USMLE practice questions set 6

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


51. The table below depicts blood pressure values taken from six adults. Which set of values is most consistent with aortic regurgitation?

Systolic pressure (mm Hg)

Diastolic pressure (mm Hg)



















Answer 51


52. In a hospital cardiac care unit, there are three patients with different cardiac conditions: a 52-year-old man with dilated cardiomyopathy, an 18-year-old girl with mitral valve prolapse, and a 30-year-old man with infective endocarditis of the mitral valve. Which of the following features do all these patients most likely share?

(A) Decreased compliance
(B) Depressed myocardial contractility
(C) Infectious etiology
(D) Mitral valve stenosis
(E) Risk of systemic thromboembolism
Answer 52


53. A 68-year-old man sustains a myocardial infarct resulting from thrombotic occlusion at the origin of the left circumflex artery. Cardiac catheterization demonstrates that the patient has a left dominant coronary circulation. In which of the following areas of the heart has ischemic necrosis most likely occurred?

(A) Apex of left ventricle and anterior portion of septum
(B) Lateral left ventricular wall and posterior portion of the septum
(C) Lateral wall of the left ventricle only
(D) Posterior portion of the septum only
(E) Right ventricular wall
Answer 53


54. A patient arrives in the emergency department after having been stabbed. He has sustained a penetrating wound in the left fourth intercostal space immediately lateral to the sternal border. Which of the following thoracic structures is most likely to have been injured?

(A) Left atrium
(B) Left ventricle
(C) Right atrium
(D) Right ventricle
(E) Upper lobe of the left lung
Answer 54


55. A 14-year-old boy has just moved with his family from Brazil to the U.S. He starts complaining of shortness of breath and palpitations. Chest x-ray films demonstrate pulmonary congestion, and EKG shows alterations in heart rhythm. Echocardiography reveals biventricular dilatation with massive cardiac enlargement. An endomyocardial biopsy shows diffuse interstitial fibrosis, myocyte necrosis, chronic inflammation, and the presence of intracellular protozoan parasites. The patient may also develop which of the following complications?

(A) Achalasia
(B) Chronic arthritis
(C) Cysts in the brain
(D) Pleuritis
(E) Splenomegaly
Answer 55


56. A 65 year-old man is admitted to the coronary care unit with a diagnosis of a large myocardial infarct (MI) of the left ventricle. On his 6th postinfarct day, he goes into shock and dies, manifesting signs and symptoms of cardiac tamponade. Which of the following complications is the most likely cause of this patient's death?

(A) Aortic dissection
(B) Extension of previous MI
(C) Fatal arrhythmia
(D) Rupture of the left ventricular wall
(E) Rupture of papillary muscle
Answer 56


57. A 15-year-old is brought to the emergency department in a coma. An alert ambulance attendant notes that the patient's breath smells like acetone. This observation is most consistent with which of the following diagnoses?

(A) Alcohol intoxication
(B) Diabetic hyperosmolar coma
(C) Diabetic ketoacidosis
(D) Heroin overdose
(E) Profound hypoglycemia
Answer 57


58. A 24-year-old woman in her third trimester of pregnancy presents with urinary frequency and burning for the past few days. She denies fever, nausea, vomiting, or chills. She takes no medications besides prenatal vitamins and is generally in good health. Physical examination is remarkable for mild suprapubic tenderness, and a urine dipstick is positive for white blood cells, protein, and a small amount of blood. Culture produces greater than 100,000 colonies of gram-negative bacilli. Which of the following attributes of this uropathogenic organism is most strongly associated with its virulence?

(A) Bundle-forming pili
(B) GVVPQ fimbriae
(C) Heat labile toxins
(D) Heat stable toxins
(E) P pili
(F) Type 1 pili
Answer 58


59. A 12-year-old girl has a temperature of 102.5 F and a sore throat. Two days later, she develops a diffuse erythematous rash and is taken to her pediatrician. On physical examination, there is circumoral pallor, and an erythematous rash with areas of desquamation is noted. The myocardial damage that can follow this infection is produced in a manner similar to the damage associated with which of the following disorders?

(A) Atopic allergy
(B) Contact dermatitis
(C) Graft-vs-host disease
(D) Graves disease
(E) Idiopathic thrombocytopenic purpura
(F) Myasthenia gravis
(G) Rheumatoid arthritis
(H) Serum sickness
(I) Systemic lupus erythematosus
Answer 59


60. A 45-year-old man with cirrhosis due to alpha1-antitrypsin deficiency receives a liver transplant. Although currently in good health, he is at increased risk of developing which of the following types of emphysema?

(A) Centriacinar
(B) Compensatory
(C) Interstitial
(D) Panacinar
(E) Paraseptal
Answer 60


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