Repeated USMLE Questions- USMLE Q Bank Step 1- 220

Q- A 50-year-old man has noticed darker urine for the last week. There is no pain, discomfort or any other symptoms. Examination reveals no abnormalities. Urine analysis shows 2+blood, no glucose or protein. Urine cytology shows atypical cells. Cystoscopy shows no mucosal lesions of the urinary bladder. He has a 30-year history of smoking.

Which of the following is the most likely diagnosis?

A- Adenocarcinoma of the prostate

B- Interstitial cell carcinoma of the urinary bladder

C- Renal cell carcinoma

C- Renal cell carcinoma- It is the most common and smoking is a major risk. It manifests as hematuria which is usually accompanied by lower back pain.


Q- In a case of multiple myeloma, a sternal bone marrow sample is performed. Which of the following cell types is mostly found in this aspirate?

A- Giant cells

B- Fibroblasts

C- Osteoblasts

D- Plasma cells

D- Plasma cells- Serum globulin is also high in multiple myeloma due to monoclonal gammopathy. Other types of cells are just distractions.


Q- A 23-year-old woman presents to her physician with ptosis, meiosis and anhidrosis in the left eye.

Which one of the following drugs is used to determine whether this lesion is preganglionic or postganglionic?

A- Albuterol

B- Atenolol

C- Cocaine

D- Epinephrine

E- Phenylephrine

C- Cocaine- This is a typical case of Horner’s syndrome. Indirect sympathomimetic drugs such as cocaine act on postganglionic noradrenergic neurons. Administration of cocaine causes mydriasis if the lesion preganglionic but it has no effect if the lesion is postganglionic. Direct sympathomimetic drugs such as epinephrine and phenylephrine act on both pre- and postganglionic neurons. Beta-blockers have no effect on both neurons.

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