USMLE Clinical Medicine 3

Question 1

A 60-year-old man presents with lower back pain, hypercalcemia, anemia, and lytic bone lesions. Serum protein electrophoresis shows an M-spike. What is the diagnosis?

Accepted Answer

Multiple myeloma

Answer

Metastatic prostate cancer

Answer

Paget disease of bone

Answer

Primary hyperparathyroidism

Question 2

A patient with type 1 diabetes presents with nausea, vomiting, Kussmaul breathing, and fruity breath. ABG shows pH 7.20, glucose 450 mg/dL, and urine ketones positive. What is the treatment priority?

Accepted Answer

IV fluid resuscitation and insulin infusion

Answer

Immediate bicarbonate administration

Answer

Oral glucose

Answer

Glucagon injection

Question 3

A 70-year-old woman with osteoporosis has a compression fracture. DEXA scan shows T-score of -2.8. Which medication reduces fracture risk by inhibiting osteoclast function?

Accepted Answer

Alendronate (bisphosphonate)

Answer

Teriparatide

Answer

Denosumab

Answer

Raloxifene

Question 4

A patient presents with fever, right lower quadrant pain, rebound tenderness, and elevated WBC. CT shows fat stranding around a dilated appendix. What is the diagnosis?

Accepted Answer

Acute appendicitis

Answer

Crohn disease

Answer

Mesenteric lymphadenitis

Answer

Ovarian torsion

Question 5

A 55-year-old man presents with severe epigastric pain radiating to the back, nausea, and vomiting. Serum lipase is 5x the upper limit of normal. What are the two most common causes?

Accepted Answer

Gallstones and alcohol

Answer

NSAID use and hypercalcemia

Answer

Hypertriglyceridemia and medications

Answer

Trauma and ERCP

Question 6

A patient with atrial fibrillation is started on warfarin. Target INR range for non-valvular AF is:

Accepted Answer

2.0-3.0

Answer

1.5-2.0

Answer

3.0-4.0

Answer

2.5-3.5