Otázky s chybnou odpovědí, č.j. 3431890
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TEST:usmle1en  Varianta:3         Tisknuto:04/06/2019
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 16. ( 10.orig.) A 16-year-old girl is incoherent and has a fever, severe lower abdominal pain, and a foul-smelling cervicovaginal discharge. A self-induced abortion is suspected. Which of the following methods should be used to collect a sample of the cervical discharge for bacterial culture? 
 1) - Placing a swab in transport medium at room temperature (zaškrtl-a)
 2) + Taking samples of the discharge with a syringe and transferring them directly to the laboratory (nezaškrtl-a)
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 22. ( 20.orig.) Breast carcinomas often cause the skin of the breast to become puffy and pitted, resembling orange peel. The pits most likely correspond with which of the following? 
 1) + Attachments of suspensory ligaments (retinacula cutis) to the dermis (nezaškrtl-a)
 5) - Diffuse scarring in subcutaneous fibrous tissue (zaškrtl-a)
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 41. ( 32.orig.) During a prenatal visit, a 25-year-old woman who is 10 weeks' pregnant comments that she feels too nauseated and fatigued to be interested in sex, and her husband wonders if they will ever be sexually active again.  The most appropriate next step is to advise her that sexual interest often returns during which of the following periods? 
 1) + Second trimester (nezaškrtl-a)
 2) - Third trimester (zaškrtl-a)
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 50. (  8.orig.) Moderate alcohol consumption may protect against coronary artery disease by which of the following mechanisms? 
 2) + Increasing serum concentration of HDLs (nezaškrtl-a)
 4) - Decreasing serum concentration of LDLs (zaškrtl-a)
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 56. ( 21.orig.) A 56-year-old woman has adenocarcinoma of the colon that is surgically resected. Which of the following patterns of growth by the neoplasm most strongly suggests a poor prognosis? 
 1) - Extension to the muscularis mucosa (zaškrtl-a)
 4) + Extension to the serosa (nezaškrtl-a)
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 57. ( 29.orig.) Lactation does not occur during pregnancy because the action of prolactin is blocked by increased concentrations of which of the following hormones? 
 1) - Human chorionic somatomammotropin and prostaglandin (zaškrtl-a)
 3) + Estrogen and progesterone (nezaškrtl-a)
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 62. (  1.orig.) Following infection with measles virus, a 6-year-old boy produces antibodies to all eight viral proteins. The following year he is again exposed to measles virus. Antibodies to which viral protein are most likely to be protective?
 3) + Hemagglutinin (nezaškrtl-a)
 4) - Nucleocapsid (zaškrtl-a)
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 66. (  4.orig.) In sensitized persons, immediate (type I) hypersensitivity responses are primarily the result of  liberation of vasoactive substances by the action of which of the following? 
 1) + IgE on basophils and mast cells  (nezaškrtl-a)
 5) - IgA on basophils and mast cells (zaškrtl-a)
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 67. ( 22.orig.) A 52-year-old woman is admitted to the hospital because of  breast cancer metastatic to the liver. Her prognosis is poor. She begs her husband to stay with her at the hospital because she is afraid to be left alone. Which of the following defense mechanisms best explains her behavior? 
 1) + Regression (nezaškrtl-a)
 4) - Displacement (zaškrtl-a)
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 69. ( 31.orig.) An asymptomatic 26-year-old man has a scrotal mass.  When he is standing, the left scrotal sac is enlarged with a tubular, worm-like, freely movable, nontender mass. The mass is not palpable when he is supine.  The most likely diagnosis is 
 1) - indirect inguinal hernia (zaškrtl-a)
 3) + varicocele (nezaškrtl-a)
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 90. ( 37.orig.) A 38-year-old man reports with some embarrassment that he is unable to urinate in a public urinal, but at home he experiences no difficulty.  The most likely diagnosis is 
 4) - generalized anxiety disorder (zaškrtl-a)
 5) + social phobia (nezaškrtl-a)
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 94. ( 26.orig.) After fasting, a patient has no gastric acid secretion when chewing and no receptive relaxation of the proximal stomach when swallowing. Which of the following best explains these findings? 
 3) + Vagally denervated stomach (nezaškrtl-a)
 5) - Increased concentration of somatostatin (zaškrtl-a)
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 97. (  9.orig.) A 48-year-old woman has loss of pain and temperature sensation in the left upper and lower limbs. Which of the following labeled areas in the medulla is the most likely site of the causal lesion?  
 2) - B (zaškrtl-a)
 3) + C (nezaškrtl-a)
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115. ( 11.orig.) Patients X and Y both have respirations of 12/min and tidal volumes of 500 mL. However, patient X has an arterial PCO2 of 35 mm Hg, while patient Y has an arterial PCO2 of 45 mm Hg. The difference in PCO2 between these patients is best explained by a difference in which of the following? 
 3) - Forced expiratory volume in 1 sec  (FEV1) (zaškrtl-a)
 4) + Dead space ventilation (nezaškrtl-a)
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TEST:usmle2en  Varianta:3         Tisknuto:04/06/2019
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  1. ( 36.orig.) A 20-year-old primigravid woman delivers a full-term 3200-g (7-lb 1-oz) newborn vaginally under epidural anesthesia. A second-degree midline episiotomy was required.  On postpartum day 1, she has perineal pain.  The perineum is slightly edematous with no evidence of purulent drainage or episiotomy breakdown. Which of the following is the most appropriate next step in management? 
 1) + Sitz baths twice daily (nezaškrtl-a)
 3) - Intravenous ampicillin therapy (zaškrtl-a)
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  2. ( 22.orig.) A 6-month-old boy bruises easily and has bleeding gums on several occasions for 2 months. A maternal uncle has a bleeding disorder. Examination shows several small bruises on the legs. Partial thromboplastin time is prolonged, and prothrombin time is normal. Which of the following is the most likely coagulation factor deficiency?
 1) + Factor VIII (nezaškrtl-a)
 5) - Factor VII (zaškrtl-a)
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  6. ( 14.orig.) A 20-year-old woman is brought to the emergency department because of fever, severe myalgias diarrhea, and a diffuse scarlatiniform rash for hours. She recovered from a similar illness 6 months ago. She is menstruating and using a tampon. She appears very ill.  Her temperature is 40°C (104°F), pulse is 130/min, and blood pressure is 75/30 mm Hg Which of the following is the most appropriate pharmacotherapy?
 1) - Ampicillin (zaškrtl-a)
 2) + Oxacilin (nezaškrtl-a)
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 15. ( 30.orig.) A 22-year-old man with a seizure disorder has had increasing cough and shortness of breath for 3 days and fever for 1 day. He has foul-smelling sputum. He had a generalized tonic-clonic seizure 1 week ago. His temperature is 39,4°C (103°F). Crackles are heard on auscultation of the chest. An x-ray of the chest shows a right upper-lobe infiltrate of the lung. Which of the following is the most likely cause?
 3) - Chemical pneumonitis (zaškrtl-a)
 5) + Pneumonia secondary to anaerobes (nezaškrtl-a)
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 26. ( 40.orig.) A 6-year-old man with emphysema is brought to the emergency department 1 hour after becoming lethargic and incoherent. Over the past 3 days, he has had increasing episodes of dyspnea, cough, and sputum production. Oxygen was administered en route to the hospital. On arrival, the patient is confused and lethargic but responsive to painful stimuli. Arterial blood gas analysis while breathing 6l/min of oxygen shows: pH 35 [H+] nmol/l (36-44), pCO2 12,7 kPa (4,4-5,9), pO2 13,3 kPa (10,0-14,0). Which of the following is the most appropriate next step in management?
 2) - Discontinuation of the oxygen (zaškrtl-a)
 5) + Endotracheal intubation and mechanical ventilation (nezaškrtl-a)
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 40. ( 11.orig.) A 10-year-old boy with chronic sinusitis is brought to the emergency department following a 3-minute generalized tonic-clonic seizure. He has a 3-day history of increasingly severe headaches and a 2-day history of vomiting and temperatures to 38.7°C (101.7°F). His temperature is 39.5°C (103.1°F), pulse is 80/min, respirations are 16/min, and blood pressure is 135/90 mm Hg. He is slightly lethargic but answers questions appropriately. Examination shows papilledema. No other abnormalities are noted. Which of the following is the most appropriate initial step in management? 
 1) + CT scan of the head (nezaškrtl-a)
 3) - EEG (zaškrtl-a)
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 64. (  7.orig.) A 64-year-old woman comes to the physician because of a 5-month history of increasing shortness of breath, sore throat, and a cough productive of a small amount of white phlegm. Over the past week, she has had nausea related to excess coughing.  Over the past year, she has had a 3.2-kg (7-lb) weight loss. She has asthma treated with theophylline and inhaled beta-adrenergic agonists and corticosteroids. She has smoked one pack of cigarettes daily for 44 years and drinks one alcoholic beverage daily. She appears thin. Examination shows a 2-cm, nontender lymph node in the right supraclavicular area. Examination shows no other abnormalities. An x-ray of the chest shows a large right lower lobe density. A CT scan of the chest shows a 7.5 x 7.5 x 6-cm right lower lobe mass with some scattered calcifications. The lesion abuts the posterior chest wall without clear invasion. There are right lower peritracheal, precarinal, right hilar, and subcarinal lymph nodes. There is a 1.5-cm mass in the right adrenal gland. A biopsy specimen of the lung mass is most likely to show which of the following? 
 1) - Metastatic adenocarcinoma of the breast (zaškrtl-a)
 4) + Non-small cell lung carcinoma (nezaškrtl-a)
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 93. ( 26.orig.) A 17-year-old boy comes to the physician because of right groin pain for 2 hours; elevation of the scrotum does not relieve the pain. There is no history of trauma.  He is sexually active and has had multiple sexual partners over the past 3 years. He does not use condoms regularly. He had chlamydial urethritis 1 year ago treated with doxycycline. Examination shows an enlarged, swollen, erythematous, and acutely tender right scrotum. The left testis is found in a horizontal position; the cremasteric reflex is absent on the right. Which of the following is the most likely diagnosis? 
 3) - Epididymitis (zaškrtl-a)
 4) + Torsion of the testicle (nezaškrtl-a)
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105. (  6.orig.) A 28-year-old woman, gravida 3, para 2, comes to the physician for her first prenatal visit at 36 weeks´ gestation. She has been taking over-the-counter ferrous sulfate. Although her intake of protein and calories has been adequate, she rarely eats fruits or fresh vegetables. This patient is at increased risk for a deficiency of which of the following?
 1) + Folic acid (nezaškrtl-a)
 4) - Vitamin B12 (cobalamin) (zaškrtl-a)
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106. ( 35.orig.) A16-year-old girl is brought to the physician because of intermittent pain and swelling of both ankles over the past month. She is currently not in pain. When the pain occurs, it is so severe that she is unable to walk. There is no associated fever or chills. She is sexually active and has had one sexual partner for 12 months. Her temperature is 37°C, pulse is 80/min, and blood pressure is 145/87 mm Hg. Examination shows no abnormalities or tenderncess of the ankle joints. There is a nonpainful ulcer on the oral buccal mucosa. The lungs are clear to auscultation. Cardiac examination shows no abnormalities. Laboratory studies show: BLOOD: leukocyte count 4000/mm3 (4500-11000), segmented neutrophils 65% (54-62), eosinophils 3% (1-3), lymphocytes 25% (25-33), monocytes 7% (3-7), platelet count 60,000/mm3 (150,00-400,000), erythrocyte sedimentation rate 100mm/h; SERUM: antinuclear antibodies 1:320, anti-DNA antibodies - positive, rapid plasma reagin 1:16, rheumatoid factor - negative; URINE: protein +++, RBC casts negative, RBC none, WBC +. X-rays of the ankles show no abnormalities other than tissue swelling. Which of the following is the most likely diagnosis?
 3) - Reactive arthritis (zaškrtl-a)
 4) + Systemic lupus erythematosus (nezaškrtl-a)
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110. ( 39.orig.) A 37-year-old woman, gravida 3, para 3, comes to the physician because of labor-like pains and a small amount of vaginal bleeding for 2 days. She has had increasingly heavy, regular menstrual periods over the past 3 years; her last menstrual period was 18 days ago. Her youngest child is 10 years old. The cervix is moderately effaced and 2 cm dilated; there is beefy red tissue in the os. Which of the following is the most likely diagnosis? 
 1) + Pedunculated submucous leiomyoma (nezaškrtl-a)
 3) - Incomplete abortion (zaškrtl-a)
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TEST:usmle3en  Varianta:3         Tisknuto:04/06/2019
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 19. (  2.orig.) A 75-year-old woman comes to the clinic because she has band-like burning pain in the right upper quadrant extending from the epigastrium around to the midline of the back. On physical examination, there is no abdominal tenderness. Findings on ultrasonography of the gallbladder are normal; serum amylase concentration is normal. Which of the following is the most likely diagnosis? 
 2) + Herpes zoster (nezaškrtl-a)
 5) - Acalculous cholecystitis (zaškrtl-a)
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 29. (  8.orig.) A 56-year-old man is admitted to the hospital from the emergency department because of an acute myocardial infarction. He has no identified risk factors and no history of heart disease. He had no major complications and is discharged after 8 days. At discharge, which of the following diagnostic tests should be scheduled for the 2-week follow-up visit in order to predict most accurately his risk for another infarction? 
 1) + Exercise stress test (nezaškrtl-a)
 4) - Electrocardiogram (zaškrtl-a)
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 54. (  7.orig.) You plan to discharge an 81-year-old woman in a few days following a 3-week stay in the hospital for repair of a fractured hip that she sustained while gardening. She now ambulates with difficulty using a walker, but she is determined to become independent again and to return to her own home. Which of the following is most likely to prevent another fall and a possible fracture in this patient? 
 2) + Request a visiting nurse to assess the safety of her living environment (nezaškrtl-a)
 5) - Ensure that she does not have orthostatic hypotension (zaškrtl-a)
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 73. ( 24.orig.) A 20-year-old woman who is 35 weeks pregnant with her first child is admitted to the hospital because of persistent hypertension and 1+ protein on urinalysis obtained 36 hours ago. She is confined to bed awaiting further diagnostic studies for preeclampsia. Her blood pressure is now 160/100 mm Hg. She is complaining of headaches, blurred vision and epigastric pain. At this time it is most appropriate to conclude that this patient has which of the following? 
 1) + Severe preeclampsia and requires immediate medical management and delivery (nezaškrtl-a)
 2) - Mild preeclampsia and should continue bed rest pending further diagnostic studies (zaškrtl-a)
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 75. (  6.orig.) You plan to discharge an 81-year-old woman in a few days following a 3-week stay in the hospital for repair of a fractured hip that she sustained while gardening. She now ambulates with difficulty using a walker, but she is determined to become independent again and to return to her own home. Her daughter, who is in the room with the patient, says, "I want to take Mother home with me because I'm concerned that she could fall and break her hip again. Mom says she doesn't really want to leave her own home, but she will do what is best." The daughter turns to her mother and says firmly, "Isn't that right, Mom?" The mother says, "Yes, I guess so," averting eye contact with both her daughter and you by looking down toward the floor. Which of the following is the most appropriate response to the mother? 
 1) + "I would like to talk with you in private now." (nezaškrtl-a)
 3) - "Is this really your decision or is it your daughter's?" (zaškrtl-a)
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 76. (  5.orig.) A 22-year-old woman who has a 5-year history of ulcerative colitis is admitted to the hospital because of increasing abdominal pain, diarrhea and hematochezia. Her disease is limited to the descending colon. Current therapy includes sulfasalazine and corticosteroid enemas. While she is receiving parenteral corticosteroid therapy, she is discovered to be 8 weeks pregnant. Which of the following statements should be emphasized in discussing this pregnancy with her? 
 1) - Abortion should be considered because of the teratogenic effects of her colitis therapy (zaškrtl-a)
 3) + Sulfasalazine and corticosteroids are not known to be teratogenic (nezaškrtl-a)
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 82. ( 15.orig.) A 19-year-old white woman returns to the office 2 months after having a medroxyprogesterone injection for contraception. She is complaining of nonstop bleeding since her menses 3 weeks ago. She is using eight pads a day. She denies any sexual activity since she received the injection. She realizes that spotting is a side effect; however, she is anxious about the length of time and the amount of the bleeding. She tells you, "I can't stand this, Doctor. I want the bleeding to stop now!" Repeat pregnancy test is negative. Which of the following is the most appropriate treatment option for her bleeding? 
 4) + Conjugated estrogen therapy for 2 weeks (nezaškrtl-a)
 5) - Triphasic oral contraceptive therapy for one cycle (zaškrtl-a)
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 84. ( 38.orig.) A husband and wife, ages 29 years and 34 years, respectively, come to the office for advice regarding their risk for having hearingimpaired children. They are both hearing-impaired and require hearing aids. Their hearing loss is sensorineural and is not associated with any other health problems. The wife tells you, "We have both learned to live with this disability, but we want to take it into account before we decide to have children." Their pedigree is shown with the patients identified as II2 and II3. Which of the following is the most appropriate advice to the couple? 
 4) - It is unlikely that they will have hearing-impaired children (zaškrtl-a)
 5) + Accurate risk estimation is impossible without further evaluation (nezaškrtl-a)
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 87. ( 32.orig.) A 62-year-old man strikes the steering wheel of his car during a low-speed automobile accident. In the emergency department he is alert and his vital signs are normal. He complains of mild tenderness on sternal compression. Chest x-ray film shows a widened mediastinum. The most appropriate first step is to order which of the following? 
 2) - Bronchoscopy (zaškrtl-a)
 5) + CT scan of the chest with contrast (nezaškrtl-a)
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 92. ( 21.orig.) A 60-year-old man is admitted to the hospital because of acute pancreatitis. Laboratory studies show: SERUM: Amylase 1,000 U/L (25-125), Calcium 2,1 mmol/l (2,1-2,8), Urea nitrogen 0,85 mmol urea/l (1,2-3); BLOOD: Hematocrit 42% (41-53), WBC 14,000/mm3 (4500-11000).Results of serum liver chemistry profile are normal. After 48 hours of fluid therapy and observation, a poor prognosis would be indicated by which of the following laboratory studies? 
 2) - Serum amylase of 2,000 U/L (zaškrtl-a)
 4) + Serum calcium of 1,6 mmol/l (nezaškrtl-a)
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 98. ( 13.orig.) At a routine physical examination, the Pap smear of a 27-year-old woman shows evidence of marked inflammation suggestive of moderate dysplasia (HGSIL). Her last Pap smear 2 years ago was normal. Pelvic examination today is normal. She has never been pregnant and her menstrual periods are regular. She has been in a stable relationship with the same man for 3 years and she uses a diaphragm with spermicidal jelly for contraception. Which of the following is the most appropriate next step? 
 2) - Do conization of the cervix (zaškrtl-a)
 5) + Do colposcopic examination of the cervix after application of 5% acetic acid solution (nezaškrtl-a)
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 99. ( 12.orig.) A 50-year-old woman comes to the office for the first time because of recurrent abdominal pain. Review of her extensive medical chart, which she has brought with her, discloses that she has a long history of varying physical complaints. Definitive causes for these complaints have not been found despite extensive diagnostic studies, consultations with many physicians and several surgical explorations. She gives dramatic and exaggerated descriptions of her present and past symptoms, and she makes conflicting statements about her history. She has been hospitalized at least 23 times since age 18 years. Which of the following is the most likely diagnosis? 
 1) + Histrionic personality disorder (nezaškrtl-a)
 5) - Somatization disorder (zaškrtl-a)
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112. ( 39.orig.) A 76-year-old woman returns to the office because of aching and weakness in her arms to the point where she cannot lift her arm to brush her hair. Physical examination shows no muscle tenderness or other evidence of joint disease in both arms. The aching improves when she takes the prescribed nonsteroidal anti-inflammatory drug (NSAID). She also describes tenderness over the right parietal area of her scalp. Physical examination of the scalp shows no lesions. Which of the following is the most appropriate next step? 
 3) + Order determination of erythrocyte sedimentation rate (nezaškrtl-a)
 4) - Order determination of serum rheumatoid factor (zaškrtl-a)
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113. ( 11.orig.) A 32-year-old man and his 29-year-old wife are being evaluated for infertility. The woman's gynecologist reports that the woman had a normal anatomic and physiologic evaluation and suggests the need for assessment of potential male factors. On examination, the man is 188 cm (6 ft 3 in) tall with fair skin and little facial hair. His testicles are small and firm, and he has mild gynecomastia. No sperm are seen on analysis of his semen. Which of the following tests is most likely to establish the underlying cause of the infertility? 
 1) - Serum estrogen and testosterone concentrations (zaškrtl-a)
 5) + Karyotype from peripheral leukocytes (nezaškrtl-a)
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114. ( 17.orig.) A 58-year-old man comes to the office because of a lesion on the lip, which is shown. The patient says he has had the lesion for about 9 months. He has not seen a physician for 5 years and he is in the office today only because, he says, "My wife made me come." On physical examination the lower lip is fixed to the anterior aspect of the mandible. Which of the following is the most likely diagnosis? 
 1) + Squamous cell carcinoma (nezaškrtl-a)
 2) - Keratoacanthoma (zaškrtl-a)
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116. ( 30.orig.) A 42-year-old Anglo-American man is brought to the emergency department by his same sex partner because of confusion, diplopia and mild right arm weakness. On examination the patient is somewhat agitated and shows confusion for recent events. There is decreased pupillary response on the left with some paresis of lateral gaze on the right. Temperature is 38.3°C (101.0°F). Peripheral leukocyte count is increased. Which of the following is the most appropriate next step in evaluation of his neurologic signs and symptoms? 
 3) + CT scan of the head (nezaškrtl-a)
 4) - Lumbar puncture (zaškrtl-a)
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118. ( 23.orig.) A 50-year-old woman is in the recovery room following an uneventful cholecystectomy. Two hours after the procedure she begins to have ventricular extra-systoles and her systolic blood pressure falls from 110 mm Hg to 90 mm Hg. Arterial blood gas values while breathing room air are: PO2 7,7 kPa (10,0-14,0),  PCO2 6,9 kPa (4,4-5,9), pH [H+]36,8 nmol/l (36-44). These signs are most likely the result of which of the following? 
 2) + Alveolar hypoventilation (nezaškrtl-a)
 5) - Primary hypoxemia resulting from anesthetic gases (zaškrtl-a)