USMLE1 practice Qbank

USMLE1 Cranial Nerves-1

2011-09-21T19:30:00.000-07:00

Cranial Nerves:Which of the following cranial nerves is necessary for horizontal conjugate movements of the eyes?

a. III

b. IV

c. VI

d. Both A and B

e. Both A and C –Occulomotor & Abducens

2. Which of the following cranial nerves is necessary for elevation of the eyeball?

a. III- Occulomotor

b. IV

c. VI

d. V

e. None of the above

3. Which of the following combinations of extraocular muscle and cranial nerve of supply are involved in mediating depression or downward movements of the eyeball?

a. superior oblique - Nerve III

b. inferior oblique - Nerve IV

c. inferior rectus - Nerve VI

d. inferior oblique - Nerve IV

e. superior oblique - Nerve IV-Trochlear

4. Which of the following is NOT a function of cranial nerve III?

a. elevation of eyes

b. adduction of eyes

c. constriction of pupil

d. dilatation of pupil

e. changing the shape of the lens

5. Which of the following ganglia is involved in mediating pupillary light reflex?

a. ciliary ganglion

b. celiac ganglion

c. trigeminal ganglion

d. pterygopalatine ganglion

e. none of the above

6. Which of the following in NOT a sign/symptom of dysfunction of cranial nerve III?

a. constricted pupil (miosis)

b. downward and outward deviation of the eye ball

c. loss of pupillary light reflex

d. ptosis (drooping of the upper lid)

e. none of the above

7. Which of the following cranial nerves innervate smooth muscles?

a. IX

b. V

c. VII

d. Both A and C

e. III-occulomotor

8. Which of the following muscles remain functional after a complete interruption of cranial nerve III?

a. ciliary muscle

b. lateral rectus

c. superior oblique

d. superior rectus

e. Both B and C

9. Which of the following cranial nerves has the longest intracranial course (between points of attachment to the brain stem and exit through its cranial foramen)?

a. III

b. V

c. VI -abducens

d. VII

e. IX

10. Which of the following is a TRUE statement?

a. all cranial nerves carry motor, sensory and parasympathetic fibers

b. all cranial nerves have sensory ganglia attached to them

c. cranial nerves carry sympathetic preganglionic fibers

d. all spinal nerves carry sensory and motor fibers

e. all spinal nerves carry parasympathetic fibers

11. Trigeminal nerve:

a. is a mixed cranial nerve with both motor and sensory functions

b. has a sensory ganglion

c. innervates the muscles of mastication

d. does not carry preganglionic parasympathetic fibers

e. all of the above are true

12. Which of the following cranial nerves is/are closely related to the cavernous sinus?

a. III -occulo

b. VI -abducent

c. IV -trochlear

d. ophthalmic and maxillary divisions of V-trigeminal

e. all of the above

13. The ophthalmic nerve:

a. gives rise to branches which supply the cornea

b. innervates the muscles of mastication

c. is necessary for the motor response of the corneal reflex

d. innervates the buccinator muscle

e. provides sensory innervation to the skin of the cheek

14. The maxillary division of trigeminal nerve:

a. passes through the pterygopalatine fossa

b. becomes the infraorbital nerve

c. supplies the skin of the cheek, lower eyelid and upper lip

d. supplies the lining of the maxillary air sinus

e. all of the above are true

15. Damage to the motor fibers in the trigeminal nerve may cause:

a. flattening of the side of the jaw due to atrophy of the masseter muscle

b. difficulty in closing the eyes

c. slight deviation of the jaw toward the affected side when the mouth is opened

d. Both A and B

e. Both A and C

16. Mandibular division of the trigeminal nerve conveys cutaneous sensory information from:

a. the upper lip

b. the lower lip

c. the bony part of the cheek

d. Both A and C

e. Both B and C

17. Which of the following is NOT supplied by branches of the mandibular division of V:

a. gums and teeth of the lower jaw

b. anterior two-thirds of the tongue

c. muscles of mastication

d. skin over the angle of the mandible

e. e. mucous membrane lining the cheek

18. Facial nerve:

a. enters the internal auditory meatus

b. courses in the facial canal in the petrous temporal bone in relation to the middle ear cavity

c. exits from the skull through the stylomastoid foramen

d. enters the substance of the parotid salivary gland

e. all of the above are true

19. Which of the following cranial nerves is likely to be damaged during surgery on middle ear and mastoid antrum?

a. V

b. VI

c. VII -facial

d. X

e. None of the above

20. Which of the following is NOT supplied by the vagus, along with the cranial accessory?

a. constrictor muscles of the pharynx

b. muscles of the soft palate

c. muscles of the larynx

d. mucous membrane of the larynx

e. mucous membrane of the nasal cavity

21. The recurrent laryngeal branch of the vagus:

a. arises in the thorax on the left side

b. is found in the groove between the trachea and the esophagus in the neck

c. supplies all muscles of the larynx except the cricothyroid

d. only A and C are correct

e. A, B and C are correct

22. The cranial division of the accessory nerve:

a. arises from the spinal cord

b. contains parasympathetic fibers which innervate the heart and other viscera

c. joins the vagus and is distributed through it to the skeletal muscles of the larynx, soft palate and pharynx

d. is found in the roof of the posterior triangle

e. supplies the sternocleidomastoid muscle

23. A normal gag reflex is dependent on the intactness of the following nerves:

a. V

b. IX

c. X and cranial XI

d. Both A and B

e. Both B and C

24. You are testing palatal movements in a patient. When the patient is asked to say "Ah", the right side of the palate is found to be at a lower level than the left and the uvula is deviated toward the left. This patient is likely to have a lesion of the:

a. right vagus and cranial accessory

b. left vagus and cranial accessory

c. right glossopharyngeal nerve

d. left glossopharyngeal nerve

e. none of the above

25. Which of the following cranial nerves carry parasympathetic preganglionic fibers?

a. III -occulo

b. VII -facial

c. IX -glossopharyngeal

d. X -vagus

e. all of the above

26. Which of the following muscles is innervated by parasympathetic postganglionic fibers?

a. ciliary muscle

b. superior rectus

c. sphincter pupillae

d. dilator pupillae

e. both A and C

27. A complete interruption of the right cranial nerve VI will result in:

a. paralysis of the left lateral rectus

b. inability to abduct the right eye

c. diplopia in looking to the left

d. inability to adduct the right eye

e. all of the above

28. Which of the following can produce ptosis (drooping of upper eyelid)?

a. loss of innervation of the levator palpebrae superioris

b. loss of function of cranial nerve III

c. loss of sympathetic innervation of the eye

d. paralysis of orbicularis oculi muscle

e. all of the above except D

29. Pupillary dilation results from:

a. contraction of dilator pupillae

b. activation of sympathetic preganglionic neurons in the spinal cord

c. activation of sympathetic postganglionic fibers arising from the superior cervical ganglion

d. release of norepinephrine from nerves which innervate the dilator pupillae

e. all of the above

30. Which of the following cranial nerves carry motor fibers to skeletal muscles?

a. facial

b. hypoglossal

c. vagus

d. mandibular branch of trigeminal

e. all of the above

31. Which of the following cranial nerves travel through the superior orbital fissure?

a. III –occulo

b. IV -troch

c. ophthalmic division of V

d. maxillary division of V

e. all of the above except D

32. Ophthalmic division of V:

a. passes through the optic foramen

b. enters the orbit through the inferior orbital fissure

c. supplies skeletal muscles in the orbit

d. is the major sensory nerve to the eye by way of its nasociliary branch

e. all of the above

33. The frontal nerve:

a. divides into supraorbital and supratrochlear branches

b. supplies the skin of the forehead

c. supplies the frontal air sinus

d. is a sensory nerve

e. all of the above

34. Cutaneous distribution of the maxillary nerve includes:

a. upper eyelid

b. lower eyelid

c. lower lip

d. bridge of the nose

e. all of the above

35. Branches of the trigeminal nerve supply:

a. Meninges

b. mucous lining of nasal cavities and paranasal air sinuses

c. cornea

d. mucosa of the anterior two-thirds of the tongue

e. all of the above

36. Branches of the mandibular division of the trigeminal nerve supply:

a. masseter

b. buccinator

c. medial and lateral pterygoids

d. orbicularis oculi

e. A and C

37. The corneal reflex is a test for the integrity of:

a. ophthalmic division of V

b. cranial nerve III

c. cranial nerve VII

d. both (a) and (b)

e. both (a) and (c)

38. The mandibular nerve:

a. passes through the foramen spinosum

b. is a purely sensory nerve, with no motor components

c. provides sensory innervation to the posterior third of the tongue

d. passes through the pterygopalatine fossa

e. its lingual branch carries the chorda tympani branch of nerve VII

39. Which of the following types of fibers is/are NOTcontained in the facial nerve?

a. motor

b. parasympathetic preganglionic

c. special sensory from taste buds

d. general sensory from the facial skin

e. general sensory from the mucous membranes

40. Parasympathetic fibers contained in the facial nerve are responsible for the innervation of:

a. submandibular salivary gland

b. lacrimal gland

c. sublingual salivary gland

d. parotid salivary gland

e. all of the above except D

41. Inflammatory reaction confined to an area around the stylomastoid foramen is one of the conditions that leads to a clinical entity referred to as "Bell's palsy". This is likely to manifest as:

a. difficulty in opening the eyes

b. absence of wrinkling of the forehead

c. complete lack of secretion of saliva

d. inability to perceive taste sensation from the anterior two-thirds of the tongue

e. all of the above

42. Loss of taste sensation at the tip of the tongue indicates an involvement of:

a. branches of the facial nerve in the parotid gland

b. chorda tympani branch of facial nerve

c. the facial nerve at the level of the stylomastoid foramen

d. the facial nerve in the cranial cavity before it enters the facial canal

e. Both B and D

43. Glossopharyngeal nerve innervates:

a. taste buds in the posterior third of the tongue

b. general sensory receptors in the posterior third of the tongue

c. stylopharyngeus muscle

d. baroreceptors in the carotid sinus

e. e. all of the above

44. Sensory innervation of the mucous membrane of the larynx is provided by:

a. the glossopharyngeal nerve

b. trigeminal nerve

c. the spinal accessory nerve

d. the vagus

e. all of the above

45. On asking a patient to protrude her tongue, you observe that the tongue deviates to the right side. This patient is likely to have:

a. a paralysis of the right genioglossus muscle

b. a complete interruption of the right hypoglossal nerve

c. wasting (atrophy) of the right half of the tongue

d. a normal left hypoglossal nerve

e. all of the above

46. Which of the following is correct regarding the larynx?

a. mucous membrane below the vocal cords is supplied by the internal laryngeal branch of vagus

b. external laryngeal branch supplies the cricothyroid muscle

c. all muscles other than the cricothyroid are supplied by the internal laryngeal branch

d. one muscle is supplied by the glossopharyngeal nerve

e. sensory innervation is in part provided by the glossopharyngeal nerve

47. Which of the following combinations of skeletal muscle and its nerve of supply is/are NOT correct?

a. buccinator - facial nerve

b. lateral cricoarytenoid - vagus

c. genioglossus - hypoglossal nerve

d. mylohyoid- cervical spinal nerve

e. infrahyoid muscles- hypoglossal nerve

48. Which of the following cranial nerves is/are responsible for initiating reflexes resulting from the stimulation of receptors in the carotid body and sinus?

a. IX –the carotid sinus is thickening of wall of internal carotid artery, near common carotid. Baroreceptors fire when pressure in sinus is changed.

b. V

c. XI

d. VII

e. all of the above

49. Which of the following branches of cranial nerves contains preganglionic parasympathetic fibers?

a. chorda tympani

b. greater superficial petrosal

c. lacrimal

d. both a and b

e. All of the above

50. Which of the following cranial nerves carry taste sensation?

a. VII -facial

b. IX -glosso

c. X -vagus

d. XI -accessory

e. all of the above except D

1. A&C, 2. E, 3. E, 4. D, 5. A, 6.A, 7.E, 8.E, 9.C, 10. D, 11.E, 12. E, 13.A, 14. E, 15.E, 16. B, 17. D, 18. E, 19. C, 20. E, 21. E, 22. C, 23. E, 24. A, 25. E, 26. E, 27. B, 28. E, 29. E, 30. E, 31.E, 32. D, 33. E, 34. B, 35.E, 36. E, 37. E, 38. E, 39. D, 40. E, 41. B, 42. E, 43. E, 44. D, 45. E, 46. B, 47. D, 48. A, 49. E, 50. E.

USMLE1- Quick review-Practice Questions

2011-09-14T19:32:00.000-07:00

Practice Questions- Quick review

1. Which of the following is the antidote for the toxin Benzodiazepines?

A. Flumazenil
B. Methylene blue
C. Deferoxamine
D. Alkalinize urine

2. Which of the following is the antidote for the toxin Lead?

A. Naloxone
B. Nitrite
C. CaEDTA
D. Dialysis

3. Which of the following is the primary site of activity for the drug Warfarin?

A. Kidney
B. Liver
C. Blood
D. Heart

4. Lansoprazole is not used in which of the following cases?

A. Gastritis
B. Peptic Ulcers
C. Zollinger-Ellison syndrome
D. Thalamus hypertrophy

5. Which of the following drugs is associated with the reaction of Cinchonism?

A. Valproic acid
B. Quinidine
C. Isoniazid
D. Ethosuximide

6. Which of the following drugs is associated with the reaction of hepatitis?

A. Valproic acid
B. Quinidine
C. Isoniazid
D. Ethosuximide

7. Which of the following drugs is associated with the reaction of Stevens-Johnson syndrome?

A. Valproic acid
B. Quinidine
C. Isoniazid
D. Ethosuximide

8. Which of the following drugs is associated with the reaction of Tendon dyfunction?

A. Digitalis
B. Niacin
C. Tetracycline
D. Fluoroquinolones

9. A drug ending in the suffix (pril) is considered a ______.

A. H
B. ACE inhibitor
C. Antifungal
D. Beta agonist

10. A drug ending in the suffix (azole) is considered a ______.

A. H
B. ACE inhibitor
C. Antifungal
D. Beta agonist

11. A drug ending in the suffix (tidine) is considered a ______.

A. Antidepressant
B. Protease inhibitor
C. Beta antagonist
D. H₂ antagonist

12. A drug ending in the suffix (navir) is considered a ______.

A. Antidepressant
B. Protease inhibitor
C. Beta antagonist
D. H₂ antagonist

13. Which of the following drugs is associated with the reaction of extreme photosensitivity?

A. Digitalis
B. Niacin
C. Tetracycline
D. Fluoroquinolones

14. Which of the following is not related to a drug toxicity of Prednisone?

A. Cataracts
B. Hypotension
C. Psychosis
D. Acne

15. Which of the following is not related to a drug toxicity of Atenolol?

A. CHF
B. Tachycardia
C. AV block
D. Sedative appearance

16. Which of the following is considered a class IA Sodium Channel blocker?

A. Mexiletine
B. Aminodarone
C. Quinidine
D. Procainamide

17. Which of the following is considered a class IA Sodium Channel blocker?

A. Propafenone
B. Disopyramide
C. Aminodarone
D. Quinidine

18. Potassium sparing diuretics have the primary effect upon the _____ found in the kidney.

A. Proximal convoluted tubule
B. Loop of Henle
C. Collecting duct
D. Distal convoluted tubule

19. Which of the following is not directly related to a drug toxicity of Nitroglycerin?

A. Headaches
B. Tachycardia
C. Dizziness
D. Projectile vomiting

20. Which of the following is not directly related to a drug toxicity of Ibuprofen?

A. Nausea
B. Renal dysfunction
C. Anemia
D. Muscle wasting

Answer Key
1. A , 2. C , 3. B , 4. D 5. B 6. C 7. D 8. D 9. B 10. C 11. D 12. B 13. C 14. B 15. B
16. B 17. A 18. D 19. D 20. D

USMLE1 Practice Questions-4

2011-09-14T19:29:00.000-07:00

1. A 45 year old female presents to your office with complaints of a 3 month history of aches and pains in her hands. She says that both of her hands are equally affected, but the pain is limited to only some of her joints. Upon further questioning, you find that the joints that are affected are the MCP's and PIP's. The patient also says that she has morning stiffness for about 45 minutes but gets better when she starts doing her morning chores. A potential treatment for this patient's condition can also be used in the treatment of an infectious disease that causes hemolytic anemia. Which of the following is the correct mechanism of action of this drug?
A. Binds to an inflammatory cytokine
B. Inhibits chemotaxis of inflammatory cells
C. Inhibits an enzyme involved in DNA synthesis
D. Inhibits an enzyme involved in prostaglandin synthesis
E. Is structurally similar to a cell surface receptor

2. A 67 year old male patient presents to your office with his wife. She is very concerned because she says that her husband has become progressively inactive over the past couple years. He sits on the couch with a blank look on his face and his hands shake when he is not using them. She says that her husband used to be very happy, but now he barely even smiles. You examine the patient and notice that he has a shuffling gait. One of the potential drugs used in the treatment of this patient is also an anti-viral medication that works by which of the following mechanisms?
A. Inhibits DNA-dependent RNA polymerase
B. Blocks attachement/release of virus
C. Inhibits uncoating of the virus
D. Inhibits mRNA transcription
E. Inhibits DNA-dependent DNA polymerase
F. Inhibits Reverse Transcriptase

3. A 6 year old male patient presents to the emergency room with his mother with severe vomiting, excessive salivation, urinary and bowel incontinence, and miosis. The mother is frantic and says that her son had gotten into one of their medicine cabinets and ingested some bug spray less than 2 hours ago. A drug that you administer to treat this condition acts in which of the following ways?
A. Binds to and inhibits an enzyme
B. Cleaves an effector molecule
C. Phosphorylates an effector molecule
D. Irreversibly binds to a receptor
E. Decreases the Vmax of an enzyme

4. Milrinone is a strong inotropic agent. Its mechanism of action involves inhibition of phosphodiesterase isoenzyme 3. Which of the following additional responses is most likely an extension of its pharmacologic effect?
A. Angioedema
B. Antiarrhythmic action
C. Vasodilation
D. Increased right atrial pressure
E. Sodium and water retention
F. AV conduction block

5. A 42 year old man is brought into the emergency dept. with diffuse muscle weakness & heart palpitations. Physical examination reveals tachycardia, mydriasis and an elevated body temperature. Which of the following would most likely lead to all of this patients symptoms?

A. Atropine

B. Ephedrine

C. Phenelzine

D. Botulinum Toxin

E. Succinylcholine

6. If a drug is highly bound to plasma proteins, it:
A. has a large Vd.
B. has a high renal clearance.
C. is a likely candidate for drug interactions.
D. is most likely carried by alpha-glycoprotein.
E. is a quaternary ammonium salt.
7. most drugs gain entry to cells by:
A. passive diffusion with zero-order kinetics.
B. passive diffusion with first-order kinetics.
C. active transport with zero-order kinetics.
D. active transport with first-order kinetics.
E. passive diffusion through membrane pores.

8. A patient known to be a heroin abuser comes to ER with a painful stab wound . The ER physician administers Nalbuphine for the pain. Why is this not a good idea?
a. The patient is probably tolerant to Nalbuphine.
b. The drug may precipitate a withdrawal state.
c. Nalbuphine is a weaker analgesic than codeine .
d. Vasodilating effects of nalbuphine increase blood loss .
e. Nalbuphine is a strong miu receptor agonist .

9. A 54 yr old man is hospitalized after a planned abdominal surgery. One of his physicians administers a new drug whose mechanism of action you do not know. Shortly after administration, the pt develops flushing, daiphoresis & nausea. His blood pressure is 100/70 mm Hg & heart rate is 55/ min. His pupils are constricted but reactive to light. The medication is most likely given for which of the following conditions?

A. Fluid overload

B. UTI

C. Urinary obstruction

D. Hypovolemic shock

E. Atonic Bladder

10. A pharmaceutical company has developed a drug that prevents egress of Mg+2 from N-methyl D aspartame (NMDA) receptor. What is most likely effects of this drug in a patient with acute stroke?
A) Decreased risk of seizures because of hypomagnesima
B) Facilitation of Ca entry into neuron and enhancement of excitation mediated cell death
C) Hyperpolarization of membrane and conduction block
D) Prevention of Ca+2 entry into neuron and reduction of excitation mediated cell death
E) Rapid depolarization of membrane with lowering of seizure threshold

Answers: 1.B, 2. C, 3. B, 4. C, 5. D, 6. C, 7. B, 8. B, 9. E, 10. D

Pharmacology - Know the Adverse Effects:

2011-09-14T19:26:00.001-07:00

Pharmacology Practice Questions- Know the Adverse Effects:

1. Which of the following is not a side effect of the cholinoreceptor blocker (Atropine)?

A. Increased pulse
B. Urinary retention
C. Constipation
D. Mydriasis

2. Which of the following is not a side effect of the Ace Inhibitor (Captopril)?

A. Rash
B. Angioedema
C. Cough
D. Congestion

3. Which of the following is not a side effect of the Vasodilator (Nifedipine)?

A. Nausea
B. Flush appearance
C. Vertigo
D. Sexual dysfunction

4. Which of the following is not a side effect of the Sympathoplegics (Clonidine)?

A. Hypertension
B. Asthma
C. Dry oral cavity
D. Lethargic behavior

5. Which of the following is not a side effect of the Dieuretics (Loop dieuretics)?

A. Alkalosis
B. Nausea
C. Hypotension
D. Potassium deficits

6. Which of the following is not an effect of the drug (Isoflurane)?

A. Elevated lipid levels
B. Nausea
C. Increased blood flow to the brain.
D. Decreased respiratory function

7. Which of the following is not an effect of the drug (Midazolam)?

A. Amnesia
B. Decreased respiratory function
C. Anesthetic
D. Dizziness

8. Which of the following is not an effect of the drug (Clozapine)?

A. Agranulocytosis
B. Antipsychotic
C. Used for Schizophrenia
D. Increased appetite

9. Which of the following is not treated with (Epinephrine)?

A. Renal disease
B. Asthma
C. Hypotension
D. Glaucoma

10. Which of the following is not treated with (Ephedrine)?

A. COPD
B. Hypotension
C. Congestion
D. Incontinence

11. Which of the following are not treated with Barbiturates?

A. Seizures
B. Hypotension
C. Insomnia
D. Anxiety

12. Which of the following are not treated with opoid analgesics like (dextromethorphan and methadone)?

A. Pulmonary Edema
B. Cough suppression
C. Sedation
D. Pain

13. Which of the following are not treated with Hydrochlorothiazide?

A. CHF
B. HTN
C. Nephritis
D. Hypercalciuria

14. Which of the following are not treated with Nifedipine?

A. Angina
B. Arrhythmias
C. Htn
D. Fluid retention

15. Which of the following are not treated with Methotrexate?

A. Sarcomas
B. Leukemias
C. Ectopic pregnancy
D. Rheumatic fever

16. Which of the following are not treated with Prednisone?

A. Cushing's disease
B. Testicular cancer
C. Lympthomas
D. Chronic leukemias

17. Which of the following are not treated with Dexamethasone?

A. Inflammation
B. Asthma
C. Addison's disease
D. Wilson's disease

18. Which of the following are not treated with Lansoprazole?

A. Zollinger-Ellison syndrome
B. Gastritis
C. Hypertension
D. Reflux

19. Which of the following is the antidote for the toxin Heparin?

A. Protamine
B. Methylene blue
C. N-acetylcysteine
D. Glucagon

20. Which of the following is the antidote for the toxin Copper?

A. Glucagon
B. Aminocaproic acid
C. Atropine
D. Penicillamine

Answer Key
1. Bm , 2. D, 3. D, 4. B, 5. B, 6. A, 7. D, 8. D, 9. A, 10. A
11. B, 12. C, 13. C, 14. D, 15.D, 16 B, 17. D, 18. C, 19. A, 20. D

USMLE1-Pharmacology General principles

2011-09-14T19:24:00.000-07:00

General principles: Quick review

1. The most important factor influencing drug absorption rate following intramuscular injection is:

a. needle diameter

b. rate of administration

c. injection site blood flow

d. injection volume

2. Mechanism(s) of drug permeation

a. lipid diffusion

b. aqueous diffusion

c. use of carrier molecules

d. endocytosis and exocytosis

e. all of the above

3. Pharmacological antagonists:

a. cause receptor down regulation

b. prevent binding of other molecules to the receptor by their binding to the receptor

c. atropine (blocks ACh action on the heart

d. A & B

e. B & C

4. Dramatic decrease in systemic availability of a drug following oral administration is most likely due to:

a. extreme drug instability at stomach pH

b. hepatic "first-pass" effect

c. drug metabolized by gut flora

d. tablet does not dissolve

e. patient non-compliance

5. Drug delivery method LEAST suitable for long term (days to weeks) slow release

a. pellet implant under the skin (subcutaneous)

b. time release capsule

c. i.m. injection of a drug-oil suspension

d. transdermal patch

6. Factors that influence the rate of passive movement to molecules down the concentration gradient (Fick's Law)

a. concentration difference across the barrier

b. area across which diffusion occurs

c. drug mobility in the diffusion panel

d. thickness -- length of the diffusion pass

e. all the above

7. Definition: Therapeutic Index

a. ED50/LD50

b. potency/selectivity

c. EC50/LD50

d. TD50/ED50

e. ED50

8. Primary site for drug metabolism:

a. stomach

b. small intestine

c. kidney

d. muscle

e. liver

9. Drug mixed-function oxidase (p450) mainly localized:

a. mitochondrial fraction

b. cell membranes

c. golgi bodies

d. microsomal fraction

e. nucleolus

10. Cytochrome-P450 INDEPENDENT oxidation:

a. amine oxidase

b. epoxidation

c. N-oxidation

d. S-oxidation

e. deamination

Answers: 1. C, 2. E, 3. E, 4.B, 5. B, 6. E, 7. D, 8. E, 9. D, 10. A

USMLE1 Practice test- Antibacterial Drugs

2011-08-19T06:51:00.000-07:00

The following posting is a set of 50 Questions in Pharmacology based on Antibacterial therapy, for high yield concepts on anitbacterial therapy please visit usmle1fordummies.blogspot.com

1. A 35 year old HIV positive male patient comes to the OPD with complaint of anorexia, nausea and vomiting and abdominal pain. His abdomen is tender in the epigastric area. Laboratory results reveal a raised serum amylase activity and a preliminary diagnosis is made of acute pancreatitis. Which of the following anti-retroviral drugs has the patient most likely been taking?

a)    Saquinavir
b)    Zidovudine
c)    Didanosine
d)    Efavirenz
e)    Enfuvirtide

2.    A 40 year old HIV positive patient is receiving HAART regimen (Highly active anti-retroviral therapy). Four weeks after initiating therapy, he comes to the emergency department complaining of severe pain in the flank, nausea and frequent urination. Which one of the following drugs is most likely the cause of his symptoms?
a)    Zidovudine
b)    Indinavir
c)    Efavirenz
d)    Nevirapine
e)    Nelfinavir

3. A 30 year old man is recently diagnosed with HIV and therapy is started. After the first week of therapy, the patient complains of headaches, irritability, and nightmares. Which one of the following anti-retroviral drugs is most likely to be causing these symptoms?
a) Efavirenz
b) Indinavir
c) Lamivudine
d) Nevirapine
e) Stavudine

4.    A 35 year old woman is diagnosed with chronic hepatitis B infection and therapy is initiated. Just after a few hours she comes to the emergency department complaining of fever, chills and muscle aches. Which one of the following drugs most likely caused these symptoms?
a)    Lamivudine
b)    Adefovir
c)    Entecavir
d)    Interferon alfa
e)    Ribavirin

6. A 60 year old man with known history of Parkinson’s disease is to receive prophylaxis against Influenza A virus. He is given a drug that is useful against Parkinson’s disease as well for prophylaxis against influenza. The drug with which of the following mechanisms of action is most likely to have been given?

a) It prevents entry and penetration of the virus
b) It prevents uncoating of the virus
c) It prevents replication of the virus
d) It prevents assembly of newly synthesized virus particles
e) It prevents release of the newly synthesized virus
7. Antimicrobial agent of choice for the outpatient treatment of infections due to animal bite wound be:
a) Cefuroxime sodium
b) Amoxicillin/clavulanate potassium
c) Penicillin V
d) Ampicillin sodium/Salbactam sodium
e) Ticarcillin disodium/clavulanate potassium
8. An antibiotic is distributed in total body water and has an elimination half life of 45 minutes. Which one of the following statements is consistent with that observation?
a) The drug is stored in high concentration in fat
b) The rapid rate of disappearance rules out metabolism of the drug by the liver
c) The drug is actively transported into tubular urine
d) The drug cannot be bound to plasma proteins
e) The drug is eliminated only by glomerular filtration
9. Which one of the following is indicated for treatment of chlamydial urethritis during pregnancy?
a) Amoxicillin (Amoxil)
b) Penicillin V
c) Erythromycin base
d) Doxycycline (Monodox)
e) Tetracycline
10. A 25-year-old male has a dental infection associated with facial swelling and lymphadenopathy. Which one of the following is the most appropriate antibiotic?
a) Cephalexin
b) Tetracycline
c) Penicillin (note: watch an animation on penicillin mechanism of action)
d) Erythromycin
e) Gentamicin
11. A 16-year-old sexually active nulliparous white female complains of pelvic pain and vaginal discharge. On examination she is found to have a temperature of 39.8° C (102.0° F), pain with movement of the cervix, and tenderness and a mass in the right adnexa. Which one of the following treatment would be appropriate?

a) Outpatient treatment with penicillin G procaine ,intramuscularly; probenecid orally; plus doxycycline (Vibramycin) orally for 14 days and reexamination in 3 days
b) Outpatient treatment with ceftriaxone intramuscularly; probenecid orally; plus doxycycline twice a day for 14 days and reexamination in 1 week
c) Outpatient treatment with cefoxitin intramuscularly; plus doxycycline twice a day for 14 days and reexamination in 10 days
d) Hospitalization for treatment with cefoxitin intravenously and doxycycline orally or intravenously, then doxycycline orally twice a day to complete 14 days of treatment
e) Erythromycin 2 grams orally as a single dose
12. A drug that may cause nephrotoxicity, is:
a) Penicillin G
b) Erythrocin
c) Gentamycin
d) Cefuroxime
e) Penicillin V
13. Which one of the following is a common early side effect of Penicillin?
a) Constipation
b) Loss of appetite
c) Orthostatic hypotension
d) Atrioventricular block
e) Skin rash
14. Which of the following might be seen in patient of TB, who has regularly been injecting intramuscular injection of streptomycin:
a)    Depression
b)    Sialorrhea
c)    Increased serum alanine aminotransferase
d)    Priapism
e)    Deafness
15. Significant negative interaction has been known to occur between the following drugs if given concurrently:
a) Penicillin G & Penicillin V
b) Penicillin & tetracycline
c) Penicillin & Gentamycin
d) Penicillin & Clavulanic acid
e) Ticarcillin & Clavulanic acid
16. Which of the following is NOT a recognized complication of ampicillin toxicity:
a) Hemolytic anemia
b) Diarrhea
c) Nausea
d) Overgrowth of gram-positive organisms
e) Ventricular fibrillation

17. Doctor is wrong when he suggests his patient to get drug:
a)    Streptomycin by IV route
b)    Gentamycin by IV route
c)    Neomycin by oral route
d)    Penicillin V by oral route
e)    Cefepime by IV route

18. Telithromycin:
a)    Is structurally related to tetracycline
b)    Is structurally related to beta lactam antibiotics
c)    Is structurally related to aminoglycosides

d) Binds more tightly to ribosomes and so it is a poor substrate for bacterial efflux pumps that mediate antibiotic resistance
e) Is used for UTI

19. Doxycycline is used:
a)    for Pneumonia as drug of 1st choice
b)    for the prevention of TB
c)    for the prevention of malaria
d)    for the prevention of leprosy
e)    for the treatment of sexually transmitted diseases

20. Clindamycin:
a)    is chemically related to macrolides
b)    binds to 30S ribosomal subunit
c)    is not recommended for oral route
d)    cross-resistance may be observed between macrolides and Clindamycin
e)    is excreted in breast milk

21. Which of the following statement is true:
a)    nafcillin is beta-lactamase resistant antibiotic
b)    cefazolin is second generation cephalosporin
c)    tazobactam is used in gonorrhea mainly
d)    penicillin G is contraindicated in infections caused by spirochetes
e)    thrombocytosis is main side effect of Linezolid

22. All of the following statement is true, except:
a)    chlorampehnicol is broad spectrum protein synthesis inhibitor
b)    linezolid and streptogramins are narrow spectrum protein synthesis inhibitors
c)    mechanism of resistance to chlorampehnicol is plasmid mediated and occurs through the formation of acetyltransferases that inactivate the drug
d)    tetracyclines are narrow spectrum protein synthesis inhibitors
e)    susceptible organisms accumulate tetracycline intracellularly via energy dependant transport systems in their cell membranes

23. in a patient with culture-positive enterococcal endocarditis who has failed to respond to vancomycin because of resistance, the treatment most likely to be effective is:
a)    clarithromicin
b)    erythromycin
c)    linezolid
d)    minocycline
e)    Ticarcillin

24. A 24 year old male patient is suffering from peptic ulcer. He was advised anti-peptic ulcer drugs including doxycycline. Which one of the following statements about doxycycline is false?
a)    it is bacteriostatic
b)    it is excreted mainly in the feces
c)    it is used in Lyme disease
d)    it has a long elimination half-life
e)    it is more active than tetracycline against H. Pylori

25. A 12 years old female patient came to pediatrician suffering from headache, high grade fever, moderate chest pain, joint pain and drowsy. When doctor got history, he was told to take diazepam 2.5 mg by patient 15 hours ago. Actually it was already a diagnosed case of pneumonia and she was on drug treatment including streptogramin. Concerning streptogramins, which one of the following statements is false:
a)    they are active against methicillin-resistant staphylococci
b)    they may cause a syndrome of arthralgia and myalgia
c)    they are used in the management of infections caused by vancomycin-resistant enterococci
d)    they are associated with post antibiotic effect
e)    they induce formation of hepatic drug-metabolizing enzymes

26. Telithromycin:
a)    is cell wall synthesis inhibitor
b)    is a ketolide structurally related to macrolides
c)    it binds very loosely to ribosomes so it is good substrate for bacterial efflux pumps that mediate resistance
d)    is used in Lyme disease mainly
e)    is used in pneumonia as drug of 1st choice

27. Which statement is true about tetracyclines?
a)    resistance mechanisms include decreased activity of the uptake systems and, most importantly, the development of mechanisms like efflux pumps for active extrusion of tetracyclines
b)    is contraindicated in gram-positive bacterial infections
c)    is absolutely contraindicated in gram-negative bacterial infections
d)    mechanism of action of tetracycline is same as Clindamycin
e)    resistant organisms are killed when tetracycline is used in large doses

28. A 33 years old male patient has been diagnosed mycoplsma pneumoniae infection. He was treated by one of the broad spectrum antibacterial drug group tetracycline 2 gram TID for 21 days. What may be most appropriate toxicity?
a)    anemia
b)    hepatic necrosis
c)    thrombocytosis
d)    alopecia
e)    sleeplessness

29. an elderly debilitated patient has a fever believed to be due to an infection. He has extensive skin lesions, scrapings of which reveal the presence of large numbers of gram-positive cocci. The most appropriate drug to use for treatment of this patient is:
a)    amoxicillin
b)    salbactam
c)    cefoxitin
d)    nafcillin
e)    penicillin G

30. A 21 year old man was seen in a clinic with a complaint of dysuria and urethral discharge of yellow pus. He has a painless clean-base ulcer on the penis and nontender enlargement of the regional lymph nodes. Gram stain of the urethral exudates showed gram negative diplococci within polymorphonucleocytes. The patient informed the clinic staff that he was unemployed and had not eaten a meal for two days. The most appropriate treatment of gonorrhea in this patient is:
a)    amoxicillin orally for 7 days
b)    vancomycin intramuscularly as a single dose
c)    ceftriaxone intramuscularly as a single dose
d)    tetracycline orally for 7 days
e)    procaine penicillin G intramuscularly as a single dose plus one gram of probenecid

31. Eighty years old male patient having 73 Kg body weight was suffering from fever, headache and lumbar pain since last 7 days. He was examined in clinic. Gram stain of the smear of CSF revealed gram positive rods resembling diphtheroids. The antibiotic regimen for empiric treatment would include:
a)    Erythromycin
b)    Ticarcillin
c)    Cefotetan
d)    Cefazolin
e)    Ampicillin

32. A 25 year old male presents to the medical OPD with complaint of cough and low grade fever since the last 3 months. Laboratory tests show sputum positive for acid fast bacteria. Which of the following combination of drugs is most likely to be administered at the start to this patient?
a)    Streptomycin, Isoniazid, Rifampicin and Pyrazinamide
b)    PAS, Pyrazinamide and Rifampicin
c)    Pyrazinamide, Ethambutol and Isoniazid
d)    Streptomycin and Rifampicin
e)    Streptomycin alone

33. A 25 year old male has been given treatment for pulmonary tuberculosis for 2 months as initial phase. Now he comes to the OPD for medication for the continuation phase. Which of the following drugs will he most likely be given for the continuation phase?
a) Pyrazinamide and Isoniazid
b) Ethambutol and Streptomycin
c) Isoniazid and Rifampicin
d) Rifampicin and Streptomycin
e) Ethambutol and Pyrazinamide

34. A young man 26 years old is started treated for pulmonary tuberculosis. He comes to the medical OPD after 1 week with complaint of orange red colored urine and sweat and tears. Which of the following drugs is most likely causing these symptoms?
a) Streptomycin
b) Rifampicin
c) Ethambutol
d) Pyrazinamide
e) Thiacetazone

35. A 30 year old male with known TB infection and taking medication since 1 month comes to the Eye OPD with complaint of visual disturbances including decreased visibility and slight color blindness. If these symptoms are due to his drug treatment, which one of the following drugs is most likely the cause of his symptoms?
a) Streptomycin
b) Ciprofloxacin
c) Ethambutol
d) Rifampicin
e) Isoniazid

36. A 35 year old male recently diagnosed with tuberculosis and is started on medication. After a few days he comes to the emergency department a few hours after taking a meal at McDonald’s with severe pain in the big toe. Blood tests show a very high uric acid level. Which of the following drugs most likely caused these symptoms?
a) Streptomycin
b) Rifampicin
c) Isoniazid
d) Amikacin
e) Pyrazinamide

37. A 40 year old male taking medication for tuberculosis since the last 2 months comes to the ENT OPD with complaint of hearing problems and ringing in the years. The drug with which of the following mechanisms of action is most likely causing these symptoms?
a) Binds to 30 S Ribosome subunit & inhibits initiation complex
b) Inhibits DNA Dependent RNA Polymerase
c) Inhibits synthesis of mycolic acid
d) Inhibits synthesis of arabinoglycan subunits
e) Inhibits DNA Gyrase

38. A 35 year old female taking medication for tuberculosis and oral contraceptives comes to the Gynaecology OPD with complaint of amenorrhea. Laboratory test shows a positive pregnancy test. Which one of the following drugs most likely caused her to become pregnant?
a) Rifampicin
b) Pyrazinamide
c) Streptomycin
d) Ethambutol
e) Isoniazid

39. A 45 year old male with diagnosed chronic liver disease gets infected with the tuberculosis. Which one of the following drugs would be most safe for this patient for the treatment of tuberculosis?
a) Isoniazid
b) Rifampin
c) Pyrazinamide
d) Ethambutol
e) Ethionamide

40. A 48 year old male is diagnosed with tuberculosis and has been treated for 2 months with isoniazid and rifampicin with good response. But the patient develops numbness and paresthesias in the extremities. What will you most likely do next?
a) Add pyridoxine
b) Stop isoniazid
c) Add vitamin E
d) Replace rifampin with ethambutol
e) Replace isoniazid with streptomycin

41. A 30 year old male presents with history of fever occurring in a step-ladder fashion for the last 10 days. He also feels abdominal pain after taking meals. Lab tests show decreased TLC count and a positive Vidal test. The drug which is most likely to be given acts by which one of the following mechanisms?
a) Ciprofloxacin
b) Ampicillin
c) Cotrimoxazole
d) Cefixime
e) Azithromycin

42. A 35 year old pregnant woman presents to the gynecology department with complaint of pain with rising fever since the last 5 days. Lab tests show gram negative bacilli and widal test comes out positive. Which one of the following drugs will most likely be administered?
a) Ciprofloxacin
b) Levofloxacin
c) Ofloxacin
d) Norfloxacin
e) Ampicillin

43. A 27 year old male football player gets injured in a match. He comes to the emergency department with pain and swelling near the ankle. On examination, there is small wound with a tender swelling near the ankle joint. Further tests reveal tendon rupture with tendonitis setting in. Which one of the following antibiotics, if required, will most probably not be given to this patient?
a) Ceftriaxone
b) Clarithromycin
c) Aminoglycoside
d) Ciprofloxacin
e) Amoxicillin

44. A 40 year old male comes to the medical OPD with symptoms of cough & fever for the last few days. Sputum culture shows presence of gram positive cocci. Which one of the following Fluoroquinolones is most likely to be administered to this patient?
a) Ciprofloxacin
b) Norfloxacin
c) Ofloxacin
d) Gatifloxacin
e) Levofloxacin

45. A 50 year old patient comes to the emergency department, a day after he has been administered an antibiotic for an on-going infection, with complaint of palpitations. ECG reveals prolonged QT interval. Which one of the following Fluoroquinolones most likely caused this adverse effect?
a) Ciprofloxacin
b) Norfloxacin
c) Levofloxacin
d) Ofloxacin
e) Gatifloxacin

46. Disinfectants are:
a) Strong chemical agents that inhibit or kill micro-organisms
b) Agents with sufficient toxicity for host cells
c) They kill both vegetative cells and spores
d) A process intended to kill or remove all types of micro-organisms including spores and include viruses
e) A process that kills non-sporulating microorganisms by hot water or steam at 65-100 C

47. A patient with watery stools is diagnosed as suffering from amebic dysentery. He is given a drug that causes a metalic taste in the mouth which drug may be given.
a) Iodoquinol
b) Diloxanide furate
c) Metronidazole
d) Pentamiline
e) Emetine.

48. The reason for giving Metronidazole for oropharyngeal infection is due to its good activity against:
a)Gram positive cocci
b)Gram Negative cocci
c)Gram positive bacilli
d)Gram negative bacilli
e)Anaerobes like B. fragilis

49. Patient comes to emergency with the complaints of marked visual and auditory abnormities, vomiting diarrhea abdominal pain & skin rashes. From the history of the patient it was revealed that he took some drug for the treatment of fever. What could be probable diagnosis?
a)Cinchonism
b)Acute gastro enteritis
c)Cholera
d)Typhoid fever
e)Acid peptic disease

50. A 37 year old male is having repeated episodes of fever with chills with blood smear positive for malaria since last one year. He was given chloroquine each time & the fever subsided. Which of the following drugs would you add with chloroquine this time?
a)Artemether
b)Mefloquine
c)Malarone
d)Primaquine
e)Halofantrine

USMLE 1 Practice Questions1

2011-08-18T13:12:00.000-07:00

1. A 15-year-old healthy girl with no major medical problems says that she breaks out with blotchy areas of erythema that are pruritic over the skin of her arms, legs, and trunk within an hour every time she eats seafood, followed by diarrhea. These problems abate within a few hours, and physical examination reveals no abnormal findings. Which of the following immunologic abnormalities is she most likely to have?

A Localized anaphylaxis

B Cell-mediated hypersensitivity

C Release of complement C3b

D Hypergammaglobulinemia

E Immune complex deposition

2. A 55-year-old man has developed progressive renal failure for the past 5 years. Microscopic examination of a renal biopsy shows extensive glomerular and vascular deposition of pink amorphous material on H&E staining. This material demonstrates apple-green birefringence under polarized light after Congo red staining. Immunohistochemical staining of these deposits is positive for lambda light chains. Which of the following conditions is most likely to be present in this man?

A Rheumatoid arthritis

B Tuberculosis

C Systemic lupus erythematosus

D Multiple myeloma

E Alzheimer disease

3. A 22-year-old woman has experienced episodes of myalgias, pleural effusions, pericarditis, and arthralgias without joint deformity over the course of the past 3 years. She has continued working at her job. A CBC reveals a mild normocytic anemia. Which of the following laboratory screening tests is most appropriate to begin the workup for her condition?

A CD4 lymphocyte count

B Blood culture

C Antinuclear antibody test

D Sedimentation rate

E Creatine phosphokinase

4. A male infant is born at term. No congenital anomalies are noted on examination. A year later he now has failure to thrive and has been getting one bacterial pneumonia after another with both Hemophilus influenzae and Streptococcus pneumoniae cultured from his sputum. Which of the following diseases is he most likely to have?

A DiGeorge syndrome

B Selective IgA deficiency

C Epstein-Barr virus (EBV) infection

D Acute leukemia

E X-linked agammaglobulinemia

5. A study is performed of outcomes involving patients who received renal allografts. It is noted that patients who received renal allografts with matching to the donor by tissue typing for HLA-DR (Class II) antigens have a low rate of complications. Which of the following immunologic abnormalities is most likely to be diminished by tissue typing?

A Amyloidosis

B Cell lysis by CD8 lymphocytes

C Graft versus host disease

D CD4 lymphocyte activation

E Serum sickness

6. A 25-year-old woman has been feeling tired for the past 4 weeks. She says she "aches all over". Physical examination reveals only an erythematous malar rash. Laboratory findings include a serum creatinine of 3.8 mg/dl and a positive antinuclear antibody (ANA) test with titer of 1:512. Which of the following additional laboratory tests would be most useful to perform in her case for a more definitive diagnosis?

A Blood culture

B Skin biopsy

C CD4 lymphocyte count

D Sedimentation rate

E Anti-double stranded DNA

7. A 20-year-old woman has had a 6 month history of symmetrical, proximal muscle weakness. She has 4/5 motor strength in all extremities. A deltoid biopsy shows a neutrophilic infiltrate with focal necrosis of the muscle fibers. Her antinuclear antibody test is negative, but she has histidyl-tRNA synthetase (Jo-1) antibody in her serum. Which of the following additional laboratory test findings would be most likely be present in this patient?

A Heart failure

B Malabsorption

C Peripheral neuropathy

D Skin rash

E Renal failure

8. An appropriate, useful type I hypersensitivity response of the immune system, accompanied by eosinophilia, would most likely be directed against which of the following?

A Amyloid protein

B Spirochetes

C Neoplasms

D Inhaled dusts

E Liver flukes

9. A 54-year-old woman goes to her physician because she has noted that during the past month her fingers become cold and painful upon exposure to cold. She has mild dyspnea, but no wheezing. She is found to have a blood pressure of 170/110 mm Hg. The antinuclear antibody test is positive with a titer of 1:256 and a nucleolar pattern. Her serum urea nitrogen is 15 mg/dL with creatinine of 1.1 mg/dL. These findings most strongly suggest that she has which of the following autoimmune diseases?

A Discoid lupus erythematosus (DLE)

B Progressive systemic sclerosis (PSS)

C Polymyositis-dermatomyositis

D Sjogren's syndrome (SS)

E Rheumatoid arthritis (RA)

10. Twelve hours after going on a hike through dense foliage, a 40-year-old man notices a slightly raised and tender irregular reddish rash on one forearm that was not covered by clothing. This rash gradually increases in intensity for 2 days and then fades after two weeks. Which of the following forms of hypersensitivity is most likely demonstrated in this patient?

A Type I hypersensitivity

B Type II hypersensitivity

C Type III hypersensitivity

D Type IV hypersensitivity

11. A 30-year-old woman has experienced myalgias for the past 3 months. On physical examination she has 5/5 motor strength in all extremities. She has dullness to percussion at lung bases. A chest x-ray shows bilateral pleural effusions. Laboratory studies show a positive antinuclear antibody test at a titer of 1:1024. Her serum urea nitrogen is 30 mg/dL. A renal biopsy is performed and microscopic examination shows a granular pattern of immunofluorescence staining with antibody to complement component C1q. This pattern is most typically produced as a consequence of which of the following immunologic mechanisms?

A IgE coating mast cells

B Antiglomerular basement membrane antibody

C Antigen-antibody complexes

D Macrophage release of lymphokines

E Release of prostaglandins

12. The second pregnancy for a 23-year-old woman appears uncomplicated until ultrasound performed at 19 weeks shows hydrops fetalis. The fetal organ development is consistent for 19 weeks, and no congenital anomalies are noted. Her first pregnancy was uncomplicated and resulted in the birth of a normal girl at term. The current pregnancy ends with birth of a baby boy at 32 weeks gestation. On examination the baby has marked icterus. Laboratory studies show a hemoglobin of 7.5 g/dL, and an exchange transfusion is performed. Which of the following immunologic mechanisms best explains this infant's findings?

A Anti-receptor antibody

B Loss of self tolerance

C Immune complex formation

D Delayed type hypersensitivity

E Complement mediated cell destruction

13. A previously healthy 12-year-old girl develops a sore throat over the past 2 days. On physical examination she has marked pharyngeal erythema with overlying yellowish exudate. A throat culture grows group A beta-hemolytic streptococcus. The pharyngitis resolves, but three weeks later she develops chest pain along with fever and malaise. The girl describes aching of her knees, hips, shoulders, and elbows. Multiple subcutaneous skin nodules are noted on physical examination, and she exhibits slight shaking movements of her head and neck. Her antistreptolysin-O and anti-DNAse B titers are elevated. Her creatine kinase MB fraction is elevated. These findings are most likely the result of which of the following immunologic mechanisms?

A Bypass of low-zone tolerance through cross-reactivity

B Deposition of antigen-antibody complexes in multiple tissue

C Formation of an antibody to immune complexes

D Exposure of a previously sequestered antigen

E Interaction between genetic predisposition and environmental insults

14. A 60-year-old woman has developed a crippling arthritis over the past 20 years. On physical examination the arthritis primarily involves her hands and feet, with marked joint deformities characterized by ulnar deviation and swan-neck deformities of her fingers. She has an irregular heart rate. Laboratory studies show that her rheumatoid factor titer is markedly elevated, but her antinuclear antibody test is negative. A rectal biopsy shows submucosal deposition of pink amorphous material that stains positively with Congo red. Which of the following precursor proteins most likely gave rise to these deposits?

A Serum amyloid-associated protein

B Lambda light chains

C Transthyretin

D Amyloid precursor protein

E Beta-2-microglobulin

15. A 35-year-old man has experienced a malar skin rash, polyarthritis with swelling and warmth of his hands, and sensitization to cold for the past 6 months. On physical examination he has generalized lymphadenopathy and pale conjunctivae. Laboratory findings include a hemoglobin of 9.5 g/dL, total WBC count of 2100/microliter, total serum protein 8.8 g/dL, albumin 3.6 g/dL, creatinine 1.1 mg/dL, and creatine kinase of 468 U/L. His antinuclear antibody test is positive at 1:256. Which of the following additional serologic tests is most likely to determine his underlying disease process?

A Anti-centromere

B Anti-RNP

C Rheumatoid factor

D Serum C1q complement level

E HIV test

16. A 48-year-old man has had a chronic cough with fever for 2 months. On physical examination his temperature is 37.9 C. A chest radiograph reveals a diffuse bilateral reticulonodular pattern. A transbronchial biopsy is performed. On microscopic examination of the biopsy there are focal areas of inflammation containing epithelioid macrophages, Langhans giant cells, and lymphocytes. These findings are most typical for which of the following immunologic responses?

A Type I hypersensitivity

B Type II hypersensitivity

C Graft versus host disease

D Polyclonal B-cell activation

E Type IV hypersensitivity

17. A 9-year-old boy has a sore throat. A throat culture grows group A hemolytic streptococcus. He receives antibiotic therapy. However, 17 days later he develops dark-coloured urine. Laboratory studies show 3+ blood on urinalysis. A renal biopsy is performed. On immunofluorescence staining the biopsy shows granular deposition of IgG and complement around glomerular capillary loops. Which of the following immune hypersensitivity mechanisms is most likely responsible for this pattern of findings?

A Type I

B Type II

C Type III

D Type IV

18. A 40-year-old woman has had increasing difficulty swallowing for over the past year. She also notes that it is more difficult to use the keyboard of her computer because she finds in hard to move her fingers, though the joints are not painful. She has lost the facial wrinkles that she was beginning to develop in middle age. A skin biopsy is performed and shows extensive dermal fibrosis but almost no inflammatory cell infiltrates. These findings are most typical for which of the following conditions?

A Mixed connective tissue disease

B Discoid lupus erythematosus

C CREST syndrome

D Dermatomyositis

E Amyloidosis

19. A 27-year-old woman is given intravenous penicillin to treat infective endocarditis. Within minutes of starting this therapy, she begins to have severe difficulty breathing with respiratory stridor and tachypnea. She suddenly develops an erythematous skin rash over most of her body. Her symptoms are most likely to be produced by release of which of the following chemical mediators?

A Interleukin 1

B Bradykinin

C Complement C5a

D Histamine

E Thromboxane

20. A 42-year-old man has lost 7 kg over the past two years. During that time he has had pain and swelling around the small joints of his hands and feet. He has had a series of upper respiratory tract infections, with organisms including Staphylococcus aureus, Streptococcus pneumoniae, and Pseudomonas aeruginosa cultured. He has a chronic diarrhea. A stool specimen is found to have Giardia lamblia cysts. Laboratory studies show a hemoglobin of 8.8 g/dL with a reticulocyte count of 3.2%. His serum urea nitrogen is 19 mg/dL with creatinine 1.0 mg/dL. His antinuclear antibody test is negative. Quantitative serum immunoglobulins show IgA 70 mg/dL, IgG 303 mg/dL, and IgM 64 mg/dL. By flow cytometry there are normal numbers of T cells and slightly reduced numbers of B cells. Which of the following conditions is most likely to be present in this man?

A HIV infection

B Polymyositis

C Bruton agammaglobulinemia

D Common variable immunodeficiency

E Diabetes mellitus

21. A 31-year-old woman has noted chest pain for the past week. On physical examination she has decreased breath sounds with dullness to percussion at lung bases. A chest radiograph shows modest bilateral pleural effusions. On chest CT scan, the pleural effusions, as well as a pericardial effusion, are seen. A thoracentesis on the left yields clear fluid with a low protein and cell count. She is found to have an anti-double stranded DNA titer of 1:512. If she is later found to have a serum urea nitrogen that is 55 mg/dL, it will most likely be the result of which of the following pathologic processes?

A Atherosclerosis

B Glomerular immune deposits

C Amyloid deposition

D Vascular chronic inflammation

E Anti-glomerular basement membrane antibody

22. A 28-year-old woman undergoes allogeneic bone marrow transplantation for acute leukemia. Three weeks later, she has marrow engraftment and her hemoglobin and WBC count are returning to normal. However, she has the appearance of a fine, scaling skin rash over her trunk and upper extremities. These findings are most consistent with which of the following complications?

A Reduced numbers of megakaryocytes

B Apoptosis of epidermal keratinocytes

C Dry gangrene

D Contact dermatitis

E Abrasions from a fight in the ICU

23. A 22-year-old woman is bothered by an erythematous rash involving her cheeks and nose every time she spends more than a few minutes outdoors on a sunny day. On physical examination between these episodes, there are no abnormal findings. A biopsy of the skin involved with the rash shows deposition of IgG along the basement membrane by immunofluorescence microscopy, but uninvolved skin does not demonstrate this IgG deposition. Her antinuclear antibody test is negative. She has no other complaints. Her renal function tests are normal. Which of the following is the most likely diagnosis?

A Discoid lupus erythematosus

B Progressive systemic sclerosis

C Contact dermatitis

D Systemic lupus erythematosus

E Dermatomyositis

24. A 37-year-old woman develops a malar rash when she spends several hours outside at a cricket match. Ordinarily, she avoids being in the sun, but a friend provided free tickets to a West Indies test match. When she sees her physician, a urinalysis is performed that shows hematuria and proteinuria. A skin biopsy shows immunofluorescence positivity along the dermal-epidermal junction with antibody to C1q. Which of the following additional complications is she most likely to suffer as a consequence of her underlying disease?

A Pulmonary hemorrhage

B Joint ankylosis

C Nodular glomerulosclerosis

D Pulmonary fibrosis

E Pericarditis

25. An 11-month-old infant has had upper and lower respiratory tract infections almost continuously since the time of birth, with organisms including Pneumocystis carinii (jiroveci) and Pseudomonas aeruginosa identified. The baby also has oropharyngeal candidiasis. The baby succumbs to a cytomegalovirus pneumonitis. At autopsy, the thymus is markedly hypoplastic, and lymph nodes throughout the body are small, with absent germinal centers on microscopic examination. Which of the following mechanisms is most likely to explain these findings?

A Adenosine deaminase deficiency

B Failure of B cells to become plasma cells

C Human immunodeficiency virus infection

D Autoantibodies to both T and B lymphocytes

E Failure of development of 3rd and 4th pharyngeal pouches

26. Every springtime, a young healthy man is bothered by episodes of nasal congestion accompanied by sneezing and watery eyes. He has no cough. On physical examination he is afebrile. There is swelling of his nasal passageways, but no other findings. His problems are most likely produced by release of chemical mediators from which of the following cell types?

A Neutrophil

B Mast cell

C CD4+ cell

D NK cell

E Macrophage

27. A 28-year-old woman has noted respiratory difficulties for the past 13 months. She has also noted a non-productive cough and mild fever. Her symptoms improve when she is on vacation. A chest radiograph reveals nodular infiltrates. A transbronchial lung biopsy reveals microscopic findings consistent with an extrinsic allergic alveolitis with interstitial infiltrates composed of lymphocytes along with a few neutrophils and eosinophils. Which of the following histories is most likely to explain these findings?

A She raises parrots in the basement of her house.

B She is a heavy cigarette smoker.

C Her house is downwind from a lead smelter.

D She abuses crack cocaine.

E She has systemic lupus erythematosus.

28. A 30-year-old man has the sudden onset of fever, cough, and dyspnea. He has lost about 10% of his normal body weight over the past 6 months, along with a chronic, watery diarrhea. A bronchoalveolar lavage is performed, and cysts of Pneumocystis carinii (jiroveci) are seen in the fluid. He is treated with clotrimoxazole and recovers. He develops pain and decreased vision on the right, and funduscopic examination reveals a cytomegalovirus retinitis; this improves with ganciclovir therapy. He develops tan-yellow plaques on his tongue with Candida albicans. Which of the following laboratory test findings is most likely to be present in this man?

A ANA titer of 1:1024

B Platelet count of 15,000/microliter

C Serum IgA of 10 mg/dL

D CD4 lymphocyte count of 100/microliter

E cANCA titer of 1:256

29. A 40-year-old woman complains of dry mouth and dry eyes that have become almost constant during the past 2 years, regardless of her fluid intake or the weather outside. However, her fingers do not turn blue or painful upon exposure to cold. She is found serologically to have autoantibodies to the nuclear antigen SS-A, along with a positive antinuclear antibody test. Which of the following is most likely to be the worst long term complication of her underlying disease?

A Pneumocystis carinii (jiroveci) pneumonia

B Monoclonal B-lymphocyte proliferation

C Malabsorption with diarrhea

D Diffuse pulmonary interstitial fibrosis

E Glomerulonephritis

30. A 3-year-old boy has had numerous bacterial infections, including respiratory infections with Hemophilus influenzae, Streptococcus pneumoniae, and Staphylococcus aureus since infancy. He develops a polyarthritis that clears with immunoglobulin therapy. A lymph node biopsy is performed, and microscopically the germinal centers of his nodes are rudimentary. During the 3rd decade of his life he develops systemic lupus erythematosus. He demonstrates skin test positivity to Candida antigen. Laboratory studies show that his serum IgG is 110 mg/dL. His total WBC count is 7650/microliter with differential count of 65 segs, 4 bands, 22 lymphs, and 9 monos. Which of the following immunologic disorders best explains these findings?

A A deficiency of adenosine deaminase

B Malformation of 3rd and 4th pharyngeal pouches

C Reduction in CD4 lymphocytes

D A defect of NADPH oxidase

E Failure of maturation of B cells into plasma cells

31. A bee sting is suffered by a 28-year-old man, and his wife searches frantically for the medical kit with the injectable epinephrine. Which of the following immunologic mechanisms are they trying to prevent?

A Local immune complex formation

B Interleukin release from macrophages

C Binding of anti-receptor antibody

D Systemic anaphylaxis

E Complement activation

32. A 35-year-old man has decreasing mobility of his spine, and he becomes more "hunched over" during the past 5 years. He has hip pain bilaterally. On physical examination he has loss of lumbar lordosis and diminished range of motion at the hips. A radiograph of the pelvis shows ankylosis with sacroiliitis of the sacroiliac joints bilaterally. No other joints appear to be affected. His antinuclear antibody test is negative. He has no other significant medical problems. Which of the following laboratory test findings is most likely to be present in this man?

A HLA B27

B ANA positive at 1:256

C Elevated rheumatoid factor

D Markedly decreased serum complement

E Monoclonal gamma spike

33. A 45-year-old man has been plagued by mild chronic diarrhea and increased numbers of minor respiratory tract infections for most of his life. Following a motor vehicle accident with multiple lacerations to the lower leg, he has a significant blood loss requiring transfusion of blood products. During the transfusion, he is noted to have an anaphylactic transfusion reaction. Which of the following diseases is he most likely to have?

A Selective IgA deficiency

B Amyloidosis

C Systemic lupus erythematosus

D Niemann-Pick disease

E Graft versus host disease

34. A 55-year-old woman has had increasing difficulty with swallowing over the past year. On physical examination her blood pressure is 210/110 mm Hg. Laboratory testing reveals a positive antinuclear antibody test with a nucleolar pattern on immunofluorescence. Her serum complement levels are normal. Which of the following lesions is most likely to be seen in her kidneys with renal biopsy?

A Renal cell carcinoma

B Nodular glomerulosclerosis

C Acute glomerulonephritis

D Hyperplastic arteriolosclerosis

E Polycystic change

35. A positive tuberculin skin test, with a firm 15 mm diameter dark red firm area of induration on the forearm, appears 60 hours following injection of the PPD. This finding is most likely to be a consequence of which of the following types of hypersensitivity reaction?

A Type I hypersensitivity

B Type II hypersensitivity

C Type III hypersensitivity

D Type IV hypersensitivity

E Complement activation

Answers: 1 A, 2 D, 3 C, 4 E, 5 D, 6 E, 7 D, 8 E, 9 B, 10 D

11 C, 12 E, 13 A, 14 A, 15 B, 16 E, 17 C, 18 C, 19 D, 20 D

21 B, 22 B, 23 A, 24 E, 25 A, 26 B, 27 A, 28 D, 29 B, 30 E

31 D, 32 A, 33 A, 34 D, 35 D.

USMLE 1 practice Questions 3

2011-08-16T13:19:00.001-07:00

1. A 30 year old female patient presents to her primary care physician with recurrent bacterial cystitis, cultured for proteus sp, from the bladder, the physician starts her on amikacin (aminoglycoside) which of the following best describes the mechanism of action of the drug.

A. Inhibition of cell wall synthesis by blocking transpeptidation of peptidoglycan.

B. Disruption of bacterial cell wall by pore formation.

C. Binding of bacterial 30 S ribosomal subunit and blocking bacterial protein synthesis.

D. Binding of bacterial 50 S ribosomal subunit and blocking bacterial protein synthesis.

2. A 32 year old Caucasian male patient suffering from HIV is on acyclovir for a herpes simplex infection, the patient develops toxicity, hence what be the clinical signs seen and what adjustments are to be made to the current regime.

A. Acute Hepatotoxicity, stop acyclovir administration and start supportive care.

B. Acute renal disease, administer probenecid concomitantly with acyclovir.

C. neurologic disorders, stop acyclovir administration and start anticonvulsant therapy as needed.

D. Hepatoencephalopathy, stop acyclovir administration and start anticonvulsant therapy and antiemetics as needed.

3. A 46 year old immigrant from india comes to office after noting hypopigmented anesthetic patch on his back. On further examination the physician discover bilaterally thickened ulnar nerves. Skin biopsy reveals numerous acid fast bacilli and negative lepromin test. What combination of drugs is best recommended for the patient.

A. Isoniazid, rifampin, dapsone

B. ethambutol, Isoniazid, clofazimine

C. pyrazinamide, Isoniazid, rifampin

D. ethambutol, Dapsone, clofazimine

E. Dapsone, clofazimine, rifampin.

4. A 28 year old immmuno compromised patient presents to the physician with cryptococcal meningitis, which of the following antifungal agents can be used safely in this patient despite hepatic failure.

A. miconazole

B. ketoconazole

C. Amphotericin B

D. flucytosine

E. itraconazole

5. A 40 year old patient presents in the emergency room with intense ocular itching and increased sensitivity, he reports he has been using a topical preparation for an eye infection prescribed by his ophthalmologist for keratitis. Which of the following drug was he most likely using.

A. Amphotericin B

B. Amantadine

C. Zidovudine

D. idoxuridine

E. acyclovir

6. A 24 year old man presents with painful blisters at right angle of his mouth for 2 days. He has had tingling and burning sensations at the site for 4-5 days. Has no significant past history. On examination the physician finds the temperature to be 99.5F and other vital signs to be normal multiple small vesicles are found at right angle of his mouth and no such lesions elsewhere what would be the drug of choice for the treatment for this condition.

A. Zidovudine

B. Amantadine

C. acyclovir

D. interferon

7. The physician explains to 40 year old patient that one of the drugs he is going to take is cephalosporin A. The physician explains that cephalosporin A is a useful drug for patients with organ transplants because

A. the drug acts as an immunosuppressant

B. it is an anti fungal agent

C. the drug increases antigen in circulation

D. it is a powerful antibiotic

E. increases the level of interleukin-2

8. A 26 year old sexually active woman was diagnosed to have tuberculosis and was put on therapy immediately, the physician advises her to use another form of contraceptive in addition to oral contraceptive pills that she taking then this is because

A. streptomycin is teratogenic

B. rifampin stimulates the liver microsomal enzymes

C. INH stimulates ovulation

D. INH is hepatotoxic

E. ethambutol potentiates side effects of OCP

9. Tetracyclines display broad-spectrum activity and are Effective against both gram-positive and gram-negative bacteria, including atypical microorganisms , the antimicrobial activity of tetracyclines involve which of the following mechanisms

A. inhibition of DNA gyrase.

B. Block the attachment of aminoacyl tRNA to acceptor site.

C. inhibition of bacterial cell synthesis

D. inhibition of microbial protein synthesis

E. both B and D.

10. A 32 year old Caucasian male patient suffering from HIV is on acyclovir for a herpes simplex infection, the patient does not respond to acyclovir which of the following is best likely reason.

A. the defective expression of cellular kinase

B. the herpes virus encoded DNA polymerase is inhibited by acyclovir

C. The herpes virus strain is defective for thymidine kinase expression

D. the HIV patients with genital herpes do not respond to acyclovir

Answers: 1. C, 2. B, 3. E, 4. D, 5. D, 6. C, 7. A, 8. B, 9. E, 10. C

USMLE 1 Practice Questions-2

2011-08-14T17:00:00.000-07:00

1. A 48-year-old female is being treated for breast carcinoma. Over the past few days, she has been complaining of dysuria and frequency. Laboratory examination revealed the presence of microscopic hematuria. The next day the patient developed gross hematuria. Which of the following agents most likely caused the development of these signs and symptoms?

A. Mitomycin

B. Paclitaxel

C. Vincristine

D. Cyclophosphamide

E. Vinblastine

2. A 41-year-old male on combination therapy for remission maintenance ALL (acute lymphocytic leukemia) develops increase frequency of urine, suprapubic pain, dysuria, and hematuria. Evidence of hemorrhage and UTI is apparent on cystoscopy of the urinary bladder. His liver function and pulmonary function tests are nearly normal but blood test (CBC) and urine microscopic examination revealed leucocytosis and plenty of pus cells respectively. Which of the following agents most likely caused these findings?

A. 6-MP

B. Methotrexate

C. Cyclophosphamide

D. Doxorubicin

E. Carmustine

3. A 28-year-old white man was on vacation for 2 weeks in northern Minnesota in July. He was fishing and hiking in the forest for a number of days. He was healthy, with no known underlying disease or illness. Approximately 3 weeks after returning from his vacation, a red macule–papule developed on his right anterior thigh. Increasing redness developed around the initial site. The central area of this lesion showed some clearing. Several other similar lesions developed on his right leg and trunk. The patient did not note any arthropod bites. Which of the following antimicrobials would be the drug of choice for this patient?

A. Chloramphenicol

B. Cephalexin

C. Doxycycline

D.Gentamicin

E. Ampicillin

4. A 35-year-old man under treatment for pulmonary tuberculosis has acute-onset right big toe pain, swelling, and low- grade fever. His physical examination was consistent with gouty arthritis, and he was found to have high serum uric acid levels. Which of the following antituberculosis drugs is known to cause high uric acid levels?

A. Cycloserine

B. Thiacetazone

C. Pyrazinamide

D. Rifampin

E. Aminosalicylic acid

5. A 26-year-old truck driver, a recent immigrant from Mexico, could not obtain a Florida driving license because of his poor performance in red-green color vision discrimination. He denies any family history of color vision–related problems in the past. He is taking a four-drug regimen for pulmonary tuberculosis. He does not recall the names of the drugs. Which of the following antituberculosis drugs is responsible for his lack of color vision discrimination?

A. Ethambutol

B. Ethionamide

C. Aminosalicylic acid

D. Rifampin

E. Isoniazid

6. A 68-year-old white South African man receiving treatment for lepromatous leprosy has increasing red-brown pigmentation. Which of the following antileprosy drugs is responsible for the patient’s skin pigmentation?

A. Dapsone

B. Rifampin

C. Clofazimine

D. Capreomycin

E. Thiacetazone

7. A 23 year-old college student is diagnosed with Neisseria meningitidis based on his clinical presentation, gram-negative diplococci on Gram stain, and isolation of bacteria from cerebrospinal fluid. Which of the following drugs can be used as a prophylactic agent for roommates and other close contacts?

A. Amoxicillin

B. Isoniazid

C. Dapsone

D. Clarithromycin

E. Rifampin

8. A 65-year-old man with acute leukemia recently underwent induction chemotherapy and subsequently developed neutropenia and fever (with no source of fever identified). Fever persisted despite the use of empirical antibacterial therapy, and amphotericin B has been prescribed for possible fungal sepsis. Which laboratory test is the most helpful in monitoring for toxicities associated with amphotericin B?

A. Liver function tests and fasting lipid profile

B. Renal function tests

C. Serum magnesium, chloride

D. Serum blood sugar both FBS and RBS

E. Hemoglobin and hematocrit

9. A 42-year-old male suddenly develops dysuria and frequency despite the absence of bacteriuria; microscopic hematuria is noted. Over the course of the next few days, gross hematuria is seen. The patient is being treated for non-Hodgkin's lymphoma with a nitrogen mustard-type antineoplastic agent. Which of the following agents could have been administered to prevent the onset of the patient's symptoms?

A. Leucovorin

B. Allopurinol

C. Penicillamine

D. Mesna (it neutrolyzes acrolin at acidic pH in urine)

E. Sodium thiosulfate

10. A 19-year-old male has just returned from a trip to Southeast Asia. In the past 24 hours, he has developed shaking, chills, and a temperature of 104F. A blood smear reveals Plasmodium vivax. Which of the following agents should be used for Radical cure (exoerythrocytic phase) with the clinical cure of the organism?

A. Primaquine and Pyrimethamine

B. Pyrimethamine

C. Quinacrine

D. Chloroquine and Primaquine combination

E. Chloroquine only

11. Streptomycine and pyrazinamide are administered concurrently with other antitubercular drugs in the treatment of TB in order to

A. Reduce the pain of injection

B. Facilitate penetration of the blood-pulmonary barrier and rapid onset of action.

C. Retard the development of organism resistance

D. Delay excretion of other antitubercular drugs by the kidney and increase half life

E. Retard absorption after intramuscular injection

12. A 55-year-old obese woman with adult-onset diabetes mellitus has been receiving amoxicillin for treatment of an acute exacerbation of chronic bronchitis. After a week of therapy, the patient develops dysuria and increased urinary frequency. Urinalysis shows 10 to 50 white blood cells per high-power field, and Gram stain of urine shows many budding yeasts. Which antifungal agent would be best in treating this patient for Candida cystitis?

A. Oral ketoconazole

B. Oral fluconazole

C. Topical clotrimazole

D. Oral 5-flucytosine

E. Oral itraconazole

13. A 43-year-old woman recently underwent allogeneic bone marrow transplantation after chemotherapy failed in the treatment of metastatic breast carcinoma. The patient has had a stormy hospital course after her transplant, with respiratory failure requiring mechanical ventilation. A month into her hospitalization, surveillance sputum cultures reveal Aspergillus fumigatus, and a new infiltrate appears on her chest radiograph. Which antifungal agent is recommended for the treatment of invasive pulmonary aspergillosis in this patient?

A. Fluconazole

B. Amphotericin B

C. Nystatin

D. Capsofungin

E. Itraconazole

14. A 29-year-old medical entomologist comes to the hospital with chief complaints of fever, headache, and photophobia. This illness began about 6 days prior to admission, when he returned from a 2- month visit to the jungles of Central and South America. On his return flight, about 6 days prior to admission, he described having fever and shaking chills. He saw his physician 2 days prior to admission; the physician made a diagnosis of influenza and prescribed tetracycline. On the day of admission, the patient had shaking chills followed by temperature elevation to 104°F (40°C). Physical examination revealed a well-developed man who appeared ill. There is some left upper quadrant tenderness but no organomegaly; blood pressure, 126/90; pulse, 120; and respirations, 22. Laboratory findings were hemoglobin, 14.5 mg/dL (normal, 13.4–17.4 mg/dL); hematocrit, 45% (normal, 40–54%); Giemsa stained blood smear (thick and thin) revealed Plasmodium vivax. What is the oral drug of choice to rid the blood of plasmodia?

A. Primaquine

B. Chloroquine

C. Sulfadiazine

D. Quinine

E. Mefloquine

15. A 52-year-old real estate salesperson has a 2-week history of watery diarrhea without blood. The patient states that 4 to 5 weeks ago she and her husband visited Aspen, Colorado, on a backpacking vacation and on occasion drank water from mountain streams. They were sure the water was potable, as the unspoiled, pristine area abounded with fish, beaver, and plant life. She states she has enjoyed perfect health except that she takes antacids for what she describes as gastroesophageal reflux disease. Her physical examination produced unremarkable findings. Examination of liquid stool revealed trophozoites and cysts of G. lamblia .Which of the following is the correct treatment for this disease?

A. Melarsoprol

B. Mefloquine

C. Mebendazole

D. Metronidazole

E. Fluroquinolone

16. To optimize drug therapy, it is necessary to know in what phase of the cell cycle antineoplastic agents are effective. Which one of the following agents is cytotoxic only to cells in the S-phase of the cycle?

A. Fluorouracil (pyrimidines antagonist

B. Mechlorethamine (alkylating, can act on all stages p.300)

C. Bleomycin

D. Carmustin

E. Methotrexate (in general: antimetabolites are S Phase-specific

17. Which class of drugs bind avidly to tubulin/microtubule and cause arrest of cells in metaphase?

A. Fluorouracil

B. Mechlormethamine

C. Bleomycin

D. Vincristine

E. Methotrexate

18. A 58-year-old female develops sudden onset of orthopnea, paroxysmal nocturnal dyspnea, and nocturia. On examination, the patient is tachycardic and both pulmonary rales and a third heart sound (S3) are noted. X-ray chest P/A and lateral views and ECG revealed cardiomegaly and arrhythmia respectively. If the patient is receiving antineoplastic therapy for treatment of breast cancer, which of the following agents did she most likely receive?

A. Bleomycin

B. Cisplatin

C. Doxorubicin

D. Methotrexate

E.Methotrexate

19. An anticancer chemotherapeutic agent that acts by first-order kinetics would be expected to kill a

A. constant number of cancer cells

B. constant proportion of cancer cells

C. variable number of cells depending on the half-life of the drug

D. variable number of cells depending on the proportion of cells in S phase

E. variable proportion of cells depending on the number of cells in the G0 phase

20. A 33-year-old woman presents with profound nausea, vomiting, sweating, hyperventilation, tachycardia, and vertigo. She states that she was out with a couple of friends having a few glasses of wine when she suddenly became ill. She has been previously diagnosed with a duodenal ulcer and is currently taking medication for her condition. Which of the following medications is most likely responsible for her latest symptoms?

A. Amoxicillin

B. Bismuth subsalicylate

C. Erythromycin

D. Metronidazole (it has disulfiram like effect, alcohol should be avoided)

E. Tetracycline

21. A 32-year-old male, infected with HIV, is diagnosed with Hodgkin's lymphoma. If the patient's CD4 count is 505/mm3, which of the following agents would be suitable for the treatment of this patient's lymphoma without further compromising his immune system?

A. Cyclophosphamide

B. Busulfan

C. Paclitaxel

D. Vincristine

E. Methotrexate

22. A 33-year-old man receiving chemotherapy for testicular carcinoma develops signs of renal tubular damage. Which of the following drugs is most likely responsible for this nephrotoxicity?

A. Cyclophosphamide

B. Bleomycin

C. Vinblastine

D. Vincristine

E. Methotrexate (MTX)

23. A 25-yr-old male AIDS pt has a fever of 102 F and complains of severe headaches during the past week. Staining of his CSF with India ink reveals Cryptococcus neoformans. The patient is admitted to the hospital and is treated with

A. IV amphotericin B plus flucytosine

B. Oral ketokonazole

C. Intrathecal (within a sheath, within either the subarochnoid or subdural space) Amphotericin B plus IV flucytosine

D. oral fluconazole

E. IV amphotericin B plus fluconazole

24. A 45-year-old female being treated for a chronic UTI develops acute alcohol intolerance. Which of the following agents could have caused this intolerance?

A. Cefoperazone (3^rd generation Cephalosporin)

B. Amoxicillin

C. Sulfamethoxazole-trimethoprim

D. Norfloxacin

E. Tetracycline

25. A 27-year-old male with a three-year history of AIDS complains of progressive blurring of vision for two days. Eye examination reveals evidence of retinitis consistent with cytomegalic virus inclusion disease. Intravenous treatment is started, and within five days the patient complains of muscular weakness and cramping. Blood chemistries show a creatinine of 5.2 mEq/L and Hb% of 9 mg/dl but normal Ca level. Select the drug that most likely caused the adverse effect:

A. Ribavirin

B. Amantadine

C. Dideoxycytidine

D. Foscarnet

E. Ganciclovir

Answers: 1 D, 2 C, 3 C, 4 C, 5 A, 6 C, 7 E, 8 B, 9 D, 10 D, 11 C, 12 B, 13 B, 14 B, 15 C, 16 E, 17 D, 18 C, 19 B, 20 D
21 D, 22 E, 23 C, 24 A, 25 E

USMLE 1 Practice Questions-1

2011-08-13T12:05:00.000-07:00

1.An overweight 52-year-old male presents with complaints of increased thirst and frequent urination. Laboratory examination reveals a blood glucose level of 180 mg/dL. The patient's past medical history is unremarkable, except for an anaphylactic reaction that occurred one year ago when he was given trimethoprim-sulfamethoxazole for a sinus infection. Based on this information, which of the following agents should be prescribed?

A. Chlorpropamide

B. Glipizide

C Glucagon

D. Metformin

E. Propranolol

2.A 62-year-old Type 2 diabetic patient presents with complaints of malaise, myalgias, respiratory distress, and increased somnolence. If laboratory examination reveals an anion gap of 26 mmol/L, HCO3- of 17 mmol/L and an arterial blood pH of 7.27, the patient is most likely receiving

A. glyburide

B. metformin

C. repaglinide

D. miglitol

E. troglitazone

3.A 55-year-old man with peptic ulcer disease has been on drug therapy for more than 4 months. While on this regimen, he noticed changes in his bowel habits, increasing headaches, dizziness, skin rashes, loss of libido, and gynecomastia. The drug most likely responsible for these effects is

A. cimetidine

B. famotidine

C. metronidazole

D. omeprazole

E. sucralfate

4. A 67-year-old woman is being treated for metastatic ovarian cancer with cisplatin and cyclophosphamide. To prevent nausea and vomiting, she is given an agent that selectively antagonizes 5-hydroxytryptamine-3 (5-HT3) receptors. Which of the following drugs is this patient most likely taking?

A. Dimenhydrinate

B. Dronabinol

C. Metoclopramide

D. Ondansetron

E. Prochlorperazine

5. A 64-year-old man presents to his doctor with aching, burning pain after meals. He had been self-medicating for several months with antacids, but he found this to be increasingly ineffective. His physician decides to take him off the antacids and instead places him on a combination of ranitidine and sucralfate. Why is this combination a bad idea?

A. Ranitidine increases the toxicity of sucralfate

B. Ranitidine increases the action of sucralfate

C. Sucralfate and ranitidine coprecipitate

D. Sucralfate increases the toxicity of ranitidine

E. Sucralfate interferes the absorption of ranitidine

6. A 54-year-old man is brought to the emergency department after experiencing several syncopal episodes. The patient states that he is currently taking erythromycin for treatment of bronchitis and another medication for treatment of gastroesophageal reflux disease (GERD). If an electrocardiogram reveals torsades de pointes (cardiac arrhythmia), the patient is most likely taking which of the following medications for treatment of his reflux disease?

A. Cisapride

B. Famotidine

C. Lansoprazole

D. Metoclopramide

E. Sucralfate

7. A 28-year-old man is placed on haloperidol after he is diagnose with schizophrenia. A few days later his concerned mother brings him back to the psychiatrist because he is exhibiting strange movements. The physician observes movements that consist of sustained contractions and twisting motions of his limbs and trunk, with his eyes tonically deviated upward for several minutes. Which of the following adverse reactions is occurring in this patient?

A. Muscarinic receptor blockage

B. Dystonia (extrapyramidal side effect)

C. Neuroleptic malignant syndrome

D. Parkinsonism

E. Alpha receptor blockage

8. A 60-year-old woman with Parkinson’s disease. Her current therapy is levodopa–carbidopa. She complains that she frequently goes from being fairly mobile to being immobile in only a matter of a few minutes. Her neurologist decides to add tolcapone to her therapy. What blood tests should be performed before and during her treatment with tolcapone?

A. Red blood cell count

B. White blood cell count

C. Serum levels of calcium and phosphorus

D. Serum levels of creatinine and uric acid

E. Serum levels of transglutaminase enzymes

9. A.45-year-old schizophrenic who finally has his antipsychotic medication adjusted properly and who is doing reasonably well at the moment. He came to your office today exhibiting many signs of parkinsonism, including tremor, rigidity, stooped posture, and shuffling gait. He indicates that even though his schizophrenia is under control, these new symptoms are very unpleasant. What do you do?

A. Withdraw his antipsychotic medication.

B. Prescribe levodopa.

C. Prescribe a muscarinic blocking agent.

D. Prescribe a dopa agonist.

E. Prescribe amantadine.

10. A 68-year-old woman is taking L-dopa and carbidopa for Parkinson's disease. She presents to her physician complaining of a worsening tremor. Her neurologist decides to add trihexyphenidyl to her drug regimen but warns her about the potential side effects of this drug. Which of the following side effects will this patient most likely experience?

A. Diaphoresis

B. Diarrhea

C. Dry mouth

D. Miosis

E. Urinary incontinence

Answer: 1 D, 2 B, 3 A, 4 D, 5 E, 6 A, 7 B, 8 E, 9 A, 10 C