[A Ss:yanrld man wit history of alcahiem is oeptalized for acste pancreas, He develops sudden-cnset dyspnea anh oxygen saturation draps fom 97% t9& Pulse fs 94min, and resprctor rate is 30min. Aportabe radiograph of re chest reveals blsteral pulmonary ifrates. His physician suspects acute respiratcry dist Daarage to hich ofthe fallow call types fs mast important he pabephysiogy of his endiion? A. Clara cal 38078 : Jonathan O A. Clara cals © B Goblet cats © C.Peeudosdtumnar elated ells © D.Type 1 pneumacytes © E-Type? pneumocytes [eames]‘The correct answer is . 39% chose this Acule respiratory distess syndroe (ARDS) s cirical syndrome of acte- inset dyspnea, hypoxemia. and cifisepulranary inflates fat leads orespratry flue. k's assccated wih a wide range of undying dscrder, including parcreaiis, ARDS is characterized by diftee alvaclar Gamage, wich leads to alvectar Capillary permeadliy and proteinsch leakage into alved, ard ultimately he fermaton af an ina-alvacarhyalie rmemorane, Therafcre the aval are he ung shuchires most affected by tis syncrome. Type 1 peumocytes line 97% of he surface ofthe avec. not correct. 5% chose this. Clara cals are found in the terminal brcnchicles, not he alveoli, where the cytokine radiated damage assceisted vith ARDS cecurs B is not correct. 2% chose this Goblet calls extond only oth terminal bronchicles, and are therefre rot feundin the bel, where the cytoene-medised damage associated with ARDS cesurs Cis not correct. 4% chose this Pseudccolumnar cited alls extend only to the respiratery bronchi rot curd the alveal, where the cytckine-edlated damage associated wth ARDS. cecurs Eis not correct. 60% chose this. Type 2 pneursocys are also found he alec, but they are culbcidal in shape, ard only line aporskimataly 2% of he alveaiar surface In ARDS, he cytokine mediates damage tthe alveclacapilar inertace = "much mere prenaunced on the more populous lype 1 preumocyles. Bottom Line: and are therefore [Type 1 preumocyias ire appronimataly 07% of he surlace of avec calls of he bnPreumacytes| Pecos ised eohasnar cell exten ta the wespzatory bronchioles macrophages ear debas in avec; goblet cel extend only tthe terminal bronchioles Type Tells (97% of aeoar sfc) lne the bea Samoan thin er opal gs ion, ‘Type Il ells (3%) secret pulmonary snactat (digaliitoslphorpbatidleholine), which F the slscoltanfice tension, Cboidal and cer Ao serve precinor tape Tell 2d other type I cell. Type Heol proliferate ding Jung damage. (Cars celli=noite colar sth serene eramils Secret component of surfactant Alggad toxins eta rene cells Mucus secretin re sep ctf the lung ovat the rout by cilisted ool A ecithindosphingomyelin rai oF > 2m amie i ind cate of etal Jung matuniytp wo tates com ap/ 857 2TDStat aspeTSVC=ESSETOL 9750-182 baSb4MEDSIES ee ee 27. A.10-ear-old boy with light blond hair, pale skin, and significant mental retardation (IQ of 50) sme defect at which ofthe following points inthe biochemical pathway? Thyroxine (T4) 1B o¢ Phenylalanine = Tyrosine =» DOPA —™ Melanin ' Homogentisic Acid {E Acetoacetic Aci¢ A) ©B) ©C) 2D) ©F)po tates com ap/857 2TDStat aspeTSVC=ESSETIOL 750-182 baSb AMES 28. Female pseudohermaphroditism is most often due to a deficiency of which of the following enzymes biosynthesis? © A)20,22-.Desmolase | © B)17aHydroxjlase © ©) 18- Hydrolase ® D)21-Hydrowlase E) 2-Hydroxysteroid dehydrogenaseaie ere keener 28. A17-jear-old gir has hemophilia A. Her older brother also has hemophilia A, but neither ‘Which ofthe following is the most likely explanation for the development of hemophilia int © A)Aneuploidy © B) Balanced autosomal translocation ® C)Inhertance of defective factor Vill alleles from both parents (0) Skewed X-chromosome inactivation © E) Unequal recombinationpo tates com ap/857 2TDStat aspeTSVC=ESSETIOL9750-(8E2-baSbAMEDSIES aie ere keener 40. A 77-year-old man has had repeated episodes of dificuty speaking, facial numbness, and cum Doppler utasonography of his carotid arteries shows no abnormaities, Which ofthe following d appropnate therapy to prevent future ep:sodes? © A)Aspian B) Difiunisal C) Methyl salicylate © D) Olsalazine E) Salicylic acid © F)Salsalate © G) Sodium salicylate © H)Suttasalazinedisorder? © A) Adjustment disorder B) Anxiety disorder C) Bipolar cisorder 1D) Borderline personally disorder © E) Schizoid personality disorder rece 41. A 26-year-old woman has sepsis that resulted from sel.nficted slash wounds to the forearm, Some of the staff feel ‘emotionally atached to her, others describe her as a difficult patient She is labile and impulsive. She has a history of many psychiatric hospitalizations and abuse of multiple drugs. Which ofthe following is the most likely psychiaticet od EE ica p/n states com/ ap 57 21TD Start asrdSVC=6386791-9750-3e2-beBb-TOI303003 nN eee ery cr 42. A 21-year-old woman is evaluated for renal insufficiency. A photomicrograph of structure seen an urinalysis is shown. ‘This finding is most consistent with which ofthe following diagnoses? © A)Acute cystitis B) Hepatitis B G) Minimal change disease © D) Postnfectious glomerulonephatis © E)Renal amyloidosis(ns ne Sr i | p/n states com/ ap 57 21TD Start asrdSVC=6386791-9750-3e2-beBb-TOI303003 eo neers crete 42. An 87-year-old woman who has been taking ibuprofen for the past 5 years for pain associated with rheumatoid artvitis ‘comes to the physician because of a 3-day history of epigastric pain. Her temperature is 37°C (98 6°F), pulse is 74imin, and blood pressure is 130/88 mm Hg. Hemogiobin concentration is 13.4 g/dL. There is mild epigastic tenderness. Esophagagastroduadenoscopy shows mild gastiis. She does not want to discontinue the ibuprofen. Which of the following drugs is most appropriate fo add to her current regimen? A) Aluminum hydroxide © B) Bismuth subsalicylate © C) Calcium carbonate © D)Fentanyi © E)Magnesium oxide © E) Misoprostol © @)Nitroalycean © H)Propythiouwacitcoeetree 44. A 52.year-old woman has medial strabismus of the right eye: she is unable to move this eye beyond midposition during ‘attempted horizontal gaze tothe right. Which of the following cranial nerves labeled on the ventral surface ofthe brain ‘stem is most likely to be damaged? A) ©B) ®C) ©D) OE) OF) OG) OH) © } OY(ton hc res lillies po tates com api/ 857 2TDStat aspeTSVC=ESBETOL750-(8E2-baSbAMEDSIES a) OF Cen een eee ers Peer ee 45. The sickling of erythrocytes in patients with sickle cell disease results from which of the following? © A)Agategation and polymerization ofthe site cell hemoglobin (HbS) © B) Inabilty of HbS to bind heme © ©) Inabilty ofthe FibS molecules to forma tetramer © D)Instabilty of the HbS molecules(ton hc res lillies | p/n states com/ ap 57 21TD Start asrdSVC=6386791-9750-3e2-beBb-TOI303003 nN eee ery 46. After a motorcycle colision, a 23-year-old man who is being transfused with erythrocytes and fresh frozen plasma has a systemic anaphylactic reaction. He has a history of recurrent respiratory tract infections. Blood hemoglobin concentration 1s 6.5 g/dL, and circulating B and T lymphocyte counts are normal, Which of the following is the most ikely explanation of, these findings? © A)ADS. B) Common variable immunodeficiency C) Druo.induced immunodeficiency D)IgA deficiency © E) Xinked agammagiobulinemia(tnt hc ris = lillie | p/w sates com/ apt 57 2 DStartasrdSVC=6386791-9750-3e2-beBb-TOI303063 nN eee ery 47. A 44,year-old man is brouatt to the emergency department because of a S-hour history of severe epigastric pain that radiates to his back. He drank approximately twelve 12-ounce cans of beer before his pain began. Abdominal examination shows distention with generalized tendamess and no masses. His serum amylase act's 500 U/L, and serum lipase activily is 325 U/L (N=14~280). Which of the following types of necrosis is most ikely inthis patient's retropentoneum? A) Caseous B) Coagulative C)Fat © D)Fibnnoid © B)Liquefactive(tnt hc ris = lillie | p/w sates com/ apt 57 2 DStartasrdSVC=6386791-9750-3e2-beBb-TOI303063 nN eee ery cee ee 48. A 56-year-old man with alcoholism comes to the emergency department because he is unable to raise the fingers of his left hand. He is afraid that he has had a stroke. He tells the physician that he fell asieep the night before at his favorite bar ‘with his arm across the arm ofthe chair. Which of the follwing nerves is most likely affected in this patient? © A)Brachial © B) Median C) Musculocutaneous © D) Radial © E)Uinarse a ST |( two states. com/api/4.57 2/TDStanepePSVC6308701-9730-1e2-balb-4236203 Cone keener ree 49. An 18-year-old man undergoes removal of 75% of the iver following a gunshot wound. In the remaining hepatocytes, the first change in cell cycle distribution will be movement of calls between which of the following phases? © A)GoIDG: © B)GitoS ©)S 1062 © D)G2toM E)Mto Go(tnt hc ris = lillie | p/w sates com/ apt 57 2 DStartasrdSVC=6386791-9750-3e2-beBb-TOI303063 nN eee ery 50. A 31-year-old woman begins taking a tricyclic antidepressant for major depressive disorder. Which of the following is the most likely direct mechanism of the beneficial effect ofthis drug? ‘A) Inhibition of adenosine receptors 1B) Inhibition of monoamine oxidase ® C) hibition of norepinephrine uptake 1D) Stimulation of adenosine receptors © E) Stimulation of dopamineraic (D2) receptors(a tp wo atest com ap/ 857 2TDStat aspsTSVC=ESBETIOL 9750-182 baSb AMOI nN eee ery 12. Aninvestigator conducts a study to assess the effectiveness of altering school lunches for improving serum Ipid concentrations in middle schoo! students. A low-fat diet is compared to the standard lunch. In order to minimize changes inthe lunch habits of the students who wil be given the lowfat Get (study group) the lower-fat lunch is gtven to five middle sschools on the north side ofthe city. The cantral group consists of five schools on the south side of the city where the students will continue to receive the standard lunch. The results indicate that students in the study group have a significant ‘decrease in their average serum cholesterol concentrations compared to the students in the control aroup who have an | erage increase in serum cholesterol concentrations Which ofthe folowing raises the most concem about the vaiiy of | the study results? \© A) Biased measurement © B) Lack of generalizability © ©) Lack of a placebo D) Lack of randomization © E) Low power(ft hc is = illest (apo starts com api/4 57 27DSta aspePSVC=SS96711 5750-132. bao 4386S a] @ Cone keener One nnee 1. A.couple who have no children seek genetic counseling because the husband's two brothers died in their teens of Duchenne muscular dystrophy. Which of the following best describes the husband's risk of being a carrier of Duchenne muscular dystrophy? Ao © Ba 13 © p12 © E)3/4(ts a En tp wo tates com ap/857 2TDStat asprTSVC=ESSETIOL9750-(8E2-baSbAMEDSIES eo neers 2. A 48-year-old man with coronary artery disease and renal insufficiency starts treatment wit atorvastatin to decrease his serum cholesterol concentration. ifhe needs additional hypocholesterolemic therapy, which of the following would be safest to avoid rhabdomyolysis? A) Cholestyramine B) Fenofibrate C) Fiwastatin © D) Gemtibroai(tnt hc ris = lillie (apn starts com api/4 57 27 DSta aspePSVC=SS98711 5730-132. ao ACHES a] @ Cone keener rae 2. A 45-year-old man is diagnosed with a somatostatin-producing tumor. Which ofthe following sets of physiolocic changes ismost ikely inthis man? Insulin Secretion Gastric Motility Glucagon Secretion A t © B) ©) eb) @® 5) ©8) »)(tn hc is = lillie |( won stants. com/api/4.57 2/TDStan epePSVC=6308701-9730-1e2-balb-4623620 Cone keener Eee 4. A50-year-old surgeon with alcohol on his breath enters the surgical suite to do a procedure. Prior to the procedure, he is asked to leave. Later that day, he is confronted by the hospitals physician's assistance committee. He confesses that he has been drinking alcohol heavily on a daily basts. Which of the following long-term plans is most ikely to help the physician maintain sobriety? © A) Cognitive therapy far depression ® B) Participation in Alcoholics Anonymous © ©) Therapy with an antidepressant © D) Therapy with a y-aminobutyrc acid (GABA) agonist © E) Therapy with disuitram © F) Therapy with an opiate agonist,p/w states com/ api 57 21TD Start asrdSVC=G3867B91-9750-3e2-beBb-TOI303003 5. A 70-year-old man has easy fabgabilty, malaise, and an ataxic gait He is pale and has a sore tonow sense up to his knees, and bilateral extensor plantar reflexes. A peripheral blood smear is shown, Wr the most likely cause ofthis patients disorder? © A)Acqured deficiency of intrinsic factor B) Carcinoma of the colon C) Congenital absence of transcobalarin I 'D) Congenital malabsorption of vitamin B12 (cobalamin) © E)Hookworm infestationOTe eae po tates com apf 57 2TDStart aspsTSVC=ESBETIOL9750-(8E2-baSbAMEDIES a) OF Cen een eee ers cere 6. Aleft ventricular pressure-volume loop describing one cardiac cycle is shown. Mitral valve opening occurs at which of the following labeled points? 8 a Few © BE qe |p ) A) ©B) ©C) OD) @E)(© TE ic po tates com ap/457 2TDStat aspeTSVC=ESSETIOL9750-(8e2-baSbAMEDIES eo neers creer 7. A 42-year-old man has a temperature of 39.2°C (102.6°F) and mild jaundice 2 days after ransfusion of packed red cells for the treatment of chronic anemia. Laboratory studies show hypexbilirubinemia and a mild increase in serum factate Gehycrogenase activity. Which of the folowing findings will most likely be observed on analysis of peripheral blood cels? ‘A) Complement protein C3bi bound to monocytes © B) Degranulated neutrophils C) Enythracyte ghosts D)HLA.DR upregulation in citculating CD2+ T ymphocytes E) Immunogiobuiin bound to erytwocytes| © F)Nucleated erythrocytes(tn hc is = lillie 1 en AST SSN I CE nN eee ery 8. A6-year-old boy is brought to the physician by his parents because his behavior has been different over the past 2 ‘months. His mother says, "He seems fine during the day, but he wakes up once or twice a week screaming and making no sense. His eyes are open curing an episode, but he doesn't recognize me or his father. It seems as though he's looking right through us. After about 10 minutes, he calms down and fas back to sleep," Which of the falowing responses by the physician is most appropriate? | © A)"lwould like child protective services to evaluate your Family * ‘© B)""tis best for your son to undergo an EEG." | is best for your son to undergo evakiation for a psychiatric disorder" is best for your son to undergo an MIR ofthe brain.” his most ikely is a comimon Benin sleep disorder that willresove on its ov.”(tnt hc ris = lillie tp wo atest com ap/ 857 2TDStat aspsTSVC=ESBETIOL 9750-182 baSb AMOI nN eee ery 9. A30-year-old woman has a 72-hour history of chills and abdominal pain. Her last menstrual period was 2 weeks ago. Her temperature is 38.8°C (101 8°F), pulse is 120/min, respirations are 18imin, and blood pressure is 132/82 mm Hg. ‘Abdominal and pelvic examinations show tendemess on palpation of the night lower quadrant, pain in the right lower ‘quadrant afer pressure is quickly released from the left lewer quadrant, pain in the right lower quadrant when the right hip is flexed against resistance, and tendemess in the right recial wall Bowel sounds are absent. Test of stool for occult blood isneative. Which of the following is the most likely diagnosis? © A) Appendicitis © B) Cystitis © ©) Dwertcuitis © D) Ectopic pregnancy © E) Pec inflammatory disease(tnt hc ris = lillie Te Sn AST SSCS RCE nN eee ery 10. Some oncogenes are mutants of normal cell-surface receptors that heve tyrosine protein kinase rots in their Cytoplasmic domains. The type of mutation of such a receptor that is most likely to result in cl transformation is a mutant protein wih which ofthe foloming characteristics? © A) Constitutive activation of cellar transcription © B) Deletion ofthe cytoplasmic domain © C) Failure to become phosphorylated upon receiving the signal 1D) Failure to receive the signal that normally activates cellular transcnption © E) Recognition of dfferet signal than usual(sd En tp wo tates com ap/ 857 2TDStat asprTSVC=ESBETIOL 750-182 baSbAMEDSIES a) @F nN eee ery 11. A67-year-old woman comes to the physician because of an 18-month history of progressive persistent lt hip pain. The pain is characterized as baring and aching itis not reieved by rest and worsens with ambulation. She walks with a imp because of the pain. She has Decome "hard of hearing" ver the past 5 years and has passed two kidney stones in the last 6 months. She has pain when diect pressure is applied over the greater trochanter of the eft femur and femoral shait. There is also pain and limited range of motion othe left hip with flexion and external rotation. Serum calcium and phosphorus concentrations are within the reference range, serum alkaline phosphatase activ is markedly increased, } and urinary hydroxyproline excretion isincreased. Which ofthe folowing is the most likely diagnosis? © A) Ostetis defornans (Paget disease) © B) Osteoarthnts © ©) Osteomalacia © D) Osteomyelitis | E) Osteoporosis © F) Rheumatoid artis,(sd En a) @- p/w states com/ apt 57 2 DStart asdSVC=C396791-9750-3e2-beBb-TOI303063 Pree nN eee ery 12. Dorsal root ganglia and the sensory cangiia of the trigeminal, facial, vestibulocochleer, glossopharyngeal, and vagus nerves are derived from which ofthe folowing? © A)Newal crest ces © B) Newoblasts denved trom the neural tive © ©) Newoepithaial cel ofthe neural tube 0) Somites © E) Undifferentiated mesenchyme(tn hc is = lillie 1 en AST SSN I CE nN eee ery Porn 13. AST-year-old man is brought to the emergency department because cf the sudden onset of severe left-sided chest pain duting exercise. Laboratory findings and an ECG suggest a large, transmural, anterior wall myocardial infarction. Which of the following microscopic changes are most likely to be present in the inured myocardium 36 hours after the beginning of the infarction? ® A) Coagulation necrosis and neutrophilic inflammation 5) Granuiation tissue formation © O)Interstital anc penvascular lymphocytes © D) Macrophagic phagocytosis of degenerated myocytes © E) Necrotizing artents of coronary vessels,(ton hc res lillies ln Cone keener Preeree 414. A22-year-old man comes to the emergency department because of the sudden onset of excruciating chest pain that radiates to his back. His pulse is weak and rapid. A CT scan of the chest shows a fluid density within the aortic wall. A defect of which ofthe folowing proteins is most likely inthis patient? © AElastin ® B)Fibnilin C) Fibronectin, © D)lateggin © E) Laminin(sd En a) @- p/w states com/ apt 57 2 DStart asdSVC=C396791-9750-3e2-beBb-TOI303063 nN eee ery rece 15. Genetic screening shows that a newborn with a 48,XY karyotype has a disabling mutation of the 5c-reductase gene. ‘Which ofthe following best describes this newborn's genital system? © A) Female external genitalia and female genital ducts © B) Female external genitalia and male genital ducts © C) Female external genitalia and male and female genital ducts (0) Male external gentalia and female genital ducts © E) Male external genital and male gental ducts © F) Male external genitalia and male and female genital ductsrh 0. [NE] 16. Norepinephrine (NE) is administered in increasing doses to a smooth muscle preparation rich in a-adrenergic receptors, ‘The graph shows the response of muscle tension with NE- alone (sold curve) and with NE inthe presence of an «a-adrenergic blocking agent (dashed curve) Which of he folowing a-adrenergic blocking agents is most ikely being used? A) Doxazosin ® B) Phenoxybenzamine C) Phentolamine © D) Prazosin © E)Tolazoline[os a tpi tates com ap/4.57 2TDStat aspsTSVC=ESSETIOL 9750-182 baSbAMEDSIES ea 17. A16-year-old ait is febrile and incoherent but able to indicate that she has severe lower abdomi ‘examination shows a foul-smeling cervicovaginal discharge, and a septic abortion is suspected procedures is most appropriate for identifying the microbial agents causing her infecton? ‘A) Inoculation of anaerobic transport media at he bedside © B) Inoculation of the specimen into tissue culture ©) Quantitation ofthe bacteria in the discharge by using a calibrated inoculating loop 1D) Streaking a swab specimen orto Thayer-Martin media at the bedside E) Use of Lowenstein-Jensen and Sabouraud media for acic-fast bacteria and fungi, respective18. An 18-year-old woman has had pharyngitis, fever, and lethargy for 3 days. Leukocyte count is 11,500/mm. The photomicrograph shows the type of cel that is predominant in her peripheral blood smeer. Which of the folowing isthe most ikely diagnosis? © A) Acute lymphoblastic leukemia B) Acute monocytic leukemia © ©) Acute myelogenous leukemia 1) Bacterial pharyngitis ® E) Infectious mononucleosis,nN eee ery res 19. Ina patient who is hemorthaging, which of the following is an adaptive response that helps to maintain mean arterial pressure? © A)ncreased end-systolic volume © B)|ncreased venous complance © C) Inhibition of secretion of ADH (vasopressin) © D)A fluid shift from ierstiial to vascular compastments © E) Release of atnal namuretic peptde alenN eee ery ees 20. A 28-year-old man has a 9-month history of progressive dyspnea. X-ray of the chest shows diffuse interstitial pulmonary infitrates. Examination of tissue obtained on lung biopsy shows chronic interstitial infammatory infitrates with hyperplasia of type Il pneumocytes and irregular areas of collagen deposition, Which ofthe follwing Is the most likely diagnosis? © A) Acute respiratory distress syndrome 8) Bronchial asthma © ©) Bronchiedtasis, © D) Emphysema ‘© E)Idiopatnic pulmonary fibrosis alenN eee ery Tees 21. A 17-year-old boy has chronic renal insufficiency. His serum urea nitrogen (BUN) and creatinine concentrations are increased, and his serum cakcium concentration is decreased, Which of the following is most likely responsible for the development of hypocalcemia in this patient? © A) Decreased secretion of parathyroid hormone © B) High concentration of parathyroid ormone-related peptide C) Hyperphosphateria © D)|ncreased secretion of caleitonin © E) Vitamin D toxicity alenN eee ery 22. To determine the location of an occult infection, a 34-year-old man is given an injection of his own neutrophils that have been labeled with a radioactive tracer After sufficient time to allow the labeled neutrophils to reach the site of infection, ‘whole-body scintigraphy is performed. Collections of radiolabeled neutrophils are most likely to resut from locally high concentrations of which of the folowing? © A)C3b ® B)C5a C) Cerulopiasmin © D) Cyclaoxygenase © Bla © P)lnterteukins (L-6) © G)o2-Macroglobulin aleCone ees 23. Cyclic AMP-dependent protein kinases are activated by which of the following mechanisms? © A)Association of the catalytic subunits to form active dimers on binding to cyclic AMP © B) Association of the catalic subunits with the regulatory subunits that are bound to cyclic AMP. © C) Binding of cyclic AMP to the regulatory subunts, which releases the catalytic subunits © D) Binding of cyclic AMP ta both the regulatory and catalytic subunits alenN eee ery 24. A 75.jear-old man is brouaht to the physician by his family because of akinesia, rigidity, postural instability, and tremor. ‘Symptoms improve with levodopa therapy, but he develops anorexia, nausea, voniting, and mid orthostatic hypotension, ‘Accrug with which of the following mechanisms of action 's most appropiate to decrease the gastrointestinal symptoms ‘and hypotension? © A) Inhibition of catechol-O-methyttransferase 8) Inhibition of monoamine oxidase B © C)|nhibition of peripheral dopa decarboxylase © D) Stimulation of cholinergic receptors © E) Stimulation of dopamine receptors aleea pao 25. A 27-year-old man has a blood pressure of 160/28 mm Ha. He is not taking any medications. Findings on physical ‘examination are unremarkable, Laboratory studies of serum show Nat 143 mE ql. cr 110 mE ql. K 24mEql Hoos” 30 mEq, Ghicose 130 mgidl_ Uicacid = 43 mgt Findings on urinalysis and renal function studies are unremarkable. Which ofthe following types of drugs is the mast ‘appropnate therapy for the hypertension and hypokalemia? ‘A)a-Adrenersic blocking agent © B)Aldosterone antagonist © ©) Calcium channel blocking agent (0) Sympatholytic agent @ E) Thiazide diuretic © F) Vasodilator aleeo Pee Mexirnel contraction (9) 8 1 1 100 1000 [Substance] nM 26. The effects of administration of drug X only and norepinephrine only are tested on an isolated muscle. The graph shows the maximal contraction of the muscle as a function ofthe concentrations of drug X and norepinephrine. Both drugs act through the same receptor. Which of the following best descnbes drug X? A) Competitive antagonist B) Fullagonist (©) Fullantagonist © D) inverse agonist E) Noncompetitive antagonist © F)Pattialagonist aleTa A tpi tates com ap/4.57 2TDStat aspsTSVC=ESSETIOL 9750-182 baSbAMEDSIES a) @F nN eee ery Peete 27. A24-jear-old woman is brought to the emeraency department after she collapsed when she retumed from a nonstop flight from New Delhi to New York City. She has smoked 1 pack of cigarettes daily for 16 years. She is sewually active and uses an oral contraceptive. Her pulse Is 125imin, and blood pressure is 75/50 mm Hg. Physical examination shows jugular venous distention. The lungs are clear to auscultation. Pulmonary artery catheterization shows a pulmonary systolcidiastolc artenal pressure of 50/25 mm Hg (N=15-30/3-12) and a pulmonary artery wedge pressure of 5 mm Hg (N=28-16). Which of the following is the most likely cause of her pulmonary hypertension? © A) Decteased cardiac output B) Increased lef atial pressure © C) Increased lett vertricular diastolc pressure © D) Increased puimonary blood flow © E) Increased pumonary venous resistance F) Occlusion of et ventncular outiow tract © G) Oceiusion of pulmonary arteries © H) Pericardial tamponade ale