USMLE Full Length Exam 1
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- 1.A new patient presents to a clinic in Denver, Colorado with complaints of dyspnea and fatigue on exertion. On history, the patient informs the doctor that she just moved from the California coastline less than 1 week ago, and has been attempting to do her 3-mile run every morning. The patient is told to limit her running until her body adjusts to the new altitude. Which of the following will occur in this woman’sbody in response to the high altitude?
- A.
An increased partial oxygen pressure at 50% saturation on the hemoglobin-oxygen dissociation curve
- B.
Decreased pulmonary vascular resistance
- C.
Decreased RBC 2,3-diphosphoglycerate concentration
- D.
Increased arterial partial oxygen pressure
- E.
Right ventricular atrophy
- 2.A 32-year-old woman with pheochromocytoma is being treated with phenoxybenzamine. After surgical excision of the tumor, the patient has an episode of hypotension requiring 30 seconds of cardiopulmonary resuscitation and subsequent treatment in the intensive care unit. The attending physician asks his intern what physiologic responses he would expect to see if the patient had been given epinephrine during resuscitation. What would have been observed following administration of epinephrine?
- A.
Decrease in blood pressure
- B.
Decrease in heart rate
- C.
Increase in blood pressure
- D.
Increase in respiratory rate
- E.
No changes in vital signs
- 3.A 35-year-old man with no signifi cant past medical history presents to his primary care physician complaining of shortness of breath on exertion for the past several months. The patient acknowledges recent heart palpitations, but denies chest pain, cough, lower extremity edema, paroxysmal nocturnal dyspnea, or weakness. He further denies any recent illness, and he states that he does not smoke. Cardiac examination shows an irregularly irregular rhythm, a widely split fixed S2, and a midsystolic ejection murmur over the left upper sternal border. ECG reveals that the patient is in atrial fibrillation. Based on these findings, the physician concludes that these symptoms are due to pathology of which of the following fetal structures?
- A.
Aorticopulmonary septum
- B.
Ductus arteriosus
- C.
Ductus venosus
- D.
Foramen ovale
- E.
Interventricular septum
- 4.A 10-year-old boy is referred to the neurologist with intellectual deterioration, personality changes, generalized seizures, and visual disturbances that have worsened over the last few months. The patient’s cerebrospinal fluid culture shows no bacterial growth. Further analysis shows normal glucose levels and normal protein. The patient is afebrile and reports no headache. The child’s parents say that he has not received any vaccinations since arriving in the United States last year. They also say that he has had only one major illness prior to this. The child was approximately 2 years old when he developed a high fever, cough, and runny nose. Soon after the onset of these symptoms, he developed a red maculopapular rash that spread downward from his head. Antibodies against which of the following are likely to be found in this patient’s cerebrospinal fluid?
- A.
Herpes simplex virus type 2
- B.
Measles virus
- C.
Mumps virus
- D.
Neisseria meningitidis
- E.
Rubella virus
- F.
Treponema pallidum
- 5.A 34-year-old man comes to the clinic because his gums have become swollen and have exhibited a tendency to bleed. He states that he has been brushing his teeth at least twice a day. On examination, he is found to have several bruises on his legs in different stages of healing. The patient adds that his bruises have been taking longer than usual to heal. His complete blood cell count and coagulation panel are within normal limits. What is the likely cause of this patient’s symptoms?
- A.
Decreased platelet count
- B.
Decreased von Willebrand factor
- C.
Defect in hydroxylation of collagen residues
- D.
Mutation of dystrophin gene
- E.
Mutation of spectrin
- 6.A 21-year-old woman with no family or personal history of breast cancer presents with a small, firm mass in the lower inner quadrant of her right breast that seems mobile when palpated. It is nontender. There are no overlying skin changes or nipple discharge. Which of the following would most likely be found on biopsy of this mass?
- A.
Blue dome cysts and some atypical epithelial hyperplasia
- B.
Cells in a single fi le formation
- C.
Fibrosing stroma around normal-looking glands
- D.
Large cells with clear “halos”
- E.
Multicentric lobes with lymphocytic infi ltrate
- 7.A 50-year-old woman who works as a secretary comes to the physician because of numbness and tingling in her hands. On examination, the patient is found to have decreased sensation in all of her fingers except her fifth digit. Which of the following muscles is most commonly weakened in patients with this condition?
- A.
Adductor pollicis
- B.
Dorsal interossei
- C.
Lumbricals (3 and 4)
- D.
Opponens digiti minimi
- E.
Opponens pollicis
- 8.
A 19-year-old man presents to the emergency department complaining of fatigue, lethargy, and a history of a recent upper respiratory infection. His temperature is 37° C (98.6° F) and his physical examination shows jaundice and prominent splenomegaly. Blood counts show decreased hemoglobin (9 g/dL), elevated mean cell hemoglobin concentration, and increased reticulocyte count. A peripheral blood smear is shown in the image. Which of the following is the definitive choice of therapy for this condition?- A.
Blood transfusion
- B.
Chemotherapy
- C.
Folic acid supplementation
- D.
Iron chelation therapy
- E.
Iron supplementation
- F.
Splenectomy
- 9.A 22-year-old woman presents to her familyphysician because of increasing fatigue and because she looks “pale” despite spending many hours outside as a camp counselor. She also states that her urine looks “cola-colored” when she first goes to the bathroom in the morning. The patient feels well otherwise. Blood analysis shows a low platelet count, a low RBC count, and a low WBC count. The patient’s RBCs are mixed with acidifi ed normal serum and compared to normal RBCs at room temperature and at 37° C (98.6° F); both temperatures cause the patient’s, but not the normal, RBCs to lyse. Based on this clinical picture and the laboratory tests, this patient most likely has which of the following disorders?
- A.
Alkaptonuria
- B.
Cystinuria
- C.
Hemophilia A
- D.
Maple syrup urine disease
- E.
Paroxysmal nocturnal hemoglobinuria
- 10.A 34-year-old man presents to the emergency department complaining of a 2-day history of fatigue and double vision. Physical examination shows a right nystagmus. A detailed history reveals that he recently began treatment for recurrent tonic-clonic seizures. Laboratory studies show: Na+: 143 mEq/L K+: 4.5 mEq/L Cl-: 103 mEq/L HCO3-: 26 mEq/L Blood urea nitrogen: 45 mg/dL Creatinine: 4.3 mg/dL Which of the following agents is most likely responsible for this patient’s condition?
- A.
Clozapine
- B.
Imipramine
- C.
Lithium
- D.
Phenytoin
- E.
Sumatriptan
- F.
Valproic acid
- 11.A 4-year-old boy has a sublingual mass. A scan using 99mTc pertechnetate, which behaves as iodine and approximates iodine uptake, shows significant uptake in this region with little activity lower in the neck. Which of the following is the embryologic explanation for thismass?
- A.
The third and fourth branchial (pharyngeal) arches have hypertrophied
- B.
The thymus has developed ectopically
- C.
The thymus has hypertrophied
- D.
The thyroid has failed to migrate caudally
- E.
The thyroid has migrated too far rostrally
- 12.A 27-year-old healthy man presents because heand his wife have been repeatedly unsuccessful in conceiving a child. His wife has been tested and determined to be fertile. Upon questioning, the patient denies coronary or lipid abnormalities but admits to having multiple sinus infections and a chronic productive cough. Further analysis of his semen shows a normal number of sperm. Which of the following is the most likely etiology for the patient’s infertility?
- A.
Age-related increase in estradiol with possible prostate dihydrotestosterone sensitization
- B.
Autosomal recessive dysfunction of a chloride ion channel
- C.
Failure of testicles to descend into the scrotum
- D.
Familial disease causing early atherosclerosis leading to erectile dysfunction
- E.
Lack of dynein ATPase arms in microtubules of cilia
- 13.An anxious young woman presents to the emergency department with an acute onset of severe abdominal pain. She states that she “partied a little bit last night” and consumed approximately 8 or 9 alcoholic drinks. She also admits to using diuretics to “lose water weight.” Her stool is guaiac-negative, but she has periumbilical tenderness to palpation. An arterial blood gas study shows that her pH is 7.55 and her bicarbonate level is 21 mEq/L, with a partial pressure of carbon dioxide of 25 mm Hg. Her serum shows normal sodium chloride levels. Which of the following is the origin of her acid-base disturbance?
- A.
A build-up of unmeasured anions due to hepatic metabolism of alcohol
- B.
Electrolyte imbalance due to diuretic use
- C.
Hyperventilation secondary to pain and anxiety
- D.
Hypoventilation due to the respiratory depression caused by alcohol ingestion
- E.
Vomiting due to alcohol toxicity
- 14.A 38-year-old white woman presents to the physician with a 2-week history of aching painin her left calf that is made worse by dorsiflexion of her foot. On physical examination, her left calf is found to be erythematous, warm, and swollen. Which of the following measures should she take to decrease similar problems in the future?
- A.
Begin taking a bile acid resin
- B.
Begin taking a statin
- C.
Begin taking low-dose oral contraceptives
- D.
Exercise 30 minutes three times per week
- E.
Quit smoking
- F.
Reduce alcohol consumption to one or two glasses of red wine per week
- 15.An 18-year-old woman presents to her physician’s office with symptoms of nausea and vomiting as well as jaundice. She is taking oral contraceptives, but also reports consistent condom use. She denies illicit drug use. On physical examination the patient shows no hepatomegaly or right upper quadrant tenderness to deep palpation. Laboratory studies show a total bilirubin level of 4 mg/dL, direct bilirubin level of 1mg/dL, and indirect bilirubin level of 3 mg/dL. Liver enzyme levels are within normal limits. A direct Coombs’ test is negative. Which of the following is the most likely diagnosis?
- A.
Autoimmune hemolytic anemia
- B.
Crigler-Najjar syndrome type I
- C.
Gilbert’s disease
- D.
Hepatitis C
- E.
Oral contraceptive-associated cholestasis
- 16.A 74-year-old man is brought to the emergency department after he became combative and was screaming that “the little people” were after him. The staff is unable to obtain a history or physical examination because of his agitation, although the triage nurse is able to obtain his vital signs, which are signifi cant for a temperature of 40o C (104o F) and a blood pressure of 90/50 mm Hg. His family reports that he was fi ne earlier in the day except for an occasional cough, and that he has never had any psychiatric issues before. By the time the psychiatrist arrives, the patient is somnolent and somewhat confused. Which of the following will confi rm this patient’s most likely diagnosis?
- A.
Blood alcohol level
- B.
Blood, urine, and sputum cultures
- C.
CT of the head
- D.
Electroencephalography
- E.
Urine toxicology screen
- 17.A 34-year-old woman who is at 26 weeks of gestation and who has a history of multiple spontaneous abortions presents with severe abdominal pain, jaundice, ascites, and mental status change. Ultrasonography reveals an obscure hepatic venous connection to the inferior vena cava and absence of any waveform in the hepatic veins. She has a positive serum antiphospholipid antibody titer. Which of the following is the most likely diagnosis?
- A.
Budd-Chiari syndrome
- B.
Congestive heart failure
- C.
Polymyalgia rheumatica
- D.
Portal vein thrombosis
- E.
Veno-occlusive disease
- 18.A 5-year-old girl is brought to the pediatrician by her mother for evaluation of readiness to enter school. The mother is worried because the child had to be withdrawn from preschool last year because of an inability to cope with the other children. She reports that the child becomes very upset if her daily routine is interrupted. The child’s birth history and past medical history are unremarkable. She reached all of her neurodevelopmental milestones, including speech development, on schedule. Which of the following is the most likely diagnosis?
- A.
Asperger’s syndrome
- B.
Autistic disorder
- C.
Childhood disintegrative disorder
- D.
Expressive language disorder
- E.
Rett’s disorder
- 19.A 4-year-old boy with a history of mental retardation and seizures is brought to the physician with a 3-month history of worsening shortness of breath. During physical examination, the physician notices numerous acnelike papules on the patient’s face. Echocardiography shows signifi cant left ventricular outfl ow obstruction. Which of the following is the most likely diagnosis for this patient’s heart condition?
- A.
Coronary artery disease
- B.
Dilated cardiomyopathy
- C.
Myxoma
- D.
Rhabdomyoma
- E.
Transposition of the great vessels
- 20.A 28-year-old male physician is seeing a new patient, who is a 25-year-old woman. At the beginning of the encounter he recognizes her as someone he met at a bar several weeks ago. He was highly attracted to her at that time, but she left the bar before he could invite her on a date. What is the physician’s best course of action during this visit?
- A.
Ask her on a date
- B.
Continue the visit as normal
- C.
Refer her to another doctor
- D.
Refer her to another doctor, then ask her on a date
- E.
Return to the room with a chaperon and conduct the visit as normal
- 21.
A 45-year-old man visited his primary care physician 1 month ago because of chest pain that he had experienced four times in the past 4 months. The onset of the pain is sudden and radiates to his left jaw. He usually feels the pain when he is watching television but has never felt it during exertion. During last month’s visit, the physician prescribed sublingual nitroglycerin, and the patient reports that this has shortened the duration of his episodes. Last month’s ECG is shown in the image. Which of the following is the most likely cause of this patient’s chest pain?
- A.
Myocardial infarction
- B.
Pericarditis
- C.
Prinzmetal’s angina
- D.
Stable angina
- E.
Unstable angina
- 22.A clinical study is performed on young male subjects who have deafness, ocular abnormalities, and a nephritic syndrome. Kidney biopsies of these subjects reveal no pathology under immunofl uorescence or light microscopy. Which of the following is the most common glomerular pathological characteristic likely to be seen under electron microscopy?
- A.
Diffuse epithelial foot process fusion
- B.
Immune complex deposits
- C.
Split basement membrane
- D.
Wire-loop appearance
- 23.A researcher is designing an in vitro experimental system to study the kinetics of GLUT4- mediated glucose transport into mammalian cells. The system will measure radiolabeled glucose concentrations in cell culture media both before and at intervals following the addition of insulin. Which of the following cell types is the best choice for use in this experimental system?
- A.
Adipocytes
- B.
Cortical neurons
- C.
Erythrocytes
- D.
Hepatocytes
- E.
Pancreatic β cells
- 24.Myasthenia gravis is an autoimmune disorder that affects approximately 3 in 100,000 people. Individuals with mysasthenia gravis classically present with complaints of muscle weakness and fatigue secondary to the formation of autoantibodies directed against the acetylcholine receptors at neuromuscular junctions. The most accurate method of diagnosis involves the detection of these autoantibodies. On average, this test is approximately 80% sensitive and 90% specifi c. If an individual has a positive test for autoantibodies against the acetylcholine receptor, what is the approximate post-test probability of having this disease, assuming a pre-test probability of 50%?
- A.
80%
- B.
85%
- C.
89%
- D.
90%
- E.
95%
- F.
99%
- 25.An 85-year-old man is rushed to the emergency department from his primary care physician’s offi ce after his physician palpates a pulsating mass in his abdomen. The patient is diagnosed with an abdominal aortic aneurysm. Instead of repairing the aneurysm by surgically opening the abdomen, the surgeon decides to perform endovascular stenting and grafting. The stent is inserted into the femoral artery and threaded up toward the aortic defect. To access the femoral artery the surgeon must open the femoral sheath and expose its contents. Which of the following structures is enclosed inside the femoral sheath?
- A.
Cooper’s ligament
- B.
Femoral canal
- C.
Femoral nerve
- D.
Obturator nerve
- E.
Tunica vaginalis
.JPG "A 19-year-old man presents to the emergency department complaining of fatigue, lethargy, and a history of a recent upper respiratory infection. His temperature is 37° C (98.6° F) and his physical examination shows jaundice and prominent splenomegaly. Blood counts show decreased hemoglobin (9 g/dL), elevated mean cell hemoglobin concentration, and increased reticulocyte count. A peripheral blood smear is shown in the image. Which of the following is the definitive choice of therapy for this condition?")
.JPG "A 45-year-old man visited his primary care physician
1 month ago because of chest pain that
he had experienced four times in the past 4
months. The onset of the pain is sudden and
radiates to his left jaw. He usually feels the pain
when he is watching television but has never
felt it during exertion. During last month’s
visit, the physician prescribed sublingual nitroglycerin,
and the patient reports that this has
shortened the duration of his episodes. Last
month’s ECG is shown in the image. Which of
the following is the most likely cause of this patient’s
chest pain?")
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