Usmle step 1 Sample Test Questions
Myocardial Myocardial O
Yüklə 1,54 Mb. Pdf görüntüsü
|
- Bu səhifədəki naviqasiya:
- Blood Pressure (mm Hg) Pulse (/min) Jugular Venous Pressure Pulsus Paradoxus
- Glomerular Filtration Rate Filtration Fraction Renal Blood Flow
- Arterial Baroreceptor Systemic Vascular Pulmonary Vascular Systemic Capillary
- Calcium Phosphorus 1,25-Dihydroxyvitamin D
- Total Peripheral Sodium Plasma
|
Myocardial Myocardial O 2
Heart Rate Contractility Consumption (A)
No change increased increased (B)
No change increased decreased (C)
No change decreased increased (D)
No change decreased decreased (E)
Decreased increased decreased (F)
Decreased decreased increased (G)
Decreased decreased decreased
10
10.
A 55-year-old woman with small cell carcinoma of the lung is admitted to the hospital to undergo chemotherapy. Six days after treatment is started, she develops a temperature of 38°C (100.4°F). Physical examination shows no other abnormalities. Laboratory studies show a leukocyte count of 100/mm 3 (5% segmented neutrophils and 95% lymphocytes). Which of the following is the most appropriate pharmacotherapy to increase this patient's leukocyte count?
(A) Darbepoetin (B) Dexamethasone (C) Filgrastim (D) Interferon alfa (E) Interleukin-2 (IL-2) (F) Leucovorin
11.
A technician wants to determine whether cytomegalovirus (CMV) DNA is present in the blood of a bone marrow transplant recipient. DNA purified from the leukocytes of the patient is reacted in a mixture containing oligonucleotides specific for CMV DNA, thermostable DNA polymerase, and nucleotides. Repetitive cycles of heating and cooling are performed, and the reaction product is detected by gel electrophoresis. The technician most likely used which of the following laboratory procedures on this patient's blood?
(A) Northern blotting (B) Polymerase chain reaction (C) Reverse transcription (D) Southern blotting (E) Western blotting
Over 1 year, a study is conducted to assess the antileukemic activity of a new tyrosine kinase inhibitor in patients with chronic myeloid leukemia in blast crisis. All patients enrolled in the study are informed that they would be treated with the tyrosine kinase inhibitor. They are assigned to successive dose cohorts of 300 to 1000 mg/day of the drug. Six to eight patients are assigned to each dose. Treatment efficacy is determined based on the results of complete blood counts and bone marrow assessments conducted regularly throughout the study. This study is best described as which of the following?
(A) Case-control study (B) Crossover study (C) Open-labeled clinical trial (D) Randomized clinical trial (E) Single-blind, randomized, controlled trial
11
13.
A 12-year-old boy is brought to the physician by his mother because of a 1-month history of pain below the left knee. His mother says, "He can usually walk around, but he hasn't been able to play in any of his soccer games since this all began." Examination of the left knee shows warmth, swelling, and tenderness. An x-ray of the knee is shown. Which of the following structures is attached to the abnormal anterior tibial area?
(A) Anterior cruciate ligament (B) Gastrocnemius muscle (C) Patellar ligament (D) Popliteus muscle (E) Posterior cruciate ligament (F) Soleus muscle
14.
A 45-year-old man comes to the physician for HIV testing. He says that he has been having an extramarital affair with a woman for 6 months, and he hopes this affair will continue because it has made him very happy. He has no plans to tell his wife about the affair. The wife is also a patient of the physician. Physical examination shows no abnormalities, and the result of a serum HIV antibody test is negative. Which of the following is the most appropriate action by the physician?
(A) Alert the local public health department to the patient's activities (B) Explain to the patient that one of them must tell the wife about the affair for her own safety (C) Refer the patient for counseling (D) Say nothing about the affair to anyone other than the patient (E) Tell the patient's wife about the affair so she can make an informed decision about possibly being placed at risk in the future
12
15.
A 63-year-old homeless man is brought to the emergency department 1 hour after police found him unresponsive. His respirations are 30/min. Crackles are heard over the left upper and the entire right lung fields. Despite appropriate lifesaving measures, he dies. A photomicrograph of a section of the right lung obtained at autopsy is shown. Which of the following mediators is the most likely cause of the position of the cell indicated by the arrow?
(A) Bradykinin (B) C5a (C) Histamine (D) Nitrous oxide (E) Prostaglandins
A 63-year-old woman comes to the physician because of a 2-week history of fatigue, malaise, nausea and vomiting, and decreased appetite; these symptoms have worsened during the past week. She was diagnosed with tuberculosis 3 months ago; a multidrug regimen was initiated at that time. Her temperature is 37.1°C (98.8°F). Physical examination shows scleral icterus and tenderness over the right upper quadrant of the abdomen; there is no hepatomegaly. Serum studies show a total bilirubin concentration of 6.5 mg/dL, AST activity of 580 U/L, and ALT activity of 650 U/L. Which of the following drugs is the most likely cause of these findings?
(A) Ethambutol (B) Isoniazid (C) Levofloxacin (D) Streptomycin (E) Vitamin B 6 (pyridoxine)
17. A 48-year-old woman comes to the emergency department because of shortness of breath. She has no history of cardiac or pulmonary disease. Her current medication is timolol for glaucoma. Her pulse is 75/min. Diffuse wheezing is heard in the lower lung fields. An ECG shows no abnormalities. In addition to discontinuing timolol, which of the following drugs is the most appropriate treatment to relieve symptoms at this time?
(A) Adenosine (B) Albuterol (C) Beclomethasone (D) Cromolyn (E) Propranolol
13
18.
A 55-year-old man is brought to the emergency department because of shortness of breath and confusion for 4 hours. He has hypertension and chronic kidney disease requiring hemodialysis. An ECG shows low voltage with electrical alternans. Physical examination is most likely to show which of the following findings?
Pulse (/min) Jugular Venous Pressure Pulsus Paradoxus (A)
85/60 120
increased increased (B) 85/60
120 increased normal (C)
85/60 120
normal normal
(D) 120/80
80 increased increased (E)
120/80 80
normal increased (F) 120/80
80 normal
normal
19.
A healthy 28-year-old woman comes to the physician for advice on losing weight. She is 150 cm (4 ft 11 in) tall and weighs 56 kg (124 lb); BMI is 25 kg/m 2 . Physical examination shows no other abnormalities. The physician recommends a diet that will restrict her daily intake by 500 kilocalories. Which of the following processes is most likely to increase in this patient as a result of following this diet?
(A) Adipocyte glucose uptake (B) Cerebral ketone utilization (C) Hepatic lipid oxidation (D) Muscle glucose uptake (E) Resting energy expenditure
A 14-year-old girl with a 9-year history of type 1 diabetes mellitus is brought to the physician by her mother for a follow-up examination. She has been admitted to the hospital twice in the past 3 months because of diabetic ketoacidosis. She previously had been compliant with monitoring her blood glucose concentration and with her diet and insulin regimen. She acknowledges that, when she is with her peers, she eats whatever she wants and does not check her blood glucose concentration. She adds, "I'm embarrassed to inject myself in front of them." The physician is having a great deal of difficulty with her 15-year-old son who has been truant from school and sneaking out of the house. She says to the patient, "You should be ashamed for not taking care of yourself. We've all worked so hard to keep you healthy." Which of the following terms best describes the physician's reaction to the patient?
(A) Countertransference (B) Identification with the aggressor (C) Projection (D) Splitting (E) Sublimation
A sexually active 23-year-old man with multiple sex partners has dysuria and a yellow urethral exudate. Gram stain of the exudate shows numerous neutrophils, many that contain intracellular gram-negative diplococci. He has had three similar episodes of urethritis over the past 2 years. Which of the following properties of the infecting organism best explains the reinfection?
(A) Antigenic variation (B) Catalase (C) Inhibition of B-lymphocyte function (D) Inhibition of T-lymphocyte function (E) Polysaccharide capsule
14
22.
A 40-year-old woman receives an intravenous infusion of drug X that selectively constricts the efferent arterioles in her kidneys. Following the infusion, total cardiac output and renal afferent arteriolar tone are unchanged, but renal efferent arteriolar tone and total renal vascular resistance have both increased. Which of the following sets of changes most likely occurred following the infusion of drug X?
Glomerular Filtration Rate Filtration Fraction Renal Blood Flow (A)
↓ ↓ ↑ (B) ↓ ↑ ↓ (C)
↓ ↑ ↔ (D) ↑ ↓ ↔ (E)
↑ ↑ ↓
23. A 23-year-old woman comes to the physician for genetic counseling prior to conception. Her brother and maternal uncle had Duchenne muscular dystrophy (DMD) and died at the ages of 28 and 17 years, respectively. Genetic analysis was not performed on either relative prior to death. Serum studies show a muscle creatine kinase concentration of 120 U/L (N=22– 198). The patient's 50-year-old mother has a serum muscle creatine kinase concentration of 300 U/L. Which of the following is the most appropriate assessment of this patient's carrier status for this disease?
(A) The patient has a 50% risk for developing DMD (B) The patient has a 50% risk of having a child with DMD (C) The patient is a carrier of the disease based on her family history of DMD (D) The patient is not a carrier of the DMD based on her normal creatine kinase concentration (E) The patient's DMD carrier status is uncertain because of random X inactivation
A 45-year-old man comes to the physician because of right shoulder pain that began after he chopped wood 2 days ago. Examination of the right upper extremity shows no obvious bone deformities or point tenderness. The pain is reproduced when the patient is asked to externally rotate the shoulder against resistance; there is no weakness. In addition to the teres minor, inflammation of which of the following tendons is most likely in this patient?
(A) Infraspinatus (B) Pectoralis (C) Subscapularis (D) Supraspinatus (E) Trapezius
A 39-year-old woman with a 1-month history of itching, watery eyes, nasal congestion, runny nose, and sneezing undergoes hypersensitivity testing. During the test, allergens are introduced by pricking the skin with lancets coated with pollen and grass extracts. Within 30 minutes, a visible reddening reaction of the skin occurs at the sites of allergen introduction. Which of the following most likely initiates the inflammatory response to these allergens in this patient?
(A) C3 (B) IgE (C) Interferon gamma (D) Interleukin-2 (IL-2) (E) Tumor necrosis factor
15
26.
A 26-year-old man is brought to the emergency department by ambulance 30 minutes after being shot in the leg. He is unconscious and appears markedly pale. His pulse is 120/min, respirations are 16/min, and blood pressure is 80/60 mm Hg. Compared with a healthy adult, which of the following findings is most likely in this patient?
Systemic Vascular Pulmonary Vascular Systemic Capillary
Resistance Resistance Fluid Transfer (A)
↑ ↑ ↑ filtration (B)
↑ ↓ ↑ absorption (C)
↑ ↓ ↓ filtration (D)
↓ ↑ ↑ absorption (E)
↓ ↑ ↓ filtration (F)
↓ ↓ ↓ absorption
27.
A 1-day-old newborn is evaluated for possible sepsis. Blood cultures grow gram-positive cocci in pairs and chains that agglutinate with group B antiserum. The most likely epidemiologic risk factor for this infection involves bacterial colonization of which of the following?
(A) Mother's vagina (B) Newborn's gastrointestinal tract (C) Newborn's nasopharynx (D) Placenta (E) Umbilical cord remnant
A 14-year-old boy is brought to the physician because of a 2-day history of a sore throat and fever that peaks in the late afternoon. He also has a 1-week history of progressive fatigue. He recently began having unprotected sexual intercourse with one partner. He appears ill. His temperature is 39°C (102.2°F). Physical examination shows cervical lymphadenopathy and pharyngeal erythema with a creamy exudate. Which of the following is the most likely diagnosis?
(A) Candidiasis (B) Herpangina (C) Infectious mononucleosis (D) Mumps (E) Syphilis
A 50-year-old man comes to the physician because of a persistent cough for the past 2 months. He has had a 5-kg (11-lb) weight loss during this period. He is a poultry farmer. Current medications include atenolol, enalapril, hydrochlorothiazide, and omeprazole for hypertension and gastroesophageal reflux. Physical examination shows no other abnormalities. Laboratory studies show histoplasmosis infection. Itraconazole therapy is initiated and omeprazole is discontinued. Which of the following best describes the reason for removing omeprazole from this patient's medication regimen?
(A) It decreases distribution volume of itraconazole (B) It decreases gastrointestinal absorption of itraconazole (C) It decreases partitioning from blood to lung of itraconazole (D) It enhances hepatic metabolism of itraconazole (E) It enhances protein binding of itraconazole (F) It enhances renal elimination of itraconazole
16
30.
A 25-year-old woman comes to the physician because of a 10-year history of frequent occurrences of fever blisters. Physical examination shows perioral vesicles. Microscopic examination of culture of scrapings from three vesicles shows herpes simplex virus 1. Which of the following patterns in the figure shown was most likely observed when the viral DNA from the cultures was examined by restriction enzyme analysis on polyacrylamide gels?
31. An investigator is studying the effect of parathyroid hormone (PTH) in experimental animals. During an 8-hour period, Animal X is infused with PTH and Animal Y is infused with 5% dextrose in water. Which of the following sets of findings best describes the most likely serum concentrations in Animal X compared with Animal Y at the end of the infusion?
Phosphorus 1,25-Dihydroxyvitamin D (A)
Increased increased increased (B)
Increased increased decreased (C)
Increased decreased increased (D)
Increased decreased decreased (E)
Decreased increased increased (F)
Decreased increased decreased (G)
Decreased decreased increased (H)
Decreased decreased decreased
32.
A study of a new antihypertensive drug is being conducted in experimental animals. It is found that one of its pharmacologic effects is a decrease in plasma renin activity and serum angiotensin II concentration. A possible mechanism of action that would produce this effect is blockade of which of the following?
(A) α
1 -Adrenoreceptor (B) β 1
(C) Angiotensin-converting enzyme (D) Angiotensin II AT 1 receptor (E) Renal tubular Cl − reabsorption (F) Renal tubular Na + reabsorption
17
33.
A 19-year-old man is brought to the emergency department because of a 12-hour history of severe headache and double vision. He underwent extraction of all four third molars 1 week ago. Ophthalmologic examination shows exophthalmos on the right and weakness with abduction of the right eye. Further studies confirm the diagnosis of cavernous sinus thrombosis. Which of the following is the most likely cause of the diplopia in this patient?
(A) Compression of the oculomotor nerve (B) Compression of the trochlear nerve (C) Compression of the ophthalmic division of the trigeminal nerve (D) Compression of the abducens nerve (E) Infection of the inferior oblique muscle (F) Infection of the inferior rectus muscle (G) Infection of the lateral rectus muscle (H) Infection of the medial rectus muscle (I)
Infection of the superior oblique muscle (J) Infection of the superior rectus muscle
A 44-year-old man is brought to the emergency department because of a 2-day history of severe headache and blurred vision. His blood pressure is 185/95 mm Hg. Physical examination shows no other abnormalities. His plasma renin activity is 210 μU/mL (N=5–97). Losartan therapy is initiated. Which of the following sets of findings is most likely in this patient after 28 days of treatment?
Total Peripheral Sodium Plasma
Excretion Aldosterone (A)
Increased increased increased (B)
Increased increased decreased (C)
Increased decreased increased (D)
Decreased increased decreased (E)
Decreased decreased increased (F)
Decreased decreased decreased
35.
A 31-year-old woman comes to the physician because of a 2-week history of malaise, nausea, vomiting, and decreased appetite. She is a known user of intravenous heroin. She appears chronically ill. She is 165 cm (5 ft 5 in) tall and weighs 47 kg (103 lb); BMI is 17 kg/m 2 . Her temperature is 36.7°C (98.1°F), pulse is 90/min, respirations are 18/min, and blood pressure is 114/68 mm Hg. Physical examination shows scleral icterus and a liver span of 16 cm. The spleen is not palpable. Serum studies show:
Total bilirubin 3.2 mg/dL AST
774 U/L ALT
820 U/L HIV antibody negative Hepatitis B surface antigen negative Hepatitis B surface antibody positive Anti-hepatitis B core antibody positive Hepatitis B DNA negative Anti-hepatitis C virus positive Hepatitis C RNA positive
Which of the following is the most likely outcome of this patient's infection? (A) Complete resolution of infection (B) Latent infection with intermittent viremia (C) Lifelong persistent infection (D) Patient death from acute infection
18
36.
A 62-year-old woman comes to the physician because of low back pain for 1 week. Menopause occurred 10 years ago. Physical examination shows localized tenderness over the lumbar spine after movement. X-rays of the spine show a compression fracture of L1-2. A DEXA scan shows decreased bone mineral density. Serum calcium and phosphorus concentrations and serum alkaline phosphatase activity are within the reference ranges. A bisphosphonate drug is prescribed. The expected beneficial effect of this drug is most likely due to which of the following actions?
(A) Decreased insulin-like growth factor-1 concentration (B) Decreased osteoclast activity (C) Decreased osteoprotegerin production (D) Increased 1,25-dihydroxycholecalciferol concentration (E) Increased osteoblast activity (F) Increased receptor activator of NF-κB ligand (RANKL) production
37.
A 22-year-old woman contacts a medical student and asks if he would like to join her for dinner. The student met the woman when he was assigned to her care during her 2-week hospitalization for treatment of major depressive disorder. He has not treated or seen the patient since she was discharged from the hospital. He is attracted to this former patient and would be interested in dating her. Which of the following is the most appropriate action by the medical student regarding this patient's invitation?
(A) He can date her because he was a medical student, not a physician, when he contributed to her care (B) He can date her because she is no longer his patient (C) He can date her, but only after at least 1 year has passed since he treated her (D) He cannot date her because she was once his psychiatric patient (E) He cannot date her unless she agrees never to seek care at his hospital in the future
A 26-year-old woman is brought to the emergency department 3 hours after ingesting approximately 50 tablets of aspirin in a suicide attempt. She is nauseated, confused, and sleepy. Her pulse is 130/min, respirations are 30/min, and blood pressure is 100/60 mm Hg. Which of the following sets of laboratory values is most likely on evaluation of blood obtained before treatment?
Yüklə 1,54 Mb. Dostları ilə paylaş:
|