1|Page
ACHE BOG EXAM 2026-2027 BANK QUESTIONS WITH
DETAILED VERIFIED ANSWERS EXAM QUESTIONS WILL
COME FROM HERE (100% CORRECT ANSWERS A+ GRADED
Question 1
A 58-year-old male presents to the emergency department with acute
onset, severe chest pain radiating to his back. He has a history of
hypertension. His blood pressure is 180/100 mmHg in his left arm and
130/80 mmHg in his right arm. A chest X-ray shows a widened
mediastinum. Which of the following is the most appropriate next step
in management?
A) Administer thrombolytic therapy
B) Initiate beta-blocker therapy and order a CT angiogram of the chest
C) Perform a transthoracic echocardiogram
D) Obtain a ventilation/perfusion (V/Q) scan
Answer: B
Explanation: The presentation of acute, severe chest pain radiating to
the back, pulse differential between arms, hypertension, and widened
mediastinum on chest X-ray is highly suggestive of an acute aortic
dissection. Beta-blockers are the first-line pharmacologic agent to
reduce the force of left ventricular contraction (dP/dt) and lower heart
rate and blood pressure, which stabilizes the dissection flap. A CT
angiogram of the chest is a definitive imaging study for diagnosis.
,2|Page
Thrombolytic therapy is contraindicated. Echocardiography may show a
pericardial effusion or tamponade but is less sensitive for assessing the
full extent of dissection, and a V/Q scan is used for pulmonary
embolism, which does not typically present with a pulse differential.
Question 2
A 25-year-old woman with major depressive disorder has been on
fluoxetine 20 mg daily for 8 weeks with partial response. She reports
significant fatigue and weight gain. Which of the following is the most
appropriate pharmacological strategy?
A) Switch to bupropion
B) Add aripiprazole
C) Increase fluoxetine to 40 mg daily
D) Switch to amitriptyline
Answer: A
Explanation: The patient is experiencing antidepressant side effects of
fatigue and weight gain, which are common with selective serotonin
reuptake inhibitors. She has also had only a partial response.
Bupropion, a norepinephrine-dopamine reuptake inhibitor, is activating
and not typically associated with weight gain or sexual dysfunction,
making it a suitable alternative. Aripiprazole is an augmenting agent,
usually considered after multiple failed monotherapy trials. Increasing
fluoxetine might worsen side effects. Amitriptyline, a tricyclic
antidepressant, is highly anticholinergic and histaminergic, often
causing more sedation and weight gain.
,3|Page
Question 3
Which of the following cellular changes is considered irreversible?
A) Cellular swelling
B) Fatty change
C) Karyolysis
D) Ribosomal detachment from endoplasmic reticulum
Answer: C
Explanation: Irreversible cell injury leading to necrosis is characterized
morphologically by nuclear changes: pyknosis (nuclear shrinkage),
karyorrhexis (nuclear fragmentation), and karyolysis (nuclear fading).
These indicate complete dissolution of the nucleus and cell death.
Cellular swelling and fatty change are reversible alterations, as is
ribosomal detachment, though the latter leads to a reduction in protein
synthesis, which can be fatal if prolonged but is initially reversible.
Question 4
A 10-year-old boy is brought to the clinic due to progressive difficulty
walking. Physical examination reveals calf muscle hypertrophy and a
positive Gowers' sign. His serum creatine kinase level is markedly
elevated. A deletion mutation in the gene encoding which of the
following proteins is the most likely cause?
A) Myelin basic protein
B) Dystrophin
C) Fibrillin
D) Collagen type I
, 4|Page
Answer: B
Explanation: The clinical presentation is classic for Duchenne muscular
dystrophy (DMD), an X-linked recessive disorder. It is caused by
mutations, often deletions, in the dystrophin gene. Dystrophin
connects the intracellular actin cytoskeleton to the extracellular matrix
in muscle cells, providing mechanical support during contraction. Its
absence leads to sarcolemma damage, calcium influx, and muscle fiber
necrosis. Fibrillin is defective in Marfan syndrome, collagen type I in
osteogenesis imperfecta, and myelin basic protein is targeted in
multiple sclerosis.
Question 5
A 72-year-old male with chronic atrial fibrillation presents with an acute
onset of severe, non-progressive right lower quadrant abdominal pain
and tenderness without rebound. Laboratory studies show leukocytosis
with a left shift, and a CT scan reveals a thickened caecal wall. Which
artery is most likely occluded?
A) Superior mesenteric artery
B) Inferior mesenteric artery
C) Celiac artery
D) Internal iliac artery
Answer: A
Explanation: The caecum is a midgut structure, and its arterial supply
comes from the ileocolic artery, a branch of the superior mesenteric
artery. An embolus from the left atrium in atrial fibrillation can cause
acute mesenteric ischemia. The initial phase presents with severe pain
that is often out of proportion to physical examination findings, though
ACHE BOG EXAM 2026-2027 BANK QUESTIONS WITH
DETAILED VERIFIED ANSWERS EXAM QUESTIONS WILL
COME FROM HERE (100% CORRECT ANSWERS A+ GRADED
Question 1
A 58-year-old male presents to the emergency department with acute
onset, severe chest pain radiating to his back. He has a history of
hypertension. His blood pressure is 180/100 mmHg in his left arm and
130/80 mmHg in his right arm. A chest X-ray shows a widened
mediastinum. Which of the following is the most appropriate next step
in management?
A) Administer thrombolytic therapy
B) Initiate beta-blocker therapy and order a CT angiogram of the chest
C) Perform a transthoracic echocardiogram
D) Obtain a ventilation/perfusion (V/Q) scan
Answer: B
Explanation: The presentation of acute, severe chest pain radiating to
the back, pulse differential between arms, hypertension, and widened
mediastinum on chest X-ray is highly suggestive of an acute aortic
dissection. Beta-blockers are the first-line pharmacologic agent to
reduce the force of left ventricular contraction (dP/dt) and lower heart
rate and blood pressure, which stabilizes the dissection flap. A CT
angiogram of the chest is a definitive imaging study for diagnosis.
,2|Page
Thrombolytic therapy is contraindicated. Echocardiography may show a
pericardial effusion or tamponade but is less sensitive for assessing the
full extent of dissection, and a V/Q scan is used for pulmonary
embolism, which does not typically present with a pulse differential.
Question 2
A 25-year-old woman with major depressive disorder has been on
fluoxetine 20 mg daily for 8 weeks with partial response. She reports
significant fatigue and weight gain. Which of the following is the most
appropriate pharmacological strategy?
A) Switch to bupropion
B) Add aripiprazole
C) Increase fluoxetine to 40 mg daily
D) Switch to amitriptyline
Answer: A
Explanation: The patient is experiencing antidepressant side effects of
fatigue and weight gain, which are common with selective serotonin
reuptake inhibitors. She has also had only a partial response.
Bupropion, a norepinephrine-dopamine reuptake inhibitor, is activating
and not typically associated with weight gain or sexual dysfunction,
making it a suitable alternative. Aripiprazole is an augmenting agent,
usually considered after multiple failed monotherapy trials. Increasing
fluoxetine might worsen side effects. Amitriptyline, a tricyclic
antidepressant, is highly anticholinergic and histaminergic, often
causing more sedation and weight gain.
,3|Page
Question 3
Which of the following cellular changes is considered irreversible?
A) Cellular swelling
B) Fatty change
C) Karyolysis
D) Ribosomal detachment from endoplasmic reticulum
Answer: C
Explanation: Irreversible cell injury leading to necrosis is characterized
morphologically by nuclear changes: pyknosis (nuclear shrinkage),
karyorrhexis (nuclear fragmentation), and karyolysis (nuclear fading).
These indicate complete dissolution of the nucleus and cell death.
Cellular swelling and fatty change are reversible alterations, as is
ribosomal detachment, though the latter leads to a reduction in protein
synthesis, which can be fatal if prolonged but is initially reversible.
Question 4
A 10-year-old boy is brought to the clinic due to progressive difficulty
walking. Physical examination reveals calf muscle hypertrophy and a
positive Gowers' sign. His serum creatine kinase level is markedly
elevated. A deletion mutation in the gene encoding which of the
following proteins is the most likely cause?
A) Myelin basic protein
B) Dystrophin
C) Fibrillin
D) Collagen type I
, 4|Page
Answer: B
Explanation: The clinical presentation is classic for Duchenne muscular
dystrophy (DMD), an X-linked recessive disorder. It is caused by
mutations, often deletions, in the dystrophin gene. Dystrophin
connects the intracellular actin cytoskeleton to the extracellular matrix
in muscle cells, providing mechanical support during contraction. Its
absence leads to sarcolemma damage, calcium influx, and muscle fiber
necrosis. Fibrillin is defective in Marfan syndrome, collagen type I in
osteogenesis imperfecta, and myelin basic protein is targeted in
multiple sclerosis.
Question 5
A 72-year-old male with chronic atrial fibrillation presents with an acute
onset of severe, non-progressive right lower quadrant abdominal pain
and tenderness without rebound. Laboratory studies show leukocytosis
with a left shift, and a CT scan reveals a thickened caecal wall. Which
artery is most likely occluded?
A) Superior mesenteric artery
B) Inferior mesenteric artery
C) Celiac artery
D) Internal iliac artery
Answer: A
Explanation: The caecum is a midgut structure, and its arterial supply
comes from the ileocolic artery, a branch of the superior mesenteric
artery. An embolus from the left atrium in atrial fibrillation can cause
acute mesenteric ischemia. The initial phase presents with severe pain
that is often out of proportion to physical examination findings, though
