Judgments
USMLE 16Th-April-2019-Exam-1.docx
Judgement of 17 pages for the course usmle at usmle (16Th-April-2019-E)
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16th April 2019 Exam’s RecallThis work is tributed to the souls of the Sudanese revolution’s martyrs who gave their
lives for our freedom.
Paper 1
1.A 26-year-old man presents to the Emergency Department with extensive bleeding
from his arm after sustaining a glass injury. On examination there is a 7 cm transverse
laceration across the anterior aspect of his elbow. On exploring the cubital fossa you would
expect the brachial artery to be:
A. anterior to the median nerve
B. lateral to the biceps tendon
C. lateral to the median nerve
D. medial to the median nerve
E. superficial to the bicipital aponeurosis
2.A 22-year-old man has been stabbed in the left fifth intercostal space at the edge of the
sternum. Which structure is most likely to have been penetrated?
A Left atrium
B Left lobe of the liver
C Left ventricle
D Right atrium
E Right ventricle
3.A 30-year-old man is admitted to the intensive care unit with an isolated severe head injury. A CT scan shows
multiple intracerebral bleeds but no midline shift. He is intubated and ventilated. His pupils are dilated and
react sluggishly to light. His heart rate is 50 beats/minute blood pressure 170/110 mmHg and his respiratory rate
is set at 10 breaths/minute. The rising blood pressure is likely to be caused by:
A. aortic and carotid baroreceptor stimulation
B Cortisol stimulation
C. renin-angiotensin stimulation
D. sympathetic stimulation related to blood loss
E. sympathetic stimulation related to intracranial pressure
4.The right and left pulmonary arteries are derived from which of the following embryological aortic arches?
A Second aortic arch
B Third aortic arch
C Fourth aortic arch
D fifth aortic arch'
E Sixth aortic arch
5.Activation of which of the following transport systems best describes how aldosterone leads to maintenance of
the intravascular volume and oliguria?
A. Na+/glucose in the proximal tubule
B. Na/H+ in the descending loop of Henle
C. Na+/K in the ascending loop of Henle
D. Na+/Cl in the distal tubule
E. Na/K in the collecting ducts
6.relatio of ureter to the gonadal vessels at pelvic brim? Posterior to it
7.how to identify the uncinate process? Answer was posterior to superior mesenteric artery
8. relation of ureter to the renal artery? posterior
9. patient with signs of facial and trigeminal nerves palsy,where’s the level of tumor compression? Pons
10.anterior relation to the rt adrenal gland ? IVC
,11.calculating CPP? Answer was 75
12. A 19-year-old woman presents to the Emergency Department profoundly
hypovolemic having fallen from a horse. A postero-anterior (PA) chest radiograph
shows a fracture to the medial third of the left clavicle. Which of the following
vessels is most likely to be damaged?
A Brachiocephalic trunk
B Left axillary artery
C Left common carotid artery
D Left subclavian artery
E Left vertebral artery
13.A 69-yeac-oJd man has been admitted to the high dependency unit following an
anterior resection under general anesthesia. He was given 2 mg of intrathecal
morphine. On examination, he looks pale and drowsy. Arterial blood gasses results are:
PH pCo2 pO2 Base Excess Gluose Lactate
Finding 7.28 8.1 kPA 10.2 kPa -2.1 21 mmol/L 4.0mmol/L
Normal 7.35-7.45 4.7-6.0 11.9-13.3 -2 to +2 4-7 0.5-2.2
Which of the following is the most likely diagnosis?
A. Diabetic ketoacidosis
B. Metabolic acidosis
C. Metabolic alkalosis
D Respiratory acidosis
E Respiratory Alkalosis
14.Patient cant dorsiflex his big toe, Which nerve root is most likely to be involved?
A. T12
b. L3
C. L5
D. S1
E. S2
15.A 42 years old woman has a cholecystectomy and develops a self-limiting
postoperative wound infection. By what process would bacterial ingestion have
been enhanced?
A. Apoptosis
B. Autophagy
C. Metaplasia
D. Opsonisation
E. Phagocytosis
16.Pericardioperitoneal membrane defect will lead to :
A. Congenital Diaphragmatic hernia
B. Ectopia cordis
17.Facial nerve transection during parotidectomy will lead to:
A. numbness over the cheek
B. loss of corneal reflex
C. lower lip dropping
18.post parotidectomy patient developed gustatory sweating during meals,what is the mechanism?
A. regeneration of the parasympathetic fibers of auriculotemporal nerve into sympathetic fibers innervating
the sweat gland
, 19. pt with pancreatitis, what is the enzyme responsible for autodigestion?
A. lipase
B. elastase
C. trypsin
D. amylase
20.A 58-year-oid woman presented to the Emergency Department with a large fluctuant swelling at the site of a
recent insect bite. She is anxious, tachycardic, and pyrexial. ECG shows critical fibrillation. She is noted to have
a goiter. The swelling at the site of the bite requires surgical drainage. Which of the following classes of drug
would be most appropriate as part of her preoperative preparation for surgery?
A. Alpha-1 adrenoceptor agonist
B. Alpha-2 adrenoceptor agonist
C. Alpha adrenoceptor blocker
D. Beta adrenoceptor agonist
E. Beta adrenoceptor blocker
21.A 26-year-old man is admitted to the Emergency Department with multiple peripheral
fractures. He is clinically shocked. Which is the structure responsible for the first
hemostatic response to a fall in systemic arterial blood pressure?
A.Adenohypophysis
B.Baroreceptor
C.Chemoreceptor
D.renin
E. Neurohypophysis
22.Failure of caudal part of metanephron to develop will result in
A. renal agenesis
B. horseshoe kidney
C. polycystic kidney
23.patient fall at his wrist resulted in median nerve injury? Due to lunate dislocation.
24.which of the following is requir to be divided during tracheostomy?
A. anterior jugular vein
B. thymus
C. thyroid isthmus
25.A 45-year-old man has established cirrhosis. At a follow-up appointment a palpable
spleen four fingers breadths below the costal margin is noticed. Full blood counts have
shown a persistent thrombocytopaenia. Bone marrow examination shows megakaryocyte
hyperplasia. What is the most likely cause of the thrombocytopaenia?
A. Ineffective production in the bone marrow
B. Platelet destruction in the bone marrow
C. Platelet destruction in the liver
D. Platelet destruction in the spleen
E.Platelet storage in the spleen
26.The branchial cyst derived from which paryngeal arch?
A. First
B.Second
C.Third
D.Fourth
E.sixth
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