Otázky s chybnou odpovědí, č.j. 3541274
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TEST:usmle1en  Varianta:9         Tisknuto:04/06/2019
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  2. ( 38.orig.) The intracellular domain of the insulin receptor has which of the following enzyme activities? 
 2) - Adenylyl cyclase (zaškrtl-a)
 3) + Tyrosine kinase (nezaškrtl-a)
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 11. ( 35.orig.) A 45-year-old man has abnormal circadian variation disruption of the sleep-wake cycle, and an impaired nocturnal surge of secretion of melatonin. An MRI of the head is most likely to show a lesion involving which of the following nuclei? 
 2) - Supraoptic (zaškrtl-a)
 4) + Suprachiasmatic (nezaškrtl-a)
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 24. ( 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 
 3) + social phobia (nezaškrtl-a)
 5) - generalized anxiety disorder (zaškrtl-a)
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 63. ( 33.orig.) While smoking crack cocaine, a 16-year-old boy develops substernal chest pain. An ECG is consistent with anterior wall myocardial ischemia. The drug most likely had which of the following effects on the heart? 
 4) - Indirect inhibition of -adrenergic receptors (zaškrtl-a)
 5) + Indirect stimulation of -adrenergic receptors (nezaškrtl-a)
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 66. ( 34.orig.) A healthy 19-year-old man receives a tetanus immunization booster prior to induction in the Marines. Six hours later, he has pain and massive swelling at the site of injection. The following day, the skin breaks down, forming an ulcer at the site. Which of the following events plays a critical role in this reaction? 
 1) - Accumulation of mononuclear cells at the site of antigen injection (zaškrtl-a)
 4) + Local fixation of complement by preformed circulating antibodies (nezaškrtl-a)
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 69. (  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?
 2) - Nucleocapsid (zaškrtl-a)
 3) + Hemagglutinin (nezaškrtl-a)
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 75. ( 30.orig.) A neonate develops meningitis. Streptococcus is isolated from the mother's vagina. The organism agglutinates with antiserum directed against type B surface carbohydrate. The virulence of this organism is related to a bacterial constituent that interferes with	 which of the following host phagocyte functions? 
 2) - Intracellular killing (zaškrtl-a)
 3) + Ingestion (nezaškrtl-a)
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 83. ( 36.orig.) A 4-year-old girl has been unable to eat for 2 days because of a gastrointestinal tract disorder. Which of the following is the major source of fuel being oxidized by her skeletal muscles? 
 1) + Serum fatty acids (nezaškrtl-a)
 4) - Muscle glycogen (zaškrtl-a)
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 99. (  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?  
 1) + C (nezaškrtl-a)
 2) - B (zaškrtl-a)
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108. ( 19.orig.) A 32-year-old man is unable to adduct his right eye during conjugate gaze but is able to adduct it during visual convergence. A lesion of which of the following structures on the right side is most likely to produce this finding? 
 3) + Medial longitudinal fasciculus (nezaškrtl-a)
 5) - Nucleus of the oculomotor nerve (zaškrtl-a)
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109. ( 12.orig.) An 18-year-old female athlete reports easy fatigability and weakness. Findings on physical examination are unremarkable.  Laboratory data are:  SERUM: Na+ 141 mmol/l (136-145), Cl- 85 mmol/l (95-105), K+ 2,1 mmol/l (3,5-5), HCO3- 35 mmol/l (22-28); URINE: Na+ 80 mmol/24h, K+ 170 mmol/24h. The most likely diagnosis is 
 1) - Aldosterone deficiency (zaškrtl-a)
 5) + Surreptitious use of diuretics (nezaškrtl-a)
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110. ( 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) - Sublimation (zaškrtl-a)
 5) + Regression (nezaškrtl-a)
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TEST:usmle2en  Varianta:9         Tisknuto:04/06/2019
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  5. ( 23.orig.) A 67-year-old man comes to the physician because of a nontender lesion on the top of his forehead that has recently bled. He states that the lesion has been there since he was hit on the head with a bottle 18 months ago. Examination shows erythematous areas on other parts of his forehead. The lesion is 1 cm in diameter with a rolled-up, darkened border and a translucent, ulcerated center. Which of the following is the most likely diagnosis? 
 3) + Basal cell epithelioma (nezaškrtl-a)
 5) - Actinic keratosis (zaškrtl-a)
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 15. ( 13.orig.) A 24-year-old jackhammer operator comes to the physician because of a 1-week history of pain and swelling that involves the entire right upper extremity; the pain worsens with exercise. Examination shows enlarged cutaneous veins over the right anterior chest wall. Which of the following is the most likely diagnosis?
 1) + Axillary-subclavian venous thrombosis (nezaškrtl-a)
 3) - Thrombosis of preexisting upper extremity varicosities (zaškrtl-a)
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 19. (  1.orig.) A 54-year-old woman with a 10-year history of progressive systemic sclerosis (scleroderma) undergoes an emergency laparotomy for a perforated appendix with peritonitis. During the immediate postoperative period, she has a blood pressure of 180/110 mm Hg. Over the next 3 days, her serum creatinine concentration increases, and her urinary output decreases to 250 ml/day. On postoperative day 4, she has mild shortness of breath. Her peripheral oxygen saturation on room air is 89%. Serum studies show a potassium concentration of 6.2 mmol/l (3,5-5,0), a urea nitrogen concentration of 5,8 mmol/l (1,2-3,0), and a creatinine concentration of 344,5 mmol/l (53-106). Which of the following is the most appropriate next step in management? 
 2) + Hemodialysis (nezaškrtl-a)
 4) - Intravenous administration of ACE inhibitors (zaškrtl-a)
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 30. (  3.orig.) A 32-year-old woman, gravida 5, para 4, is admitted to the hospital at 32 weeks gestation because of mild, bright red vaginal bleeding for 2 hours.  She has had no pain or contractions. Her last two children were delivered by low cervical cesarean section.  Vital signs are stable, and the fetal heart rate is 140/min and regular. Blood is drawn for complete blood count and typing and crossmatching, and intravenous administration of fluids is begun.  Which of the following is the most appropriate next step in management? 
 2) + Placental localization by ultrasonography (nezaškrtl-a)
 5) - Placental localization by double set-up examination (zaškrtl-a)
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 38. (  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?
 3) + Folic acid (nezaškrtl-a)
 5) - Vitamin B12 (cobalamin) (zaškrtl-a)
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 46. ( 34.orig.) A 58-year-old man comes to the physician because of extreme fatique and malaise for 3 weeks. He has felt well except for a toothache 5 weeks ago treated with a root canal procedure. He has a history of a cardiac murmur first noted at the age of 19 years. His temperature is 37,8°C, pulse is 110/min, and blood pressure is 120/80 mm Hg. The lungs are clear to auscultation. Cardiac examination shows a grade 2/6, systolic ejection murmur heard best at the right second intercostal space as well as an S4 and an ejection click. Laboratory studies show: hemoglobi 1,4 mmol/l (2,09-1,71I), leukocyte count 10,000/mm3; segmented neutrophils 90%, bands 10%; erythrocyte sedimentation rate 90mm/h; urine, blood positive. Blood culture are obtained. Gram stain of the blood culture is most likely to show which of the following?
 1) - Gram-positive diplococci (zaškrtl-a)
 3) + Gram-positive cocci in chains (nezaškrtl-a)
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 50. ( 24.orig.) A 13-year-old boy has nasal discharge and itching of the eyes each year in the early summer. Fifteen minutes after skin testing with a mixture of grass pollens, he develops erythema and a 15-mm wheal at the site.  The skin test response is most likely a result of which of the following mechanisms? 
 1) - Release of lymphokines by sensitized lymphocytes reacting with antigens (zaškrtl-a)
 4) + Release of histamine from mast cells (nezaškrtl-a)
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 54. (  8.orig.) A 54-year-old woman comes to the physician 2 months after her husband died of a myocardial infarction. She tires easily and has chest pain when she inhales deeply at rest. She has had frequent crying spells associated with thoughts of her husband and feels uninvolved in daily activities. Which of the following is the most likely diagnosis? 
 1) + Normal grief (nezaškrtl-a)
 2) - Conversion disorder (zaškrtl-a)
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 88. ( 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?
 1) + Endotracheal intubation and mechanical ventilation (nezaškrtl-a)
 3) - Discontinuation of the oxygen (zaškrtl-a)
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113. ( 31.orig.) A previously healthy 34-year-old woman is brought to the physician because of fever and headache for 1 week. She has not been exposed to any disease. She takes no medications. Her temperature is 39,3°C (102°F), pulse is 104/min, respirations are 24/min, and blood pressureis 135/88 mm Hg. She is confused and oriented only to person. Examination shows jaundice of the skin and conjunctivae. There are a few scattered petechiae over the trunk and back. There is no lympadenopathy. Physical and neurologic examinations show no other abnormalities. Test of the stool for occult blood is positive. Laboratory studies show:BLOOD: hematocrit 0,32 (0,36-0,46), with fragmented and nucleated erythrocytes; leukocyte count 12,500/mm3 (4,500-11,000); platelet count 20,000/mm3 (150,000-400,000); prothrombin time 10 sec (11-15); partial thromboplastin time 30 sec (40);fibrin split products - negative. SERUM: urea nitrogen (BUN) 6,0 mmol urea/l (1,2-3,0); creatinine 265 mmol/l (53-106); bilirubin total 50 mmol/l (2-17); bilirubin direct 10 mmol/l (0-5); lactate dehydrogenase 1000U/l (45-90). Blood and urine cultures are negative. A CT scan of the head shows no abnormalities. Which of the following is the most likely diagnosis?
 1) - Immune thrombocytopenic purpura (zaškrtl-a)
 3) + Thrombotic thrombocytopenic purpura (nezaškrtl-a)
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117. ( 32.orig.) A 28-year-old woman comes to the emergency department 6 hours after the onset of insomnia, flank discomfort, and constipation that she attributes to a kidney stone. She is a resident of another state and is here visiting relatives. She takes oxycodone (six to eight tablets daily) for chronic low back pain, sumatriptan for migraines, and amitriptyline (25 mg at bedtime) and paroxetine (30 mg daily) for bulimia nervosa. Her pulse is 100/min, and blood pressure is 130/80 mm Hg. Examination shows diaphoresis and dilated pupils. She is alert and cooperative but seems restless. She has not had hallucinations or suicidal ideation. She becomes angry when she is asked for the telephone numbers of her regular physicians. Serum amitriptyline concentration is 150 mg/100 ml. Urinalysis shows 0-2 RBC/hpf. Which of the following is the most likely explanation for her symptoms? 
 4) + Opiate withdrawal (nezaškrtl-a)
 5) - Tricyclic intoxication (zaškrtl-a)
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TEST:usmle3en  Varianta:9         Tisknuto:04/06/2019
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 20. ( 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? 
 1) - They can have amniocentesis during pregnancy to test whether the infant will be hearing-impaired (zaškrtl-a)
 3) + Accurate risk estimation is impossible without further evaluation (nezaškrtl-a)
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 23. ( 29.orig.) A 38-year-old nurse comes to the emergency department after leaving work early because of a "horrible headache." She has had a "cold" with sinus congestion for the past week, and yesterday she began taking an over-the-counter combination of diphenhydramine and pseudoephedrine. She tells you she has a history of "migraines," multiple allergies, premenstrual syndrome and depression, for which she takes phenelzine (a monoamine oxidase inhibitor). Vital signs are: temperature 37.2°C (99.0°F), pulse 90/min, respirations 16/min and blood pressure 210/118 mm Hg. Which of the following is the most appropriate action? 
 2) - Order CT scan of the head (zaškrtl-a)
 3) + Administer phentolamine, intravenously (nezaškrtl-a)
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 32. (  3.orig.) An obese 10-year-old boy with diabetes mellitus is admitted to the hospital because of severe ketoacidosis and cardiovascular collapse. Initial management consists of cardiac monitoring and intravenous administration of fluids, electrolytes and insulin. Because of the difficulty in obtaining satisfactory peripheral venous access, the left femoral vein is catheterized percutaneously. Six hours later, his mental status is improved, blood pressure is 120/70 mm Hg and serum glucose concentration is 13,6 mmol/l (3,8-6,1). Physical examination at that time shows a cold left foot with diminished pulses compared with those of the right foot. Which of the following is the most likely explanation for this patient's diminished pulses? 
 1) - Paradoxical embolus from the femoral vein (zaškrtl-a)
 3) + Inadvertent injury of the femoral artery (nezaškrtl-a)
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 42. ( 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) - Conversion disorder (zaškrtl-a)
 2) + Histrionic personality disorder (nezaškrtl-a)
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 43. ( 10.orig.) A 3-year-old boy is brought to the office by his father because of a 3-month history of decreased activity, poor appetite, sporadic vomiting, clumsiness and speech regression. Since his birth his family has lived in an old area of the city where there is demolition of old buildings. Examination of a peripheral blood smear is likely to show which of the following? 
 3) - Macrocytic erythrocytes (zaškrtl-a)
 4) + Basophilic stippling of erythrocytes (nezaškrtl-a)
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 48. ( 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) - Keratoacanthoma (zaškrtl-a)
 2) + Squamous cell carcinoma (nezaškrtl-a)
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 59. (  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) - Radionuclide ventriculography (zaškrtl-a)
 4) + Exercise stress test (nezaškrtl-a)
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 64. (  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) - Ensure that she does not have orthostatic hypotension (zaškrtl-a)
 3) + Request a visiting nurse to assess the safety of her living environment (nezaškrtl-a)
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 74. ( 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? 
 4) - Primary hypoxemia resulting from anesthetic gases (zaškrtl-a)
 5) + Alveolar hypoventilation (nezaškrtl-a)
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 92. ( 37.orig.) A male colleague asks you to write a prescription for a narcotic analgesic for one of his female patients. You have noticed that this patient frequently has been coming by the office to see your colleague, and that several of the visits have been marked "No Charge." When you ask your colleague why he cannot write the prescription himself, he seems defensive and says, "Because I don't want anybody to get the wrong idea." Which of the following is the most appropriate response to your colleague? 
 4) + "It sounds like there is more to this story than you are telling me; maybe we should talk about it." (nezaškrtl-a)
 5) - "I wish I could help you, but I never prescribe that medication for a patient unless I have seen the patient myself." (zaškrtl-a)
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111. ( 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? 
 3) + Severe preeclampsia and requires immediate medical management and delivery (nezaškrtl-a)
 5) - Mild preeclampsia and should continue bed rest pending further diagnostic studies (zaškrtl-a)