NBME CBSE REAL MEDICATION EXAM 200 QUESTIONS AND CORRECT ANSWERS LATEST (USMLE STEP 1)

NBME CBSE REAL MEDICATION EXAM 200 QUESTIONS AND CORRECT ANSWERS LATEST (USMLE STEP 1) 1. An 84-year-old woman who resides in an assisted living facility is brought to the emergency department because of fever and cough for 1 week. The cough has been productive of foul-smelling, yellow-green sputum for 24 hours. She has a 2-year history of dementia, Alzheimer type. Her temperature is 38.5°C (101.3°F), pulse is 80/min, respirations are 20/min, and blood pressure is 116/66 mm Hg. Coarse inspiratory crackles are heard over the right lung field. Laboratory studies show a leukocyte count of 13,500/mm 3 (72% segmented neutrophils, 8% bands, 1% eosinophils, 16% lymphocytes, and 3% monocytes). A CT scan shows a cavitary lesion in the superior segment of the right lower lobe. The lesion has a thick wall and an irregular peripheral margin; there is no displacement of the adjacent bronchovascular bundle. Which of the following is the most likely cause of the lung lesion in this patient? A. Antecedent viral pneumonia B. Aspiration of gastric contents C. Bronchial obstruction by metastatic carcinoma D. Lung infarction secondary to arterial thrombosis E. Primary carcinoma of the lung F. Secondary infection of a congenital lung cyst G. Septic embolism from an extrapulmonary site B 2. An otherwise healthy 26-year-old woman has had petechiae on her legs during the last 24 hours. Laboratory studies show: Hemoglobin Hematocrit Leukocyte count Neutrophils Lymphocytes Monocytes Mean corpuscular volume Platelet count 13.1 g/dL 39.7% 8500/mm 3 65% 30% 5% 82.2 μm 3 20,000/mm 3 A peripheral blood smear shows normal red cell morphology; a bone marrow smear shows mature megakaryocytic hyperplasia. Which of the following is the most likely diagnosis? A. Acute megakaryocytic leukemia B. Acute myelogenous leukemia C. Aplastic anemia D. Immune thrombocytopenic purpura E. Epstein-Barr viral infection F. Papovavirus infection G. Thrombotic thrombocytopenic purpura D 3. An 83-year-old man comes to the physician because of a 2-day history of constant severe pain of his right knee. He had a similar episode 1 year ago that subsided in 1 month without treatment. His temperature is 37.7°C (99.9°F). Examination of the right knee shows swelling; there is no overlying warmth or apparent deformity. Palpation and movement of the right knee produce pain; range of motion is limited by pain. An x-ray of the right knee shows large subchondral cysts and linear meniscal calcifications. Examination of fluid obtained on joint aspiration of the knee shows: Amount Appearance Leukocyte count Segmented neutrophils Lymphocytes 2 mL cloudy with diminished viscosity and crystals present 49,000/mm 3 65% 35% His pain is moderately improved after the joint aspiration and injection of corticosteroids. Treatment with ibuprofen during the next week significantly improves his condition. Histologic examination of the joint fluid aspirate is most likely to show which of the following types of crystals? (A)Calcium pyrophosphate (B)Cholesterol (C)Oxalic acid D. Potassium phosphate A 4. A 16-year-old boy comes to the physician because of a rash on his left inner thigh that first appeared 2 days after he returned from a hunting trip with friends in Minnesota. A photograph of the rash is shown. Without treatment, this patient is at increased risk for which of the following? A. Carditis B. Glomerulonephritis C. Hepatitis D. Pancreatitis E. Thrombocytopenia A 5. A previously healthy 24-year-old woman comes to the emergency department because of fever and diarrhea for the past 5 days. She has more than 10 bowel movements daily, accompanied by abdominal cramping and the passage of mucus and blood clots. She has not traveled out of the United States. Tympanic temperature is 39°C (102.2°F). Bowel sounds are increased. Test of stool for occult blood is positive. Which of the following is the most likely causal organism? A. Bacillus cereus B. Cryptosporidium parvum C. Giardia lamblia D. Shigella sonnei E. Staphylococcus aureus D 6. A 63-year-old homeless man is brought to the emergency department 1 hour after police found him unresponsive. His respirations are 30/min. Crackles are heard over the left upper and the entire right lung fields. Despite appropriate lifesaving measures, he dies. A photomicrograph of a section of the right lung obtained at autopsy is shown. Which of the following mediators is the most likely cause of the position of the cell indicated by the arrow? A. Bradykinin B .C5a C. Histamine D. Nitrous oxide E. Prostaglandins B 7. A 63-year-old woman comes to the physician because of a 2-week history of fatigue, malaise, nausea and vomiting, and decreased appetite; these symptoms have worsened during the past week. She was diagnosed with tuberculosis 3 months ago; a multidrug regimen was initiated at that time. Her temperature is 37.1°C (98.8°F). Physical examination shows scleral icterus and tenderness over the right upper quadrant of the abdomen; there is no hepatomegaly. Serum studies show a total bilirubin concentration of 6.5 mg/dL, AST activity of 580 U/L, and ALT activity of 650 U/L. Which of the following drugs is the most likely cause of these findings? A. Ethambutol B. Isoniazid C. Levofloxacin D. Streptomycin E. Vitamin B 6 (pyridoxine) B 8. A 48-year-old woman comes to the emergency department because of shortness of breath. She has no history of cardiac or pulmonary disease. Her current medication is timolol for glaucoma. Her pulse is 75/min. Diffuse wheezing is heard in the lower lung fields. An ECG shows no abnormalities. In addition to discontinuing timolol, which of the following drugs is the most appropriate treatment to relieve symptoms at this time? A. Adenosine B. Albuterol C. Beclomethasone D. Cromolyn E. Propranolol B 9. A healthy 28-year-old woman comes to the physician for advice on losing weight. She is 150 cm (4 ft 11 in) tall and weighs 56 kg (124 lb.); BMI is 25 kg/m 2. Physical examination shows no other abnormalities. The physician recommends a diet that will restrict her daily intake by 500 kilocalories. Which of the following processes is most likely to increase in this patient as a result of following this diet? A. Adipocyte glucose uptake B. Cerebral ketone utilization C. Hepatic lipid oxidation D. Muscle glucose uptake E. Resting energy expenditure C