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) An 18 year-old student visits her physician for a routine physical examination. She has no complaints. Physical examination is unremarkable except for a mid-systolic click followed by a late systolic murmur heard at the lower left sternal border and apex. The murmur duration increases in standing and shortens with squatting. Electrocardiogram (ECG) shows no abnormalities. Which of the following is the most likely diagnosis of this condition? A) Mitral stenosis B) Aortic stenosis C) Mitral valve prolapse D) Tricuspid regurgitation E) Dilated cardiomyopathy Read moreCookie Policy The only diagnosis that matches the described murmur is mitral valve prolapse. Patients with MVP are usually asymptomatic and only diagnosed accidently or due to progress to mitral regurgitation. Normal ECG findings support this diagnosis. Mitral valve prolapse is confirmed by echocardiography. 2 / 20 2) A 25-year-old woman presents to the clinic complaining of general aches for two years. Pain is getting worse over the past 3 months. Every morning, she has stiffness all over her body, which is usually relieved in about 5-10 min. She has no history of trauma or any medical condition. Her BMI is 21 and she has no rash or joint swelling. She has multiple tender points. All laboratory investigations are within normal limits. What is the most appropriate management of this patient? A) Perform electromyogram (EMG) B) Perform nerve conduction studies C) Start duloxetine D) Start hydrocodone E) Start prednisone This patient most likely has fibromyalgia. It is diagnosed clinically depending on the presence of multiple tender points with the absence of any rash or joint swelling. The treatment of choice of fibromyalgia is duloxetine as it is approved to have positive results in many cases. In case of failure of medical treatment, investigations as EMG and nerve conduction studies can be done to exclude other conditions. 3 / 20 3) A 73-year-old man with a history of benign prostatic hyperplasia (BPH) presents to the emergency room complaining of repeated falls. His wife admits that during the past 3 weeks he has had unsteady gait, urinary incontinence and memory disturbances. His medical, surgical and family histories are unremarkable. He has never smoked or taken any recreational drugs. He drinks alcohol socially. His laboratory tests are all normal. A CT scan of the head shows slightly enlarged ventricles and slightly compressed gyri. What is the most likely diagnosis of this patient’s condition? A) Normal pressure hydrocephalus B) Alzheimer’s disease C) Middle cerebral artery stroke D) Anterior pituitary adenoma E) Trauma to the head due to elderly abuse This is a typical presentation of normal pressure hydrocephalus. It is characterized by unsteady gait, urinary incontinence and dementia. The combination of these symptoms is diagnostic of this condition. Other options are characterized by one or two of these symptoms and other signs as well. A CT scan is always performed in old age with similar symptoms to exclude hematomas and confirm the diagnosis. 4 / 20 4) A 37-year-old woman complains of watery diarrhea, abdominal cramps and periodic facial flushing for the last six months. Examination reveals bilateral wheezing and slightly enlarged liver. Urine analysis shows high levels of 5-hydroxyindoleacetic acid (5-HIAA). Multiple tumors are detected by a CT scan. What is the most likely primary site of these tumors? A) Colon B) Esophagus C) Small Intestine D) Stomach This is a typical presentation of carcinoid tumors which arise from the neuroendocrine cells. The most common site of these tumors is the small intestine (50%). Other less common sites are the colon and the tip of the appendix. They secrete serotonin and histamine which are responsible for these symptoms. Serotonin secreted by these tumors is inactivated to 5-HIAA by the liver which excreted in urine. When the tumors spread to the liver, the secretion of serotonin bypass the inactivation of it resulting in carcinoid syndrome which is featured in this patient. 5 / 20 5) A 26-year-old man presents to the clinic with a complaint of recurrent episodes of bloating, flatulence and diarrhea following eating dairy products. He mentions that he does not experience these symptoms if he does not drink milk or if he is fasting. What is the most likely cause of diarrhea in this patient? A) Inflammatory B) Osmotic C) Psychogenic D) Secretory These symptoms indicate lactase insufficiency, known as lactose intolerance. Presence of non-absorbable osmotically active substance such as lactose in the intestinal lumen leads to osmotic diarrhea. Osmotic diarrhea also occurs after ingestion of magnesium-containing laxatives as Milk of Magnesium. Other types of diarrhea do not subside after fasting or avoiding dairy products which confirm the diagnosis of lactose intolerance. 6 / 20 6) Which of the following is the mechanism of action of vinblastine? A) Interferes with DNA mobilization and replication B) Interferes with microtubule assembly C) Interferes with microtubule disassembly D) Interferes with purine synthesis 7 / 20 7) What is the most common cause of abdominal aortic aneurysm? A) Atherosclerosis B) Complication of coronary artery disease C) Post-inflammatory D) Post-operative 8 / 20 8) Which one of the following local anesthetics can NOT be given parenterally due to its physicochemical properties? A) Benzocaine B) Etidocaine C) Mepivacaine D) Procaine 9 / 20 9) Which of the following is a characteristic finding in isopropanol poisoning? A) Blindness due to ocular accumulation B) Elevated anion gap C) Elevated serum BUN and creatinine D) Ketosis without acidosis 10 / 20 10) Failure of degeneration of the urachus may lead to which of the following defects? A) Bladder adenocarcinoma B) Bladder exstrophy C) Polycystic kidney disease D) Renal agenesis Persistent urachus creates a fistula between the bladder and umbilicus and gives rise to cysts which are potential sites of bladder adenocarcinoma. 11 / 20 11) Bicornuate uterus results from failure of the fusion of which of the following structures? A) Mesonephric ducts B) Nephrogenic ridges C) Paramesonephric ducts D) Urogenital sinus Uterus is developed by the fusion of the caudal ends of the paramesonephric ducts. 12 / 20 12) Which of the following in the most likely cause of spontaneous abortion in the first trimester? A) Chromosomal abnormalities B) Congenital infection C) Maternal drug use D) Toxemia of pregnancy Fetal abnormalities are the most common in the first trimester while maternal problems usually cause abortion in the second and third trimesters. 13 / 20 13) Which of the following substances lines the vesicles that involved in LDL uptake by hepatocytes? A) Chylomicrons B) Clathrin C) Laminin D) Transferrin Clathrin-coated vesicles carry the LDL into the cytoplasm of hepatic cells. 14 / 20 14) A 58-year-old man takes verapamil for hypertension and angina. Which of the following is a common adverse effect of high dose of this drug? A) Constipation B) Diarrhea C) Hyperglycemia D) Sexual dysfunction This is a common side effect of calcium channel blockers and could be dose limiting. Other side effects are hypotension, bradycardia and peripheral edema. 15 / 20 15) Which one of the following antihypertensive medications is NOT safe in pregnancy? A) Labetalol B) Lisinopril C) Nifedipine D) Methyldopa ACE inhibitors are NOT safe in pregnancy as they are teratogenic. Other options are safe during pregnancy. 16 / 20 16) In a case of methemoglobinemia, which one of the following is the most likely cause of the brown color of the patient’s blood? A) Carbon monoxide B) Decreased oxygen affinity C) Oxidized hemoglobin D) Reduced hemoglobin The brown color is due the oxidation of the iron in the hemoglobin to ferric state (methemoglobin). 17 / 20 17) Which one of the following joints is the only articulation between the upper limb and the trunk? A) Acromioclavicular joint B) Coracoclavicular joint C) Glenohumeral joint D) Sternoclavicular joint This is the only articulation between the upper limb and the trunk. Other joints are between bones of the upper limb. 18 / 20 18) A 40-year-old woman complains of swelling in her neck. Examination reveals a small, non-tender nodule in her thyroid. Which of the following is the best next step of action? A) Excisional biopsy B) Fine needle aspiration C) T4 and TSH levels D) Ultrasound of the thyroid It is the best next step to exclude malignancy. Malignant nodules are not functional. 19 / 20 19) Periumbilical discoloration is found in a patient diagnosed with acute pancreatitis. Which of the following signs is considered positive in this patient? A) Cullen’s sign B) Grey Tunner sign C) Murphy’s sign D) Nikolsky’s sign It is positive if periumbilical discoloration is found in abdominal examination. B- Flank discoloration is also seen in acute pancreatitis. C- It is positive in acute cholecystitis. D- It is positive in pemphigus vulgaris. 20 / 20 20) A 69-year-old man presents to the clinic with his wife for evaluation of his memory problem. His wife tells you that her husband has begun to forget recent events insidiously since last year. He forgets recent conversations and recent appointments. He is no longer able to manage his checkbook and daily budget as he used to do. He has no history of general medical condition and he only takes baby aspirin daily. His examination is normal. Mini mental status examination reveals prominent memory loss. MRI shows a few areas of cerebral atrophy. Which of the following is the most likely diagnosis? A) Old age dementia B) Alzheimer’s disease C) Vascular dementia D) Lewy body dementia E) Creutzfeldt-Jakob disease This patient has an insidious history of disturbed memory and difficulty with daily activities. Progressive dementia as well as gradual difficulty in daily life activities is a common feature of Alzheimer’s disease. MMSE and MRI are also consistent with this diagnosis. The patient is not too old and there are no other symptoms or previous medical conditions that suggesting any of the other choices. 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:
