Repeated USMLE Questions Step 1- Review- 145

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Q- A patient who was involved in a motor vehicle accident 2 years ago now has chronic pain. He tells his doctor he thinks he is becoming addicted to his short-acting morphine. He has been visiting multiple physicians to obtain prescription refills. Which of the following is the most appropriate treatment for his opioid use disorder?

A- Acamprosate

B- Buprenorphine

C- Naltrexone

D- Varenicline

B- Buprenorphine- Buprenorphine is a partial opioid agonist used as first-line therapy for opioid use disorder. It helps reduce cravings and withdrawal symptoms.

Acamprosate is for alcohol dependence.

Naltrexone can be used for opioid dependence, but only after detoxification.

Varenicline is used for smoking cessation.

 

Q- A 40-year-old man with long-standing hypertension dies suddenly. Autopsy of the kidney shows small, granular kidneys with hyaline thickening of arterioles.
What is this microscopic finding called?

A- Fibrinoid necrosis

B- Hyaline arteriosclerosis

C- Medial calcific sclerosis

D- Onion-skinning

B- Hyaline arteriosclerosis- Long-standing hypertension causes hyaline arteriosclerosis, which leads to hyaline thickening of arteriolar walls and results in small, granular kidneys (benign nephrosclerosis).

Fibrinoid necrosis and onion-skinning occur in malignant hypertension, while medial calcific sclerosis (Monckeberg) affects medium arteries and does not cause small granular kidneys.

 

Q- A 2-year-old boy is brought by his mother because of recurrent fevers and infections. The child has silvery hair, swollen gums, and a history of repeated infections. A peripheral blood smear shows large cytoplasmic inclusions in granulocytes and eosinophils. Bone marrow aspirate also reveals similar inclusions in precursor cells. Which of the following cellular processes is most likely defective in this patient?

A- Leukocyte adhesion molecules

B- Phagolysosomal fusion

C- Respiratory burst activity

D- TNF-α receptor signaling

B- Phagolysosomal fusion- This presentation is classic for Chediak–Higashi syndrome, characterized by silvery hair, recurrent infections, and giant granules in neutrophils. It results from a defect in phagolysosomal fusion (LYST gene).

The other options describe defects seen in different immune disorders (e.g., respiratory burst defect in CGD, adhesion defect in LAD).

 

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