USMLE practice questions set 5

Free USMLE practice questions are provided by: Kaplan Test Prep. Check out Kaplan USMLE Step 1 Qbank.

 

41. A 57-year-old woman with a history of hypertension and arthritis is referred to a rheumatologist for evaluation. A complete blood count (CBC) is normal, and a mini-chem panel shows no electrolyte abnormalities. Her erythrocyte sedimentation rate (ESR) is elevated, and an antinuclear antibody test (ANA) is positive. Further antibody studies are performed, and the results are shown below.

Anti-histones high titer

Anti-double stranded DNA not detected

Anti-single stranded DNA not detected

Anti-SSA not detected

Anti-SSB not detected

Anti-SCI-70 not detected

Anti-Smith not detected

Anti-centromere not detected

Anti-RNP not detected

Which of the following diseases is suggested by these results?

(A) CREST syndrome
(B) Diffuse form of scleroderma
(C) Drug-induced lupus
(D) Sjögren syndrome
(E) Systemic lupus erythematosus (SLE)
Answer 41

 

42. A 55-year-old hypertensive man develops sudden onset of excruciating pain beginning in the anterior chest, and then radiating to the back. Over the next 2 hours, the pain moves downward toward the abdomen. Which of the following is the most likely diagnosis?

(A) Aortic dissection
(B) Aortic valve stenosis
(C) Atherosclerotic aneurysm
(D) Myocardial infarction
(E) Syphilitic aneurysm
Answer 42

 

43. A 22-year-old woman presents to her physician with amenorrhea, weight loss, anxiety, tremor, heat intolerance, and palpitations. Laboratory examination is consistent with hyperthyroidism, and the physician prescribes propylthiouracil. The patient's response to propylthiouracil is disappointing, and the symptoms recur, then worsen. Subtotal thyroidectomy is successfully performed, but following the surgery, the woman is extremely hoarse, and can barely speak above a whisper. This hoarseness is most probably related to damage to a branch which of the following cranial nerves?

(A) Facial
(B) Glossopharyngeal
(C) Hypoglossal
(D) Trigeminal
(E) Vagus
Answer 43

 

44. A 54-year-old African-American woman undergoes a routine insurance physical examination. Chest x-ray film reveals bilateral hilar masses. Biopsy of the masses shows granulomata, but acid-fast and fungal stains are negative for organisms. Which of the following is the most likely diagnosis?

(A) Caroli disease
(B) Raynaud disease
(C) Sarcoidosis
(D) Scleroderma
(E) Systemic lupus erythematosus
Answer 44

 

45. A 67-year-old man is evaluated for persistent shooting pains, lower limb ataxia, and bladder dysfunction. Physical examination demonstrates small irregular pupils that constrict with accommodation but not in response to light. A VDRL test is positive. A CT scan of the spinal cord would most likely demonstrate atrophy of which of the following structures?

(A) Dorsal column
(B) Dorsal horn
(C) Lateral column
(D) Ventral column
(E) Ventral horn
Answer 45

 

46. An oncologist tells his patient that her laboratory results support a diagnosis of advanced malignant melanoma with multiple metastases to the liver and brain. He also advises her that the prognosis is poor. Which of the following is most likely to be the first statement that the patient will make?

(A) "Can you keep me alive until my daughter graduates from medical school?"
(B) "Damn you doctor, you should have caught this earlier!"
(C) "Doctor, you must be wrong."
(D) "I think it is time that I make a will and say good-bye to everyone."
(E) "It's no use, I always lose and get the short end of the stick."
Answer 46

 

47. A 44-year-old businessman presents to a physician because of a markedly inflamed and painful right great toe. He states that he just returned from a convention, and noticed increasing pain in his right foot during his plane trip home. Physical examination is remarkable for swelling and erythema of the right great toe as well as small nodules on the patient's external ear. Aspiration of the metatarsal-phalangeal joint of the affected toe demonstrates needle-shaped negatively birefringent crystals. Which of the following agents would provide the most immediate relief for this patient?

(A) Allopurinol
(B) Aspirin
(C) Colchicine
(D) Probenecid
(E) Sulfinpyrazone
Answer 47

 

48. A Guatemalan child with a history of meconium ileus is brought to a clinic because of a chronic cough. The mother notes a history of respiratory tract infections and bulky, foul-smelling stools. After assessment of the respiratory tract illness, the practitioner should also look for signs of

(A) cystinuria
(B) hypoglycemia
(C) iron deficiency anemia
(D) sphingomyelin accumulation
(E) vitamin A deficiency
Answer 48

 

49. During a fight, a 32-year-old man is hit on the back of the neck with a chair. A CT scan reveals a bony fragment that penetrated the lateral portion of the dorsal columns. Which of the following functions would most likely be affected by a lesion at this site?

(A) Fine motor control of the ipsilateral fingers
(B) Motor control of the contralateral foot
(C) Proprioception from the ipsilateral leg
(D) Sweating of the ipsilateral face
(E) Vibratory sense from the ipsilateral arm
Answer 49

 

50. A 61-year-old man presents with a chief complaint of difficulty swallowing. To evaluate his dysphagia, the physician orders a barium swallow with fluoroscopy, as well as an esophagogram. She finds that the anterior wall of the esophagus in the mid-thorax is being compressed. Which of the following structures is most likely responsible for this compression?

(A) Left atrium
(B) Left ventricle
(C) Pulmonary trunk
(D) Right atrium
(E) Right ventricle
Answer 50

 

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