CLINMED INTG-RCEH 2025
Are you preparing for complex medical board-style questions like interpreting renal histology, understanding C-peptide levels, diagnosing nephrotic syndrome from urinalysis, or differentiating causes of anemia from blood smears? Whether it’s nephritic vs. nephrotic syndromes, diabetic emergencies, or endocrine pathologies, these integrated clinical exams can feel overwhelming—especially when taken on platforms like ProctorU, PSI Bridge, Examplify, LockDown Browser, or Honorlock. But you’re not alone.
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A patient’s gross and microscopic urine samples are attached (figure 11). What would best describe their condition?
Nephrotic syndrome with an expected urinary loss of more than 3.5g protein per day Nephritic syndrome with an expected urinary loss of more than 3.5g protein per day
Nephrotic syndrome with an expected urinary loss of less than 3.5g protein per day Nephritic syndrome with an expected urinary loss of less than 3.5g protein per day
QUESTION 60
A patient is brought in to the ER. The patient is non-responsive and sweating profusely. Examination and labs reveal the following: BP 150/110, Respiration 30 breaths/min, arterial pH 7.4, and C peptide (serum) 7.0 ng/ml. What is the most likely diagnosis?
A patient who has developed an insulinoma
Teenage girl with diabetes who stopped taking insulin because her friends told her it was making her fat
Teenage boy without diabetes who had been injecting himself with increasing amounts of insulin after work outs because his friends told him insulin was anabolic
A diabetic patient in HHS
Figure 11
Polarized light
What best describes Metabolic Syndrome (before the development of Diabetes)?
increased insulin resistance; decreasing insulin production decreased insulin resistance; decreasing insulin production
increased insulin resistance; increasing insulin production
decreased insulin resistance; increasing insulin production
2.7 points
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A patient has the attached gross and microscopic images of their urine (figure 9). What is the most likely diagnosis?
Pyelonephritis
Cystitis
Urethritis
O Ureteritis
MFG 1106282
QUESTION 55
Zollinger Ellison syndrome would result in
O hyperglycemia
O hypoglycemia
ulcers
2.7 points
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QUESTION 56
2.7 points
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Why is an ACE inhibitor effective at reducing renal damage in diabetes?
It blocks the effect of Ang II leading to vasodilation primarily of the efferent arteriole, decreased glomerular hydrostatic pressure, and increased perfusion of the renal medulla
It blocks the effect of Ang II leading to vasodilation primarily of the afferent arteriole, increased glomerular hydrostatic pressure, and increased perfusion of the renal medulla
It blocks the effect of Ang II leading to vasodilation primarily of the afferent arteriole, decreased glomerular hydrostatic pressure, and increased perfusion of the renal medulla
It blocks the effect of Ang II leading to vasodilation primarily of the efferent arteriole, increased glomerular hydrostatic pressure, and increased perfusion of the renal medulla
It blocks the effect of Ang II leading to vasodilation primarily of the efferent arteriole, increased glomerular hydrostatic pressure, and decreased perfusion of the renal medulla
B
QUESTION 54
A patient is brought in to the ER. The patient is non-responsive and sweating profusely. Examination and labs reveal the following: BP 150/110, Respiration 30 breaths/min, arterial pH 7.4, and C peptide (serum) 0.1 ng/ml. What is the most likely diagnosis?
A patient who has developed an insulinoma
Teenage girl with diabetes who stopped taking insulin because her friends told her it was making her fat Teenage boy without diabetes who had been injecting himself with increasing amounts of insulin after work outs because his friends told him insulin was anabolic
A diabetic patient in HHS
Methylmalonic acid (serum)
Renin activity (plasma) adult (upright)
Respiratory Rate (resting, adult)
0-4.7 pg/al
0.5-3.3 ng/mL/hr
12-20 breaths/min
Osmolarity (plasma)
Thyroid stimulating hormone (TSH). (serum)
Thyroxine, total (T4) (serum)
Vitamin B12, serum
280-300 mOsm/L
0.4-5.0 mU/L
4.5-10.9 μgm/dL
210-911 pg/mL
Спопое
[CO2] arterial plasma
Blood Urea nitrogen (BUN)
Creatinine
101-111 mmol/L
1.05-1.35 mmol/L
7-20 mg/dL
0.7-1.4 mg/dL
20-29 mmol/L
1.1-1.3 mmol/L
Iron Studies
Serum Ferritin
TIBC
10-300 ng/mL
250-350 μg/dL
Bicarbonate (HCOs)
Cat (Free or ionized)
CBC Values
WBC count, total (blood)
3600-11,200/mm3
MCV
80-100 fL
Hematocrit (male)
40-50%
Hemostasis
Hematocrit (female)
35-45%
Hemoglobin Concentration (male)
13-17 g/dl
PT
PTT
Hemoglobin Concentration (female)
RDW
Reticulocyte Count
12-15 g/dl
Bleeding Time
11-14 seconds
25-40 seconds
1-9 minutes
11-15%
Platelet Count
0.5-2.7% of RBC’s
150,000-400,000 /ml
NOTE: THESE ARE FOR EDUCATIONAL PURPOSES ONLY!!! NOTE: FOR OUR PURPOSES SERUM OR PLASMA ARE USED INTERCHANGEABLY!
2.7 points
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In figure 1 showing oxygen levels (pO2) in the 4 heart chambers, what is the normal condition?
Parameter
Normal values
Parameter
Normal values
Urine
Miscellaneous
ACTH (serum)
9-46 pg/mL
Aldosterone, (serum) Standing
aldosterone-to-renin ratio (ARR)
Blood Glucose (fasting)
Blood pressure
7-30 ng/dl
Cortisol (Urine Free)
Metanephrines (Urine)
20-70 μg/24 hours
44-261 μg/24 hours
20-40
64-125 mg/dL
Cerebrospinal fluid (CSF)
albumin
90/60-140/90 mmHg
leukocyte count
11-48 mg/dL
0-5/mm3
Cortisol (plasma) 8AM
6-23 μgm/dL
chloride
118-132 mmol/L
C-peptide (serum)
0.9-3.9 ng/mL
glucose
50-75 mg/dL
Creatinine, serum
0.7-1.4 mg/dL
IgG
8.0-8.6 mg/dL
Haptoglobin (serum)
50-220 mg/dL
pressure
8-15 mm Hg
Heart Rate (resting) adult
60-100 bpm
protein
15-45 mg/dL
Electrolytes (serum)
Hemoglobin A1C
4.1-6.5%
Sodium
136-144 mmol/L
Homocysteine (serum)
4-15 μmol/L
Potassium
3.7-5.2 mmol/L
Insulin (serum) total
5-35 μU/mL
Methylmalonic acid (serum)
0-4.7 μg/dL
Chloride
101-111 mmol/L
Figure 1
Heart Chamber po2 Levels
A
B
R Atria
L Atria
R Atria
L Atria
R Ventricle L Ventricle R Ventricle L Ventricle
R Atria
C
LAtria
R Atria
D
LAtria
R Ventricle L Ventricle
R Ventricle L Ventricle
100 mM Hg po2
40 mm Hg po2
EKG 1
http://www.cvphysiology.com
EKG from previous visit
EKG from current visit
RK 16
A 65-year-old man was rushed to the hospital following the sudden onset of an episode of crushing substernal chest pain. An EKG is taken and is shown in figure 2 and compared to an EKG taken during a previous checkup. The observed EKG abnormality is seen most strikingly in leads recording over the left anterior portion of the heart. What is most consistent with these observations?
thrombosis and complete occlusion of the RCA leading to transmural infarction
thrombosis and partial occlusion of the RCA leading to subendocardial ischemia
thrombosis and partial occlusion of the LAD leading to subendocardial ischemia
thrombosis and complete occlusion of the LAD leading to transmural infarction
QUESTION 52
Chronic bronchitis is best described as
Obstructive disease with increased airway resistance
Obstructive disease with decreased lung compliance
Restrictive disease with increased lung volume
Restrictive lung disease with decreased airway resistance
QUESTION 50
A patient has a creatinine clearance of 15ml/min and a BUN of 80 with a creatinine of 8. What other condition would be most expected?
Increased hematocrit
Hypokalemia
Increased respiratory rate
O blood pH of 7.5
Patient D
Patient E
Using figure 17. Erythroblastosis fetalis would be the most likely to develop if mom was patient
B; C
D; E
C; B
E; D
B; A
and dad was patient
2.7 points
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Patient D
Patient E
Using figure 17. Erythroblastosis fetalis would be the most likely to develop if mom was patient
B; C
D; E
E; D
B; A
Patient D
Patient E
and dad was patient
Using figure 17. Erythroblastosis fetalis would be the most likely to develop if mom was patient
and dad was patient
B; C
D; E
E; D
B; A
Patient A
Patient B
Patient C
Patient D
Figure 17 Blood type results
Anti-A
Anti-B Anti-Rh
Figure 3
Microscopic view of area near arrow in A
A college basketball player dies suddenly during a basketball game. An autopsy reveals the heart image attached as figure 3 and a microscopic image of a biopsy taken from the area of the arrow is shown. What is your most likely diagnosis of the condition this athlete suffered from?
dilated cardiomyopathy
rheumatic heart disease
restrictive cardiomyopathy hypertophic cardiomyopathy
rigure 11
(Peripheral smear)
4
A patient has the following bloodwork: Hematocrit 30%, Hemoglobin 10 g/dL, MCV 115 fL. A neurological exam is abnormal. A peripheral blood smear is shown in figure 11. What is the most likely diagnosis?
Pernicious Anemia
Folate Deficiency
Iron Deficiency Anemia
Chronic Infection
Thalassemia
Renin activity (plasma) adult (upright)
0.5-3.3 ng/mL/hr
Respiratory Rate (resting, adult)
Osmolarity (plasma)
Thyroid stimulating hormone (TSH). (serum)
Thyroxine, total (T4) (serum)
Vitamin B12, serum
12-20 breaths/min
280-300 mOsm/L
0.4-5.0 mU/L
4.5-10.9 μgm/dL
210-911 pg/mL
[CO2] arterial plasma
Blood Urea nitrogen (BUN)
Creatinine
Bicarbonate (HCO3)
Cat (Free or ionized)
1.05-1.35 mmol/L
7-20 mg/dL
0.7-1.4 mg/dL
20-29 mmol/L
1.1-1.3 mmol/L
Iron Studies
Serum Ferritin
10-300 ng/mL
TIBC
250-350 μg/dL
CBC Values
WBC count, total (blood)
3600-11,200/mm3
MCV
80-100 fL
Hematocrit (male)
40-50%
Hemostasis
Hematocrit (female)
35-45%
Hemoglobin Concentration (male)
13-17 g/dl
PT
PTT
11-14 seconds
25-40 seconds
Hemoglobin Concentration (female)
12-15 g/dl
Bleeding Time
1-9 minutes
RDW
Reticulocyte Count
11-15%
Platelet Count
0.5-2.7% of RBC’s
150,000-400,000 /ml
NOTE: THESE ARE FOR EDUCATIONAL PURPOSES ONLY!!! NOTE: FOR OUR PURPOSES SERUM OR PLASMA ARE USED INTERCHANGEABLY!
Parameter
ACTH (Serum)
Aldosterone, (serum) Standing
aldosterone-to-renin ratio (ARR)
Blood Glucose (fasting)
Blood pressure
Normal values
Parameter
Normal values
Urine
Miscellaneous
9-46 pg/mL
7-30 ng/dl
Cortisol (Urine Free)
Metanephrines (Urine)
20-70 μg/24 hours
44-261 μg/24 hours
20-40
64-125 mg/dL
albumin
Cerebrospinal fluid (CSF)
11-48 mg/dL
90/60-140/90 mmHg
leukocyte count
0-5/mm3
Cortisol (plasma) 8AM
6-23 μgm/dL
chloride
118-132 mmol/L
C-peptide (serum)
0.9-3.9 ng/mL
glucose
50-75 mg/dL
Creatinine, serum
0.7-1.4 mg/dL
IgG
8.0-8.6 mg/dL
Haptoglobin (serum)
50-220 mg/dL
pressure
8-15 mm Hg
Heart Rate (resting) adult
60-100 bpm
protein
15-45 mg/dL.
Electrolytes (serum)
Hemoglobin A1C
4.1-6.5%
Homocysteine (serum)
Insulin (serum) total Methylmalonic acid (serum)
Renin activity (plasma) adult (upright)
5-35 μU/mL 0-4.7 μg/dL
0.5-3.3 ng/mL/hr
4-15 μmol/L
Sodium
Potassium
136-144 mmol/L
3.7-5.2 mmol/L
Chloride
[CO2] arterial plasma
101-111 mmol/
1.05-1.35 mmol/L
Respiratory Rate (resting, adult)
12-20 breaths/min
Blood Urea nitrogen (BUN)
7-20 mg/dL
An adult male patient reports with chest pain, shortness of breath, and tenderness in the left leg after a 15 hour plane flight from Australia. Troponin I levels are normal and no EKG changes are noted. Their pulmonary function test is shown in black (attached as fig 1). What is the most likely cause?
Asthma
Chronic Bronchitis
Myocardial Infarction
Pulmonary embolism
QUESTION 46
2.7 points
Volume Expired (L)
4
3
2
1
5
1
05. 40, 140. 16, 1907
The obese group only would be classified as diabetic.
The normal weight only would be classified as diabetic.
Time (sec)
Both the obese and the normal weight group would be considered diabetic.
Neither the obese nor the normal weight group would be considered diabetic.
QUESTION 45
What best describes type I diabetes?
Increased insulin resistance
Increased insulin production
Autoimmune destruction of the beta cells
Autoimmune destruction of the alpha cells
Save Answer
Blood
100
Plasma Insulin Units/ml
120
60
8888
50-
300-
240
180
O
2
Hours after glucose load
The Journal of Clinical Investigation Vol. 46, No. 12, 1967
100+
50
300-
240-
180
120-
Insulin Units/ml
7
3
QUESTION 44
The attached figure shows blood glucose and plasma insulin in response to an oral glucose load in obese and non- obese/normal weight individuals. Which statement is correct based on the data?
Blood glucose and Plasma Insulin in response to an oral glucose load, given after time 0
250
Oral
•Normal Wt
o Obese
Blood Glucose mg/100 ml
2000
150
100
QUESTION 41
Highest incidence cancer in male
Colon
Prostate
Breast
Lung
Bladder
2.7 points
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QUESTION 42
2.7 points
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A patient reports with hyponatremia. This would most likely be associated with
Breast carcinoma related secretion of ACTH
Renal carcinoma related secretion of parathyroid hormone related peptide Small cell lung carcinoma related secretion of ADH
Breast carcinoma related secretion of parathyroid hormone related peptide Renal carcinoma related secretion of EPO
QUESTION 43
2.7 points
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A patient was diagnosed with breast carcinoma. A histological section of a biopsy from the breast shows anaplasia, lack of polarity, a large number of mitoses, and nuclear pleomorphism. These properties are used to assess the and would be more consistent with a _______ cancer.
Grade; high grade
Stage; low stage
Grade; low grade
Stage; high grade
QUESTION 40
What is the proper order of the 5 r’s of inflammation?
Regulation, Repair, Recognition, Recruitment, Removal Recognition, Recruitment, Removal, Regulation, Repair Removal, Regulation, Repair, Recognition, Recruitment O Recognition, Recruitment, Repair, Removal, Regulation
Which lymph node would stomach carcinoma most likely spread to?
Right supra-clavicular node
Left supra-clavicular node
Axillary node
Inguinal node
QUESTION 39
Blocking COX-1 would most directly lead to:
Clot formation
Gl irritation
Decreased Leukotriene production
Increased prostacyclin production by the endothelium
QUESTION 40
What is the proper order of the 5 r’s of inflammation?
Regulation, Repair, Recognition, Recruitment, Removal Recognition, Recruitment, Removal, Regulation, Repair Removal, Regulation, Repair, Recognition, Recruitment Recognition, Recruitment, Repair, Removal, Regulation
QUESTION 37
normal
Figure 3
A
B
In figure 3, what is the process that lead to the morphology seen in panel A?
atrophy
apoptosis
metaplasia
hyperplasia
hypertrophy
2.7 points
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QUESTION 36
Highest incidence cancer in female
Colon
Cervical
Breast
Lung
Bladder
QUESTION 35
Highest cancer mortality in males and females
Colon
Cervical
Breast
Lung
Bladder
QUESTION 34
Glucocorticoids block:
COX enzymes
Leukotriene production
Phospholipase enzymes
PRR receptors
QUESTION 35
Which is an example of a permanent tissue?
Smooth muscle
Epithelial tissue
Cardiac Muscle
All of these
QUESTION 31
Figure 4
Mean Arterial Pressure
Cardiac Output
Total
Peripheral Resistance
44
↑
End Diastolic Volume
Skin Temp
A patient reports with the following conditions below in Figure 4. What is your most likely diagnosis?
A stab wound and hemorrhage
Excess TLR-4 activation
Myocardial Infarction
QUESTION 32
A patient reports with polycythemia. This would most likely be associated with
Breast carcinoma related secretion of ACTH
Renal carcinoma related secretion of parathyroid hormone related peptide Small cell lung carcinoma related secretion of ADH
Breast carcinoma related secretion of parathyroid hormone related peptide O Renal carcinoma related secretion of EPO
QUESTION 29
The most likely of these cancers to metastasize is
Squamous Cell
Basal Cell
Melanoma
O All are equally likely to metastasize
QUESTION 30
What causes the redness, swelling, and heat of inflammation?
Vasoconstriction in response to histamine
Vasodilation in response to histamine
Vasodilation in response to epinephrine
O Vasoconstriction in response to complement protein activation
2.7 points
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2.7 points
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QUESTION 27
Figure 6
Mean Arterial Pressure
Cardiac Output
Total Peripheral Resistance
↑
44
End Diastolic
Volume
Skin Temp
A patient reports with the following conditions below in Figure 6. What is your most likely diagnosis?
A stab wound and hemorrhage
Excess TLR-4 activation
Myocardial Infarction
QUESTION 28
RB would both be considered,
Tumor suppressor genes; gain Tumor suppressor genes; loss Proto-oncogenes; gain Proto-oncogenes; loss
↑
2.7 points
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2.7 points
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which must undergo a
of function to promote cancer.
QUESTION 25
Which of the following findings would have the highest prognostic value?
Grade of the tumor
Tumor size
Metastasis to distant tissue
Spread to local lymph nodes
QUESTION 26
A change in type of stress or demand on a tissue is most likely to result in
O Anaplasia
Hyperplasia
Metaplasia
Necrosis
Apoptosis
2.7 points
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2.7 points
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normal
Figure 3
A
B
An autopsy of a 55 year old man who died of complications from myocardial infarction results in the image of the heart that is attached. A section of the heart is shown in figure 3. What is the process that lead to the loss of tissue indicated by the large arrow?
O necrosis
apoptosis
metaplasia
hyperplasia
anaplasia
QUESTION 24
normal
Figure 3
A
B
An autopsy of a 55 year old man who died of complications from myocardial infarction results in the image of the heart that is attached. A section of the heart is shown in figure 3. What is the process that lead to the loss of tissue indicated by the large arrow?
necrosis
apoptosis
metaplasia
hyperplasia
anaplasia
* Question Completion Status:
QUESTION 23
If alveolar PO2 is 50mmHg in part of a lung, what will result in pulmonary vessels serving that part of the lung?
Vasoconstriction and increased perfusion
Vasodilation and increased perfusion
Vasoconstriction and decreased perfusion
Vasodilation and decreased perfusion
2.7 points
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2.7 points
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Patient A (left)
Fig 6
In the chest X-ray provided (figure 6), the patient A on the left is most likely
A “blue bloater” with chronic bronchitis
A “blue bloater” with emphysema
A “pink puffer” with chronic bronchitis
A “pink puffer” with emphysema
The Journal of Clinical Investigation Vol. 46, No. 12, 1967
The obese group shows decreased insulin production
The obese group shows an increased insulin sensitivity
The obese group shows decreased insulin sensitivity.
The normal weight group shows a decreased insulin sensitivity
Patient B (right)
Blood Glu
100
50
300-
240-
180
120-
60-
Plasma Insulin u Units/ml
O
2
3
QUESTION 21
Hours after glucose load
The attached figure shows blood glucose and plasma insulin in response to an oral glucose load in obese and non- obese/normal weight individuals. Which statement is correct based on the data?
Blood glucose and Plasma Insulin in response to an oral glucose load, given after time 0
Oral
250r
Normal Wt o Obese
200-
ood Glucose mg/100ml
150-
홍 10아
A
B
C
D
E
Homocysteine (serum)
Insulin (serum) total Methylmalonic acid (serum)
Renin activity (plasma) adult (upright)
Respiratory Rate (resting, adult)
Osmolarity (plasma)
Thyroid stimulating hormone (TSH), (serum)
Thyroxine, total (T4) (serum)
Vitamin B12, serum
4-15 μmol/L
5-35 μU/mL 0-4.7 μg/dL
0.5-3.3 ng/mL/hr
12-20 breaths/min
280-300 mOsm/L
0.4-5.0 mU/L
4.5-10.9 μg/dL
210-911 pg/mL
Potassium
Chloride
[CO2] arterial plasma
Blood Urea nitrogen (BUN)
Creatinine
Bicarbonate (HCO3)
Cat (Free or ionized)
3.7-5.2 mmol/L
101-111 mmol/L
1.05-1.35 mmol/L
7-20 mg/dL
0.7-1.4 mg/dL
20-29 mmol/L
1.1-1.3 mmol/L
Iron Studies
Serum Ferritin
10-300 ng/mL
TIBC
250-350 μg/dL
CBC Values
WBC count, total (blood)
3600-11.200/mm3
MCV
80-100 fL
Hematocrit (male)
40-50%
Hemostasis
Hematocrit (female)
35-45%
PT
Hemoglobin Concentration (male)
13-17 g/dl
Hemoglobin Concentration (female)
12-15 g/dl
PTT
Bleeding Time
11-14 seconds
25-40 seconds
1-9 minutes
11-15%
RDW
Reticulocyte Count
Platelet Count
0.5-2.7% of RBC’s
150,000-400,000 /ml
NOTE: THESE ARE FOR EDUCATIONAL PURPOSES ONLY!!! NOTE: FOR OUR PURPOSES SERUM OR PLASMA ARE USED INTERCHANGEABLY!
Parameter
Normal values
Parameter
Normal values
Urine
Miscellaneous
ACTH (Serum)
9-46 pg/mL
7-30 ng/dl
Cortisol (Urine Free)
Metanephrines (Urine)
20-70 μg/24 hours
44-261 μg/24 hours
Aldosterone, (serum) Standing
aldosterone-to-renin ratio (ARR)
Blood Glucose (fasting)
Blood pressure
20-40
64-125 mg/dL
albumin
Cerebrospinal fluid (CSF)
11-48 mg/dL
90/60-140/90 mmHg
leukocyte count
0-5/mm3
Cortisol (plasma) 8AM
6-23 pgm/dL
chloride
118-132 mmol/L
C-peptide (serum)
0.9-3.9 ng/mL
glucose
50-75 mg/dL
Creatinine, serum
0.7-1.4 mg/dL
IgG
8.0-8.6 mg/dL
Haptoglobin (serum)
50-220 mg/dL
pressure
8-15 mm Hg
Heart Rate (resting) adult
60-100 bpm
protein
15-45 mg/dL
Hemoglobin A1C
Electrolytes (serum)
4.1-6.5%
Sodium
136-144 mmol/L
280-300 mOsm/L
Thumid stimulating hormone (TCH)
(canım)
04 50 mil
Homocysteine (serum)
Insulin (serum) total Methylmalonic acid (serum)
Renin activity (plasma) adult (upright)
Respiratory Rate (resting, adult)
Osmolarity (plasma)
5-35 μU/mL 0-4.7 μg/dL
0.5-3.3 ng/mL/hr
12-20 breaths/min
Chloride
[CO2] arterial plasma
Blood Urea nitrogen (BUN)
Creatinine
4-15 μmol/L
Potassium
3.7-5.2 mmol/L
101-111 mmol/L
1.05-1.35 mmol/L
7-20 mg/dL
0.7-1.4 mg/dL
QUESTION 20
A
Figure 8
systemic arterial po2
B
D
E
C
systemic arterial po
100 mM Hg paO, (normal)
70 mM Hg paO,
In figure 8 showing oxygen levels (pO2) in the systemic arterial blood, what would be expected with a patent ductus arteriosus after development of Eisenmenger syndrome?
QUESTION 19
A patient reports complaining of not urinating very much following a recent MI that occurred 3 weeks ago. Their labs reveal the following BUN 80 mg/dL (normal 10) Creatinine 8 mg/dL (normal 1). How would you describe the condition?
Pre-renal azotemia
Intra-renal azotemia
Hypo-perfusion of an otherwise healthy kidney
Hyper-perfusion of an otherwise healthy kidney
A graduate student (who may or may not have paid attention during pathophysiology class) was looking to design a drug that would cause an increase in insulin release from beta cells in the pancreas. He came to his boss with several suggestions. Which one should the boss choose for his next grant proposal?
A drug that increases the opening of K+ channels in beta cells
A drug that increases the activity of the Na+/K+ ATPase in beta cells
A drug that increases the expression of uncoupling protein in beta cells
A drug that increases the amount of ATP produced per glucose molecule in beta cells
A drug that blocks voltage gated Ca2+ cells in beta cells
In the figure provided (figure 5), what is the epithelium?
O A
B
U
C
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B
A
Extracellular matrix
D
Collagen fibrils
Red cell
A
Plasma
In the figure provided (figure 5), what is the epithelium?
Figure 13
8
Fibroblast
2 μm
A patient reports with oliguria and a microscopic analysis of the urine is attached (figure 13) showing a brown, granula What is your most likely diagnosis?
Acute tubular necrosis
Nephrotic syndrome
Nephritic syndrome
Pyelonephritis
Which of the pulmonary function tests (attached as fig 1) indicates COPD?
O Black
Red
Green
QUESTION 15
Volume Expired (L)
3
2
1
5
1
Atrial Fibrillation would most affect which heart sound?
S4
S3
S2
S1
Time (sec)
པ་
Atrial Fibrillation would most affect which heart sound?
S4
S3
S2
S1
QUESTION 15
2.7 points
Save Answer
QUESTION 13
Fig 6
http://www.cvphysiology.com
RK 16
At rest
On treadmill
An individual comes to a clinic for a cardiac stress test after complaining of chest pain while walking up stairs that goes away upon resting. Resting EKG’s are taken before and 20 minutes after a 5 minute treadmill exercise and are shown in figure 6. His resting EKG’s are the same and are represented in the left trace labeled “at rest”. The EKG during the test is shown as the right trace labeled “on treadmill”. The patient experienced chest pain during the “on treadmill” EKG that subsided after resting. What is the best description of what is occurring to yield the chest pain and EKG results while on the treadmill?
O subendocardial infarction
O transmural ischemia
O subendocardial ischemia
O subepicardial ischemia
O transmural infarction
The Journal of Clinical Investigation Vol. 46, No. 12, 1967
The amount if insulin produced per oral glucose load is more in the normal weight group.
The amount of insulin produced per oral glucose load is the same in the obese vs. normal weight group.
The amount if insulin produced per oral glucose load is more in the obese group.
Blood
100
Plasma Insulin u Units/ml
120
60
180
88888
T
T
50
300-
240
O
2
3
Hours after glucose load
The Journal of Clinical Investigation Vol. 46, No. 12, 1967
ง
2.7 points
Save Answer
QUESTION 12
The attached figure shows blood glucose and plasma insulin in response to an oral glucose load in obese and non- obese/normal weight individuals. Which statement is correct based on the data?
Blood glucose and Plasma Insulin in response to an oral glucose load, given after time 0
Oral
250r
•Normal Wt
• Obese
2000
Blood Glucose mg/100ml
150-
100
Spherocytosis
Thalassemia
O Sickle Cell Anemia
Iron Deficiency
B12 Deficiency
T
QUESTION 11
Steroid hormones typically have receptors located where?
inside the cell
outside the cell
between cells
DUFCTION 4n
2.7 poin
QUESTION 10
Figure 14 (Peripheral Smear)
A 5 year old male patient in remote Africa reports complaining of episodic pain in his hands and feet. His parents report that these started when he was 6 months old. He has the following bloodwork; Hematocrit 30%, Hemoglobin 10 g/dL, MCV 90 fL, and a corrected reticulocyte count of 8%. His peripheral blood smear shows many RBC’s like that shown in figure #14. What is your likely diagnosis?
Hemolytic anemia
Anemia of chronic disease
Iron deficiency anemia
Pernicious anemia
nemogooMTATO
Homocysteine (serum)
Insulin (serum) total Methylmalonic acid (serum)
Renin activity (plasma) adult (upright)
Respiratory Rate (resting, adult)
Osmolarity (plasma)
Thyroid stimulating hormone (TSH). (serum)
Thyroxine, total (T4) (serum)
Vitamin B12, serum
4.1-0.010
4-15 μmol/L
5-35 μU/mL 0-4.7 μg/dL
0.5-3.3 ng/mL/hr
12-20 breaths/min
280-300 mOsm/L
0.4-5.0 mU/L
4.5-10.9 μgm/dL
210-911 pg/mL
Sodium
Potassium
136-144 mmol/L
3.7-5.2 mmol/L
101-111 mmol/L
1.05-1.35 mmol/L
Chloride
[CO2] arterial plasma
Blood Urea nitrogen (BUN)
Creatinine
Bicarbonate (HCO3)
Cat (Free or ionized)
7-20 mg/dL
0.7-1.4 mg/dL
20-29 mmol/L
1.1-1.3 mmol/L
WBC count, total (blood)
MCV
Hematocrit (male)
Iron Studies
Serum Ferritin
TIBC
10-300 ng/mL
250-350 μg/dL
CBC Values
3600-11.200/mm3
80-100 fL
40-50%
Hemostasis
35-45%
13-17 g/dl
PT
PTT
12-15 g/dl
Bleeding Time
11-14 seconds
25-40 seconds
1-9 minutes
Hematocrit (female)
Hemoglobin Concentration (male)
Hemoglobin Concentration (female)
RDW
Reticulocyte Count
Platelet Count
11-15%
0.5-2.7% of RBC’s
150,000-400.000 /ml
NOTE: THESE ARE FOR EDUCATIONAL PURPOSES ONLY!!! NOTE: FOR OUR PURPOSES SERUM OR PLASMA ARE USED INTERCHANGEABLY!
2.8 points
Save Answer
QUESTION 9
A 78-year-old woman has developed increasing dyspnea and fatigue. Scleral icterus is noted. A CBC shows Hemoglobin 7 g/dL, Hematocrit 21%, MCV 95 fL, platelet count 200,000/microliter, corrected reticulocyte count of 8%, and WBC count 6500/microliter. Which of the following is the most likely diagnosis?
ACTH (Serum)
Aldosterone, (serum) Standing
aldosterone-to-renin ratio (ARR)
Blood Glucose (fasting)
Blood pressure
Parameter
Normal values
Parameter
Normal values
Urine
Miscellaneous
9-46 pg/mL
7-30 ng/dl
Cortisol (Urine Free)
Metanephrines (Urine)
20-70 μg/24 hours
44-261 μg/24 hours
20-40
64-125 mg/dL
90/60-140/90 mmHg
albumin
Cerebrospinal fluid (CSF)
11-48 mg/dL
leukocyte count
0-5/mm3
Cortisol (plasma) 8AM
6-23 μgm/dL
chloride
118-132 mmol/L
C-peptide (serum)
0.9-3.9 ng/mL
glucose
50-75 mg/dL
Creatinine, serum
0.7-1.4 mg/dL
IgG
8.0-8.6 mg/dL
Haptoglobin (serum)
50-220 mg/dL
pressure
Heart Rate (resting) adult
60-100 bpm
protein
8-15 mm Hg
15-45 mg/dL
Electmlutas (canım)
QUESTION 8
A patient suffers an MI involving the RCA. He is treated and released. No unusual heart sounds or murmurs were noted prior to his release. 3 days later he returns with shortness of breath and a systolic murmur that wasn’t present previously. What is the most likely diagnosis?
rupture of the posteromedial papillary muscle leading to mitral insufficiency
rupture of the anterolateral papillary muscle leading to mitral insufficiency
mitral stenosis
aortic insufficiency
cardiac tamponade
B
A
E
2.7 points
Save Answer
2.7 points
Save Answer
Respiratory Rate (resting, adult)
12-20 breaths/min
Osmolarity (plasma)
Thyroid stimulating hormone (TSH), (serum)
Thyroxine, total (T4) (serum)
Vitamin B12, serum
280-300 mOsm/L
0.4-5.0 mU/L
4.5-10.9 μgm/dL
210-911 pg/mL
Blood Urea nitrogen (BUN)
Creatinine
Bicarbonate (HCO3)
Ca* (Free or ionized)
7-20 mg/dL
0.7-1.4 mg/dL
20-29 mmol/L
1.1-1.3 mmol/L
Iron Studies
Serum Ferritin
TIBC
10-300 ng/mL
250-350 μg/dL
CBC Values
WBC count, total (blood)
3600-11,200/mm3
MCV
Hematocrit (male)
80-100 fL
40-50%
Hemostasis
Hematocrit (female)
35-45%
Hemoglobin Concentration (male)
13-17 g/dl
PT
PTT
11-14 seconds
25-40 seconds
RDW
Hemoglobin Concentration (female)
Reticulocyte Count
12-15 g/dl
Bleeding Time
1-9 minutes
11-15%
Platelet Count
0.5-2.7% of RBC’S
150,000-400,000 /ml
NOTE THESE ARE FOR EDUCATIONAL PURPOSES ONLY!!! NOTE: FOR OUR PURPOSES SERUM OR PLASMA ARE USED INTERCHANGEABLY!
Parameter
Normal values
Parameter
Normal values
Urine
Miscellaneous
ACTH (serum)
9-46 pg/mL
7-30 ng/dl
Cortisol (Urine Free)
Metanephrines (Urine)
20-70 μg/24 hours
44-261 μg/24 hours
Aldosterone, (serum) Standing
aldosterone-to-renin ratio (ARR)
Blood Glucose (fasting)
Blood pressure
20-40
64-125 mg/dL
90/60-140/90 mmHg
albumin
Cerebrospinal fluid (CSF)
11-48 mg/dL
leukocyte count
0-5/mm3
Cortisol (plasma) 8AM
6-23 μgm/dL
chloride
118-132 mmol/L
C-peptide (serum)
0.9-3.9 ng/mL
glucose
50-75 mg/dL
Creatinine, serum
0.7-1.4 mg/dL
IgG
8.0-8.6 mg/dL
Haptoglobin (serum)
50-220 mg/dL
pressure
8-15 mm Hg
Heart Rate (resting) adult
60-100 bpm
protein
15-45 mg/dL
Electrolytes (serum)
Hemoglobin A1C
4.1-6.5%
Sodium
136-144 mmol/L
Respiratory Rate (resting, adult)
12-20 breaths/min
Homocysteine (serum)
Insulin (serum) total Methylmalonic acid (serum)
Renin activity (plasma) adult (upright)
5-35 μU/mL 0-4.7 μg/dL
0.5-3.3 ng/mL/hr
Chloride
[CO2] arterial plasma
Blood Urea nitrogen (BUN)
4-15 μmol/L
Potassium
3.7-5.2 mmol/L
101-111 mmol/L
1.05-1.35 mmol/L
7-20 mg/dL
A
D
Figure 8
systemic arterial po2
B
C
systemic arterial po
100 mM Hg paO, (normal)
70 mM Hg pao
In figure 8 showing oxygen levels (pO2) in the systemic arterial blood, what would be expected with an infant born with a VSD prior to development of Eisenmenger syndrome?
QUESTION 6
Figure 16
A patient complains of epistaxis and bleeding from small superficial scratches. Their arm is shown in figure #16. What is the most likely lab result?
PT of 30 seconds
PTT of 60 seconds
Platelet count of 50,000/ml
PT of 30 seconds and PTT of 60 seconds
Hemophilia B
Thrombocytopenia
O Hemophilia A
O NSAID use
O Von Willebrand Disease
2.7 points
Save Answer
* Question Completion Status:
Insulin (serum) total
Methylmalonic acid (serum)
Renin activity (plasma) adult (upright)
Respiratory Rate (resting, adult)
Osmolarity (plasma)
Thyroid stimulating hormone (TSH), (serum)
Thyroxine, total (T4) (serum)
Vitamin B12, serum
5-35 μU/mL 0-4.7 μg/dL
0.5-3.3 ng/mL/hr
12-20 breaths/min
280-300 mOsm/L
0.4-5.0 mU/L
4.5-10.9 μgm/dL
210-911 pg/mL
Potassium
Chloride
[CO2] arterial plasma
Blood Urea nitrogen (BUN)
Creatinine
Bicarbonate (HCO3)
Cat (Free or ionized)
3.7-5.2 mmol/L
101-111 mmol/
1.05-1.35 mmol/L
7-20 mg/dL
0.7-1.4 mg/dL
20-29 mmol/L
1.1-1.3 mmol/L
Iron Studies
Serum Ferritin
10-300 ng/mL
TIBC
250-350 μg/dL
CBC Values
WBC count, total (blood)
3600-11,200/mm3
MCV
80-100 fL
Hematocrit (male)
40-50%
Hemostasis
Hematocrit (female)
35-45%
Hemoglobin Concentration (male)
13-17 g/dl
PT
PTT
Hemoglobin Concentration (female)
12-15 g/dl
Bleeding Time
11-14 seconds
25-40 seconds
1-9 minutes
RDW
Reticulocyte Count
11-15%
Platelet Count
0.5-2.7% of RBC’S
150,000-400,000 /ml
NOTE: THESE ARE FOR EDUCATIONAL PURPOSES ONLY!!! NOTE: FOR OUR PURPOSES SERUM OR PLASMA ARE USED INTERCHANGEABLY
A patient is bleeding excessively after a surgery. The following lab results are found: Platelet count of 200,000/ml, bleeding time of 15 minutes, PT of 12 seconds, PTT of 60 seconds the Ristocetin agglutination test is abnormal. What is the best explanation for the bleeding?
Parameter
Normal values
Parameter
Normal values
Urine
Miscellaneous
ACTH (serum)
9-46 pg/mL
7-30 ng/dl
Cortisol (Urine Free)
Metanephrines (Urine)
20-70 μg/24 hours
44-261 μg/24 hours
Aldosterone, (serum) Standing
aldosterone-to-renin ratio (ARR)
Blood Glucose (fasting)
Blood pressure
20-40
64-125 mg/dL
albumin
Cerebrospinal fluid (CSF)
11-48 mg/dL
90/60-140/90 mmHg
leukocyte count
0-5/mm3
Cortisol (plasma) 8AM
6-23 μgm/dL
chloride
118-132 mmol/L
C-peptide (serum)
0.9-3.9 ng/mL
glucose
50-75 mg/dL
Creatinine, serum
0.7-1.4 mg/dL
IgG
8.0-8.6 mg/dL
Haptoglobin (serum)
50-220 mg/dL
pressure
8-15 mm Hg
Heart Rate (resting) adult
60-100 bpm
protein
15-45 mg/dL
Electrolytes (serum)
Hemoglobin A1C
4.1-6.5%
Homocysteine (serum)
4-15 μmol/L
Sodium
Potassium
136-144 mmol/L
3.7-5.2 mmol/L
Insulin (serum) total
5-35 μU/mL
A patient’s gross and microscopic urine samples are attached (figure 10). What would best describe their condition?
Nephrotic syndrome with an expected urinary loss of more than 3.5g protein per day
Nephritic syndrome with an expected urinary loss of more than 3.5g protein per day
Nephrotic syndrome with an expected urinary loss of less than 3.5g protein per day
O Nephritic syndrome with an expected urinary loss of less than 3.5g protein per day
MFG 1608222
HIELE
LICHLE
700
202407–00
A lack of green leafy vegetables in the diet of the patient
A bacterial overgrowth in the intestines
O Pernicious Anemia
A strict vegan patient
O Pancreatitis
4
Osmolarity (plasma)
Thyroid stimulating hormone (TSH). (serum)
Thyroxine, total (T4) (serum)
Vitamin B12, serum
280-300 mOsm/
0.4-5.0 mU/L
Creatinine
Bicarbonate (HCO3)
0.7-1.4 mg/dL
20-29 mmol/L
4.5-10.9 μgm/dL
210-911 pg/mL
Car (Free or ionized)
1.1-1.3 mmol/L
Iron Studies
Serum Ferritin
TIBC
10-300 ng/mL
250-350 μg/dL
CBC Values
WBC count, total (blood)
3600-11,200/mm3
MCV
80-100 fL
Hematocrit (male)
40-50%
Hemostasis
Hematocrit (female)
35-45%
Hemoglobin Concentration (male)
13-17 g/dl
PT
PTT
11-14 seconds
25-40 seconds
Hemoglobin Concentration (female)
RDW
Reticulocyte Count
12-15 g/dl
Bleeding Time
1-9 minutes
11-15%
Platelet Count
0.5-2.7% of RBC’s
150,000-400,000 /ml
NOTE: THESE ARE FOR EDUCATIONAL PURPOSES ONLY!!! NOTE: FOR OUR PURPOSES SERUM OR PLASMA ARE USED INTERCHANGEABLY!
A lack of green leafy vegetables in the diet of the patient
A bacterial overgrowth in the intestines
Pernicious Anemia
A strict vegan patient
Parameter
Normal values
Parameter
Normal values
Urine
Miscellaneous
ACTH (serum)
Aldosterone, (serum) Standing
aldosterone-to-renin ratio (ARR)
Blood Glucose (fasting)
9-46 pg/mL
7-30 ng/dl
Cortisol (Urine Free)
Metanephrines (Urine)
20-70 μg/24 hours
44-261 μg/24 hours
20-40
64-125 mg/dL
albumin
Cerebrospinal fluid (CSF)
11-48 mg/dL
Blood pressure
90/60-140/90 mmHg
leukocyte count
0-5/mm3
Cortisol (plasma) 8AM
6-23 μgm/dL
chloride
118-132 mmol/L
C-peptide (serum)
0.9-3.9 ng/mL
glucose
50-75 mg/dL
Creatinine, serum
0.7-1.4 mg/dL
IgG
8.0-8.6 mg/dL
Haptoglobin (serum)
50-220 mg/dL
pressure
8-15 mm Hg
Heart Rate (resting) adult
60-100 bpm
protein
15-45 mg/dL
Electrolytes (serum)
Hemoglobin A1C
4.1-6.5%
Respiratory Rate (resting, adult)
12-20 breaths/min
Homocysteine (serum)
Insulin (serum) total Methylmalonic acid (serum)
Renin activity (plasma) adult (upright)
5-35 μU/mL 0-4.7 μg/dL
0.5-3.3 ng/mL/hr
Chloride
[CO2] arterial plasma
Blood Urea nitrogen (BUN)
4-15 μmol/L
Sodium
Potassium
136-144 mmol/L
3.7-5.2 mmol/L
101-111 mmol/L
1.05-1.35 mmol/L
7-20 mg/dL
(Peripheral smear)
A patient has the following bloodwork: Hematocrit 30%, Hemoglobin 10 g/dL, MCV 115 fL. A peripheral blood smear is shown in figure 11. A neurological exam is abnormal. Radioactive B12 is given orally with nothing else. Large amounts of radioactive B12 are subsequently detected in the urine. What best explains these results?
A pulmonary vessel from a patient is shown (figure 4). It is representative of most of their pulmonary vessels. What is the most
likely cause for this condition?
QUESTION 63
Metabolic syndrome typically precedes what?
type I diabetes
type II diabetes
type I and type II diabetes
Thyroid stimulating hormone (TSH). (serum)
Thyroxine, total (T4) (serum)
Vitamin B12, serum
0.4-5.0 mU/L
Bicarbonate (HCO3)
20-29 mmol/L
4.5-10.9 μgm/dL
210-911 pg/mL
Ca* (Free or ionized)
1.1-1.3 mmol/L
Iron Studies
Serum Ferritin
10-300 ng/mL
TIBC
250-350 μg/dL
CBC Values
WBC count, total (blood)
3600-11,200/mm3
MCV
80-100 fL
Hematocrit (male)
40-50%
Hemostasis
Hematocrit (female)
35-45%
Hemoglobin Concentration (male)
13-17 g/dl
PT
PTT
11-14 seconds
25-40 seconds
Hemoglobin Concentration (female)
RDW
Reticulocyte Count
12-15 g/dl
Bleeding Time
1-9 minutes
11-15%
Platelet Count
0.5-2.7% of RBC’s
150,000-400,000 /ml
NOTE: THESE ARE FOR EDUCATIONAL PURPOSES ONLY!!! NOTE: FOR OUR PURPOSES SERUM OR PLASMA ARE USED INTERCHANGEABLY!
A
O
O
B
C
D
E
Parameter
Normal values
Parameter
Normal values
Urine
Miscellaneous
ACTH (serum)
Aldosterone, (serum) Standing
aldosterone-to-renin ratio (ARR)
Blood Glucose (fasting)
Blood pressure
9-46 pg/mL
7-30 ng/dl
Cortisol (Urine Free)
Metanephrines (Urine)
20-70 μg/24 hours
44-261 μg/24 hours
20-40
Cerebrospinal fluid (CSF)
64-125 mg/dL
albumin
90/60-140/90 mmHg
leukocyte count
Cortisol (plasma) 8AM
6-23 μgm/dL
chloride
11-48 mg/dL
0-5/mm3
118-132 mmol/L
C-peptide (serum)
0.9-3.9 ng/mL
glucose
50-75 mg/dL
Creatinine, serum
0.7-1.4 mg/dL
IgG
8.0-8.6 mg/dL
Haptoglobin (serum)
50-220 mg/dL
pressure
8-15 mm Hg
Heart Rate (resting) adult
60-100 bpm
protein
15-45 mg/dL
Electrolytes (serum)
Hemoglobin A1C
4.1-6.5%
Sodium
136-144 mmol/L
4-15 μmol/L
Homocysteine (serum)
Insulin (serum) total Methylmalonic acid (serum)
Renin activity (plasma) adult (upright)
Respiratory Rate (resting, adult)
Osmolarity (plasma)
5-35 μU/mL 0-4.7 μg/dL
0.5-3.3 ng/mL/hr
12-20 breaths/min
280-300 mOsm/L
[CO2] arterial plasma
Blood Urea nitrogen (BUN)
Creatinine
7-20 mg/dL
0.7-1.4 mg/dL
Potassium
3.7-5.2 mmol/L
Chloride
101-111 mmol/L
1.05-1.35 mmol/L
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