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The following examination consists of 100 questions, mostly in the format ("single best answer") used in USMLE examinations. As in an actual examination, clinical descriptions, tables, or graphs are provided in many of the question stems.

It is suggested that you time yourself in taking this examination; in current USMLE examinations, the time allotted is approximately 1 min per question; thus, 1 h 40 min would be appropriate for this examination.


DIRECTIONS: Each numbered item or incomplete statement in this section is followed by answers or by completions of the statement. Select the ONE lettered answer or completion that is BEST in each case.

  1. Phase 3 clinical trials typically involve

    • (A) Collection of data regarding late-appearing toxicities from patients previously studied in phase 1 trials

    • (B) Double-blind, closely monitored evaluation of the new drug in hundreds of patients with the target disease by specialists in academic centers

    • (C) Evaluation of the new drug under conditions of actual use in 1000–5000 patients with the target disease

    • (D) Measurement of the pharmacokinetics of the new drug in normal volunteers

    • (E) Postmarketing surveillance of drug toxicities

  2. A patient is admitted to the emergency department for treatment of a drug overdose. The identity of the drug is unknown, but it is observed that when the urine pH is alkaline, the renal clearance of the drug is much greater than when the urine pH is acidic. The drug is probably a

    • (A) Strong acid

    • (B) Weak acid

    • (C) Nonelectrolyte

    • (D) Weak base

    • (E) Strong base

  3. A 66-year-old woman is in the coronary care unit after an acute myocardial infarction. She has developed signs of pulmonary edema of rapidly increasing severity and several drugs have been suggested. Furosemide, dobutamine, and digoxin can each

    • (A) Decrease conduction velocity in the atrioventricular node

    • (B) Decrease venous return

    • (C) Reduce pulmonary edema

    • (D) Increase peripheral vascular resistance

    • (E) Increase the amount of cAMP in cardiac muscle cells

  4. A 45-year-old man presents with pulmonary hypertension. Which of the following cause–treatment pairs is most relevant to this patient?

    • (A) Angiotensin II–minoxidil

    • (B) Atrial natriuretic peptide–losartan

    • (C) Bradykinin–furosemide

    • (D) Endothelin–ambrisentan

    • (E) Substance P–capsaicin

  5. A 45-year-old man with a duodenal ulcer and laboratory evidence of Helicobacter pylori infection was treated with omeprazole, clarithromycin, and amoxicillin. Which of the following is the most accurate description of the mechanism of omeprazole’s therapeutic action?

    • (A) Activation of prostaglandin E receptors

    • (B) Formation of protective coating over the ulcer bed

    • (C) Inhibition of bacterial protein synthesis

    • (D) Inhibition of H2 histamine receptors

    • (E) Irreversible inactivation of H+/K+ ATPase

  6. A patient discharged from the hospital after a myocardial infarction had been receiving small doses of procainamide to suppress a ventricular tachycardia. One month later, his local physician prescribed high-dose hydrochlorothiazide therapy for ankle edema, which was ascribed to congestive heart failure. Three weeks after beginning thiazide therapy, the patient was readmitted ...

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