Preparing for the United States Medical Licensing Exam Step 1, 2 or 3 is difficult, time-consuming, and anxiety-provoking. Knowing the information cold is the best way to ace the test. Although the test is multiple-choice, studies have shown that being able to answer unkeyed questions shows a higher level of mastery of the material. Try these to see how you are doing…
A mildly mentally handicapped 31 year old male is noted to have 10 cafÃ©-au-lait spots greater than 2 cm, pigmented iris hamartomas, and multiple peripheral nerve Schwannomas. What enzyme is lacking?
This is von Recklinghausenâ€™s disease
The defect is on chromosome 17
If a patient has increased histamine release, venous telangiectasia, bronchoconstriction,
and edema, what is the best test to confirm the diagnosis?
This is carcinoid syndrome
Lab findings in carcinoid syndrome include:
Increased urinary 5-HIAA
Increased urinary histamine
Increased serum bradykinin
Increase peptide P substance
A 17 year old girl has abdominal pain, sweating, headaches, and black urine every time she consumes alcohol. What enzyme is decreased?
This is acute intermittent porphyria
Other gastrointestinal symptoms in acute intermittent porphyria include:
A 72 year old man has swelling and pain in his left great toe joint which developed over
12 hours. There is no fever or other constitutional systems. What is the best drug to treat this condition?
This is gout
Other drugs used to treat gout include:
Colchines between attacks
Uricosuric drugs â€“ probenecid, sulfinpyrazone
A 28 year old man was taken to the operating room for an abdominal obstruction where it was discovered that his ileum contained four 1 cm smooth, submucosal nodules that were yellowish tan on the cut surface. What is the most likely diagnosis?
see answer below
30% of ileal carcinoids are multicentric
Anatomic distribution of abdominal carcinoids is:
Appendix â€“ 45%
Jejunum-ileum â€“ 28%
Rectum â€“ 16%
Colon â€“ 2%
Ovary – 1%
If a patient has coarsened facial features, prominent supraorbital ridges, large, spadelike hands and feet, soft tissue proliferation and an enlarged sella, what substance is most likely to be secreted in excess?
This is acromegaly
Microanatomy of acromegaly includes:
Well-defined pituitary adenoma â€“ most commonly in lateral wings of sella
Adenomas very rarely in sphenoid sinus or parapharyngeal regions
Ectopic production rarely in pancreatic islet cell tumors or lung tumors
If a 6 year old girl has hemorrhagic diarrhea, rapidly progressive renal failure and purpura, what two microorganisms are the most likely cause?
This is hemolytic uremic syndrome
Other signs and symptoms include:
A 54 year old man finally died of his progressive dementia after a 15 year course. He had choreoathetoid movements in the last two years. What is the cause of this disease?
This is Huntingtonâ€™s chorea
Presenting sign of Huntingtonâ€™s chorea is striking emotional changes years before choreoathetoid movements
A 65 year old man has an oat cell neoplasm of the lung. He develops total body edema, lethargy and confusion, and nausea. Overproduction of what substance is the likely cause of this condition?
This syndrome of inappropriate antidiuretic hormone secretion (SIADH)
Other signs and symptoms of SIADH include:
Can be asymptomatic and picked up only by low serum sodium
If a patient has paroxysmal hypertension, sweating, palpitations and nervousness, and headache, is she more likely to be hypoglycemic or hyperglycemic?
This is pheochromocytoma
Lab findings in pheochromocytoma include:
Increased serum epinephrine
Increased serum norepinephrine
A 24 year old man has bilateral anterior conical displacement of the lens, hearing loss, and renal insufficiency. What is the characteristic gene defect?
This is Alportâ€™s disease
Bilateral anterior conical displacement of the lens is called lenticonus and is pathognomonic for Alportâ€™s syndrome.
A 21 year old man develops low back pain with progressive stiffness and later develops pain in his shoulders bilaterally. Serum tests for rheumatoid factor are repeatedly negative. What is his most likely HLA type?
This ankylosing spondylitis
90% of patients with ankylosing spondylitis have HLAB-27 but only 1% of HLA-B27 patients develop ankylosing spondylitis.
A 47 year old woman pulls a tick off her back and 48 hours later notices at the tick site a erythematous ring of tissue that slowly expands over the next several days. She also develops a fever and headache. What 4 infections are considered coinfections with this disease?
This is Lyme disease
The most common causative agent of Lyme disease in the United States is Borrelia burgdorferi.
If a patient has purple striae, muscle atropy in the upper and lower extremities, borderline diabetes, and menstrual difficulties, is the patient more likely to be hypokalemic or hyperkalemic?
This is Cushingâ€™s syndrome
Lab findings in Cushingâ€™s syndrome include:
Increased plasma cortisol
Increased urinary cortisol
Increased urinary 17-hydroxycorticoid
A 68 year old man has the onset of angina and then in the next 6 months develops syncope and congestive heart failure. What is the most characteristic finding observed when the patientâ€™s carotid artery is auscultated?
This is aortic stenosis
Aortic stenosis becomes symptomatic when the cross-sectional area of the valve is < 1.0 sq cm
If a patient has hypertension, metabolic alkalosis, and hypokalemia, what substance has excess secretion?
This is Connâ€™s disease
Physiology of Connâ€™s disease includes:
Increased sodium reabsorption with exchange of potassium and hydrogen
Extracellular volume expansion
A 50 year old white male presents with abdominal pain, fever, skin pigmentation and arthritis in his shoulders bilaterally. The endoscopic biopsy shows flat and thickened villi and a small, gram-positive rod. What is the best treatment for this patient?
This is Whippleâ€™s disease
Other signs and symptoms of Whippleâ€™s disease include:
A previously normal 4 year-old boy seems to have lost muscle strength in his shoulder area, but has developed overly muscular calf muscles with contractures in his heel cords affecting his ambulation. What substance is most likely missing in his muscle fibers?
This is Duchenneâ€™s muscular dystrophy
Histology of Duchenneâ€™s muscular dystrophy includes:
Breakdown of sarcolemma
Degeneration and necrosis of muscle fibers
Type 1 and 2 muscle fibers attempt to repair and regenerate with fibrosis
A 72 year old female has pain in her right thumb and index finger. An arteriogram shows a non-obstructing â€œpipestemâ€ lesion in the right radial artery. What layer of artery is most likely normal in this condition?
see answer below
This is Monckebergâ€™s arteriosclerosis
Most typically affects medium-sized muscular arteries
A 58-year old female has recurrent angina with left chest pressure and jaw pain. She has three cardiac catheterizations in the last 8 months with completely normal anatomy and no obstructive lesions. Are these episodes of chest pain more likely to occur during exertion or rest?
This is Prinzmetalâ€™s angina
Attacks tend to occur at same time of the day for unknown reason.
A 67 year old male has striking splenomegaly, recurring bacterial infections, recurrent epistaxis, and development of a warm antibody hemolytic anemia. What is the most characteristic cell seen on peripheral blood smear?
This chronic lymphocytic leukemia (CLL)
95% of cases are B-cell in origin.
A 28 year male was noted on physical exam to have a blood pressure of 200/100. On further investigation he was found to have blood in his urine, a creatinine of 3.2 and enlarged, palpable bilateral flank masses. What is the most likely associated gastrointestinal lesion in this condition?
This is adult polycystic kidney disease
Diverticular disease occurs in almost 100% of cases.
A 14 year old boy has moderate mental retardation, long facies with an overly prominent jaw, arched palate with speech difficulties, protruding ears, and enlarged, non-tender bilateral testicles. A DNA analysis of this patientâ€™s lymphocytes shows what abnormality?
This is Fragile X syndrome
Female carriers may show impaired learning.
A 53 year old male drank untreated water from a mountain stream in Kentucky. Two days later he developed abdominal pain and cramps, bloating, and copious foul-smelling diarrhea. He was started on drug therapy by his physician and cautioned against drinking what beverage?
see answer below
This is giardiasis and the treating antibiotic is metronidazole
Alcohol consumed within 3 days of metronidazole use will cause severe vomiting.
A 78 year old women falls onto her outstretched right hand and suffers a proximal humeral fracture. On exam post trauma, what is the most likely neurological deficit secondary to her fracture?
This is an axillary nerve injury
The axillary nerve supplies motor to the deltoid muscle that is used in abduction of the shoulder.
A 34 year old woman stranded in a refugee camp with near starvation develops dermatitis on her face, neck, and the dorsum of her hands and feet and also develops chronic diarrhea and mental status changes. What two elements missing from her diet most likely caused these symptoms?
see answer below
This is pellagra
Niacin can be synthesized from tryptophan. The three Dâ€™s of pellagra are dermatitis, diarrhea, and dementia.
An 18 year old male falls asleep in his running car by the side of the road. When the police stop two hours later, the patient has agonal breathing a bright red cherry color to his skin. Which molecule in the body has an extremely high affinity for the causative substance in this case of hypoxic injury?
This is carbon monoxide poisoning.
Hemoglobin has an affinity for carbon monoxide that is 200 times greater than that for oxygen.
A 29 year old female is having her gallbladder removed. Shortly after induction of general anesthesia she develops a tachycardia to 160 beats per minute, a fever to 105 F, hypotension, and an obstructive endotracheal tube due to a clenched jaw. What intracellular substance has a striking increase in this condition?
This is malignant hyperthermia.
Other signs and symptoms of malignant hyperthermia:
Increased muscle metabolism
A 38 year old pre-menopausal female developed breast cancer and was given a chemotherapy agent which caused myelosuppression, hair loss, and decreased cardiac ejection fraction. What is the cellular mechanism of action of this drug?
DNA breakage and decreased replication of tumor cells via
This is adriamycin (doxorubicin)
A 74 year old man was taken to the operating room due to an enlarging bulge that occurred with effort in his right groin. In the operating room the surgeon noted the lesion occurred just medial to the inferior epigastric vessels. What anatomic space did the lesion occupy?
This is a direct inguinal hernia and occurs when bowel contents bulge through Hesselbachâ€™s triangle.
A 6 month old infant is sent home from daycare with respiratory difficulty which progresses to bronchiolitis and pneumonia. Is the causative agent a DNA or RNA virus and an enveloped or nucleocapsid virus?
RNA enveloped virus
This is respiratory synctyial virus (RSV)
A 52 year old woman develops increasing dementia. Her mother developed the same symptoms at age 51 years. Her work-up indicates she has the PS-1 and PS-2 genes. What histological lesion is very likely to be found in the cytoplasm of her brain pyramidal cells?
This is early onset Alzheimerâ€™s disease.
PS-1 and PS-2 are the presenilin genes found in 50% of early onset, autosomal dominant Alzheimerâ€™s.
An 8 year old boy developed a â€œsore throatâ€ and was culture positive for group A beta hemolytic streptococci on throat swab. He did not receive any treatment for this and 3 weeks later he developed carditis, polyarthritis, and fever. What is the name of the diagnosing criteria for this condition?
This is rheumatic fever. Diagnosis requires presence of two major and one minor or one minor and two major criteria.
Erythema marginatum (10%)
Erythema nodosum (10%)
Increased ESR or C-reactive protein
EKG changes (especially prolonged PR interval)
Preceeding attack of rheumatic fever