1103 USMLE QUESTIONS BANK November 16, 2022 1 Min Read 1 USMLE QUESTION BANK USMLE quiz helps us to increase our knowledge Read moreScrape Multiple-Choice Questions from the Web1 / 20 1) A 65 year-old woman presents to the emergency room for transient loss of consciousness. While she was walking with her husband today, she felt lightheaded and lost her consciousness for a few minutes then, she made a full recovery. On examination, her pulse is 86/min. and her blood pressure is 148/82. On auscultation, there is a systolic ejection murmur heard at the 2nd right intercostal space and radiates to the carotids. Lungs are clear bilaterally. What is the most likely diagnosis? A) Mitral stenosis B) Mitral regurgitation C) Aortic stenosis D) Aortic insufficiency E) Pulmonic stenosis Read moreCookie Policy This is a typical presentation of aortic stenosis with the typical murmur, mid systolic crescendo-decrescendo ejection murmur heard loudest at the second right intercostal space. Aortic stenosis causes low blood ejected to the carotids and eventually less blood to the brain, which causes transient loss of consciousness. 2 / 20 2) A 54 year-old man with a history of chronic obstructive pulmonary disease (COPD) presents by his son to the emergency room semi-unconscious with shortness of breath. He has nausea, diarrhea and restlessness for the last four hours. His arterial oxygen saturation is 88% with room air. His ECG shows normal sinus rhythm with non-specific changes in lateral leads. The patient uses albuterol inhalation, ipratropium bromide, theophylline and Lisinopril. Three days ago, he had an exacerbation of his COPD and was prescribed ciprofloxacin and supplemental oxygen at night and during ambulation. What is the most likely cause of this patient presentation to the ER? A) Interaction of ciprofloxacin to albuterol B) Interaction of ciprofloxacin to ipratropium bromide C) Interaction of ciprofloxacin to theophylline D) Interaction of ciprofloxacin to Lisinopril E) Interaction of ciprofloxacin to oxygen Ciprofloxacin administration leads to increase in the level or effect of oral theophylline by altering the drug metabolism. Combination may lead to theophylline toxicity and life-threatening interaction. Other drugs mentioned above do not have any undesirable interaction with ciprofloxacin. 3 / 20 3) A 5-year-old boy is brought to the ER by his mother. He has fever, cough, lethargy, headache and neck pain. On examination, his temperature is 103.2 F, his neck is rigid and tender and Kernig sign is positive. CSF is clear and significant for glucose 60 mg/dL, protein 80 mg/dL, no bacteria or pus cells and lymphocytes count is 70%. What is the most likely causative organism? A) Echovirus B) Neisseria Meningitidis C) Streptococcus Bovis D) Streptococcus Pneumonia E) Staphylococcus Aureus History and clinical picture suggest meningitis. CSF analysis suggests viral infection rather than bacterial. Echovirus is the only choice that most likely the causative organism in this case. 4 / 20 4) Workers in the aniline dye industry are more susceptible to bladder cancer than general population. Meanwhile, studies show that animals, when exposed to beta-naphthylamine develop liver cancer but not bladder cancer. What is the most likely explanation of this finding? A) Metabolism of beta-naphthylamine by human cytochrome 450 system in the liver B) Detoxification of beta-naphthylamine by glucuronic acid conjugation. C) Human urinary glucuronidase splits beta-naphthylamine into glucuronic acid and a toxic metabolite. D) Beta-naphthylamine is directly carcinogenic to human bladder Urinary glucuronidase is found only in human. It splits beta-naphthylamine into glucuronic acid and a toxic carcinogenic metabolite. This metabolite is the responsible agent for bladder cancer in human. Other options are distractions. 5 / 20 5) A 74-year-old man presents to the clinic with a complaint of palpitation and lightheadedness. Image studies revealed blockage of the artery to the SA node. This artery arises from which of these arteries? A) Left coronary artery B) Right coronary artery C) Circumflex artery D) Anterior interventricular artery E) Posterior interventricular artery The artery to the SA node is supplied by the right coronary artery. 6 / 20 6) Researchers perform a study on foot ulcers caused by diabetes. They collect patients of foot ulcers and divided them into a group of patients with diabetes and another group of non-diabetic patients. The researchers compute the rate of foot ulcers in diabetic patients versus non-diabetic patients. This study is considered: A) Case-control study B) Cohort study C) Longitudinal study D) Cross-sectional study E) Double-blind study This study is case-control study as it is retrospective and compared an odds ratio. It is not prospective because the patients already had foot ulcers. 7 / 20 7) A 23-year-old woman was involved in a motor car accident three days ago. She was hypotensive and diagnosed with internal bleeding. She received several units of blood. Today her urine output is very low for the last six hours. Her urinalysis showed hematuria, proteinuria, muddy brown epithelial cells and granular casts. Her lab tests also show BUN: 26 mg/dL and serum creatinine: 2.6 mg/dL. What is the most likely diagnosis of her renal pathology? A) Acute glomerulonephritis B) Interstitial nephritis C) Acute tubular necrosis D) Traumatic avulsion of the ureter Acute tubular necrosis (ATN) is the most likely pathology in this case. It is caused by decrease in blood volume which leads to prerenal azotemia. The most common cause of renal failure associated with prerenal azotemia is acute tubular necrosis. It is characterized by rapid decline of renal function and acute elevation of blood urea and serum creatinine. The BUN/creatinine ratio is usually normal as in this case. The muddy brown epithelial cells and granular casts are also typical in ATN. Acute glomerulonephritis is characterized by the humpy lumpy appearance under light microscope and sub epithelial humps under electron microscope. It is type III hypersensitivity forming immune complexes (antigen-antibody complexes) which deposit below the podocyte foot processes of the basement membrane of the glomeruli. It occurs mainly after streptococcal infection. Interstitial nephritis is inflammation of the kidney tissue that surrounds the tubules. It is caused mainly as a side effect of some drugs or post-infection. It is characterized by eosinophilia and eosinophiluria. Traumatic avulsion of the ureter is mainly occurs as a complication of ureteroscopy. There is no mention to any surgery or trauma of any kind in this patient’s history. 8 / 20 8) Which one of the following drugs is a beta blocker (Class II)? A) Amiodarone B) Carvedilol C) Procainamide D) Verapamil 9 / 20 9) Which of these drugs inhibits epoxide reductase? A) Aspirin B) Heparin C) Streptokinase D) Warfarin 10 / 20 10) Which one of the following cell markers is unique for NK cells? A) CD14 B) CD16 C) CD40 D) CD56 11 / 20 11) Which of the following organisms is associated with pneumonia precipitated by aerosolized water (air conditions)? A) Chlamydophila pneumonia B) Legionella pneumophila C) Mycoplasma pneumonia D) Pneumocystis jirovecii 12 / 20 12) Which one of the following conditions most likely shows lower than normal erythrocyte sedimentation rate (ESR)? A) Giant cell arteritis B) Multiple myeloma C) Polycythemia D) Pregnancy 13 / 20 13) A young man complains of syncope, dyspnea and chest pain after exercise. A crescendo-decrescendo systolic murmur is heard over the left sternal border without radiation. What is the most likely etiology? A) Aortic dissection B) Aortic regurgitation C) Aortic stenosis D) Hypertrophic cardiomyopathy 14 / 20 14) Which one of the following medications is used for cases of Parkinson’s disease and influenza type A? A) Amantadine B) Benztropine C) Bromocriptine D) Ribavirin 15 / 20 15) The tracheal tube is originated from which of the following structures? A) Ductus arteriosus B) Foregut C) Fourth pharyngeal arch D) Third pharyngeal arch Trachea and lungs are originated from invagination in the foregut. 16 / 20 16) A liposomal preparation of which one of the following medications may reduce the incidence of renal toxicity? A) Acyclovir B) Amphotericin B C) Ketoconazole D) Vancomycin It decrease creatinine clearance leading to renal toxicity which can be reduced by using a liposomal preparation of amphotericin B. 17 / 20 17) Which of the following conditions may occur as a result of a long umbilical cord? A) Abruptio placenta B) Amnion nodosum C) Nuchal cord D) Placenta previa It is usually discovered during delivery When the cord wraps around the fetus. It causes very rare complications such as compromised blood supply to the fetus. 18 / 20 18) Which one of the following gastrointestinal conditions is NOT associated with blood in stools? A) Cancer colon B) Diverticulosis C) Irritable bowel syndrome D) Ulcerative colitis 19 / 20 19) A young woman presents with chronic diarrhea found to have rectovaginal fistula. Which of the following is most likely her diagnosis? A) Celiac disease B) Crohn’s disease C) Ischemic colitis D) Ulcerative colitis 20 / 20 20) Heparin acts by binding to which of the following substances to achieve its anticoagulant activity? A) Antithrombin III B) Factor V C) Factor VIII D) Prothrombin Antithrombin III- Heparin binds to this coagulation inhibitor to increase its activity. Other choices are clotting factors and do not interact with heparin. Your score is 0% Restart quiz Uncategorized Show Comments Leave a Reply Cancel reply Save my name, email, and website in this browser for the next time I comment. Hover or click the text box below Share Article:
