BioBeyond Making Protiens Exam| Questions Solved with
Verified Answers 2025/2026 UPDATE |COMPLETE EXAM
TEST AND VERIFIED ANSWERS MULTIPLE CHOICES
WITH RATIONALES| ACCURATE ANSWERS|100%
SOLVED
Question:1
A 54-year-old male has a history of gout complicated by several prior episodes of
acute gouty arthritis and 3 prior instances of nephrolithiasis secondary to uric acid
stones. He has a serum uric acid level of 11 mg/dL (normal range 3-8 mg/dL), a 24
hr urine collection of 1300 mg uric acid (normal range 250-750 mg), and a serum
creatinine of 0.8 mg/dL with a normal estimated glomerular filtration rate (GFR).
Which of the following drugs should be avoided in this patient?
A. Naproxen
B. Colchicine
C. Allopurinol
D.Indomethacin
E. Probenecid - ANSWER-*E. Probenecid*
Uricosuric drugs, such as probenecid, should be avoid in patients with high uric
acid excretion (generally, > 800 mg/24hr is indicative of a uric acid
overproducer) because this increases the risk of forming uric acid stones.
1|Page
,Uricosuric medications should only be used in patients who underexcrete uric
acid. These agents should not be used in patients with a history of kidney
stones, unless the stones have been confirmed to NOT be uric acid stones.
Patients taking uricosuric agents should be instructed to have high fluid intake
to minimize the risk of uric acid precipitation and stone formation.
Question:2
*A 55-year-old male presents with left hip pain and stiffness. Radiographs are
shown in Figures A and B. Serum alkaline phosphatase levels are elevated. A
biopsy of the left femur is performed and shown in Figure C. Which of the
following cells are initially responsible for this condition?*
Figure A shows the skull with areas of lysis, areas of sclerosis ('cotton-wool
spots'), and calvarial thickening.
Figure B demonstrates coarsened trabeculae, cortical thickening, and
enlargement of the left femur.
Figure C is a histologic slide showing abnormal bone formation with a mosaic
pattern of woven bone and irregular sections of thickened trabecular bone and
numerous cement lines.
A. osteoblasts
B. osteoclasts
C. Neutrophils
D. TCells
E. fibroblasts - ANSWER-*B. osteoclasts*
The radiographs and histology are consistent with Paget disease, which is
initially caused by increased osteoclastic bone resorption, and followed by an
increase in bone formation through osteoblast activity.
2|Page
,Paget disease of the bone is a disorder of bone remodeling characterized by
rapid bone turnover. The excessive bone resorption and bone formation disrupt
normal bone architecture and lead to various complications such as bone pain,
osteoarthritis, pathological fracture, bone deformity, deafness, and nerve
compression syndromes.
Question:3
A 39-year-old male who recently presented with acetaminophen overdose was
admitted to the MICU, where several attempts were made at obtaining
intravenous access without success. The decision was made to place a right
axillary arterial line, which became infected and was removed by the medical
student while the patient was still intubated. It was later noticed that he had
substantial swelling and bruising of the upper extremity. Given his sedation, a
proper neuro exam was not performed at that time. Several days later, after the
patient's liver function improved, he was successfully extubated. On exam, he
complained of lack of sensation over the palmar and dorsal surface of the small
finger and half of the ring finger, as well as weak digit abduction, weak thumb
adduction, and weak thumb-index finger pinch of the affected extremity. What is
the most likely cause and corresponding location of the injury?
1. Needle in - ANSWER-*3. compression of ulnar nerve secondary to
coagulopathy*
The patient in this question has likely experienced compression of the brachial
plexus secondary to hematoma formation resulting from coagulopathy in the
setting of acetaminophen-induced hepatic failure.
The clotting cascade is disrupted when the liver in unable to produce clotting
factors. As such, without compression hematoma formation may occur upon
removal of arterial lines. A large hematoma in the axilla can cause compression
to the brachial plexus which in this case has resulted in motor and sensory
deficits to the ulnar nerve. The ulnar nerve is responsible for flexion, opposition,
3|Page
, and abduction of the small finger, as well as the sensory distribution discussed
in the question stem.
* Question:4
A 41-year-old male presents to your office with paresthesias on the lateral left
calf and the dorsum of the left foot that he reports has been worsening over the
past three months. An MRI of the lumbar spine was unremarkable. An MRI of the
left knee with a representative axial cut through the proximal tibiofibular joint is
shown in Figure A. Which of the following abnormal physical exam findings would
you expect to see in this patient?*
MRI shows T2 weighted MRI axial cut of a proximal tibiofibular joint showing a
cyst.
1. Inability to walk on his toes with the heel elevated on the left
2. Decrease Achilles tendon reflex
3. Positive Trendeleberg test
4. Decreased patellar tendon reflex on the left
5. Inability to walk on his heel with the forefoot elevated off the ground on the
left - ANSWER-*5. inability to walk on his heel w/ forefoot elevated off the
ground*
The clinical and radiographic presentation are consistent for proximal
tibiofibular joint cyst with compression of the common peroneal nerve.
Numbness on the lateral calf, dorsal foot, and weakness to ankle dorsi-flexion
and foot eversion would be the expected physical exam finding.
The common peroneal (fibular) nerve arises from the sciatic nerve at the apex of
the popliteal fossa where it passes laterally to the gastrocnemius muscle and
then superficially around the head and neck of the fibula. As this nerve wraps
4|Page
Verified Answers 2025/2026 UPDATE |COMPLETE EXAM
TEST AND VERIFIED ANSWERS MULTIPLE CHOICES
WITH RATIONALES| ACCURATE ANSWERS|100%
SOLVED
Question:1
A 54-year-old male has a history of gout complicated by several prior episodes of
acute gouty arthritis and 3 prior instances of nephrolithiasis secondary to uric acid
stones. He has a serum uric acid level of 11 mg/dL (normal range 3-8 mg/dL), a 24
hr urine collection of 1300 mg uric acid (normal range 250-750 mg), and a serum
creatinine of 0.8 mg/dL with a normal estimated glomerular filtration rate (GFR).
Which of the following drugs should be avoided in this patient?
A. Naproxen
B. Colchicine
C. Allopurinol
D.Indomethacin
E. Probenecid - ANSWER-*E. Probenecid*
Uricosuric drugs, such as probenecid, should be avoid in patients with high uric
acid excretion (generally, > 800 mg/24hr is indicative of a uric acid
overproducer) because this increases the risk of forming uric acid stones.
1|Page
,Uricosuric medications should only be used in patients who underexcrete uric
acid. These agents should not be used in patients with a history of kidney
stones, unless the stones have been confirmed to NOT be uric acid stones.
Patients taking uricosuric agents should be instructed to have high fluid intake
to minimize the risk of uric acid precipitation and stone formation.
Question:2
*A 55-year-old male presents with left hip pain and stiffness. Radiographs are
shown in Figures A and B. Serum alkaline phosphatase levels are elevated. A
biopsy of the left femur is performed and shown in Figure C. Which of the
following cells are initially responsible for this condition?*
Figure A shows the skull with areas of lysis, areas of sclerosis ('cotton-wool
spots'), and calvarial thickening.
Figure B demonstrates coarsened trabeculae, cortical thickening, and
enlargement of the left femur.
Figure C is a histologic slide showing abnormal bone formation with a mosaic
pattern of woven bone and irregular sections of thickened trabecular bone and
numerous cement lines.
A. osteoblasts
B. osteoclasts
C. Neutrophils
D. TCells
E. fibroblasts - ANSWER-*B. osteoclasts*
The radiographs and histology are consistent with Paget disease, which is
initially caused by increased osteoclastic bone resorption, and followed by an
increase in bone formation through osteoblast activity.
2|Page
,Paget disease of the bone is a disorder of bone remodeling characterized by
rapid bone turnover. The excessive bone resorption and bone formation disrupt
normal bone architecture and lead to various complications such as bone pain,
osteoarthritis, pathological fracture, bone deformity, deafness, and nerve
compression syndromes.
Question:3
A 39-year-old male who recently presented with acetaminophen overdose was
admitted to the MICU, where several attempts were made at obtaining
intravenous access without success. The decision was made to place a right
axillary arterial line, which became infected and was removed by the medical
student while the patient was still intubated. It was later noticed that he had
substantial swelling and bruising of the upper extremity. Given his sedation, a
proper neuro exam was not performed at that time. Several days later, after the
patient's liver function improved, he was successfully extubated. On exam, he
complained of lack of sensation over the palmar and dorsal surface of the small
finger and half of the ring finger, as well as weak digit abduction, weak thumb
adduction, and weak thumb-index finger pinch of the affected extremity. What is
the most likely cause and corresponding location of the injury?
1. Needle in - ANSWER-*3. compression of ulnar nerve secondary to
coagulopathy*
The patient in this question has likely experienced compression of the brachial
plexus secondary to hematoma formation resulting from coagulopathy in the
setting of acetaminophen-induced hepatic failure.
The clotting cascade is disrupted when the liver in unable to produce clotting
factors. As such, without compression hematoma formation may occur upon
removal of arterial lines. A large hematoma in the axilla can cause compression
to the brachial plexus which in this case has resulted in motor and sensory
deficits to the ulnar nerve. The ulnar nerve is responsible for flexion, opposition,
3|Page
, and abduction of the small finger, as well as the sensory distribution discussed
in the question stem.
* Question:4
A 41-year-old male presents to your office with paresthesias on the lateral left
calf and the dorsum of the left foot that he reports has been worsening over the
past three months. An MRI of the lumbar spine was unremarkable. An MRI of the
left knee with a representative axial cut through the proximal tibiofibular joint is
shown in Figure A. Which of the following abnormal physical exam findings would
you expect to see in this patient?*
MRI shows T2 weighted MRI axial cut of a proximal tibiofibular joint showing a
cyst.
1. Inability to walk on his toes with the heel elevated on the left
2. Decrease Achilles tendon reflex
3. Positive Trendeleberg test
4. Decreased patellar tendon reflex on the left
5. Inability to walk on his heel with the forefoot elevated off the ground on the
left - ANSWER-*5. inability to walk on his heel w/ forefoot elevated off the
ground*
The clinical and radiographic presentation are consistent for proximal
tibiofibular joint cyst with compression of the common peroneal nerve.
Numbness on the lateral calf, dorsal foot, and weakness to ankle dorsi-flexion
and foot eversion would be the expected physical exam finding.
The common peroneal (fibular) nerve arises from the sciatic nerve at the apex of
the popliteal fossa where it passes laterally to the gastrocnemius muscle and
then superficially around the head and neck of the fibula. As this nerve wraps
4|Page
