Medical Student

USMLE Practice Questions Set 2

USMLE Practice Questions Set 2

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11. A 2-month-old child is evaluated for failure to thrive. During the examination, the child has a seizure. Stat serum chemistries demonstrate severe hypoglycemia, hyperlipidemia, lactic acidosis, and ketosis. Physical examination is remarkable for hepatomegaly, a finding confirmed by CT scan, which also reveals renomegaly. Which of the following diseases best accounts for this presentation?

(A) Gaucher disease
(B) McArdle disease
(C) Niemann-Pick disease
(D) Pompe disease
(E) Von Gierke disease

Answer 11

12. The parents of a 7-year-old boy divorce. The boy lives with the mother and sees his father every-other weekend. During these visits, the boy is sullen and angry with the father, but when it is time to return home, he clings to the father and cries in a desperate manner while saying “I’m sorry! I want you and mom to live together again.” Which of the following is the most helpful statement that the father can make to the son?

(A) “Big boys don’t cry.”
(B) “I left your mother, I didn’t leave you.”
(C) “I’ll see you in 2 weeks.”
(D) “You’re the man of the house now.”
(E) “Your mother was too hard to live with.”

Answer 12

13. A letter carrier is severely bitten by a pit bull guarding a junkyard. The wound is cleansed, and the letter carrier receives a booster injection of tetanus toxoid and an injection of penicillin G. Several days later, the wound is inflamed and purulent. The exudate is cultured on blood agar and yields gram-negative rods. Antibiotic sensitivity tests are pending. The most likely agent to be isolated is

(A) Bartonella henselae
(B) Brucella canis
(C) Clostridium tetani
(D) Pasteurella multocida
(E) Toxocara canis

Answer 13

14. A 25-year-old man presents to a rheumatologist with complaints of joint pain involving the large joints of the legs. On questioning, the patient indicates that exacerbations in the joint pain are frequently accompanied by diarrhea. Which of the following is the most likely diagnosis?

(A) Amebic colitis
(B) Chronic appendicitis
(C) Diverticulosis
(D) Pseudomembranous colitis
(E) Ulcerative colitis

Answer 14

15. A couple has a daughter who is ataxic and has a seizure disorder. She also has a strange affect characterized by excessive laughter at inappropriate times. Cytogenetic analysis demonstrates a normal genotype with 46 chromosomes and no apparent deletions. These symptoms are most likely due to

(A) confined placental mosaicism
(B) expansion of a trinucleotide repeat
(C) a point mutation in an autosome
(D) random inactivation of the X chromosome
(E) uniparental disomy

Answer 15

16. A 65-year-old man develops oliguria and peripheral edema over a period of weeks. Urinalysis reveals hematuria and proteinuria; examination of the urinary sediment reveals red cell casts. Radiologic and ultrasound studies fail to demonstrate an obstructive lesion. Renal biopsy shows many glomerular crescents. This presentation is most suggestive of which of the following conditions?

(A) Anti-glomerular basement membrane disease
(B) Diabetic nephropathy
(C) Hypertensive nephropathy
(D) Lupus nephritis
(E) Minimal change disease

Answer 16

17. A 75-year-old woman presents to the physician with a chief complaint of vaginal spotting. She has been postmenopausal for 25 years and does not take hormones. An ultrasound shows a mass in the uterine fundus. A hysterectomy is performed, and pathologic examination of the removed uterus reveals a malignant tumor of the endometrial glands and stroma. Which of the following is the most likely diagnosis?

(A) Endolymphatic stromal myosis
(B) Endometrial carcinoma
(C) Endometrial stromal sarcoma
(D) Leiomyosarcoma
(E) Malignant mixed mullerian tumor

Answer 17

18. A neonate does not pass meconium until 48 hours after his birth. Two weeks later his mother reports that he has not been passing stool regularly. Anorectal manometry reveals increased internal anal sphincter pressure on rectal distention with a balloon. Radiographic studies reveal massive dilation of the colon proximal to the rectum. The findings in this case indicate a developmental abnormality of which of the following embryonic tissues?

(A) Ectoderm
(B) Endoderm
(C) Neural crest
(D) Neural ectoderm
(E) Splanchnic mesoderm

Answer 18

19. A 2-year-old child with uncomplicated coarctation of the aorta appears to be in good health. Growth and development are normal. The constriction is located just distal to the subclavian arteries. Which of the following is decreased in this patient?

(A) Blood flow in the lower body
(B) Blood flow in the upper body
(C) Blood pressure in the upper body
(D) Vascular resistance in the lower body
(E) Vascular resistance in the upper body

Answer 19

20. A 75-year-old man presents to his physician with complaints of nocturia, urinary urgency, and a feeling that he could not completely empty his bladder. A digital rectal exam reveals a firm, enlarged prostate. A bone scan is ordered and shows positivity in multiple vertebral bodies. Elevation of which of the following substances would be most strongly associated with the development of bone lesions?

(A) Prostatic acid phosphatase
(B) Prostate-specific antigen
(C) Serum alkaline phosphatase
(D) Tartrate-resistant acid phosphatase
(E) Urinary hydroxyproline

Answer 20

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