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DOI: 10.1036/007137633X

Terms of Use
 CONTENTS
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix

INFECTIOUS DISEASE
Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . . 14

RHEUMATOLOGY
Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . . 36

PULMONARY DISEASE
Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . . 57

CARDIOLOGY
Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . . 85

ENDOCRINOLOGY AND METABOLIC DISEASE

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . 108

GASTROENTEROLOGY
Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . 127

NEPHROLOGY
Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . 143

Terms of Use
vi Contents

HEMATOLOGY AND ONCOLOGY

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . 163

NEUROLOGY
Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . 181

DERMATOLOGY
Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . 196

GENERAL MEDICINE AND PREVENTION

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . 211

ALLERGY AND IMMUNOLOGY

Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
Answers, Explanations, and References . . . . . . . . . . . . . . . . . . . . . 227

Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
INTRODUCTION
Medicine: PreTest® Self-Assessment and Review, Ninth Edition, is intended to
provide medical students, as well as house officers and physicians, with a
convenient tool for assessing and improving their knowledge of medicine.
The 500 questions in this book are similar in format and complexity to
those included in Step 2 of the United States Medical Licensing Examina-
tion (USMLE). They may also be a useful study tool for Step 3.
Each question in this book has a corresponding answer, a reference to
a text that provides background for the answer, and a short discussion of
various issues raised by the question and its answer. A listing of references
for the entire book follows the last chapter.
To simulate the time constraints imposed by the qualifying examina-
tions for which this book is intended as a practice guide, the student or
physician should allot about one minute for each question. After answering
all questions in a chapter, as much time as necessary should be spent
reviewing the explanations for each question at the end of the chapter.
Attention should be given to all explanations, even if the examinee
answered the question correctly. Those seeking more information on a sub-
ject should refer to the reference materials listed or to other standard texts
in medicine.

vii
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ACKNOWLEDGMENTS
We would like to offer special thanks to
Our wives, Shirley Berk and Janet Davis, for moral support and helpful
suggestions concerning the format of the questions
Our children, Jeremy Berk, Justin Berk, Abby Davis, and Kyle Davis, for
their computer expertise
Our staff, Margie McAlister, Jackie Hammett, and Donna Forrester, for
excellent support in organizing, collating, and typing the manuscript
To Texas Tech University School of Medicine at Amarillo—in the pursuit of
excellence
To students of Texas Tech University School of Medicine, for review of the
text.

The publisher wishes to thank Carol Bunten, a medical student from the
University of Iowa College of Medicine, for reviewing this manuscript
prior to publication.

ix
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 INFECTIOUS DISEASE
DIRECTIONS: Each item below contains a question or incomplete
statement followed by suggested responses. Select the one best response to
each question.

1. A 30-year-old male patient has 2. A 70-year-old patient with long-

complained of fever and sore throat standing type 2 diabetes mellitus
for several days. The patient pre- presents with complaints of pain in
sents to you today with additional the left ear with purulent drainage.
complaints of hoarseness, difficulty On physical exam, the patient is
breathing, and drooling. On exam- afebrile. The pinna of the left ear is
ination, the patient is febrile and tender, and the external auditory
has inspiratory wheezes. Which of canal is swollen and edematous.
the following would be the best The peripheral white blood cell
course of action? count is normal. The organism
a. Begin outpatient treatment with most likely to grow from the puru-
ampicillin lent drainage is
b. Culture throat for beta-hemolytic a. Pseudomonas aeruginosa
streptococci b. Staphylococcus aureus
c. Admit to intensive care unit and c. Candida albicans
obtain otolaryngology consultation d. Haemophilus influenzae
d. Schedule for chest x-ray e. Moraxella catarrhalis

Terms of Use
2 Medicine

Items 3–4 Items 5–7

A 25-year-old male student A 20-year-old female college
presents with a chief complaint of student presents with a five-day
rash. There is no headache, fever, history of cough, low-grade fever
or myalgia. A slightly pruritic mac- (temperature 100°F), sore throat,
ulopapular rash is noted over the and coryza. On exam, there is mild
abdomen, trunk, palms of hands, conjunctivitis and pharyngitis.
and soles of feet. Inguinal, occipi- Tympanic membranes are inflamed
tal, and cervical lymphadenopathy and one bullous lesion is seen.
is also noted. Hypertrophic, flat, Chest exam shows few basilar rales.
wartlike lesions are noted around Laboratory findings are as follows:
the anal area. Laboratory studies
Hct: 38
show the following:
WBC: 12,000/mm3
Hct: 40% Lymphocytes: 50%
Hgb: 14 g/dL Mean corpuscular volume (MCV):
WBC: 13,000/mm3 83 µm3
Diff Reticulocytes: 3% of red cells
Segmented neutrophils: 50% CXR: Bilateral patchy lower lobe
Lymphocytes: 50% infiltrates

3. The most useful laboratory test 5. The sputum Gram stain is likely
in this patient is to show
a. Weil-Felix titer a. Gram-positive diplococci
b. Venereal Disease Research Labora- b. Tiny gram-negative coccobacilli
tory (VDRL) test c. White blood cells without organ-
c. Chlamydia titer isms
d. Blood cultures d. Tubercle bacilli

4. The treatment of choice for this 6. This patient is likely to have

patient would be a. High titers of adenovirus
a. Penicillin b. High titers of IgM cold agglutinins
b. Ceftriaxone c. A positive silver methenamine stain
c. Tetracycline d. A positive blood culture for Strepto-
d. Interferon alpha coccus pneumoniae
e. Erythromycin
 Infectious Disease 3

7. Treatment of choice would be 8. The most important initial test

a. Erythromycin would be
b. Supportive therapy a. Liver biopsy
c. Trimethoprim-sulfamethoxazole b. Strep screen
d. Cefuroxime c. Peripheral blood smear
d. Toxoplasmosis IgG
Items 8–10 e. Lymph node biopsy

A 19-year-old male presents 9. The most important serum test is

with a one-week history of malaise
a. Heterophile antibody
and anorexia followed by fever and
b. Hepatitis B IgM
sore throat. On physical examina- c. Cytomegalovirus IgG
tion, the throat is inflamed without d. ASLO titer
exudate. There are a few palatal e. Hepatitis C antibody
petechiae. Cervical adenopathy is
present. The liver is percussed at 12 10. Corticosteroids would be indi-
cm and the spleen is palpable. cated if
Throat culture: negative for group a. Liver function tests worsen
A streptococci b. Fatigue lasts more than one week
Hct: 38% c. Severe hemolytic anemia is demon-
Hgb: 12 g/dL strated
d. Hepatitis B is confirmed
Reticulocytes: 4%
WBC: 14,000 mm3
Segmented: 30%
Lymphocytes: 60%
Monocytes: 10%
Bilirubin total: 2.0 mg/dL (n 0.2 to
1.2)
Lactic dehydrogenase (LDH) serum:
260 IU/L (n 20 to 220)
Aspartate (AST): 40 U/L (n 8 to 20
U/L)
Alanine (ALT): 35 U/L (n 8 to 20
U/L)
Alkaline phosphatase: 40 IU/L (n 35
to 125)
4 Medicine

DIRECTIONS: Each group of questions below consists of lettered

headings followed by a set of numbered items. For each numbered item,
select the one lettered heading with which it is most closely associated.
Each lettered heading may be used once, more than once, or not at all.

Items 11–14 Items 15–18.

Match the clinical description Select one antiviral agent for
with the most likely organism. each patient.
a. Streptococcus pneumoniae a. Ganciclovir
b. Staphylococcus aureus b. Acyclovir
c. Viridans streptococci c. Interferon alpha
d. Providencia stuartii d. Didanosine
e. Actinomyces israelii e. Ribavirin
f. Haemophilus ducreyi f. Amantadine
g. Neisseria meningitidis g. Vidarabine
h. Listeria monocytogenes h. Zalcitabine

11. A 30-year-old female with 15. Military recruit develops

mitral valve prolapse and mitral pneumonia secondary to influenza
regurgitant murmur develops fever, A. Symptoms began 24 hours prior
weight loss, and anorexia after to physician visit.
undergoing dental procedure.
16. HIV-positive patient with CD4
12. An 80-year-old-male, hospital- count of 50 complains of onset
ized for hip fracture, has Foley visual blurring; opacity seen on
catheter in place when he develops fundoscopic exam.
shaking chill, fever, and hypoten-
sion. 17. Sexually active young woman
has anogenital warts, requests
13. A young man develops pain- intralesional therapy.
less, fluctuant, purplish lesion over
the mandible. Cutaneous fistula is 18. Infant with respiratory syncy-
noted after several weeks. tial virus infection requires
mechanical ventilation.
14. A sickle cell anemia patient
presents with high fever, toxicity,
signs of pneumonia, and stiff neck.
 Infectious Disease 5

Items 19–21 20. Diabetic patient is admitted

with elevated blood sugar and aci-
Match the fungal agent most
dosis. Complains of headache and
likely responsible for the disease
sinus tenderness. Has black, ne-
process described below.
crotic material draining from nares.
a. Histoplasma capsulatum
b. Blastomycosis dermatitidis
21. Young woman with asthma,
c. Coccidioides immitis
d. Cryptococcus neoformans
eosinophilia. Fleeting pulmonary
e. Candida albicans infiltrates occur with bronchial
f. Aspergillus fumigatus plugging.
g. Zygomycosis

19. Fever, cough, and weight loss

in young, previously healthy male.
Presents with verrucous skin
lesions and bone pain. Chest x-ray
shows nodular infiltrates.
6 Medicine

DIRECTIONS: Each item below contains a question or incomplete

statement followed by suggested responses. Select the one best response to
each question.

Items 22–24 24. Treatment of choice would be

A 40-year-old male develops a. Penicillin or ceftriaxone
b. Acyclovir
bilateral facial weakness. The
c. Corticosteroids
patient returned from a camping
d. Aminoglycoside
trip in Wisconsin that had lasted
six weeks. The patient gives a his-
25. You are a physician in charge of
tory of arthralgias. On exam, he
the patients that reside in a nursing
cannot close either eye well or raise
home. Several of the patients have
either eyebrow. The first heart
developed influenza-like symp-
sound is diminished. There is no
toms, and the community is in the
evidence of arthritis.
midst of an influenza A outbreak.
Hgb: 14 g/dL None of the nursing home residents
WBC: 10,000/mm3 have received the influenza vaccine.
VDRL: Negative What course of action would be
FTA-Abs: Positive most appropriate?
EKG: First-degree AV block a. Give the influenza vaccine to all
residents of the nursing home who
22. Which of the following would do not have a contraindication to
be most useful? the vaccine (allergy to eggs)
b. Give the influenza vaccine to all
a. CT scan of head
residents of the nursing home who
b. MRI of head
do not have a contraindication to
c. More detailed history
the vaccine. Also give amantadine
d. Kveim test
for a two-week period
c. Give amantadine alone to all nurs-
23. The likely cause of these ing home residents
symptoms is d. Do not give any prophylactic regi-
a. Intracranial infection men
b. Lyme disease
c. Endocarditis
d. Herpes simplex
 Infectious Disease 7

26. Which of the following state- 28. A 30-year-old man who has
ments concerning cryptococcal spent 5 of the last 10 years in
meningoencephalitis is correct? prison in New York City is referred
a. It may occur in patients with no from the prison because of hemop-
identifiable immunological defect tysis. He has a history of tuberculo-
b. Urine and blood cultures are sis diagnosed three years ago and
always negative took isoniazid and rifampin for
c. The india ink preparation usually about a month. A cavitary lesion is
reveals gram-negative bacteria seen on chest x-ray. One should do
d. Detection of cryptococcal polysac- all the following except
charide antigen in cerebrospinal
fluid (CSF) is sensitive but nonspe- a. Obtain sputum for acid-fast bacilli
cific (AFB) stain, culture, and sensitivity
b. Start supervised isoniazid and
rifampin administration
27. Patients with cellular immune c. Start a supervised multiple drug
dysfunction are least susceptible to combination to treat multidrug-
infection with which of the follow- resistant tuberculosis
ing organisms? d. Place the patient in respiratory iso-
a. Cytomegalovirus lation
b. Haemophilus influenzae e. Perform routine screening of
c. Mycobacterium tuberculosis inmates and staff for tuberculosis
d. Pneumocystis carinii
e. Histoplasma capsulatum 29. A recent outbreak of severe
diarrhea is currently being investi-
gated. Several children developed
bloody diarrhea, and one remains
hospitalized with acute renal fail-
ure. A preliminary investigation has
determined that all the affected
children ate at the same restaurant.
The food they consumed was most
likely to be
a. Pork chops
b. Hamburger
c. Gefilte fish
d. Sushi
e. Soft-boiled eggs