USMLE Clinical Medicine

Question 1

A 65-year-old man presents with chest pain radiating to the left arm, diaphoresis, and ST elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?

Accepted Answer

Right coronary artery (RCA)

Answer

Left anterior descending artery (LAD)

Answer

Left circumflex artery (LCx)

Answer

Left main coronary artery

Question 2

A patient with hypertension develops a sudden severe headache described as 'the worst headache of my life.' What is the most important diagnosis to rule out?

Accepted Answer

Subarachnoid hemorrhage (SAH)

Answer

Migraine

Answer

Tension headache

Answer

Hypertensive urgency

Question 3

A patient with type 2 diabetes presents with polydipsia, polyuria, and serum glucose of 650 mg/dL. Serum osmolality is 345 mOsm/kg. No ketones in urine. What is the diagnosis?

Accepted Answer

Hyperosmolar hyperglycemic state (HHS)

Answer

Diabetic ketoacidosis (DKA)

Answer

Diabetes insipidus

Answer

SIADH

Question 4

A 45-year-old woman with rheumatoid arthritis develops dry eyes, dry mouth, and parotid enlargement. Antibodies to SSA (Ro) and SSB (La) are positive. What is the diagnosis?

Accepted Answer

Sjögren syndrome

Answer

SLE

Answer

Sarcoidosis

Answer

Amyloidosis

Question 5

A patient presents with ascending weakness that started in the feet after a recent GI illness. CSF shows elevated protein with normal cell count (albuminocytologic dissociation). What is the diagnosis?

Accepted Answer

Guillain-Barré syndrome (GBS)

Answer

Multiple sclerosis

Answer

Amyotrophic lateral sclerosis

Answer

Myasthenia gravis

Question 6

A patient with cirrhosis develops jaundice, ascites, and confusion. Asterixis is noted on exam. Serum ammonia is elevated. What is this complication called?

Accepted Answer

Hepatic encephalopathy

Answer

Wernicke encephalopathy

Answer

Spontaneous bacterial peritonitis

Answer

Hepatorenal syndrome