These 8 quick USMLE review questions test high-yield facts that show up again and again on the exam: breast cancer screening, gout, achalasia, tamoxifen prevention, esophageal adenocarcinoma, testicular torsion, appendicitis and insulin therapy. Each question includes the correct answer.
Written by Dr. Ray Makar, MD, author of the Repeated USMLE Questions eBook series.
How to use this page: read the question, pick your answer, then tap Show Answer and Explanation.
Questions
Question 1. Which one of the following screening tests is recommended every other year for a woman at the age of 50, assuming normal test results?
A- Colonoscopy
B- DEXA scan
C- Mammogram
D- Pap smear
C- Mammogram- Colonoscopy is recommended every 10 years for normal results. Pap smear is done 3-5 years. DEXA scan starts at the age of 65 for osteoporosis screening.
The correct answer is C
Question 2. Which one of these components of food is most likely responsible for developing a painful episode of gouty arthritis?
A- Carbohydrates
B- Protein
C- Purines
D- Triglycerides
C- Purines- Gout is a very important topic in USMLE. Food rich in nucleic acids can precipitate to acute episode of gout. Other mentioned sources of food do not include purines which are converted to uric acid and trigger this episode.
The correct answer is C
Question 3. A 35-year-old man complains of progressive dysphagia for both solids and liquids for 3 months. Which one of the following is the most accurate test to confirm a diagnosis of achalasia in this patient?
C- Manometry- It is the most accurate test to diagnose achalasia. Barium esophagram will show a bird’s beak but it is not the most accurate test. Upper endoscopy is most likely useful to exclude malignancy. Chest x-ray will show widening of the esophagus.
The correct answer is C
Question 4. Which one of the following most likely benefits an asymptomatic patient with breast cancer who has a significant family history?
D- Tamoxifen- It is a selective estrogen receptor modulator and results in 50-65% reduction of in these cases of breast cancer. BRCA testing is not a beneficial screening test. Anastrozole is an aromatase inhibitor which is useful in preventing metastases in a diagnosed case of breast cancer.
The correct answer is D
Question 5. Which of the following conditions is most likely associated directly with adenocarcinoma of the esophagus?
C- Reflux esophagitis- Adenocarcinoma usually occurs at the lower part of esophagus. Chronic irritation of the esophagus by gastric acid leads to replacement of the normal squamous epithelium of the esophagus by intestinal epithelium. This process results in Barret esophagus and adenocarcinoma.
The correct answer is C
Question 6. A 28-year-old male presents with sudden-onset severe testicular pain and swelling. On examination, the affected testicle is tender, swollen, and elevated compared to the unaffected side. Cremasteric reflex is absent on the affected side. Which one of the following is the most likely diagnosis?
D- Testicular torsion- The sudden-onset severe testicular pain, swelling, and elevation of the affected testicle, along with the absence of the cremasteric reflex, are indicative of testicular torsion. Testicular torsion is a urologic emergency that occurs when the spermatic cord twists, leading to compromised blood flow to the testicle. This results in ischemia and severe pain. Prompt surgical intervention is necessary to untwist the cord and restore blood flow. Epididymitis, varicocele, hydrocele, and orchitis may present with testicular pain, but the clinical presentation described is highly suggestive of testicular torsion.
The correct answer is D
Question 7. A 28-year-old female presents to the emergency department with severe abdominal pain. Physical examination reveals tenderness in the right lower quadrant. Laboratory studies show an elevated white blood cell count. An ultrasound is performed and reveals an inflamed appendix. Which of the following is the most appropriate treatment plan for this patient?
A- Intravenous ceftriaxone and metronidazole
B- Intravenous fluids and bowel rest
C- Laparoscopic appendectomy
D- Observation with serial abdominal exams
E- Oral ciprofloxacin and metronidazole
C- Laparoscopic appendectomy- Acute appendicitis is a surgical emergency that requires prompt intervention. The most appropriate initial treatment for this patient is surgical removal. Laparoscopic appendectomy has become the preferred approach due to its advantages in terms of reduced postoperative pain, shorter hospital stay, and quicker recovery compared to open appendectomy. Intravenous antibiotics may be administered perioperatively, but the primary intervention is surgical removal of the inflamed appendix. Observation, intravenous fluids, and bowel rest alone are not sufficient for the definitive treatment of acute appendicitis.
The correct answer is C
Question 8. A 45-year-old male with a history of type 2 diabetes mellitus presents to the clinic for a routine follow-up. He reports increased thirst and urination over the past few weeks. His blood pressure is 140/90 mm Hg, and his BMI is 30 kg/m². Laboratory studies reveal a fasting blood glucose of 200 mg/dL and an HbA1c of 8.5%. Which of the following medications is the most appropriate initial choice for managing this patient’s hyperglycemia?
B- Insulin glargine- Given the patient’s elevated HbA1c and fasting blood glucose levels, indicating poor glycemic control, and the presence of symptoms suggestive of hyperglycemia, initiation of insulin therapy is warranted. Insulin glargine is a long-acting basal insulin that provides a consistent and sustained reduction in blood glucose levels. It is commonly used as an initial choice in patients with significant hyperglycemia.
Metformin is often considered the first-line oral agent for type 2 diabetes, but in cases of severe hyperglycemia or symptomatic patients, insulin may be preferred for a more rapid and effective reduction in blood glucose. Glipizide, pioglitazone, and sitagliptin are alternative oral agents but are not the most appropriate initial choice in this scenario.
The correct answer is B
High-yield points from this set
Mammogram every other year for women 50–74.
Manometry is the most accurate test for achalasia.
Sudden severe testicular pain = torsion until proven otherwise.
Barrett esophagus from reflux leads to adenocarcinoma.