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) Which of these medications is contraindicated in a case of cardiogenic shock? A) Dopamine B) Intravenous fluids C) Metoprolol D) Norepinephrine Read moreCookie Policy The treatment of all types of shock should include supportive care, intravenous fluids and other medications depends on the cause of shock. Beta blockers are contraindicated in cardiogenic shock as it worsens hypotension. Dopamine and norepinephrine can be used in case of very low ejection fraction and hypotension. 2 / 20 2) A 65-year-old man presents with gradual low back pain increasing in intensity for the last six months. X-ray shows several osteoblastic lesions on lower vertebra and pelvic bones. Additional investigations reveal that those lesions are metastases. Which of these is most likely the primary cancer in this patient? A) Chronic lymphocytic leukemia B) Hodgkin’s lymphoma C) Prostatic cancer D) Renal cell carcinoma E) Thyroid follicular carcinoma Prostatic cancer, besides it is the most common malignant tumor in men after lung cancer, is known also by osteoblastic metastasis to bones, especially the vertebral column. Other tumors metastasize to the bones in the form of osteolytic lesions. 3 / 20 3) A 2-month-old child is brought to the clinic by his parents with a complaint of failure to thrive. During an examination, the baby suffers a seizure. Test of stat serum chemistries indicates hyperlipidemia, severe hypoglycemia, ketosis, and lactic acidosis. Hepatomegaly is also confirmed by both physical examination and CT scan. Which of the following conditions is the child suffering from based on these findings? A) Gaucher disease B) Niemann-Pick disease C) Pompe disease D) Von Gierke disease Also known as glycogen storage disease type 1, Von Gierke disease, is a condition where the body is unable to break down glycogen, which is a form of glucose (sugar) that is stored in muscles and liver. Glycogen is broken down into glucose to give more energy through glycogenolysis. The condition is marked by low blood sugar, slow growth rate, weak muscles, enlarged liver, heat intolerance, etc. 4 / 20 4) A 27-year-old pregnant woman in her sixth week presents for her first prenatal visit. Ultrasound confirms fetal cardiac activity and length consistent with 6 weeks of pregnancy. It also shows a simple cyst measures 4-cm on the left ovary. What is the best next step of management? A) Assurance and follow up on next visits B) Hormonal treatment C) Surgical removal of the cyst D) Termination of pregnancy E) Wide spectrum antibiotics to prevent infection This cyst is most likely the corpus luteum of pregnancy. It is significant for sustaining pregnancy through production of progesterone. Assurance and follow up for size and symptoms is recommended in the first trimester. 5 / 20 5) A 45-year-old man who was diagnosed with malaria and received anti-malarial medication presents to the office with progressive fatigue and loss of appetite. He also mentions that he noticed that his urine has become dark lately. Urinalysis is positive for both bilirubin and urobilinogen. Blood studies show serum total bilirubin of 4.3 mg/dL, hemoglobin concentration of 8.5 g/dL and hematocrit of 30%. Which medication is used to treat this patient? A) Atovaquone B) Chloroquine C) Doxycycline D) Primaquine This is a case of hemolytic anemia due to glucose-6-phosphate dehydrogenase (G6PD) deficiency. This anemia is caused by lack of reduced glutathione secondary to decreased production of NADP. Accumulation of oxidizing metabolites such as peroxides and other free radicals in the red blood cells leads to their lysis and resulting in hemolytic anemia. G6PD deficiency is induced by some drugs such as primaquine, sulfonamides, nitrofurans, phenacetin, vitamin K derivatives, dapsone, phenazopyridine and methylene blue. Atovaquone is used in combination with proguanil in prophylaxis of malaria. It is not associated with G6PD deficiency. Chloroquine is effective in eradication of blood schizonts and is not associated with hemolytic anemia and so is doxycycline. 6 / 20 6) A 51-year-old man is brought to the emergency room because of severe abdominal pain which is radiating to his back. Today, the patient had many episodes of vomiting. He is an alcoholic, drinking daily but he does not smoke or take any recreational drugs. On physical examination, the patient is lying down in the fetal position and appearing to be ill and febrile. There is also an area of bluish periumbilical discoloration on the skin of his abdomen. However, there is no flank discoloration. There are also reduced bowel sounds and he is having severe mid epigastric tenderness upon palpitation. The rectal examination is normal. What is your primary diagnosis? A) Appendicitis B) Pyelonephritis C) Necrotizing pancreatitis D) Acute cholecystitis Necrotizing pancreatitis is a condition where acute pancreatitis develops severe complications. The pancreas becomes inflamed, leaking its enzymes into the other parts of the pancreas. These enzymes can cause the death of the pancreatic tissue, thus causing necrotizing pancreatitis. Once the dead tissue becomes infected, it can lead to life-threatening complications. Immediate surgery for removing the dead tissue and medical treatment are required. 7 / 20 7) A 35-year-old unresponsive man is brought to the emergency room after an episode of agitation and confusion. He has a history of inadequately treated Graves’ disease. Physical examination reveals temperature of 102.5F. Blood pressure of 100/70 mm Hg, and pulse of 165 per minute. After stabilizing this patient, which of the following would be the best pharmacotherapy for treating his underlying condition? A) Dobutamine B) Iodine C) Levothyroxine D) Propylthiouracil E) Warfarin The patient is brought unconscious due to a medical emergency commonly known as a ‘thyroid storm’. It is a rare condition occurs due to inadequate treatment of Grave’s disease and thyrotoxicosis. Once primary stabilization has been carried out, propylthiouracil or methimazole will be the best pharmacologic treatment as it will prevent the endogenous synthesis of thyroxine from taking place in the body, thus preventing worsening of the patient’s condition and hopefully preventing future episodes. 8 / 20 8) Which one of the following complications is the common cause of death in acromegaly? A) Heart failure B) Hepatic failure C) Splenic infarction D) Renal failure 9 / 20 9) Which of the following defense mechanisms is most likely associated with paranoia? A) Projection B) Splitting C) Superego lacunae D) Undoing 10 / 20 10) Which of the following laboratory tests is diagnostic for adrenal insufficiency? A) ACTH stimulation test B) CT scan of adrenal gland C) Serum ACTH D) Serum cortisol 11 / 20 11) Which of the following is the most sensitive test for myocardial infarction? A) Creatine kinase myocardial fraction (CK-MB) B) Lactose dehydrogenase (LDH) C) Troponin-1 D) Troponin-C 12 / 20 12) Which of the following medications is selectively used in NSAID-induced gastric ulcer? A) Bismuth B) Cimetidine C) Famotidine D) Misoprostol NSAIDs inhibit the synthesis of prostaglandins which is GI protective. 13 / 20 13) Which one of the following anti-depressant drugs is contraindicated if the patient has a history of seizures? A) Bupropion B) Fluoxetine C) Imipramine D) Venlafaxine This is the only one on the list that may worsen or even cause seizures. 14 / 20 14) A 56-year-old woman is found to have elevated intraocular pressure during a routine eye examination. Examination also reveals normal optic disc and open angle of the eye. Her doctor explains to her that her condition is probably due to increased secretion of aqueous fluid. This fluid is produced by which of the following structures? A) Endothelial cells of the cornea B) Epithelial cells of the ciliary body C) Epithelia cells of the cornea D) Epithelial cells of the retina It is only source of aqueous fluid which flows inside the chambers of the eye and leaves through canal of Schlemm. 15 / 20 15) Injury of the which of the following nerves results in loss of sensations of over the right scrotum and the medial side of the thigh? A) Genitofemoral nerve B) Ilioinguinal nerve C) Lateral cutaneous nerve D) Pudendal nerve A supplies motor of cremaster muscles, B supplies skin over the lateral side of the thigh and D supplies external anal sphincter and a part of the dorsal skin of the scrotum. 16 / 20 16) Which of the following insects is the victor responsible for transmission of Rocky Mountain spotted fever? A) Flea B) Louse C) Mite D) Tick 17 / 20 17) A young man was stuck on his leg by a falling rack a week ago. Today, a purple bruise developed on the site of injury. Which one of the following substances is responsible for the color at the site of injury? A) Bilirubin B) Hemosiderin C) Melanin D) Thromboplastin Heme pigment of the blood is transformed into yellowish brown hemosiderin granules which are accumulated at the site of injury resulting in the purple color of the bruise. 18 / 20 18) Which one of the following anti-arrhythmic drugs may lead the development of torsade de pointes at therapeutic doses? A) Adenosine B) Lidocaine C) Propranolol D) Quinidine Its use is very strict due to this fatal side effect. 19 / 20 19) Which one of the following tumors is commonly associated with mutations affecting tumor suppressor gene (APC) and TP 53? A) Colorectal adenocarcinoma B) Hepatocellular carcinoma C) Invasive ductal carcinoma of the breast D) Small cell carcinoma of the lung It commonly affects the intestinal epithelium of the colon and rectum. It counts for 95% of colorectal cancers. 20 / 20 20) Which of the following cell types is responsible for forming the blood brain barrier (BBB)? A) Astrocytes B) Microglia C) Oligodendrocytes D) Schwann cells Microglia mediates immune response, Oligodendrocytes produce myelin in the CNS and SC produce myelin in peripheral NS. 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:
