USMLE Full Length Exam 2

48 Questions | Total Attempts: 128

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USMLE Full Length Exam 2

Questions and Answers
  • 1. 
    An oncologist recently discovered that certain cancerous cells secrete a protein named ca- 1panc. Using this protein, he developed a new blood test to detect this type of cancer. He performed the blood test on 1,000 patients. One hundred of these patients had the cancer, and the test came back positive for 60 of them, while for the remaining 40 patients the test was negative. Nine hundred of the patients did not have the cancer; however, the test was positive for 100 of them. In the remaining 800, the test came back negative. Which of the following numbers represents how well the test identifi ed those who had the cancer?
    • A. 

      10.0%

    • B. 

      37.5%

    • C. 

      60.0%

    • D. 

      88.8%

    • E. 

      90.0%

    • F. 

      95.2%

  • 2. 
    A 27-year-old woman who is pregnant at 32 weeks’ gestation presents to the emergency department following a motor vehicle accident. Results of fetal heart monitoring are reassuring, and there is no evidence of rupture of membranes. Radiologic studies show a fractured femur. The patient is admitted to the hospital for expectant management and is placed on strict bed rest with delivery planned at 37 weeks’ gestation. Which of the following medications would be most appropriate for preventing deep venous thrombosis in this patient?
    • A. 

      Heparin

    • B. 

      Indomethacin

    • C. 

      Prostaglandin E2

    • D. 

      Streptokinase

    • E. 

      Warfarin

  • 3. 
    A 38-year-old woman with a history of type 2 diabetes mellitus gives birth to a term male infant. Immediately after birth, the infant is noted to be cyanotic and tachypneic. His hypoxemia quickly worsens over minutes, and he is taken to cardiac catheterization, where a balloon is guided to perforate the atrial septum. He is also given an infusion of prostaglandin E1. The infant’s hypoxia stabilizes, and he is later taken for defi nitive, corrective surgery. Which of the following is the underlying pathophysiology of this infant’s hypoxemia?
    • A. 

      Coarctation of the aorta

    • B. 

      Concomitant ventricular septal defect

    • C. 

      Delayed closure of the ductus arteriosus

    • D. 

      Failure of the aorticopulmonary septum to spiral

    • E. 

      Overriding aorta

  • 4. 
    A 34-year-old man presents to his primary care physician with night sweats, a fever of 38º C (100.2º F), and weight loss of 5 kg (12 lb) over the last 3 months. A CT scan demonstrates mediastinal lymphadenopathy, and results of a biopsy of the node are shown in the image. Which of the following drugs is part of the multidrug regimen that would be used to manage this patient’s disease?
    • A. 

      Cyclosporine

    • B. 

      Hydroxyurea

    • C. 

      Imatinib

    • D. 

      Isoniazid

    • E. 

      Vinblastine

  • 5. 
    A 14-year-old high school freshman presents to her family doctor for a sports physical. She has not played organized sports in the past but is in good physical shape. She mentions that she experienced severe leg cramps after trying out for the soccer team last week. The night after the tryouts, she noticed that her urine had a reddish tinge. She has no other medical complaints. Her physician orders an ischemic forearm exercise test, which reveals no increase in venous lactate. Which of the following enzymes is most likely defi cient in this patient?
    • A. 

      Cystathionine synthase

    • B. 

      Glucose-6-phosphatase

    • C. 

      α-1,6-Glucosidase

    • D. 

      Glycogen phosphorylase

    • E. 

      Lysosomal α−1,4-glucosidase

  • 6. 
    A 35-year-old man comes to the physician because he has been experiencing bone pain, in addition to confusion, lethargy, recurrent renal stones, duodenal ulcer, and a small nodule on the anterior neck. Laboratory tests show: Calcium: 17 mg/dL Phosphate: 1.0 mg/dL Alkaline phosphatase: 500 U/L Parathyroid hormone: 900 pg/mL Which of the following is most likely to be seen in this patient’s bones?
    • A. 

      Hypertrophic osteoarthropathy

    • B. 

      Osteitis fibrosa cystica

    • C. 

      Osteopetrosis

    • D. 

      Osteoporosis

    • E. 

      Paget’s disease of the bone

  • 7. 
    A 45-year-old man comes to the physician with a 3-day history of a temperature of 39° C (102.2° F). He also complains of headache, neck stiffness, and a maculopapular rash on his trunk. A diagnosis of meningitis is made, and a smear and culture of his cerebrospinal fl uid identify Neisseria meningitidis as the causative agent. In the most severe form of meningococcemia, which of the following symptoms is most likely to develop?
    • A. 

      Acute renal failure and thrombocytopenia with hemolytic anemia

    • B. 

      Fever, migratory polyarthritis, and carditis

    • C. 

      Fever, new murmur, small erythematous lesions on the palms, and splinter hemorrhages on the nail bed

    • D. 

      Shock, widespread purpura, disseminated intravascular coagulation, and adrenal insuffi ciency

    • E. 

      Symmetric ascending muscle weakness beginning in the distal lower extremities

  • 8. 
    Cyclooxygenase-2 (COX-2) inhibitors, unlike similar nonselective nonsteroidal anti-infl ammatory drugs, may be associated with cardiovascular events, including myocardial infarction. Which of the following proposals might explain why selective COX-2 inhibitors may cause more cardiovascular events than does aspirin? (PGI2 = prostaglandin I2, TxA2 = thromboxane A2)
    • A. 

      A

    • B. 

      B

    • C. 

      C

    • D. 

      D

    • E. 

      E

  • 9. 
    A 30-year-old woman with systemic lupus erythematosus treated with high-dose prednisone comes to her physician with symptoms of anemia. The patient’s blood studies show a low hemoglobin level (10 g/dL), a low serum iron level, an elevated ferritin level, and a low total iron-binding capacity with normocytic RBCs on blood smear. Which of the following is the most appropriate treatment for this patient’s anemia?
    • A. 

      Erythropoietin

    • B. 

      Ferrous sulfate

    • C. 

      Folate

    • D. 

      Parenteral vitamin B12

    • E. 

      Phlebotomy

  • 10. 
    A 7-year-old girl is brought to the emergency department by her parents because of concerns that she is not growing and not developing appropriately. The parents say that the patient has cold intolerance, easy fatigability, and polyuria. A physical examination is notable for short stature and bilateral papilledema. Thyroid function tests are notable for low levels of triiodothyronine, thyroxine, and thyroid-stimulating hormone (TSH). An MRI shows an enhancing multilobulated suprasellar mass with ring calcifi cation in the region of the sella turcica. If the lesion represents a primary intracranial neoplasm, which of the following is the most likely diagnosis?
    • A. 

      Craniopharyngioma

    • B. 

      Ependymoma

    • C. 

      Hemangioblastoma

    • D. 

      Prolactinoma

    • E. 

      Thyrotropinoma

  • 11. 
    An obese 56-year-old African-American man with a 25-pack-year history of smoking experiences chest pain associated with an apparent heart attack. The pain radiates to the man’s left shoulder and down his left arm. What is the reason for referred pain to this region?
    • A. 

      Lymphatic drainage of mediators of infl ammation and pain

    • B. 

      Proximity of sensory nerve fi ber tracts in the anterior horn of the spinal cord

    • C. 

      Proximity of sensory nerve fi ber tracts in the posterior horn of the spinal cord

    • D. 

      Shared parasympathetic pathways

    • E. 

      Shared sympathetic pathways

  • 12. 
    A 57-year-old man who is HIV-positive presents to his physician with headache, nausea and vomiting, and a change in mental status. No nuchal rigidity is noted. A lumbar puncture is performed and shows a high opening pressure. A preparation of his bronchoalveolar lavage fl uid with India ink stain is shown in the image. Intravenous treatment is started for the acute condition. Which of the following adverse effects would most likely occur with this patient’s initial treatment?
    • A. 

      Arrhythmia

    • B. 

      Bone marrow suppression

    • C. 

      Gynecomastia

    • D. 

      Flushing

    • E. 

      Nausea and vomiting

  • 13. 
    A 21-year-old sexually active college student presents to the clinic complaining of odorous green vaginal discharge and itchiness. Multiple oval fl agellated motile organisms are seen on wet mount. She is prescribed an antibiotic treatment. While on therapy she goes to a party, where on consumption of one alcoholic beverage she experiences fl ushing, tachycardia, headaches, and vomiting. The same effects could be observed when alcohol is mixed with which drug?
    • A. 

      Ampicillin

    • B. 

      Erythromycin

    • C. 

      Glipizide

    • D. 

      Imipenem

    • E. 

      Tolbutamide

  • 14. 
    A woman with a 2-year-old son comes to her physician because she has been unable to conceive a second child for more than a year. The woman is currently breastfeeding her son. Which of the following explains how lactation suppresses ovulation?
    • A. 

      Lactation antagonizes estrogen action

    • B. 

      Lactation decreases secretion of prolactin

    • C. 

      Lactation inhibits secretion of gonadotropin- releasing hormone

    • D. 

      Lactation increases secretion of folliclestimulating hormone

    • E. 

      Lactation increases secretion of sterility hormones

  • 15. 
    A 5-day-old normally developed boy presents to the emergency department with vomiting and constipation. The mother states that the child has not passed stool since birth but only recently began vomiting. The vomitus has a greenish coloration. On examination, the abdomen is markedly distended and is dull to percussion. Digital rectal examination shows an empty rectum, but stool is passed explosively following the examination. A sweat chloride test is negative. The disorder in this infant arises from cells derived from which of the following embryologic cell populations?
    • A. 

      Endoderm

    • B. 

      Mesoderm

    • C. 

      Neural crest

    • D. 

      Neuroectoderm

    • E. 

      Surface ectoderm

  • 16. 
    A woman strikes her head in a car crash and is admitted to the hospital, where she begins urinating up to 1 L every few hours and complaining of constant thirst. Which of the following is the most appropriate treatment?
    • A. 

      Demeclocycline

    • B. 

      Desmopressin

    • C. 

      Furosemide

    • D. 

      Insulin

    • E. 

      Mannitol

  • 17. 
    A 65-year-old man presents to his family doctor for a regularly scheduled check-up. He is recently widowed and appears unkempt at this visit. His past medical history is signifi cant for alcoholism, hypertension, and type 2 diabetes mellitus. His current medications are hydrochlorothiazide, metformin, and clonidine. On physical examination, his blood pressure is 158/90 mm Hg. His body mass index is 33 kg/ m2, and he reports a 4.5-kg (10-lb) weight loss over the past 3 months. On further questioning the patient admits to owning a gun and states that he has thought repeatedly of shooting himself in the head. Which of the following actions is most appropriate in the care of this patient?
    • A. 

      Hospitalize voluntarily or involuntarily

    • B. 

      Prescribe an antidepressant

    • C. 

      Refer to a psychiatrist

    • D. 

      Schedule for a regular visit

    • E. 

      Tell the patient’s children so that they can intervene

  • 18. 
    A 5-year-old girl is brought to the emergency department with acute onset of projectile vomiting and severe headache. Her parents report that over the past couple of months her gait has become increasingly unstable. Her medical history is negative for seizures and signs of meningitis. Physical examination is notable for truncal ataxia and papilledema. CT reveals a mass at the cerebellar vermis. Which of the following is most likely to be seen on histological examination of tissue from this mass?
    • A. 

      Cells with round, regular, centrally located nuclei surrounded by a perinuclear halo

    • B. 

      Prolifi c vasculature and receding rows of nuclei

    • C. 

      Rod-shaped perinuclear inclusions

    • D. 

      Round calcifi cations

    • E. 

      Small cells with high nuclear:cytoplasmic ratios surrounding the vasculature

  • 19. 
    A patient presents to the emergency department with a crushing injury to her right ankle. A medical student working there is told to evaluate the vascular integrity of the patient’s right lower extremity. She feels for femoral, dorsalis pedis, and posterior tibial pulses and fi nds that they are intact and symmetric bilaterally. In which of the following locations did the student palpate the posterior tibial pulse?
    • A. 

      Between the two heads of the gastrocnemius muscle

    • B. 

      Deep in the popliteal fossa

    • C. 

      Immediately anterior to the medial malleolus

    • D. 

      Immediately posterior to the lateral malleolus

    • E. 

      Immediately posterior to the medial malleolus

    • F. 

      On the dorsal surface of the foot

  • 20. 
    A 53-year-old man with a long-standing history of allergic rhinitis and asthma presents with uveitis, mild hearing loss, numbness and tingling in his right hand, and diffuse joint pain for the past 10 days. Physical examination shows weak to absent left knee patellar refl exes (right knee refl ex strong and intact). Laboratory studies show a markedly elevated eosinophil count. A diagnosis is made, and the patient is treated with cyclophosphamide. Further laboratory studies show elevated serum levels of the most common autoantibody associated with this condition. What structure is primarily targeted by the autoantibodies that are most likely elevated in this patient’s serum?
    • A. 

      Acetylcholine receptors

    • B. 

      Neutrophils

    • C. 

      Oligodendrocytes

    • D. 

      RBCs

    • E. 

      TSH receptors

  • 21. 
    A 32-year-old HIV-positive man with a recent CD4+ cell count of 84/mm³ and a 3-week history of worsening headaches is brought to the emergency department by ambulance because of acute mental status changes. Upon arrival he is noted to have papilledema, a third cranial nerve palsy, and a rigid neck that cannot be fl exed or extended. He subsequently dies from an overwhelming infection involving his nervous system. An autopsy specimen of the patient’s brain is shown in the image. What is the underlying cause of this patient’s symptoms?
    • A. 

      Bacterial meningitis

    • B. 

      Fungal meningitis

    • C. 

      Herpes encephalitis

    • D. 

      Mycobacterial meningitis

    • E. 

      Viral meningitis

  • 22. 
    A 32-year-old female dialysis patient visits her general internist for a health maintenance visit. She subsequently has a dual-energy x-ray absorption examination, which demonstrates signifi cant osteoporosis. What is the most likely etiology of this patient’s osteoporosis?
    • A. 

      Chronic metabolic alkalosis

    • B. 

      1,25-Dihydroxycholecalciferol excess

    • C. 

      Hypercalcemia

    • D. 

      Hypophosphatemia

    • E. 

      Secondary hyperparathyroidism

  • 23. 
    A 62-year old man arrives at his doctor’s offi ce complaining of recent onset dull pain in his left fl ank region. He is a retired steel plant worker with a long history of excessive smoking, hypertension, and obesity. He does not recall any history of similar illness in his family. On physical examination a fi rm, homogeneous, nontender movable mass is palpated deep in the left umbilical region near the lower pole of the kidney. Laboratory tests show hypercalcemia, hypophosphatemia, and moderate polycythemia. Urinalysis reveals the presence of hematuria. Which of the following is the most likely diagnosis?
    • A. 

      Adult polycystic kidney disease

    • B. 

      Angiomyolipoma

    • C. 

      Pheochromocytoma

    • D. 

      Renal cell carcinoma

    • E. 

      Wilms’ tumor

  • 24. 
    A 55-year-old woman presents to her primary care physician with complaints of nausea, fatigue, early satiety, and abdominal distension. Physical examination reveals the presence of ascites as well as signifi cant pelvic discomfort. CT scanning reveals the presence of multiple masses spread diffusely throughout the abdomen. The patient is subsequently taken to surgery to reduce her tumor burden and to confi rm a diagnosis of metastatic ovarian cancer. Her oncologist then places her on a treatment regimen that includes paclitaxel. Which of the following characterizes the mechanism of this chemotherapy agent?
    • A. 

      Alkylating agent that covalently links DNA

    • B. 

      Binds tubulin and hyperstabilizes polymerized microtubules

    • C. 

      Depolymerizes microtubules

    • D. 

      Inhibits DNA polymerase

    • E. 

      Inhibits topoisomerase II

  • 25. 
    A 7-year-old girl has numerous vesicles on her face, particularly around her mouth. Over a few days, the vesicles turn into pustules and crust over, becoming fl aky and light yellow in color. Which of the following statements about the organism most likely responsible for this girl’s infection is correct?
    • A. 

      Sabouraud’s agar is required to culture this bacterium

    • B. 

      The bacterium is a facultative intracellular organism

    • C. 

      The bacterium is a group B β-hemolytic organism

    • D. 

      The bacterium is bacitracin-sensitive

    • E. 

      The bacterium is protected from host defenses by protein M

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