USMLE question and answers

o ACTUAL TEST QUESTIONS AND
o ANSWERS


 62 year old woman - osteoporosis - a bisphosphonate
is prescribed. The expected beneficial effect of the
drug is due to which of the following? -Answer-
Decreased Osteoclast Activity

 Cohot Study of elderly women - relative risk ratio for
hip fractures among those who exercise regularly is
1.2 (95% confidence interval of 1.1 to 1.8). Which of
the following is the conclusion about the effect of
exercise on the risk of hip fracture? -Answer-
Statistically Significant Overall Increase Risk

 52 year old man goes to ER with chest pain radiating
to his jaw while shoveling snow. Pulse is 80/min and
blood pressure is 130/70. The most immediate
treatment mechanism of action? -Answer- Increased
nitric oxide concentration

 24 year old woman - spilled hot grease on her left leg
while working at a fast-food restaurant. Exam of leg
shows 7cm pink, soft, granular, edematous wound.
The formation of this tissue was most likely caused
by increased activity of which? -Answer- a. Vascular
Endothelial Growth Factor
o VEGF - stimulates angiogenesiss.
 TYPE III Collagen = Blood Vessels - early wound repair

 27 year old man- MVC - skull x-ray shows a linear,
nondepressed basal skull fracture - increased serum
osm and decreased urin osm. Following
desmopressin urine osm increases. Desmopressin's
effect is due to the activation of which of the

, following? - Answer- a. Adenylyl Cyclase
 Adenylate Cyclase - ATP - CAMP --
PROTEKINASE A -- Ca v2

 A 10 month old boy - 4 day history of fever and
cough. He attends day care center. Chest exam
shows intercostal retractions along with bilateral,
diffuse wheezes and expiratory rhonchi. The
infectious agent most likely has which of the following
properties? -Answer- Mediation of Cell Entry via a
fusion protein

 A 17 year old girl in ED - 15 minutes after being stung
by a bee. Mild light headedness but no difficulty
swallowing- Bilateral wheezing - Which is most
appropriate pharmacotherapy for this patient? -
Answer- B2- Agonist

 14 year old boy - 2 day history of sore throat and
fever that peaks in late afternoon. 1 week of
fatigue. He recentaly had sex with one partner.
Physical exam show cervical lymphadenopathy
and pharyngeal erythema with a creamy exudate.
DX?
 -Answer- Infectious Mononucleosis

, 57 year old man - radiation therapy for squamous cell
carcinoma of the lung. Despite therapy, tumor
increases in size and he dies 6 months later. The
progressive tumor growth is due to a defect in cell
cycle arrest in which of the following phases of cell
cycle? -Answer- G1

 28 year old - lived in sub-Saharan Africa - until he
came to the US. Temp of 100.4 - imaging shows
bilateral hydroureter and hydronephrosis. Biopsy
shows marked fibrosis and scattered granulomas.
DX? -Answer- Schistosomiasis

 A couple with a family history of a-thalassemia.
Woman has one gene deletion and man has two
gene deletion. If the two gene is trans - what
percentage of offspring will have a two gene
deletion? -Answer- 50%

 previously healthy 40 year brought to emergency
department by her husband - 2 day history of fever,
lethargy, confusion. PE shows scattered petechiae
and ecchymoses over the lower extremities - 3+
polychromasia and 3+ schistocytes and Low
platelets Dx? -Answer- Thrombotic
Thrombocytopenia Purpura

 16 year old boy - is admitted to the ER because of a
knife wound to the left side of his chest. An X-ray of
the chest shows an air-fluid level in the left side of
the chest, partial collapse of the left lung, and the
elevation of the stomach bubble. The mediastinum
is midline. DX? -Answer- Hemopneumpothorax
under tension

 49 year old woman - coronary artery disease - BP

, 140/90 - High Cholesterol, High LDL (190), High
triglycerides (350) - TX with atorvastatin and
losartan. What are the effects on HDL and
Triglycerides? -Answer- HDL increased
 Triglycerides Decreased

 73 yeare old - diffuse weakness and tingling of her
arms and legs. Sensation and vibration and position
is decreased in all extremities. What vitamin
deficiency? -Answer- Vitamin B12 - (cyanocobalamin)
 Tea and Toast - low B12 in diet

 15 year old girl - 3 month history of acne - which is
the underlying cause of the patients acne? -Answer-
Stimulation of Sebaceous Glands by androgens
 b. ACNE = Propionibacterium ACNE

 4 year old from Brazil - PE shows single 12x10cm
lesion in the right side of jaw with diffuse regular
edges. Photomicrographs of an incisional biopsy
(looks like Burkitts Lymphoma/ Starry night) - which
of the processes most likely to occur in the region
indicated by the arrow? -Answer- Apoptosis
 b. Endemic Burkitt lymphoma can happen in Brazil as
well as Africa (jaw lesion, puffy face).