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Тест: United States Medical Licensing Examination

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United States Medical Licensing Examination
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A 32-year-old construction worker arrives in the emergency department after an accident on the job. The tendon of the biceps brachii at the elbow has been severed by a laceration that extends 2 cm medially from the tendon. Which of the following structures is likely to have been injured by medial extension of the laceration?

A genotypic male (XY) is born with feminized external genitalia. The testes are retained within the abdominal cavity, and the internal reproductive tracts exhibit the normal male phenotype. Which of the following could account for this abnormal development?

A 24-year-old AIDS patient develops chronic abdominal pain, low-grade fever, diarrhea, and malabsorption. Oocysts are demonstrated in the stool. Which of the following organisms is most likely to be the cause of the patient’s diarrhea?

A 28-year-old man decides to donate a kidney to his brother, who is in chronic renal failure, after HLA typing suggests that he would be a suitable donor. He is admitted to the hospital, and his right kidney is removed and transplanted into his brother. Which of the following indices would be expected to be decreased in the donor after full recovery from the operation?

Bilateral ovarian masses are identified on pelvic examination of a 40-year-old woman. Ultrasound examination reveals multiloculated cystic masses involving both ovaries. The patient is treated with total abdominal hysterectomy with removal of both adnexa. Pathologic examination demonstrates papillary carcinoma producing serous fluid. Which of the following tumor markers would be most useful in monitoring for recurrence?

In a normal individual, a tube with a transducer at its tip is swallowed and passed an unknown distance down the esophagus. Between swallows it records a pressure of 25 mm Hg. A small amount of water is swallowed. Within 2 seconds, the pressure falls to 5 mm Hg, where it remains until returning to its resting pressure 6 seconds later. In a patient with achalasia, the transducer is advanced to the same location. Between swallows, it records a pressure of 30 mm Hg. After swallowing, the pressure fails to decrease at all. In which of the following sites is the transducer most likely located?

A 54-year-old man with extensive, severe atherosclerosis sustains a thrombotic occlusion of the celiac trunk. The organs that receive their blood supply from this artery continue to function normally. Anastomoses between which of the following pairs of arteries would explain this phenomenon?

A 54-year-old man presents to the emergency department with intense pain in his right eye. Examination reveals a red ring surrounding his iris and elevated intraocular pressure in the same eye. After obtaining a careful history with the aid of the man’s wife, the emergency room physician concludes that this episode was triggered by which of the following agents?

While lying supine in bed eating, a child aspirates a peanut. Which of the following bronchopulmonary segments would this foreign object most likely enter?

A 47-year-old man with a history of sickle cell disease has had numerous hospitalizations requiring the placement of IV lines. The patient has poor peripheral venous access, and a catheter is placed in right subclavian vein. The patient subsequently develops right arm discomfort and swelling and a temperature of 40.1 C with chills. Multiple blood cultures are taken, and gram-positive cocci are isolated. The organism is catalase positive and grows on mannitol salt agar, but does not turn the agar yellow; the colonies are gamma-hemolytic on a sheep blood agar plate. Which of the following organisms is the most likely cause of this patient’s symptoms?

A 2-month-old child is evaluated for failure to thrive. During the examination, the child has a seizure. Stat serum chemistries demonstrate severe hypoglycemia, hyperlipidemia, lactic acidosis, and ketosis. Physical examination is remarkable for hepatomegaly, a finding confirmed by CT scan, which also reveals renomegaly. Which of the following diseases best accounts for this presentation?

The parents of a 7-year-old boy divorce. The boy lives with the mother and sees his father every-other weekend. During these visits, the boy is sullen and angry with the father, but when it is time to return home, he clings to the father and cries in a desperate manner while saying “I’m sorry! I want you and mom to live together again.” Which of the following is the most helpful statement that the father can make to the son?

A letter carrier is severely bitten by a pit bull guarding a junkyard. The wound is cleansed, and the letter carrier receives a booster injection of tetanus toxoid and an injection of penicillin G. Several days later, the wound is inflamed and purulent. The exudate is cultured on blood agar and yields gram-negative rods. Antibiotic sensitivity tests are pending. The most likely agent to be isolated is

A 25-year-old man presents to a rheumatologist with complaints of joint pain involving the large joints of the legs. On questioning, the patient indicates that exacerbations in the joint pain are frequently accompanied by diarrhea. Which of the following is the most likely diagnosis?

A couple has a daughter who is ataxic and has a seizure disorder. She also has a strange affect characterized by excessive laughter at inappropriate times. Cytogenetic analysis demonstrates a normal genotype with 46 chromosomes and no apparent deletions. These symptoms are most likely due to

A 65-year-old man develops oliguria and peripheral edema over a period of weeks. Urinalysis reveals hematuria and proteinuria; examination of the urinary sediment reveals red cell casts. Radiologic and ultrasound studies fail to demonstrate an obstructive lesion. Renal biopsy shows many glomerular crescents. This presentation is most suggestive of which of the following conditions?

A 75-year-old woman presents to the physician with a chief complaint of vaginal spotting. She has been postmenopausal for 25 years and does not take hormones. An ultrasound shows a mass in the uterine fundus. A hysterectomy is performed, and pathologic examination of the removed uterus reveals a malignant tumor of the endometrial glands and stroma. Which of the following is the most likely diagnosis?

A neonate does not pass meconium until 48 hours after his birth. Two weeks later his mother reports that he has not been passing stool regularly. Anorectal manometry reveals increased internal anal sphincter pressure on rectal distention with a balloon. Radiographic studies reveal massive dilation of the colon proximal to the rectum. The findings in this case indicate a developmental abnormality of which of the following embryonic tissues?

A 2-year-old child with uncomplicated coarctation of the aorta appears to be in good health. Growth and development are normal. The constriction is located just distal to the subclavian arteries. Which of the following is decreased in this patient?

A 75-year-old man presents to his physician with complaints of nocturia, urinary urgency, and a feeling that he could not completely empty his bladder. A digital rectal exam reveals a firm, enlarged prostate. A bone scan is ordered and shows positivity in multiple vertebral bodies. Elevation of which of the following substances would be most strongly associated with the development of bone lesions?

An adult patient presents with persistent headaches. A CT scan of the head demonstrates a 2-cm spherical mass at the junction of the white and gray matter of the lateral aspect of the cerebral hemisphere. Which of the following would most likely produce this lesion?

A 37-year-old woman presents to the emergency department with a fever. Chest x-ray film shows multiple patchy infiltrates in both lungs. Echocardiography and blood cultures suggest a diagnosis of acute bacterial endocarditis limited to the tricuspid valve. Which of the following is the most probable etiology?

A 5-year-old child, who has not had routine pediatric care, develops a febrile disease with cough and a blotchy rash and is brought to the emergency department. On physical examination, there is cervical and axillary lymphadenopathy. Also noted is an erythematous, maculopapular rash behind the ears and along the hairline, involving the neck and, to a lesser extent, the trunk. Examination of this patient’s oropharynx would most likely reveal which of the following lesions?

A 57-year-old man is brought to the emergency room for a suspected myocardial infarction. An electrocardiogram indicates the appearance of a wide-complex ventricular tachycardia with a rate of 126 beats per minute. The physician prescribes a drug to decrease SA node automaticity, increase AV node refractoriness, and decrease AV node conduction velocity. Which of the following agents was most likely prescribed?

While performing a subtotal thyroidectomy, a surgeon inadvertently sections the recurrent laryngeal nerve. Which of the following muscles would retain its innervation subsequent to this injury?

A newborn infant who was apparently healthy at birth develops aspiration pneumonia in the first 2 days of life. All attempts to feed the infant cause it to cough and choke. Which of the following abnormalities is the most likely cause of the infant’s difficulties?

A 46-year-old man sustains a spider bite on his upper eyelid, and an infection develops. The physician is very concerned about spread of the infection to the dural venous sinuses of the brain via emissary veins. With which of the following dural venous sinuses does the superior ophthalmic vein directly communicate?

A 15-year-old high school student and several of her friends ate lunch at a local Chinese restaurant. They all were served the daily luncheon special, which consisted of sweet and sour pork with vegetables and fried rice. All the girls developed nausea, vomiting, abdominal pain, and diarrhea within 6 hours of eating lunch. Which of the following is the most likely cause of these symptoms?

A 24-year-old woman with a history of allergic rhinitis is involved in an automobile accident and sustains a splenic laceration. She undergoes abdominal surgery and is then transfused with four units of blood of the appropriate ABO and Rh type. As the transfusion progresses, she becomes rapidly hypotensive and develops airway edema, consistent with anaphylaxis. Which of the following pre-existing conditions best accounts for these symptoms?

A couple presents to a clinic for workup of infertility after 5 years of unprotected intercourse. The wife denies any medical problems and notes regular menstrual cycles. The husband states that he has had chronic sinusitis and lower respiratory tract infections. Physical examination of the woman is unremarkable. Examination of the man is remarkable for dextrocardia. Further workup of the husband will most likely reveal

A patient presents with cervical lymphadenopathy. Biopsy demonstrates a nodular lymphoma with follicle formation. This lesion would most likely be associated with which of the following?

A 25-year-old woman presents with pain and tenosynovitis of the wrists and ankles, and arthralgias of other joints. She notes two prior episodes similar to the present one. She just had her menstrual period during the previous week. Physical examination reveals ulcerated lesions overlying the wrists and ankles. These symptoms are likely due to deficiency of which of the following?

A 5-year-old girl is thoroughly evaluated because of growth failure. The child has been complaining of headaches, which are exacerbated when she tries to read. Funduscopic examination reveals papilledema. CT scan demonstrates a mass involving the area above and within the sella turcica. Surgical resection of the mass yields a multiloculated cystic and solid tumor containing dark brown, oily fluid. This tumor is thought to arise from epithelial rests derived from which of the following structures?

A new antifungal medication is being tested in Phase I clinical trials. Examination of the pharmacokinetic properties of the drug reveals that the half-life of the drug is 6 hours. If a continuous intravenous infusion of this drug were started on a research subject, how long would it take to reach 75% of steady state?

A patient presents to a physician with jaundice. Physical examination reveals a nodular, enlarged liver. CT of the abdomen shows a cirrhotic liver with a large mass. CT-guided biopsy of the mass demonstrates a malignant tumor derived from hepatic parenchymal cells. Infection with which of the following viruses would most likely be directly related to the development of this tumor?

A man brings his 45-year-old wife to the emergency department. He states she has been ill for 3 days and has been running a temperature of 99.8 to 100.5 F. Today she is having difficulty staying awake, is talking to persons who are not there, and at times appears to be frightened of something. She is restless and somewhat combative when restrained. What is the most likely diagnosis?

A patient consults a physician because of a small lesion on the lips that, on biopsy, proves to be a mucosal neuroma. The patient’s mother had medullary carcinoma of the thyroid. In addition to medullary carcinoma of the thyroid, to which of the following conditions would this patient be particularly vulnerable?

A 2-year-old boy has a CT scan of the head performed after a pediatrician notices a disproportionate growth in his head circumference compared with the rest of the body. The scan demonstrates a large choroid plexus papilloma involving the body of the right lateral ventricle. Which of the following brain structures might be affected by direct extension of this tumor?

A premature infant develops progressive difficulty breathing over the first few days of life. Deficient surfactant synthesis by which of the following cell types may be contributing to the infant’s respiratory problems?

A 67-year-old woman who has been in very good health is brought to her physician's office by her husband. He states that over the course of the past 5 years she has had difficulty recognizing her grandchildren, she has not been able to plan their daily activities, she has forgotten things left cooking on the stove, and at night she has been wandering through the house with an “absent” look on her face. She is beginning to demonstrate difficulty in recalling the names of common objects, and her speech is limited to simple two- or three-word sentences. Which of the following is the most likely diagnosis?

A 57-year-old woman with a history of hypertension and arthritis is referred to a rheumatologist for evaluation. A complete blood count (CBC) is normal, and a mini-chem panel shows no electrolyte abnormalities. Her erythrocyte sedimentation rate (ESR) is elevated, and an antinuclear antibody test (ANA) is positive. Further antibody studies are performed, and the results are shown below.

Anti-histoneshigh titer
Anti-double stranded DNAnot detected
Anti-single stranded DNAnot detected
Anti-SSAnot detected
Anti-SSBnot detected
Anti-SCI-70not detected
Anti-Smithnot detected
Anti-centromerenot detected
Anti-RNPnot detected


Which of the following diseases is suggested by these results?

A 55-year-old hypertensive man develops sudden onset of excruciating pain beginning in the anterior chest, and then radiating to the back. Over the next 2 hours, the pain moves downward toward the abdomen. Which of the following is the most likely diagnosis?

A 22-year-old woman presents to her physician with amenorrhea, weight loss, anxiety, tremor, heat intolerance, and palpitations. Laboratory examination is consistent with hyperthyroidism, and the physician prescribes propylthiouracil. The patient's response to propylthiouracil is disappointing, and the symptoms recur, then worsen. Subtotal thyroidectomy is successfully performed, but following the surgery, the woman is extremely hoarse, and can barely speak above a whisper. This hoarseness is most probably related to damage to a branch which of the following cranial nerves?

A 54-year-old African-American woman undergoes a routine insurance physical examination. Chest x-ray film reveals bilateral hilar masses. Biopsy of the masses shows granulomata, but acid-fast and fungal stains are negative for organisms. Which of the following is the most likely diagnosis?

A 67-year-old man is evaluated for persistent shooting pains, lower limb ataxia, and bladder dysfunction. Physical examination demonstrates small irregular pupils that constrict with accommodation but not in response to light. A VDRL test is positive. A CT scan of the spinal cord would most likely demonstrate atrophy of which of the following structures?

An oncologist tells his patient that her laboratory results support a diagnosis of advanced malignant melanoma with multiple metastases to the liver and brain. He also advises her that the prognosis is poor. Which of the following is most likely to be the first statement that the patient will make?

A 44-year-old businessman presents to a physician because of a markedly inflamed and painful right great toe. He states that he just returned from a convention, and noticed increasing pain in his right foot during his plane trip home. Physical examination is remarkable for swelling and erythema of the right great toe as well as small nodules on the patient’s external ear. Aspiration of the metatarsal-phalangeal joint of the affected toe demonstrates needle-shaped negatively birefringent crystals. Which of the following agents would provide the most immediate relief for this patient?

A Guatemalan child with a history of meconium ileus is brought to a clinic because of a chronic cough. The mother notes a history of respiratory tract infections and bulky, foul-smelling stools. After assessment of the respiratory tract illness, the practitioner should also look for signs of

During a fight, a 32-year-old man is hit on the back of the neck with a chair. A CT scan reveals a bony fragment that penetrated the lateral portion of the dorsal columns. Which of the following functions would most likely be affected by a lesion at this site?

A 61-year-old man presents with a chief complaint of difficulty swallowing. To evaluate his dysphagia, the physician orders a barium swallow with fluoroscopy, as well as an esophagogram. She finds that the anterior wall of the esophagus in the mid-thorax is being compressed. Which of the following structures is most likely responsible for this compression?

The table below depicts blood pressure values taken from six adults. Which set of values is most consistent with aortic regurgitation?

Systolic pressure (mm Hg)Diastolic pressure (mm Hg)
(A)50 Undetectable
(B)9580
(C)12080
(D)16050
(E)170100
(F)220130



In a hospital cardiac care unit, there are three patients with different cardiac conditions: a 52-year-old man with dilated cardiomyopathy, an 18-year-old girl with mitral valve prolapse, and a 30-year-old man with infective endocarditis of the mitral valve. Which of the following features do all these patients most likely share?

A 68-year-old man sustains a myocardial infarct resulting from thrombotic occlusion at the origin of the left circumflex artery. Cardiac catheterization demonstrates that the patient has a left dominant coronary circulation. In which of the following areas of the heart has ischemic necrosis most likely occurred?

A patient arrives in the emergency department after having been stabbed. He has sustained a penetrating wound in the left fourth intercostal space immediately lateral to the sternal border. Which of the following thoracic structures is most likely to have been injured?

A 14-year-old boy has just moved with his family from Brazil to the U.S. He starts complaining of shortness of breath and palpitations. Chest x-ray films demonstrate pulmonary congestion, and EKG shows alterations in heart rhythm. Echocardiography reveals biventricular dilatation with massive cardiac enlargement. An endomyocardial biopsy shows diffuse interstitial fibrosis, myocyte necrosis, chronic inflammation, and the presence of intracellular protozoan parasites. The patient may also develop which of the following complications?

A 65 year-old man is admitted to the coronary care unit with a diagnosis of a large myocardial infarct (MI) of the left ventricle. On his 6th postinfarct day, he goes into shock and dies, manifesting signs and symptoms of cardiac tamponade. Which of the following complications is the most likely cause of this patient’s death?

A 15-year-old is brought to the emergency department in a coma. An alert ambulance attendant notes that the patient's breath smells like acetone. This observation is most consistent with which of the following diagnoses?

A 24-year-old woman in her third trimester of pregnancy presents with urinary frequency and burning for the past few days. She denies fever, nausea, vomiting, or chills. She takes no medications besides prenatal vitamins and is generally in good health. Physical examination is remarkable for mild suprapubic tenderness, and a urine dipstick is positive for white blood cells, protein, and a small amount of blood. Culture produces greater than 100,000 colonies of gram-negative bacilli. Which of the following attributes of this uropathogenic organism is most strongly associated with its virulence?

A 12-year-old girl has a temperature of 102.5 F and a sore throat. Two days later, she develops a diffuse erythematous rash and is taken to her pediatrician. On physical examination, there is circumoral pallor, and an erythematous rash with areas of desquamation is noted. The myocardial damage that can follow this infection is produced in a manner similar to the damage associated with which of the following disorders?

A 45-year-old man with cirrhosis due to alpha1-antitrypsin deficiency receives a liver transplant. Although currently in good health, he is at increased risk of developing which of the following types of emphysema?

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