USMLE Practice Questions Set 5
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?
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?
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?
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?
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?
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?
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?
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
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?
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?
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