Stanford University MD INDE 201 Practice of
Medicine I – Stanford Medical School Study Guide,
Original Practice Questions & Answers, INDE 201
Exam Preparation, Comprehensive Practice of
Medicine Review, Medical Interviewing, Physical
Examination, Clinical Skills, Patient
Communication, Information Literacy, Nutrition,
Clinical Epidemiology, Biostatistics, Evidence-Based
Medicine, Psychiatry, Biomedical Ethics, Health
Policy, Population Health & Simulated Clinical
Encounters
Question 1: A 72-year-old male with a history of hypertension and type 2
diabetes presents with a 2-day history of right lower quadrant abdominal pain,
anorexia, and a fever of 38.5°C. On examination, he has localized tenderness
at McBurney's point. Which of the following physiological changes associated
with aging most significantly complicates the diagnosis and management of his
suspected condition?
A. Increased hepatic metabolism of analgesics
B. Age-related thymic involution and altered T-cell function
C. Diminished sensation of thirst leading to dehydration
D. Decreased renal clearance of contrast dyes
CORRECT ANSWER: B. Age-related thymic involution and altered T-cell
function
Rationale: The patient's presentation suggests acute appendicitis. In elderly patients,
age-related thymic involution leads to a decline in naïve T-cell production and altered
immune function. This blunts the typical febrile and leukocytic responses to infection,
often leading to a delayed diagnosis and increased risk of perforation. While decreased
renal function is a concern for management, the altered immune response is the primary
factor complicating the initial diagnosis.
Question 2: A 55-year-old female with a history of chronic obstructive
pulmonary disease (COPD) and heart failure is prescribed a new medication.
Her physician counsels her to monitor for peripheral edema and weight gain.
Which physiological principle explains this specific side effect profile?
A. Increased capillary hydrostatic pressure due to vasodilation
B. Decreased plasma oncotic pressure from reduced hepatic synthesis
C. Increased tubular reabsorption of sodium and water
D. Increased lymphatic obstruction leading to fluid accumulation
CORRECT ANSWER: C. Increased tubular reabsorption of sodium and water
,Rationale: Many medications, such as thiazolidinediones used in diabetes or certain
antihypertensives, can cause fluid retention by increasing sodium and water
reabsorption in the renal tubules. This expands the extracellular fluid volume, leading to
peripheral edema and weight gain, which is particularly dangerous in patients with heart
failure.
Question 3: A patient with end-stage renal disease is undergoing hemodialysis.
During the procedure, the nurse notes a sudden drop in blood pressure and the
patient reports nausea and muscle cramps. What is the most likely underlying
physiological mechanism for these symptoms?
A. Rapid removal of urea and other solutes causing a fluid shift
B. Anaphylactic reaction to the dialysate solution
C. Bleeding at the vascular access site
D. Cardiac arrhythmia induced by electrolyte imbalances
CORRECT ANSWER: A. Rapid removal of urea and other solutes causing a fluid
shift
Rationale: Intradialytic hypotension is a common complication. The rapid removal of
solutes (urea) from the blood creates an osmotic gradient that can cause fluid to shift out
of the intravascular space into the intracellular and interstitial spaces. This hypovolemia
leads to hypotension, nausea, and muscle cramps.
Question 4: A 68-year-old male is evaluated for progressive difficulty with
memory and executive function. His family reports he has become apathetic
and has difficulty planning tasks. MRI reveals bilateral atrophy of the frontal
and temporal lobes. Which of the following findings is most characteristic of
the underlying pathology?
A. Intracellular accumulation of alpha-synuclein in Lewy bodies
B. Extracellular deposition of beta-amyloid plaques
C. Intracellular deposition of hyperphosphorylated tau protein in neurofibrillary tangles
D. Intracellular accumulation of TDP-43 protein
CORRECT ANSWER: D. Intracellular accumulation of TDP-43 protein
Rationale: The clinical picture of progressive behavioral changes, executive dysfunction,
and frontotemporal atrophy is characteristic of Frontotemporal Dementia (FTD). The
most common pathological subtype of FTD is characterized by the accumulation of
TDP-43 protein inclusions within neurons. While tau pathology is also seen, TDP-43 is
the most common.
Question 5: An otherwise healthy 45-year-old woman presents with a 3-month
history of fatigue, arthralgias, and a photosensitive malar rash. Laboratory
tests show a positive antinuclear antibody (ANA) and anti-dsDNA antibodies.
She asks about the genetic basis of her disease. Which of the following major
histocompatibility complex (MHC) class II alleles is most strongly associated
with this condition?
,A. HLA-B27
B. HLA-DR2
C. HLA-DR3
D. HLA-DR4
CORRECT ANSWER: C. HLA-DR3
Rationale: The patient's presentation is classic for Systemic Lupus Erythematosus (SLE).
SLE is strongly associated with the HLA-DR3 allele. HLA-B27 is associated with
ankylosing spondylitis, HLA-DR4 with rheumatoid arthritis, and HLA-DR2 is also seen
in some SLE patients but DR3 is the strongest association, particularly in Caucasian
populations.
Question 6: A 60-year-old male with a 40-pack-year smoking history presents
with a new-onset, non-productive cough and hoarseness. A chest X-ray reveals
a right hilar mass. Biopsy reveals small cell lung carcinoma (SCLC). What
specific paraneoplastic syndrome is most characteristic of this tumor type?
A. Hypercalcemia due to PTHrP secretion
B. Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
C. Hypertrophic pulmonary osteoarthropathy
D. Peripheral neuropathy
CORRECT ANSWER: B. Syndrome of Inappropriate Antidiuretic Hormone
(SIADH)
Rationale: SCLC is a neuroendocrine tumor that frequently produces ectopic hormones.
SIADH, caused by the secretion of antidiuretic hormone (ADH) or its analogues, is a
classic paraneoplastic syndrome associated with SCLC, leading to hyponatremia.
Hypercalcemia is more common with squamous cell carcinoma.
Question 7: A 28-year-old primigravida at 36 weeks gestation is brought to the
emergency department after a generalized tonic-clonic seizure. Her blood
pressure is 165/110 mmHg, and she has 3+ proteinuria on a urine dipstick.
Which medication is the first-line treatment to prevent further seizures in this
patient?
A. Phenytoin
B. Lorazepam
C. Magnesium sulfate
D. Levetiracetam
CORRECT ANSWER: C. Magnesium sulfate
Rationale: This patient is presenting with eclampsia, defined as new-onset seizures in a
preeclamptic patient. Magnesium sulfate is the first-line and most effective agent for
preventing and controlling seizures in eclampsia, reducing the risk of recurrent seizures
by over 50%. It works primarily as a vasodilator and by blocking NMDA receptors to
prevent seizure activity.
, Question 8: A patient is newly diagnosed with type 2 diabetes mellitus. The
physician is considering starting a medication that inhibits the SGLT-2
transporter in the proximal convoluted tubule. What is the primary
mechanism by which this class of drugs lowers blood glucose?
A. Increasing insulin secretion from pancreatic beta cells
B. Decreasing glucose absorption from the gastrointestinal tract
C. Increasing urinary glucose excretion
D. Decreasing hepatic gluconeogenesis
CORRECT ANSWER: C. Increasing urinary glucose excretion
Rationale: SGLT-2 inhibitors (e.g., canagliflozin, dapagliflozin) work by blocking the
sodium-glucose cotransporter 2 in the proximal tubule of the kidney. This reduces
glucose reabsorption, causing more glucose to be excreted in the urine, thereby
lowering plasma glucose levels. This mechanism is independent of insulin.
Question 9: A 52-year-old male presents with acute, severe back pain and a
new abdominal bruit. He has a history of hypertension and atherosclerosis. A
CT angiography reveals a dilated infrarenal aorta. What is the primary
modifiable risk factor that should be aggressively managed to prevent the
progression of his condition?
A. Hypercholesterolemia
B. Tobacco smoking
C. Obesity
D. Sedentary lifestyle
CORRECT ANSWER: B. Tobacco smoking
Rationale: The patient is presenting with an abdominal aortic aneurysm (AAA). While all
these are risk factors for atherosclerosis, tobacco smoking is the most potent modifiable
risk factor specifically for the development and expansion of AAAs. It is associated with
a significantly faster rate of aneurysm growth and an increased risk of rupture.
Question 10: A 34-year-old female with a family history of breast and ovarian
cancer is considering genetic testing. A mutation in which of the following
genes would most definitively establish a significantly elevated risk for both of
these malignancies?
A. BRCA1
B. p53
C. HER2/neu
D. APC
CORRECT ANSWER: A. BRCA1
Rationale: Mutations in the BRCA1 and BRCA2 genes are the most well-known
hereditary risk factors for breast and ovarian cancers. While both are associated, BRCA1
mutations are particularly known for a very high risk of both breast and ovarian cancer.
Medicine I – Stanford Medical School Study Guide,
Original Practice Questions & Answers, INDE 201
Exam Preparation, Comprehensive Practice of
Medicine Review, Medical Interviewing, Physical
Examination, Clinical Skills, Patient
Communication, Information Literacy, Nutrition,
Clinical Epidemiology, Biostatistics, Evidence-Based
Medicine, Psychiatry, Biomedical Ethics, Health
Policy, Population Health & Simulated Clinical
Encounters
Question 1: A 72-year-old male with a history of hypertension and type 2
diabetes presents with a 2-day history of right lower quadrant abdominal pain,
anorexia, and a fever of 38.5°C. On examination, he has localized tenderness
at McBurney's point. Which of the following physiological changes associated
with aging most significantly complicates the diagnosis and management of his
suspected condition?
A. Increased hepatic metabolism of analgesics
B. Age-related thymic involution and altered T-cell function
C. Diminished sensation of thirst leading to dehydration
D. Decreased renal clearance of contrast dyes
CORRECT ANSWER: B. Age-related thymic involution and altered T-cell
function
Rationale: The patient's presentation suggests acute appendicitis. In elderly patients,
age-related thymic involution leads to a decline in naïve T-cell production and altered
immune function. This blunts the typical febrile and leukocytic responses to infection,
often leading to a delayed diagnosis and increased risk of perforation. While decreased
renal function is a concern for management, the altered immune response is the primary
factor complicating the initial diagnosis.
Question 2: A 55-year-old female with a history of chronic obstructive
pulmonary disease (COPD) and heart failure is prescribed a new medication.
Her physician counsels her to monitor for peripheral edema and weight gain.
Which physiological principle explains this specific side effect profile?
A. Increased capillary hydrostatic pressure due to vasodilation
B. Decreased plasma oncotic pressure from reduced hepatic synthesis
C. Increased tubular reabsorption of sodium and water
D. Increased lymphatic obstruction leading to fluid accumulation
CORRECT ANSWER: C. Increased tubular reabsorption of sodium and water
,Rationale: Many medications, such as thiazolidinediones used in diabetes or certain
antihypertensives, can cause fluid retention by increasing sodium and water
reabsorption in the renal tubules. This expands the extracellular fluid volume, leading to
peripheral edema and weight gain, which is particularly dangerous in patients with heart
failure.
Question 3: A patient with end-stage renal disease is undergoing hemodialysis.
During the procedure, the nurse notes a sudden drop in blood pressure and the
patient reports nausea and muscle cramps. What is the most likely underlying
physiological mechanism for these symptoms?
A. Rapid removal of urea and other solutes causing a fluid shift
B. Anaphylactic reaction to the dialysate solution
C. Bleeding at the vascular access site
D. Cardiac arrhythmia induced by electrolyte imbalances
CORRECT ANSWER: A. Rapid removal of urea and other solutes causing a fluid
shift
Rationale: Intradialytic hypotension is a common complication. The rapid removal of
solutes (urea) from the blood creates an osmotic gradient that can cause fluid to shift out
of the intravascular space into the intracellular and interstitial spaces. This hypovolemia
leads to hypotension, nausea, and muscle cramps.
Question 4: A 68-year-old male is evaluated for progressive difficulty with
memory and executive function. His family reports he has become apathetic
and has difficulty planning tasks. MRI reveals bilateral atrophy of the frontal
and temporal lobes. Which of the following findings is most characteristic of
the underlying pathology?
A. Intracellular accumulation of alpha-synuclein in Lewy bodies
B. Extracellular deposition of beta-amyloid plaques
C. Intracellular deposition of hyperphosphorylated tau protein in neurofibrillary tangles
D. Intracellular accumulation of TDP-43 protein
CORRECT ANSWER: D. Intracellular accumulation of TDP-43 protein
Rationale: The clinical picture of progressive behavioral changes, executive dysfunction,
and frontotemporal atrophy is characteristic of Frontotemporal Dementia (FTD). The
most common pathological subtype of FTD is characterized by the accumulation of
TDP-43 protein inclusions within neurons. While tau pathology is also seen, TDP-43 is
the most common.
Question 5: An otherwise healthy 45-year-old woman presents with a 3-month
history of fatigue, arthralgias, and a photosensitive malar rash. Laboratory
tests show a positive antinuclear antibody (ANA) and anti-dsDNA antibodies.
She asks about the genetic basis of her disease. Which of the following major
histocompatibility complex (MHC) class II alleles is most strongly associated
with this condition?
,A. HLA-B27
B. HLA-DR2
C. HLA-DR3
D. HLA-DR4
CORRECT ANSWER: C. HLA-DR3
Rationale: The patient's presentation is classic for Systemic Lupus Erythematosus (SLE).
SLE is strongly associated with the HLA-DR3 allele. HLA-B27 is associated with
ankylosing spondylitis, HLA-DR4 with rheumatoid arthritis, and HLA-DR2 is also seen
in some SLE patients but DR3 is the strongest association, particularly in Caucasian
populations.
Question 6: A 60-year-old male with a 40-pack-year smoking history presents
with a new-onset, non-productive cough and hoarseness. A chest X-ray reveals
a right hilar mass. Biopsy reveals small cell lung carcinoma (SCLC). What
specific paraneoplastic syndrome is most characteristic of this tumor type?
A. Hypercalcemia due to PTHrP secretion
B. Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
C. Hypertrophic pulmonary osteoarthropathy
D. Peripheral neuropathy
CORRECT ANSWER: B. Syndrome of Inappropriate Antidiuretic Hormone
(SIADH)
Rationale: SCLC is a neuroendocrine tumor that frequently produces ectopic hormones.
SIADH, caused by the secretion of antidiuretic hormone (ADH) or its analogues, is a
classic paraneoplastic syndrome associated with SCLC, leading to hyponatremia.
Hypercalcemia is more common with squamous cell carcinoma.
Question 7: A 28-year-old primigravida at 36 weeks gestation is brought to the
emergency department after a generalized tonic-clonic seizure. Her blood
pressure is 165/110 mmHg, and she has 3+ proteinuria on a urine dipstick.
Which medication is the first-line treatment to prevent further seizures in this
patient?
A. Phenytoin
B. Lorazepam
C. Magnesium sulfate
D. Levetiracetam
CORRECT ANSWER: C. Magnesium sulfate
Rationale: This patient is presenting with eclampsia, defined as new-onset seizures in a
preeclamptic patient. Magnesium sulfate is the first-line and most effective agent for
preventing and controlling seizures in eclampsia, reducing the risk of recurrent seizures
by over 50%. It works primarily as a vasodilator and by blocking NMDA receptors to
prevent seizure activity.
, Question 8: A patient is newly diagnosed with type 2 diabetes mellitus. The
physician is considering starting a medication that inhibits the SGLT-2
transporter in the proximal convoluted tubule. What is the primary
mechanism by which this class of drugs lowers blood glucose?
A. Increasing insulin secretion from pancreatic beta cells
B. Decreasing glucose absorption from the gastrointestinal tract
C. Increasing urinary glucose excretion
D. Decreasing hepatic gluconeogenesis
CORRECT ANSWER: C. Increasing urinary glucose excretion
Rationale: SGLT-2 inhibitors (e.g., canagliflozin, dapagliflozin) work by blocking the
sodium-glucose cotransporter 2 in the proximal tubule of the kidney. This reduces
glucose reabsorption, causing more glucose to be excreted in the urine, thereby
lowering plasma glucose levels. This mechanism is independent of insulin.
Question 9: A 52-year-old male presents with acute, severe back pain and a
new abdominal bruit. He has a history of hypertension and atherosclerosis. A
CT angiography reveals a dilated infrarenal aorta. What is the primary
modifiable risk factor that should be aggressively managed to prevent the
progression of his condition?
A. Hypercholesterolemia
B. Tobacco smoking
C. Obesity
D. Sedentary lifestyle
CORRECT ANSWER: B. Tobacco smoking
Rationale: The patient is presenting with an abdominal aortic aneurysm (AAA). While all
these are risk factors for atherosclerosis, tobacco smoking is the most potent modifiable
risk factor specifically for the development and expansion of AAAs. It is associated with
a significantly faster rate of aneurysm growth and an increased risk of rupture.
Question 10: A 34-year-old female with a family history of breast and ovarian
cancer is considering genetic testing. A mutation in which of the following
genes would most definitively establish a significantly elevated risk for both of
these malignancies?
A. BRCA1
B. p53
C. HER2/neu
D. APC
CORRECT ANSWER: A. BRCA1
Rationale: Mutations in the BRCA1 and BRCA2 genes are the most well-known
hereditary risk factors for breast and ovarian cancers. While both are associated, BRCA1
mutations are particularly known for a very high risk of both breast and ovarian cancer.
