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 24 year old medical student visits her physician for a refill of her treatment of depression. She is prescribed imipramine, a tricyclic antidepressant. During discussion of the treatment, her physician mentions that this drug undergoes first pass hepatic metabolism. The prescribed drug is most likely administered by which route? A) Intramuscular B) Intravenous C) Oral D) Subcutaneous E) Sublingual Read moreCookie Policy Drugs administered by oral route are the first drugs to reach portal hepatic circulation. They undergo first pass metabolism and they are bio transformed before they reach systemic circulation. The net result is either reduction or activation of the drug depending on the properties of each drug. Imipramine is methylated by hepatic enzymes and converted to an active metabolite. 2 / 20 2) A 56 year old man is taken to the emergency room after having grand mal seizure during a staff meeting. He has no history of seizure but he complains lately of recurrent headaches on the morning and decrease in intensity later in the day. Laboratory investigations and imaging studies are performed. Which of these tests will confirm the diagnosis of glioblastoma multiform? A) Brain biopsy B) CSF analysis C) Head CT scan D) MRI of the brain All tests would suggest the presence of occupying lesion in the brain but the only confirmatory test is the brain biopsy taken during operating on the tumor. It is a common question in the USMLE and it is a tricky one. You should read the question carefully and know the difference between regular primary test and confirmatory test. In this case the next test would be head CT scan but it is not confirmatory and eventually it is not the correct answer. 3 / 20 3) A 65-year-old man is scheduled for a repair of an abdominal hernia. The patient has an abdominal hernia that can be reduced by pushing the contents of the abdomen back through the external ring. While performing the repair, the surgeon observes that the hernial sac is protruding from the superior abdominal wall to the inguinal ligament. It is also medial to the inferior epigastric vessels. After observing all these, what can be concluded about the type of a hernia the patient is suffering from? A) Direct inguinal hernia B) Indirect inguinal hernia C) Femoral hernia D) Hiatal hernia The patient is suffering from a direct inguinal hernia. This type of hernias is known to protrude direction through the abdominal wall in the Hesselbach triangle. This is surrounded by the inguinal ligament, the inferior epigastric vessels, and the rectus abdominis muscle. The patient’s abdominal contents passed through the wall of the abdomen and went through the external inguinal ring. Many older patients are often diagnosed with direct inguinal hernias. This is because, over a period of time, the pressure and tension exerted on the hernia eventually causes the abdominal wall to give way. 4 / 20 4) A 37-year-old woman presents to the emergency room complaining of general tingling sensation all over her body and spasm of her right hand for 1 hour. Her spasm is worsening and she feels as her body becomes more rigid. She had undergone subtotal thyroidectomy 2 weeks ago and the incision is healed and clean. Blood tests reveal very low serum calcium level. What should be the immediate therapy to reverse her symptoms? A) Vitamin D B) Calcitonin C) Calcium gluconate D) Levothyroxine E) Parathyroid hormone Low levels of parathyroid hormone (PTH) occur due to loss of parathyroid glands during thyroid surgeries or after the use of radioactive iodine for the treatment of hypothyroidism. This condition leads to low calcium and high phosphorus serum levels. IV Calcium gluconate is the treatment of choice for severe hypocalcemia. Long term treatment with vitamin D and parathyroid hormone should be initiated as soon as diagnosis is confirmed. 5 / 20 5) A 42-year-old man complains of rash and itching. He has no fever, headache or myalgia. On examination, there is maculopapular rash on the abdomen, palms of the hands and soles of the foot. There are also hypertrophic wart-like lesions around the anal area. Cervical, occipital and inguinal lymph nodes are enlarged. CBC shows marked increase in lymphocytes. What is the most appropriate laboratory test to confirm his diagnosis? A) Nucleic acid amplification test for chlamydia B) Serology for Human papilloma virus C) VDRL for syphilis D) Biopsy of the anal lesions E) Stool and urine analysis This patient most probably has secondary syphilis characterized by rash involving palms of the hands and soles of the feet. It is also characterized by condyloma lata, which are hypertrophic wart-like lesions and specific for syphilis. VDRL test is positive in all cases of secondary syphilis. 6 / 20 6) A 16-year-old high school student presents to the office with her mother for consultation. Her mother admits that her daughter is sad because she broke up with her friend recently. Yesterday, she tried to cut her wrist but her brother screamed and they stopped her. The girl does not make eye contact and her head is bent down through the interview. She tells the doctor that she does not want to live anymore. She refuses to answer any question and declined physical examination. What is the most appropriate next step of management for this patient? A) Admit to the hospital B) Refer to the psychiatric clinic next day C) Refer to the social worker D) Prescribe antidepressant and follow up in a week E) Advise family that it is a normal reaction and keep an eye on her The role of thumb in cases of suicide attempts is hospitalization and everything else would come after that. This is a common question in all steps of USMLE and you will see this case a lot in practice. Any interaction other than admission to the hospital is considered a high liability and will lead to a lawsuit. 7 / 20 7) Which one of the following drugs is often added to nasal decongestants? A) Albuterol B) Epinephrine C) Norepinephrine D) Phenylephrine 8 / 20 8) Primitive spermatogenic germ cells are located in which one of the following sites? A) Interstitium of the testes B) Seminal vesicles C) Seminiferous tubules D) Vas deferens 9 / 20 9) Which of the following is the percentage of thymine in a DsDNA if it contains 20% guanine? A) 20% B) 30% C) 40% D) 50% 10 / 20 10) Administration of clopidogrel with aspirin is an example of which of the following drug interactions? A) Additive B) Permissive C) Synergistic D) Tachyphylactic 11 / 20 11) Which of the following correctly describes pleiotropy? A) Increased severity of a disease in succeeding generations B) Not all individuals with mutant genotype show the same mutant phenotype C) One gene contributes to multiple phenotypic effects D) Phenotype is always the same among individuals having the same genotype 12 / 20 12) Which of the following differentiates HIV virus from RNA tumor viruses? A) HIV virus contains 2 copies of RNA B) HIV virus contains the pol gene C) HIV virus has a cytolytic activity D) HIV virus is a retrovirus 13 / 20 13) Organophosphorus poisoning can be treated with which of the following agents? A) Atenolol B) Atropine C) Ipratropium bromide D) Physostigmine It blocks the action of acetyl choline peripherally and though CNS. Atenolol has no role in this case. Ipratropium bromide doesn’t penetrate BBB and physostigmine would worsen the case. 14 / 20 14) Which of the following is the mechanism of action of flumazenil in the treatment of lorazepam toxicity? A) Competitive inhibition at benzodiazepine receptors B) Inhibition of alpha adrenoceptors C) Noncompetitive inhibition of benzodiazepine receptors D) Stimulation of dopamine receptors Flumazenil reverses the action of benzodiazepines on GABA receptors. 15 / 20 15) Which of the following is the mechanism of action of zileuton for asthma? A) Inhibition of 5-lipoxygenase B) Inhibition of phosphodiesterase C) Inhibition of Phospholipase A D) Stimulation of beta-2 receptors This mechanism inhibits the synthesis of leukotrienes from arachidonic acid. 16 / 20 16) Which one of the following medications should be taken on an empty stomach and at least one hour before meals? A) Aspirin B) Levothyroxine C) Prednisone D) Propranolol The only one on the list that should be taken that way. Other drugs on the list should be taken with food. 17 / 20 17) In which one of the following locations a mural thrombus commonly occurs following myocardial infarction? A) Left atrium B) Left ventricle C) Right atrium D) Right ventricle E) Thoracic aorta Ischemic heart disease commonly affects the left ventricle. Mural thrombi develop due to damage of the left ventricle. They are common in the right atrium in cases of mitral stenosis. 18 / 20 18) Which of the following agents most likely causes vasoconstriction? A) Bradykinin B) Histamine C) Nitric oxide D) Norepinephrine This is the only one on the list can cause vasoconstriction. The others cause vasodilation. 19 / 20 19) Which one of the following types of cells is programmed to destroy cells the fail to display MHC class 1 antigen properly? A) B lymphocyte B) CD4 lymphocyte C) CD8 lymphocyte D) Natural killer cells These cells play an important role in clearing viral infections if the virus downregulates MHC expression. 20 / 20 20) A 78 year-old patient is admitted to the hospital for treatment of pneumonia. On the third day, the nurse noticed that his heart rate is 150/min. and blood pressure is 116/86 mmHg. The patient is stable with no chest pain or shortness of breath. His ECG shows saw tooth pattern with no other abnormalities. What is the most appropriate next step of management of this patient? A) Start heparin B) Start metoprolol C) Order cardiac enzymes D) Perform electric cardioversion E) Refer to a cardiologist This patient has atrial flutter which is common in elderly hospitalized patients. He needs urgent rate control by metoprolol before conducting any further investigations. 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:
