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 40-pack-year smoking history presents
with a 2-month history of hoarseness and a non-productive cough. Flexible
laryngoscopy reveals a lesion on the right vocal fold. Which of the following is
the most significant risk factor for malignancy in this patient's presentation?
A. Age greater than 70 years
B. Duration of cough
C. History of tobacco use
D. Presence of hoarseness
CORRECT ANSWER: C. History of tobacco use
Rationale: Tobacco use is the single most significant risk factor for squamous cell
carcinoma of the larynx. While age is a risk factor, the pack-year history of smoking is
the most directly associated with the development of laryngeal malignancy. Hoarseness
is a symptom, not a risk factor.
Question 2: A 45-year-old woman presents with episodic palpitations,
sweating, and headache. Her blood pressure is 180/110 mmHg during an
episode. Which of the following laboratory findings would most strongly
support a diagnosis of pheochromocytoma?
A. Elevated serum serotonin
B. Elevated urinary metanephrines
C. Elevated serum cortisol
D. Elevated plasma renin activity
CORRECT ANSWER: B. Elevated urinary metanephrines
Rationale: Pheochromocytomas are catecholamine-secreting tumors. The measurement
of fractionated metanephrines (metabolites of epinephrine and norepinephrine) in a 24-
hour urine collection is the most sensitive and specific biochemical test for diagnosis.
Question 3: A 60-year-old patient with chronic kidney disease is started on
lisinopril. Which of the following adverse effects is most commonly associated
with this medication and requires monitoring of serum levels?
,A. Hypokalemia
B. Hyperkalemia
C. Hyponatremia
D. Hypocalcemia
CORRECT ANSWER: B. Hyperkalemia
Rationale: ACE inhibitors like lisinopril decrease aldosterone secretion, leading to
reduced potassium excretion by the kidneys. This can result in hyperkalemia,
particularly in patients with underlying renal impairment.
Question 4: In the context of a complete blood count (CBC), which of the
following parameters is most indicative of the average size of red blood cells?
A. Hemoglobin
B. Hematocrit
C. Red blood cell count
D. Mean corpuscular volume
CORRECT ANSWER: D. Mean corpuscular volume
Rationale: The mean corpuscular volume (MCV) is a measure of the average volume of
a red blood cell. It is calculated from the hematocrit and the red blood cell count.
Hemoglobin is the protein within the cell, and hematocrit is the proportion of blood
volume occupied by red cells.
Question 5: A 55-year-old man with a history of gout presents with acute,
severe pain in his right great toe. Which of the following medications is most
appropriate for the acute management of this condition, assuming no
contraindications?
A. Allopurinol
B. Colchicine
C. Febuxostat
D. Probenecid
CORRECT ANSWER: B. Colchicine
Rationale: Colchicine is an anti-inflammatory medication used for the acute treatment of
gout flares. Allopurinol and febuxostat are used for chronic urate-lowering therapy and
can precipitate an acute attack if started during a flare. Probenecid promotes uric acid
excretion.
,Question 6: A 28-year-old medical student is studying the anatomy of the
upper limb. Which of the following muscles is primarily responsible for the
initial 15 degrees of shoulder abduction?
A. Deltoid
B. Supraspinatus
C. Infraspinatus
D. Teres minor
CORRECT ANSWER: B. Supraspinatus
Rationale: The supraspinatus muscle initiates abduction of the shoulder. The deltoid
muscle is responsible for abduction beyond the first 15 degrees. The infraspinatus and
teres minor are external rotators of the shoulder.
Question 7: A 70-year-old female is diagnosed with osteoporosis. Which of the
following laboratory findings would be most consistent with this diagnosis?
A. Elevated serum calcium
B. Elevated serum phosphate
C. Normal serum calcium and phosphate
D. Elevated alkaline phosphatase
CORRECT ANSWER: C. Normal serum calcium and phosphate
Rationale: Osteoporosis is characterized by decreased bone mass with normal bone
mineralization. Therefore, serum calcium and phosphate levels are typically normal. A
DEXA scan is the diagnostic test. Elevated alkaline phosphatase would be more
characteristic of Paget's disease or osteomalacia.
Question 8: A patient is prescribed a beta-blocker for hypertension. Which of
the following is a primary contraindication for the use of a non-selective beta-
blocker like propranolol?
A. Diabetes mellitus
B. Asthma
C. Hyperthyroidism
D. Migraine
CORRECT ANSWER: B. Asthma
Rationale: Non-selective beta-blockers block both beta-1 and beta-2 receptors. Beta-2
blockade in the lungs can cause bronchoconstriction, making them contraindicated in
patients with asthma or COPD. Selective beta-1 blockers are preferred for patients with
reactive airway disease.
, Question 9: A 40-year-old man presents with a painless, slowly growing mass
on the lateral aspect of his forearm. On examination, the mass is firm, fixed to
the underlying bone, and does not transilluminate. Which of the following is
the most likely diagnosis?
A. Ganglion cyst
B. Lipoma
C. Osteochondroma
D. Epidermoid cyst
CORRECT ANSWER: C. Osteochondroma
Rationale: Osteochondromas are benign bone tumors that present as painless, firm
masses that are fixed to the bone. Ganglion cysts are typically mobile and
transilluminate. Lipomas are soft and mobile. Epidermoid cysts are mobile and can be
transilluminated.
Question 10: A 65-year-old patient with a history of heart failure is started on
furosemide. Which of the following electrolyte imbalances is a common
adverse effect of this medication?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypercalcemia
CORRECT ANSWER: B. Hypokalemia
Rationale: Furosemide is a loop diuretic that inhibits sodium-potassium-chloride
cotransporter in the thick ascending limb of the loop of Henle. This leads to increased
excretion of potassium, which can result in hypokalemia.
Question 11: A 50-year-old patient with a history of chronic alcohol use
presents with confusion, ophthalmoplegia, and ataxia. Which of the following
vitamin deficiencies is the most likely cause of this presentation?
A. Vitamin B12
B. Vitamin B1 (Thiamine)
C. Vitamin B6 (Pyridoxine)
D. Vitamin C
CORRECT ANSWER: B. Vitamin B1 (Thiamine)
Rationale: The classic triad of confusion, ophthalmoplegia, and ataxia is characteristic of
Wernicke's encephalopathy, which is caused by a deficiency in thiamine (vitamin B1).
This is commonly seen in patients with chronic alcoholism.
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 40-pack-year smoking history presents
with a 2-month history of hoarseness and a non-productive cough. Flexible
laryngoscopy reveals a lesion on the right vocal fold. Which of the following is
the most significant risk factor for malignancy in this patient's presentation?
A. Age greater than 70 years
B. Duration of cough
C. History of tobacco use
D. Presence of hoarseness
CORRECT ANSWER: C. History of tobacco use
Rationale: Tobacco use is the single most significant risk factor for squamous cell
carcinoma of the larynx. While age is a risk factor, the pack-year history of smoking is
the most directly associated with the development of laryngeal malignancy. Hoarseness
is a symptom, not a risk factor.
Question 2: A 45-year-old woman presents with episodic palpitations,
sweating, and headache. Her blood pressure is 180/110 mmHg during an
episode. Which of the following laboratory findings would most strongly
support a diagnosis of pheochromocytoma?
A. Elevated serum serotonin
B. Elevated urinary metanephrines
C. Elevated serum cortisol
D. Elevated plasma renin activity
CORRECT ANSWER: B. Elevated urinary metanephrines
Rationale: Pheochromocytomas are catecholamine-secreting tumors. The measurement
of fractionated metanephrines (metabolites of epinephrine and norepinephrine) in a 24-
hour urine collection is the most sensitive and specific biochemical test for diagnosis.
Question 3: A 60-year-old patient with chronic kidney disease is started on
lisinopril. Which of the following adverse effects is most commonly associated
with this medication and requires monitoring of serum levels?
,A. Hypokalemia
B. Hyperkalemia
C. Hyponatremia
D. Hypocalcemia
CORRECT ANSWER: B. Hyperkalemia
Rationale: ACE inhibitors like lisinopril decrease aldosterone secretion, leading to
reduced potassium excretion by the kidneys. This can result in hyperkalemia,
particularly in patients with underlying renal impairment.
Question 4: In the context of a complete blood count (CBC), which of the
following parameters is most indicative of the average size of red blood cells?
A. Hemoglobin
B. Hematocrit
C. Red blood cell count
D. Mean corpuscular volume
CORRECT ANSWER: D. Mean corpuscular volume
Rationale: The mean corpuscular volume (MCV) is a measure of the average volume of
a red blood cell. It is calculated from the hematocrit and the red blood cell count.
Hemoglobin is the protein within the cell, and hematocrit is the proportion of blood
volume occupied by red cells.
Question 5: A 55-year-old man with a history of gout presents with acute,
severe pain in his right great toe. Which of the following medications is most
appropriate for the acute management of this condition, assuming no
contraindications?
A. Allopurinol
B. Colchicine
C. Febuxostat
D. Probenecid
CORRECT ANSWER: B. Colchicine
Rationale: Colchicine is an anti-inflammatory medication used for the acute treatment of
gout flares. Allopurinol and febuxostat are used for chronic urate-lowering therapy and
can precipitate an acute attack if started during a flare. Probenecid promotes uric acid
excretion.
,Question 6: A 28-year-old medical student is studying the anatomy of the
upper limb. Which of the following muscles is primarily responsible for the
initial 15 degrees of shoulder abduction?
A. Deltoid
B. Supraspinatus
C. Infraspinatus
D. Teres minor
CORRECT ANSWER: B. Supraspinatus
Rationale: The supraspinatus muscle initiates abduction of the shoulder. The deltoid
muscle is responsible for abduction beyond the first 15 degrees. The infraspinatus and
teres minor are external rotators of the shoulder.
Question 7: A 70-year-old female is diagnosed with osteoporosis. Which of the
following laboratory findings would be most consistent with this diagnosis?
A. Elevated serum calcium
B. Elevated serum phosphate
C. Normal serum calcium and phosphate
D. Elevated alkaline phosphatase
CORRECT ANSWER: C. Normal serum calcium and phosphate
Rationale: Osteoporosis is characterized by decreased bone mass with normal bone
mineralization. Therefore, serum calcium and phosphate levels are typically normal. A
DEXA scan is the diagnostic test. Elevated alkaline phosphatase would be more
characteristic of Paget's disease or osteomalacia.
Question 8: A patient is prescribed a beta-blocker for hypertension. Which of
the following is a primary contraindication for the use of a non-selective beta-
blocker like propranolol?
A. Diabetes mellitus
B. Asthma
C. Hyperthyroidism
D. Migraine
CORRECT ANSWER: B. Asthma
Rationale: Non-selective beta-blockers block both beta-1 and beta-2 receptors. Beta-2
blockade in the lungs can cause bronchoconstriction, making them contraindicated in
patients with asthma or COPD. Selective beta-1 blockers are preferred for patients with
reactive airway disease.
, Question 9: A 40-year-old man presents with a painless, slowly growing mass
on the lateral aspect of his forearm. On examination, the mass is firm, fixed to
the underlying bone, and does not transilluminate. Which of the following is
the most likely diagnosis?
A. Ganglion cyst
B. Lipoma
C. Osteochondroma
D. Epidermoid cyst
CORRECT ANSWER: C. Osteochondroma
Rationale: Osteochondromas are benign bone tumors that present as painless, firm
masses that are fixed to the bone. Ganglion cysts are typically mobile and
transilluminate. Lipomas are soft and mobile. Epidermoid cysts are mobile and can be
transilluminated.
Question 10: A 65-year-old patient with a history of heart failure is started on
furosemide. Which of the following electrolyte imbalances is a common
adverse effect of this medication?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypercalcemia
CORRECT ANSWER: B. Hypokalemia
Rationale: Furosemide is a loop diuretic that inhibits sodium-potassium-chloride
cotransporter in the thick ascending limb of the loop of Henle. This leads to increased
excretion of potassium, which can result in hypokalemia.
Question 11: A 50-year-old patient with a history of chronic alcohol use
presents with confusion, ophthalmoplegia, and ataxia. Which of the following
vitamin deficiencies is the most likely cause of this presentation?
A. Vitamin B12
B. Vitamin B1 (Thiamine)
C. Vitamin B6 (Pyridoxine)
D. Vitamin C
CORRECT ANSWER: B. Vitamin B1 (Thiamine)
Rationale: The classic triad of confusion, ophthalmoplegia, and ataxia is characteristic of
Wernicke's encephalopathy, which is caused by a deficiency in thiamine (vitamin B1).
This is commonly seen in patients with chronic alcoholism.
