USMLE CK and CK2 (Block VII)

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USMLE CK1 & CK2 – Block VII

Master challenging USMLE topics with Block VII’s high-yield practice questions and detailed explanations.

Q121- The image below shows PA chest radiograph of a 64-year-old male with history of hemoptysis, cough, and dyspnea on exertion. A) The right hemithorax is opaque and the mediastinum is shifted to the right. B) The left hemithorax is opaque and the mediastinum is shifted to the left C) Collapse of the left lung D) The left main bronchus appears to be cut off (arrow). E) Right lung pneumonic patch

Q121- CT of a 56-year-old male with pain in the right suprascapular area radiating down the medial right forearm. He has a 60 pack-year H/O cigarette smoking, and previous exposure to asbestos shows a right apical mass, involving. The mass is in close proximity to axillary artery, which is suspicious for brachial plexus involvement by tumor. The image below is showing ?

A) CT confirms the involvement of the axillary artery B) CT with bone windowing confirms rib involvement by tumor (arrows). C) CT confirms involvement of the pleura by tumor D) CT confirms there is no involvement of the axillay plexus E) CT with bone windowing confirms no rib involvement by tumor (arrows).

Q123- The image below is CT of an 81-year-old lady with H/O dyspnea, wheezing, cough, fatigue. There is 13-lb weight loss, and a H/O cigarette smoking. CT shows ? A) A mass completly obstructing the left main bronchus (arrow). B)A mass partially obstructing the right main bronchus (arrow). C) A pneumonic patch (arrow). D) A mass partially obstructing the left main bronchus (arrow). E) Enlarged medistinal lymphnodes

Q124- The image below is of a 60-years-old male with small cell carcinoma. The image below PA chest radiograph which shows ? A) A large “mediastinal” mass associated with leftward shift of the trachea. B) A large lower right lung mass associated with rightward shift of the trachea. C) A large “mediastinal” mass associated with rightward shift of the trachea. D) A large left upper lobe mass associated with rightward shift of the trachea. E) A large left lower lobe mass associated with leftward shift of the trachea.

Q125-A 28-year-old man presents with recurrent abdominal pain, weight loss and perianal fistula. Colonoscopy shows skip lesions. What is the most likely diagnosis? A) Crohn’s disease B) Ulcerative colitis C) IBS D) Colon cancer E) Celiac disease

Q126-A 70-year-old woman presents with progressive memory loss, disorientation and personality changes. MRI shows cortical atrophy. What is the most likely diagnosis? A) Frontotemporal dementia B) Parkinson’s disease dementia C) Vascular dementia D) Lewy body dementia E) Alzheimer’s disease

Q127-A 35-year-old man is brought to the emergency department after a motor vehicle accident. He is hypotensive and tachycardic. Focused assessment with sonography in trauma (FAST) reveals free fluid in the abdomen. On exploratory laparotomy, the spleen is found to be ruptured with significant hemorrhage. Which of the following best describes the mechanism of hypotension in this patient? A) Obstructive shock B) Distributive shock C) Cardiogenic shock D) Hypovolemic shock E) Neurogenic shock

Q128-A 64-year-old man is evaluated in the emergency department for severe chest pain that began 2 hours ago while climbing stairs. He describes the pain as a heavy pressure radiating to his left arm and jaw. His history includes hyperlipidemia and hypertension. He takes atorvastatin and hydrochlorothiazide. On examination, he appears diaphoretic and anxious. Blood pressure is 90/60 mm Hg, pulse is 120/min, and respirations are 28/min. Jugular venous distension is noted. Cardiac auscultation reveals clear lung fields and a new holosystolic murmur at the left lower sternal border. ECG shows ST-segment elevations in leads II, III, and aVF. Which of the following is the most likely diagnosis? A) Acute pericarditis B) Aortic dissection C) Papillary muscle rupture D) Right ventricular infarction E) Ventricular septal rupture

Q129-A 23-year-old woman comes to the clinic with a 2-week history of fatigue, fever, and night sweats. She has also noticed unintentional weight loss. She recently returned from a trip to sub-Saharan Africa. On examination, she has cervical and axillary lymphadenopathy. Laboratory studies show hemoglobin 10.2 g/dL, leukocyte count 18,000/mm³, and ESR is elevated. A chest x-ray shows widened mediastinum. Lymph node biopsy reveals Reed-Sternberg cells. Which of the following is the most likely diagnosis? A) Acute myeloid leukemia B) Burkitt lymphoma C) Hodgkin lymphoma D) Non-Hodgkin lymphoma E) Tuberculosis lymphadenitis

Q130-A 47-year-old man presents with increasing abdominal girth and swelling in his legs over the past 2 months. He has a history of heavy alcohol use for 20 years. Examination reveals spider angiomas, gynecomastia, shifting dullness, and bilateral lower extremity edema. Laboratory studies show: AST 130 U/L, ALT 65 U/L, total bilirubin 3.8 mg/dL, albumin 2.2 g/dL, INR 2.1. An abdominal ultrasound shows a nodular liver and ascites. Which of the following mechanisms best explains his pedal edema? A) Decreased capillary hydrostatic pressure B) Decreased lymphatic drainage C) Decreased plasma oncotic pressure D) Increased capillary permeability E) Increased venous hydrostatic pressure

Q131-A 72-year-old woman is evaluated for progressive memory decline, difficulty performing daily activities, and frequent disorientation over the past year. She has a history of type 2 diabetes mellitus and hypertension. Mini-Mental State Examination score is 18/30. MRI of the brain shows diffuse cortical atrophy, particularly in the hippocampus and temporal lobes. Which of the following is the most likely diagnosis? A) Alzheimer disease B) Frontotemporal dementia C) Lewy body dementia D) Normal pressure hydrocephalus E) Vascular dementia

Q132-A 58-year-old man comes to the emergency department with crushing substernal chest pain radiating to his left shoulder. The pain began 1 hour ago while he was watching television. He has a history of hyperlipidemia and smokes 1 pack of cigarettes daily. His father died of a myocardial infarction at age 60. Blood pressure is 135/85 mm Hg and pulse is 95/min. ECG shows ST-segment elevations in leads V2–V5. Cardiac troponin I is elevated. A graph of left ventricular pressure-volume loops before and after administration of an intravenous drug is shown. The drug most likely given to this patient has which of the following mechanisms?

A) Beta-adrenergic antagonist B) Inhibition of late sodium current C) Inhibition of platelet aggregation D) Phosphodiesterase-5 inhibition E) Soluble guanylate cyclase stimulation

Q133-A 68-year-old woman with long-standing hypertension presents with progressive dyspnea on exertion and orthopnea. On examination, she has bilateral crackles at the lung bases, S4 heart sound, and ankle edema. Echocardiogram reveals concentric left ventricular hypertrophy and preserved ejection fraction. BNP is elevated. A graph of ventricular pressure-volume loops demonstrates increased left ventricular end-diastolic pressure with normal end-diastolic volume. Which of the following is the most likely diagnosis?

A) Dilated cardiomyopathy B) Heart failure with preserved ejection fraction C) Myocardial infarction D) Restrictive pericarditis E) Systolic heart failure

Q134-A 35-year-old man presents with recurrent episodes of palpitations, sweating, and headaches. These episodes last for 15–20 minutes and resolve spontaneously. He has lost 5 kg over the past 3 months despite increased appetite. On examination, his blood pressure is 165/100 mm Hg. Laboratory studies reveal elevated plasma metanephrines. An abdominal CT scan shows a 4-cm adrenal mass. Which of the following is the most likely diagnosis? A) Adrenal adenoma B) Cushing syndrome C) Neuroblastoma D) Pheochromocytoma E) Zollinger-Ellison syndrome

Q135- 20-year-old lady develops the physical exam finding when she spends several hours outside at a game. She usually avoids being in the sun. When she visits her clinician, urinalysis is done which shows hematuria and proteinuria. Which of the following is the likely diagnosis?

A) Sjogren syndrome B) Dermatomyositis C) Systemic lupus erythematosus D) Diffuse systemic sclerosis E) Acute rheumatic fever

Q136-A 3-year-old child presents with barking cough, stridor and fever. What is the most likely diagnosis? A) Croup B) Epiglottitis C) Bronchiolitis D) Asthma E) Pertussis

Q137-A 70-year-old man presents with tremor, masked facies, rigidity and shuffling gait. What is the most likely diagnosis? A) ALS B) Alzheimer’s disease C) Wilson’s disease D) Parkinson’s disease E) Essential tremor

Q138-A 65-year-old man presents with cough, hemoptysis, weight loss and a hilar mass on chest x-ray. What is the most likely diagnosis? A) TB B) Lung cancer C) Pneumonia D) Sarcoidosis E) Aspergillosis

Q139-A 45-year-old woman presents with amenorrhea, galactorrhea and headache. MRI shows pituitary adenoma. What is the diagnosis? A) Prolactinoma B) Craniopharyngioma C) Sheehan syndrome D) Cushing’s disease E) Acromegaly

Q140-A 25-year-old man presents with jaundice, hemolytic anemia and splenomegaly. Peripheral smear shows spherocytes. What is the most likely diagnosis? A) Thalassemia B) Sickle cell anemia C) Hereditary spherocytosis D) G6PD deficiency E) Autoimmune hemolytic anemia