Medical Student

USMLE Practice Questions Set 4

USMLE Practice Questions Set 4

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31. A patient presents with cervical lymphadenopathy. Biopsy demonstrates a nodular lymphoma with follicle formation. This lesion would most likely be associated with which of the following?

(A) bcr-c-abl
(B) bcl-2 activation
(C) c-myc activation
(D) t(8, 14)
(E) t(9, 22)

Answer 31

32. A 25-year-old woman presents with pain and tenosynovitis of the wrists and ankles, and arthralgias of other joints. She notes two prior episodes similar to the present one. She just had her menstrual period during the previous week. Physical examination reveals ulcerated lesions overlying the wrists and ankles. These symptoms are likely due to deficiency of which of the following?

(A) C1 esterase inhibitor
(B) Ciliary function
(C) Complement (C6-C8) components
(D) Endothelial adhesion molecules
(E) Eosinophils

Answer 32

33. A 5-year-old girl is thoroughly evaluated because of growth failure. The child has been complaining of headaches, which are exacerbated when she tries to read. Funduscopic examination reveals papilledema. CT scan demonstrates a mass involving the area above and within the sella turcica. Surgical resection of the mass yields a multiloculated cystic and solid tumor containing dark brown, oily fluid. This tumor is thought to arise from epithelial rests derived from which of the following structures?

(A) Hypothalamus
(B) Pineal gland
(C) Posterior pituitary gland
(D) Rathke’s pouch
(E) Superior colliculus

Answer 33

34. A new antifungal medication is being tested in Phase I clinical trials. Examination of the pharmacokinetic properties of the drug reveals that the half-life of the drug is 6 hours. If a continuous intravenous infusion of this drug were started on a research subject, how long would it take to reach 75% of steady state?

(A) 3 hours
(B) 6 hours
(C) 9 hours
(D) 12 hours
(E) 18 hours
(F) 24 hours

Answer 34

35. A patient presents to a physician with jaundice. Physical examination reveals a nodular, enlarged liver. CT of the abdomen shows a cirrhotic liver with a large mass. CT-guided biopsy of the mass demonstrates a malignant tumor derived from hepatic parenchymal cells. Infection with which of the following viruses would most likely be directly related to the development of this tumor?

(A) Epstein-Barr virus (EBV)
(B) Hepatitis B virus (HBV)
(C) Human herpesvirus type 8 (HHV 8)
(D) Human papillomavirus (HPV)
(E) Human T-lymphocyte virus (HTLV-1)

Answer 35

36. A man brings his 45-year-old wife to the emergency department. He states she has been ill for 3 days and has been running a temperature of 99.8 to 100.5 F. Today she is having difficulty staying awake, is talking to persons who are not there, and at times appears to be frightened of something. She is restless and somewhat combative when restrained. What is the most likely diagnosis?

(A) Acute stress disorder
(B) Bipolar I disorder, manic type
(C) Brief psychotic disorder
(D) Delirium
(E) Dementia

Answer 36

37. A patient consults a physician because of a small lesion on the lips that, on biopsy, proves to be a mucosal neuroma. The patient’s mother had medullary carcinoma of the thyroid. In addition to medullary carcinoma of the thyroid, to which of the following conditions would this patient be particularly vulnerable?

(A) Gastrinoma
(B) Insulinoma
(C) Parathyroid adenoma
(D) Pheochromocytoma
(E) Pituitary adenoma

Answer 37

38. A 2-year-old boy has a CT scan of the head performed after a pediatrician notices a disproportionate growth in his head circumference compared with the rest of the body. The scan demonstrates a large choroid plexus papilloma involving the body of the right lateral ventricle. Which of the following brain structures might be affected by direct extension of this tumor?

(A) Caudate nucleus
(B) Cerebellum
(C) Hippocampus
(D) Hypothalamus
(E) Pons

Answer 38

39. A premature infant develops progressive difficulty breathing over the first few days of life. Deficient surfactant synthesis by which of the following cell types may be contributing to the infant’s respiratory problems?

(A) Alveolar capillary endothelial cells
(B) Bronchial mucous cells
(C) Bronchial respiratory epithelium
(D) Type I pneumocytes
(E) Type II pneumocytes

Answer 39

40. A 67-year-old woman who has been in very good health is brought to her physician’s office by her husband. He states that over the course of the past 5 years she has had difficulty recognizing her grandchildren, she has not been able to plan their daily activities, she has forgotten things left cooking on the stove, and at night she has been wandering through the house with an “absent” look on her face. She is beginning to demonstrate difficulty in recalling the names of common objects, and her speech is limited to simple two- or three-word sentences. Which of the following is the most likely diagnosis?

(A) Alzheimer’s disease
(B) Amnestic disorder
(C) Pseudodementia
(D) Substance-induced persisting dementia
(E) Vascular dementia

Answer 40

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