If your patient takes some medications for several months – sometimes they become tolerant to the drugs

because their systems become able to breakdown the drugs faster. Such a slow increase in the capacity

of the drug clearance pathway is most likely to occur through

A patient of yours has a heart attack and is under your care. You are monitoring recovery by measuring

serum enzymes. Over the next two days, you find that his CK – MB levels are decreasing towards

normal but CK-MM levels are increasing. It is most likely that

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

An alcoholic patient of yours presents with confusion and disorientation. You suspect alcoholic

ketoacidosis. Under alcoholic ketoacidosis:

Gene expression profiles are quickly made by which method?

Cloning

. In the mid 1800s, there was a cholera outbreak that was associated with the ingestion of contaminated

water from the Broad Street well in London. This outbreak was attributable to

Which of the following osteopathic physicians developed the technique known as “facilitated positional

release” (FPR)?

Stanley Schiowitz, D.O.

The pathways of sympathetic nerves can be distinguished anatomically from those of parasympathetic
nerves because:
A.Parasympathetic ganglia are located near the target organ

B. Parasympathetics have longer postganglionic fibers
C.Parasympathetics pass through paravertebral ganglia
D.Sympathetics arise from the sacral and head regions.

E. Sympathetics do not enter the body wall or limbs

A 50-year-old male patient of yours complains of chest pain. You suspect a heart attack. You order the
serum tests. If the patient did in fact have a heart attack, you will expect to see:
A decrease in myoglobin levels in serum
An increase in alkaline phosphatase levels in serum
An increase in creatine kinase MB levels in serum
An increase in hemoglobin levels in serum
An increase in M4 lactate dehydrogenase levels in serum

Increase biting frequency

increase breeding period

Which of the following represents the correct pairing?
Anatomy – mostly Greek origins
Endocarditis – inflammation of the external covering of the heart
Gastritis – “itis” is the prefix
Psychooncology – teaching/study of the psychosocial factors associated with cancer
Pyelonephritis – inflammation of the veins of the kidney

Which one is a correct statement about DNA replication?

Mismatched nucleotides are removed from the 3' end
Primase is required to separate the two strands
DNA polymerase I acts on the leading strand
Addition of all new nucleotides is done by DNA polymerase III
Telomerase relaxes positive supercoils

Mismatched nucleotides are removed from the 3' end

DNA polymerase I acts on the leading strand

The sample contains more than one protein

or

the protein is pure and has at least two amino ends

decidua capsularis

or

more generally the Endometrium

which structure will fuse to the chorion?

1. The amnion
2. The back of the embryo
3. The placenta
4. The connecting stalk
5. Oropharyngeal membrane

Most of the long muscles in the body utilize:

1. A first-class lever action, with the fulcrum placed between the point of effort and resistance
2. A concentric contraction only
3. A second-class lever action, with the resistance placed between the fulcrum and the point of effort
4. A third-class lever action, with the point of effort between the fulcrum and resistance
5. A static contraction action only

Your patient complains of upper thoracic pain after studying for an exam for several days at a low desk.
You diagnose T3 Extended, Rotated Right, Sidebent Right (T3 ERrSr). Which facet is involved and
which function is it unable to perform?

1. The right facet cannot open
2. The left facet cannot open
3. The right facet cannot close
4. The left facet cannot close

A 38-year-old mother presents to the office with her 17-year-old son who was apparently injured in
football tackle three days ago. He has low back pain but there is no pain elsewhere. He is healthy
otherwise and denies any other problems. History and physical examination were otherwise entirely
negative except for increased muscle tone in the lumbar paravertebral muscles. The mother insists to
have an X-ray taken as well as an MRI and a bone scan, and specific rheumatological laboratory studies,
because she states that “this is what I have read on the internet should be done.” Which of the following
statements would be the most appropriate in this situation?

1. You order the tests and labs requested by the mother, since all osteopathic tenets apply to thissituation
2. You advise the mother that the tests should not be done as they are too expensive, and there is noestablished connection between structure and function
3. You order an X-ray to “please the mother,” because you want to demonstrate that you care
4. You refer the patient to an orthopedic surgeon in order for the patient to have the benefit of the fullscope of osteopathic medical practice
5. You explain to the mother your rationale of how to proceed, an activity which you see as part ofbeing a “health navigator”

Which of the following statements about “manual medicine” is correct?

1. It is one of the youngest healing arts
2. Its practice remains “separate and alternative” as its techniques cannot be integrated into the
3. standard/orthodox medical approach
4. Is the overarching term that includes such approaches as osteopathic manipulative medicine, ancient
5. manipulation techniques, and others
6. Is associated with a large number of major complications
7. Has failed to analyze to date its own successes and failures as there exists no formal research

Recent advances in the field of manual medicine that have improved scientific understanding include
which of the following?

1. Increasing numbers of manipulation performed each year
2. Successful marketing campaigns by various professional groups
3. Growth of various rehabilitation programs that include manual medicine procedures
4. The development of standardized, internationally recognized, terminology
5. Introduction of specific terms such as “osteopathic lesion”, “subluxation”, and “joint blockage”

Vaccination, water and sewage treatment, and safe food handling have all vastly improved our ability to
control which type of disease?

1. Cancer
2. Cardiac Disease
3. Cerebrovascular accidents
4. Certain infectious diseases
5. Diabetes

An enzyme that catalyzes a reaction changes

1. the free energy change of the reaction
2. the equilibrium of the reaction
3. the equilibrium concentration of the product
4. the rate of the reaction
5. the temperature of the reaction

For the reduction of NAD+ to NADH, the standard reduction potential is - 0.320 V (negative 0.320V) .
This suggests that, under standard conditions,

1. the equilibrium will be to the product (NADH) side
2. the equilibrium will be to the reactant (NAD+) side
3. the system is at equilibrium
4. NADH will oxidize Oxygen to water
5. NADH cannot be oxidized

Reducing equivalents (electrons) may enter the mitochondria from the cytosol as

1. NADH
2. NAD+
3. Malate
4. Aspartate
5. Dihydroxyacetonephosphate

When reentry of protons into the mitochondria through the ATP synthase is inhibited by Oligomycin

1. the proton gradient and respiration will increase
2. the proton gradient will be steady at a high value and respiration will decrease
3. the proton gradient will be steady at a low value and respiration will decrease
4. the proton gradient will be steady at a high value and respiration will increase
5. the proton gradient will be steady at a low value and respiration will increase

DNA polymerase III

1. Has moderate processivity
2. Has 5’ to 3’ exonuclease activity
3. Acts to remove primers
4. Removes mismatched nucleotides
5. Acts to extend telomeres

4. remove mismatched nucleotide

During transcription

1. The mRNA has the same sequence as the antisense strand
2. RNA polymerase requires a primer for initiation
3. Both DNA strands are copied simultaneously
4. Topoisomerases help form the transcription initiation complex
5. The sigma subunit of RNA polymerase recognizes the promoter

The first enzyme to act during base excision repair is

1. AP (apurinic/apyrimidinic) endonuclease
2. DNA ligase
3. DNA polymerase
4. DNA glycosylase

Patients with xeroderma pigmentosum (XP) are prone to developing skin cancer due to sensitivity to
sunlight. One form of XP is due to the absence of

1. Topoisomerase
2. Exonuclease
3. Endonuclease
4. DNA glycosylase
5. DNA ligase

The electron transport chain component that is entirely outside the matrix

1. NADH
2. Complex II
3. Complex III
4. Succinic acid
5. Cytochrome c

What are the terms for fast heart rate & slow heart rate respectively?

1. Tachycardia & Angina
2. Tachycardia & Bradycardia
3. Bradycardia & Tachycardia
4. Bradycardia & Jaundice
5. Angina & Myocardial Infarction

A 22-year-old woman with Wilson disease is about to receive a liver transplant.
The transplant surgeon, an osteopathic physician, enters the following information in the medical chart:
“Palpation of the abdomen reveals an enlarged liver. Even slight palpatory pressure over the liver caused
significant discomfort to the patient. Palpation of the tissues surrounding the right transverse processes
of T6, T7 and T8 was associated with significant tenderness, increased muscle tone and swelling. There
was a somatic dysfunction at T8-T9 on the right.”
Which of the following is an objective finding associated with the diagnosis of somatic dysfunction?

1. Abdominal tenderness
2. Tenderness in the area of the T8 transverse process
3. Enlarged liver
4. Increased muscle tone at T7, on the right
5. Absence of swelling at the T 9 level on the left

Facet Joints of the spine

1. are Formed by the inferior and superior articular processes
2. are pseudo-synovial joints since they lack a joint capsule
3. typically allow greater than 40 degrees of motion at each joint
4. have similar inclination angles in the thoracic and lumbar spine
5. are located anterior to the vertebral body

Which of the following would be listed under the subjective section in the SOAP format when making a
diagnosis of somatic dysfunction?

1. Tissue texture change
2. Asymmetry
3. Motion restriction
4. Swollen facet joint
5. Tenderness

During examination of a 16-year-old girl , a group curve is noted that is concave to the left. The curve
includes the thoracic vertebral units from T3 through T7. These segments remain markedly rotated in the
same direction whether this thoracic spinal region is flexed or extended. The examiner concludes that
this region displays neutral Type I Fryette spinal mechanics. The expected segmental spinal diagnosis in
this group from T3 through T7 is:

1. extended, side-bent right, rotated right
2. flexed, side-bent right, rotated right
3. side-bent left rotated left
4. side-bent left rotated right
5. side-bent right, rotated left