The best question-and-answer review for anatomy, histology and cell biology questions on the USMLE Step 1 and shelf exams. If you can answer these questions, you''ll ace the test 500 USMLE Step 1-type anatomy, histology and cell biology questions, many in clinical vignette format. This book includes concise, referenced answers.
Notice M edicine is an ever-changing science As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work Readers are encouraged to confirm the information contained herein with other sources For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration This recommendation is of particular importance in connection with new or infrequently used drugs Robert M Klein, PhD Professor of Anatomy and Cell Biology Associate Dean, Professional Development and Faculty Affairs University of Kansas, School of M edicine Kansas City, Kansas George C Enders, PhD Associate Professor and Director of M edical Education Assistant Dean for Student Affairs Department of Anatomy and Cell Biology University of Kansas, School of M edicine Kansas City, Kansas To my wife, Beth, and our children M elanie, Jeffrey, and David, for their support and patience during the writing and revision of this text; and to my parents, Nettie and David, for their emphasis on education and the pursuit of knowledge -RM K To Sally Ling, M D, an incredibly hard working and considerate person whom I am lucky enough to call my wife She has given us three great children, Carolyn, Tyler, and Robert who keep me on my toes; and to my mother and my father who always encouraged "the boys" to our best -GCE Jodie Bachman UM DNJ School of Osteopathic M edicine Class of 2011 Benjamin Chidester Eastern Virginia M edical School Class of 2011 M onique Cunningham-Lindsay UM DNJ School of Osteopathic M edicine Class of 2011 Jeffrey A Klein University of Kansas, School of M edicine Class of 2010 Andrew Schlachter University of Kansas, School of M edicine Class of 2009 J Eva Selfridge University of Kansas, School of M edicine Class of 2012 Gustaf Van Acker I I I University of Kansas, School of M edicine Class of 2012 200 A 50-year-old woman presents to the family medicine clinic She admits to drinking a six-pack of beer each day with a little more intake on weekends Laboratory tests show elevated alanine aminotransferase/ serum glutamic pyruvic transaminase (ALT/SGPT) and aspartate aminotransferase/serum glutamic oxaloacetic transaminase (AST/SGOT) Her sclerae appear jaundiced and her serum bilirubin is 2.5 mg/dL (normal 0.3-1.9 mg/dL) A biopsy of her liver shows eosinophilic intracytoplasmic inclusions (M allory bodies) derived from intermediate filament proteins What is the most likely source of M allory bodies? a Hepatic stellate cells b Kupffer cells c Vimentin d Keratin e Desmin 20I I The resting parietal cell does not secrete acid for which one of the following reasons? a The Na', K+-ATPase is inserted into the apical membrane b The chloride channel of the apical plasma membrane is closed c The H+, K+-ATPase is sequestered in tubulovesicles d Carbonic anhydrase is not produced e Histamine receptors are uncoupled from their second messengers 202 A 52-year-old man is diagnosed with a carcinoid after an appendectomy The cell of origin in the carcinoid differs from goblet cells in which of the following ways? a The direction of release of secretion b The use of exocytosis for release of secretory product from the cell c Their presence in the small and large intestine d Their origin from a crypt stem cell e Secretion by a regulated pathway 203 In regard to the enteroendocrine cells and the cells composing the enteric nervous system of the gut, which of the following applies to both types of cells? a They are derived from neural crest b They secrete similar peptides c They are essential for the intrinsic rhythmicity of the gut d They are turned over rapidly e They are found only in the small intestine 204 A 17-year-old with counterfeit identification has a piercing done at a local tattoo/piercing establishment She chooses to have a stainless steel barbell inserted in the piercing through the anterior two-thirds of her tongue There is damage to the structures shown in the associated photomicrograph Primary afferents from those structures travel through which of the following cranial nerves? (M icrograph courtesy of Dr.John K.Young.) a V b VII c IX d X e XII 205 Hirschsprung disease and Chagas disease result in disturbance of intestinal motility The site of this disruption is most likely which of the layers on the accompanying micrograph? (M icrograph courtesy of Dr.John K.Young.) a Layer A b Layer B c Layer C d Layer D e Layer E 206 A 48-year-old woman presents to the allergy and rheumatology clinic with itching eyes, dryness of the mouth, difficulty swallowing, loss of sense of taste, hoarseness, fatigue, and swollen parotid glands She reports increasing joint pain over the past years She complains of frequent mouth sores Laboratory tests show a positive antinuclear antibody (ANA) and rheumatoid factor (RF) levels of 70 U/mL (normal levels less than 60 U/mL) by the nephelometric method A parotid gland biopsy shows inflammatory infiltrates in the interlobular connective tissue with damage to acinar cells and striated ducts In this case, resorption of which of the following will be most altered by destruction of the striated ducts? a Na' b K+ c HCO3 d Cle Ca'+ 207 Which of the following is the primary regulator of salivary secretion? a Antidiuretic hormone b Autonomic nervous system c Aldosterone d Cholecystokinin e Secretin 208 A young child presents with hepatomegaly and renomegaly, failure to thrive, stunted growth, and hypoglycemia A deficiency in glucose 6-phosphatase is identified and the diagnosis of von Gierke disease is made In the liver, the structures labeled with the arrows in the accompanying transmission electron micrograph accumulate during this disease What are the labeled structures? a Chylomicra b Glycogen c M itochondria d Peptide-containing secretory granules e Ribosomes 209 The branching structures highlighted by the arrows in the scanning electron micrograph below (taken from the region between two adjacent hepatocytes) are involved in which of the following? (Electron micrograph courtesy of Dr Kuen-Shan Hung and Karen Grantham, KUM C Electron M icroscopy Center.) a Communication between the hepatocytes b Preventing flow between adjacent hepatocytes c Bile flow d Blood flow e Spot welds between hepatocytes 210 In the photomicrograph of a plastic-embedded, thin section shown below, which of the following is the structure labeled A? (M icrograph courtesy of Eileen Roach.) a A parasympathetic ganglion b A cluster of hepatocytes c A serous acinus d An intralobular duct e An islet of Langerhans 211 A pathologist views the following tissues (A and B) in a biopsy She determines that the tissues are normal The presence of both of these tissues indicates that the sample was taken from the region of the junction between which of the following? a Anal canal and rectum b Esophagus and stomach c Skin of the face and mucous epithelium of the lip d Stomach and duodenum e Vagina and cervix 212 A 52-year-old woman with a provisional diagnosis of celiac disease presents with bouts of diarrhea and extreme fatigue Verification was sought through performance of esophagogastroduodenoscopy to obtain small bowel biopsies Biopsies of the region shown in the accompanying light micrograph disclose hyperplasia of the structures labeled with the asterisks The labeled structures produce which of the following? a Acid b M ucus and HC03 c Pepsinogen d Lysozyme e Enterokinase 213 Inflammation in the organ shown in the photomicrograph may result in referred pain to which of the following areas? a Top of the right shoulder b Neck c Spine between the scapulae d Groin e Umbilical region 214 The asterisk-labeled cells in the center of the transmission electron micrograph below function in which one of the following processes? (Reproduced with permission, from M cKenzie, Klein,Am.J.Anat 164: 175-186, 1982.) a Immune defense mechanisms b M ucus secretion c Heparin and histamine secretion and release d Endocrine secretion e Regulation of the flora of the small bowel f Absorption of nutrients from the lumen of the small bowel 215 In hemolytic jaundice, the structure labeled with the arrow in the accompanying photomicrograph will contain which one of the following? a Elevated urobilinogen levels b Elevated bilirubin levels c Decreased urobilinogen levels d Decreased bilirubin levels e Elevated numbers of lymphocytes undergoing diapedesis 216 A 4-day-old newborn weighing lb oz is brought to the emergency room by his parents The examining emergency room physician notes that his skin and sclerae are icteric A blood test indicates elevated unconjugated bilirubin in the serum The elevated bilirubin levels in this patient are most likely the result of which one of the following? a Deficiency of enzymes regulating bilirubin solubility b Hepatocellular proliferation c Decreased destruction of red blood cells d Dilation of the common bile duct e Increased hepatocyte uptake of bilirubin 217 A 42-year-old woman (5 ft in, 170 lb) complains of sudden onset of severe pain in the right upper abdomen "under the ribs" accompanied by sweating, nausea, and a feeling of imminent collapse The pain lasts for about hours and then persists as a dull ache When seen several hours later, she has normal bowel sounds, is tender throughout the abdomen, especially in the right upper quadrant, and is faintly icteric She has noticed her urine is darker than usual but has not passed stool recently She recalls occasional episodes of "indigestion" referred to the right upper abdomen and radiating to the shoulder This has occurred especially after eating fried foods or after eating a meal following a long period of fasting She has no fever but is anxious and tachycardic The test results available are a blood count and blood chemistry including liver enzymes, alkaline phosphatase, and bilirubin She has a WBC of 10,000 Her cellular hepatic enzymes are: AST/SGOT = 52 (normal 333) and ALT/SGPT = 70 (normal 4-44), alkaline phosphatase = 300 (normal 17-91), bilirubin = 6.3 (normal 0.2-1.0) Which one of the following is the most probable diagnosis? a Hepatitis A b Hepatitis B c Carcinoma of the head of the pancreas d Gallstone obstructing common bile duct e Biliary cirrhosis 218 A 14-month-old girl is brought to the pediatric dentistry clinic because her erupted deciduous teeth are opalescent with fractures and chips in the surface X-rays reveal bulb-shaped crowns and thin roots Structure D on the diagram is abnormally large in her teeth The structure labeled "B" on the diagram is prepared for histology and shows disoriented, irregular, widely-spaced tubules with wide vascular channels Which one of the following applies to the layer labeled "B"? a It has a composition similar to that of bone and is produced by cells similar in appearance to osteocytes b It is formed on a noncollagenous matrix that is resorbed on mineralization by the same cells that secreted it c It contains abundant nerves, blood vessels, and loose connective tissue d It consists of mineralized collagen secreted by cells derived from neural crest e It is the site of inflammation in diabetic patients and is sensitive to deficiency in vitamin C 219 A 39-year-old woman presents with dyspnea, fatigue, pallor, tachycardia, anosmia, and diarrhea Laboratory results are: hematocrit 32% (normal 36.1%-44.3%), M CV 102 fL ([normal 78-98 fL]), 0.3 % reticulocytes (normal 0.5%-2.0%), 95 pg/mL vitamin B12 (normal 200-900 pg/mL), and an abnormal stage I of the Schilling test Autoantibodies are detected to a cell type that is found in a region shown in the accompanying diagram In which region would those cells be found? a A b B C C d D e E f F g G 220 A 43-year-old man who recently returned from a trip to rural Peru presents with severe watery diarrhea, vomiting, and dehydration He also has marked leg cramps and has lost lb since his return from the trip Fecal culture is positive for Vibrio cholerae How does this bacterium exert its effect? a Activation of enterokinase on the brush border of epithelial cells b Activation of cholecystokinin effects on pancreatic secretion c Closure of chloride channels in the enterocyte cell membrane d Inhibition of cyclic AM P in the enterocytes e ADP-ribosylation of Gs of the GTP-binding protein in enterocytes 221 A 35-year-old man visits his family medicine physician complaining of bloating, a sense of urgency, cramping abdominal pain, meteorism, and diarrhea with excessive flatulence several hours after ingestion of milk or dairy products He says that he has always enjoyed milk and dairy products without any problems, but now eating them causes him abdominal distress In this disorder, the area shown by the arrows would most likely have a decrease in which one of the following? a Specific disaccharidase activity b Glucose/galactose transporter activity c Passive diffusion of monosaccharides d Uptake of triglycerides by endocytosis e Active transport of glycerol ... 11 3 Cell Biology: Cytoplasm Questions 11 7 Answers 12 6 Cell Biology: Intracellular Trafficking Questions 13 7 Answers 14 3 Cell Biology: Nucleus Questions 14 9 Answers... Histology and Cell Biology 19 Anatomy 53 Neural Pathways 81 Embryology: Early and General Questions 85 Answers 95 Cell Biology: M embranes Questions 10 9 Answers 11 3... (tract and associated glands), endocrine, urinary, and male and female reproductive systems, as well as the eye and the ear The topics in tissue and organ histology and cell biology include light and