aorta, pulmonary stenosis, and right ventricular hypertrophy. Which of the following is the most likely diagnosis? (A) Coarctation of the aorta (B) Patent ductus arteriosus (C) Rheumatic heart disease (D) Tetralogy of Fallot (E) Transposition of the great vessels

A 3-year-old girl presents with generalized edema shortly after recovery from an upper respiratory infection. Laboratory studies reveal marked albuminuria, as well as hypoalbuminemia and hyperlipidemia. Prior similar episodes responded to adrenal steroid medication. The most likely diagnosis is (A) focal segmental glomerulosclerosis. (B) membranous glomerulonephritis. (C) minimal change disease. (D) poststreptococcal glomerulonephritis. (E) rapidly progressive glomerulonephritis.

A 30-year-old female patient's electrocardiogram (ECG) shows two P waves preceding each QRS complex. The interpretation of this pattern is (A) decreased firing rate of the pacemaker in the sinoatrial (SA) node (B) decreased firing rate of the pacemaker in the atrioventricular (AV) node (C) increased firing rate of the pacemaker in the SA node (D) decreased conduction through the AV node (E) increased conduction through the His-Purkinje system

A 30-year-old man presents with hypertension, hematuria, palpable renal masses, and flank pain. He states that a kidney disease runs in his family, and his mother and maternal grandfather have it. Laboratory abnormalities confirm renal failure. Which of the following is associated with the disorder described here? (A) Autosomal recessive inheritance (B) Berry aneurysm of the circle of Willis (C) Clinical manifestation most commonly at birth (D) Multiple small medullary cysts in both kidneys (E) Presence of uric acid stones

A 32-year-old patient who weighs 275 lb comes to the doctor's office. On the surface of the chest, the physician is able to locate the apex of the heart: (A) At the level of the sternal angle (B) In the left fourth intercostal space (C) In the left fifth intercostal space (D) In the right fifth intercostal space (E) At the level of the xiphoid process of the sternum

A 37-year-old man is brought to the emergency department complaining of severe chest pain. His angiogram reveals thromboses of both brachiocephalic veins just before entering the superior vena cava. This condition would most likely cause a dilation of which of the following veins? (A) Azygos (B) Hemiazygos (C) Right superior intercostal (D) Left superior intercostal (E) Internal thoracic

A 37-year-old patient with palpitation was examined by her physician, and one of the diagnostic records included a posterior-anterior chest radiograph. Which of the following comprises the largest portion of the sternocostal surface of the heart seen on the radiograph? (A) Left atrium (B) Right atrium (C) Left ventricle (D) Right ventricle (E) Base of the heart

A 37-year-old patient with severe chest pain, shortness of breath, and congestive heart failure was admitted to a local hospital. His coronary angiograms reveal a thrombosis in the circumflex branch of the left coronary artery. Which of the following conditions could result from the blockage of blood flow in the circumflex branch? (A) Tricuspid valve insufficiency (B) Mitral valve insufficiency (C) Ischemia of AV node (D) Paralysis of pectinate muscle (E) Necrosis of septomarginal trabecula

A 4-year-old boy is taken by his parents to the pediatrician because of vomiting, head aches, and tenderness in the bones of his arms and legs. On palpation, the physician notes that many lymph nodes are enlarged, as is the liver. The pediatrician should order a complete blood count in order to determine whether or not the child may have (A) chronic leukemia. (B) infectious mononucleosis (C) von Willebrand disease (D) acute leukemia. (E) pernicious anemia

A 4-year-old boy presents with severe proteinuria, hypoalbuminemia, generalized edema, and hyperlipidemia. The patient improves on an empiric trial of corticosteroids, with complete resolution of proteinuria. Which of the following is the most likely diagnosis? (A) Diabetic nephropathy (B) Focal segmental glomerulosclerosis (C) Lupus nephropathy (D) Membranous glomerulonephritis (E) Minimal change disease

A 42-year-old man is seen because of a long history of slowly developing congestive heart failure. His blood pressure is normal. Coronary artery angiography reveals no vascular disease. No heart murmurs are heard. The white blood cell count, differential, and erythrocyte sedimentation rate are normal. The most likely diagnosis is (A) carcinoid heart disease. (B) cardiomyopathy. (C) coarctation of the aorta. (D) constrictive pericarditis. (E) myocardial infarction.

A 43-year-old woman notices a lump in her left breast which upon pathological examination of a needle biopsy is diagnosed as stage 3 adenocarcinoma of the mammary gland. She elects to have a single mastectomy and the surgeon also removes several axillary lymph nodes to be examined to determine the tumor's state of metastasis. The patient recovers well from the surgery, but at a 6-month follow-up visit at the clinic her upper left arm is seen to be swollen and the surgeon prescribes a bandage wrap for "lymph edema." This condition likely resulted from which of the following? (A) Angiogenesis from arterial branches that brought blood to the left breast (B) Growth of cancer cells and blockage of lymphatic drainage from the left arm (C) Surgical disruption of the left arm's lymphatic drainage by removal of lymph nodes (D) Surgical damage to the thoracic duct during lymph node removal (E) Hypertrophy of the vessels in the upper arm to accommodate blood otherwise flowing to the left breast

A 44-year-old African-American woman visits her family physician for a physical examination at the urging of her husband. She has no current complaints and is taking no medications. She is allergic to erythromycin. She works as a software developer and lives with her 52-year-old husband and 12-year-old daughter. She is a nonsmoker and drinks an occasional glass of wine when she and her husband go out to dinner. She is involved in no regular exercise. Her mother is 66 and suffers from type II diabetes, hyperlipidemia, and hypertension and had a myocardial infarction last year. The patient's father died of a stroke last year at the age of 72. On examination, the patient's blood pressure is 155/100 mm Hg, pulse 84, weight 215 lb (increased from 180 lb 3 years ago), and height 5 ft. 7 in. In this patient, during the period of weight gain which one of the following responses would be most likely in her white fat? (A) Increased synthesis of growth hormone (B) Decreased synthesis of leptin (C) Increased release of chylomicrons to the blood (D) Decreased conversion of beige adipocytes to unilocular white adipocytes (E) Increased incorporation of fatty acids into triglycerides

A 44-year-old man with a stab wound was brought to the emergency department, and a physician found that the patient was suffering from a laceration of his right phrenic nerve. Which of the following conditions has likely occurred? (A) Injury to only GSE fibers (B) Difficulty in expiration (C) Loss of sensation in the fibrous pericardium and mediastinal pleura (D) Normal function of the diaphragm (E) Loss of sensation in the costal part of the diaphragm

A 45-year-old man comes to the emergency department in obvious severe pain. He states that he has severe pain in his right flank that extends down to his right groin. The pain is sharp and severe, and it started several minutes earlier. An abdominal radiograph demonstrates the presence of right ureteral urolithiasis. Which of the following is the most likely composition of this patient's stone? (A) Ammonium magnesium phosphate (B) Calcium (C) Cystine (D) Uric acid

A 45-year-old man presents with nephrolithiasis or kidney stones. The process of calcium oxalate stone formation as seen in this patient begins with Randall plaques found in the basement membranes of which one of the following structures found only in the renal medulla? (A) Proximal convoluted tubules (B) Distal convoluted tubules (C) Thin loops of Henle (D) Afferent arterioles (E) Collecting ducts

A 45-year-old woman develops severe diarrhea while on vacation. She has the following arterial blood values: pH = 7.25 Pco2 = 24 mm Hg [HCO3-] = 10 mEq/L Venous blood samples show decreased blood [K+] and a normal anion gap. The correct diagnosis for this patient is (A) metabolic acidosis (B) metabolic alkalosis (C) respiratory acidosis (D) respiratory alkalosis (E) normal acid-base status

A 45-year-old woman develops severe diarrhea while on vacation. She has the following arterial blood values: pH = 7.25 Pco2 = 24 mm Hg [HCO3-] = 10 mEq/L Venous blood samples show decreased blood [K+] and a normal anion gap. Which of the following statements about this patient is correct? (A) She is hypoventilating (B) The decreased arterial [HCO3-] is a result of buffering of excess H+ by HCO3- (C) The decreased blood [K+] is a result of exchange of intracellular H+ for extracellular K+ (D) The decreased blood [K+] is a result of increased circulating levels of aldosterone (E) The decreased blood [K+] is a result of decreased circulating levels of antidiuretic hormone (ADH)

A 45-year-old woman presents with a tumor confined to the posterior mediastinum. This could result in compression of which of the following structures? (A) Trachea (B) Descending aorta (C) Arch of the aorta (D) Arch of the azygos vein (E) Phrenic nerve

A 46-year-old patient comes to his doctor's office and complains of chest pain and headache. His computed tomography (CT) scan reveals a tumor located just superior to the root of the right lung. Blood flow in which of the following veins is most likely blocked by this tumor? (A) Hemiazygos vein (B) Arch of the azygos vein (C) Right subclavian vein (D) Right brachiocephalic vein (E) Accessory hemiazygos vein

A 47-year-old man with a known atrial fibrillation returns to see his cardiologist for follow-up of his cardiac health. The right atrium is important in this case because it: (A) Receives blood from the oblique cardiac vein (B) Is associated with the apex of the heart (C) Contains the SA node (D) Receives the right pulmonary vein (E) Is hypertrophied by pulmonary stenosis

A 5-year-old boy diagnosed with post- streptococcal glomerulonephritis was admitted to the hospital several weeks ago. Over the last several weeks, his clinical state has not improved. Severe oliguria has developed, his serum creatinine has continued to rise, and his glomerular filtration rate has decreased by 50% since his admission to the hospital. Which of the following is the most likely diagnosis? (A) Alport syndrome (B) Membranoproliferative glomerulonephritis (C) Membranous glomerulonephritis (D) Rapidly progressive glomerulonephritis (E) Renal papillary necrosis

E (poststreptococcal glomerulonephritis)

A 5-year-old boy presents with "tea- colored urine," oliguria, and periorbital edema. He had a sore throat 2 weeks ago that had resolved before his parents sought medical treatment. The patient is found to be hypertensive. Urea nitrogen and creatinine are elevated. Antistreptolysin O titer and anti-DNAase B titer are also elevated. Urine tests are positive for blood and red cell casts. Which of the following is the most likely mechanism for this patient's condition? (A) Acute bacterial infection of the kidneys (B) Amyloid deposits (C) ANCA-positive vasculitis (D) Antibody against glomerular basement membrane antigens (E) Immune complex deposits

A 5-year-old boy presents with hematuria. His mother states that he has had a sore throat for the past 2 days and that he has had hematuria a few times in the past, also concomitantly with a sore throat. She states that his urine usually returns to a normal clear yellow color after a few days. Which of the following is the most likely diagnosis? (A) Alport syndrome (B) Goodpasture syndrome (C) IgA nephropathy (D) Membranoproliferative glomerulonephritis (E) Poststreptococcal glomerulonephritis

A 5-year-old boy swallows a bottle of aspirin (salicylic acid) and is treated in the emergency room. The treatment produces a change in urine pH that increases the excretion of salicylic acid. What was the change in urine pH, and what is the mechanism of increased salicylic acid excretion? (A) Acidification, which converts salicylic acid to its HA form (B) Alkalinization, which converts salicylic acid to its A- form (C) Acidification, which converts salicylic acid to its A- form (D) Alkalinization, which converts salicylic acid to its HA form

A 5-year-old girl is brought to the emergency department because of difficulty breathing (dyspnea), palpitations, and shortness of breath. Doppler study of the heart reveals an atrial septal defect (ASD). This malformation usually results from incomplete closure of which of the following embryonic structures? (A) Ductus arteriosus (B) Ductus venosus (C) Sinus venarum (D) Foramen ovale (E) Truncus arteriosus

A 50-year-old man presents with sudden weakness in his left leg. He has felt well lately and has no past medical history of coronary artery disease, hyperlipidemia, or hypertension, and no family history of myocardial infarction or stroke. Physical examination reveals motor weakness in the left leg, with no other neurologic deficits, and no cardiac murmur. Magnetic resonance imaging of the brain demonstrates a small ischemic infarct in the arterial distribution of the brain correlating with motor control of the left leg. Angiography and echocardiography reveal normal coronary arteries, normal valves with no vegetations, and a small right-to-left shunt. Which of the following is most likely associated with this scenario? (A) Atrial septal defect (B) Bacterial endocarditis (C) Nonbacterial thrombotic (marantic) endocarditis (D) Tetralogy of Fallot (E) Ventricular septal defect

A 50-year-old man with hypertension and the nephrotic syndrome undergoes a renal biopsy. The biopsy shows nodular glomerulosclerosis. Of the following possible additional laboratory findings, which one is most characteristically associated with this lesion? (A) Decreased creatinine clearance (B) Fixed specific gravity of urine (C) Hyperglycemia (D) Hypocalcemia (E) Increased blood urea nitrogen

A 50-year-old woman with a 20-year history of type 2 diabetes mellitus presents with proteinuria, hypoalbuminemia, edema, and hyperlipidemia. She has not monitored her serum glucose levels over the past several years. Diabetic nephropathy is diagnosed. What is the classic morphologic finding in diabetic nephropathy? (A) Crescentic formation in glomeruli on light microscopy (B) Intramembranous and epimembranous immune complex deposits in the glomerular basement membrane on electron microscopy (C) Nodular accumulations of mesangial matrix on light microscopy (D) Sclerosis within capillary tufts that involves only some glomeruli and only parts of affected glomeruli on light microscopy (E) Wire-loop abnormalities from immune complex deposits and thickening of the glomerular basement membrane on light microscopy

D (Q = ∆P/R)

A 53-year-old woman is found, by arteriography, to have 50% narrowing of her left renal artery. What is the expected change in blood flow through the stenotic artery? (A) Decrease to 1⁄2 (B) Decrease to 1⁄4 (C) Decrease to 1⁄8 (D) Decrease to 1⁄16 (E) No change

A 53-year-old woman presents with dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, edema in the legs and feet, and fatigue. She has no history of angina, other signs of coronary artery disease, hypertension, or valvular disease. Echocardiography reveals cardiomegaly, with four-chamber hypertrophy and dilation. Which of the following is the most likely diagnosis? (A) Congestive or dilated cardiomyopathy (B) Hypertrophic cardiomyopathy (C) Myocarditis (D) Restrictive cardiomyopathy

A 54-year-old man presents with recurrent breathlessness and chronic fatigue. After routine tests followed by a bone marrow biopsy he is diagnosed with lymphocytic leukemia. Chemotherapy is administered to remove the cancerous cells, which also destroys the precursor cells of erythrocytes. To reestablish the erythrocytic lineage, which of the following cells should be transplanted? (A) Reticulocytes (B) Orthochromatophilic erythroblasts (C) Megakaryoblasts (D) Basophilic erythroblasts (E) Metamyelocytes

A 54-year-old patient is implanted with an artificial cardiac pacemaker. Which of the following conductive tissues of the heart had a defective function that required the pacemaker? (A) Atrioventricular (AV) bundle (B) AV node (C) Sinoatrial (SA) node (D) Purkinje fiber (E) Moderator band

A 54-year-old woman is diagnosed with congestive heart failure (CHF). You prescribe captopril, a medication proven to reduce her mortality. This agent delivers several benefits to patients with CHF. Which of the following effects is caused by this drug? (A) It has a high affinity for angiotensin II receptors (B) It promotes increased peripheral vascular resistance (C) It decreases cardiac output and increases afterload (D) It causes venodilation and induces natriuresis (E) It increases preload

A 55-year-old man presents with painless hematuria. On cystoscopy, a papillary mass is found in the bladder. Which of the following is a characteristic of this lesion? (A) Hematuria as a late manifestation (B) Marked tendency to recur after resection (C) Much more likely to be benign than malignant (D) Occurrence only in the bladder and nowhere else in the urinary tract (E) Usual presence of distant metastases at the time of diagnosis

A 55-year-old woman presents with complaints of chest pain. She states that the chest pain predictably occurs when she climbs four flights of stairs to reach her apartment or when she has been jogging for more than 10 minutes. She is particu- larly concerned because her mother died of a myocardial infarction at 50 years of age. Which of the following best describes this patient's state? (A) Arrhythmia (B) Myocardial infarction (C) Prinzmetal angina (D) Stable angina pectoris (E) Unstable angina pectoris

A 56-year-old patient recently suffered a myocardial infarction in the area of the apex of the heart. The occlusion by atherosclerosis is in which of the following arteries? (A) Marginal artery (B) Right coronary artery at its origin (C) Anterior interventricular artery (D) Posterior interventricular artery (E) Circumflex branch of the left coronary artery

A 56-year-old woman presents with dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, and pulmonary edema. She also presents with severe dizziness and syncope, fatigue, weight loss, and arthralgias. After undergoing several tests, she is diagnosed with a primary heart tumor that is causing a "ball-valve obstruction" of her mitral valve. Which of the following is the most likely tumor? (A) Fibroma (B) Leiomyoma (C) Lipoma (D) Myxoma (E) Rhabdomyoma

A 57-year-old patient has a heart murmur resulting from the inability to maintain constant tension on the cusps of the AV valve. Which of the following structures is most likely damaged? (A) Crista terminalis (B) Septomarginal trabecula (C) Chordae tendineae (D) Pectinate muscle (E) Anulus fibrosus

A 58-year-old man is given a glucose tolerance test. In the test, the plasma glucose concentration is increased and glucose reabsorption and excretion are measured. When the plasma glucose concentration is higher than occurs at transport maximum (Tm), the (A) clearance of glucose is zero (B) excretion rate of glucose equals the filtration rate of glucose (C) reabsorption rate of glucose equals the filtration rate of glucose (D) excretion rate of glucose increases with increasing plasma glucose concentrations (E) renal vein glucose concentration equals the renal artery glucose concentration

A 60-year-old businessman is evaluated by his physician, who determines that his blood pressure is significantly elevated at 185/130 mm Hg. Laboratory tests reveal an increase in plasma renin activity, plasma aldosterone level, and left renal vein renin level. His right renal vein renin level is decreased. What is the most likely cause of the patient's HTN? (A) Aldosterone-secreting tumor (B) Adrenal adenoma secreting aldosterone and cortisol (C) Pheochromocytoma (D) Left renal artery stenosis (E) Right renal artery stenosis

A 60-year-old man presents with angina. He has no past medical history of heart disease. On questioning, the patient reveals that he had repeated sexually transmitted diseases in the past, including a painless chancre (a hard, round sore) on his penis, for which he never sought medical attention. Rapid plasma reagin (RPR), Venereal Disease Research Laboratory (VDRL) slide test, and fluorescent treponemal antibody (FTA) serologic tests (indicative of syphilis infection) are positive. Echocardiography and computed tomography of the heart are performed. The history of untreated syphilis suggests that these tests will most likely detect which of the following abnormalities? (A) Aortic valvular insufficiency and linear calcification along the ascending aorta (B) Bicuspid aortic valve with aortic stenosis (C) Large valvular vegetations from bacterial endocarditis (D) Right-sided heart failure from the carcinoid syndrome (E) Small fibrin deposits on the mitral valve from nonbacterial thrombotic (marantic) endocarditis

B (renal cell carcinoma)

A 60-year-old woman dies of a tumor that had invaded the renal vein and entered the inferior vena cava. At autopsy, the kidney has cells with a clear cell appearance Which of the following is a characteristic or association of this neoplasm? (A) Adrenal origin (B) Hematuria (C) Hypocalcemia (D) Tumor cells in the urine (E) Typical symmetrical bilateral involvement

A 60-year-old-man is discharged after being observed in the hospital for 4 days following a myocardial infarction. He returns to his normal activities, which include sedentary work only. This point in time following a myocardial infarct is noteworthy for the special danger of which of the following? (A) Arrhythmia (B) Mural thrombosis (C) Myocardial (pump) failure (D) Myocardial rupture (E) Ventricular aneurysm

A 62-year-old man of African descent presents with exercise-induced angina. His serum cholesterol is 277 mg/dL (normal < 200), LDL is 157 (normal < 100), HDL is 43 (normal > 35), and triglycerides 170 (normal < 150). His body mass index (BMI) is 34 and his coronary risk ratio is 6.84 (normal < 5). Cardiac catheterization reveals an occlusion of the left anterior descending and the origin of the right coronary artery. This disease process initially involved which one of the following? (A) Smooth muscle cell proliferation (B) Formation of an intimal plaque (C) Intimal thickening through addition of collagen and elastin (D) Adventitial proliferation of fibroblasts (E) Injury to endothelial cells

A 62-year-old patient with pericardial effusion comes to a local hospital for aspiration of pericardial fluid by pericardiocentesis. The needle is inserted into the pericardial cavity through which of the following intercostal spaces adjacent to the sternum? (A) Right fourth intercostal space (B) Left fourth intercostal space (C) Right fifth intercostal space (D) Left fifth intercostal space (E) Right sixth intercostal space

A 62-year-old woman who is a heavy smoker has an advanced lung cancer that spread into her right third posterior intercostal space posterior to the midaxillary line. If cancer cells are carried in the venous drainage, they would travel first to which of the following veins? (A) SVC (B) Right superior intercostal vein (C) Right brachiocephalic vein (D) Azygos vein (E) Hemiazygos vein

A 64-year-old man complains of an acute onset of unilateral eye pain and reduction in visual acuity. On physical examination, you notice conjunctival injection (eye redness) and a mid- dilated and nonreactive pupil. Funduscopic examination reveals cupping of the optic disc. Recognizing the signs and symptoms as glaucoma, you administer the medication acetazolamide to decrease the production of aqueous fluid and lower the intraocular pressure. Acetazolamide is a noncompetitive inhibitor of carbonic anhydrase and, therefore, will lead to which of the following concerning the kinetic constants of carbonic anhydrase? (A) An increase in the apparent Km (B) A decrease in the apparent Km (C) An increase in Vmax (D) A decrease in Vmax (E) A decrease in both the apparent Km and Vmax

A 64-year-old woman presents with dependent peripheral edema in her ankles and feet. She has long-standing chronic obstructive lung disease and a long history of cigarette smoking. Further investigation reveals that she has cor pulmonale with right-sided heart failure. Which of the following is the most likely cause of the right-sided heart failure in this patient? (A) Constrictive pericarditis (B) Disease of the lungs or pulmonary vessels (C) Left-sided heart failure (D) Pulmonary infundibular or valvular stenosis (E) Systemic hypertension

A 66-year-old man diagnosed with type II diabetes 10 years earlier presents with an aching pain in the muscles of his lower extremities. He says the pain is relieved by rest and worsened by physical activity. His lower limbs appear cold, pale, discolored, and he has a sore on the skin of his left heel. He has a weak tibial pulse on both sides and poor skin filling from dermal capillaries. The problems with blood distribution in this patient's leg are most likely associated with what vascular structures? (A) Veins and venules (B) Arterioles (C) Branches of the aorta (D) Lymphatic vessels (E) Ventricles

A (ACE inhibitors cause dry productive cough)

A 66-year-old man presents to your office with a 5-month history of dry cough. He denies any other symptoms. His past medical history includes a recent myocardial infarction (MI), after which he was placed on several medications. He does not smoke, nor has he had a history of asthma. You decide that a medication side effect is the most likely cause of this patient's symptoms. Which medication might this be? (A) Lisinopril (B) Nitroglycerin (C) Lovastatin (D) Digoxin (E) Quinidine

A 66-year-old man, who has had a sympathectomy, experiences a greater- than-normal fall in arterial pressure upon standing up. The explanation for this occurrence is (A) an exaggerated response of the renin- angiotensin-aldosterone system (B) a suppressed response of the renin- angiotensin-aldosterone system (C) an exaggerated response of the baroreceptor mechanism (D) a suppressed response of the baroreceptor mechanism

A 70-year-old woman has a long history of metastatic colon cancer, and she donates her body for use in medical school anatomy courses. At death, the body is emaciated and cachectic, and gross dissection reveals small fibrin deposits arranged around the line of closure of the leaflets of the mitral valve. The valvular lesions most likely represent (A) bacterial endocarditis. (B) endocarditis of the carcinoid syndrome. (C) Libman-Sacks endocarditis. (D) nonbacterial thrombotic (marantic) endocarditis. (E) rheumatic endocarditis.

A 72-year-old woman, who is being treated with propranolol, finds that she cannot maintain her previous exercise routine. Her physician explains that the drug has reduced her cardiac output. Blockade of which receptor is responsible for the decrease in cardiac output? (A) α1 Receptors (B) β1 Receptors (C) β2 Receptors (D) Muscarinic receptors (E) Nicotinic receptors

A 75-year-old woman, who is admitted for the management of her recent stroke, develops increased blood pressure, up to 195/105, with a heart rate of 95. Her physician is worried about the possibility of cerebral hemorrhage into the preexisting infarct and decides to administer a fast-acting vasodilating agent, which is also commonly used for severe decompensated congestive heart failure (CHF). Which medication did the doctor use? (A) Nitroprusside (B) Furosemide (C) Dobutamine (D) Losartan (E) Digoxin

A 78-year-old man with long-standing prostatic nodular hyperplasia dies of a stroke. At autopsy, both kidneys demonstrate coarse asymmetric renal corticomedullary scarring, deformity of the renal pelvis and calyces, interstitial fibrosis, and atrophic tubules containing eosinophilic proteinaceous casts. These findings are most suggestive of (A) Berger disease. (B) chronic analgesic nephritis. (C) chronic pyelonephritis. (D) membranoproliferative glomerulone- phritis. (E) renal papillary necrosis.

A 9-month-old girl was admitted to the children's hospital with tachypnea (fast breathing) and shortness of breath. Physical examination further exhibits tachycardia (fast heart rate), a bounding peripheral pulse, and her angiographs reveal a patent ductus arteriosus. Which of the following embryonic arterial structures is most likely responsible for the origin of the patent ductus arteriosus? (A) Right fourth arch (B) Left fifth arch (C) Right fifth arch (D) Left sixth arch (E) Right sixth arch

A 9-year-old girl is diagnosed with acute rheumatic fever. Instead of recovering as expected, her condition worsens, and she dies. Which of the following is the most likely cause of death? (A) Central nervous system involvement (B) Endocarditis (C) Myocarditis (D) Pericarditis (E) Streptococcal sepsis

A cardiologist is on clinical rounds with her medical students. She asks them, "During the cardiac cycle, which of the following events occurs?" (A) AV valves close during diastole (B) Aortic valve closes during systole (C) Pulmonary valve opens during diastole (D) Blood flow in coronary arteries is maximal during diastole (E) Aortic valve closes at the same time as AV valve

A competitive inhibitor would cause which of the following? (A) An increase in the apparent Km (B) A decrease in the apparent Km (C) An increase in Vmax (D) A decrease in Vmax (E) A decrease in both the apparent Km and Vmax

A fenestrated elastic laminae in the thick tunica media is acharacteristic feature of which of the following? (A) Large Elastic artery (B) Medium Muscular artery (C) Small artery (D) veins

D (Goodpasture syndrome)

A glomerular immunofluorescent pattern for IgG similar to that shown in the figure would be expected in which of the following patients? (A) A 3-year-old girl with recurrent bouts of the nephrotic syndrome (B) A 9-year-old boy with "smoky" urine 2 weeks after recovery from a streptococcal infection (C) An 18-year-old woman with nephrotic syndrome and progressive chronic renal disease (D) A 25-year-old man with hemoptysis and hematuria (E) A 26-year-old woman with a "butterfly" rash

A healthy 35-year-old man is running a marathon. During the run, there is a increase in his splanchnic vascular resistance. Which receptor is responsible for the increased resistance? (A) α1 Receptors (B) β1 Receptors (C) β2 Receptors (D) Muscarinic receptors

A histological slide shows marked myocyte hypertrophy, haphazard myocyte disarray, & interstitial fibrosis & banana-like configuration in ventricular cavity. What is the most likely dx? (A) Dilated cardiomyopathy (B) Hypertrophic cardiomyopathy (C) Restrictive cardiomyopathy (D) arrhythmogenic right ventricular cardiomyopathy

A large number of immature neutrophils (band cells) is known as "shift to the left" and is a sign of (A) leukemia (B) bacterial infection (C) anemia (D) liver failure

A major mechanism for changing blood flow in the cardiovascular system is by changing ______ of blood vessels, mainly _______ (A) pressure gradient; arteries (B) pressure gradient; venules (C) resistance; venules (D) resistance; arterioles

A man presents with hypertension and hypokalemia. Measurement of his arterial blood gases reveals a pH of 7.5 and a calculated HCO3− of 32 mEq/L. His serum cortisol and urinary vanillylmandelic acid (VMA) are normal, his serum aldosterone is increased, and his plasma renin activity is decreased. Which of the following is the most likely cause of his hypertension? (A) Cushing syndrome (B) Cushing disease (C) Conn syndrome (primary hyperaldosterinism) (D) Renal artery stenosis (E) Pheochromocytoma

A mother with diabetes gives birth to a baby who is diagnosed as having dextroposition of the aorta and the pulmonary trunk with cyanosis and shortness of breath. Which of the following structures is required to remain patent until surgical correction of the deformity? (A) Umbilical arteries (B) Umbilical vein (C) Ductus arteriosus (D) Ductus venosus (E) Sinus venosus

A negative free-water clearance (−CH2O ) will occur in a person who (A) drinks 2 L of distilled water in 30 minutes (B) begins excreting large volumes of urine with an osmolarity of 100 mOsm/L after a severe head injury (C) is receiving lithium treatment for depression and has polyuria that is unresponsive to the administration of antidiuretic hormone (ADH) (D) has an oat cell carcinoma of the lung, and excretes urine with an osmolarity of 1,000 mOsm/L

A neonate appears severely cyanotic and breathing rapidly. Cardiac echocardiogram reveals that the aorta lies to the right of the pulmonary trunk. Which of the following is most likely occurred during development? (A) AP septum failed to develop in a spiral fashion (B) Excessive resorption of septum primum (C) Pulmonary valve atresia (D) Persistent truncus arteriosus (E) Coarctation of the aorta

A newborn baby is readmitted to the hospital with hypoxia and upon testing is found to have pulmonary stenosis, dextraposition of the aorta, interventricular septal defect, and hypertrophy of the right ventricle. Which of the following is best described by these symptoms? (A) ASD (B) Patent ductus arteriosus (C) Tetralogy of Fallot (D) Aortic stenosis (E) Coarctation of the aorta

A parasternal heave on a cardiovascular exam would be indicative of (A) right ventricular hypertrophy (B) left ventricular hypertrophy (C) coronary artery disease (D) congestive heart failure

A patient arrives at the emergency room with low arterial pressure, reduced tissue turgor, and the following arterial blood values: pH = 7.69 [HCO3-] = 57 mEq/L (high) Pco2 = 48 mm Hg (high) Which of the following responses would also be expected to occur in this patient? (A) Hyperventilation (B) Decreased K+ secretion by the distal tubules - -2 (C) Increased ratio of H2PO4 to HPO4 (D) Exchange of intracellular H+ for extracellular K+

A patient comes in complaining of chest pain, SOB, cough, diaphoresis, dizziness, fainting, fatigue, & palpitations. What is the greatest immediate concern? (A) hypertensive crisis (B) sudden cardiac death (C) prinzmetal variant angina (D) CHF

A patient comes in complaining of severe, crushing substernal chest pain that radiates to the neck, jar, epigastrium, & L arm. What should be your immediate concern? (A) unstable angina (B) MI (C) prinzmetal angina (D) SCD

A patient comes in presenting with orthopnea, cardiomegaly, tachycardia, S3 heart sound, & fine rales at lung bases. What is the most likely dx? (A) left-sided heart failure (B) right-sided heart failure (C) cardiac tamponade (D) MI

A patient comes in with fever, chills, weakness, nonspecific fatigue, & lassitude. Which of the following is the most likely dx? (A) rheumatic heart disease (B) SCD (C) MI (D) IE (infective endocarditis)

A patient complains of shortness of breath even after only mild exercise. She states that she has had this condition for 2 years but recently has noticed that it has become more pronounced. Her medical history indicates that she had rheumatic fever when she was a child. Auscultation indicates an enlarged heart. What may the physician expect to find with other diagnostic tests? (A) Mitral valve stenosis (B) Tetralogy of Fallot (C) Pulmonary artery aneurysm (D) Coronary heart disease (E) Ischemic heart disease

A patient has a small but solid tumor in the mediastinum, which is confined at the level of the sternal angle. Which of the following structures would most likely be found at this level? (A) Bifurcation of the trachea (B) Beginning of the ascending aorta (C) Middle of the aortic arch (D) Articulation of the third rib with the sternum (E) Superior border of the superior mediastinum

A patient has the following arterial blood values: pH = 7.52 Pco2 = 20 mm Hg [HCO3−] = 16 mEq/L Which of the following statements about this patient is most likely to be correct? (A) He is hypoventilating (B) He has decreased ionized [Ca2+] in blood (C) He has almost complete respiratory compensation (D) He has an acid-base disorder caused by overproduction of fixed acid (E) Appropriate renal compensation would cause his arterial [HCO3-] to increase

A patient is experiencing a small-vessel occlusion following a vessel spasm due to elevated catecholamines. Which of the following is the most likely dx? (A) transmural infarction (B) subendocardial infarction (C) microscopic infarction (D) general MI

A patient is on MWF weekly regimen of hemodialysis. When should their dental surgery be scheduled? (A) Monday (B) Friday (C) Saturday (D) Sunday

A patient present with -L ventricular hypertrophy -L atrial dilation -Boxcar nuclei What is the most likely dx? (A) pulmonary HTN (B) Systemic HTN (C) valvular heart disease (D) SCD

A patient presents with: -hepatosplenomegaly -nutmeg liver -pleural effusion -peripheral edema -Ascites Which of the following is the most likely dx? (A) left-sided heart failure (B) right-sided heart failure (C) cardiac tamponade (D) MI

A patient who has a hx of IV drug abuse would most likely have infective endocarditis of which of the following? (A) aortic valve (B) mitral valve (C) tricuspid valve (D) A or B

A patient with Wilms tumor has an enormous left-sided flank mass and which of the following additional characteristics? (A) Berry aneurysm of the circle of Willis (B) Hemihypertrophy (C) Increased serum uric acid (D) Marked amplification of genes on the short arm of chromosome 11 (E) Spontaneous regression

A person's electrocardiogram (ECG) has no P wave, but has a normal QRS complex and a normal T wave. Therefore, his pacemaker is located in the (A) sinoatrial (SA) node (B) atrioventricular (AV) node (C) bundle of His (D) Purkinje system (E) ventricular muscle

A radiologist examines posterior-anterior chest radiographs of a 27-year-old victim of a car accident. Which of the following structures forms the right border of the cardiovascular silhouette? (A) Arch of the aorta (B) Pulmonary trunk (C) SVC (D) Ascending aorta (E) Left ventricle

A smear of blood from a 70-year-old leukemia patient reveals a larger than normal population of cells that have large, round nuclei with one or two nucleoli. The cytoplasm of these cells shows azurophilic granules. Which of the following forms of leukemia would you suspect? (A) Promyelocytic leukemia (B) Basophilic leukemia (C) Lymphoblastic leukemia (D) Stem cell leukemia (E) Eosinophilic leukemia

A typical dental practice serving 2,000 patients would expect to treat how many individuals with heart failure (HF)? (A) 1 to 2 (B) 15 to 20 (C) 50 to 80 (D) 150 to 200

A woman has a plasma osmolarity of 300 mOsm/L (high) and a urine osmolarity of 1200 mOsm/L. The correct diagnosis is (A) syndrome of inappropriate antidiuretic hormone (SIADH) (B) water deprivation (C) central diabetes insipidus (D) nephrogenic diabetes insipidus (E) drinking large volumes of distilled water

A woman runs a marathon in 90°F weather and replaces all volume lost in sweat by drinking distilled water. After the marathon, she will have (A) decreased total body water (TBW) (B) decreased hematocrit (C) decreased intracellular fluid (ICF) volume (D) decreased plasma osmolarity (E) increased intracellular osmolarity

A woman who is undergoing an endocrine work-up to diagnose the cause of a large multinodular goiter develops atrial fibrillation. Which of the following would be best to treat this arrhythmia? (A) Verapamil (B) Propranolol (C) Digitalis (D) Bretylium (E) Tocainide

increase, harder

A(n) (decrease/increase) in total peripheral resistance (TPR) leads to COUNTERclockwise rotation of the vascular function curve and blood flow back to heart is made (harder/easier)

decrease, easier

A(n) (decrease/increase) in total peripheral resistance (TPR) leads to clockwise rotation of the vascular function curve and blood flow back to heart is made (harder/easier)

ACE inhibitors (e.g. captoPRIL) (A) block action of angiotensin II at its receptor → decrease BP (B) block conversion of angiotensinogen to angiotensin I → decrease BP (C) block conversion of angiotensin I to angiotensin II → decrease BP (D) block synthesis & secretion of aldosterone by adrenal cortex → decrease BP

decreases, increases

ACh (increases/decreases) inward Ca2+ current during plateau ACh (increases/decreases) IK-ACh → shortens duration of action potential

AHA recommends Oral Anticoagulant therapy (OAC) for patients with a CHA2-DS2-VASc score of (A) ≥ 1 (B) ≥ 2 (C) ≥ 4 (D) ≥ 5

ASH/ISH recommends goal of ______ mm Hg for patients w/ chronic kidney disease w/ albuminuria (A) < 130/80 (B) < 140/90 (C) <150/90 (D) <180/100

About 4 to 6 days after you place a normal person on a low-sodium diet, which of the following will be observed? (A) plasma renin and aldosterone are below normal (B) plasma renin and aldosterone are above normal (C) plasma sodium concentration is below normal (D) plasma sodium concentration is normal (E) B and D are correct.

According to JNC 8, what is the goal BP for older adults when treating HTN with drugs? (A) < 130/80 (B) < 140/90 (C) <150/90 (D) <180/100

According to the Bohr effect, there will be a right shift (decrease in O2 affinity) in the O2 saturation curve with which of the following? I. decreasing pH II. increasing pH III. decreasing [H+] IV. increasing [H+] (A) I only (B) II only (C) I & IV (D) II & III

proportional to, proportional to, C

According to the Poiseuille equation, resistance to flow is 1. (proportional to/inversely proportional to) to viscosity of blood 2. (proportional to/inversely proportional to) length of the blood vessel 3. proportional to ________ of the radius of the blood vessel (A) 1/2 power (B) 1/3rd power (C) 1/4th power (D) 1/8th power

Activated by 2 IgG antibody molecules or 1 IgM antibody bound to surface of microorganism (A) Classical (B) Lectin (C) Alternative (D) All of the above

Activated by spontaneously formed C3b binding components of microbial cell surface (A) Classical (B) Lectin (C) Alternative (D) All of the above

Activated lymphocytes leave the LN via (A) high endothelial venules (B) afferenti lymphatic vessels (C) efferent lymphatic vessels (D) all of the above

Activation of which of the following on afferent arterioles leads to vasoconstriction & ↓ in both RBF & GFR? (A) α₁ (B) α₂ (C) β₁ (D) β₂

decrease, decrease, decrease, decrease, increase, increase

Acute hemorrhage → (increase/decrease) in Pa → (increase/decrease) stretch on carotid sinus baroreceptors → (increase/decrease) firing rate of carotid sinus nerve (Hering's nerve) → (increase/decrease) in parasympathetic (vagal) outflow to heart & (increase/decrease) in sympathetic outflow to heart & blood vessels → (increase/decrease) in Pa

Acute kidney injury is characterized by an acute increase in serum _______ often associated with _______ (A) ASH; proteinuria or phosphaturia (B) BUN; anuria or oliguria (C) Creatinine; oliguria or anuria (D) Albumin; proteinuria or oliguria

Acute occlusion of the ____ artery is the cause of 40 to 50% of all MIs (A) LAD (B) LCX (C) RCA (D) great cardiac

Acute occlusion of which of the following would lead to ischemia of the (1) anterior wall of L ventricle (2) anterior 2/3 of ventricular septum & (3) most of heart apex? (A) LAD (B) LCX (C) RCA (D) all of the above

Acute occlusion of which of the following would lead to ischemia of the R ventricle? (A) LAD (B) LCX (C) RCA (D) all of the above

Acute occlusion of which of the following would lead to ischemia of the lateral L ventricle? (A) LAD (B) LCX (C) RCA (D) all of the above

Adult remnant of the ductus arteriosus is the _____________ (A) Medial umbilical ligament (B) Ligamentum arteriosum (C) Ligamentum venosum (D) Oval fossa (E) Round ligament of the liver

After macula densa, tubule continues as ________, where electrolyte levels of filtrate are adjusted further controlled by aldosterone (A) TAL (B) connecting tubules (C) Loop of Henle (D) DCT

increase, increase

Aldosterone and increased Na+-H+ exchange both work to (decrease/increase) Na+reabsorption by renal distal tubule → (decrease/increase) ECF V, blood V, & Pa

Alkalemia causes _______ Acidemia causes ________ (A) hypokalemia, hyperkalemia (B) hyperkalemia, hypokalemia

All formed elements of blood enter circulation by crossing the _________ _______ of sinusoids in red marrow (A) discontinuous endothelium (B) stratified squamous epithelium (C) tunica intima (D) tunica adventitia

All of the following are Primary (azurophilic) granules of neutrophils EXCEPT (A) lactoferrin (B) myeloperoxidase (C) elastase (D) cathepsin G

All of the following are advantages of peritoneal dialysis EXCEPT (A) Relatively low initial cost (B) Ease of performance (C) No requirement of anticoagulation (D) Eliminates need for frequent sessions

All of the following are adverse effects of loop diuretics EXCEPT (A) dry mouth (B) hypersalivation (C) orthostatic hypotension (D) loss of K+ in some cases

All of the following are characteristic features of drug-induced tubulointerstitial nephritis (TIN) EXCEPT (A) fever (B) eosinophilia (C) HTN (D) rash

All of the following are characteristic of malignant HTN EXCEPT (A) Papilledema, encephalopathy, cardiovascular abnormalities, & renal failure (B) pinpoint petechial hemorrhages (C) kidney has flea-bitten appearance (D) dilation of arterioles & small arteries

E (major)

All of the following are considered INTERMEDIATE clinical risk factors EXCEPT (A) hx of ischemic heart disease (B) hx of compensated or previous HF (C) Renal insufficiency (D) hx of cerebrovascular disease (E) symptomatic mitral stenosis

C (intermediate)

All of the following are considered MAJOR clinical risk factors EXCEPT (A) Unstable coronary syndromes (B) Decompensated HF (C) DM (D) Severe valvular disease (E) Significant arrhythmias

A (intermediate)

All of the following are considered MINOR clinical risk factors EXCEPT (A) DM (B) Advanced age (> 70) (C) abnormal ECG (C) rhythm other than sinus (D) uncontrolled systemic HTN

A (minor)

All of the following are considered intermediate risk factors for predictors of increased perioperative cardiovascular risk EXCEPT (A) advanced age (>70) (B) hx of ischemic heart disease (C) DM (D) renal insufficiency

D (intermediate)

All of the following are considered major risk factors for predictors of increased perioperative cardiovascular risk EXCEPT (A) decompensated heart failure (B) unstable coronary syndromes (C) significant arrhythmias (D) renal insufficiency

C (intermediate)

All of the following are considered minor risk factors for predictors of increased perioperative cardiovascular risk EXCEPT (A) uncontrolled systemic HTN (B) advanced age (>70) (C) DM (D) abnormal ECG

C (decreased chance)

All of the following are disadvantages of peritoneal dialysis EXCEPT (A) need for frequent sessions (B) frequent association with abdominal hernia (C) increased chance of infectious disease transmission (D) significantly lower effectiveness than for hemodialysis

All of the following are early signs of HTN EXCEPT (A) narrowing & sclerosis of retinal arterioles (B) tinnitus (C) dizziness (D) papilledema

All of the following are oral cavity lymphoid tissues EXCEPT (A) lingual tonsils (B) palatine tonsils (C) Peyer's patches (D) pharyngeal tonsils

All of the following are oral manifestations of chronic kidney failure EXCEPT (A) pallor; pigmentation, & petechiae of oral mucosa (B) infections (C) enamel defects of developing dentition (D) caries (E) Osteodystrophy (radiolucent jaw lesions) (F) xerostomia, parotid infections, & halitosis

B (negative)

All of the following are true of 2,3-BPG EXCEPT (A) intermediate in carbohydrate metabolism (B) positive allosteric effector (C) deoxygenated Hb (T state) preferentially interacts with negatively charger 2,3-BPG (D) level of 2,3-BPG increases in chronic hypoxia

C (lower respiratory tract infections)

All of the following are true of M catarrhalis EXCEPT (A) gram-negative diplococcus (B) causes otitis media & sinusitis; endocarditis & meningitis (C) also causes upper respiratory tract infections in elderly patients w/ COPD (D) can be treated w/ amoxicillin-clavulanic acid; cephalosporins; macrolides; & fluoroquinolones

B (50% in women, 20% in men)

All of the following are true of N gonorrhoeae EXCEPT (A) disease only in humans (B) risk of transmission is 20% in women & 50% in men (C) transmitted by sexual contact (D) major reservoirs are asymptomatic carriers

B (protection from capsule)

All of the following are true of N meningitidis EXCEPT (A) starts with colonization of nasopharynx mediated by pili (B) bacteria able to spread due to protection provided by pili (C) endotoxin activity causes toxic effects (D) spread by respiratory droplets

B (b/w 150 & 200)

All of the following are true of atrial tachycardias EXCEPT (A) arise above AV junction (B) atrial rate b/w 250 to 350 (C) ECG shows P-wave different from that for sinus rhythm (D) common in patients w/ MI, coronary artery disease, digitalis intoxication, or cor pulmonale

All of the following are true of cysts EXCEPT (A) smooth contours (B) produce fluid signals on U/S (C) are avascular (D) produce solid tissue signals on U/S

All of the following are true of digoxin (digitalis glycosides) EXCEPT (A) ACE inhibitors are preferred for patients w/ HF & AFIB/rapid ventricular response (B) have narrow therapeutic range & can easily result in toxicity (C) may cause arrhythmias & hypersalivation (D) principally used to treat residual symptoms not controlled by other drugs

D (hydrophobic buries inside)

All of the following are true of globins EXCEPT (A) ancient family of soluble metalloproteins (B) invariant residues of PheCD & HisF8 (C) polar AAs on exterior surface contribute to high solubility (D) hydrophilic residues buried in interior to stabilize folding of polypeptide

D (contain endotoxin (LPS/LOS) in outer membrane)

All of the following are true of gram-negative bacteria EXCEPT (A) stain red/pink (B) have a thin peptidoglycan layer (C) have a periplasmic space (D) contain teichoic/lipoteichoic acids in cell wall

A (purple/blue)

All of the following are true of gram-positive bacteria EXCEPT (A) stain red/pink (B) have a thick peptidoglycan layer (C) lack a periplasmic space (D) contain teichoic/lipoteichoic acids in cell wall

All of the following are true of hemodialysis EXCEPT (A) heparin usually given during procedure to prevent clotting (B) treatments performed every 2 or 3 days requiring 3 to 4 hours for each session (C) takes less time than peritoneal dialysis (D) Requires arteriovenous graft or fistula or central catheter

B (single epitope)

All of the following are true of monoclonal antibodies EXCEPT (A) Generated by fusing lymphocytes from spleen of immunized mice w/ myeloma cells to produce hybridomas → can by screened for by its antibody product that would recognize the epitope of interest (B) recognizes multiple epitopes on antigenw (C) Useful for ELISAs (D) Useful for therapeutics

C (azurophilic granules)

All of the following are true of neutrophils EXCEPT (A) 50 to 70% of WBCs (B) initiate phagocytic defense against bacterial infection (C) specific granules include myeloperoxidase, elastase, & cathepsin G (D) perform diapedesis to squeeze in between endothelial cells

All of the following are true of peritoneal dialysis EXCEPT (A) Chronic Ambulatory PD (CAPD) more common than Continuous Cyclic PD (CCPD) because it allows patients more freedom (B) Both CCPD & CAPD allow patients to perform routine functions b/w exchanges (C) Method of choice when azotemia occurs & dialysis is needed longterm (D) Hypertonic solution instilled into peritoneal cavity through a permanent peritoneal catheter

B (retention)

All of the following are true of the body's response to water deficit (dehydration) EXCEPT (A) decreased plasma volume (B) Na+ & water secretion (C) decreased renal blood flow (D) decreased GFR

C (increased GFR)

All of the following are true of the body's response to water excess (dehydration) EXCEPT (A) increased plasma volume (B) increased renal blood flow (C) decreased GFR (D) increased loss of Na+ & water in urine

C (5 to 10 day)

All of the following are true of the primary immune response EXCEPT (A) generated as production of antibodies by plasma cells (B) IgM produced 1st, followed by IgG (C) occurs after a 3- to 5-day lag period (D) leads to production of memory cells in lymphoid tissues

B (IgG)

All of the following are true of the secondary immune response EXCEPT (A) Memory cells facilitate quicker response to antigen (B) Antibodies are primarily IgM (C) initiated when antigen enters blood or tissues again (D) Occurs after 3 to 5 days

All of the following come from Lymphoid progenitors EXCEPT (A) B cells (B) T cells (C) dendritic cells (D) NK cells

All of the following come from myeloid progenitors EXCEPT (A) erythrocytes (B) basophils (C) monocytes (D) T cells

All of the following contribute to development & consequences of coronary atherosclerosis EXCEPT: (A) inflammation (B) thrombosis (C) high levels of NO (D) vasoconstriction

All of the following increase risk for development of coronary atherosclerotic heart disease at a younger age EXCEPT (A) paternal hx (B) maternal hx (C) sibling hx (D) hx in both parents

All of the following treat HF by inhibiting cardiotoxic effects of neurohumoral system in order to retard progression of HF EXCEPT (A) ACE inhibitors (B) beta blockers (C) angiotensin receptor blockers (ARBs) (D) CCBs

All of the following would cause a LEFT shift (increased affinity for O2) EXCEPT (A) ↓ pCO2 (B) ↓ [H+] (C) ↑ 2,3-DPG (D) ↓ Temp (E) HbF

All of the following would cause a RIGHT shift (decreased affinity for O2) EXCEPT (A) ↑ pCO2 (B) ↑ [H+] (↓pH) (C) ↑ 2,3-DPG (D) ↓ temp

An 18-year-old woman presents with suprapubic pain, urinary frequency, dysuria, and hematuria for the past hour. Urine tests show the presence of pyuria but no white cell casts. Physical examination is remarkable only for suprapubic tenderness on palpation. Which of the following is the most likely diagnosis? (A) Acute pyelonephritis (B) Chronic pyelonephritis (C) Cystitis (D) Fanconi syndrome (E) Nephrocalcinosis

An 8-year-old boy with ASD presents to a pediatrician. This congenital heart defect shunts blood from the left atrium to the right atrium and causes hypertrophy of the right atrium, right ventricle, and pulmonary trunk. Which of the following veins opens into the hypertrophied atrium? (A) Middle cardiac vein (B) Small cardiac vein (C) Oblique cardiac vein (D) Anterior cardiac vein (E) Right pulmonary vein

An 83-year-old man with a typical coronary circulation has been suffering from an embolism of the circumflex branch of the left coronary artery. This condition would result in ischemia of which of the following areas of the heart? (A) Anterior part of the left ventricle (B) Anterior interventricular region (C) Posterior interventricular region (D) Posterior part of the left ventricle (E) Anterior part of the right ventricle

An ECG shows ST segment elevations & negative Q waves with loss of R wave amplitude. Which of the following MIs has occurred? (A) transmural infarction (B) subendocardial infarction (C) microscopic infarction (D) any of the above could have occurred

An acute decrease in arterial blood pressure elicits which of the following compensatory changes? (A) Decreased firing rate of the carotid sinus nerve (B) Increased parasympathetic outflow to the heart (C) Decreased heart rate (D) Decreased contractility (E) Decreased mean systemic pressure

An electrocardiogram (ECG) on a person shows ventricular extrasystoles. After an extrasystole, the next "normal" ventricular contraction produces (A) increased pulse pressure because the contractility of the ventricle is increased (B) increased pulse pressure because total peripheral resistance (TPR) is decreased (C) increased pulse pressure because compliance of the veins is decreased (D) decreased pulse pressure because the contractility of the ventricle is increased (E) decreased pulse pressure because TPR is decreased

An electrocardiogram (ECG) on a person shows ventricular extrasystoles. The extrasystolic beat would produce (A) increased pulse pressure because contractility is increased (B) increased pulse pressure because heart rate is increased (C) decreased pulse pressure because ventricular filling time is increased (D) decreased pulse pressure because stroke volume is decreased (E) decreased pulse pressure because the PR interval is increased

An immunohistochemical technique using antibodies against aquaporins to stain a section of kidney would be expected to stain cells in which structures most intensely? (A) Collecting ducts (B) Lining of the major and minor calyces (C) Proximal convoluted tubules (D) Distal convoluted tubules (E) Glomeruli

An increase in arteriolar resistance, without a change in any other component of the cardiovascular system, will produce (A) a decrease in total peripheral resistance ( TPR) (B) an increase in capillary filtration (C) an increase in arterial pressure (D) a decrease in afterload

An increase in contractility is demonstrated on a Frank-Starling diagram by (A) increased cardiac output for a given end- diastolic volume (B) increased cardiac output for a given end- systolic volume (C) decreased cardiac output for a given end-diastolic volume (D) decreased cardiac output for a given end-systolic volume

An increase in the osmolality of the extracellular fluid will: (A) stimulate the volume and osmoreceptors, and stimulate ADH secretion (B) stimulate the volume and osmoreceptors, and inhibit ADH secretion (C) inhibit the volume and osmoreceptors, and stimulate ADH secretion (D) inhibit the volume and osmoreceptors, and inhibit ADH secretion (E) cause no change in ADH secretion

stressed, unstressed

An increase in venous compliance means blood is shifted from (stressed/unstressed) of the arteries to (stressed/unstressed) of the veins

An infarct is grossly identified by a red-blue discoloration caused by stagnated, trapped blood. How old is the MI? (A) < 12 hours old (B) 12 to 24 hours old (C) 2 to 3 weeks old (D) > 5 years old

Anemia, malnutrition, & bone disease (hyperparathyroidism) corrected/controlled starting in (A) stage 1 (B) stage 2 (C) stage 3 (D) stage 4 (E) stage 5

A, B, C, F

Angiotensin II has which of the following effects (select all that apply) (A) stimulate synthesis & secretion of aldosterone by adrenal cortex (B) Increases Na+-H+ exchange in proximal convoluted tubule (C) Increases thirst (D) decreases urination (E) Vasodilation (F) Vasoconstriction

Angiotensin II stimulates Na+-H+ exchange in _____ → reabsorption of Na⁺, HCO₃⁻, & water → contraction ________ (A) PCT, acidosis (B) PCT, alkalosis (C) loop of Henle, acidosis (D) loop of Henle, alkalosis

Angiotensin receptor (AT1) agonists (e.g. losartan) (A) block action of angiotensin II at its receptor → decrease BP (B) block conversion of angiotensinogen to angiotensin I → decrease BP (C) block conversion of angiotensin I to angiotensin II → decrease BP (D) block synthesis & secretion of aldosterone by adrenal cortex → decrease BP

Antibiotic susceptibility testing of bacteria (A) Sabouraud dextrose agar (B) chocolate agar (C) buffered charcoal yeast extract (BCYE) (D) Mueller-Hinton Agar

Antibodies directed against fixed antigens in GBM lead to (A) linear pattern of staining (B) granular pattern of staining (C) circular pattern of staining (D) random pattern of staining

Aortic valve incompetent → blood ejected into aorta flows backward into ventricle (A) Arteriosclerosis (B) Aortic stenosis (C) Aortic regurgitation (D) Pulmonary HTN

Aortic valve narrowed → decreased stroke volume → less blood enters aorta on each beat → decrease in systolic, pulse, & mean pressure (A) Arteriosclerosis (B) Aortic stenosis (C) Aortic regurgitation (D) Pulmonary HTN

Apex of the heart is formed by the______ (A) Left ventricle (B) Left atrium (C) Right ventricle (D) Right atrium

Applied to adipocytes, the term "multilocular" refers to which of the following? (A) The large number of small cytoplasmic lipid droplets (B) The proliferation of the cells in an obese individual (C) The large number of mitochondria in the cells (D) The high density of nerves supplying the tissue (E) The type of mesenchymal cells also present

Approximately 80% of filtrate is reabsorbed in the ____ driven by the electrochemical gradient created by Na+/K+ ATPase (A) PCT (B) DCT (C) loop of Henle (D) collecting tubules

Arrival of _____ triggers coalescence of foam cells & extracellular pools of lipid into lipid core (A) IL-1 (B) cardiac myocytes (C) smooth muscle cells (D) creatine kinase

increases, increase, increases

As venous return increases, R atrial pressure (decreases/increases), and end-diastolic V & end-diastolic fiber length (decrease/increase) → cardiac output (decreases/increases)

Aspirin works to reduce fever by (A) inhibiting production of IL-1 (B) increasing production of pyrogens (C) inhibiting COX enzyme needed for synthesis of prostaglandins (D) inhibiting ability of anterior hypothalamus to activate heat generating mechanisms

Assays of which of the following are most sensitive & specific in differentiating cardiac muscle damage from trauma to skeletal muscle or other organs? (A) troponin I & T (B) creatine kinase isoenzyme (CK-MB) (C) creatinine (D) Myoglobin

At plasma para-aminohippuric acid (PAH) concentrations below the transport maximum (Tm), PAH (A) reabsorption is not saturated (B) clearance equals inulin clearance (C) secretion rate equals PAH excretion rate (D) concentration in the renal vein is close to zero (E) concentration in the renal vein equals PAH concentration in the renal artery

At which site is systolic blood pressure the highest? (A) Aorta (B) Central vein (C) Pulmonary artery (D) Right atrium (E) Renal artery (F) Renal vein

Atherogenesis is initiated by ______ (A) nitric oxide (B) MI (C) high blood pressure (D) endothelial damage

Atheroma formation is initiated by (A) injury of arterial intima (B) adherence of monocytes to altered endothelium (C) migration of monocytes into intima (D) macrophages engulfing lipid molecules

Atheromas can lead to arterial bulges (aneurysms) that can rupture in which of the following? (A) Large Elastic artery (B) Medium Muscular artery (C) Small artery (D) veins

Attached monocytes migrate into the intima of the vessel in atheroma formation to become (A) neutrophils (B) platelets (C) macrophages (D) plasma cells

Attachment of bacteria to macrophage membrane is facilitated by binding of _____ to bacterial membrane (A) C5 convertase (B) opsonin (C) selectins (D) C3b

Autonomic effects on HR are called _____ effects. Autonomic effects on conduction velocity in AV node are called ______ effects. (A) chronotropic, ionotropic (B) ionotropic, dromotropic (C) chronotropic, dromotropic (D) dromotropic, ionotropic

Azotemia is the buildup of nonprotein nitrogen compounds due to loss of glomerular filtration function. Level is measured as (A) Creatinine (B) BUN (C) GFR (D) Clearance of Inulin

Azurophilic granules stain with _______ dyes and are _____ among all 3 types of granulocytes (A) acidic; different (B) acidic; similar (C) basic; different (D) basic; similar

B cells & macrophages are arranged in follicles in which layer of the LN? (A) cortex (B) paracortex (C) medulla (D) all layers

Balance b/w the _______ is fundamental for the circulation of substrates & nutrients (A) electrochemical gradients (B) oncotic & hydrostatic pressure (C) pressure gradients (D) interstitial & extracellular fluids

Baroreceptors that monitor arterial BP by detecting changes in pressure (A) carotid sinuses (B) aortic sinuses (C) carotid bodies (D) aortic bodies

Between the glomerulus & distal tubule of the kidneys is the juxtaglomerular apparatus which functions as (A) sodium sensors (B) sites of renin secretion (C) sites of ANP secretion (D) A & B (E) all of the above

Bicarbonate is generated in (A) RBCs (B) alveolar cells (C) Renal tubules (D) A & B (E) A & C

Binds to receptor in renal collecting ducts → regulates Na+/K+ ATPase & transporters → increased sodium reabsorption & increased excretion of K+ & H+ (A) Renin (B) Aldosterone (C) ACE (D) angiotensin II

Blood flow to which organ is controlled primarily by the sympathetic nervous system rather than by local metabolites? (A) Skin (B) Heart (C) Brain (D) Skeletal muscle during exercise

Blood from the pericardium drains into the _______ system of veins + the internal thoracic & superior phrenic veins (A) azygous (B) phrenic (C) cavernous (D) coronary

Blood in the renal arcuate arteries flows next into which vessels? (A) Afferent arterioles (B) Efferent arterioles (C) Glomerular capillaries (D) Interlobar arteries (E) Interlobular arteries

Buildup of waste products serves as substrate for development of ______ → ammonia retention (A) metabolic alkalosis (B) metabolic acidosis (C) respiratory alkalosis (D) respiratory acidosis

decrease, right

CO2 is increased in venous capillaries, causing an (increase/decrease) in Hb affinity for O2 and a shift in what direction of the O2 saturation curve?

Ca2+ channel blockers, such as nifedipine, diltiazem, & verapamil, work by inhibiting ________ of ______ (A) inward Ca2+ current of voltage-gated channels (B) outward Ca2+ current of L-type channels (C) inward Ca2+ current of L-type channels (D) outward Ca2+ current of voltage-gated channels

Can be used to determine the amount of DNA or RNA in a sample by measuring how fast new DNA is made through the increase in fluorescence of a reporter molecule (A) ELISA (B) Real time PCR (C) Flow cytometry (D) DNA probe

Carbon dioxide (CO2) regulates blood flow to which one of the following organs? (A) Heart (B) Skin (C) Brain (D) Skeletal muscle at rest (E) Skeletal muscle during exercise

Cardiac glycosides are positive ionotropic agents that act by _____ so that intracellular [Ca2+] increases and there is an increase in tension (A) inhibiting H+ pump (B) stimulating outflow of K+ (C) inhibiting outflow of Na+ (D) inhibiting Na+-K+ pump

Cardiac malformations associated with _____ are distinguished by early cyanosis (A) ASDs (B) left-to-right shunts (C) PDAs (D) right-to-left shunts

Cardiac output is a function of (A) end-systolic volume (B) end-diastolic volume (C) aortic pressure (D) heart rate

Cardiac output of the right side of the heart is what percentage of the cardiac output of the left side of the heart? (A) 25% (B) 50% (C) 75% (D) 100% (E) 125%

Cardiopulmonary baroreceptors are located in veins, atria, & pulmonary arteries and sense (A) changes in blood volume (B) decreases in hormone balance (C) decreases in PO2 (D) changes in Pa (mean arterial pressure)

Cardiotoxic drugs, catecholamines, & viral infections are common causes of (A) restrictive cardiomyopathy (B) rheumatic fever heart disease (C) myocarditis (D) arrhythmias

Cardiovascular risk strongly related to plasma concentrations of total cholesterol & ______ & inversely related to _____ (A) LDL, HDL (B) HDL, LDL (C) IDL, HDL (D) IDL, LDL

Causes abrupt & intense headache, stiff neck, vomiting, coma, & fever (A) N gonorrhea (B) N meningitidis (C) E corrodens (D) M catarrhalis

Cell depletion of free cholesterol → ____ in SREBPs → _____ cholesterol synthesis & LDL receptor expression (A) decrease, decrease (B) increase, increase (C) decrease, increase (D) increase, decrease

Cells interacting weakly with MHC I molecules differentiate into (A) CD4+ cells (B) CD8+ cells (C) regulatory T cells (D) B cells

Cells interacting weakly with MHC II molecules differentiate into (A) CD4+ cells (B) CD8+ cells (C) regulatory T cells (D) B cells

Central chemoreceptors are mainly sensitive to (A) decreases in PO2 (B) changes in PCO2 & pH (C) changes in Pa (D) decreases in Pa

Chance that a given drug will be dialyzed (removed from circulating blood) is governed by I. MW & Size II. Degree of protein binding III. Volume of drug distribution IV. Endogenous drug clearance (A) I & II (B) I & III (C) II, III, & IV (D) I, II, III, & IV

Changes in plasma protein concentration lead to changes in (A) P∨GC (B) P∨BS (C) π∨GC (D) B & C

Changes in resistance of afferent & efferent arterioles leads to changes in (A) P∨GC (B) P∨BS (C) π∨GC (D) B & C

Changes in the ventricular pressure-volume loops are a result of 1. Increased ________ (end-diastolic V) → increase in stroke volume 2. increased ________ (aortic pressure) → less blood ejected during systole → stroke volume decreases & end systolic volume increases 3. increased ______ → stroke volume increases & end systolic volume decreases (A) preload, contractility, afterload (B) afterload, preload, contractility (C) preload, afterload, contractility (D) contractility, preload, afterload

Characterized by a primary decrease in ventricular compliance → impaired ventricular filling during diastole (wall is stiffer) (A) Dilated cardiomyopathy (B) Hypertrophic cardiomyopathy (C) Restrictive cardiomyopathy (D) arrhythmogenic right ventricular cardiomyopathy

Characterized by: -presence of crescents (crescentic GN) & in most cases appears to be immunologically mediated -loss of renal function, lab findings typical of nephritic syndrome, & severe oliguria (A) Focal Segmental Glomerulosclerosis (B) Rapidly Progressive GN (C) Membranoproliferative GN (D) Hereditary Nephritis

Chemoreceptors that monitor blood CO2 & O2 levels & its pH (A) carotid sinuses (B) carotid bodies (C) aortic bodies (D) A & B (E) B & C

Chronic dilation of the L atrium leads to an "irregularly irregular" heartbeat known as (A) ventricular fibrillation (B) R-sided heart failure (C) atrial fibrillation (D) tetralogy of fallot

Chronic kidney disease (CKD) is considered to be abnormalities of kidney structure or function lasting _________ w/ implications for health (A) 6 weeks or longer (B) 2 months or longer (C) 3 months or longer (D) 6 months or longer

Chronic kidney disease is characterized by all of the following EXCEPT (A) hyperphosphatemia (B) dyslipidemia (C) metabolic alkalosis (D) metabolic acidosis

Classical, Alternative, & Lectin Complement pathways converge at a common point of (A) formation of C3 convertase (B) formation of C5 convertase (C) activation of C3 component by C3 convertase (D) formation of membrane attack complex

Classically, which of the following is responsible for referred pain to the L arm during an MI? (A) phrenic nerve (B) intercostobrachial nerve (C) musculocutaneous nerve (D) radial nerve

Classification & diagnosis of HTN is based on average of __ or more properly measured BP readings obtained in seated patient on each of __ or more office visits (A) 1, 1 (B) 2, 1 (C) 2, 2 (D) 5, 5

Clinical abnormalities that develop after excessive fluid loss depend on the ______ of the lost fluid (A) volume (B) ionic composition (C) rate (D) A & C

Cold → activate centers in _______ → activate motoneurons innervating skeletal muscle → rhythmic contraction to generate heat & raise body temp (shivering) (A) anterior hypothalamus (B) posterior hypothalamus (C) Na+-K+ ATPase (D) alpha 1 receptors in vascular smooth muscle of skin blood vessels

Compared with a person who ingests 2 L of distilled water, a person with water deprivation will have a (A) higher free-water clearance (CH2O) (B) lower plasma osmolarity (C) lower circulating level of antidiuretic hormone (ADH) (D) higher tubular fluid/plasma (TF/P) osmolarity in the proximal tubule (E) higher rate of H2O reabsorption in the collecting ducts

Competitive blocker of α1, β1, & β2 receptors w/ greater affinity for β receptors (A) quinapril (B) hydrochlorothiazide (C) amlodipine (D) labetalol

Complement dysregulation due to acquired or hereditary abnormalities of the alternative pathway of complement activation is the underlying cause of (A) C3 GN (B) dense deposit disease (C) MPGN type I (D) A & B (E) all of the above

Compliance of veins (<,>,=) compliance of arteries

Condenser prevents transmitted light from directly illuminating specimen but enables scattered light to reach specimen & illuminate it against a black background (A) bright-field microscopy (B) dark-field microscopy (C) phase contrast microscopy (D) fluorescence microscopy

Conduction time prolonged but all impulses are conducted (A) 1st degree heart block (B) 2nd degree - Mobitz type I (Wenckebach) (C) 2nd degree - type II (D) 3rd degree

Conduction velocity depends on I. size of inward current during upstroke of action potential II. rate of rise of upstroke III. action potential duration (A) I only (B) III only (C) I and III (D) I and II (E) I, II, and III

Congenital heart diseases most commonly arise from faulty embryogenesis during gestational weeks (A) 1 to 4 (B) 3 to 8 (C) 8 to 12 (D) 24 to 36

Connecting tubules from several nephrons join to form the cortical collecting ducts of simple cuboidal epithelium, which enter medulla in parallel with _______ & become larger w/ more columnar cells (A) PCT & DCT (B) loops of Henle & vasa recta (C) afferent & efferent arterioles (D) PCT & interlobular arteries

Constricts vascular smooth muscle → increase BP & reduce renal blood flow & GFR (A) Renin (B) Aldosterone (C) ACE (D) angiotensin II

phrenic nerve vagus CN X thoracic duct left recurrent laryngeal nerve brachiocephalic aortic arch thymus trachea lymph nodes esophagus SVC

Contents of the Superior Mediastinum (PVT Left BATTLES)

Controls immune response (A) Th1 (B) Th2 (C) Th3 (D) Threg

Coronary angiographs of a 44-year-old male patient reveal an occlusion of the circumflex branch of the left coronary artery. This patient has been suffering from myocardial infarction in which of the following areas? (A) Right and left ventricles (B) Right and left atria (C) Interventricular septum (D) Apex of the heart (E) Left atrium and ventricle

Coronary circulation & Cerebral circulation are controlled by (A) distant hormones (B) local metabolic factors (C) pressure differences (D) prostaglandins only

Curve A in the figure represents (A) aortic pressure (B) ventricular pressure (C) atrial pressure (D) ventricular volume

Curve B in the figure represents (A) left atrial pressure (B) ventricular pressure (C) atrial pressure (D) ventricular volume

Dabigatran (Pradaxa), Rivaroxaban (Xarelto), Apixaban (Eliquis), or Edoxaban (Savaysa) are examples of (A) oral anticoagulatives (B) CCBs (C) DOACs (D) K+ channel blockers

Decreased arterial pressure → increased autonomic stimulation to JGA → JG cells release _______ →cleaves angiotensinogen into inactive angiotensin I → ACE converts angiotensin I to angiotensin II → vasoconstriction that raises systemic BP → stimulates adrenals to secrete _______ → promotes Na+ & water reabsorption in DCT & Connecting tubules → raises blood V to help increase BP (A) renin, aldosterone (B) aldosterone, ADH (C) erythropoietin, vasopressin (D) ADH, renin

C (retention)

Decreasing CO leads to stimulation of renin-angiotensin & sympathetic system to compensate for loss of function which leads to all of the following EXCEPT (A) ↑ HR & myocardial contractility (B) ↑ peripheral resistance (C) Na+ & H2O secretion (D) Redistribution of blood flow to heart & brain (E) ↑ in efficiency of O2 utilization by tissues

Defects in vasopressin secretion & defective aquaporins cause (A) diabetic ketoacidosis (B) diabetes insipidus (C) SIADH (D) A & B (E) B & C

Dehydration increases protein concentration in blood → increase in ____ → filtration out of capillary is _______ (A) πc (capillary oncotic pressure), favored (B) Pc (capillary hydrostatic pressure), favored (C) Pc (capillary hydrostatic pressure), opposed (D) πc (capillary oncotic pressure), opposed

Dehydration → ADH released from posterior pituitary → makes _______ more permeable to water & increases rate at which water molecules pulled osmotically from filtrate (A) collecting ducts (B) PCT (C) Loop of Henle (D) DCT

Dendritic cells present antigens to T cells to initiate specific immune response in which layer of the LN? (A) cortex (B) paracortex (C) medulla (D) all layers

Depolarization of the ventricles (A) P wave (B) PR interval (C) QRS complex (D) T wave (E) QT interval

Depolarization → Na+ activation gates _____ and inactivation gates ______ → inactivation gates _______ → no inward depolarizing current → no action potential → cell is refractory (A) open, open slowly, open & unavailable (B) closed, open slowly, open (C) open, close slowly, closed & unavailable (D) closed, close rapidly, closed but available

Deprivation of water → ___ is plasma osmolarity → ___ ADH secretion → ____ H2O permeability of principal cells →→ return plasma osmolarity back to normal (A) ↑, ↓, ↓ (B) ↑, ↑, ↑ (C) ↓, ↑, ↑ (D) ↓, ↓, ↓

Determination of risks for treating patients with HTN includes evaluation of all of the following factors EXCEPT (A) risk imposed by patient's cardiovascular disease (B) risk imposed by surgery or procedure (C) risk imposed by functional reserve or capacity of the patient (D) risk of compliance in showing back up if patient does not receive dental treatment that day

Diagnosed from blood or CSF samples as an oxidase-positive, gram-negative diplococcus that grows on chocolate agar (A) N gonorrhea (B) N meningitidis (C) E corrodens (D) M catarrhalis

Diagnostic tests for ischemic heart disease usually reveal (A) malformed heart valves. (B) atherosclerosis of coronary arteries. (C) irregular heartbeat. (D) faulty SA valve. (E) arteriosclerosis of coronary arteries.

Dialysis is usually begun in stage 5, when GFR is (A) > 90 (B) 50 - 70 (C) 35 - 49 (D) < 30

Diastolic pressure is (A) lowest, Parteries during ventricular relaxation (B) lowest, Parteries after blood ejected from L ventricle during systole (C) highest, Parteries during ventricular relaxation (D) highest, Parteries after blood ejected from L ventricle during systole

Different pillin proteins cause antigenic variations in N gonorrhoeae. Which pillin protein is described below? -prevents phagosome-lysosome fusion in neutrophils -facilitates invasion of epithelial cells -confers resistance to complement-mediated killing of bacterium (A) porB (protein I) (B) Opa (protein II) (C) Tbp1 & Tbp2 (D) Lbp

Different pillin proteins cause antigenic variations in N gonorrhoeae. Which pillin protein is described below? lactoferrin-binding protein that helps in acquisition of iron (A) porB (protein I) (B) Opa (protein II) (C) Tbp1 & Tbp2 (D) Lbp

Different pillin proteins cause antigenic variations in N gonorrhoeae. Which pillin protein is described below? mediates attachment to epithelial cells (A) porB (protein I) (B) Opa (protein II) (C) Tbp1 & Tbp2 (D) Lbp

Different pillin proteins cause antigenic variations in N gonorrhoeae. Which pillin protein is described below? transferrin binding proteins that facilitate the acquisition of iron (needed to synthesize nucleic acids) (A) porB (protein I) (B) Opa (protein II) (C) Tbp1 & Tbp2 (D) Lbp

Differentiate b/w Salmonella & Shigella species (A) MacConkey agar (B) Xylose lysine deoxycholate agar (C) Löwenstein-Jensen medium & Middlebrook agar (D) Mannitol salt agar

Differentiated lymphoid tissues along intestines involved in antigen internalization & facilitating encounter of antigen with lymphocytes, macrophages, & DCs (A) Spleen (B) Peyer's patches (C) Waldeyer's ring (D) Thymus

Digoxin has a positive ionotropic effect by inhibiting Na+/K+ ATPase and decreasing (A) extrusion of Na+ (B) intrusion of K+ (C) intrustion of Na+ (D) extrusion of Ca2+

Dilation of the renal pelvis & calyces, w/ accompanying atrophy of the parenchyma, caused by obstruction to outflow or urine (A) pyelonephritis (B) nephrosclerosis (C) hydronephrosis (D) urolithiasis

Drugs excreted by kidneys are eliminated twofold less efficiently when GFR drops to ____ mL/min & may reach toxic levels at lower GFR → must reduce drug dosage & timing of administration should be prolonged (A) 10 (B) 30 (C) 50 (D) 90

↑↑ ↑ ↑↑ ↑ ↑ ↓↓ ↑↑

During exercise, sympathetic outflow to the heart & blood vessels is increased, resulting in: -HR (↑↑/↓↓) -Stroke volume (↑/↓) -cardiac output (↑↑/↓↓) -arterial pressure (↑/↓) -pulse pressure (↑/↓) -TPR (↑↑/↓↓) -AV O2 difference (↑↑/↓↓)

During exercise, total peripheral resistance (TPR) decreases because of the effect of (A) the sympathetic nervous system on splanchnic arterioles (B) the parasympathetic nervous system on skeletal muscle arterioles (C) local metabolites on skeletal muscle arterioles (D) local metabolites on cerebral arterioles (E) histamine on skeletal muscle arterioles

During light microscopic examination of a tissue, you note a vessel that has no smooth muscle but a large amount of connective tissue at its periphery. Which of the following vessels are you examining? (A) Arteriole (B) Venule (C) Elastic artery (D) Capillary (E) Large vein

During the _____ stage of granulopoiesis, azurophilic granules are secreted in the golgi (A) myeloblast (B) promyelocyte (C) myelocyte (D) band cell (E) metamyelocyte

During the _____ stage of granulopoiesis, the golgi packages proteins for specific granules - 1st visible sign of differentiation into specific granulocyte type (A) myeloblast (B) promyelocyte (C) myelocyte (D) band cell (E) metamyelocyte

E (ventricular P < atrial P → mitral valve opens)

During which phase of the cardiac cycle does the mitral valve open? (A) Atrial systole (B) Isovolumetric ventricular contraction (C) Rapid ventricular ejection (D) Reduced ventricular ejection (E) Isovolumetric ventricular relaxation (F) Rapid ventricular filling (G) Reduced ventricular filling (diastasis)

During which phase of the cardiac cycle is aortic pressure highest? (A) Atrial systole (B) Isovolumetric ventricular contraction (C) Rapid ventricular ejection (D) Reduced ventricular ejection (E) Isovolumetric ventricular relaxation (F) Rapid ventricular filling (G) Reduced ventricular filling (diastasis)

During which phase of the cardiac cycle is ventricular volume lowest? (A) Atrial systole (B) Isovolumetric ventricular contraction (C) Rapid ventricular ejection (D) Reduced ventricular ejection (E) Isovolumetric ventricular relaxation (F) Rapid ventricular filling (G) Reduced ventricular filling (diastasis)

During which phase of the ventricular action potential is the conductance to Ca2+ highest? (A) Phase 0 (B) Phase 1 (C) Phase 2 (D) Phase 3 (E) Phase 4

During which phase of the ventricular action potential is the membrane potential closest to the K+ equilibrium potential? (A) Phase 0 (B) Phase 1 (C) Phase 2 (D) Phase 3 (E) Phase 4

Dysfunctional endothelium facilitates entry & retention of _______ in the intima (A) chemokines (B) macrophages (C) lipoproteins (D) bacteria

Dyspnea (SOB) on exertion is usually earliest & most significant sign of (A) left-sided heart failure (B) right-sided heart failure (C) cardiac tamponade (D) MI

ECF makes up 20% of body weight. Which of the following is NOT a major ion in ECF? (A) Na+ (B) K+ (C) Cl- (D) HCO3-

Edema occurs when volume of interstitial fluid exceeds capacity of lymphatics to return it to circulation and can be caused by (A) Excess filtration (B) Excess absorption (C) Blocked lymphatics (D) B & C (E) A & C

Efferent arterioles from cortical glomeruli branch diffusely as ________. Those from juxtamedullary glomeruli branch as long microvascular loops called _______ (A) afferent arterioles, efferent arterioles (B) interlobular arteries, peritubular capillaries (C) efferent arterioles, interlobular arteries (D) peritubular capillaries, vasa recta

Electrical & magnetic fields are reduced _____ with the _____ of the distance from the source (A) proportionately, square (B) proportionately, third (C) inversely, square (D) inversely, third

Elevated levels of which of the following lead to reduced risk for coronary atherosclerosis? (A) LDL (B) triglyceride (C) β-lipoprotein (D) HDL

Elevated levels of which of the following lead to the greatest increase in risk for coronary atherosclerosis? (A) LDL (B) triglyceride (C) β-lipoprotein (D) HDL

Enormously enlarged kidneys similar to the one shown in the figure are found at autopsy in a 65-year-old woman. Which of the following is a well-known association or characteristic of this adult polycystic kidney disease? (A) Berry aneurysm of the circle of Willis (B) Nephrotic syndrome (C) Polycystic ovaries (D) Polycythemia vera (E) X-linked inheritance

Enzymes with positive cooperativity have hill coefficients (H) _____ Enzymes with negative cooperativity have hill coefficients (H) _____ (A) =1.0; ≠1.0 (B) >1.0, <1.0 (C) > 0.0, < 0.0 (D) > 10, < 10

Epithelial cell membrane domains containing many stiffened plaques of protein are an important feature in which part of the urinary system? (A) Juxtaglomerular apparatus (B) Bladder mucosa (C) Collecting ducts (D) Renal pyramids (E) Membranous urethra

Evidence of HF begins around ejection fractions of ___%, and severe HF is indicated by EF around __% (A) 70%; 50% (B) 60%; 50% (C) 50%; 30% (D) 50%; 20%

Existing evidence indicates use of modest doses ________ cartridges of 2% lidocaine w/ 1 : 100,000 epinephrine carries little clinical risk in patients with HTN & benefits for use outweigh any potential problems (A) 1 to 2 (B) 3 to 4 (C) 5 to 6 (D) cannot use any cartridges - all contraindicated

Expected findings on electron microscopic examination of the glomerulus from a patient with poststreptococcal glomerulonephritis demonstrate (A) marked subendothelial immune complex deposition. (B) marked thickening of the glomerular basement membrane with numerous intramembranous and epimembranous (subepithelial) immune complex deposits. (C) no changes except for fused epithelial foot processes. (D) normal-appearing glomerular basement membrane with electron-dense "humps" in subepithelial location. (E) striking increase in thickness of glomerular basement membrane and diffuse increase in mesangial matrix material.

Ezetimibe (A) inhibit HMG-CoA reductase (B) act through PPARα TF (C) inhibit intestinal absorption by binding bile acids & inhibiting cholesterol transport (NPC1L1) (D) bind to LDL receptor

Facilitate IgA production (A) Th1 (B) Th2 (C) Th3 (D) Th17

Factors that INCREASE filtration out of capillary (A) ↓ Pc, ↓ Pi, ↓ πc, ↓, πi (B) ↑ Pc, ↓ Pi, ↓ πc, ↑, πi (C) ↓ Pc, ↑ Pi, ↓ πc, ↑, πi (D) ↑ Pc, ↓ Pi, ↑ πc, ↓, πi

Failure of a valve to close completely due to intrinsic disease of valve cusps or disruption of supporting structures w/o primary cuspal injury → regurgitation of blood (A) stenosis (B) insufficiency (C) atresia (D) hyperplasia

Failure of a valve to open completely due to primary cuspal abnormality stemming from chronic process → obstructs forward flow (A) stenosis (B) insufficiency (C) atresia (D) hyperplasia

Familial hypercholesterolemia is a monogenic disorder caused by mutation in the gene coding for _____ receptor (A) VLDL (B) IDL (C) LDL (D) HDL

Fibrates (A) inhibit HMG-CoA reductase (B) act through PPARα TF (C) inhibit intestinal absorption by binding bile acids & inhibiting cholesterol transport (D) bind to LDL receptor

Filtration fraction = GFR/RPF. Which of the following is the normal filtration fraction? (A) 10% (B) 20% (C) 50% (D) 70%

First ventricular depolarization to last ventricular repolarization (A) P wave (B) PR interval (C) QRS complex (D) T wave (E) QT interval

Fixed stenosis occluding ≥ ___% of vessel lumen → inadequate coronary blood flow with symptoms at rest (unstable angina) (A) 20% (B) 50% (C) 70% (D) 90%

Fluorescent dyes distinguish live & dead bacteria or eukaryotic cells. SYTO9 dye labels all bacterial DNA ______, while propidium iodide labels bacteria with damaged membranes _______ (A) red; blue (B) green; pink (C) green; red (D) purple; green

Foam cells are _____ that form conglomerates called fatty streaks & are found in _______ (A) neutrophils, renal failure (B) macrophages, atherosclerotic plaques (C) neutrophils, pulmonary disease (D) macrophages, CHF

For CKD of _______ or higher, it is recommended to obtain consultation w/ patient's PCP suggested before dental care provided (A) stage 1 (B) stage 2 (C) stage 3 (D) stage 4 (E) stage 5

For those substances that are actively reabsorbed, the maximal amount that can be transported per unit time by the kidney tubules: (A) depends on the maximum rate at which the transport mechanism itself operates (B) is directly related to the plasma concentration of the substance (C) is termed the tubular transport maximum (D) is dependent upon tubular load (E) A and C are correct.

For which of the following is antibiotic prophylaxis NOT routinely recommended? (A) after device placement for patients who undergo dental, respiratory, GI, or genitourinary procedures (B) patients with above devices if undergoing incision & drainage of infection at other sites or replacement of an infected device (C) patients with residual leak after device placement for attempted closure of leak associated with patent ductus arteriosus, ASD, or VSD (D) all of the above require routine antibiotic prophylaxis

From PCT, filtrate flow into ______, located in medulla with its squamous thin descending & ascending limbs (A) renal corpuscle (B) connecting tubules (C) Loop of Henle (D) DCT

Fully differentiated white adipocytes are large cells, typically having diameters of approximately what size? (A) 5 μm (B) 10 μm (C)100 μm (D) 500 μm (E) 1000 μm

Giant cells with large polyploid nuclei with irregularly lobulated coarse chromatin that are rich in MT, golgi, & RER (A) Myelocyte (B) Reticulocyte (C) Megakaryoblast (D) Monocyte

Glomerular filtration produces an ultrafiltrate of plasma: (A) in which the concentration of electrolytes is equal to plasma (B) in which the concentration of protein is equal to plasma (C) containing only those substances which must be eliminated in the urine (D) A and B are correct.

Glyceryl trinitate is used to relieve chest pain caused by inadequate oxygen supply to heart muscle. It works by (A) inhibiting NO release (B) stimulating ANP release (C) inhibiting Ca2+ channels (D) stimulating NO release

Greatest benefit realized when patients receive thrombolytic drugs within 1st _____ after infarction (A) 60 min (B) 3 hours (C) 12 hours (D) 24 hours

HF may occur as a result of which of the following? (A) impaired myocardial contractility (B) increased ventricular stiffness or impaired myocardial relaxation (C) disorders of heart rate or rhythm (D) states in which heart is unable to compensate for increased peripheral blood flow or metabolic requirements (E) all of the above

2.7; 4

Hb binds oxygen cooperatively, with a Hill coefficient of _____ Hb can bind up to ____ molecules of O2 in a cooperative manner

Heart rate is the number of ______ or R waves per minute (A) P wave (B) PR interval (C) QRS complex (D) T wave (E) QT interval

Heme is a porphyrin molecule that binds (A) Ca2+ (B) Fe2+ (C) Na+ (D) Mg2+

Hendrick Gerber would need a liver function test before he could be given which of the following medications (A) ACE inhibitors (B) thiazide diuretics (C) NSAIDs (D) statins

High levels of angiotensin II → constriction of afferent arterioles → _____ resistance _____ RPF _____ GFR (A) ↑, ↑, ↑ (B) ↓, ↓, ↓ (C) ↑, ↓, ↓ (D) ↓, ↑, ↑

Hormone secreted by posterior pituitary gland that regulates blood flow osmolarity & participates in regulation of Pa (A) Aldosterone (B) ADH or Vasopressin (C) Cortisol (D) Leptin

How does the kidney produce urine that is LESS concentrated than blood (hypoosmotic)? (A) via Na+-Cl--K+ cotransporter in PCT (B) tubular fluid diluted in "diluting segments" that reabsorb NaCl w/o water (C) by preventing urea recycling (D) by equilibration of tubular fluid in collecting ducts w/ high osmolarity of corticopapillary osmotic gradient

How does the kidney produce urine that is more concentrated than blood (hyperosmotic)? (A) via Na+-Cl--K+ cotransporter in PCT (B) tubular fluid diluted in "diluting segments" that reabsorb NaCl w/o water (C) by preventing urea recycling (D) by equilibration of tubular fluid in collecting ducts w/ high osmolarity of corticopapillary osmotic gradient

How much of the total body lymph does the Right lymphatic duct drain? (A) 25% (B) 50% (C) 75% (D) 100%

How much of the total body lymph does the thoracic duct drain? (A) 25% (B) 50% (C) 75% (D) 100%

How would the cardiologist know if the placement of a right renal artery stent was performed successfully in Victor Dermody? (A) pressure gradient would decrease on both sides of stent (B) renin levels would even out (C) blood chemistry test (D) angiogram (E) A & B

Hypoxia or conversion of Hb to T state causes which of the following to be released from Hb to cause vasodilation? (A) EPO (B) NO (C) serotonin (D) Fe2+

ICF makes up 40% of body weight. Which of the following is NOT a major ion of ICF? (A) K+ (B) Mg2+ (C) Na+ (D) proteins & organic phosphates

myocardial demand

IHD is a consequence of inadequate coronary perfusion relative to ________ ________

reabsorption, secretion

If Filtered load > excretion rate → net ________ If Filtered load < excretion rate → net _______

If a patient has chest pain that is unremitting after ____, MI should be assumed (A) 5 min (B) 10 min (C) 15 min (D) 30 min

If a patient is on warfarin, dosage should be adjusted until INR is (A) < 1 (B) between 2 & 3 (C) between 3 & 4 (D) > 4

If a patient is taking _____, there is concern that injection of epinephrine or any other pressor agent may cause uncompensated peripheral vasoconstriction b/c of unopposed stimulation of α1 receptors, leading to elevated BP & compensatory bradycardia (A) CCBs (B) ACE inhibitors (C) β blockers (D) thiazide diuretics

If ceftriaxone cannot be given to a patient with infection by N gonorrhoeae, patient should be given 2 g of (A) erythromycin (B) penicillin G (C) azithromycin (D) cefixim

If extracting __ or more teeth, DOAC should be withheld the night before surgery & resumed the day after surgery (A) 1 (B) 2 (C) 3 (D) 4

If renal perfusion pressure does not change, which of the following changes in afferent and efferent arteriolar resistance would result in an increase in renal blood flow but no change in filtration fraction?

If the brain becomes ischemic (decreased cerebral blood flow) → cerebral PCO2 _______ & pH ______ → medullary chemoreceptors detect changes → direct _____ in sympathetic outflow → intense arteriolar vasoconstriction & increase in TPR (A) increases, increases, decrease (B) increases, decreases, decrease (C) decreases, increases, increase (D) increases, decreases, increase

If the clearance of Substance X is greater than the clearance of inulin, it is most likely that Substance X is: (A) bound to tubular proteins (B) bound to plasma proteins (C) secreted (D) reabsorbed (E) neither secreted nor reabsorbed

B (ejection fraction = stroke volume / end-diastolic volume

If the ejection fraction increases, there will be a decrease in (A) cardiac output (B) end-systolic volume (C) heart rate (D) pulse pressure (E) stroke volume (F) systolic pressure

C (stroke volume = end-diastolic - end-systolic = 140 - 65 = 75; cardiac output = stroke volume x HR = 75 x 70 = 5250 mL/min)

If the heart rate is 70 beats/min, then the cardiac output of this ventricle is closest to (A) 3.45 L/min (B) 4.55 L/min (C) 5.25 L/min (D) 8.00 L/min (E) 9.85 L/min

increase, larger

If there is a positive ionotropic effect, there will be (increase/decrease/no change) in stroke volume & cardiac output for a given end-diastolic volume → (smaller/larger/same) fraction of end-diastolic volume ejected per beat

If there is increased parasympathetic activity or damage to the AV node, some action potentials will not be conducted at all from atria to ventricles leading to a (A) stroke (B) MI (C) heart block (D) valve defect

Immune deposits in which of the following locations will give a granular immunofluorescence? (A) subendothelial (B) subepithelial (C) mesangial (D) all of the above

Important target cells of leptin are found in which organ? (A) Small intestine (B) White adipose tissue (C) Large intestine (D) Hypothalamus (E) Brown adipose tissue

In > 90% of cases, IHD is a consequence of reduced coronary blood flow secondary to (A) Obstructive Atherosclerotic Vascular disease (B) MI (C) Congenital R-to-L shunt (D) pulmonary HTN

In CHF, RBCs are phagocytosed in leaky capillary spaces → hemosiderin-laded alveolar macrophages (heart failure cells) reflect (A) ischemic heart disease (B) mitral valve disease (C) previous pulmonary edema (D) cardiac tamponade

In ESRD, failing kidney does NOT synthesize ______, thereby inhibiting Ca2_ absorption in the gut and leading to sustained high levels of PTH (A) ergocalciferol (B) 25OHD (C) 1,25(OH)₂D₃ (D) CYP27B1

In _______ overload states such as HTN, there is concentric hypertrophy & the ventricular wall thickness increases In ________ overload states such as valvular regurgitation, muscle fiber length increases & HR is the best measure of hypertrophy (A) valvular, volume (B) pressure, volume (C) pressure, valvular (D) volume, pressure

C (water flow = Kf x net pressure = 0.5 x 9 = 4.5)

In a capillary, Pc is 30 mm Hg, Pi is −2mmHg, πc is 25 mm Hg, and πi is 2 mm Hg If Kf is 0.5 mL/min/mm Hg, what is the rate of water flow across the capillary wall? (A) 0.06 mL/min (B) 0.45 mL/min (C) 4.50 mL/min (D) 9.00 mL/min (E) 18.00 mL/min

D (net P = (Pc - Pi) - (πc - πi); positive → filtration out)

In a capillary, Pc is 30 mm Hg, Pi is −2mmHg, πc is 25 mm Hg, and πi is 2 mm Hg What is the direction of fluid movement and the net driving force? (A) Absorption; 6 mm Hg (B) Absorption; 9 mm Hg (C) Filtration; 6 mm Hg (D) Filtration; 9 mm Hg (E) There is no net fluid movement

In a wet mount, staining the background with India ink (negative staining) can allow visualization of (A) fimbriae (B) peptidoglycan wall (C) capsules (D) endotoxin

In addition to serologic evidence of previous strep infection, diagnosis of ______ is made w/ 2 or more of the following Jones Critera: -Carditis -Migratory polyarthritis of large joints -Subcutaneous nodules -Erthematous annular skin rash -Sydenham chorea (A) SCD (B) transmural MI (C) acute rheumatic heart disease (D) unstable angina

In an anteroposterior chest radiograph, the right border of the heart is represented by the___________ (A) Left auricle (B) Right ventricle (C) Left ventricle (D) Right atrium (E) Right auricle

In anemia, there is a decrease in hematocrit (mass of RBCs) → decrease in viscosity → _____ NR & _____ blood flow (A) lower, turbulent (B) lower, laminant (C) higher, turbulent (D) higher, laminant

In clinical labs, most compounds are measured by automated enzymatic methods. ______ is the most common assay for blood glucose concentration (A) glucose oxidase (B) hexokinase (C) peroxidase (D) glucose oxidase & peroxidase mix (GOP)

In cortex, _______ enter capillary clusters called glomeruli, which are drained by ________ instead of venules → arrangement allows higher hydrostatic pressure in the capillaries (A) afferent arterioles, efferent arterioles (B) interlobular arteries, peritubular capillaries (C) efferent arterioles, interlobular arteries (D) peritubular capillaries, vasa recta

In dysfunctional endothelium, (A) NFκB dominates (B) KLF-2 & KLF-4 suppressed (C) NFκB supressed (D) A & B

In kids/adolescents, HTN is considered elevated BP that persists on repeated measurements at ____ percentile or greater for age, height, & gender (A) 85th (B) 90th (C) 95th (D) 99th

In negative chronotropic effects, the parasympathetic system releases ___ → activates SA node _____ receptors → (A) norepinephrine, beta 1 (B) norepinephrine, beta 2 (C) ACh, alpha 1 (D) ACh, Muscarinic (M2)

lower, higher

In order to equalize osmotic pressures, water always moves from a compartment w/ ________ osmolality to the one with ________ osmolality

In parallel resistance, as seen with blood flow among various major arteries branching the aorta: 1. total resistance ____ any of the individual resistances 2. there is _______ pressure (A) <, decreasing (B) >, decreasing (C) <, no loss of (D) >, no loss of

In positive chronotropic effects, the sympathetic system releases ______→ activates SA node _______ receptors → increase in If → increase rate of phase 4 depolarization (A) norepinephrine, beta 1 (B) norepinephrine, beta 2 (C) ACh, alpha 1 (D) ACh, Muscarinic (M2)

In rheumatic heart disease, ______ is the main feature in children, while ______ is the main feature in adults (A) carditis, arthritis (B) SOB, orthopnea (C) PND, peripheral edema (D) jugular venous distention, syncope

In series resistance, as seen in the arrangement of blood vessels within a given organ: 1. total resistance ____ the sum of the individual resistances 2. total flow is constant at each level and pressure _____ at each level A. >, is constant B. <, decreases progressively C. <, increases progressively D. =, decreases progressively E. =, is constant

In series resistance, the greatest decrease in pressure occurs in ______ because they have the largest resistance (R) (A) arterioles (B) arteries (C) capillaries (D) venules (E) veins

left, right

In systemic hypertension, the (right/left) ventricle hypertrophies In pulmonary hypertension, the (right/left) ventricle hypertrophies

In the Bainbridge reflex, Increased pressure detected at ________ → increase in HR → increase in cardiac output → increased renal perfusion & increased Na+ & water excretion (A) carotid sinus baroreceptors (B) medullary chemoreceptors (C) venous high-pressure receptors (D) Atrial high-pressure receptors

In the SA node (A) phase 0 through 5 are present (B) phase 1 is absent (C) phase 2 is absent (D) B & C

In the _____, glucose, organic nutrients, small proteins & peptides (AAs), & a lot of water & electrolytes are REABSORBED from the filtrate & transferred to peritubular capillaries (A) renal corpuscle (B) PCT (C) Loop of Henle (D) DCT

In the ________ , - Na+ moves into cell via Na+-K+-Cl- cotransporter (NKCC2) (A) PCT (B) thin ascending limb of loop of Henle (C) DCT (D) collecting ducts

In the cortex, the ____ (aka the distal straight tubule) contacts the arterioles at the vascular pole of its parent renal corpuscle & thickens focally there as macula densa (A) TAL (B) connecting tubules (C) Loop of Henle (D) DCT

In the cushing reaction, intracranial pressure increases and compresses the cerebral arteries leading to an increase in PCO2 and decrease in pH, which is detected by ______ that respond by increasing sympathetic outflow which increases TPR → increase Pa (A) Renin-Angiotensin II-Aldosterone System (B) Baroreceptors in carotid sinus (C) Peripheral Chemoreceptors in carotid & aortic bodies (D) Central (Medullary) Chemoreceptors

In the fed state, triglycerides are delivered from the intestine to the periphery by _______ → remnants form after triacylglycerols are removed (A) apolipoproteins (B) LDL (C) chylomicrons (D) ACAT

placenta

In the fetus, blood is oxygenated in the ________, not the lungs, which is why there are 3 shunts that partially bypass the lungs and liver

In the presence of _____, aquaporins are inserted in principal cells to make them permeable to water (A) Aldosterone (B) ADH (C) Renin (D) Angiotensin II

In the sinoatrial (SA) node, phase 4 depolarization (pacemaker potential) is attributable to (A) an increase in K+ conductance (B) an increase in Na+ conductance (C) a decrease in Cl- conductance (D) a decrease in Ca2+ conductance (E) simultaneous increases in K+ and Cl- conductances

In uncomplicated cases of infection by N gonorrhoeae, which of the following is recommended? (A) single dose of ceftriaxone (B) single dose of axithromycin (C) doxycycline BID for 7 days (D) any of the above

In which of the following cells involved in erythropoiesis does hemoglobin synthesis begin? (A) Orthochromatic erythroblast (B) Polychromatophilic erythroblast (C) Reticulocyte (D) Basophilic erythroblast (E) Proerythroblast

In which of the following situations is pulmonary blood flow greater than aortic blood flow? (A) Normal adult (B) Fetus (C) Left-to-right ventricular shunt (D) Right-to-left ventricular shunt (E) Right ventricular failure (F) Administration of a positive inotropic agent

Incapable of generating a 2nd action potential no matter the size of the stimulus (A) Absolute Refractory Period (ARP) (B) Effective Refractory Period (ERP) (C) Relative Refractory Period (RRP) (D) Supranormal Period (SNP)

Incompetence of vesicoureteral orifice, resulting in vesicoureteral reflux (VUR), is an important cause of (A) descending acute pyelonephritis (B) ascending acute pyelonephritis (C) hematogenous infection (D) IgA nephropathy

increased, decreased, vasodilation, increased

Increase in blood V detected by cardiopulmonary baroreceptors leads to 1. (increased/decreased) secretion of ANP → increased Na+ & water excretion in kidneys 2. (increased/decreased) secretion of ADH 3. renal (vasoconstriction/vasodilation) 4. (increased/decreased) HR

A (Pc = capillary hydrostatic P)

Increase in either arterial or venous pressure increases ______, which means ______ will be favored (A) Pc, filtration (B) Pi, filtration (C) Pc, absorption (D) Pi, absorption

Increased ratio of BUN/creatinine to > 20 is indicative of (A) chronic renal failure (B) prerenal azotemia (C) hypervolemia (D) pheochromocytoma

Increased secretion of ANP binds to ANP receptors on vascular smooth muscle causing (A) vasoconstriction → increased Na+ & water reabsorption by kidneys (B) vasodilation → increased Na+ & water reabsorption by kidneys (C) vasoconstriction → increased Na+ & water excretion by kidneys (D) vasodilation → increased Na+ & water excretion by kidneys

Increases in plasma protein concentration → ↑ in πGC → ___ net ultrafiltration P ___ GFR ___ Filtration Fraction (GFR/RPF) (A) ↑, ↑, ↑ (B) ↓, ↓, ↓ (C) ↑, ↓, ↓ (D) ↑, ↓, ↑

vasoconstriction, vasodilation

Increases in sympathetic tone → (vasoconstriction/vasodilation) Decreases in sympathetic tone → (vasoconstriction/vasodilation)

Individuals with Marfan syndrome have mutations in the fibrillin gene and commonly experience aortic aneurisms. What portion of the arterial wall is most likely to be affected by the malformed fibrillin? (A) Endothelium (B) Tunica intima (C) Tunica media (D) Tunica adventitia (E) Vasa vasorum

Ineffective megakaryopoiesis due to deficiencies of folic acid or vitamin B12 can lead to a reduction in the number of platelets, known as (A) hyperemia (B) demarcation membrane (C) Thrombocytopenia (D) Erythrocytopenia

Infarction is tissue death due to obstruction of blood supply. Which of the following points towards infarction over ischemia? (A) coolness (B) not helped with rest (C) helped with rest (D) syncope

Infections caused by which of the following are most common in children under 1 & young adults between 15 & 19? (A) N gonorrhea (B) N meningitidis (C) E corrodens (D) M catarrhalis

Inflammation - produce IL-17 which induces chemokine & cytokine production leading to recruitment of PMNs (A) Th1 (B) Th2 (C) Th3 (D) Th17

Inhibit Na+ reabsorption & K+ secretion by principal cells (A) loop diuretics (B) ACE inhibitors (C) K+ sparing diuretics (D) thiazide diuretics

Inhibits Ca2+ influx in vascular smooth muscle & the heart w/ the same potency → ↓ BP by vasodilation & reduced CO (A) Dilitiazem (B) verapamil (C) dihydropyridines (D) A & B

Injections of sympathomimetic drugs (epinephrine or levonodefrin) may cause elevated BP in patients taking (A) nitrates (B) nonselective beta-blockers (C) CCBs (D) statins

Inside cells, what buffers H+ ions? (A) HCO3- (B) proteins (C) phosphates (D) B & C (E) all of the above

Inspiration "splits" the second heart sound because (A) the aortic valve closes before the pulmonic valve (B) the pulmonic valve closes before the aortic valve (C) the mitral valve closes before the tricuspid valve (D) the tricuspid valve closes before the mitral valve (E) filling of the ventricles has fast and slow components

Into which junction does the right lymphatic duct open? (A) right internal jugular & right subclavian vein (B) left internal jugular & left subclavian veins (C) bifurcation of jugular vein (D) superior vena cava

Into which junction does the thoracic duct open? (A) right internal jugular & right subclavian vein (B) left internal jugular & left subclavian veins (C) bifurcation of jugular vein (D) superior vena cava

Invasive procedure planned for patient with CKD above ______ - consult w/ PCP to assess need for antibiotics (A) stage 1 (B) stage 2 (C) stage 3 (D) stage 4 (E) stage 5

Inverted T waves on an EKG are a sign of (A) MI (B) hyperkalemia (C) ischemia (D) left ventricular hypertrophy

Ischemia of papillary muscles may cause mitral regurgitation and a pansystolic murmur in a patient with an acute MI of which of the following? (A) LAD (B) RCA (C) LCX (D) Great cerebral

Ischemic ATI is characterized by lesions where? I. straight portions of PCT II. straight portions of DCT III. ascending thick limbs IV. descending thick limbs (A) I & II (B) III & IV (C) I & III (D) I, II, & IV

Ischemic heart disease is the usual sequel to (A) arteriosclerosis. (B) abdominal aortic aneurysm. (C) rheumatic fever. (D) varicose veins. (E) atherosclerosis.

Isolate mycobacteria (A) MacConkey agar (B) Xylose lysine deoxycholate agar (C) Löwenstein-Jensen medium & Middlebrook agar (D) Mannitol salt agar

Jared and Adam both weigh 70 kg. Jared drinks 2 L of distilled water, and Adam drinks 2 L of isotonic NaCl. As a result of these ingestions, Adam will have a (A) greater change in intracellular fluid (ICF) volume (B) higher positive free-water clearance (CH2O ) (C) greater change in plasma osmolarity (D) higher urine osmolarity (E) higher urine flow rate

Jugular venous distention, orthopnea, edema and paroxysmal nocturnal dyspnea point towards (A) peripheral artery disease (B) congestive heart failure (C) myocardial infarction (D) hemorrhagic stroke

K+ sparing diuretics inhibit all actions of _____ on principal cells in order to inhibit K+ secretion (A) ADH (B) Aldosterone (C) Renin (D) PAH

L ventricular dilation & hypertrophy often w/ discrete areas of gray-white scarring from previous healed infarcts is characteristic of (A) angina pectoris (B) acute myocardial infarction (C) chronic IHD (D) sudden cardiac death (SCD)

LVHF leads to all of the following clinical presentations EXCEPT (A) pulmonary vascular congestion (B) systemic venous congestion (C) pulmonary edema (D) dyspnea

Laminar flow is streamlined and silent. The velocity of flow is (A) equal throughout stream (B) zero at vessel wall and maximal at center of stream (C) maximal at vessel wall and zero at center of stream (D) none of the above

Large amount of free cholesterol → SREBP pathway ______ → _____ cholesterol synthesis & receptor expression (A) inhibited, increased (B) inhibited, decreased (C) stimulated, increased (D) stimulated, decreased

Large cells that are pink to mauve and arranged in nets with capillaries in between would be indicative of? (A) medullary thyroid carcinoma (B) pheochromocytoma (C) parathyroid tumor (D) mucosal neuroma

Large, bulbous superficial cells of urothelium called ________have apical membranes consisting of hinged regions w/ dense plaques of uroplakin proteins that protect the cytoplasm (A) mesangial cells (B) podocytes (C) umbrella cells (D) juxtaglomerular cells

Lesions that occlude > ___% of vessel lumen → "critical stenosis" - symptoms when increased demand (stable angina) (A) 20% (B) 50% (C) 70% (D) 90%

Light rays moving through more dense material are retarded more than those going through the medium giving a 3-D image of microorganism → *more detailed analysis of internal structures* (A) bright-field microscopy (B) dark-field microscopy (C) phase contrast microscopy (D) fluorescence microscopy

Lipids mobilized from adipocytes by hormone-sensitive lipase activated by________released from adrenal gland & various peptide hormones (A) leptin (B) norepinephrine (C) insulin (D) dopamine

Lipoproteins distribute ______ b/w the intestine, liver, & peripheral tissues (A) glucose (B) triacylglycerols (C) cholesterol (D) A & B (E) B & C

Lipoproteins fulfill a duel function: 1. distribution of _____ 2. _____ delivery to cells (A) cholesterol, triacylglycerols (B) triacylglycerols, cholesterol (C) chylomicrons, cholesterol (D) chylomicrons, TG

Low levels of angiotensin II → constriction of efferent arterioles → _____ resistance _____ RPF _____ GFR (A) ↑, ↑, ↑ (B) ↓, ↓, ↓ (C) ↑, ↓, ↓ (D) ↑, ↓, ↑

Low plasma albumin will lead to low plasma _______ and ultimately _______ (A) hydrostatic pressure; dehydration of tissues (B) hydrostatic pressure; edema (C) oncotic pressure; dehydration of tissues (D) oncotic pressure; edema

Lymphocytes from adjacent tissues or LNs enter LN through (A) high endothelial venules (B) afferenti lymphatic vessels (C) efferent lymphatic vessels (D) all of the above

Lymphocytes from circulation enter LN through (A) high endothelial venules (B) afferenti lymphatic vessels (C) efferent lymphatic vessels (D) all of the above

Macrolide antibiotics can increase plasma level of ___ → severe hypotension (A) ACE inhibitors (B) Beta-blockers (C) CCBs (D) nitrates

Macrophages that have migrated into intima engulf lipid molecules to become _____ found in fatty streaks (A) dust cells (B) foam cells (C) rosettes (D) heart failure cells

Magnitude of muscle tension is (A) proportional to amount of cross-bridge cycling (B) proportional to intracellular [Na+] (C) proportional to intracellular [Ca2+] (D) inversely proportional to intracellular [K+]

Main predisposing factor for IE = (A) seeding of the blood w/ microbes (B) smoking (C) family hx (D) high cholesterol

Malignant HTN is considered to be BP greater than (A) 180/80 (B) 200/100 (C) 200/120 (D) 250/150

1-B, 2-D, 3-C, 4-A

Match the component of the Renin-Angiotensin II-Aldosterone system to its description 1. Enzyme 2. Inactive 3. Physiologically active vasoconstrictor 4. Degrades angiotensin II A. Angiotensinase B. Renin C. Angiotensin II D. Angiotensin I

1-B, 2-A, 3-C

Match the following: 1. thick-walled with extensive elastic tissue & smooth muscle; under HIGH pressure 2. thin-walled with single layer of endothelial cells; largest total cross-sectional SA 3. thin-walled and under LOW pressure A. Capillaries B. Arteries C. Veins

1-B, 2-A, 3-C

Match the heart block to its correct description: 1. 1st degree 2. 2nd degree 3. 3rd degree A. intermittent transmission of AV node signal B. Prolongation of P-R interval on ECG C. complete failure

1-B, 2-A. 3-C

Match the male portion of the urethra to the correct lining epithelium 1. prostatic urethra 2. membranous urethra 3. spongy (penile) urethra A. stratified columnar & pseudostratified columnar B. urothelium C. stratified columnar & pseudostratified columnar w/ stratified squamous distally

1-C, 2-A, 3-B

Match the occlusion location to the outcome 1. coronary artery 2. artery supplying brain 3. leg arteries A. stroke B. peripheral artery disease C. MI

1-B, 2-A, 3-D, 4-E, 5-C

Match the phase to its event 1. phase 0 2. phase 1 3. phase 2 4. phase 3 5. phase 4 A. initial repolarization (net outward current) B. upstroke - rapid depolarization C. resting membrane potential or electrical diastole D. plateau - stable, depolarized membrane potential E. repolarization - outward currents>inward currents

1-B, 2-C, 3-A

Match the substance to its method of passage across the capillary wall 1. Lipid-soluble (O2 & CO2) 2. Small water-soluble (water, glucose, & AAs) 3. Large water-soluble A. pinocytosis B. simple diffusion C. water-filled clefts b/w endothelial cells

1-B, 2-C, 3-A

Match the temperature regulation disturbance to its description 1. Heat exhaustion 2. Heat stroke 3. Malignant hyperthermia A. massive increase in metabolic rate, increased O2 consumption, & increased heat production in skeletal muscle B. excessive sweating → decreased ECF V, decreased blood V, decreased Pa, & fainting C. body temp increases to point of tissue damage

1-B, 2-A, 3-C

Match the type of angina pectoris to its description: 1. occurs predictably at certain levels of exertion 2. caused by vessel spasm 3. occurs w/ progressively less exertion or at rest A. prinzmetal B. stable C. unstable

1-A, 2-B

Match the vasopressin (ADH) receptor to its description 1. V1 2. V2 A. vascular smooth muscle - activation causes vasoconstriction of arterioles & increased TPR B. principal cells of renal collecting ducts - water reabsorption in collecting ducts & maintenance of body fluid osmolarity

Mean Arterial Pressure (MAP) = (A) diastolic - systolic (B) systolic - diastolic (C) diastolic + systolic + 1/3 (diastolic - systolic) (D) diastolic + systolic + 1/2 (systolic - diastolic)

Mean arterial pressure is the average pressure in a complete cardiac cycle. It is the driving force for blood flow in _______ and is influenced more by _______ than _______ because a greater proportion of the cardiac cycle is spent in ________ (A) veins, systole than diastole, systole (B) veins, diastole than systole, diastole (C) arteries, diastole than systole, diastole (D) arteries, systole than diastole, systole

Mean arterial pressure is the driving force for blood flow, and must be maintained at a high constant level of ~ ______. Pa = ? (A) ~50 mm Hg; = cardiac output x venous return (B) ~ 150 mm Hg; = venous return x TPR (C) ~100 mm Hg; =cardiac output x TPR (D) ~200 mm Hg; = TPR x R atrial P

B, C

Mean systemic pressure = R atrial pressure when there is not flow in cardiovascular system. It is decreased (shifted to the LEFT) by (select all that apply): (A) increase in blood volume (B) decrease in blood volume (C) increase in venous compliance (D) decrease in venous compliance

A, D

Mean systemic pressure = R atrial pressure when there is not flow in cardiovascular system. It is increased (shifted to the RIGHT) by (select all that apply): (A) increase in blood volume (B) decrease in blood volume (C) increase in venous compliance (D) decrease in venous compliance

Menactra (MCV-4) is used in all of the following scenarios EXCEPT (A) outbreak of disease with a serogroup present in vaccine (B) children under age 2 (C) travelers to hyperendemic areas (D) individuals at increased risk (patients w/ complement deficiency)

Metabolic syndrome is a cluster of pathologic findings consisting of all of the following EXCEPT (A) COPD (B) obesity (C) insulin resistance (D) low HDL cholesterol (E) elevated triglycerides (F) HTN

Metarterioles, vessels interposed between arterioles and capillary beds, (A) function to control blood flow into arterioles. (B) possess a complete layer of smooth muscle cells in their tunica media. (C) possess precapillary sphincters. (D) receive blood from thoroughfare channels. (E) possess valves to regulate the direction of blood flow.

Mild ↓ in GFR (60 - 89) (A) stage 1 (B) stage 2 (C) stage 3 (D) stage 4 (E) stage 5

Modified, heated form of blood agar used to identify Neisseria (A) Sabouraud dextrose agar (B) chocolate agar (C) buffered charcoal yeast extract (BCYE) (D) Mueller-Hinton Agar

More potent at inhibiting Ca2+ influx at vascular smooth muscle than the heart → pronounced vasodilation w/ little direct effect on cardiac function (A) Dilitiazem (B) verapamil (C) dihydropyridines (nifedipine) (D) A & B

Myocardial contractility is best correlated with the intracellular concentration of (A) Na+ (B) K+ (C) Ca2+ (D) Cl- (E) Mg2+

Myocardial inflammatory lesions called Aschoff bodies are pathognomonic for which of the following? (A) Calcific aortic stenosis (B) Myxomatous Mitral Valve (C) Rheumatic Valvular disase (D) infective endocarditis

A (resistance due to beta-lactamase not chromosomal)

N gonorrhoeae have chromosomal resistance to all of the following EXCEPT (A) penicillin G (B) tetracyclines (C) erythromycin (D) aminoglycosides

Na+ EXCRETION < Na+ INTAKE (A) positive Na+ balance → ECF volume expansion (B) positive Na+ balance → ECF volume contraction (C) negative Na+ balance → ECF volume expansion (D) negative Na+ balance → ECF volume contraction

Na+ EXCRETION > Na+ INTAKE (A) positive Na+ balance → ECF volume expansion (B) positive Na+ balance → ECF volume contraction (C) negative Na+ balance → ECF volume expansion (D) negative Na+ balance → ECF volume contraction

Na+ reabsorption via Na+-Cl- cotransporter (NCC) occurs in the _____ (A) PCT (B) thin ascending limb of loop of Henle (C) DCT (D) collecting ducts

Na+ reabsorption via amiloride-sensitive Na+ channel (ENaC) occurs in the ______ (A) PCT (B) thin ascending limb of loop of Henle (C) DCT (D) collecting ducts

Na+-glucose cotransporter (SGLT) in luminal membrane of PCT is an example of (A) primary active transport (B) secondary active transport (C) facilitated diffusion (D) passive transport

Na+/K+ ATPase hydrolyzes 1 ATP to drive transfer of ________ & _______ (A) 3 Na+ in; 2 K+ out (B) 1 Na+ in; 1 K+ out (C) 3 Na+ out; 2 K+ in (D) 2 Na+ out; 2 K+ in

No impulses are conducted (A) 1st degree heart block (B) 2nd degree - Mobitz type I (Wenckebach) (C) 2nd degree - type II (D) 3rd degree

Normally, filtration out of capillaries is slightly greater than absorption of fluid into capillaries. Excess filtered fluid is returned to circulation via ______ (A) plasma proteins (B) lymph (C) transmembrane proteins (D) RBCs

R, T

O2 affinity is HIGHER in the _____ state of Hb and LOWER in the ____ state

O2 released from Hb is tissue capillaries → _____ binds O2 → diffuses into tissues (A) another molecule of Hb (B) Chromatin (C) Mb (D) transferrin (E) albumin

ONLY nephron segment where Ca2+ reabsorption is NOT coupled directly to Na+ reabsorption (A) PCT (B) loop of henle (C) DCT (D) collecting ducts

Obesity & DM lead to dyslipidemia caused by increased ___ production (A) VLDL (B) IDL (C) LDL (D) HDL

Obstructing urine flow produces changes in (A) P∨GC (B) P∨BS (C) π∨GC (D) B & C

Occasional or repetitive sudden block of conduction of an impulse WITHOUT previous lengthening of conduction time (A) 1st degree heart block (B) 2nd degree - Mobitz type I (Wenckebach) (C) 2nd degree - type II (D) 3rd degree

Occlusion of which of the following will result in a decrease in blood supply to the SA node, the natural pacemaker of the heart, and the A-V node, which is the natural electrical conduit between the atria and ventricles, which can lead to bradycardia (A) LAD (B) RCA (C) LCX (D) Great cerebral

Omega-3 fatty acids lower (A) VLDL (B) HDL (C) triglycerides (D) LDL

On EKG - ______ → loss of P-waves, characteristic tall peaked T-waves, & widened QRS complexes (A) hyponatremia (B) hypernatremia (C) hyperkalemia (D) hypokalemia

On EKG, ______ → prolonged PR intervals, peaked P-waves, flattened T-waves, & prominent U-waves (A) hyponatremia (B) hypernatremia (C) hyperkalemia (D) hypokalemia

B (ventricles contract but all valves closed so ventricular P increases but volume stays the same)

On the graph showing left ventricular volume and pressure, isovolumetric contraction occurs between points (A) 4→1 (B) 1→2 (C) 2→3 (D) 3→4

Oncotic pressure balanced by hydrostatic pressure, which (A) retains water in vascular bed (B) retains water in cells (C) forces fluids out of capillaries (D) has not effect

One international unit (IU) of enzyme catalyzes conversion of (A) 1 nmol of substrate to product per minute (B) 1 µmol of substrate to product per minute (C) 1 µmol of substrate to product per second (D) 1 mol of substrate to product per minute

PCSK9 inhibitors are the newest class of cholesterol-lowering drugs that work by (A) inhibit HMG-CoA reductase (B) act through PPARα TF (C) inhibit intestinal absorption by binding bile acids & inhibiting cholesterol transport (NPC1L1) (D) increasing availability of LDL receptor & decreasing LDL-C

-slows -hyperpolarizes -increases

Parasympathetic release of ACh and activation of M2 receptors → - (increases/slows) rate of phase 4 depolarization -(depolarizes/repolarizes/hyperpolarizes) maximum diastolic potential so more inward current needed to reach threshold potential -(increases/decreases) threshold potential

Partial obstruction & limited myocardial necrosis → ST segment _______ More complete obstruction, profound ischemia, & larger area of necrosis → (A) elevated, not elevated (B) not elevated, elevated (C) elevated, elevated (D) not elevated, not elevated

Patients at high risk for HF but without structural heart disease or symptoms of HF (A) stage A (B) stage B (C) stage C (D) stage D

Patients taking large doses of corticosteroids to manage ESRD may develop adrenal insufficiency. Before any surgical procedures, you should make sure the patient ________ to avoid adrenal crisis (A) takes usual corticosteroid dose (B) takes double the usual corticosteroid dose (C) takes half the usual corticosteroid dose (D) does not take the usual corticosteroid dose for at least 24 hours prior

Patients with refractory HF requiring special intervention (A) stage A (B) stage B (C) stage C (D) stage D

Patients with structural heart disease but without signs or symptoms of HF (A) stage A (B) stage B (C) stage C (D) stage D

Patients with structural heart disease with prior or current symptoms of HF (A) stage A (B) stage B (C) stage C (D) stage D

Penicillin allergies are mediated by recognition I. IgM II. IgE III. T cells IV. B cells (A) I & II (B) I & III (C) II & III (D) I, II, III, & IV

Pericarditis is inflammation of the pericardium. Similar to MIs, it causes continuous central chest pain, but unlike MIs, pain can be relieved by: (A) open bypass surgery (B) sitting forward (C) lying down (D) taking beta blockers (E) taking baby aspirin

Periorbital edema is considered to be a characteristic feature of (A) CHF (B) severe kidney disease (C) MI (D) peripheral vascular disease

Peripheral chemoreceptors in carotid & aortic bodies are primarily sensitive to (A) changes in blood volume (B) decreases in hormone balance (C) decreases in PO2 (D) changes in Pa (mean arterial pressure)

Person who cannot perform at a minimum of a __ MET level is at increased risk for a cardiovascular event (A) 2 (B) 4 (C) 6 (D) 8

Pheochomocytomas are usually benign and arise in the (A) adrenal cortex (B) parathyroid gland (C) thyroid gland (D) adrenal medulla

Phosphaturia (increased phosphate excretion) & increased urinary cAMP are hallmarks for action of (A) Calcitonin (B) PTH (C) Insulin (D) Aldosterone

Phosphorylation of _________ stimulates Ca2+ ATPase in SR → greater uptake & storage of Ca2+ → faster relaxation and increased amount of stored Ca2+ for release (A) calmodulin (B) protein kinase A (C) phospholamban (D) actin

oppose

Pi is the interstitial fluid hydrostatic pressure. Increases in Pi (favor/oppose) filtration out of capillary

C, B, E, A, D

Place the following steps in DNA microarray analysis in the correct order: A. If gene has been expressed, labeled DNA corresponding to that RNA binds to spot corresponding to that gene B. RNA expressed under 2 different conditions extracted & reverse transcribed to cDNA & DNA is labeled w/ fluorescence (green & red) C. Microarray created by microspotting each gene of species on glass slide D. Relative amounts of green & red DNA at spot measured & indicate relative expression of that gene under different conditions E. Labeled DNA layered over microarray

B, E, C, D, A

Place the following steps of atherogenesis in the correct order: A. Inflammatory activity destabilizes the plaque, making it prone to rupture B. Cells enter vascular intima C. Oxidized lipoproteins are taken up by macrophages D. Migration of vascular smooth muscle cells changes the structure of the vascular wall E. Monocyte transforms into resident macrophages

C, E, G, A, D, F, H, J, I, B

Place the following steps of excitation-contraction coupling in the correct order: A. Ca2+-induced Ca2+ release B. Ca2+ reaccumulated in SR by Ca2+ ATPase → relaxation C. Cardiac action potential D. Ca2+ release from SR E. T tubules spread depolarization to cell interior F. further increase in [Ca2+] & Ca2+ binds to troponin C G. inward Ca2+ current during plateau (trigger Ca2+) H. tropomyosin moved out of the way so actin-myosin can bind I. thick and thin filaments move past each other → tension J. cross-bridge cycling

C, B, A, D

Place the sequence of events in a typical MI in the correct order: A. Activation of coagulation B. Platelets adhere, aggregate, & are activated C. Atheromatous plaque is eroded D. Thrombus grows to occlude coronary artery lumen

Plaque deposits in arterial walls → decreased diameter → stiffer & less compliant → decrease in systolic, pulse, & mean pressure (A) Arteriosclerosis (B) Aortic stenosis (C) Aortic regurgitation (D) Pulmonary HTN

Plasma ________ concentration is the marker of the activity of the fuel distribution stage (A) cholesterol (B) triglyceride (C) ApoE (D) chylomicron

Plasma lipoprotein _____ forms an extracellular pool available to cells (A) cholesterol (B) triglyceride (C) ApoE (D) chylomicron

Polyuria (diuresis) occurs in a diabetic patient who has a GFR = 120 mL/min and a blood sugar = 350 mg/dL. This is indicative of: (A) losses of water and sodium which could be prevented by administration of antidiuretic hormone (ADH) and an aldosterone-like mineralocorticoid (B) diuresis due to reduced active transport of sodium out of the tubule because of diminished activity of the Na+/K+ ATPase (C) a cellular and extracellular over-hydration due to water retention, caused by the glucose (D) an osmotic diuresis due to glucosuria, in which water loss will exceed "salt" loss (E) B and D are correct.

Positive ionotropic agents (cardiac glycosides) produce increased contractility & increased cardiac output. As a result, (A) equilibrium point shifts to a higher cardiac output & a higher R atrial pressure (B) new equilibrium point where both cardiac output & R atrial pressure are increased (C) new equilibrium where both cardiac output & R atrial pressure are decreased (D) equilibrium point shifts to a higher cardiac output & a lower R atrial P

Posterior intercostal arteries in the 6th and 7th intercostal spaces are the branches of the_________ (A) Abdominal aorta (B) Descending thoracic aorta (C) Internal thoracic artery (D) Subclavian artery

Preadipocytes within lateral mesoderm of embryo produce ______ adipocytes while those within the paraxial mesoderm produce _____ adipocytes (A) white, beige (B) beige, white (C) beige, brown (D) white, brown (E) brown, white

Preexcitation syndrome (e.g. Wolff-Parkinson-White Syndrome) are tachycardias involving the (A) SA node (B) Atrial rhythm (C) AV junction (D) Ventricles

Presence of xanthomata (lipid deposits on hand & knee tendons & achilles tendon) is diagnostic for (A) familial hypercholesterolemia (B) familial defective apolipoprotein B (FDB) (C) familial combined hyperlipidemia (D) Familial dysbetalipoproteinemia

Principal cells of _______ are pale-staining, w/ relatively few MT & distinct cell membranes that are rich in aquaporins (water channels) for passive water reabsorption (A) collecting ducts (B) connecting tubules (C) Loop of Henle (D) ureters

Progressive lengthening of conduction time → non-conducted P wave (atrial depolarization) (A) 1st degree heart block (B) 2nd degree - Mobitz type I (Wenckebach) (C) 2nd degree - type II (D) 3rd degree

Promote antibody production (A) Th1 (B) Th2 (C) Th3 (D) Th17

Promote local initial defenses & delayed type hypersensitivity responses (ex. TB skin test) (A) Th1 (B) Th2 (C) Th3 (D) Th17

Pronounced engorgement of systemic & portal venous systems with minimal pulmonary congestion is characteristic of which of the following (A) left-sided heart failure (B) right-sided heart failure (C) cardiac tamponade (D) MI

Propanolol has which of the following effects? (A) Decreases heart rate (B) Increases left ventricular ejection fraction (C) Increases stroke volume (D) Decreases splanchnic vascular resistance (E) Decreases cutaneous vascular resistance

vasodilators, vasoconstrictors

Prostacyclin and E-series prostaglandins are (vasoconstrictors/vasodilators) F-series prostaglandins & Thromboxane A2 are (vasoconstrictors/vasodilators)

Proteins (albumin) exert _______ pressure → retains water in vascular bed (A) oncotic (B) hydrostatic (C) neutral (D) electrochemical

Pulse pressure = __________ and usually reflects the volume of blood ejected from the left ventricle on a single beat, known as ________ (A) systolic - diastolic, cardiac output (B) systolic - diastolic, stroke volume (C) diastolic - systolic, cardiac output (D) diastolic - systolic, stroke volume

Pulse pressure is (A) the highest pressure measured in the arteries (B) the lowest pressure measured in the arteries (C) measured only during diastole (D) determined by stroke volume (E) decreased when the capacitance of the arteries decreases (F) the difference between mean arterial pressure and central venous pressure

IL-1, prostaglandins, fever

Pyrogens increase production of ___ → acts on anterior hypothalamus to increase local production of _______ → increase set point temperature → normal core temperature seen by hypothalamic center as "too low" → heat-generating mechanism activated to raise body temp → _______

Rate at which blood is pumped from the ventricle (A) cardiac output (B) venous return (C) cardiac input (D) arterial return

Rate at which blood is returned to the atria (A) cardiac output (B) venous return (C) cardiac input (D) arterial return

Recover Candida species (A) MacConkey agar (B) Xylose lysine deoxycholate agar (C) CandiSelect 4 agar & CHOMagar (D) Mannitol salt agar

Renal Plasma Flow (RPF) is estimated from clearance of _____ because it is not metabolized or synthesized by the kidney & it does not alter RPF since all that enters kidney is excreted in urine (A) glucose (B) PAH (C) inulin (D) aldosterone

Renal arteries branch to form smaller arteries b/w the renal lobes, w/ _________ entering the cortex to form the microvasculature (A) afferent arterioles (B) interlobular arteries (C) efferent arterioles (D) peritubular capillaries

Renin is produced and secreted from juxtagranular cells located in the: (A) macula densa (B) mesangial cells (C) intercalated cells (D) afferent arteriole (E) interstitial cells

Repolarization of ventricles (A) P wave (B) PR interval (C) QRS complex (D) T wave (E) QT interval

decrease, increase, increase, ACE, increase, increase, vasoconstriction

Response of Renin-Angiotensin II-Aldosterone System to acute hemorrhage Decrease in Pa → 1. (decrease/increase) in renal perfusion pressure 2. (decrease/increase) in renin 3. (decrease/increase) conversion of angiotensinogen to angiotensin I 4. ______ converts angiotensin I to angiotensin II 5. (decrease/increase) angiotensin II 6. (decrease/increase) in aldosterone, Na+-H+ exchange, and thirst AND (vasoconstriction/vasodilation) → Increase in Pa toward normal

Results from mutations in the PKHD1 gene, coding for a putative membrane receptor protein called fibrocystin (A) Alport syndrome (B) Goodpasture syndrome (C) Autosomal dominant (adult) polycystic kidney disease (D) Autosomal recessive (childhood) polycystic kidney disease

Reverse cholesterol transport refers to cholesterol transported from (A) liver to intestine (B) intestine to liver (C) liver to peripheral cells (D) peripheral cells to liver

Reynolds number is used to predict whether blood flow will be laminar or turbulent. 1. NR < 2,000 → 2. NR > 3,000 → (A) 1. laminar 2. turbulent (B) 1. turbulent 2. laminar

Richard Trumble did not have any Roth spots on his HEENT or splinter hemorrhages on his skin, but if he had, we would have been concerned about (A) SCD (B) ASD (C) infective endocarditis (D) MI

Richard Trumble was diagnosed with Eisenmenger's syndrome which has its onset when (A) RVH causes R heart pressures to exceed that of the left heart leading to reversal of blood flow through the shunt (B) LVH causes L heart pressures to exceed that of the right heart leading to reversal of blood flow through the shunt (C) at birth (D) when left-to-right shunting leads to development of pulmonary HTN

Richard Trumble was diagnosed with Eisenmenger's syndrome which is characterized by all of the following EXCEPT (A) left-to-right shunting leads to development of pulmonary HTN (B) starts with right-to-left shunt that eventually switches to left-to-right shunt (C) right-to-left shunt causes decreased O2 saturation & cyanosis (D) may cause polycythemia secondary to hypoxia

Right ventricular failure following LVHF, leads to (A) systemic venous congestion (B) peripheral edema (C) dyspnea (D) A & B

S1 ("lub") heart sound is caused by (A) closure of tricuspid & mitral valves at onset of ventricular diastole (B) opening of tricuspid & mitral valves at onset of ventricular diastole (C) closure of tricuspid & mitral valves at onset of ventricular systole (D) opening of tricuspid & mitral valves at onset of ventricular systole

S2 ("dub") heart sound is caused by (A) closure of aortic & pulmonary valves at onset of ventricular diastole (B) opening of aortic & pulmonary valves at onset of ventricular diastole (C) closure of aortic & pulmonary valves at onset of ventricular systole (D) opening of aortic & pulmonary valves at onset of ventricular systole

Secreted by posterior pituitary → controls water permeability of principal cells (A) ADH (B) Aldosterone (C) Renin (D) angiotensin II

Secretion of K+ by the distal tubule will be decreased by (A) metabolic alkalosis (B) a high-K+ diet (C) hyperaldosteronism (D) spironolactone administration (E) thiazide diuretic administration

Sequalae of which of the following includes dyspnea, orthopnea, PND, edema, hemoptysis, fatigue, weakness, & cyanosis? (A) hypertensive crisis (B) sudden cardiac death (C) prinzmetal variant angina (D) CHF

Shear is the consequence of blood traveling at different velocities within a blood vessel. It is responsible for (A) breaking up aggregates of RBCs (B) Causing aggregates of RBCs (C) decreasing blood viscosity (D) A & C

Shear is the consequence of blood traveling at different velocities within a blood vessel. Shear is ______ at blood vessel wall and _______ at the center of blood vessel (A) highest, lowest (B) lowest, highest

Shortly after her birth a baby is diagnosed with a mutation in the erythropoietin receptor gene which leads to familial erythrocytosis (familial polycythemia). During the seventh to ninth months of fetal development, the primary effect on her red blood cell production was in which of the following? (A) Liver (B) Yolk sac (C) Spleen (D) Thymus (E) Bone marrow

Small mass of specialized cardiac muscle fibers in myocardium at upper end of crista terminalis near opening of SVC in R atrium (A) SA node (B) AV node (C) Bundle of His (D) Purkinje fibers

dyads

Smooth muscle differs from skeletal muscle in that it forms _____ with SR, which is the site of storage and release of Ca2+ for excitation-contraction coupling, whereas skeletal muscle forms triads

Specimen is heated for which of the following differential stains? (A) Ziehl-Neelsen stain (B) Kinyuoun fluorescent stain (C) auramine-rhodamine fluorescent stain (D) All of the above

Statins (A) inhibit HMG-CoA reductase (B) act through PPARα TF (C) inhibit intestinal absorption by binding bile acids & inhibiting cholesterol transport (D) bind to LDL receptor

Stroke volume divided by end-diastolic volume = ejection fraction, which is a measure of (A) Atrial efficiency (B) Cardiac efficiency (C) Perfusion efficiency (D) Ventricular efficiency

Symmetrically contracted kidneys w/ red-brown & diffusely granular surfaces (A) Malignant HTN (B) Chronic Kidney Disease (C) Chronic Pyelonephritis (D) Ischemic ATI

Sympathetic activates ______ receptors → adenylyl cyclase → production of cAMP → activation of protein kinase A → phosphorylation of proteins that increase ________ (A) beta-1, contractility (B) beta-1, HR (C) alpha-1, conduction velocity (D) beta-2, conduction velocity

increase, decrease

Sympathetic → (increase/decrease) HR Parasympathetic → (increase/decrease) HR

Systolic pressure is (A) lowest, Parteries during ventricular relaxation (B) lowest, Parteries after blood ejected from L ventricle during systole (C) highest, Parteries during ventricular relaxation (D) highest, Parteries after blood ejected from L ventricle during systole

T cells, B cells, & antibody-producing plasma cells are found in which layer of the LN? (A) cortex (B) paracortex (C) medulla (D) all layers

false (STEMI but not in non-STEMI)

T/F Early fibrinolytic therapy improves outcomes in both STEMI & non-STEMI

false (next beat)

T/F Postextrasystolic potentiation means that when an extrasystole occurs, tension on the current beat is greater than normal

false (no sustained plateau)

T/F SA node has a unstable RMP and a sustained plateau

false

T/F There is protective immunity with N gonorrhoeae

false (true capillaries do NOT have smooth muscle)

T/F True capillaries have smooth muscle in addition to their single layer of endothelial cells surrounded by basement membrane

Tall epithelial cells of the macula densa & specialized smooth muscle cells in adjacent afferent arteriole (juxtaglomerular cells) that secrete ______, comprise a JGA (juxtaglomerular apparatus) important for regulating BP (A) renin (B) aldosterone (C) erythropoietin (D) ADH

Ten days after birth a full-term newborn boy develops firm, erythematous nodules, and plaques over his trunk, arms, buttocks, thighs, and cheeks. His mother's pregnancy was complicated by placenta previa and his airway was cleared of aspirated meconium immediately after birth. A biopsy of subcutaneous tissue shows necrosis within the brown adipose tissue. What metabolic activity is liable to be affected in this patient? (A) Export of fatty acids from fat (B) Thermal insulation (C) Oxidation of fatty acids for thermogenesis (D) Activation of the adenylate cyclase system (E) Initiation of shivering

The 60-40-20 rule states that (A) 60% of body weight is water, 40% is ECF, 20% is ICF (B) 60% of body weight is ICF, 40% is water, 20% is ECF (C) 60% of body weight is ECF, 40% is ICF, 20% is water (D) 60% of body weight is water, 40% is ICF, 20% is ECF

The ECG shows a fixed number of nonconducted P waves for every QRS complex. Which heart block does the patient have and where is the problem? (A) 1st degree, SA node delayed conduction (B) 2nd degree type I (Wenckebach), AV bundle (C) 2nd degree type II, bundle of His (D) 3rd degree, complete block of AV node

The ECG shows a fixed prolonged P-R interval. Which heart block does the patient have and where is the problem? (A) 1st degree, SA node delayed conduction (B) 2nd degree type I, AV bundle (C) 2nd degree type II, bundle of His (D) 3rd degree, complete block of AV node

The ECG shows progressive prolongation of PR interval until a ventricular beat is dropped. Which heart block does the patient have and where is the problem? (A) 1st degree, SA node delayed conduction (B) 2nd degree type I (Wenckebach), AV bundle (C) 2nd degree type II, bundle of His (D) 3rd degree, complete block of AV node

The Frank-Starling relationship states that: (A) volume heart ejects in systole > volume it receives in venous return (B) volume heart ejects in systole < volume it receives in venous return (C) volume heart ejects in systole = volume it receives in venous return (D) no relationship between volume heart ejects in systole and volume it receives in venous return

The LDL receptor is regulated by the (A) intracellular cholesterol concentration (B) extracellular cholesterol concentration (C) intracellular triacylglycerol concentration (D) extracellular triacylglycerol concentration

The Michaelis constant, ___, is expressed in units of concentration & corresponds to the substrate concentration at which v is 50% of the maximum velocity (A) Kcat (B) Km (C) Vmax (D) [S]

The Na⁺-Cl⁻ cotransporter is responsible for net reabsorption of Na⁺ & Cl⁻ in which of the following (A) PCT (B) thick ascending limb of loop of Henle (C) Early DCT (D) Late DCT & collecting ducts

The Na⁺-K⁺-2Cl⁻ cotransporter is responsible for net reabsorption of Na⁺, K⁺, & Cl⁻ in the (A) PCT (B) thick ascending limb of loop of Henle (C) Early DCT (D) Late DCT & collecting ducts

increase (parasympathetic); decrease (sympathetic)

The PR segment correlates with conduction time through AV node. -decrease in conduction velocity → (decrease/increase) in PR interval -increase in conduction velocity → (decrease/increase) in PR interval

The Valsalva Maneuver tests the integrity of the baroreceptor mechanism by having a patient expire against a closed glottis, which causes 1. _____ in intrathoracic P 2. _____ in venous return 3. _____ in cardiac output & Pa (A) ↑↑↑ (B) ↑↓↓ (C) ↓↑↑ (D) ↓↓↓

The _____ is located at the junction between the superior vena cava and the right atrium. (A) Atrioventricular (AV) node (B) Purkinje fibers (C) Sinoatrial (SA) node (D) Atrioventricular (AV) bundle (of His)

The _____ is responsible for regulation of body temperature core temp ___ set-point temp → heat-generating & heat-retaining mechanisms activated core temp ___ set-point temp → heat-dissipating mechanism activated (A) anterior hypothalamus, <, > (B) posterior hypothalamus, >, < (C) anterior pituitary, >, < (D) sympathetic nervous system, <, >

left ventricle, right ventricle

The ______ ______ pumps blood to the body The ______ ______ pumps blood to the lungs

The ______ _______ is an important pericardial sinus to cardiac surgeons because while performing surgery on the aorta or pulmonary artery, a surgeon could stop blood circulation with a ligature (A) Oblique sinus (B) Pericardial cavity (C) Pleural space (D) Transverse Sinus (E) Sagittal Sinus

The ______ is a groove on the external surface of the heart that marks the division between the atria and ventricles (A) sulcus terminalis (B) coronary sulcus (C) marginal groove (D) coronary sinus (E) crista terminalis

The afterload of the left ventricle = Velocity of shortening ______ after afterload increases (A) arterial pressure, increases (B) aortic pressure, decreases (C) capillary pressure, increases (D) vena cava pressure, decreases

The anion gap in plasma is normally _______, but may be increased in renal failure & diabetic ketoacidosis (A) 2 mmol/L (B) 5 mmol/L (C) 10 mmol/L (D) 20 mmol/L

C (ventricular P < aortic P → aortic valve closes)

The aortic valve closes at point (A) 1 (B) 2 (C) 3 (D) 4

The aortic valve is most audible (A) Over the medial end of the second left intercostal space (B) Over the medial end of the second right intercostal space (C) In the left fourth intercostal space at the midclavicular line (D) In the left fifth intercostal space at the mid- clavicular line (E) Over the right half of the lower end of the body of the sternum

The atrial muscle of the heart produces a hormone that (A) decreases blood pressure. (B) increases blood pressure. (C) causes vasoconstriction. (D) facilitates the release of renin. (E) facilitates sodium resorption in the kidneys.

The attending faculty in the coronary intensive care unit demonstrates to his students a normal heart examination. The first heart sound is produced by near-simultaneous closure of which of the following valves? (A) Aortic and tricuspid (B) Aortic and pulmonary (C) Tricuspid and mitral (D) Mitral and pulmonary (E) Tricuspid and pulmonary

The base of the heart DOES NOT include___________ (A) Proximal parts of the great veins (B) Left atrium (C) Left ventricle (D) A small portion of the right atrium

The blood volume of ________ is stressed volume, while the blood volume of ________ is unstressed volume (A) veins, arteries (B) capillaries, arteries (C) arteries, capillaries (D) arteries, veins

The blood-brain-barrier is thought to exist because capillaries in the CNS have which of the following characteristics? (A) Discontinuous basal lamina (B) Fenestrae with diaphragms (C) Fenestrae without diaphragms (D) A few pinocytic vesicles (E) No basement membrane

The calyces, renal pelvis, ureters, & urinary bladder are lined by urothelium (__________ epithelium), which protects underlying cells from hypertonic, potentially toxic effects of urine (A) simple squamous (B) transitional (C) pseudostratified columnar (D) simple cuboidal

The capillary vessel wall separates (A) plasma & interstitial fluid (B) intracellular & extracellular fluid (C) skin & the environment (D) plasma & iskin

The capillary vessel wall separates plasma & the interstitial fluid and is freely permeable to which of the following? (A) water (B) electrolytes (C) proteins (D) A & B (E) All of the above

1. increase, increase 2. increase, increase 3. increase, increase 4. increase, stressed

The carotid sinus baroreceptor response to a DECREASE in Pa is to INCREASE the sympathetic outflow which leads to 1. (increase/decrease) HR → (increase/decrease) cardiac output 2. (increase/decrease) contractility & stroke volume → (increase/decrease) cardiac output 3. (increase/decrease) vasoconstriction of arterioles → (increase/decrease) in TPR 4. (increase/decrease) in vasoconstriction of veins → increase in (stressed/unstressed) V

The change indicated by the dashed lines on the cardiac output/venous return curves shows (A) decreased cardiac output in the "new" steady state (B) decreased venous return in the "new" steady state (C) increased mean systemic pressure (D) decreased blood volume (E) increased myocardial contractility

The coronary sinus opens onto the ________________ (A) Left atrium (B) Right ventricle (C) Left ventricle (D) Right atrium

The dashed line in the figure illustrates the effect of (A) increased total peripheral resistance(TPR) (B) increased blood volume (C) increased contractility (D) a negative inotropic agent (E) increased mean systemic pressure

The electrochemical gradient drives the passive movement of ______ through ion channels (A) water (B) electrolytes (C) phosphates (D) proteins

The epicardium is one of the three layers of the heart. It is (A) continuous with the endocardium. (B) also known as the visceral pericardium. (C) composed of modified cardiac muscle cells. (D) capable of increasing intraventricular pressure. (E) capable of decreasing the rate of contraction.

The first heart sound corresponds to point (A) 1 (B) 2 (C) 3 (D) 4

B (clearance of X < clearance of inulin)

The following information was obtained in a 20-year-old college student who was participating in a research study in the Clinical Research Unit: Plasma [Inulin] = 1 mg/mL Urine [Inulin] = 150 mg/mL Plasma [X] = 2 mg/mL Urine [X] = 100 mg/mL Urine flow rate = 1 mL/min Assuming that X is freely filtered, which of the following statements is most correct? (A) There is net secretion of X (B) There is net reabsorption of X (C) There is both reabsorption and secretion of X (D) The clearance of X could be used to measure the glomerular filtration rate (GFR) (E) The clearance of X is greater than the clearance of inulin

The generation of impulses in the normal heart is the responsibility of which of the following structures? (A) Atrioventricular (AV) node (B) AV bundle of His (C) Sympathetic nerves (D) Sinoatrial (SA) node (E) Purkinj e fibers

The glomerular filter has 3 parts: 1. ________ capillary endothelium 2. Thick _____________ 3. ________ b/w pedicels covered by thin filtration slit diaphragms (A) fenestrated, podocyte layer, occluding junctions (B) continuous, mesangial cell layer, gap junctions (C) sinusoidal, stratified epithelial layer, mesangial cells (D) fenestrated, fused basal laminae, slit pores

The great cardiac vein is a tributary of the__________ (A) Azygos vein (B) Internal jugular vein (C) Coronary sinus (D) Superior vena cava (E) Inferior vena cava

The greatest pressure decrease in the circulation occurs across the arterioles because (A) they have the greatest surface area (B) they have the greatest cross-sectional area (C) the velocity of blood flow through them is the highest (D) the velocity of blood flow through them is the lowest (E) they have the greatest resistance

The hormone-sensitive lipase in the cells of adipose tissue acts primarily on what substrate? (A) Glucose (B) Free fatty acids (C) Glycerol (D) Triglycerides (E) Very-low-density lipoproteins

The law of Laplace states that pressure correlates directly with _____ and wall thickness correlates inversely with _______ (A) tension, tension (B) tension, pressure (C) radius, tension (D) tension, radius

The loops of Henle of the outer cortical nephrons: (A) are functionally unimportant in the renal conservation of sodium and water (B) do not contribute to the medullary osmotic gradient (C) do not participate in the urinary diluting mechanism (D) do not play any important role in overall renal function and are simply unimportant vestiges of evolutionary development (E) A and C are correct.

The low-resistance pathways between myocardial cells that allow for the spread of action potentials are the (A) gap junctions (B) T tubules (C) sarcoplasmic reticulum (SR) (D) intercalated disks (E) mitochondria

anterior interventricular, LAD

The most common artery blocked in MI is the ______ _______ artery, aka _____ which is a branch of the left coronary artery

The myocardial lesions shown in the figure were observed at the autopsy examination of a pediatric patient who died after a short illness. During life, which of the following manifestations of his illness was most likely? (A) Chorea (B) Systemic embolization (C) Systemic lupus erythematosus (D) Unstable angina (E) Wasting diseases

The net result of the counter transport mechanism (Na+-H+ exchange) in the early PCT is (A) secretion of HCO₃⁻ (B) reabsorption of filtered HCO₃⁻ (C) secretion of NaCl (D) reabsorption of filtered NaCl

The normal human glomerular filtration rate (GFR) is approximately (in mL/min): (A) 25 (B) 50 (C) 125 (D) 300 (E) 500

The normal value for the osmolality of body fluids is _____ mOsm/L (A) 150 (B) 200 (C) 290 (D) 330

decreasing, increasing, prolongs

The parasympathetic decreases conduction velocity by: -(increasing/decreasing) inward Ca2+ current -(increasing/decreasing) outward K+ current -(shortens/prolongs) ERP

The pericardium is innervated by the vasomotor & sensory fibers from the _______ and ________ nerves & the sympathetic trunks (A) phrenic & glossopharyngeal (B) vagus & glossopharyngeal (C) phrenic & vagus (D) glossopharyngeal & axillary

The physiologic function of the relatively slow conduction through the atrioventricular (AV) node is to allow sufficient time for (A) runoff of blood from the aorta to the arteries (B) venous return to the atria (C) filling of the ventricles (D) contraction of the ventricles (E) repolarization of the ventricles

The plasma concentration at which a particular substance begins to appear in the urine is the: (A) transport maximum (Tm) (B) fractional excretion (C) filtered load (D) renal threshold (E) titration point

The plasma membrane separates (A) plasma & interstitial fluid (B) intracellular & extracellular fluid (C) skin & the environment (D) plasma & interstitial fluid

The positive staircase effect (aka Bowditch staircase) refers to the stepwise rise in ______, since with each beat more Ca2+ is accumulated by SR until a max storage level is reached (A) HR (B) tension (C) conduction velocity (D) ACh

descending aorta azygous & hemiazygous veins thoracic duct esophagus sympathetic trunk/ganglia

The posterior mediastinum is posterior to the pericardium b/w the mediastinal pleura and contains what? (DATES)

The precapillary sphincter is a band of ________ at the junction of arterioles & capillaries (A) hyaline cartilage (B) smooth muscle (C) skeletal muscle (D) fibrocartilage

The pulmonary valve is most audible (A) Over the medial end of the second left intercostal space (B) Over the medial end of the second right intercostal space (C) In the left fourth intercostal space at the midclavicular line (D) In the left fifth intercostal space at the mid- clavicular line (E) Over the right half of the lower end of the body of the sternum

The rate of enzyme-catalyzed reaction in presence of a competitive inhibitor can be increased by (A) increasing [S] (B) decreasing [S] (C) decreasing temperature (D) increasing pH

The reabsorption of filtered HCO3- (A) results in reabsorption of less than 50% of the filtered load when the plasma concentration of HCO3- is 24 mEq/L (B) acidifies tubular fluid to a pH of 4.4 (C) is directly linked to excretion of H+ as NH4+ (D) is inhibited by decreases in arterial Pco2 (E) can proceed normally in the presence of a renal carbonic anhydrase inhibitor

The right AV valve is most audible (A) Over the medial end of the second left intercostal space (B) Over the medial end of the second right intercostal space (C) In the left fourth intercostal space at the midclavicular line (D) In the left fifth intercostal space at the mid- clavicular line (E) Over the right half of the lower end of the body of the sternum

The right and left pulmonary veins drain into the: (A) Right atrium (B) Left atrium (C) Pulmonary trunk (D) Coronary sinus (E) Left ventricle

The right margin of the heart is formed by the ______________ (A) Left atrium (B) Right atrium (C) Left ventricle (D) Right ventricle (E) Arch of aorta

The sliding filament theory states that when cross bridges between _____ & ______ form and then break, thick & thin filaments move past each other (cross bridge cycling) → tension produced (A) troponin C & Ca2+ (B) actin & myosin (C) actin & titin (D) myosin & tropomyosin

The slope of the vascular curve is determined by (A) total blood volume (B) resistance of arterioles (C) pressure gradient across vasculature (D) rate of atrial contraction

The superior vena cava is formed by the union of_________ (A) Left and right internal thoracic veins (B) Left and right subclavian veins (C) Left and right brachiocephalic veins (D) Left and right internal jugular veins

E, D

The sympathetic nervous system generates heat by stimulating (1) ____ which increases metabolic rate & (2) ____ which causes vasoconstriction to reduce blood flow to skin surface & reduce heat loss (A) anterior hypothalamus (B) posterior hypothalamus (C) Na+-K+ ATPase (D) alpha 1 receptors in vascular smooth muscle of skin blood vessels (E) beta receptors in brown fat

The sympathetic nervous system increases conduction velocity by acting on the ____ receptor to increase ____ → increased inward current → increased conduction velocity; it also shortens ERP (A) beta 1, If (B) beta 1, ICa (C) M2, If (D) beta 2, ICa

The sympathetic system _______HR by acting on the beta 1 receptor to (A) increase HR, increase If & ICA (B) decrease HR, decrease If only (C) increase HR, increase If only (D) decrease HR, decrease If & ICA

The tendency for blood flow to be turbulent is increased by (A) increased viscosity (B) increased hematocrit (C) partial occlusion of a blood vessel (D) decreased velocity of blood flow

The tendency for edema to occur will be increased by (A) arteriolar constriction (B) increased venous pressure (C) increased plasma protein concentration (D) muscular activity

The thoracic duct opens into the junction between ________________ (A) Right internal jugular vein and right subclavian vein (B) Left and right pulmonary arteries (C) Left internal jugular vein and left subclavian vein (D) Left and right pulmonary veins

The tonicity of the urine as it enters the renal collecting duct is: (A) isotonic (B) hypotonic or isotonic, but never hypertonic (C) hypotonic (D) hypertonic (E) hypertonic or isotonic, but never hypotonic

The triad of chronic renal failure includes all of the following EXCEPT (A) loss of lamina dura (B) demineralized bone loss (C) gingival hypertrophy (D) localized & expansile radiolucent jaw lesions

The tunica adventitia is mostly ______________ but contains some __________ in the case of the SVC and IVC (A) skeletal muscle, elastin (B) smooth muscle, CT (C) CT, smooth muscle (D) collagen, nerves

The underlying defect of cystic diseases of the kidney is in (A) mesangial cells (B) podocytes (C) juxtaglomerular system (D) cilia-centrosome complex of tubular epithelial cells

The vasa recta: (A) are the straight portions of the proximal tubules, found just proximal to the loops of Henle (B) extend from the efferent arterioles of the superficial cortical nephrons (C) are the microvilli found on the cells of the macula densa (D) comprise the capillary network found in the medulla of the kidney (E) are the small straight segments of afferent arterioles found directly next to the macula densa

The vascular function (venous return) curve depicts a relationship b/w blood flow through vascular system (venous return) and (A) L atrial P (B) R atrial P (C) L ventricular P (D) L ventricular V

The ventricles are completely depolarized during which isoelectric portion of the electrocardiogram (ECG)? (A) PR interval (B) QRS complex (C) QT interval (D) ST segment (E) T wave

The x-axis in the figure could have been labeled (A) end-systolic volume (B) end-diastolic volume (C) pulse pressure (D) mean systemic pressure (E) heart rate

There are 3 quadrivalent meningococcal vaccines targeting all of the following N meningitidis serogroups EXCEPT (A) A (B) B (C) C (D) W-135 (E) Y

C (thrombocytopenia)

Thrombotic Microangiopathy (TMA) is characterized by all of the following EXCEPT (A) microvascular thrombosis (B) micrangiopathyic hemolytic anemia (C) erythrocytopenia (D) renal failure

Thyroid hormones stimulate ______ → increased O2 consumption → increased metabolic rate → increased heat production (A) anterior hypothalamus (B) posterior hypothalamus (C) Na+-K+ ATPase (D) alpha 1 receptors in vascular smooth muscle of skin blood vessels (E) beta receptors in brown fat

To determine axis of deviation on an ECG, you must look at the QRS complex of lead 1 and AVF to determine if its mostly upright or mostly downward. If both are pointed upward, it is _________. If lead 1 QRS (R thumb) is up and AVF QRS (L thumb) is down, it is _________. If lead 1 QRS (R thumb) is down and AVF QRS (L thumb) is up, it is ________ (A) normal, left axis deviation, right axis deviation (B) normal, right axis deviation, left axis deviation (C) right axis deviation, left axis deviation, normal (D) left axis deviation, right axis deviation, normal

To maintain normal H+ balance, total daily excretion of H+ should equal the daily (A) fixed acid production plus fixed acid ingestion (B) HCO3- excretion (C) HCO3- filtered load (D) titratable acid excretion (E) filtered load of H+

Transfer of cholesterol from ________ is the principal route of cholesterol transport in humans (A) HDL to liver (B) LDL to liver (C) LDL to triglyceride-rich particles (D) HDL to triglyceride-rich particles

1. cardioversion 2. defibrillation

Transthoracic delivery of an electric shock to terminate: 1. persistent or refractory arrhythmias electively = 2. a lethal arrhythmia in an emergency =

red line, red flare, wheal

Trauma to skin results in the "triple response", which includes what 3 things?

Tricuspid valve is located at the orifice between the___________ (A) Left ventricle and left atrium (B) Left atrium and right atrium (C) Right ventricle and right atrium (D) Left ventricle and right ventricle

Triglycerides synthesized in the liver are transported in the periphery to the ___ - happens in BOTH fed & fasting states (A) VLDL (B) IDL (C) LDL (D) HDL

Two weeks after recovery from a severe bout of pharyngitis, an 11-year-old girl is seen because of the acute onset of periorbital edema, hematuria, malaise, nausea, and headache. Which of the following findings is expected? (A) Hypotension (B) Increased antistreptolysin O titer (C) Marked hypoalbuminemia (D) Polyuria (E) Positive urine cultures for β-hemolytic streptococci

arteries, vein

Umbilical (arteries/veins) become medial umbilical ligaments after birth The right is obliterated during embryonic period, but the left umbilical (artery/vein) forms the ligamentum teres hepatis after birth

Uncompetitive inhibitors bind only to ES complex not free E, and cause (A) An increase in the apparent Km (B) A decrease in the apparent Km (C) An increase in Vmax (D) A decrease in Vmax (E) A decrease in both the apparent Km and Vmax

Unreabsorbed _____ serves as urinary buffer for H+ (A) K+ (B) phosphate (C) Ca2+ (D) magnesium

Urea will only be recycled in the presence of high (A) Aldosterone (B) ADH (C) Renin (D) Angiotensin II

Vasa vasorum serve a function analogous to that of which of the following? (A) Valves (B) Basal lamina (C) Coronary arteries (D) Endothelial diaphragms (E) Arterioles

Victor Dermody's pressure gradient was 85 mm Hg across stenosis before the stent procedure and less than 10 mm Hg after. Was the procedure successful? (A) no (B) yes, pressure gradient decreased (C) unknown because additional tests would be needed to confirm

Victor did NOT have orthopnea or PND (paroxysmal nocturnal dyspnea), jugular venous distention, or SOB or. If he had these symptoms, that would have been indicative of? (A) coronary artery disease (B) congestive heart failure (C) asthma (D) hypertension

Volume of blood ejected by ventricle on each beat =end-diastolic volume - end-systolic volume (A) stroke volume (B) ejection fraction (C) cardiac output (D) afterload

Water content is highest in the ______ tissue & lowest in the _______ tissue (A) adipose, brain (B) collagen, brain (C) brain, adipose (D) collagen, adipose

Water is what percentage of body weight? (A) 20 to 40% (B) 30 to 50% (C) 50 to 70% (D) 70 to 90%

Weilbel-Palade (WP) Bodies are special tubular organelle in endothelia that release (A) NO (B) vWF (C) norepinephrine (D) prothrombin

thymus & bone marrow

What are the 2 primary lymphoid organs?

What are the relatively large particles formed in the intestinal epithelial cells and rich in ingested lipids? (A) Fatty acids (B) Chylomicrons (C) Glycerols (D) Very low-density lipoproteins (E) Adipocytes

What begins the inflammatory repair response that starts formation of atheromatous plaque? (A) injury of arterial intima (B) adherence of monocytes to altered endothelium (C) migration of monocytes into intima (D) macrophages engulfing lipid molecules

What contains the highest proportion of the blood in the cardiovascular system? (A) arterioles (B) arteries (C) capillaries (D) venules (E) veins

What controls the plasma bicarbonate synthesis and excretion of H+? (A) Lungs (B) RBCs (C) Kidneys

What determines how high the urine osmolarity will be? (A) Na+ in ICF (B) will reflect combined functions of all diluting segments (C) will reach the osmolarity present at tip of the papilla (D) will reflect function of cortical diluting segment

What determines how low the urine osmolarity will be? (A) Na+ in ICF (B) will reflect combined functions of all diluting segments (C) will reach the osmolarity present at tip of the papilla (D) will reflect function of cortical diluting segment

direction of pressure gradient

What determines the direction of blood flow (Q)?

increase, increase

What effect do the following changes have on reynolds number (NR)? 1. decrease in hematocrit → decrease in viscosity → 2. narrowing of vessel → increase in velocity →

What factor(s) determine blood flow (Q) (A) blood type (B) pressure difference between 2 ends of the vessel (C) Resistance of vessel to blood flow (D) A & C (E) B & C

What fate often awaits granulocytes that have entered the marginating compartment? (A) Undergo mitosis (B) Crossing the wall of a venule to enter connective tissue (C) Cannot reenter the circulation (D) Differentiate into functional macrophages (E) Begin to release platelets

What is responsible for the exchange of CO2 & O2 b/w the blood and atmosphere (respiratory component of acid-base balance - pCO2)? (A) Lungs (B) RBCs (C) Kidneys

What is responsible for the following response changes in pCO2 or pH → stimulate medullary chemoreceptors → changes in outflow of medullary cardiovascular centers (A) Renin-Angiotensin II-Aldosterone System (B) Baroreceptors in carotid sinus (C) Peripheral Chemoreceptors in carotid & aortic bodies (D) Central Chemoreceptors

What is responsible for the following response: ↓ in arterial PO2 → increased firing rate from afferent nerves → arteriolar vasoconstriction & ↑ in parasympathetic outflow to heart → ↑ HR (A) Renin-Angiotensin II-Aldosterone System (B) Baroreceptors in carotid sinus (C) Peripheral Chemoreceptors in carotid & aortic bodies (D) Central Chemoreceptors

What is responsible for the transport of gases between lungs and tissues? (A) Lungs (B) RBCs (C) Kidneys

What is the daily dose of aspirin recommended in all patients with acute & chronic ischemic heart disease? (A) 0 mg (B) 25 to 100 mg (C) 75 to 325 mg (D) 500 to 825 mg

What is the distance between 2 points that can just be distinguished as being separate? In which method is it higher? (A) resolving power, bright-field (B) resolving power, dark-field (C) numerical aperture of objective lens, bright-field (D) numerical aperture of objective lens, dark-field

What is the earliest stage at which specific granulocyte types can be distinguished from one another? (A) Myelocyte (B) Band form (C) Reticulocyte (D) Metamyelocyte (E) Promyelocyte

What is the longest phase of the SA node which accounts for its automaticity? (A) phase 0 (B) phase 1 (C) phase 2 (D) phase 3 (E) phase 4

What is the most important form of lipid storage in both white and brown adipocytes? (A) Free fatty acids (B) Cholesterol (C) Chylomicrons (D) Glycerol (E) Triglycerides

What is the preferred method of revascularization in patients with STEMI? (A) Thrombolysis (B) Percutaneous transluminal coronary angioplasty with stenting (C) CABG (D) all equally effective

What is the principal function of cutaneous sympathetic nerves? (A) pain regulation (B) temperature regulation (C) pressure regulation (D) volume regulation

What is the site of highest resistance in the cardiovascular system? (A) arterioles (B) arteries (C) capillaries (D) venules (E) veins

What leads to the changes detailed in the chart? (A) Hemorrhage (B) Exercise (C) Standing (D) All of the above

What produces the greatest response in carotid sinus baroreceptors given their sensitivity to this change? (A) changes in blood volume (B) changes in hormone balance (C) changes in PO2 (D) changes in Pa (mean arterial pressure)

What reflects the ability of the lens to gather light & resolves specimen detail at a fixed object distance? (A) resolving power (B) numerical aperture of objective lens (C) numerical aperture of oil immersion lens (D) objective power

What regulates blood flow through capillaries? (A) contraction & relaxation of atria (B) hormone secretion (C) contraction & relaxation of arterioles & precapillary sphincters (D) Hematopoiesis

What single point AA substitution at the 6th residue of the β chain of Hb leads to HbS in sickle cell anemia? A. Glu → Leu B. Glu → Val C. Val → Glu D. Glu → Ala

What substance, released from the adrenal gland and some autonomic neurons, increases lipolytic activity in white adipocytes? (A) Leptin (B) Insulin (C) Norepinephrine (D) Glycogen (E) Triglyceride

What tissue is directly associated with and extends into the heart valves? (A) Myocardium (B) Epicardium (C) Atrioventricular bundle of His (D) Cardiac skeleton (E) Pericardium

What type of artery is the Aorta? (A) Elastic artery (B) Muscular artery (C) Small artery (D) it is a vein

What type of capillaries are found in red bone marrow? (A) fenestrated (B) sinusoidal (C) continuous

What type of epithelium lines the prostatic urethra? (A) Simple columnar (B) Pseudostratified columnar (C) Stratified squamous (D) Simple squamous (E) Transitional (urothelium)

What type of epithelium lines the urethra in both genders? (A) simple squamous (B) transitional (urothelium) (C) pseudostratified columnar (D) simple cuboidal

When Victor Dermody walked too far, he developed cramping in his calf muscles if he walks too far too fast, which is known as (A) atherosclerosis (B) claudication (C) hemestesis (D) angina

When a person moves from a supine position to a standing position, which of the following compensatory changes occurs? (A) Decreased heart rate (B) Increased contractility (C) Decreased total peripheral resistance (TPR) (D) Decreased cardiac output (E) Increased PR intervals

When a thrombi occurs, there is a blood clot in the vessel → narrowed diameter → decrease in velocity →______ NR & _____ blood flow (A) lower, turbulent (B) lower, laminant (C) higher, turbulent (D) higher, laminant

↑ ↑ ↑ ↑ ↑ ↑

When an individual moves from a supine to standing position, compensatory mechanisms will attempt to increase BP to normal, carotid sinus baroreceptors will decrease firing rate of carotid sinus nerves →→ -arterial BP (↑/↓) -cardiac output (↑/↓) -stroke volume (↑/↓) -Central venous pressure (↑/↓) -HR (↑/↓) -TPR (↑/↓)

↓ ↓ ↓ ↓

When an individual moves from a supine to standing position, the initial response is: -arterial BP (↑/↓) -cardiac output (↑/↓) -stroke volume (↑/↓) -Central venous pressure (↑/↓)

increased, decreased, increased

When carotid sinus baroreceptors detect a decrease in Pa as a result of acute blood loss (hemorrhage) → (increased/decreased) sympathetic outflow to heart & blood vessels & (increased/decreased) parasympathetic outflow to heart → (increased/decreased) HR, contractility, TPR, & venous return → return Pa to normal

1. increase, increase 2 decrease, decrease

When carotid sinus baroreceptors detect: 1. (decrease/increase) in Pa → INCREASED stretch → ((decrease/increase) firing rate in afferent nerve 2. (decrease/increase) in Pa → DECREASED stretch → ((decrease/increase) firing rate in afferent nerve

When testing using the Vasalva maneuver, if baroreceptor reflex is intact, a decrease in Pa will be sensed by baroreceptors → increase in sympathetic outflow to heart and blood vessels and _______ would be noted. When the maneuver is stopped, there is a rebound increase in venous return, cardiac output, & Pa. Increase in Pa is sensed by the baroreceptors and a _______ would be noted (A) increased breathing rate, decreased breathing rate (B) increased HR, decreased HR (C) spike in blood pressure, drop in blood pressure (D) heart murmur, return to normal heart sounds

Where is von Willebrand factor stored? (A) veins (B) capillaries (C) arteries (D) pituitary gland

Which agent is released or secreted after a hemorrhage and causes an increase in renal Na+ reabsorption? (A) Aldosterone (B) Angiotensin I (C) Angiotensinogen (D) Antidiuretic hormone (ADH) (E) Atrial natriuretic peptide

Which arrhythmia is associated with the following: -Blunt cardiac trauma -MVP -anaphylaxis -cardiac surgery -Coronary atherosclerotic heart disease (A) AV block (B) Ventricular extrasystole (C) Ventricular tachycardia (D) VFIB

Which arrhythmia is associated with the following: -CHF -coronary insufficiency -MI (A) Sinus bradycardia (B) Atrial extrasystoles (C) SA block (D) Sinus tachycardia (E) Atrial tachycardia

Which arrhythmia is associated with the following: -Febrile illness -Infection -Anemia -Hyperthyroidism (A) Sinus bradycardia (B) Atrial extrasystoles (C) SA block (D) Sinus tachycardia (E) Atrial tachycardia

Which arrhythmia is associated with the following: -Ischemic heart disease -CHF -MVP (A) AV block (B) Ventricular extrasystole (C) Ventricular tachycardia (D) VFIB

Which arrhythmia is associated with the following: -Ischemic heart disease -Mitral stenosis -MI -Open heart surgery (A) Atrial flutter (B) AFIB (C) AV block (D) Atrial tachycardia

Which arrhythmia is associated with the following: -MI -Mitral stenosis -Ischemic heart disease -Thyrotoxicosis -HTN (A) Atrial flutter (B) AFIB (C) AV block (D) Atrial tachycardia

Which arrhythmia is associated with the following: -MVP -MI -Coronary atherosclerotic heart disease (A) AV block (B) Ventricular extrasystole (C) Ventricular tachycardia (D) VFIB

Which arrhythmia is associated with the following: -Obstructive lung disease -pneumonia -MI (A) Sinus bradycardia (B) Atrial extrasystoles (C) SA block (D) Sinus tachycardia (E) Atrial tachycardia

Which arrhythmia is associated with the following: -Rheumatic heart disease -Ischemic heart disease -MI -Hyperthyroidism -Hodgkin disease -Myeloma -Open heart surgery (A) Atrial flutter (B) AFIB (C) AV block (D) Atrial tachycardia

Which arrhythmia is associated with the following: -Rheumatic heart disease -MI -Acute infection (A) Sinus bradycardia (B) Atrial extrasystoles (C) SA block (D) Sinus tachycardia (E) Atrial tachycardia

Which arrhythmia is associated with the following: infectious diseases; hypothermia; myxedema; jaundice; ↑ intracranial pressure; MI (A) Sinus bradycardia (B) Atrial extrasystoles (C) SA block (D) Sinus tachycardia (E) Atrial tachycardia

Which cell is a modified smooth muscle cell that secretes renin? (A) Macula densa cells (B) Mesangial cells (C) Podocytes (D) Juxtaglomerular cells (E) Endothelial cells

Which cell type comprises the visceral layer of Bowman capsule? (A) Endothelial cells (B) Juxtaglomerular cells (C) Mesangial cells (D) Podocytes (E) Extraglomerular mesangial (or Lacis) cells

Which cell type is capable of further mitosis after leaving the hemopoietic organ in which it is formed? (A) Basophil (B) Eosinophil (C) Reticulocyte (D) Lymphocyte (E) Neutrophil

Which class of antiarrhythmic drugs is described below? "Local anesthetic" properties; blocks fast Na+ channels (A) Class I (B) Class II (C) Class III (D) Class IV (E) Class V

Which class of antiarrhythmic drugs is described below? Beta adrenergic blocking agents (A) Class I (B) Class II (C) Class III (D) Class IV (E) Class V

Which class of antiarrhythmic drugs is described below? Prolong duration of cardiac action potential & enhance refractoriness through effects on blocking K+ channels (A) Class I (B) Class II (C) Class III (D) Class IV (E) Class V

Which class of antiarrhythmic drugs is described below? Slow CCBs used mainly for supraventricular tachycardias (A) Class I (B) Class II (C) Class III (D) Class IV (E) Class V

Which class of antiarrhythmic drugs is described below? Variable mechanism (A) Class I (B) Class II (C) Class III (D) Class IV (E) Class V

Which class of drugs antagonize many antiHTN drugs b/c of inhibitory effect on prostaglandin syntehsis? (A) corticosteroids (B) NSAIDs (C) antiplatelets (D) thrombolytic

Which class of enzyme is depicted by the reaction pictured & includes alkaline phosphatase & trypsin? (A) oxidoreductases (B) transferases (C) hydrolases (D) lyases (synthases) (E) isomerases (F) ligases (synthetases)

Which class of enzyme is depicted by the reaction pictured & includes dehydrogenases & peroxidases? (A) oxidoreductases (B) transferases (C) hydrolases (D) lyases (synthases) (E) isomerases (F) ligases (synthetases)

Which class of enzyme is depicted by the reaction pictured & includes fumarase & dehydratases? (A) oxidoreductases (B) transferases (C) hydrolases (D) lyases (synthases) (E) isomerases (F) ligases (synthetases)

Which class of enzyme is depicted by the reaction pictured & includes hexokinase & transaminases? (A) oxidoreductases (B) transferases (C) hydrolases (D) lyases (synthases) (E) isomerases (F) ligases (synthetases)

Which class of enzyme is depicted by the reaction pictured & includes pyruvate carboxylase & DNA ligase? (A) oxidoreductases (B) transferases (C) hydrolases (D) lyases (synthases) (E) isomerases (F) ligases (synthetases)

Which class of enzyme is depicted by the reaction pictured & includes triose phosphate isomerase & phosphoglucomutase? (A) oxidoreductases (B) transferases (C) hydrolases (D) lyases (synthases) (E) isomerases (F) ligases (synthetases)

Which curve describes aminohippuric acid (PAH) profile along the length of the nephron? (A) Curve A (B) Curve B (C) Curve C (D) Curve D

Which curve describes the alanine profile along the nephron? (A) Curve A (B) Curve B (C) Curve C (D) Curve D

Which curve describes the inulin profile along the nephron? (A) Curve A (B) Curve B (C) Curve C (D) Curve D

Which cytoplasmic components are the main constituents of the dark precipitate that forms in reticulocytes upon staining with the dye cresyl blue? (A) Golgi complexes (B) Hemoglobin (C) Nucleoli (D) Nuclear fragments (E) Polyribosomes

Which description is true of continuous capillaries? (A) Unusually wide lumens (B) Most common in both brain and muscle (C) Abundant fenestrations (D) Lack a complete basement membrane (E) Phagocytic cells often seen inserted in the intercellular clefts

Which drug class may cause the following: -neutropenia → gingival bleeding -angioedema -perisistent cough -oral burning sensations (A) CCBs (B) ACE inhibitors (C) β blockers (D) thiazide diuretics

Which drug is responsible for the following? -control fluid retention -produce more rapid symptomatic relief than other drugs -Modulate other drugs used to treat HF (A) CCBs (B) diuretics (C) ACE inhibitors (D) Statins

Which of the following BP readings would lead to deferment of elective treatment? (A) ≤ 120/80 (B) ≥ 140/90 but < 160/100 (C) ≥180/110 (D) ≥ 220/120

Which of the following agents or changes has a negative inotropic effect on the heart? (A) Increased heart rate (B) Sympathetic stimulation (C) Norepinephrine (D) Acetylcholine (ACh) (E) Cardiac glycosides

Which of the following allows expression of bacterial (or eukaryotic) genes under different conditions to be measured? (A) Oligonucleotide probes (B) Real-time PCR (C) Reverse-transcription PCR (D) DNA microarray analysis

Which of the following allows for examining yeasts & bacteria & details of eukaryotic cells? (A) low power 10x lens (B) 40x objective lens (C) 100x oil immersion lens (D) all of the above

Which of the following allows for visualization of parasites & filamentous fungi? (A) low power 10x lens (B) 40x objective lens (C) 100x oil immersion lens (D) all of the above

Which of the following are considered the cardinal manifestations of HF? (A) claudication & edema (B) SOB & syncope (C) dyspnea & fatigue (D) pulmonary HTN & gallop rhythm

Which of the following are drugs of choice in epidemics of N meningitidis because a single dose is effective in clearing infection? (A) penicillin & ampicillin (B) tetracylcine & erythromycin (C) ceftriaxone & oily chloramphenicol (D) ceftriaxone & azithromycin

Which of the following are found in lipoproteins? (A) hydrophobic molecules (B) hydrophilic molecules (C) amphipathic molecules (D) all of the above

Which of the following are heparan sulfate proteoglycans on surface of vascular endothelial cells that remove triacylglycerols from lipoprotein particles? (A) LPL (B) ApoB (C) HGTL (D) LCAT

Which of the following are normally the antibodies of choice for N meningitidis? (A) penicillin & ampicillin (B) tetracylcine & erythromycin (C) ceftriaxone & oily chloramphenicol (D) ceftriaxone & azithromycin

Which of the following are possible reasons Victor Dermody was told his coronary artery vessel disease was unsuitable for intervention? (A) too much tissue damage already (B) blockage is too proximal to pass a stent (C) blockage is too distal to pass a stent (D) A & B (E) A & C

Which of the following are responsible for distributing blood to organs? (A) Large Elastic artery (B) Medium Muscular artery (C) Small artery (D) veins

Which of the following are transported bound to albumin? (A) short-chain FAs (B) medium-chain FAs (C) long-chain FAs (D) A & B (E) All of the above

Which of the following are ways in which enzymes catalyze chemical reactions? (A) alter equilibrium (B) accelerate reaction rate (C) decrease activation energy (D) B & C (E) all of the above

C (intermediate risk)

Which of the following arrhythmias are NOT associated with major risks for complications? (A) High-grade AV block (B) symptomatic ventricular arrhythmias in presence of underlying heart disease (C) abnormal Q waves on ECG (marker of previous MI) (D) supraventricular arrhythmias w/ uncontrolled ventricular rate

Which of the following begins to rise w/i 2 to 4 hours of MI, peaks at 24 to 48 hours, & returns to normal w/i 72 hours? (A) CK-MB (creatinine kinase) (B) TnI (C) TnT (D) B & C

B (angiotensin II receptor antagonist)

Which of the following binds to angiotensin II receptor & competively inhibits action of angiotensin II & III? (A) quinapril (B) losartan (C) spironolactone (D) amlodipine

A (renin inhibitor)

Which of the following binds w/ high specificity to proteolytically active sites of human renin → reduces circulating angiotensin I & II → ↓ BP (A) Aliskiren (B) quinapril (C) losartan (D) amlodipine

Which of the following brings dietary fats to white adipocytes for storage? (A) Fatty acids (B) Chylomicrons (C) Glycerols (D) Very low-density lipoproteins

Which of the following can be added to angiotensin II blockers to prevent tachycardia? (A) diuretics (B) CCBs (C) β blocker (D) ACE inhibitors

Which of the following can be administered as an antidote for accidental ingestion of heavy metals? (A) green leafy vegetables (B) dairy products rich in Ca2+ (C) egg whites (D) fish rich in omega 3

Which of the following can be detected in the dental office and is found in about 1/3 of patients who have atherosclerosis? (A) AV heart block (B) carotid calcifications (C) ASD (D) VSD

Which of the following can be used to describe megakaryocytes? (A) Multinucleated (B) Formed by fusion of haploid cells (C) Precursors to bone marrow macrophages (D) A minor but normal formed element found in the circulation (E) Possess dynamic cell projections from which one type of formed element is released

Which of the following can be used to determine relative amounts of CD4 & CD8 cells? (A) Enzyme immunoassay (B) Enzyme-linked immunosorbent assay (ELISA) (C) Flow cytometry (D) Western blot

Which of the following can be used to identify particular organisms by shape, elevation, color, & translucency of colonies + ability to grow under presence of CO₂? (A) Wet Mount (B) Fluorescent dyes (C) Culture (D) DNA probes

Which of the following can decrease occurrence of restenosis by functioning as a permanent scaffold to help maintain vessel patency? (A) percutaneous transluminal coronary angioplasty (B) balloon angioplasty (C) stents (D) CABG

Which of the following can help reduce proteinuria of CKD? (A) Statins (B) ACE inhibitors (C) CCBs (D) beta blockers (E) diuretics

Which of the following cardiovascular diseases results from group A β-hemolytic streptococcal infections? (A) Calcific aortic stenosis (B) Myxomatous Mitral Valve (C) Rheumatic Valvular disase (D) infective endocarditis

Which of the following cause neurological symptoms, including brain swelling & encephalopathy? (A) hyponatremia (B) hypokalemia (C) hypernatremia (D) A & B (E) A & C

Which of the following causes (1) dilation of afferent arterioles & (2) constriction of efferent arterioles → overall ↑ in RBF & GFR (A) α₁ receptors (B) prostaglandins (C) angiotensin II (D) ANP

Which of the following causes a decrease in renal Ca2+ clearance? (A) Hypoparathyroidism (B) Treatment with chlorothiazide (C) Treatment with furosemide (D) Extracellular fluid (ECF) volume expansion (E) Hypermagnesemia

Which of the following causes hyperkalemia? (A) Exercise (B) Alkalosis (C) Insulin injection (D) Decreased serum osmolarity (E) Treatment with β-agonists

Which of the following causes vasoconstriction of both afferent & efferent arterioles, with efferent being more sensitive to its effects (↓ in GFR at low levels), leading to a decrease in RBF? (A) α₁ receptors (B) norepinephrine (C) angiotensin II (D) ANP

Which of the following changes will cause an increase in myocardial O2 consumption? (A) Decreased aortic pressure (B) Decreased heart rate (C) Decreased contractility (D) Increased size of the heart (E) Increased influx of Na+ during the upstroke of the action potential

Which of the following characteristics distinguishes somatic capillaries from visceral capillaries? (A) Presence or absence of fenestrae (B) Size of the lumen (C) Thickness of the vessel wall (D) Presence or absence ofpericytes (E) Thickness of the basal lamina

Which of the following combine to form C3 convertase in the classical pathway? (A) C1 & C2 (B) C2a & C4a (C) C2b & C4b (D) C2a & C3a

Which of the following component of the circulatory system contains the most distinct internal elastic lamina? (A) Aorta (B) Pulmonary trunk (C) Pulmonary veins (D) Superior vena cava (E) Medium-sized arteries

Which of the following contains UT1 which is upregulated by ADH to reabsorb 70% of filtered urea? (A) PCT (B) thin descending limb of loop of henle (C) Thick Ascending Limb of Henle, DCT, & Cortical & Outer Medullary Collecting Ducts (D) inner medullary collecting ducts

Which of the following contains principal cells with ENac (Na⁺ channels)? (A) PCT (B) thick ascending limb of loop of Henle (C) Early DCT (D) Late DCT & collecting ducts

Which of the following coordinates the mechanism for dissipating heat by shunting blood to venous plexuses near skin surface? (A) anterior hypothalamus (B) posterior hypothalamus (C) Na+-K+ ATPase (D) alpha 1 receptors in vascular smooth muscle of skin blood vessels (E) beta receptors in brown fat

Which of the following coronary arteries would most likely cause sweating (clamminess), light headedness, bradycardia, & hypotension in Donald Rivaldi and what type of MI is caused? (A) LAD, superior MI (B) RCA, inferior MI (C) LCX, superior MI (D) LAD, inferior MI

Which of the following corresponds to ventricular ejection after the aortic valve opens? (A) 4→1 (B) 1→2 (C) 2→3 (D) 3→4

Which of the following corresponds to ventricular filling, when the mitral valve opens? (A) 4→1 (B) 1→2 (C) 2→3 (D) 3→4

D (vasodilator)

Which of the following could have caused flushing of the skin on Victor Dermody's skin exam? (A) aspirin (B) HCTZ (C) atenolol (D) nitroglycerine

Which of the following describes the number of substrate molecules converted to product per enzyme molecule per unit time? (A) Kcat (B) Km (C) Vmax (D) [S]

Which of the following differential stains is used to distinguish plasmodium species? (A) gram-stain (B) wright-giemsa stain (C) acid-fast staining (D) Ziehl-Neelsen stain

Which of the following differential stains is used to identify myobacteria that retain stain after acidic decolorizing agent? (A) gram-stain (B) wright-giemsa stain (C) acid-fast staining (D) Ziehl-Neelsen stain

Which of the following differentiate into antibody secreting plasma cells upon encountering Th cells & antigen? (A) T cells (B) B cells (C) NK cells (D) Macrophages

Which of the following does NOT contribute to the formation of maximally concentrated urine? (A) active NaCl transport in the proximal convoluted tubule (B) active NaCl transport in the thick ascending limb of the loop of Henle (C) impermeability of the thick ascending limb of the loop of Henle to water (D) high water permeability of the collecting duct due to presence of ADH (E) presence of urea in the inner medullary interstitium

Which of the following does NOT empty into the coronary sinus, but drains directly into R atrium? (A) small cardiac vein (B) middle cardiac vein (C) posterior cardiac vein (D) great cardiac vein (E) anterior cardiac vein

C (low)

Which of the following does not lead to increased prevalence of Premature Ventricular Complexes (PVCs)? (A) age (B) male gender (C) high serum K+ concentration (D) heart failure

A, B, C

Which of the following drain into the coronary sinus? (Select all that apply - 3) (A) Middle cardiac vein (B) Small cardiac vein (C) Oblique cardiac vein (D) Anterior cardiac vein (E) Right pulmonary vein

Which of the following ejection fractions is considered the threshold to diagnose LVHF? (A) 25 to 35% (B) 45 to 50% (C) 55 to 70% (D) 75 to 100%

Which of the following ensures that FAs are metabolized in MT of brown adipocytes for thermogenesis rather than ATP synthesis? (A) lipase (B) uncoupling protein 1 (UCP1) (C) norepinephrin (D) leptin

Which of the following esterifies cholesterol INSIDE cells? (A) LPL (B) ACAT (C) HGTL (D) LCAT

Which of the following explains splay (portion of titration curve where glucose excreted in urine before Tm value)? (A) high affinity of Na+-glucose transporter (B) low affinity of Na+-glucose transporter (C) heterogeneity of nephrons (D) A & C (E) B & C

Which of the following has an underlying problem of central arterial stiffness & loss of elasticity? (A) Isolated diastolic (B) Isolated systolic (C) primary HTN (D) secondary HTN

Which of the following hydrolases are found on liver plasma membranes & remove triacylglycerols from the lipoprotein particles? (A) LPL (B) ACAT (C) HGTL (D) LCAT

Which of the following increase ADH secretion I. Increases in serum osmolarity II. Decreases in serum osmolarity III. Increases in blood V & BP IV. Decreases in blood V & BP (A) I & III (B) II & IV (C) I & IV (D) II & III

Which of the following increases Na+/K+ ATPase affinity for Na+? (A) angiotensin II (B) insulin (C) growth hormone (D) A & B (E) all of the above

Which of the following is CONTRAindicated in patients with cardiac conduction defects & in HF? (A) ACE inhibitors (B) renin inhibitors (C) thiazide diuretics (D) CCBs

Which of the following is NOT a cardiac serum marker of acute MI? (A) troponin I & T (B) creatine kinase isoenzyme (CK-MB) (C) creatinine (D) Myoglobin

Which of the following is NOT a cardinal feature of tetralogy of fallot? (A) VSD (B) R ventricular outflow tract obstruction (subpulmonic stenosis) (C) Overriding of VSD by the aorta (D) pulmonary HTN (E) R ventricular hypertrophy

D (R ventricular hypertrophy)

Which of the following is NOT a cardinal feature of tetralogy of fallot? (A) VSD (B) obstruction of R ventricular outflow tract (subpulmonary stenosis) (C) Aorta that overrides the VSD (D) L ventricular hypertrophy

C (acidosis)

Which of the following is NOT a cause of decreased K+ secretion? (A) low K+ diet (B) hypoaldosteronism (C) alkalosis (D) K+ sparing diuretics

E (antagonists)

Which of the following is NOT a cause of hyperkalemia? (A) insulin deficiency (B) α-adrenergic agonists (C) cell lysis (D) exercise (E) β₂-adrenergic agonists

A (hyposmolarity)

Which of the following is NOT a cause of hypokalemia? (A) hyperosmolarity (B) insulin (C) β₂ adrenergic agonists (D) alkalosis (E) α adrenergic antagonists

A (hyperaldosteronism)

Which of the following is NOT a cause of increased K+ secretion? (A) hypoaldosteronism (B) alkalosis (C) thiazide & loop diuretics (D) luminal anions

Which of the following is NOT a characteristic feature of Nephritic Syndrome? (A) Hypoalbuminemia (B) Hematuria (C) Proteinuria w/ or w/o edema (D) Azotemia (E) HTN

Which of the following is NOT a characteristic feature of Nephrotic Syndrome? (A) Proteinuria (B) Hypoalbuminemia (C) Azotemia (D) Generalized edema (E) Hyperlipidemia & lipiduria

Which of the following is NOT a common adverse effect of ACE inhibitors? (A) coughing (B) hyperkalemia (C) altered or reduced taste sensation (D) developmental defects or fetal death

B (↓)

Which of the following is NOT a consequence of hyperosmotic volume contraction (i.e. sweating, fever, diabetes insipidus)? (A) ↓ ECF volume (B) N.C. in ICF volume (C) ↓ in Osmolarity (D) N.C. Hematocrit (E) ↑ plasma [protein]

B (↓)

Which of the following is NOT a consequence of hyperosmotic volume expansion (i.e. high NaCl intake)? (A) ↑ ECF volume (B) N.C. in ICF volume (C) ↑ in Osmolarity (D) ↓ Hematocrit (E) ↓ plasma [protein]

E (↑)

Which of the following is NOT a consequence of hyposmotic volume contraction (i.e. adrenal insufficiency? (A) ↓ ECF volume (B) ↑ in ICF volume (C) ↓ in Osmolarity (D) ↑ Hematocrit (E) N.C. plasma [protein]

C (↓)

Which of the following is NOT a consequence of hyposmotic volume expansion (i.e. SIADH)? (A) ↑ ECF volume (B) ↑ in ICF volume (C) ↑ in Osmolarity (D) N.C. Hematocrit (E) ↓ plasma [protein]

C (NC)

Which of the following is NOT a consequence of isosmotic volume contraction (i.e. Diarrhea; burn)? (A) ↓ ECF volume (B) N.C. in ICF volume (C) ↑ in Osmolarity (D) ↑ Hematocrit (E) ↑ plasma [protein]

C (NC)

Which of the following is NOT a consequence of isosmotic volume expansion (i.e. infusion of isotonic NaCl)? (A) ↑ ECF volume (B) N.C. in ICF volume (C) ↑ in Osmolarity (D) ↓ Hematocrit (E) ↓ plasma [protein]

Which of the following is NOT a content of the superior mediastinum? (A) Remnants of thymus gland (B) LNs (C) fat & CT (D) SVC

Which of the following is NOT a function of principal cells? (A) Na+ reabsorption (B) K+ secretion (C) K+ reabsorption (D) water reabsorption

Which of the following is NOT a function of the cardiac skeleton? (A) surround, anchor, & support all heart valves (B) Provide firm points of insertion for cardiac muscle in atria & ventricles (C) act as electrical insulation b/w atria & ventricles (D) form part of BBB

Which of the following is NOT a function of the kidneys? (A) regulation of extracellular osmolality (B) regulation of acid-base balance (C) excretion of end-products of muscle metabolism (D) activation of antidiuretic hormone (E) activation of vitamin D

Which of the following is NOT a function of the kidneys? (A) regulation of extracellular volume (B) regulation of plasma glucose concentration (C) regulation of arterial blood pressure (D) excretion of the end products of protein metabolism (E) excretion of foreign chemicals (e.g. pharmaceuticals, food additives, etc.)

C (fenestrated)

Which of the following is NOT a location of continuous capillaries? (A) skeletal muscle (B) brain (C) kidney (D) lung

A (continuous)

Which of the following is NOT a location of fenestrated capillaries? (A) brain (B) kidney (C) endocrine gland (D) intestine

C (fenestrated)

Which of the following is NOT a location of sinusoidal (discontinuous) capillaries? (A) pituitary & lymph nodes (B) liver (C) intestine (D) spleen

Which of the following is NOT a main anion found in ICF? (A) Cl- (B) phosphate (C) proteins (D) all of the above are main anions of plasma

Which of the following is NOT a main anion found in plasma? (A) Cl- (B) HCO3- (C) proteins (D) all of the above are main anions of plasma

Which of the following is NOT a main cation found in plasma? (A) Mg2+ (B) Na+ (C) K+ (D) Ca2+

Which of the following is NOT a main function of PTH? (A) inhibiting tubular reabsorption of phosphorous (B) Inhibiting osteoclast activity (C) Stimulating renal production of vitamin D needed for Ca2+ metabolism (D) Enhancing vitamin D absorption within intestine

Which of the following is NOT a manifestation of infection from N gonorrhoeae in females? (A) acute urethritis (B) endocervical columnar epithelial cells (C) purulent vaginal discharge (D) dysuria & abdominal pain (E) salpingitis & PID

Which of the following is NOT a manifestation of infection from N gonorrhoeae in males? (A) acute urethritis (B) dysuria (C) purulent urethral discharge (D) abdominal pain (E) epididymitis & prostatitis

Which of the following is NOT a part of the triad of characteristic features of renal cell carcinoma? (A) palpable abdominal mass (B) dull flank pain (C) painful proteinuria (D) painless hematuria

Which of the following is NOT a sign of active inflammation? (A) rubor (B) cyanosis (C) tumor (D) dolor (E) calor

Which of the following is NOT a sign of digoxin toxicity? (A) hypersalivation (B) nausea & vomiting (C) visual distortions (D) xerostemia (E) ventricular premature beats

Which of the following is NOT a typical consequence of right-to-left shunts? (A) pulmonary HTN (B) clubbing of fingers & toes (C) polycythemia (D) paradoxical embolization

Which of the following is NOT an adverse effect of ACE inhibitors? (A) angioedema (B) burning mouth (C) dry mouth (D) orthostatic hypotension

Which of the following is NOT an adverse effect of angiotensin receptor blockers? (A) dry mouth (B) angioedema of lips, face, tongues (C) orthostatic hypotension

Which of the following is NOT an adverse effect of direct vasodilators? (A) lupus-like oral & skin lesions (B) lymphadenopathy (C) orthostatic hypotension (D) dry mouth

Which of the following is NOT an adverse effect of labetalol (β-blockers)? (A) coughing (B) GI disturbances (C) orthostatic HTN (D) bradycardia (E) dry mouth

Which of the following is NOT an adverse effect of nonselective beta blockers? (A) gingival overgrowth (B) taste changes (C) lichenoid reactions (D) must avoid prolonged use of NSAIDS

Which of the following is NOT an adverse effect of thiazide diuretics? (A) dry mouth (B) lichenoid reactions (C) taste changes (D) orthostatic hypotension

Which of the following is NOT an adverse effect of α adrenergic blockers? (A) dry mouth (B) taste changes (C) lupus-like oral & skin lesions (D) orthostatic hypotension

Which of the following is NOT an adverse effects of ACE inhibitors? (A) angioedema of lips, face, tongue (B) oral burning (C) orthostatic hypotension (D) gingival overgrowth

A (releases NO to cause vasodilation)

Which of the following is NOT an antiHTN drug that stimulates α2 adrenergic receptors in the brainstem→reduced sympathetic flow from brain (A) nebivolol (B) methyldopa (C) clonidine (D) guanabenz

Which of the following is NOT an assumption of the Michaelis-Menten model? (A) E, S, & ES are in rapid equilibrium (B) There are no forms of the enzyme present other than E & ES (C) Conversion of E & S into ES is a rate-limiting, irreversible step (D) Conversion of ES into E + P is a rate limiting, irreversible step

Which of the following is NOT an oral adverse effect of class I Fast Na+ channel blockers? (A) dry mouth (B) bitter taste (C) metallic taste (D) angioedema (E) oral ulcerations

Which of the following is NOT an oral adverse effect of class III: K+ channel blockers? (A) taste aberration (B) gingival overgrowth (C) angioedema (D) taste changes

Which of the following is NOT an oral adverse effect of class V: variable mechanism drugs? (A) metallic taste (B) gingival overgrowth (C) burning sensation (D) hypersalivation

Which of the following is NOT considered an acute coronary syndrome? (A) unstable angina (B) stable angina (C) MI (D) sudden cardiac death (SCD)

Which of the following is NOT indicative of CHF? (A) Jugular venous distention (B) Claudication (C) SOB (D) Paroxysmal Noctural Dyspnea (PND) (E) Orthopnea

Which of the following is NOT normally found in circulation but is detectable within 2 to 4 hours after an acute MI with levels peaking at 48 hours & remaining elevated for 7 to 10 days? (A) CK-MB (creatinine kinase) (B) TnI (C) TnT (D) B & C

Which of the following is NOT recommended for early administration in the case of an acute MI? (A) O2 (B) nitrates (C) aspirin (D) labetalol

Which of the following is NOT traditionally associated with atherosclerosis? (A) CRP (B) homocysteine (C) albumin (D) lipoprotein (a) (E) fibrinogen

Which of the following is NOT true of CCBs? (A) decrease intracellular Ca2+ (B) Cause vasodilation of coronary, peripheral & pulmonary vasculature & decreased myocardial contractility & HR (C) effective in treatment of chronic stable angina (D) competes with catecholamines for beta-adrenergic receptors

Which of the following is NOT true of MIs? (A) rapid & weak pulse (B) diaphoresis (sweating) (C) dyspnea w/ resultant acute pulmonary congetion & edema (D) associated pain relieved by nitroglycerin

Which of the following is NOT true of allosteric enzymes? (A) display sigmoidal plots of reaction rate vs. substrate concentration (B) binds to enzyme at site distinct from substrate binding site (C) Affects substrate binding (D) display hyperbolic plots of reaction rate vs. substrate concentration

Which of the following is NOT true of antibody class switching? (A) Control depends on concentration of interleukins (B) One VH gene can associate sequentially w/ different CH genes during immune response to produce different classes of immunoglobulins (C) Class switching occurs by change in heavy and light chains (D) Class switching occurs only by change in heavy chains

Which of the following is NOT true of myxomatous mitral valve? (A) 1 or both mitral valve leaflets are "floppy" & prolapse (B) men affected 7x more often than women (C) likely underlying intrinsic defect of CT synthesis or remodeling (D) ballooning (hooding) of mitral valve leaflets

Which of the following is NOT true of neisseria? (A) aerobic (B) gram-negative (C) gram-positive (D) diplococci

Which of the following is NOT true of statins? (A) used to increase LDL & lower HDL (B) inhibit HMG-CoA in liver (C) enhance expression of LDL receptors that capture blood cholesterol (D) anti-inflammatory effect

Which of the following is NOT true of the SA node? (A) located at junction of SVC & R atrium (B) regulates function of atria (C) responsible for production of QRS complex on ECG (ventricular depolarization) (D) responsible for production of P wave on ECG (atrial depolarization)

Which of the following is NOT true regarding ACE inhibitors? (A) end in -pril (B) provide immediate decrease in BP (C) should be used w/ K+ sparing diuretics (D) indicated for use in patients w/ DM

Which of the following is NOT true regarding AFIB? (A) strongly associated w/ age & HTN (B) rapid, disorganized atrial contractions at a rate of 250 to 600 beats/min (C) rapid, regular atrial rate of 250 to 350 beats/min (D) lead to increased risk of stroke & embolism

Which of the following is NOT true regarding Janice's diagnosis for MEN 2A? (A) T→C is a transversion mutation (B) T→C is a transition mutation (C) the T→C mutation caused a missense mutation (D) Similar heights of the T & C peaks showed the patient was heterozygous

D (multilocular)

Which of the following is NOT true regarding brown adipocytes? (A) makes up 5% of newborn weight but smaller amount in adults (B) color due to abundant MT & large number of blood capillaries (C) heat production is the main function (D) unilocular

D (systemic HTN)

Which of the following is NOT true regarding cor pulmonale? (A) R ventricular hypertrophy & dilation (B) caused by pulmonary HTN attributable to primary disorders of lung parenchyma or pulmonary vasculature (C) usually accompanied by R-sided HF (D) Boxcar nuclei

Which of the following is NOT true regarding dilated cardiomyopathy? (A) <40 ejection fraction (B) impairment of contractility (C) systolic dysfunction (D) diastolic dysfunction

Which of the following is NOT true regarding hypertrophic cardiomyopathy? (A) <40 ejection fraction (B) impairment of compliance (C) 50 - 80% ejection fraction (D) diastolic dysfunction

C (low renal perfusion)

Which of the following is NOT true regarding renal system control of BP? (A) long-term control (B) change in renal perfusion pressure sensed by kidneys (C) high renal perfusion causes kidneys to release renin (D) increases in angiotensin cause vasoconstriction & increased peripheral resistance

Which of the following is NOT true regarding restrictive cardiomyopathy? (A) 45 to 90% ejection fraction (B) impairment of contractility (C) impairment of compliance (D) diastolic dysfunction

A (short-term control)

Which of the following is NOT true regarding sympathetic control of BP? (A) long-term control (B) feedback from baroreceptors in the carotid sinus & aortic arch (C) increase in BP leads to increased stretch & inhibition of the sympathetic system (D) inhibition leads to ↓ HR, vascular tone, & BP

Which of the following is NOT true regarding white adipocytes? (A) 50 to 150 µm (B) mutlilocular (C) store triglycerides (D) release leptin

C (1st-dose effect)

Which of the following is NOT true regarding α1 adrenergic receptor blockers? (A) end in -zosin (B) blockage leads to vasodilation of arterioles & capacitance veins (C) heightened response later in therapy (D) ability to block α1 & α2 receptors used in treating HTN from pheochromocytoma

Which of the following is NOT true regarding β-blockers such as labetalol? (A) competitively blocks β adrenergic receptors (B) inhibits norepinephrine uptake by presynaptic terminal (C) useful in treating PCC & hypertensive emergencies (D) competitively blocks β cholinergic receptors

Which of the following is a NORMAL value for ejection fraction? (A) LVEF > 70% (B) LVEF 50 to 70% (C) LVEF 40 to 49% (D) LVEF < 30%

Which of the following is a cause of metabolic alkalosis? (A) Diarrhea (B) Chronic renal failure (C) Ethylene glycol ingestion (D) Treatment with acetazolamide (E) Hyperaldosteronism

Which of the following is a clinical presentation of RVHF? (A) systemic venous congestion (B) peripheral edema (C) pulmonary edema (D) A & C (E) A & B

Which of the following is a content of the middle mediastinum? (A) Pericardium (B) Vagus nerve (C) Esophagus (D) Thymus (E) Descending thoracic aorta

Which of the following is a direct surgical approach for arrhythmia treatment? (A) aneurysmectomy (B) CABG (C) resection of tissue & ablation (D) relief of valvular regurgitation or stenosis

Which of the following is a directly acting vasodilator that may cause abnormal hair growth (hypertrichosis)? (A) hydralazine (B) minoxidil (C) nitroprusside (D) nitroglycerine

Which of the following is a function of an implantable cardioverter defibrillator (ICD)? (A) deliver a shock (B) provide antitachycardia pacing (ATP) (C) ventricular bradycardia pacing (D) all of the above

Which of the following is a function of α-intercalated cells? (A) K+ reabsorption (B) H+ secretion (C) Na+ reabsorption (D) A & B (E) all of the above

Which of the following is a length-dependent mechanism that alters tension? (A) Maximal overlap of thick & thin filaments (B) Increasing muscle length which increases Ca2+ sensitivity to troponin C (C) Increasing muscle length → increases Ca2+ release from SR (D) A & B (E) All of the above

Which of the following is a lethal arrhythmia? (A) AFIB (B) Atrial flutter (C) sinus bradycardia (D) VFIB or ventricular flutter

Which of the following is a primary graft donor site for coronary artery bypass grafting (CABG)? I. saphenous vein from leg II. femoral artery from leg III. radial artery from arm IV. internal mammary artery from chest (A) I only (B) I & II (C) I & IV (D) I, III, & IV (E) I, II, III, & IV

Which of the following is a result of AT1 receptor activation? (A) Stimulation of inflammatory phenomena (B) Deposition of ECM (C) Generation of ROS (D) Prothrombotic effects (E) All of the above

Which of the following is a specific indicator for CHF? I. Exercise intolerance & fatigue II. rales or crackles III. PND IV. Orthopnea (A) I & II (B) I & III (C) III & IV (D) I, II, III, & IV

Which of the following is an action of parathyroid hormone (PTH) on the renal tubule? (A) Stimulation of adenylate cyclase (B) Inhibition of distal tubule K+ secretion (C) Inhibition of distal tubule Ca2+ reabsorption (D) Stimulation of proximal tubule phosphate reabsorption (E) Inhibition of production of 1,25 dihydroxycholecalciferol

Which of the following is an adverse effect of CCBs? (A) gingival overgrowth (B) dry mouth (C) taste changes (D) lymphadenopathy

Which of the following is an adverse effect of renin inhibitors like aliskiren? (A) hypotension (B) hyperkalemia (C) coughing (D) A & B

Which of the following is an effect of histamine? (A) Decreased capillary filtration (B) Vasodilation of the arterioles (C) Vasodilation of the veins (D) Decreased Pc (E) Interaction with the muscarinic receptors on the blood vessels

Which of the following is an immunocompetent cell? (A) Red blood cell (B) Lymphocyte (C) Platelet (D) Neutrophil (E) Basophil

Which of the following is an important pathway for distribution of hormones used by the anterior pituitary gland & liver? (A) microvascular pathway (B) AV anastomoses (shunts) (C) Venous portal system (D) ductus arteriosus

Which of the following is an important pathway for thermoregulation by skin? (A) microvascular pathway (B) AV anastomoses (shunts) (C) Venous portal system (D) ductus arteriosus

Which of the following is an oral adverse effect of class II beta blockers? (A) taste changes (B) dry mouth (C) angioedema (D) gingival bleeding

Which of the following is an oral adverse effect of class IV: CCBs? (A) taste aberration (B) gingival overgrowth (C) angioedema (D) taste changes

Which of the following is associated with demarcation channels? (A) Red blood cell (B) Lymphocyte (C) Platelet (D) Neutrophil (E) Basophil

Which of the following is associated with acute renal failure & BUN levels > 55 mg/dL? (A) red-orange discoloration of oral mucosa (B) xerostomia & parotid infections (C) ammonia-like odor of saliva (D) uremic stomatitis

Which of the following is associated with an underlying cardiac condition and means profuse sweating? (A) diaphoresis (B) hematemesis (C) syncope (D) steatorrhea

Which of the following is associated with conduction blocks, R ventricular involvement or both? (A) large transmural infarcts (B) anterior transmural MI (C) posterior transmural infarcts (D) lateral transmural infarcts

Which of the following is associated with free wall rupture, expansion, aneurysm formation, & formation of mural thrombi? (A) large transmural infarcts (B) anterior transmural MI (C) posterior transmural infarcts (D) lateral transmural infarcts

Which of the following is associated with higher probability of cardiogenic shock, arrhythmias, & late CHF? (A) large transmural infarcts (B) anterior transmural MI (C) posterior transmural infarcts (D) lateral transmural infarcts

Which of the following is at highest risk for having a heart attack or fatal coronary heart disease? (A) 16 year old white female (B) 40 year old hispanic female (C) 60 year old black male (D) 60 year old white male

Which of the following is characterized by subepithelial IG-containg deposits along the GBM? (A) Minimal change Disease (B) Focal Segmental Glomerulosclerosis (FSGS) (C) Membranous Nephropathy (D) Membranoproliferative GN

Which of the following is considered a high cardiac risk noncardiac surgery (> 5%)? (A) aortic & other major vascular surgery (B) intraperitoneal & intrathoracic surgery (C) head & neck surgery (D) orthopedic surgery (E) carotic endarterectomy

Which of the following is considered an intermediate cardiac risk noncardiac surgery (<5%)? (A) breast surgery (B) cataract surgery (C) head & neck surgery (D) ambulatory surgery

Which of the following is considered severe uncontrolled HTN? (A) > 160/90 (B) > 180/110 (C) > 180/120 (D) >210/120

Which of the following is derived from CFU-E? (A) Red blood cell (B) Lymphocyte (C) Platelet (D) Neutrophil (E) Basophil

Which of the following is derived from CPU-Meg (MKP cells)? (A) Red blood cell (B) Lymphocyte (C) Platelet (D) Neutrophil (E) Basophil

Which of the following is derived from myeloblasts? (A) Red blood cell (B) Lymphocyte (C) Platelet (D) Monocyte (E) Basophil

Which of the following is derived from CFU-GM? (A) Red blood cell (B) Lymphocyte (C) Platelet (D) Neutrophil (E) Basophil

Which of the following is derived from reticulocytes? (A) Red blood cell (B) Lymphocyte (C) Platelet Neutrophil (D) Monocyte

Which of the following is diastolic pressure? (A) pressure at end of ventricular contraction (B) pressure at peak of ventricular contraction (C) pressure at end of atrial filling (D) total resting resistance in arterial system after L ventricular contraction

Which of the following is elevated in MS, inflammatory bowel disease, & rheumatoid arthritis? (A) Th1 (B) Th2 (C) Th3 (D) Th17

Which of the following is essentially the ONLY cause of fibrotic mitral stenosis? (A) Calcific aortic stenosis (B) Myxomatous Mitral Valve (C) Rheumatic Valvular disase (D) infective endocarditis

Which of the following is found in true capillaries? (A) smooth muscle (B) tunica media (C) tunica adventitia (D) tunica intima endothelial layer

Which of the following is indicated for patients with coronary heart disease who also have DM, L ventricular dysfunction, or HTN? (A) beta-blockers (B) ACE inhibitors (C) statins (D) CCBs

Which of the following is manifested histologically by alterations in GBM & mesangium & by proliferation of glomerular cells? (A) Minimal change Disease (B) Focal Segmental Glomerulosclerosis (FSGS) (C) Membranous Nephropathy (D) Membranoproliferative GN

Which of the following is most commonly associated with dehydration? (A) hyponatremia (B) hypernatremia (C) hyperkalemia (D) hypokalemia

Which of the following is most often the cause of pansystolic murmur? (A) aortic stenosis (B) mitral valve prolapse causing regurgitation (C) ASD (D) pulmonary HTN

Which of the following is not a location where lipoproteins distribute triacylglycerols & cholesterol? (A) intestine (B) spleen (C) liver (D) peripheral tissues

Which of the following is pathognomonic for LVHF, but is not present in most patients with HF? (A) Cheyne-Stokes respiration (B) pulsus alternans (C) clubbing of fingers (D) jugular venous distention

Which of the following is pathognomonic for papillary necrosis? (A) hx of urinary tract obstruction (B) sharply defined gray-white to yellow necrosis of apical 2/3 of pyramids (C) Discrete, yellowish, raised abscesses grossly apparent on renal surface (D) Liquefactive necrosis & abscess formation w/i renal parenchyma

Which of the following is primarily reabsorbed in the late PCT driven by high tubular fluid concentration of Cl⁻? (A) HCO₃⁻ (B) Na+ (C) filtered AAs (D) NaCl

Which of the following is produced locally in the kidneys & causes vasodilation of both afferent & efferent arterioles? (A) α₁ receptors (B) prostaglandins (C) angiotensin II (D) ANP

B (negatively charged glycoproteins on barrier)

Which of the following is readily filtered across the glomerular capillary barrier? (A) negative charges (B) positive charges (C) large MW proteins (D) all of the above

Which of the following is responsible for countercurrent multiplication that leads to concentration & dilution of urine? (A) PCT (B) loop of Henle (C) Early DCT (D) Late DCT & collecting ducts

Which of the following is responsible for readjustments in K+ excretion when dietary K+ varies? (A) PCT (B) thick ascending limb of loop of Henle (C) Early DCT (D) Late DCT & collecting ducts

Which of the following is sensitive to thiazide diuretics? (A) PCT (B) thin ascending limb of loop of Henle (C) DCT (D) collecting ducts

Which of the following is systolic pressure? (A) pressure at end of ventricular contraction (B) pressure at peak of ventricular contraction (C) pressure at end of atrial filling (D) total resting resistance in arterial system after L ventricular contraction

Which of the following is the MoA of aspirin? (A) inhibits COX by acetylating Ser → blocks access of arachidonate to active site of enzyme (B) inhibits COX by reversibly blocking arachidonate binding site (C) irreversibly modifies aldehyde dehydrogenase, leading to accumulation of alcohol & acetylaldehyde in blood (D) inhibit enzymes with active-site sulfhydryl residues

Which of the following is the MoA of disulfiram (antabuse)? (A) inhibits COX by acetylating Ser → blocks access of arachidonate to active site of enzyme (B) inhibits COX by reversibly blocking arachidonate binding site (C) irreversibly modifies aldehyde dehydrogenase, leading to accumulation of alcohol & acetylaldehyde in blood (D) inhibit enzymes with active-site sulfhydryl residues

Which of the following is the best measure of overall kidney function? (A) BP (B) GFR (C) serum BUN (D) urinalysis

Which of the following is the correct order of osseous changes in CKD? (A) osteomalacia, osteosclerosis, osteititis fibrosa (B) osteosclerosis, osteomalacia, osteititis fibrosa (C) osteomalacia, osteititis fibrosa, osteosclerosis (D) osteosclerosis, osteititis fibrosa, osteomalacia

Which of the following is the correct path of blood flow through the vascular bed? (A) arteriole → artery → capillaries → vein → venule (B) artery → arteriole → capillaries → venule → vein (C) capillaries → arteriole → artery → venule → vein (D) arteriole → venule → capillaries → veins → arteries

Which of the following is the greatest risk factor for CKD? (A) DM (B) HTN (C) Chronic GN (D) Age > 60 (E) Male gender

Which of the following is the main cation in ICF? (A) Ca2+ (B) K+ (C) Na+ (D) Mg2+

Which of the following is the main factor in development of atherosclerosis which leads to arteriosclerotic cardiovascular disease (ASCVD)? (A) fatty diet (B) high salt diet (C) abnormal lipoprotein metabolism (D) smoking

Which of the following is the main stimulus for carotid bodies to send a message from CN IX → CN X → vasomotor center? (A) hypoxia (B) alkalosis (C) hypocapnia (D) change in pO2

Which of the following is the most common cause of PURE RVHF? (A) pneumothorax (B) lung tumor (C) emphysema (D) bronchitis

Which of the following is the most common cause of rhythm disorders? (A) pulmonary HTN (B) R-to-L congenital shunt (C) L-to-R congenital shunt (D) ischemic injury

Which of the following is the most common primary malignant tumor of the heart? (A) angiosarcomas (B) myxomas (C) rhabdomyomas (D) all of the above are benign

Which of the following is the most common type of persistent arrhythmia? (A) VFIB (B) AFIB (C) Sinus bradycardia (D) Atrial flutter

Which of the following is the most common underlying cause of HF in the U.S. (60 to 75%)? (A) dilated cardiomyopathy (DCM) (B) coronary heart disease (C) HTN (D) DM2

Which of the following is the most important determinant of ECF osmolality normally & in DM? (A) Na+; glucose (B) K+; insulin (C) Ca2+; insulin (D) K+; glucose

Which of the following is the most important protein in urine? (A) albumin (B) creatinine (C) alpha 2 (D) gamma globulins

Which of the following is the recommended initial therapy for HTN for black population? (A) ACE inhibitors (B) CCBs (C) Thiazide diuretic (D) A or B (E) B or C

Which of the following is the result of an inward Na+ current? (A) Upstroke of the action potential in the sinoatrial (SA) node (B) Upstroke of the action potential in Purkinje fibers (C) Plateau of the action potential in ventricular muscle (D) Repolarization of the action potential in ventricular muscle (E) Repolarization of the action potential in the SA node

Which of the following is the single most important modifiable risk factor for coronary heart disease? (A) obesity (B) alcohol consumption (C) cigarette smoking (D) physical inactivity

Which of the following is the site of anti-hypertensive drug action? (A) Capillaries (B) Venules (C) Arterioles (D) Veins

Which of the following is true for ventricles? (A) Located at the base of the heart (B) Myocardial cells contains abundant granules (C) Receive blood directly from the venae cavae and pulmonary veins (D) Walls contain Purkinje fibers of the right and left branches from the atrioventricular bundle (E) Contain more elastic fibers than the atria

Which of the following is true of normal endothelium? (A) has anticoagulant properties (B) has antiadhesion properties (C) controls vasodilation by secreting NO (D) all of the above are true

Which of the following is true of pericytes? (A) Are associated with the basal lamina of capillary endothelial cells (B) Have similar histological features as contractile cells of the myocardium (C) Form a layer of cells joined by gap junctions (D) Are terminally differentiated (E) Capable of forming multinucleated muscle fibers

Which of the following is true of the constant region? (A) invariant region of light chain (B) defines the class of antibody (C) antigen binding site (D) N termini of 1 light & 1 heavy chain

Which of the following is true regarding BP & risk for atherosclerotic disease? (A) Diastolic more strongly related to incidence of cardiovascular disease than systolic (B) SBP decreases throughout life (C) DBP tends to level off or decrease after age 50 (D) Isolated diastolic HTN more common in older adults

Which of the following is true regarding PDA? (A) can be caused by high levels of O2 during embryogenesis (B) is an example of R-to-L shunts (C) high pressure L-to-R shunt produces "machinery-like" murmurs (D) cause decreased pulmonary blood flow & pressure

Which of the following is true regarding primary HTN? (A) results from known disorders (B) CO normal & TPR elevated (C) Baroreceptor reflexes no longer function normally (D) Lifestyle risks such as Na+ intake and obesity are unavoidable

Which of the following is true regarding the metabolic hypothesis I. vasodilator metabolites produced as a result of metabolic activity in tissue II. Based on observation that the tissue supply of O2 is matched to the tissue demand for O2 III. based on observation that vascular smooth muscle contracts when it is stretched IV. Explains autoregulation but not active or reactive hyperemia (A) I & III (B) I, II, & IV (C) III & IV (D) I & II

Which of the following is true regarding the myogenic hypothesis I. vasodilator metabolites produced as a result of metabolic activity in tissue II. Based on observation that the tissue supply of O2 is matched to the tissue demand for O2 III. based on observation that vascular smooth muscle contracts when it is stretched IV. Explains autoregulation but not active or reactive hyperemia (A) I & III (B) I, II, & IV (C) III & IV (D) I & II

Which of the following is used as chemoprophylaxis only in newborns to prevent gonococcal eye infections (A) 1% silver nitrate solution (B) 1% tetracycline (C) 0.5% erythromycine (D) any of the above

Which of the following is used to detect spirochetes - treponema pallidum, treponema denticola, & leptospira sp.? (A) bright-field microscopy (B) dark-field microscopy (C) phase contrast microscopy (D) fluorescence microscopy

Which of the following is/are criteria for dx of systemic (L-sided) hypertensive heart disease? (A) L ventricular hypertrophy + other cardiovascular pathology (B) L ventricular hypertrophy in absence of other cardiovascular pathology (C) Hx or pathologic evidence of HTN (D) A & C (E) B & C

Which of the following is/are differences b/w N meningitidis & N gonorrhea? I. N meningitidis has a capsule but N gonorrhea does not II. N meningitidis is oxidase-positive but N gonorrhea is not III. N meningitidis causes a lethal infection in the bloodstream but N gonorrhea does not IV. N gonorrhea is a gram-negative diplococci but N meningitidis is rod-shaped (A) I only (B) I & II (C) I & III (D) I, II, III, & IV

Which of the following may cause gingival hyperplasia when plaque control is not optimal? (A) ACE inhibitors (B) Beta-blockers (C) CCBs (D) nitrates

Which of the following methods used for dx of N gonorrhoeae is important for identifying antibiotic susceptibility? (A) gram-stained diplococci in neutrophils (B) nucleic acid-based assays (C) culture in both selective & nonselective media (D) oxidase reaction (oxidase-positive w/ cytochrome C)

Which of the following might you expect to find associated with chronic renal failure? (A) elevated packed cell volume (hematocrit) (B) abnormally low plasma creatinine concentration (C) decreased bone density (D) lower than normal PTH (parathyroid hormone) concentration (E) None of the above is correct.

Which of the following occurs most often in lung disease? (A) metabolic acidosis (B) metabolic alkalosis (C) respiratory acidosis (D) respiratory alkalosis

Which of the following of Starling's forces favors filtration? (A) P∨GC (B) P∨BS (C) π∨GC (D) B & C

Which of the following of Starling's forces opposes filtration? (A) P∨GC (B) P∨BS (C) π∨GC (D) B & C

Which of the following parameters is decreased during moderate exercise? (A) Arteriovenous O2 difference (B) Heart rate (C) Cardiac output (D) Pulse pressure (E) Total peripheral resistance (TPR)

Which of the following participate in formation of C5 convertase? (A) C4b & C2b (B) C4b, C2a, & C3b (C) C5a & C5b (D) C5b, C6, C7, C8, & C9

Which of the following participate in formation of the Membrane attack complex? (A) C4b & C2b (B) C4b, C2a, & C3b (C) C5a & C5b (D) C5b, C6, C7, C8, & C9

Which of the following patients are candidates for elective dental care? (A) patient with decompensated HF (B) patient with acute MI w/i last 30 days (C) patient with unstable angina (D) patient with compensated HF

Which of the following patients can receive routine dental care? (A) stable angina (B) unstable angina (C) asymptomatic pt with MI in past (D) A & B (E) A & C

Which of the following patients can safely take macrolide antibiotics? (A) patient w/ prolonged QT (B) patient with tachycardia (C) patient with bradycardia (D) patient taking class IA & class III antiarrhythmia drugs

Which of the following patients should NOT receive antibiotics? (A) coronary heart disease (B) coronary artery stent (C) undergone a CABG procedure (D) none of the above should be prescribed antibiotics

Which of the following physiologic factors decrease BP? (A) sodium (B) fluid retention (C) anemia (D) A & B

Which of the following physiologic factors increase BP? (A) polycythemia (B) anemia (C) hemorrhage (D) B & C

Which of the following populations have the highest % of HTN at 43%? (A) Non-hispanic blacks (B) non-hispanic whites (C) hispanics (D) non-hispanic asians

Which of the following possesses specific and azurophilic granules? (A) Red blood cell (B) Lymphocyte (C) Platelet Neutrophil (D) Monocyte

Which of the following produces ANF (ANP) in order to decrease BP & Na+ in blood? (A) Right atrium (B) Left atrium (C) Right ventricle (D) Left ventricle

Which of the following reabsorbs 3% of Na+, is responsible for finetuning to ensure balance, & is the site of action of aldosterone? (A) PCT (B) thick ascending limb of loop of Henle (C) Early DCT (D) Late DCT & collecting ducts

Which of the following receptors is found on the arterioles of skeletal muscle? (A) α1 adrenergic (B) β1 adrenergic (C) β2 adrenergic (D) muscarinic

Which of the following recognizes the epitope of an antigen? (A) variable region (B) constant region (C) region of heavy chain (D) region of light chain

Which of the following results from bioactive compounds such as serotonin released by carcinoid tumors? (A) angiosarcomas (B) myxomas (C) rhabdomyomas (D) carcinoid heart disease

Which of the following results from excessive production or inefficient metabolism or excretion of nonvolatile acids? (A) metabolic acidosis (B) metabolic alkalosis (C) respiratory acidosis (D) respiratory alkalosis

Which of the following scavenger receptors binds HDL particles in liver? (A) class A (B) class B (C) CD36 (D) all of the above

A (macrolide antibiotic)

Which of the following should NOT be prescribed to patients taking HMG-CoA reductase inhibitors or CCBs? (A) erythromycin (B) pencillin (C) cephalexin (D) ciprofolxacin

Which of the following should be avoided in patients with HF? (A) NSAIDs (B) Antiarrhythmic drugs (C) CCBs (D) all of the above

Which of the following should be avoided in patients with hx of cardiovascular disease? (A) gingival retraction cord impregnated with epinephrine (B) NSAIDs (C) macrolide antibiotics (D) all of the above

Which of the following should you use first when treating Janice given that she has pheochromocytoma? (A) alpha blocker (B) alpha agonist (C) beta blocker (D) beta agonist

Which of the following statements about healthy, intact capillaries is true? (A) They control blood pressure. (B) They are lined by a simple columnar epithelium. (C) They have a smooth muscle coat. (D) They inhibit clot formation. (E) Satellite cells share their basal lamina.

Which of the following statements concerning innervation of blood vessels is true? (A) Vasoconstriction is controlled by parasympathetic nerve fibers. (B) Acetylcholine acts directly on smooth muscle cells. (C) Acetylcholine acts directly on endothelial cells. (D) Vasodilation is controlled by sympathetic nerve fibers. (E) Nitric oxide acts as a vasoconstrictor

E (B & D)

Which of the following stimulate neutrophil & macrophage chemotaxis to infection? (A) C2b (B) C3a (C) C3b (D) C5a (E) More than one of the above

Which of the following stimulates ENaC expression & activity of Na+/K+ ATPase & is antagonized by spironolactone? (A) ANP (B) ADH (C) renin (D) aldosterone

D (water, glucose, & AAs)

Which of the following substances crosses capillary walls primarily through water-filled clefts between the endothelial cells? (A) O2 (B) CO2 (C) CO (D) Glucose

Which of the following substances has the highest renal clearance? (A) Para-aminohippuric acid (PAH) (B) Inulin (C) Glucose (D) Na+ (E) Cl-

Which of the following substances or combinations of substances could be used to measure interstitial fluid volume? (A) Mannitol (B) D2O alone (C) Evans blue (D) Inulin and D2O (E) Inulin and radioactive albumin

Which of the following supplies the R atrium, R ventricle, AV node & SA node (conduction system of heart)? (A) R coronary artery (B) L coronary artery (C) Circumflex artery (D) LAD

Which of the following tests would you perform to determine ejection fraction? (A) EKG (B) Echocardiogram (C) Cardiac Enzyme (D) Angiogram

Which of the following transports lipids synthesized in the liver in the blood? (A) Fatty acids (B) Chylomicrons (C) Glycerols (D) Very low-density lipoproteins

Which of the following was a sign that phenoxybenzamine (alpha blocker) was working for Janice? (A) orthostatic hypotension (B) supine hypotension (C) orthostatic hypertension (D) supine hypertension

Which of the following would best distinguish an otherwise healthy person with severe water deprivation from a person with the syndrome of inappropriate antidiuretic hormone (SIADH)? (A) Free-water clearance (B) Urine osmolarity (C) Plasma osmolarity (D) Circulating levels of antidiuretic hormone (ADH) (E) Corticopapillary osmotic gradient

Which of the following would cause an increase in both glomerular filtration rate (GFR) and renal plasma flow (RPF)? (A) Hyperproteinemia (B) A ureteral stone (C) Dilation of the afferent arteriole (D) Dilation of the efferent arteriole (E) Constriction of the efferent arteriole

Which of the following would produce an increase in the reabsorption of isosmotic fluid in the proximal tubule? (A) Increased filtration fraction (B) Extracellular fluid (ECF) volume expansion (C) Decreased peritubular capillary protein concentration (D) Increased peritubular capillary hydrostatic pressure (E) Oxygen deprivation

Which of the following would you expect to find in a patient with SIADH? (A) hyperosmotic urine (B) hyposmotic urine (C) diluted plasma osmolarity (D) A & C (E) B & C

Which of the following would you give Janice in order to address both her tachycardia & her HTN? (A) atenolol (beta blocker) (B) quinapril (ACE inhibitor) (C) HCTZ (thiazide diuretic) (D) furosemide (loop diuretic)

A (heat, chemical denaturants, & changes in pH)

Which one of the following ailments, seen by an emergency room physician, is most likely caused by enzyme denaturation? (A) A 34-year-old man diagnosed with a gastrinoma complaining of diarrhea for 2 weeks (B) A 58-year-old man with chest pain and shortness of breath with increased activity (C) An 18-year-old boy presenting with a sore throat and fever of 101° F; he has small minimally tender anterior cervical lymph nodes and a red pharynx (D) An 18-month-old boy with a 4-day history of symptoms of an upper respiratory infection presenting with fever, irritability, and pulling at his left ear for the past 24 hours (E) A 48-year-old woman complaining of knee pain after twisting her leg playing tennis

Which one of the following cells is associated with antibody production? (A) Red blood cell (B) Lymphocyte (C) Monocyte (D) Neutrophil (E) Basophil

Which one of the following possesses a distinct internal elastic lamina? (A) Capillary (B) Metarteriole (C) Arteriole (D) Muscular artery (E) Vein

Which phase of the ventricular action potential coincides with diastole? (A) Phase 0 (B) Phase 1 (C) Phase 2 (D) Phase 3 (E) Phase 4

Which portion of the ECG represents atrial depolarization? (A) P wave (B) QRS complex (C) T wave (D) R wave

Which portion of the ECG represents ventricular depolarization? (A) P wave (B) QRS complex (C) T wave (D) R wave

Which portion of the ECG represents ventricular repolarization? (A) P wave (B) QRS complex (C) T wave (D) R wave

Which process occurs during granulopoiesis but not during erythropoiesis? (A) Cells lose their capacity for mitosis (B) Euchromatin content increases (C) Nucleus becomes increasingly lobulated (D) Overall cell diameter decreases (E) Overall nuclear diameter decreases

D (parasympathetic)

Which receptor mediates slowing of the heart? (A) α1 Receptors (B) β1 Receptors (C) β2 Receptors (D) Muscarinic receptors

Which type of antibiotic is broken down by N gonorrhoeae's penicillinase? (A) macrolide (B) fluoroquinolones (C) β-lactams (D) cephalosporins

Which type of epithelium lines the thick ascending limb of the loop of Henle? (A) Pseudostratified columnar (B) Simple columnar (C) Simple cuboidal (D) Simple squamous (E) Transitional (urothelium)

Which virulence factor of N gonorrhoeae is described below? Degrades secretory IgA found on mucous surfaces (A) Pili (B) Lipooligosaccharide (C) IgA protease (D) Penicillinase

Which virulence factor of N gonorrhoeae is described below? Lacks O-antigen but has endotoxin activity that induces production of inflammatory cytokines by host (A) Pili (B) Lipooligosaccharide (C) IgA protease (D) Penicillinase

Which virulence factor of N gonorrhoeae is described below? mediates attachment to mucosal cell surfaces; antiphagocytic (A) Pili (B) Lipooligosaccharide (C) IgA protease (D) Penicillinase

White adipocytes are derived developmentally from what precursor cells? (A) Monocytes (B) Fibroblasts (C) Mesenchymal cells (D) Brown adipocytes (E) Mast cells

Why was Victor Dermody taken off captopril once diagnosed with renal artery stenosis? (A) ACE inhibitors impair blood flow to kidney which can worsen his kidney function (B) It wasn't working (C) alpha adrenergic agonists impair blood flow to kidney which can worsen kidney function (D) it causes vasoconstriction

Yesterday, a 60-year-old man presented to the emergency department with dyspnea, diaphoresis, and crushing substernal chest pain that radiated to his neck and left arm. When asked to describe the pain, he put his fist to the center of his chest and stated that it felt "as if someone is squeezing my heart." An electrocardiogram demonstrated changes consistent with myocardial infarction, and serum troponin I levels were elevated. If the patient unexpectedly dies today, which of the following would almost certainly be found on histologic examination of the affected myocardium? (A) Coagulative necrosis with neutrophil infiltration (B) Fibrotic tissue replacing infarcted tissue (C) No histologic changes (D) Slight swelling of tissue and change of color (E) Young fibroblasts and new vessels growing into the infarcted tissue

Your patient has severe dental anxiety which leads to release of catecholamines that elevate his BP before his appointment. Which of the following could you use a pre-medication to help his situation? (A) statins (B) biphosphonates (C) SSRIs (D) benzodiazepines

[TF/P]ₙ < 1.0 (A) No reabsorption or secretion has yet occurred (B) Solute & water are proportionately reabsorbed (C) reabsorption of solute > reabsorption of water (D) Net reabsorption of solute < water (E) A & B

[TF/P]ₙ = 1.0 (A) No reabsorption or secretion has yet occurred (B) Solute & water are proportionately reabsorbed (C) reabsorption of solute > reabsorption of water (D) Net reabsorption of solute < water (E) A & B

[TF/P]ₙ > 1.0 (A) No reabsorption or secretion has yet occurred (B) Net secretion of solute into tubular fluid → concentration increases above that in plasma (C) reabsorption of solute > reabsorption of water (D) Net reabsorption of solute < water (E) B & D

___ also an opsonin that facilitates clearance of bacteria by immune system (A) C2b (B) C3a (C) C3b (D) C5a (E) More than one of the above

___% of LDL is taken up in the liver, & ___ % by peripheral tissues (A) 10, 90 (B) 20, 80 (C) 80, 20 (D) 50, 50

____ acts on principal cells of the late DCT & collecting duct → increase Na+ reabsorption (A) ADH (B) Aldosterone (C) Renin (D) angiotensin II

____ increases cotransporter activity & enhances the single effect (A) Aldosterone (B) ADH (C) Renin (D) Angiotensin II

____ is dependent on protein concentration of interstitial fluid, which is normally very low b/c very little protein is filtered. Increases in this factor ______ filtration out of capillary (A) πi (interstitial fluid oncotic pressure), favors (B) Pi (interstitial fluid hydrostatic P), favors (C) πi (interstitial fluid oncotic pressure), opposes (D) Pi (interstitial fluid hydrostatic P), opposes

____ particles remove cholesterol from cells (A) VLDL (B) IDL (C) LDL (D) HDL

____ takes cholesterol out of cells (A) VLDL (B) IDL (C) LDL (D) HDL

_____ alters rate at which action potentials are conducted from atria to ventricles (A) SA node (B) AV node (C) Purkinje Fibers (D) Bundle of His

_____ describes the volume of blood a vessel can hold at a given pressure (= V/P) The higher it is, the more volume it can hold at a given pressure (A) Compliance (Capacitance) (B) Shear (C) Flow (Q) (D) Resistance (R) (E) Elasticity

_____ diuretics increase Ca2+ reabsorption ______ diuretics decrease Ca2+ reabsorption (A) loop, thiazide (B) thiazide, loop

_____ is the total volume ejected by the ventricle per unit time =stroke volume x HR (A) stroke volume (B) ejection fraction (C) cardiac output (D) afterload

afferent, efferent

______ arterioles empty into glomerular capillaries, where ultrafiltration occurs _____ arterioles empty into peritubular capillaries surrounding nephrons, where solutes & H2O reabsorbed

right, left

______ axis deviation on an ECG points towards a pulmonary problem ______ axis deviation on an ECG is associated more with a heart problem

______ can reduce plaque inflammation & increase plaque stability in addition to their primary cholesterol-lowering activity (A) ACE inhibitors (B) diuretics (C) antiplatelet agents (D) statins

______ is a prodrug that must be hydrolyzed in the liver to become fully active but absorption is not affected by food (A) quinapril (B) lisinopril (C) captopril (D) enalapril

______ is a protease secreted by the kidney that regulates BP by cleaving circulating angiotensinogen to angiotensin I (A) renin (B) aldosterone (C) erythropoietin (D) ADH

______ is released when atrial receptors detect decrease in blood V as in hemorrhage → causes both vasoconstriction & increased water reabsorption → increase BP (A) norepinephrine (B) epinephrine (C) angiotensin II (D) Aldosterone (E) ADH

_______ = cardiac output x aortic pressure (A) stroke volume (B) stroke work (C) cardiac output (D) cardiac minute work

_______ can cause renal tubular necrosis at high doses but is safer than aspirin b/c it is metabolized by the liver (A) NSAIDs (B) Acetaminophen (C) Opioids (D) B & C

_______ catalyzes conversion of angiotensin I to angiotensin II (vasoconstrictor) in the ______ (A) ACE, plasma (B) ACE, lungs (C) Renin, plasma (D) Renin, lungs

_______ catalyzes conversion of angiotensinogen to angiotensin I in the ________ (A) ACE, plasma (B) ACE, lungs (C) Renin, plasma (D) Renin, lungs

_______ causes both arteriolar dilation & venous constriction, which together produce a large increase in Pc & local edema (A) Antihistamine (B) ADH (C) Aldosterone (D) Histamine

_______ causes the Korotkoff sounds of BP (A) laminar flow (B) turbulent flow (C) thrombi (D) mitral valve closure

_______ depends on the concentration of molecules in water (A) Volume (B) Pressure gradient (C) Osmolality (D) Density

_______ generate new bicarbonate & excrete hydrogen (A) proximal tubules (B) loop of Henle (C) distal tubules (D) collecting ducts

_______ generated by glutaminase reaction participates in excretion of H+ (A) glucose (B) ammonia (C) bicarbonate (D) phosphate

_______ has a simple squamous parietal layer of glomerular (Bowman) capsule, continuous w/ the proximal tubule, & a specialized visceral layer of podocytes surrounding glomerular capillaries (A) Glomeruli (B) Renal corpuscle (C) Renal tubule (D) Collecting Duct

_______ is a microbial infection of the heart valves or the mural endocardium that leads to formation of vegetations composed of thrombotic debris & organisms, often associated w/ destruction of underlying cardiac tissues (A) Calcific aortic stenosis (B) Myxomatous Mitral Valve (C) Rheumatic Valvular disase (D) infective endocarditis

_______ is closed slightly before the tricuspid valve by ventricular systole → S1 (A) Tricuspid (Right AV) valve (B) Pulmonary valve (C) Mitral (Biscuspid/Left AV) valve (D) Aortic Valve

_______ is the work the heart performs on each beat (A) stroke volume (B) stroke work (C) cardiac output (D) cardiac minute work

_______ stimulate thrombotic phenomena in the plaques (A) protein C & cofactor S (B) platelets (C) fibrinogen (D) B cells

________ aka ischemic Cardiomyopathy, is progressive heart failure secondary to ischemic myocardial damage (A) angina pectoris (B) myocardial infarction (C) chronic IHD (D) sudden cardiac death (SCD)

ventilation and lung perfusion

________ and _______ _______ together determine gas exchange

red, yellow

________ bone marrow is the site of hematopoiesis whereas _______ bone marrow contains adipocytes

________ causes disseminated intravascular coagulation with shock, fever, & skin manifestations (petechiae) (A) meningococcemia (B) epididytimitis (C) salpingitis (D) PID

________ cells are working cells while _______ cells rapidly spread action potentials over myocardium (A) myocardium, contractile (B) contractile, conducting (C) conducting, myocardium (D) contractile, pacemaker

________ drives movement of water b/w ICF & ECF (A) pressure gradients (B) ATPase (C) differences in osmolality (D) H+ gradients

________ enter circulation and lose all polyribosomes, at which point they become erythrocytes (A) Proerythroblasts (B) Basophilic erythroblasts (C) Polychromatophilic erythroblast (D) Orthochromatophilic erythroblasts (normoblasts) (E) Reticulocytes

________ is the primary regulator of blood flow to skeletal muscle at rest, whereas ______ regulates blood flow to skeletal muscle (A) local metabolic factors, sympathetic innervations (B) parasympathetic innervations, sympathetic innervations (C) sympathetic innervations, parasympathetic innervations (D) sympathetic innervations, local metabolic factors

__________ extend large primary processes that curve around a capillary & exert short, interdigitating secondary processes (pedicels) b/w which are narrow spaces called slit pores (A) mesangial cells (B) podocytes (C) parietal epithelial cells of Bowman's capsule (D) juxtaglomerular cells

ability to combine specifically w/ final products of immune response (A) immunogenicity (B) antigenicity (C) selection (D) opsonization

ability to induce a humoral and/or cell-mediated immune response (A) immunogenicity (B) antigenicity (C) selection (D) opsonization

activated by baroreceptor mechanism in response to decrease in Pa → VASOCONSTRICTION of afferent arterioles → increased proximal tubule Na+ reabsorption (A) Sympathetic nerve activity (B) ANP (C) Starling forces in peritubular capillaries (D) renin-angiotensin-aldosterone system

anions at physiologic pH that attach to Cl⁻ binding site of Na⁺-Cl⁻ cotransporter → prevent it from cycling → inhibit NaCl reabsorption in early DCT (A) loop diuretics (B) ACE inhibitors (C) K+ sparing diuretics (D) thiazide diuretics

anions at physiologic pH that attach to Cl⁻ binding site of Na⁺-K⁺-2Cl⁻ cotransporter → inhibits ability to cycle & stops transport → inhibits NaCl reabsorption in thick ascending limb of loop of henle (A) loop diuretics (B) ACE inhibitors (C) K+ sparing diuretcs (D) thiazide diuretcs

antibody-dependent cellular cytotoxicity cells via Fc receptors that bind Fc regions of antibodies that recognize antigens on foreign cells (A) T cells (B) B cells (C) NK cells (D) Macrophages

b/w R & L atria during normal development → allows oxygenated blood from maternal circulation to flow from R to L atrium → sustain fetal development (A) ductus arteriosus (B) ASD (C) foramen ovale (D) VSD

exothermic, decreases

binding of O2 to Hb is an (endothermic/exothermic) process, therefore O2 affinity (increases/decreases) with increasing temperature

block Na+ & Cl- cotransport in distal tubules (A) thiazide diuretics (B) loop diuretics (C) spironolactone (D) ACE inhibitors

blockage of which of the following leads to decreased CO₂ & decreased renin secretion? (A) β1 (B) α1 (C) renin (D) ACE

causes sexually transmitted infections (STIs) (A) N gonorrhea (B) N meningitidis (C) N sicca (D) N mucosa

characterized by deposition of sterile thrombi on cardiac valves - usually in those w/ an underlying hypercoagulable state (A) rheumatic heart disease (B) libman-sacks endocarditis (C) nonbacterial thrombotic endocarditis (NBTE (D) bacterial IE (infective endocarditis)

characterized by presence of sterile vegetations on valves of patients w/ systemic lupus erythematosus (A) rheumatic heart disease (B) libman-sacks endocarditis (C) nonbacterial thrombotic endocarditis (NBTE (D) bacterial IE (infective endocarditis)

clinical samples analyzed for presence of specific nucleic acid sequences by placing a small aliquot on a nitrocellulose filter, followed by addition of a labeled DNA probe (A) Culture (B) DNA sequencing (C) Dot Blot (D) ELISA

colonizes upper respiratory tract; causes meningitis, septicemia, pneumonia, arthritis, & urethritis (A) N gonorrhea (B) N meningitidis (C) N sicca (D) N mucosa

competitive inhibitor of aldosterone → inhibit Na+-K+ exchange in distal tubules & decreases K+ excretion (A) thiazide diuretics (B) loop diuretics (C) spironolactone (D) ACE inhibitors

destructive infections that usually involve highly virulent organism attacking a previously normal valve → _______ endocarditis infections by organisms of low virulence affecting a previously abnormal heart → _______ endocarditis (A) acute, chronic (B) chronic, subacute (C) subacute, acute (D) acute, subacute

found on B cell membranes & function as antigen receptors & activate B-cell growth (A) IgG (B) IgA (C) IgM (D) IgE (E) IgD

full thickness of ventricle caused by epicardial vessel occlusion through combo of chronic atherosclerosis & acute thrombosis (A) transmural infarction (B) subendocardial infarction (C) microscopic infarction (D) general MI

immunofluorescence detection of antigens in or on cells/tissues uses fluorescently labeled antibodies specific for antigen (A) Enzyme immunoassay (B) Enzyme-linked immunosorbent assay (ELISA) (C) Flow cytometry (D) Western blot

inhibit Na+ reabsorption in ascending loop of Henle (A) thiazide diuretics (B) loop diuretics (C) spironolactone (D) ACE inhibitors

intermittent chest pain caused by transient, reversible myocardial ischemia (A) angina pectoris (B) myocardial infarction (C) sudden cardiac death (D) arrhythmias

layer of arteries that is mostly smooth muscle & elastic fibers (A) tunica intima (B) tunica media (C) tunica adventitia (D) tunica externa

layer of arteries that is single squamous epithelium and subendothelial connective tissue (A) tunica intima (B) tunica media (C) tunica adventitia (D) tunica externa

measure of muscle breakdown & filtration capacity of nephron (A) Albuminuria (B) Serum BUN level (C) Serum creatinine level (D) GFR

hyper, hypo

metabolic rate increases in (hypo-/hyper-)thyroidism metabolic rate decreases in (hypo-/hyper-)thyroidism

necrosis of the heart muscle resulting from ischemia (A) angina pectoris (B) myocardial infarction (C) sudden cardiac death (D) arrhythmias

permits blood flow from pulmonary artery to the aorta, bypassing unoxygenated lungs in fetus (A) ductus arteriosus (B) ASD (C) foramen ovale (D) VSD

promote sodium excretion & decrease the BP - important markers of heart failure (A) Renin (B) Angiotensin II (C) Aldosterone (D) ANP

secreted by posterior pituitary → controls reabsorption of water in collecting ducts of kidney by regulation of aquaporins (A) Angiotensin II (B) Aldosterone (C) ADH (Vasopressin) (D) ANP

secreted from R atrium in response to increase in ECF volume → VASODILATION of AFFERENT arterioles & VASOCONSTRICTION of EFFERENT arterioles → increased GFR & decreased Na+ reabsorption in late DCT & collecting ducts (A) Sympathetic nerve activity (B) ANP (C) Starling forces in peritubular capillaries (D) renin-angiotensin-aldosterone system

site of glomerulotubular balance - mechanism for coupling reabsorption to the GFR (A) PCT (B) thick ascending limb of loop of Henle (C) Early DCT (D) Late DCT & collecting ducts

vasoconstriction, vasodilation

sympathetic stimulation of alpha 1 receptors → (vasoconstriction/vasodilation) sympathetic stimulation of beta 2 receptors → (vasoconstriction/vasodilation)

used to detect either (1) antibodies using antigen-coated wells of a 96-well plastic plate or (2) antigens by using antibody-coated wells & detecting bound antigen by a secondary antibody (A) Enzyme immunoassay (B) Enzyme-linked immunosorbent assay (ELISA) (C) Flow cytometry (D) Western blot

used to monitor presence of selected oral bacteria in plaque, saliva, & mucosal surfaces (A) Oligonucleotide probes (B) Real-time PCR (C) Reverse-transcription PCR (D) Whole genomic checkerboard DNA-DNA hybridization

heart rate = 1 / cycle length

what is the relationship of heart rate to cycle length? (cycle length = R-R interval)

macula densa

↑ in RBF & GFR is detected by the _____ ______ of the juxtaglomerular apparatus as an ↑ in delivery of Na+ & Cl- → secretes vasoactive substances to increase resistance of afferent arteriole → ↓ RBF & GFR back to normal

PBL Spring 2019 Exam 2 Practice Questions

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