Repeated USMLE Questions Step 1- Highlights- 5

Q- An alcoholic patient presents with sudden chest pain, cough and shortness of breath following repeated episodes of retching and vomiting. Examination reveals subcutaneous emphysema.

Which of the following is the most likely diagnosis?

A- Boerhaave syndrome

B- Mallory-weiss tear

C- Myocardial infarction

D- Rupture of esophageal varices

A- Boerhaave syndrome- It is a rare fatal condition. Retching and vomiting results in an increase of intraesophageal pressure which leads to esophageal perforation. It differs from Mallory-weiss tear in which it affects transmural layer causing perforation and rushing of air to the mediastinum.

Q- A 34-year-old man presents with fatigue, chills and loss of weight for the last 2 months. Examination reveals enlarged non-tender cervical lymph nodes. A biopsy of the lymph nodes shows cells expressing CD15 and CD30 cell surface antigens.

Which of the following is the most likely diagnosis?

A- Acute lymphoblastic leukemia

B- Chronic lymphocytic leukemia

C- Hodgkin lymphoma

D- Non-Hodgkin lymphoma

C- Hodgkin lymphoma- It is a B-cell lymphoma presented by lymphadenopathy and general symptoms. It is characterized by the presence of Reed-Sternberg cells which express CD15 and CD30 cell surface antigens.

Q- Which one of the following brain tumors is the most common and most malignant tumor of the cerebral cortex in adults?

A- Astrocytoma

B- Glioblastoma multiforme

C- Lymphosarcoma

D- Meningioma

B- Glioblastoma multiforme- It arises at age 40-60 years. It infiltrates adjacent brain tissue and is nearly impossible to resect. It arises in one hemisphere but can infiltrate across corpus callosum to the other hemisphere.

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