Page 1 of 51
“UWORLD 4 QUESTIONS & ANSWERS EXAM
2026 ”LATEST EXAM 2026 – 2027 SOLVED
QUESTIONS & ANSWERS VERIFIED 100%
GRADED A+ (LATEST VERSION) WELL REVISED
100% GUARANTEE PASS
Uworld 4
All of the following are clinical indications for nitrates EXCEPT
A. Pulmonary edema
B. Printzmetal angina
C. Peripheral edema
D. Stable angina
C
A - Reducing preload, nitrates unload the heart and decrease pressure in the
pulmonary vasculature.
B - Prinzmetal angina or vasospastic angina, is caused by coronary artery
vasospasm, leading to transiet MI and symptoms of angina (often at rest). Because
of their direct vasdilatory effects on coronary arteries, calcium channel blockers and
nitrates are able to prevent vasospasm
C - Peripehral edema is caused by an expansion of interstitial fluid volume and is
associated with numerous conditions, including cirrhosis, renal disease, and CHF.
Treatment usually evovles around managing the underlying condition, as well as a
combination of restricted sodium and diuretics. Nitrates are not indicated for the
treatment of peripheral edema. Oral nitrates in combination with hydralazine ahve
been shown to provide benefit for black patients with heart failure. Even in this
, Page 2 of 51
patient group though, the action isn't through targeting peripheral edema.
D - Stable angina is characterized by chest pain during times of exertion, usually due
to atherosclerosis of coronary arteries causing flow limitation during times of
increased myocardial oxygen demand. In stable angina, chest pain is predictable
with respect to frequency, severity and duration.
Researchers are analyzing oxygen consumption in various tissue beds.
Samples are extracted of venous blood from five different organs.
Oxygen content will be the lowest in which?
A. Kidney
B. Liver
C. Pancreas
D. Heart
E. Brain
D
The heart extracts the most oxygen from blood.
Nearly 80% of the arterial oxygen content is removed by the myocardium even under
resting conditions. This means that during times of increased oxygen demand from
the heart (exercise) the heart relies predominantly on vasodilation to increase blood
supply.
Lingual thyroid develops as a result of failure of what embryologic process....
A. Apoptosis
B. Differentiation
C. Fusion
D. Migration
E. Proliferation
D
The thyroid gland is formed from an outpouching (evagination) of the pharyngeal
epithelium and subsequently descends to the lower neck anterior to the upper
trachea and larynx.
The lowest part of the envagination forms the thyroid gland and the remaining
poriton is the thyroglossal duct, which extends from the foramen cecum to the
superior border of the thyroid isthmus
, Page 3 of 51
Failure to migrate, results in the the thyroid residing anywhere along the thyroglossal
duct's usual path, including the tongue. Enlargement of a lingual thyroid can cause
obstructive symptoms, typically duirng times of heightened sstimulation (puberty,
pregnancy).
A 55 yo woman with persistent morning stiffness. She was diagnosed with RA
4 months ago and prescribed methotrexate. The patient currently takes the
maximum dose.
On exam, swelling tenderness, and pain are found in the metacarpophalangeal
and proximal interphalangela wrists bilaterally.
Treatment with etanercept is considered. Which of the following should be
performed before beginning treatment with this agent?
A. brain CT scan
B. Echocardiogram
C. Fecal occult blood test
D. Pulmonary function tests
E. Tuberculin skin tests
F. Visual exam
E
TNF-alpha inhibitors are large molecule anti-inflammatory agents (biologics)
commonly used to treat moderate to severe RA, particularly in patients who have
failed methotrexate therapy.
Etanercept is a fusion protein with domains derived rom the Fc portion of IgG1 and
TNF receptor 2. It functions as a decoy receptor for TNF-alpha.
Other TNF-alpha inhibitors: Infliximab, adalimumab
Inhibition leads to impaired cell mediated immunity. TNF-alpha is necessary for
sequestration of mycobacteria within granulomas. Latent tuberculosis can reactivate.
A 25 yo man suffers head trauma after a motorcycle crash. He is admitted to
the ICU and administered mannitol to raise plasma osmolarity.
Which of the following effects is expected for movement of fluid out of
capillaries and into tissues after mannitol?
A. Increased movement into tissues
B. Decreased movement into tissues
, Page 4 of 51
C. No change
B
A 27 yo male motorcylist presents after a crash.
Internal bleeding is detected with a large amount of blood in the peritoneal and
thoracic cavities.
BP is 80/40 and pulse is 120.
Which of the folloiwng is most important in maintaining blood pressure in this
patient?
A. Renal renin release
B. Increased aortic arch baroreceptor firing
C. Decreased carotid sinus barareceptor firing
D. Increased parasympathetic activity .
E. Decreased sympathetic activity
C
This patient is suffering blood loss and hemorrhagic shock. Loss of blood volume
leads to a fall in blood pressure.
Baroreceptors in the carotid sinus will send fewer signals to the brain.
The brain will respond with increased sympathetic and decreased parasympathetic
activity.
B - The aortic arch is most sensitie to increases in blood pressure. Ulinke the carotid
sinus thoguh it has poor sensitivity to low blood pressure.
A 34 yo man is brought to the ER by ambulance after being in a motor vehicle
collision.
On arrival he is hypotensive and bleeding from several sites. H undergoes an
emergency blood transfusion.
En route to the operating room, the patient develops difficulty breathing, chills
and pain in the chest and back. Urine drainage from the Foley catheter was
clear, but now appears brown.
Which of the following is the most likley cause of the new findings?
A. CD8+ lymphocyte mediated toxicity
B. Complement mediated cell lysis
“UWORLD 4 QUESTIONS & ANSWERS EXAM
2026 ”LATEST EXAM 2026 – 2027 SOLVED
QUESTIONS & ANSWERS VERIFIED 100%
GRADED A+ (LATEST VERSION) WELL REVISED
100% GUARANTEE PASS
Uworld 4
All of the following are clinical indications for nitrates EXCEPT
A. Pulmonary edema
B. Printzmetal angina
C. Peripheral edema
D. Stable angina
C
A - Reducing preload, nitrates unload the heart and decrease pressure in the
pulmonary vasculature.
B - Prinzmetal angina or vasospastic angina, is caused by coronary artery
vasospasm, leading to transiet MI and symptoms of angina (often at rest). Because
of their direct vasdilatory effects on coronary arteries, calcium channel blockers and
nitrates are able to prevent vasospasm
C - Peripehral edema is caused by an expansion of interstitial fluid volume and is
associated with numerous conditions, including cirrhosis, renal disease, and CHF.
Treatment usually evovles around managing the underlying condition, as well as a
combination of restricted sodium and diuretics. Nitrates are not indicated for the
treatment of peripheral edema. Oral nitrates in combination with hydralazine ahve
been shown to provide benefit for black patients with heart failure. Even in this
, Page 2 of 51
patient group though, the action isn't through targeting peripheral edema.
D - Stable angina is characterized by chest pain during times of exertion, usually due
to atherosclerosis of coronary arteries causing flow limitation during times of
increased myocardial oxygen demand. In stable angina, chest pain is predictable
with respect to frequency, severity and duration.
Researchers are analyzing oxygen consumption in various tissue beds.
Samples are extracted of venous blood from five different organs.
Oxygen content will be the lowest in which?
A. Kidney
B. Liver
C. Pancreas
D. Heart
E. Brain
D
The heart extracts the most oxygen from blood.
Nearly 80% of the arterial oxygen content is removed by the myocardium even under
resting conditions. This means that during times of increased oxygen demand from
the heart (exercise) the heart relies predominantly on vasodilation to increase blood
supply.
Lingual thyroid develops as a result of failure of what embryologic process....
A. Apoptosis
B. Differentiation
C. Fusion
D. Migration
E. Proliferation
D
The thyroid gland is formed from an outpouching (evagination) of the pharyngeal
epithelium and subsequently descends to the lower neck anterior to the upper
trachea and larynx.
The lowest part of the envagination forms the thyroid gland and the remaining
poriton is the thyroglossal duct, which extends from the foramen cecum to the
superior border of the thyroid isthmus
, Page 3 of 51
Failure to migrate, results in the the thyroid residing anywhere along the thyroglossal
duct's usual path, including the tongue. Enlargement of a lingual thyroid can cause
obstructive symptoms, typically duirng times of heightened sstimulation (puberty,
pregnancy).
A 55 yo woman with persistent morning stiffness. She was diagnosed with RA
4 months ago and prescribed methotrexate. The patient currently takes the
maximum dose.
On exam, swelling tenderness, and pain are found in the metacarpophalangeal
and proximal interphalangela wrists bilaterally.
Treatment with etanercept is considered. Which of the following should be
performed before beginning treatment with this agent?
A. brain CT scan
B. Echocardiogram
C. Fecal occult blood test
D. Pulmonary function tests
E. Tuberculin skin tests
F. Visual exam
E
TNF-alpha inhibitors are large molecule anti-inflammatory agents (biologics)
commonly used to treat moderate to severe RA, particularly in patients who have
failed methotrexate therapy.
Etanercept is a fusion protein with domains derived rom the Fc portion of IgG1 and
TNF receptor 2. It functions as a decoy receptor for TNF-alpha.
Other TNF-alpha inhibitors: Infliximab, adalimumab
Inhibition leads to impaired cell mediated immunity. TNF-alpha is necessary for
sequestration of mycobacteria within granulomas. Latent tuberculosis can reactivate.
A 25 yo man suffers head trauma after a motorcycle crash. He is admitted to
the ICU and administered mannitol to raise plasma osmolarity.
Which of the following effects is expected for movement of fluid out of
capillaries and into tissues after mannitol?
A. Increased movement into tissues
B. Decreased movement into tissues
, Page 4 of 51
C. No change
B
A 27 yo male motorcylist presents after a crash.
Internal bleeding is detected with a large amount of blood in the peritoneal and
thoracic cavities.
BP is 80/40 and pulse is 120.
Which of the folloiwng is most important in maintaining blood pressure in this
patient?
A. Renal renin release
B. Increased aortic arch baroreceptor firing
C. Decreased carotid sinus barareceptor firing
D. Increased parasympathetic activity .
E. Decreased sympathetic activity
C
This patient is suffering blood loss and hemorrhagic shock. Loss of blood volume
leads to a fall in blood pressure.
Baroreceptors in the carotid sinus will send fewer signals to the brain.
The brain will respond with increased sympathetic and decreased parasympathetic
activity.
B - The aortic arch is most sensitie to increases in blood pressure. Ulinke the carotid
sinus thoguh it has poor sensitivity to low blood pressure.
A 34 yo man is brought to the ER by ambulance after being in a motor vehicle
collision.
On arrival he is hypotensive and bleeding from several sites. H undergoes an
emergency blood transfusion.
En route to the operating room, the patient develops difficulty breathing, chills
and pain in the chest and back. Urine drainage from the Foley catheter was
clear, but now appears brown.
Which of the following is the most likley cause of the new findings?
A. CD8+ lymphocyte mediated toxicity
B. Complement mediated cell lysis
