2014 Introduction To Osteopathic-Exam 1 Version A

Front 1

1. A mutant immunoglobulin seems to keep its 3 dimensional structure intact but completely loses its
ability to bind the antigen. It is most likely that the mutation is:
A. In an alpha helical segment
B. In a beta sheet area
C. In a beta bend
D. In the amino end
E. In the Carboxylic end

Back 1

B. In a beta sheet area

Front 2

2. You are developing a new drug to treat Creutzfeldt-Jakob disease by stabilizing the native form of the prion. The most likely candidate should:
A. Bind to and stabilize the alpha helices in the native protein
B. Bind to and stabilize the beta sheets in the infectious protein
C. Bind to and stabilize the beta sheets in the native protein
D. Not bind to but stabilize the beta sheets in the infectious protein
E. Not bind to but stabilize the beta sheets in the native protein

Back 2

A. Bind to and stabilize the alpha helices in the native protein

Front 3

3. Vitamins often serve as a source of:
A. Apoenzymes
B. Coenzymes
C. Enzymes
D. Products
E. Substrates

Back 3

B. Coenzymes

Front 4

4. You have been asked to design drugs to inhibit a particular metabolic pathway; it will be best to try to
develop a drug that:
A. Inhibits the fastest step in the pathway
B. Inhibits the first step in the pathway
C. Inhibits the last step in the pathway
D. Inhibits the slowest step in the pathway
E. Stimulates the last step in the pathway

Back 4

D. Inhibits the slowest step in the pathway

Front 5

5. If your patient takes some medications for several months – sometimes they become tolerant to the drugs
because their systems become able to breakdown the drugs faster. Such a slow increase in the capacity of the drug clearance pathway is most likely to occur through
A. Allosteric control
B. Cooperativity
C. Enzyme induction
D. Product inhibition
E. Reversible covalent modification

Back 5

C. Enzyme induction

Front 6

6. A patient of yours has a heart attack and is under your care. You are monitoring recovery by measuring serum enzymes. Over the next two days, you find that his CK – MB levels are decreasing towards
normal but CK-MM levels are increasing. It is most likely that:
A. The patient had another heart attack
B. The patient is recovering from the heart attack and ready to go home
C. The patient is recovering from the heart attack but is having some liver damage
D. The patient is recovering from the heart attack but is having some other muscle damage
E. The patient never had a heart attack; you were wrong

Back 6

D. The patient is recovering from the heart attack but is having some other muscle damage

Front 7

7. A popular fast food hamburger contains 30 grams of fat, 30 grams of protein and 40 grams of
carbohydrates. This hamburger contains:
A. 120 Kcal
B. 360Kcal
C. 550Kcal
D. 1200Kcal
E. 1450Kcal

Back 7

C. 550Kcal

Front 8

8. The most efficient storage of energy in the body is in the form of:
A. Fat because fat is very dry and very reduced
B. Fat because fat is very hydrated
C. Glycogen because it is very hydrated
D. Glycogen because there is normally enough to last for several weeks
E. Protein because protein breakdown releases ammonia

Back 8

A. Fat because fat is very dry and very reduced

Front 9

9. Which of the following is true?
A. Muscle cannot release sugar into blood because muscle cannot break glycogen down
B. Muscle cannot release sugar into blood because muscle does not have glucose 6 phosphatase
C. The brain stores a lot of glycogen
D. The liver cannot release sugar into blood because the liver cannot break glycogen down
E. The liver cannot release sugar into blood because the liver does not have glucose 6 phosphatase

Back 9

B. Muscle cannot release sugar into blood because muscle does not have glucose 6 phosphatase

Front 10

10. An alcoholic patient of yours presents with confusion and disorientation. You suspect alcoholic ketoacidosis. Under alcoholic ketoacidosis:
A. Anion gap will be small
B. Glucose synthesis in the body will be increased
C. Lactate levels will be low
D. Most of the NAD will be present as NADH
E. The tricarboxylic cycle activity will be very high

Back 10

B. Glucose synthesis in the body will be increased

D. Most of the NAD will be present as NADH

Front 11

11. A patient of yours presents with accidental cyanide poisoning. In this patient:
A. ATP will be low, ADP will be high, NAD will be mostly oxidized
B. ATP will be low, ADP will be high, NAD will be mostly reduced
C. ATP will be high, ADP will be low, NAD will be mostly oxidized
D. ATP will be high, ADP will be low, NAD will be mostly reduced
E. ATP will be low, ADP will be low, NAD will be half reduced

Back 11

B. ATP will be low, ADP will be high, NAD will be mostly reduced

Front 12

12. You find a mutation in the electron transport chain of a patient who complains of always feeling tired. In
this patient’s mitochondria, complexes I,II and III are very reduced; cytochrome c and cytochrome
oxidase are very oxidized. It is likely that the mutation is in:
A. Complex I
B. Complex II
C. Complex III
D. Cytochrome Oxidase
E. Ubiquinone

Back 12

C. Complex III

Front 13

Which ion has the lowest intracellular concentration?
A. Ca+2
B. Cl-
C. K+
D. Mg+2
E. Na+

Back 13

A. Ca+2

Front 14

14. Which of the following will open when the drug benzodiazepine binds to the GABA receptor?
A. Carrier channel
B. Ligand-gated channel
C. Mechanical-gated channel
D. Pore channel
E. Voltage-gated channel

Back 14

B. Ligand-gated channel

Front 15

15. What is the function of DNA ligase?
A. Adds nucleotides to the 5' end of the new DNA strand
B. Catalyzes DNA synthesis only on the leading strand
C. Connects DNA fragments on the lagging strand
D. Improves fidelity of replication by its proofreading activity
E. Removes mismatched nucleotides from DNA

Back 15

C. Connects DNA fragments on the lagging strand

Front 16

16. Antibiotics in the fluoroquinolone family:
A. Act to disrupt the initiation of bacterial protein synthesis
B. Block the action of bacterial RNA polymerase
C. Block the actions of bacterial DNA topoisomerases
D. Block the action of DNA ligase in viruses
E. Degrade bacterial DNA

Back 16

C. Block the actions of bacterial DNA topoisomerases

Front 17

17. Small RNAs (snRNAs):
A. Act as primers in DNA replication
B. Are part of ribosomes
C. Bind amino acids
D. Function in eukaryotic mRNA processing
E. Have no known function

Back 17

D. Function in eukaryotic mRNA processing

Front 18

18. The toxin of the Amanita mushroom:
A. Acts to prematurely remove the new mRNA from its DNA template
B. Inhibits eukaryotic RNA polymerase function
C. Inhibits growth of gram-negative bacteria
D. Inhibits the posttranscriptional processing of eukaryotic mRNA
E. Inhibits the splicing process in eukaryotic mRNA

Back 18

B. Inhibits eukaryotic RNA polymerase function

Front 19

19. Which histone modification is associated with a decrease in transcription?
A. Acetylation
B. Addition of a coenzyme
C. Glycosylation
D. Methylation
E. Phosphorylation

Back 19

D. Methylation

Front 20

20. Transcription regulators:
A. Are acetylated and activate protein synthesis
B. Are DNA sequences upstream of the start site
C. Are not necessary for eukaryotic protein synthesis
D. Are proteins that have an RNA-binding motif
E. Bind to regulatory DNA sequences

Back 20

E. Bind to regulatory DNA sequences

Front 21

21. Gene expression profiles are quickly made by which method?
A. Cloning
B. Microarray technique
C. Polymerase chain reaction
D. RNA interference
E. Southern blotting

Back 21

B. Microarray technique

Front 22

22. In the RNA interference (RNAi) technique:
A. An endonuclease degrades the RNA
B. Genes are silenced by the miRNAs
C. Synthetic single-stranded RNA molecules are used
D. The RISC complex is introduced into the target cells
E. Transcription of the mRNA is blocked

Back 22

B. Genes are silenced by the miRNAs

Front 23

23. If a mother and father are both carriers of an autosomal recessive disease, what is their risk of having a
child who is a carrier of the disease?
A. 0
B. 25%
C. 50%
D. 67%
E. 75%

Back 23

C. 50%

Front 24

24. A characteristic of autosomal dominant inheritance of a disease is:
A. Affecteds are usually from the mating of two carrier parents
B. Appearance of the disease normally skips generations in a large pedigree
C. Each child of an affected individual has a fifty percent chance of inheriting the disease
D. There are more males than females affected
E. There is no father to son transmission

Back 24

C. Each child of an affected individual has a fifty percent chance of inheriting the disease

Front 25

25. The higher frequency of a certain autosomal recessive gene in a population is due to greater fitness of
the gene carriers. This is:
A. Founder effect
B. Genetic drift
C. Genetic isolation
D. Heterozygote advantage
E. Higher number of new mutations

Back 25

D. Heterozygote advantage

Front 26

26. An individual is heterozygous for an autosomal dominant disease but shows no abnormal phenotypic
features. This phenomenon is called:
A. Consanguinity
B. Pleiotropy
C. Recessivity
D. Reduced penetrance
E. Variable expressivity

Back 26

D. Reduced penetrance

Front 27

27. A genetic disease that is monogenic shows multiple phenotypic effects in several different organ
systems. This is called:
A. Effect of a new mutation
B. Multifactorial inheritance
C. Pleiotropy
D. Reduced penetrance
E. Variable expressivity

Back 27

C. Pleiotropy

Front 28

28. The visible properties of an organism produced by the interaction of the genotype and the environment
is:
A. Allele
B. Genotype
C. Penetrance
D. Phenotype
E. Variable expressivity

Back 28

D. Phenotype

Front 29

29. The Amish people have a higher frequency of maple syrup urine disease than the general U.S.
population. Which one of the following terms best describes this situation?
A. Genetic isolation
B. Heterozygote advantage
C. Higher fitness of mutant gene carriers
D. Higher mutation rate of gene
E. vPopulation bottleneck

Back 29

A. Genetic isolation

Front 30

30. If a mother and father each have one mutant gene for a disease with autosomal dominant inheritance,
what is their risk of having an affected child?
A. 25%
B. 50%
C. 67%
D. 75%
E. 100%

Back 30

D. 75%

Front 31

31. Taylor’s brother Michael has sickle cell disease (autosomal recessive inheritance). Taylor is
phenotypically normal. What is the probability that Taylor is a carrier (heterozygote) of sickle cell disease?
A. 0
B. 1/4
C. 1/2
D. 2/3
E. 3/4

Back 31

D. 2/3

Front 32

32. A protozoan associated with causing encephalitis is:
A. Candida albicans
B. Chlamydia
C. Entamoeba histolytica
D. Klebsiella
E. Toxoplasma gondii

Back 32

E. Toxoplasma gondii

Front 33

33. In the mid 1800s, there was a cholera outbreak that was associated with the ingestion of contaminated water from the Broad Street well in London. This outbreak was attributable to:
A. A malfunction in the pump being used at the well
B. Bird droppings entering the well chamber
C. Rain water causing run-off of farm animal waste
D. The mixing of sewage with drinking water
E. Wild animals urinating near the well

Back 33

D. The mixing of sewage with drinking water

Front 34

34. Which of the following is true about the link between tuberculosis (TB) and HIV/AIDS?
A. Active TB makes people susceptible to developing AIDS
B. HIV infection changes the virulence of the TB organism
C. HIV infection lowers host resistance to TB
D. TB lessens the killing effects of anti-retroviral therapy
E. The TB organism can cause mutations in the HIV genome

Back 34

B, C,

Front 35

35. Nonreplicating viruses are unique because they have:
A. Both RNA and DNA but no protein
B. DNA or RNA but not both
C. Endotoxin in their outer membrane
D. Plasmids in their cytoplasm
E. Single-stranded DNA in their nucleus

Back 35

B. DNA or RNA but not both

Front 36

36. Insulin, a protein hormone, could be predicted to have its receptors located in what part of target cells?
A. The cytosol
B. The endoplasmic reticulum
C. The glycocalyx
D. The nucleus
E. The plasma membrane

Back 36

E. The plasma membrane

Front 37

37. The dissociation constant Kd for a hormone A on its receptor is 10-9 molar while that for a hormone B
on its receptor is 10-7 molar. Which of the following is true?
A. Hormone A will produce a greater magnitude of effect
B. Hormone B probably binds to an intracellular receptor
C. Hormone B will bind more rapidly
D. The affinities for A and B are not related to the Kd
E. The affinity of the receptor for A is greater

Back 37

. E. The affinity of the receptor for A is greater

Front 38

38. A characteristic of G proteins is that:
A. Only a few large but important hormones utilize them
B. They are used once and degraded
C. They are switched “on” when bound to GTP
D. They bind to outside signal molecules
E. They have globular parts and fibrous connecting parts

Back 38

C. They are switched “on” when bound to GTP

Front 39

39. Pertussis toxin (Bordatella pertussis) has the effect of destroying the function of the ai subunit of a large
G protein in airway epithelial cells. This leads to:
A. Decreased reassociation of ß? and ai subunits and decreased cyclic AMP production and levels.
B. Elevated inhibition of adenylyl cyclase activity, increased adenylyl cyclase activity, and decreased
cyclic AMP production and levels
C. Elevated inhibition of adenylyl cyclase activity, reduced adenylyl cyclase activity, and decreased
cyclic AMP production and levels
D. Reduced inhibition of adenylyl cyclase activity, increased adenylyl cyclase activity, and increased
cyclic AMP production and levels
E. Reduced inhibition of adenylyl cyclase activity, reduced adenylyl cyclase activity, and decreased
cyclic AMP production and levels

Back 39

D. Reduced inhibition of adenylyl cyclase activity, increased adenylyl cyclase activity, and increased
cyclic AMP production and levels

Front 40

40. The activity of an activated large G protein is terminated when:
A. G TP displaces GDP on the α subunit
B. G TP displaces GDP on the βγ subunits
C. Its α subunit hydrolyzes the bound GTP
D. Its α subunit separates from the βγ subunits
E. T he α subunit binds to its downstream effector

Back 40

C. Its α subunit hydrolyzes the bound GTP

Front 41

41. Which of the following osteopathic physicians developed the technique known as “facilitated positional
release” (FPR)?
A. Fred Mitchell, Sr., D.O.
B. Harrison Fryette, D.O.
C. J. Martin Littlejohn, D.O., M.D.
D. Stanley Schiowitz, D.O.
E. William Garner Sutherland, D.O.

Back 41

C. J. Martin Littlejohn, D.O., M.D

Front 42

42. After collecting human remains from a crime scene, a forensic scientist identifies an isolated bone as the
sixth thoracic vertebra. Which of the following features would most likely be found on this bone?
A. Bifid spinous process
B. Costal facet
C. Dens
D. Foramen transversarium
E. Large, kidney-shaped body

Back 42

B. Costal facet

Front 43

43. A 48-year-old male shows signs of bacterial meningitis. A sample of cerebrospinal fluid (CSF) is
collected for analysis. From which of the following spaces must the sample be taken?
A. Endopelvic
B. Epidural
C. Medullary
D. Subdural
E. Sub-arachnoid

Back 43

E. Sub-arachnoid

Front 44

44. During intrathoracic surgery to remove a lung tumor, the gray ramus communicans at the level of T2 is
accidentally severed, while the white ramus is left intact. Which of the following structures will most
likely remain unaffected?
A. Arrector pili muscles
B. Arterioles
C. Cardiac muscle
D. Sebaceous glands
E. Sweat glands

Back 44

C. Cardiac muscle

Front 45

45. The pathways of sympathetic nerves can be distinguished anatomically from those of parasympathetic
nerves because:
A. Parasympathetic ganglia are located near the target organ
B. Parasympathetics have longer postganglionic fibers
C. Parasympathetics pass through paravertebral ganglia
D. Sympathetics arise from the sacral and head regions
E. Sympathetics do not enter the body wall or limbs

Back 45

A. Parasympathetic ganglia are located near the target organ

Front 46

46. An 80-year-old man presents with back pain. Which of the following findings would be most an
abnormal finding in the spine?
A. A cervical spine lordotic curve
B. A lack of spinal curvature in the coronal plane
C. A lumbar spine kyphotic curve
D. A sacral spine kyphotic curve
E. A thoracic spine kyphotic curve

Back 46

C. A lumbar spine kyphotic curve

Front 47

47. A 65-year-old female presents with left sided back pain. She points to the region medial to her left
scapula. The pain hurts more when she moves her shoulder blade out laterally. You are able to palpate a tight muscle spasm just medial to the scapula. Which of the following muscles is the most likely one
causing her pain?
A. Iliocostalis
B. Multifidus
C. Rhomboid major
D. Rotatores thoracis
E. Serratus posterior inferior

Back 47

B. Multifidus

Front 48

48. A surgeon discovers a tumor near the bottom of the chest cavity that compresses the greater splanchnic
nerve. The most likely affected type of neuron is:
A. Postganglionic sympathetic
B. Preganglionic sympathetic
C. Preganglionic parasympathetic
D. Somatic motor
E. Somatic sensory

Back 48

B. Preganglionic sympathetic

Front 49

49. A neurosurgeon discovers a lesion on a white ramus communicans that is affecting the preganglionic
sympathetic outflow to thoracic organs. Where is this lesion most likely located?
A. C1
B. L2
C. L5
D. T1
E. T12

Back 49

D. T1

Front 50

45. The pathways of sympathetic nerves can be distinguished anatomically from those of parasympathetic
nerves because:
A. Parasympathetic ganglia are located near the target organ
B. Parasympathetics have longer postganglionic fibers
C. Parasympathetics pass through paravertebral ganglia
D. Sympathetics arise from the sacral and head regions
E. Sympathetics do not enter the body wall or limbs

Back 50

A. Parasympathetic ganglia are located near the target organ

Front 51

46. An 80-year-old man presents with back pain. Which of the following findings would be most an
abnormal finding in the spine?
A. A cervical spine lordotic curve
B. A lack of spinal curvature in the coronal plane
C. A lumbar spine kyphotic curve
D. A sacral spine kyphotic curve
E. A thoracic spine kyphotic curve

Back 51

C. A lumbar spine kyphotic curve

Front 52

47. A 65-year-old female presents with left sided back pain. She points to the region medial to her left
scapula. The pain hurts more when she moves her shoulder blade out laterally. You are able to palpate a tight muscle spasm just medial to the scapula. Which of the following muscles is the most likely one
causing her pain?
A. Iliocostalis
B. Multifidus
C. Rhomboid major
D. Rotatores thoracis
E. Serratus posterior inferior

Back 52

B. Multifidus

Front 53

48. A surgeon discovers a tumor near the bottom of the chest cavity that compresses the greater splanchnic
nerve. The most likely affected type of neuron is:
A. Postganglionic sympathetic
B. Preganglionic sympathetic
C. Preganglionic parasympathetic
D. Somatic motor
E. Somatic sensory

Back 53

B. Preganglionic sympathetic

Front 54

49. A neurosurgeon discovers a lesion on a white ramus communicans that is affecting the preganglionic
sympathetic outflow to thoracic organs. Where is this lesion most likely located?
A. C1
B. L2
C. L5
D. T1
E. T12

Back 54

D. T1

Front 55

50. Implantation commonly occurs at the:
A. Blastocyst stage
B. Eight cell stage
C. Morula stage
D. Pronuclear stage
E. Two cell stage

Back 55

A. Blastocyst stage

Front 56

51. Beta human chorionic gonadotrophin (ßHCG) is produced by the:
A. Corpus luteum
B. Endometrium
C. Inner cell mass
D. Sertoli cells
E. Syncytiotrophoblast

Back 56

E. Syncytiotrophoblast

Front 57

53. Which of the following will form from the hypaxial part of the myotome?
A. Deep muscles of the back
B. Heart
C. Upper limb muscles
D. Vasculature
E. Visceral pleura

Back 57

C. Upper limb muscles

Front 58

55. Which pleura are located immediately adjacent to the innermost intercostal muscles?
A. Cervical
B. Diaphragmatic
C. Mediastinal
D. Parietal
E. Visceral

Back 58

D. Parietal

Front 59

56. The right pulmonary veins drain into the:
A. Left atrium
B. Left lung
C. Pulmonary trunk
D. Right atrium
E. Right lung

Back 59

A. Left atrium

Front 60

57. A patient has a posterior heart wall myocardial infarction. The most likely coronary vessel that has been
injured is:
A. Anterior descending interventricular
B. Left coronary
C. Left circumflex
D. Nodal branch
E. Right coronary

Back 60

E. Right coronary

Front 61

58. A 46-year-old patient complains of chest pain. MRIs and CTs find a tumor on the root of the right lung.
Blood flow in which of the following veins is most likely to be blocked by this tumor?
A. Accessory hemiazygos vein
B. Arch of azygos vein
C. Hemiazygos vein
D. Right brachiocephalic vein
E. Right subclavian vein

Back 61

B. Arch of azygos vein

Front 62

59. Which of the following drains blood from most of the left intercostal spaces?
A. Azygos vein
B. Hemiazygos vein
C. Inferior vena cava
D. Right brachiocephalic vein
E. Superior vena cava

Back 62

B. Hemiazygos vein

Front 63

60. As you evaluate vertebral motion at the functional spinal unit, you know that with rotation left of the
anterior portion of the vertebral body, there is a coupling of:
A. Contralateral translatory slide
B. Ipsilateral translatory slide
C. Roll and slide
D. Vertical translatory compression of the disc
E. Vertical translatory distraction of the disc

Back 63

D. Vertical translatory compression of the disc

Front 64

62. A 67-year-old man complains of mid-back pain after lifting his granddaughter the previous day. You
diagnose T6 on T7 as flexed, rotated right, sidebent right. The right erector spinae muscles in the mid-back area are boggy and warm to the touch. As you have your patient flex forward to confirm your diagnosis, you expect to feel:
A. The T6 right transverse process become more anterior and asymmetrical when compared with the
left transverse process
B. The T6 right transverse process become more posterior and asymmetrical when compared with the
left transverse process
C. The T6 right transverse process become more symmetrical when compared with the left transverse
process
d. The T7 right transverse process become more posterior and asymmetrical when compared with the
left transverse process
e. The T7 right transverse process become more symmetrical when compared with the left transverse
process

Back 64

C. The T6 right transverse process become more symmetrical when compared with the left transverse
process

Front 65

63. A patient is reported as having leucocytosis. This refers to a/an:
A. Decrease in red blood cell count
B. Decrease in white blood cell count
C. Increase in platelets
D. Increase in red blood cell count
E. Increase in white blood cell count

Back 65

E. Increase in white blood cell count

Front 66

64. A patient is suffering from unexplained decreased urine output. Which specialist would you call for a
consult?
A. Cardiologist
B. Hematologist
C. Intensivist
D. Nephrologist
E. Ophthalmologist

Back 66

D. Nephrologist

Front 67

65. On her general surgery rotation, a third-year osteopathic medical student is asked to describe the usual
location of the heart in the chest. Which of the following descriptions should she use?
A. Anterior to the pectoral muscles
B. Deep to the sternum
C. Distal to the shoulders
D. Lateral to the lungs
E. Superior to the neck

Back 67

B. Deep to the sternum

Front 68

66. After an MRI series of the head and neck, a radiologist selects a transverse section 2 cm superior to the
eyes. Which of the following might he find on this image?
A. Brain tumor
B. Ear infection
C. Nasal abscess
D. Neck fracture
E. Tooth abscess

Back 68

A. Brain tumor

Front 69

67. A professor collected data from the students in his class. He recorded the following variables for each
student: height, weight, cholesterol level, age and whether or not the student had a familial history of
heart disease. Which of these is categorical variable?
A. Age
B. Cholesterol level
C. Familial history of heart disease
D. Height
E. Weight

Back 69

C. Familial history of heart disease

Front 70

68. A study evaluated the occurrence of lung cancer in smokers and non-smokers. The following were the
results: 2000 heavy smokers and 2000 nonsmokers were followed for a number of years. 50 heavy
smokers had lung cancer, while 20 nonsmokers developed the cancer over the total period of the study.
What is the relative risk of developing lung cancer by heavy smokers?
A. 0.025
B. 0.25
C. 2.5
D. 0.01
E. 100

Back 70

C. 2.5

Front 71

The ages (in days) at time of death for samples of 10 girls and 12 boys who died of sudden infant death
syndrome are shown below:
Girls {55, 57, 60, 60, 78, 80, 100, 112, 113, 115}
Boys {50, 56, 58, 76, 78, 80, 80, 80, 103, 114, 115, 130}
69. What is the mean age at time of death for the group of girls?
A. 24.96
B. 25.39
C. 78.5
D. 83
E. 85

Back 71

D. 83

Front 72

70. What is the standard deviation of the ages at time of death for the group of girls?
A. 24.96
B. 25.39
C. 78.5
D. 83
E. 85

Back 72

A. 24.96

Front 73

71. Which of the following best describes the concept of primary disease prevention?
A. Earlier detection of colon cancer through stool occult blood testing
B. Early detection of breast cancer in women who are BRCA positive
C. Early detection of lung cancer using chest CT scanning
D. Immunization against influenza
E. Treatment of influenza to prevent secondary bacterial pneumonia

Back 73

D. Immunization against influenza

Front 74

72. Endemic describes which of the following?
A. A disease that affects a large part of the world at the same time
B. A disease that exhibits a seasonal pattern, year after year
C. A disease that is always present in the population being studied, generally in a given geographic area
D. A disease that is prevalent among animals and humans alike
E. A disease that occurs way in excess of normal expectancy

Back 74

C. A disease that is always present in the population being studied, generally in a given geographic area

Front 75

75. Select the predicated leading cause of death worldwide in 2010:
A. AIDS
B. Cardiovascular disease
C. Lung cancer
D. Malaria
E. Tuberculosis

Back 75

C. Lung cancer

Front 76

76. The leading cause of maternal death in developing countries is:
A. HIV/AIDS
B. Lower Respiratory infections
C. Malaria
D. Pregnancy
E. Tuberculosis

Back 76

D. Pregnancy

Front 77

77. The leading cause of death worldwide in children under the age of 5 is:
A. HIV/AIDS
B. Malaria
C. Neonatal causes
D. Pneumonia
E. Tuberculosis

Back 77

C. Neonatal causes

Front 78

78. To be an effective culturally proficient clinician, it is important:
A. That we use printed material to always supplement our instructions.
B. To assume that the beliefs, values, norms and behaviors of one’s own culture are the correct ones,
and that those of other cultures are inferior or misguided
C. To learn the culture of specific groups rather than have a broader framework that can be applied to
any culture
D. To understand that a health care system where ‘one size fits all’ is the most cost effective and successful approach to providing good health care
E. To understand that a patient’s religion, literacy and perception of illness, can have a significant impact on their compliance with medical treatment

Back 78

E. To understand that a patient’s religion, literacy and perception of illness, can have a significant impact on their compliance with medical treatment

Front 79

79. You are seeing a young Asian woman, who has a complaint of irregular vaginal bleeding. While taking
the history, you note that she avoids all eye contact with you. You should:
A. Ask her open ended questions and make her feel comfortable and safe during the interaction
B. Chastise her for being disrespectful
C. Immediately realize that she appears to be hiding some aspect of the events leading up to her
complaint
D. Make her look directly at you during the interview
E. Refuse to continue the interview and ask a colleague to take over the case

Back 79

A. Ask her open ended questions and make her feel comfortable and safe during the interaction

Front 80

80. According to the article on “Negotiating Care: The Teaching and Practice of Cultural Competence in
Medical School. A Student Perspective”, the following is true:
A. A clinician’s medical knowledge and scientific acumen is more than adequate to provide culturally
competent care
B. Instruction in cultural competence should encourage life-long learning and generalizations about
populations which are to be used as starting points to guide conversations with individual patients,
not to stereotype them
C. Skills in cultural competence are considered by many organizations to be a secondary need to
provide quality health care to a diverse patient population.
D. The article suggests that there is no necessity or time available for teaching cultural competence in
an already extensive curriculum.
E. The article states that “Cultural competence” is simply acknowledging and tolerating differences

Back 80

B. Instruction in cultural competence should encourage life-long learning and generalizations about
populations which are to be used as starting points to guide conversations with individual patients,

Front 81

81. Viscus is related to viscera as foramen is related to _____________ (fill in the blank).
A. Foramen
B. Foramena
C. Foramina
D. Foramini
E. Foraminitdes

Back 81

C. Foramina

Front 82

82. The locality in which the first Osteopathic School was established in 1892 was:
A. Chillicothe, Ohio
B. Davenport, Iowa
C. Des Moines, Iowa
D. Kansas City, Missouri
E. Kirksville, Missouri

Back 82

E. Kirksville, Missouri

Front 83

83. Which of the following measures can be considered an indicator of risk and can be looked at in any
specific population group as well?
A. Incidence
B. Predictive value
C. Prevalence
E. Sensitivity

Back 83

A. Incidence

Front 84

84. Which of the following values, in relation to a test being performed, is dependent on the underlying
prevalence of the actual disease in the population being studied?
A. Case-fatality rate
B. Incidence
C. Positive predictive value
D. Sensitivity
E. Specificity

Back 84

C. Positive predictive value

Front 85

The ability of a test to accurately identify those without the disease best describes which of the following?
A. Negative predictive value
B. Positive predictive value
C. Point prevalence
D. Sensitivity
E. Specificity

Back 85

A. Negative predictive value

E. Specificity

Front 86

86. A diagnostic test has been introduced that will detect a prostate cancer 18 months earlier than it is
usually detected. Which of the following is most likely to happen within 10 years after the test is introduced? This assumes that early detection has no effect on the natural history of prostate cancer.
A. The age-adjusted mortality rate for all cancers will increase
B. The age-adjusted mortality rate for prostate cancer will decrease
C. The apparent 5-year survival for prostate cancer will increase
D. The incidence rate for prostate cancer will decrease
E. The period prevalence for prostate cancer will decrease

Back 86

C. The apparent 5-year survival for prostate cancer will increase

Front 87

87. A report of an interesting case that may be hypothesis generating would be represented by which of the
following?
A. Case-control study
B. Case report
C. Cohort study
D. Randomized Controlled trial
E. Surveillance

Back 87

B. Case report

Front 88

88. Which of the following may be calculated from the results of a cohort study?
A. Odds ratio
B. Prevalence rate
C. Relative risk
D. Standardized mortality ratio
E. Type 1 error

Back 88

C. Relative risk

Front 89

89. Which of the following study types describes study groups by outcomes, rather than by exposures?
A. Case-control
B. Case-series
C. Clinical trial
D. Cohort
E. Surveillance

Back 89

A. Case-control

Front 90

90. The purpose of informed consent in a clinical trial for treatment of hypertension is to:
A. Decrease the likelihood of a placebo effect
B. Decrease the likelihood of malpractice litigation
C. Decrease the likelihood of patient blinding to treatment assignment
D. Increase the level of patient participation
E. Increase the patients’ knowledge of possible risks and benefits of treatment options

Back 90

E. Increase the patients’ knowledge of possible risks and benefits of treatment options

Front 91

91. During your physical exam of a 21-year-old medical student, you find he has a heart murmur. This
physical finding would be correctly documented in the:
A. Assessment
B. Labs
C. Objective
D. Plan
E. Subjective

Back 91

C. Objective

Front 92

92. A 32-year-old female presents to the office following admission to the hospital for pneumonia. After
she is done explaining what happened, you state to her "So, I understand that you were admitted to
Southside hospital for 3 days and discharged with instructions to take amoxicillin for 7 more days."
This would be an example of:
A. Close-ended question
B. Echoing style
C. Graded response
D. Open-ended question
E. Yes/No

Back 92

B. Echoing Style

Front 93

93. Instructions to the patient for warm compresses every 4-6 hours for the next 3 days to an abscess would
be included in the following portion of the SOAP note:
A. Assessment
B. Lab portion
C. Objective
D. Plan
E. Subjective

Back 93

D. Plan

Front 94

94. A physician suspects that a middle aged man has developed chronic lead poisoning. He takes a detailed
social and occupational history. Which of the following might be associated with this diagnosis?
A. The patient is a chemist
B. The patient is a drug addict
C. The patient is married to an alcoholic
D. The patient lives in a newly constructed apartment complex
E. The patient works as a baker

Back 94

A. The patient is a chemist

Front 95

96. The process whereby neither the patient nor the investigator knows the treatment assigned is known as:
A. Cross-over
B. Masking
C. Meta-analysis
D. Pragmatic assignment
E. Stratification

Back 95

B. Masking

Front 96

97. A 42-year old male presents to the office for a routine physical. During the medical interview he tells
you that he has an allergy to penicillin. Which would be the correct section to document this finding:
A. Assessment
B. Labs
C. Objective
D. Plan
E. Subjective

Back 96

E. Subjective

Front 97

98. A 12-year old boy presents to the emergency department with shortness of breath and difficulty
swallowing after being stung by a wasp. The diagnosis of allergic reaction to wasp sting would be
correctly documented for this visit in the:
A. Assessment
B. Labs
C. Objective
D. Plan
E. Subject

Back 97

A. Assessment

Front 98

99. A 24-year old female presents with vaginal discharge. Which of the following is the best style of
question to ask first?
A. Closed-ended
B. Echoing
C. Graded response
D. Open-ended
E. Yes/No

Back 98

D. Open-ended

Front 99

100. Which of the following question styles allows the patient to know that their physician is demonstrating
empathy?
A. Close ended question
B. Echoing style question
C. Graded response
D. Multiple choice question
E. Yes/No question

Back 99

B. Echoing style question