1.

A 38-y/o apparently healthy non-smoker comes in for her first pap smear in nearly 5 years, and results return abnormal.
Lacking insurance, she does not follow up for another 3 years, when she again comes in for a pap smear. This time,
investigation reveals a moderately differentiated mass lesion several centimeters in diameter and impinging on the left
ovary. There is regional lymph node spread. There is no evidence of metastasis. 8 months following radiation and
chemotherapy, the tumor is found once again to be growing in the right and left pelvic cavity. CXR shows two small lung
nodules. Biopsy of a lung nodule reveals poorly differentiated cells. What is the grade and stage of the neoplasia before
therapy, and 8 months following therapy?
a)
b)
c)
d)
e)

Grade I, Stage Tis; Grade III, Stage IV

Grade II, Stage II; Grade IV, Stage IV
Grade II, Stage III; Grade III, Stage IV
Grade II, Stage Tis; Grade II, Stage IV
Grade II, Stage I; Grade III, Stage III

2. Which of the following is true with regards to protooncogenes/ oncogenes?

a) 50% of all cancers have a Ras mutation; p53, among other things, regulates GAP; and CDKs promote the cell
cycle through key regulatory checks.
b) 50% of all cancers have a p53 mutation; Ras, among other things, regulates GAP; and CDKIs promote the cell
cycle through key regulatory checks.
c) 50% of all cancers have a p53 mutation; Ras may be constitutively active with a mutant GAP; and bcl-2,
upregulated by p53, promotes protective apoptosis.
d) 50% of all cancers have a Ras mutation; p53 may be null (constitutively inactive) with a mutant GAP; and bax,
upregulated by p53, promotes protective apoptosis.
e) CDKIs protect by inhibiting premature progress through the cell cycle; Ras, a key signal transducer, uses raf-1 to
activate the MAP-kinase pathway; and bcl-2, in some respects, opposes the effect of p53.
3. NPV is related to which of the following (multiple answers):
a) False Positives
b) False Negatives
c) Prevalence
d) True Negatives
e) True Positives
4. Likely diagnosis?
a)
b)
c)
d)
e)

Megaloblastic Anemia
Microangiopathic Hemolytic Anemia
Sickle Cell Anemia
Warm Antibody Immune Hemolysis
Normal

-1-

5. All of the following cause a hemolytic anemia except:

a)
b)
c)
d)
e)

Human parvovirus B19

SLE
Acanthocytosis
Malaria
Disseminated Intravascular Coagulation

6. Which statement is false?

a) Thalassemia MAJOR is the only form in which blood transfusions are required.
b) A patient with a thalassemia will produce increased amounts of the globin chains present in their genome, such as
those of minor normal adult hemoglobins like Hb-Barts.
c) Hb A1c levels are useful in monitoring compliance of diabetic therapy.
d) Hb A2, Hb F, and Hb A1c are are all minor normal adult hemoglobins.
e) Homozygous Hb E Disease produces a mild hemolytic anemia.
7. Which of the following is a condition which must be met prior to or during granulocyte therapy?
a)
b)
c)
d)
e)

There must be a well-established infection, whether localized or systmeic.

You must be certain than the pathogen is bacterial or fungal.
Granulocyte counts must be less than 300-500/uL.
Antibiotic therapy must be given concurrently and at least for 3 days.
The patient must be at least 18 months of age since the granulocytes may not be well tolerated in a neonate.

8. The following paragraph describes hemostasis, but one statement is incorrect. Your mission, should you choose to
accept it, is to choose the statement that is wrong and the correct corresponding statement. (1) Primary hemostasis is the
events leading to vessel wall-platelet interactions resulting in an unstable plug. (2) Vessel injury leads to the release of
VWF from the endothelium. VWF is immobilized on the collagen. Platelet adhehion is accomplished through interactions
of glycoprotein receptor GPIa with the VWF (which has high affinity for GPIa), and this leads to platelet activation. GPIb
facilitates the adhesion of platelets to collagen. (3) Arachidonic acid is released into the cytoplasm, and cyclooxygenase
converts it into thromboxane A2; aspirin prevents coagulation by inhibiting cyclooxygenase. (4) Thromboxane A2
potentiates the mobilization of calcium. ADP and serotonin are released from dense granules. (5) ADP allows GPIIb and
GPIIIa receptors to be cross-linked by fibrinogen, and the platelet plug is formed.
a) (3) Arachidonic acid is released into the extracellular matrix, and cyclooxygenase converts it into thromboxane A 2;
aspirin prevents coagulation by inhibiting cyclooxygenase.
b) (5) ADP allows GPIIa and GPIIIb receptors to be cross-linked by fibrinogen, and the platelet plug is formed.
c) (1) Primary hemostasis is the events leading to vessel wall-platelet interactions resulting in a stable plug.
d) (2) Vessel injury leads to the release of VWF from the endothelium. VWF is immobilized on the collagen. Platelet
adhehion is accomplished through interactions of glycoprotein receptor GPIb with the VWF (which has high
affinity for GPIb), and this leads to platelet activation. GPIa facilitates the adhesion of platelets to collagen.
e) (4) Thromboxane A2 potentiates the mobilization of calcium. VWF and platelet factor 4 are released from dense
granules.

-2-

9. The types of Von Willebrand Disease which lack high-molecular-weight VWF multimers include:

a) 2M & 2N
b)
c)
d)
e)

2A & 2M
3 &1
2A, 2B, & 2M
2A & 2B

10. Which of the following is false regarding anticoagulation?

a) Only free Factor S can participate as a cofactor.
b) A homozygous deficiency of Protein C may manifest as a skin lesion on neonates. The condition is fatal when
untreated.
c) APC cleaevs Factors VIIIa and Va, blocking the formation of fibrin.
d) The majority of Factor S is free and able to participate as a cofactor for ACP catalytic activity.
e) A heterozygous deficiency of Protein C is usually asymptomatic.
11. While on your service, you notice that a patient bruises easily and has a prolonged bleeding time as a result of minor
cuts. Your work-up discovers Diffuse Intravascular Coagulation. Upon further history, physical exam, and follow-up,
which of the following would NOT be discovered?
a)
b)
c)
d)
e)

Colon Cancer
Schistocytes resulting from Microangiopathic Hemolytic Anemia
A gram negative sepsis
Decreased fibrinogen
Decreased levels of D-dimers

12. Which of the following does not belong with Tetralogy of Fallot?
a)
b)
c)
d)
e)

Patent Ductus Arteriosus

Overriding aorta
Right Ventricular Hypertrophy
Ventricular Septal Defect
Right Ventricular Outflow Tract Obstruction

13. Hirschprungs Disease is characterized by:

a)
b)
c)
d)
e)

Difficulty in neonatal respiration

Necrotizing inflammation of the intestines in neonates
Failure to pass meconium and chronic constipation
Pancreatic insufficiency
Mild anemia and jaundice

14. A 14 year old presents to your office with something growing on her arm. Your finding confirm a painless mass on the
distal right forearm, and biopsy reveals a small round blue cell tumor with skeletal muscle differentiation (strap cells). You
identify the mass as ____ and report the news that her prognosis is _____.
a)
b)
c)
d)
e)

Wilms Tumor; good.

Rhabdomyosarcoma; poor.
Ewing Sarcoma; good.
Ewing Sarcoma; poor.
Rhabdomyosarcoma; good.

-3-

15. CHF results in all of the following compensations except

a)
b)
c)
d)
e)

Increased end-diastolic wall tension

Muscle-derived vasodilators
Sodium and water retention
Myocardial dilatation
Increased sympathetic output

16. Which of the following is not given as part of thrombolytic therapy?

a)
b)
c)
d)
e)

Tissue plasminogen activator

Streptokinase
Digoxin
Aspirin
Heparin

17. Most common clinical presentation of cardiac myxoma:

a)
b)
c)
d)
e)

Pericarditis
Idiopathic Fever
Sudden Death
Si/Sx of Mitral Valve Disease
Si/Sx of Pulmonary Valve Disease

18. Which disease is characterized by vasculitis of the arteries (esp. the coronaries), aneursyms, and is identical to
polyarteritis?
a)
b)
c)
d)
e)

Kawasakis Disease
Takayasus Arteritis
Coarctation of the Aorta
Wegeners Granulomatosis
Hypersensitivity Angitis

19. Which is not true concerning diagnosing cardiac events?

a) Flipped LDH (LDH1>LDH2) can be caused by an acute MI.
b) Myoglobin is a good SnNout test.
c) Troponin subunits can be measured to test for acute MI; TnI is measured in the US, while TnT is more often
measured in Europe.
d) A timed profile of CK and CK-MB is the current gold standard of MI detection.
e) Presence of an MM band is indicative of myocardial damage.
20. Which of the following is not matched correctly?
a)
b)
c)
d)
e)

Dilated Cardiomyopathy - Cardiomegaly.

Hypertrophic Cardiomyopathy Common condition.
Dilated Cardiomyopathy .S3 gallop and ST changes.
Restrictive Cardiomyopathy Uncommon condition.
Hypertrophic Cardiomyopathy May have a genetic component.

-4-

21. A 53y/o black male is in your office for a work physical from his computer software design company. He reports his
health to be very good, and there is no history of major disease. His blood pressure is 142/81. His records show these
previous systolic BP values, starting with most recent: 145, 141, 138, 135, and 134. What should you do?
a)
b)
c)
d)
e)

Admit to hospital
Treat with medications
Monitor
Suggest lifestyle changes
Treat with medications and suggest lifestyle changes

22. Which classification of lung disease does Chronic Bronchitis fall into?
a)
b)
c)
d)
e)

Non-neoplastic, diffuse, restrictive

Non-neoplastic, localized, obstructive
Non-neoplastic, diffuse, obstructive
Non-neoplastic, localized, restrictive
Neoplastic, malignant

23. Regarding bronchiectasis all of the following are true except:

a)
b)
c)
d)
e)

Inflammatory process are at work in the lung

Obstruction may be secondary to a tumor
Obstruction results in atelectasis
Obstruction is the major influece; infection may contribute but is not necessary
Copious amounts of foul-smelling sputum is produced

24. A medical examiner seeks to determine all of the following except:

a)
b)
c)
d)
e)

Mode of Death (eg homicide vs murder)

Circumstances of death (eg whether the shooter was close range vs indeterminate range)
Cause of Death (eg gunshot)
Mechanism of Death (eg bleeding)
Manner of Death (eg homicide vs natural)

25. Which of the following DILD diseases is independently associated with lung cancer?
a)
b)
c)
d)
e)

Asbestos exposure and berylliosis

Asbestos exposure and silicosis
Silicosis and berylliosis
Asbestos exposure only
Coal workers pneumoconiosis and silicosis

26. Which disease is characterized by cough, hemoptysis, anemia, weight loss, diffuse pulmonary infiltrates, consolidated
and heavy lungs, and no renal involvement or anitbody involvement?
a)
b)
c)
d)
e)

BOOP
Desquamative interstitial pneumonia
Idiopathic pulmonary hemosiderosis
Pulmonary eosinophilia
Goodpastures syndrome

-5-

27. If a cancer presents microscopically with keratinization and intercellular bridges, which therapy will probably not be
considered?
a)
b)
c)
d)
e)

Radiation
Surgical resection
Chemotherapy
Radiation or chemotherapy
None of the above

28. In hypoxemia due to V/Q mismatch, why will hyperventilation not significantly increase pO 2?
a) Hyperventilation will lead to sympathetic stimulation from a panic response, increasing cardiac demand, and
comsuming the benefit of extra oxygen
b) The extra work of breathing will consume most of the benefit
c) Poorly oxygenated blood will still mix with saturated blood from normal parts of lung
d) Hyperventilation does nothing to improve lung perfusion, the original cause of the hypoxemia
e) None of the above
29. You are treating a patient for a pneumonia which on CXR shows no consolidation. In your excitement, taking the
history slipped your mind. You reason that the patient probably acquired the pneumonia from/ as a result of:
a)
b)
c)
d)
e)
f)

Someone from the community sneezing profusely on the #3 bus

Their possible HIV status
A possible recent hospital stay in which the infection was overlooked by your mentor
Probably either the hospital or the #3 bus
Probably either their possible HIV status or the #3 bus
Who knows? It could be any.

30. Which of the following is incorrect:

a) Forensic pathologist is in charge of determining the cause of death
b) Most common cause of death in fire accident is asphyxiation
c) Manner of death is etiologically specific
d) Cause of death is etiologically specific
e) Forensic pathologist is not in charge of the body in the scene of crime
31. A person was shot in the abdomen by his neighbour, underwent surgeries with no complication. The person seemed
to be doing fine until the tenth day when the person suddenly felt terrible pain in the right lower quadrant of his
abdomen and died within several hours. On autopsy, found burst appendix. Which of the following is true:
a) The neighbor should be told to hire Johnny Cochran
b) The manner of death is homicide
c) The immediate cause of death is appendicitis
d) The proximate cause of death is appendicitis
e) The mechanism of death cessation of respiratory system
32. Which one of these is not caused by injuries affecting the integrity of tissues caused by blunt impact:
a) Graze
b) Contusion
c) Laceration
d) Fracture
e) Chop

-6-

33. Centrally located, functional (hormone producing PTH), well differentiated, moderate, poor tumor. Which of the
following best match the description:
a) Bronchogenic carcinoma adenocarcinoma type
b) Bronchogenic carcinoma squamous cell type
c) Brochogenic carcinoma small cell
d) Bronchial carcinoid
e) Hamartoma
34. Which is not true about exudates?
a) Caused by increase in capillary permeability
b) Caused by increased hydrostatic pressure
c) High Specific gravity
d) LDH<200
e) Often found in neoplasm
35. Which one of the following is associated with rickettsial disease?
a) Serofibrinous pleuritis
b) Empyema
c) Hemorrhagic pleuritis
d) Mesothelioma
e) Fibrinous pleuriis
36. Which of the following disease associated with increased risk for lung cancer?
a) Anthracosis
b) Simple CWP
c) Complicated CWP
d) Silicosis
e) Berryliosis
37. Which of the following diseases predominantly found in younger people (<50 yr):
a) Goodpasture
b) Idiopathic Pulmonary Hemosiderosis
c) Wegener
d) Bronchial Carcinoid
e) All of the above
f) None of the above
38. Which of the following is the characteristics of Caplan syndrome
a) Pulmonary eosinophilia
b) Salivary gland involvement
c) Rheumatoid arthritis and pneumoconiosis
d) Glomerulonephritis
e) Scleroderma
39. Which is of the following is correct?
a) Normal A-a difference is 5-10 mmHg
b) The most common cause of hypoxemia is impaired diffusion
c) COPD patients often have higher hematocrit
d) The best treatment for COPD patients is breathing 100% oxygen
e) Emphysema patients have markedly decrease in TLC

-7-

40. What disease is characterized by the accumulation of Charcot-Leiden crystal:

a) Bronchiectasis
b) Chronic bronchitis
c) Emphysema
d) Asthma
e) Just kiddin Actually, none of the above
41. Which of the following conditions reversible:
a) Atelectasis
b) ARDS
c) Emphysema
d) Pulmonary Embolus
e) Small Cell Carcinoma
42. Which is characterized by diffuse alveolar damage?
a) Atelectasis
b) ARDS
c) Emphysema
d) Pulmonary Embolus
e) Small Cell Carcinoma
43. Which of the following does not cause restrictive CM?
a) Amyloidosis
b) Sarcoidosis
c) Myocarditis
d) Glycogen storage disease
44. What is the major cause of essential hypertension?
a) Idiopathic
b) Renovascular
c) Primary Aldoteronism
d) Chronic renal disease
e) Heart Disease
45. What is the common site for myxoma formation?
a) Left atrium
b) Right atrium
c) Right vetricle
d) Left Ventricle
46. Chose the correct match:
a) Mitral Stenosis : Bacterial Endocarditis
b) Aortic Stenosis: Rheumatic Fever
c) Mitral Valve Prolapse: Marantic Endocarditis
d) Splinter hemorrhages: Bacterial Endocarditis
47. Patient presented with mitral insufficiency. The gross pathology of the heart showed a lot of fibrosis in the papillary
muscle. Which blood supply was most likely occluded?
a) RCA
b) LCCA
c) LAD
d) Left main CA
e) Aorta

-8-

48. What is the most common cause of children (5-14 yr) mortality:
a) Homicide
b) Congenital Anomalies
c) Suicide
d) Malignant neoplasm
49. Which of the following statements is not true?
a) Preterm infants have problems with respiratory distress syndrome
b) Renal function develop adequately in preterm infants
c) Jaundice always indicate abnormal pathological condition
d) Difficulty with homeostasis is often found in preterm infants
50. Which of the following is malignant tumor in children?
a) Wilms tumor
b) Hemangioma
c) Teratoma
d) Lymphangioma
51. A 9 mo old baby was brought in because of weight loss, abdominal distension. Microscopic: small blue round cells.
What is the possible diagnosis?
a) Rhabdomyosarcoma
b) Ewings Sarcoma
c) Wilms tumor
d) Neuroblastoma
e) All of the above
f) None of the above
52. Upon closer analysis, you saw the tumor form characteristic rosettes. What is the diagnosis?
a) Rhabdomyosarcoma
b) Ewings Sarcoma
c) Wilms tumor
d) Neuroblastoma
e) All of the above
53. What is a defining microscopic finding of Langerhans Histiocytosis:
a) Neurosecretory granules
b) Homer Wright Rosettes
c) Cambium layer
d) Birbeck granules
e) Blastema, stromal, epithelial (triad)
54. Which of the following is a compensatory mechanism in patients with CHF?
a) Arterial vasodilation
b) Decrease wall tension and end diastolic fiber length
c) Increase A-V O2 difference
d) Bradycardia

-9-

55. Rank the following in terms of predilection in developing atherosclerosis plaque (highest to lowest):
1) Coronary arteries
2) Vertebral, basilar arteries
3) Popliteal
4) Abdominal aorta
5) Internal carotids
a) 5,4,3,2,1
b) 3,2,1,4,5
c) 2,1,5,4,3
d) 4,1,3,5,2
e)
56. Which if the following vascular disorder is characterized by affecting mostly >50 yr old, destruction of IEL and EEL,
presence of giant cells:
a) Takayasu arteritis
b) Kawasaki arteritis
c) Temporal arteritis
d) Polyarteritis nodosa
e) Wegeners granulomatosis
57. In which of the following condition that VSD is actually beneficial:
a) Truncus arteriosus
b) TOF
c) TGA
d) Tricuspid regurgitation
e) PDA
58. A child presented with weak pulse, pressure difference in upper extremities versus the lower ones. She has webbed
neck and short stature. What kind of congenital abnormality she is likely to have?
a) Truncus arteriosus
b) ASD
c) VSD
d) PDA
e) Coarctation of aorta
59. What is the indication for treating patients with erythropoietin?
a) Chronic anemia with iron deficiency
b) Chronic anemia patient with low blood volume
c) Chronic anemia patient with folate and B12 deficiency
d) Chronic anemia patient with renal disease
e) Acute anemia
60. All of the following is the morphological characteristic of thalassemia major, EXCEPT:
a) Codocytes
b) Polychromatophilia
c) Macrocytosis
d) Hypochromia
e) Poikilocytosis

- 10 -

61. Which of the following will cause excessive fibrinolysis?

a) Leiden mutation
b) XIII deficiency
c) Factor V deficiency
d) Protein C defect
e) Infection with Streptococcus in a patient who has defective plasminogen
62. Which is not one of the predicted outcomes of Thrombosis?
a) Embolization
b) Clot Lysis
c) Propagation
d) Organization
e) Replacement with fibrous tissue
63) Which of the following would NOT be characteristic of an anaplastic cell?
a) Pleomorphic
b) Hypochromatic
c) Clumping of chromatin
d) Increased mitotic activity
e) Large size
64) Which of the following tumors is malignant?
a) Adenoma
b) Leiomyoma
c) Hamartoma
d) Fibroma
e) Seminoma
65) Which of the following cell products is most diagnostic of a neoplasm?
a) Her-2-Neu
b) CD 20
c) CD 117
d) AFP
e) LDH
66) Which of the following tissues would be expected to undergo both hypertrophy and hyperplasia in response to a
stimulus?
a) Bone Marrow
b) Cardiac Myocytes
c) Adrenal Cortex
d) Prostate
e) Bladder wall
67) Mrs. Jones (a 45 year old caucasion who is G2P2) returns to her family practitioner for her annual gynecological
exam. She has a positive family history of breast cancer, cervical cancer, CAD, Type II Diabetes and colon cancer. On
exam a nodule of tissue appears white under colposcopy and PAP exam indicates dysplasia. For confirmation a biopsy is
performed and the tissue is sent to the lab. A report is returned two weeks later indicating that the mass is a cervical
adenocarcinoma, Grade II/Stage II. Which of the following is not likely to have been additionally noted in the report?
a) A decrease in the number of major histocompatability antigens
b) An increase in contact inhibition
c) An increase in cell membrane charge
d) An increased chromosome number
e) An increased nucleoli size

- 11 -

68) Which of the following regulatory cellular protein levels indicates a good prognosis?
a) Increased bax
b) Increased bcl-2
c) Increased Cyclin E
d) Increased CDK4
e) Increased CDK6
69) Which of the following is not a source of biologic and analytic variation?
a) Age
b) Nutritional status
c) Education
d) Recumbence
e) Alcohol use
70) The most frequent cause of mortality in children under 1 year of age is
a) Accidents
b) Congenital anomalies
c) Perinatal conditions
d) Malignant neoplasms
e) SIDS
71) The short limbs caused by maternal ingestion of Thalidomide
a) Malformation
b) Deformation
c) Disruption
d) Interruption
e) Sequence
72) Which of the following is the most common fetal viral infection?
a) CMV
b) Rubella
c) HIV
d) HSV
e) Parvovirus
73) Which of the following is the most common childhood tumor overall?
a) Wilms Tumor
b) Neuroblastoma
c) Hemangioma
d) Lymphangioma
e) Ewing Sarcoma
74) Which of the following features is most common to malignant childhood tumors?
a) Little incidence of metastases
b) Frequently composed of small round blue cells
c) Frequently associated with smoking or other environmental factors
d) Most are locared within the abdomen
e) Rarely regress or differentiate
75) Which of the following is the number one cause of morbidity and mortality in Kentucky?
a) Firearms
b) Coronary Artery Disease
c) Alcohol
d) Tobacco
e) Cocaine

- 12 -

76) Which of the following is true of normal erythrocytes?

a) The typical lifespan is 120-150 days
b) The liver is the primary source of production in a normal term baby
c) They have limited ability to prevent intercellular accumulation of sodium and water
d) The membranes allow for limited flexibility
e) Production can be increased up to 20 times greater than normal by erythropoietin stimulation of the liver and
spleen
77) Which of the RBC abnormalities is caused by an abnormality in lipid metabolism?
a) Target Cells
b) Spherocytes
c) Echinocytes
d) Schistocytes
e) Elliptocytes
78) A 24 year old female presents with fatigue and episodes of syncope. During the history she mentions that she has
been dieting to keep her figure. Anemia is suspected and blood is drawn. The results from the lab include an elevated
RDW, a slightly elevated PFA-100 and ferritin, tear-drop cells and Howell-Jolly bodies. What is the most likely diagnosis?
a) Iron Deficiency Anemia
b) Megaloblastic Anemia
c) Sickle Cell Anemia
d) DIC
e) Aplastic Anemia
79) The girls father is so pleased with your diagnosis, he decides to come in to see you as well. He too has been feeling
ill and fatigued for the last 6 months. He is a stock broker and usually has plenty of energy. He denies any special diet but
adds that his stools have been darkly colored. He also denies any family history of colon cancer. Here is his blood smear.
How would you treat his condition?
Vitamin B12 injections
Iron supplements
Antibiotics and Antacid
Erythropoetin
Thyroid Hormone

80) Which of the following is not a known cause of an antibody mediated acquired anemia?
a) Drugs
b) Connective Tissue Disorders
c) Infection
d) Malignancy
e) Diet

- 13 -

81) Which of the following hemostasis assays is likely to be abnormal in a completely asymptomatic patient?
a) PFA-100
b) VWF:RCof
c) APTT
d) PT
e) TCT
82) Which of the following drugs or blood products would not be beneficial if given to someone with Christmas Diease?
a) Epsilon Aminocaproic Acid
b) Tranexamic Acid
c) Desmopressin
d) PAI-1
e) antiplasmin
83) Which Von Willebrand Disease type is associated with thrombocytropenia
a) Type 1
b) Type 2A
c) Type 2B
d) Type 2M
e) Type 3
84) Which auto-immune associated coagulation disorder is treated with prednisone?
a) Antibodies to replacement coagulation factors in treated Hemophilia A
b) Antibodies to replacement coagulation factors in treated Hemophilia B
c) Antibodies to Von Willebrand Factor following parturition
d) Antibodies to Factor VIII following parturition
85) Which of the following is not a risk factor for a veinous thrombosis?
a) High levels of estrogen
b) Atherosclerosis
c) Smoking
d) Thrombocytopenia
e) Severe burns
86) Which of the following is not a potential outcome of a thrombosis?
a) Extension in size
b) Embolization
c) Granuloma formation
d) Fibrinolysis
e) Creation of channels within the thrombosis
87) Which of the following enzymes are Vitamin K Dependent?
A. Coagulation Factor II
B. Protein C
C. Coagulation Factor VIII
a) A
b) B
c) A & B
d) A & C
e) B & C

- 14 -

88) Neonatal Purpura Fulminans is caused by:

a) A homozygous deficiency of Protein C
b) A Type 3 Deficiency of Antithrombin III
c) A heterozygous deficiency of plasminogen
d) A homozygous deficiency of tissue plasminogen activator
e) A homozygous deficiency of urokinase plasminogen activator
89) Which of the following is required for the activation of Protein C?
a) Heparin
b) Protein S
c) Thrombomodulin
d) Prostocyclin
e) Plasma Protein C Reductase
90) Which of the following has the worst prognosis?
a) HbAA
b) HbAC
c) HbAS
d) HbSC
e) HbDD
91) Which of the following adverse transfusion reactions is most similar (underlying mechanism) to GVHD?
a) Uticarial
b) Delayed hemolytic
c) Anaphylactoid
d) Febrile non-hemolytic
e) Septic
92) A child is noted on physical exam to have greatly diminished posterior tibial pulses. Additionally she appears cyanotic
and has bounding radial pulses. Which of the following genetic abnormalities is most likely to lead to this condition?
a) Del 22q11
b) Chr12q22
c) Trisomy 21
d) Monosomy X
e) Chr 7, elastin gene
93) Which of the following is most likely to develop Cor Pulmonale?
a) Del 22q11
b) Chr12q22
c) Trisomy 21
d) Monosomy X
e) Chr. 7, elastin gene
94) Which of the following is the most common form of cyanotic CHD?
a) Truncus arteriosis
b) Total anomalous pulmonary vein return
c) Transposition of the great arteries
d) Tetrology of Fallot
e) Tricuspid atresia

- 15 -

95) A 68 year old female slips in her kitchen and fractures her femur at the neck. After treatment at the hospital, she is
discharged to a nursing home for recovery in bed. Three weeks later, an adult care worker discovers that she has expired
on returning from his lunchbreak. Autopsy reveals a saddle embolism. Evidence of cachexia and malnutrition is also
evident. The family files suit against the nursing home and care worker claiming neglect. Which of the following is a true
statement?
a) The immediate cause of death was cachexia
b) The immediate cause of death was the fracture
c) The immediate cause of death was the pulmonary embolism
d) The proximate cause of death was the pulmonary embolism
e) The mode of death was the pulmonary embolism
96) Which of the following would not be normally found inside an atherosclerotic plaque?
a) Foam cells
b) Cholesterol
c) Fibrin
d) Smooth muscle cells
e) Platelets
97) In which of the following blood vessels is an atherosclerotic aneurysm least likely to be found?
a) Pulmonary artery
b) Abdominal aorta
c) Iliac artery
d) Popliteal artery
e) Basilar artery
98) Which of the following is not a risk factor for atherosclerotic plaques?
a) Stroke
b) Calcification
c) Aneurysm
d) Aortic Dissection
e) Infarction
99) A 36 year old man with a 32 pack year history of smoking presents with symptoms of gangrene in his hands and
claudication. Biopsy of the radialis indices artery reveals an occluding thrombosis, neutrophil infiltration and preservation
of vessel architecture. Which of the following is the most likely diagnosis?
a) Ruptured atherosclerotic plaque
b) Hypersensitivity angitis
c) Polyarteritis nodosa
d) Wegeners granulomatosis
e) Buergers Disease
100) Which of the following is incorrect?
a) An expected outcome of right ventricular failure is a pressure sensitive state
b) Hemosiderin laden macrophages are frequently seen in the alveoli of a patient with CHF
c) Hemorrhagic enteropathy may be a consequence of increased afterload
d) A key problem in CHF is increased muscular vasoconstriction
e) The earliest indicator of CHF is dyspnea on exertion

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101) Which of the following accounts for the majority of ischemic heart disease?
a) Arterial spasm
b) Coronary arteritis
c) Atherosclerosis
d) Hypotension
e) Valve stenosis
102) Which of the following is a frequent finding in patients with myocardial infarction?
a) Decreased Q/R amplitude ratio on EKG
b) Atrial arrythmias
c) Decreased sedimentation rate
d) AST depression
e) Leukocytosis
103) Which of the following conditions is most likely to benefit from a saphenous vein bypass?
a) Left Circumflex Coronary Artery Occlusion
b) Left Anterior Descending Coronary Artery Occlusion
c) Right Coronary Artery Occlusion
d) Left Main Coronary Artery Occlusion
e) Right Marginal Coronary Artery Occlusion
104) Which of the following would not be an expected sign of an endocarditis?
a) Fever
b) Anemia
c) Hemorrhage
d) Nodules on digits
e) Valvular calcifications
105) The following picture is from the autopsy of a 53 year old man who died suddenly at home. What is the most likely
diagnosis of this abnormality?

Pericarditis
Myxoma
Mural throbosis
Infectious vegetation
Aneurysm

106) Which of the following represents the current Gold Standard for diagnosis of AMI in the absence of a conclusive
ECG?
a) Total CK
b) Timed CK isoenzyme series
c) LDH
d) AST
e) Troponin I

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107) Which of the following diseases is not likely to cause an elevation in CK-MB?
a) Muscular Dystrophy
b) Thyrotoxicosis
c) CHF
d) Pericarditis
e) Malignant Hyperthermia
108) Which of the following is true regarding tricuspid atresia?
a) Results from the disproportionate growth of the muscular septum
b) Frequently involves a right ventricular hyperplasia
c) Due to a defect on the NXK gene at the 4.5 locus
d) Requires a left-to-right shunt
e) Typically involves a large mitral valve orifice
109) Which of the following is the most common reversible secondary cause of hypertension?
a) Estrogens
b) Alcohol
c) Amphetamines
d) Renovascular
e) Hypothyroidism
110) Which of the following anti-hypertensive medications are most likely to have good patient compliance due to
negligible side effects?
a) Captopril
b) Diltiazem
c) Nifedipine
d) Potassium sparing agents
e) Aldomet
111) Which of the following is NOT true regarding restrictive cardiomyopathy?
a) It is an example of right sided heart failure
b) Known etiologies include hemochromatosis, amyloidosis, and sarcoidosis
c) It commonly results in atrial dilation
d) Decreased left and right sided filling pressures are common
e) ECG typically shows low voltage
112) Which of the following myocyte proteins is more commonly defective in older patients with familial hypertrophic
cardiomyopathies?
a) Beta myosin heavy cahin
b) Myosin-binding protein C
c) Ventricular myosin light chains
d) Alpha cardiac actin
e) Cardiac troponins
113) Which of the following types of atelectasis is most common?
a) Obstructive
b) Resorption
c) Compressive
d) Patchy
e) Contraction

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114) In which pulmonary disease would you expect to see hemosiderin laden macrophages?
a) Pulmonary Edema
b) Pulmonary Hypertension
c) Pulmonary Embolism
d) Adult Respiratory Distress Syndrome
e) Atelectasis
115) Which of the following lung pathologies is most likely to be associated with Cor Pulmonale?
a) Abscess
b) Asthma
c) Bronchitis
d) Bronchiectasis
e) Emphysema
116) Which of the following findings is indicative of a disease with imminent mortality if left untreated?
a) C-ANC Antibodies
b) Gohn Complex
c) Schaumann bodies
d) Coal macules
e) Birefringent particles
117) Mikulicz syndrome is the presence of what two pathologies?
a) Rheumatoid arthritis and coal workers pneumoconiosis
b) Rheumatoid arthritis and asbestosis
c) Sarcoidosis of the lungs and eye
d) Sarcoidosis of the salivary gland and eye
e) Sarcoidosis of the heart and lungs
118) Which of the following is not a likely cause of arterial hypoxemia?
a) Hypoventilation
b) Total anomalous pulmonary veinous return
c) Pleural effusion
d) Emphysema
e) Desquamative interstitial pneumonia
119) Which of the following is not a common cause of bronchogenic carcinoma?
a) Radiation
b) Nickel
c) Coal
d) Viral Infection
e) Beryllium
120) Which of the following organisms is responsible for producing pneumonia with a foamy alveolar exudate and
membrane hyalination?
a) Pneumocystis pneumonia
b) Staphylococcus aureus
c) Histoplasma capsulatum
d) Haemophilus influenza
e) Klebsiella

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Answers
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.

C
E
B, C, D
B
A
B
C
D
E
D
E
A
C
B
B
C
D
A
E
B
E
C
D
A
A
C
E
C
E
C

31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.

C
E
B
D
C
E
E
C
C
D
A
B
C
A
A
D
B
B? - accidents
C
A
E
D
D
C
D
C
C
E
D
C

61.
62.
63.
64.
65.
66.
67.
68.
69.
70.
71.
72.
73.
74.
75.
76.
77.
78.
79.
80.
81.
82.
83.
84.
85.
86.
87.
88.
89.
90.

- 20 -

B
E
B
E
D
D
B
A
C
C
C
A
C
B
C
C
A
B
C
E
C
C
C
D
B
C
C
A
C
D

91. D
92. D
93. B
94. D
95. C
96. E
97. A
98. D
99. E
100. A
101. C
102. E
103. D
104. E
105. B
106. B
107. D
108. E
109. A
110. D
111. D
112. B
113. C
114. A
115. C
116. A
117. D
118. E
119. D
120. A