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Repeated USMLE Questions for Medical Students

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usmle step 1

USMLE Q Bank Step 1 – 202

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A 55 year-old man presents to his physician complaining of sinusitis, chest pain and productive cough for 2 weeks. His sputum is mixed with blood. He also has pain and swelling of hands and feet for 3 months. On examination, he has synovitis of proximal interphalangeal joints of both hands. His laboratory tests reveal anemia, elevated ESR, elevated creatinine and positive c-ANCA. Urinalysis shows red blood casts and proteinuria. Chest x-ray shows multiple nodules in both lungs.

What is the most likely diagnosis?

A- Acute glomerulonephritis

B- Miliary tuberculosis

C- Wegener granulomatosis

D- Rheumatoid arthritis

E- Systemic lupus erythematosus




Answer: 

This is a typical case of Wegener granulomatosis which is characterized by upper and lower respiratory and renal involvement. Positive c-ANCA confirms the diagnosis.




USMLE Q Bank Step 1 – 201

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A 54 year old man visits his physician for evaluation of low back pain. He has a history of lung cancer and he receives a combination of radiation and chemotherapy. His back pain started 3 months ago and now he complains of numbness and tingling in his lower limbs.

What is the most likely cause of this patient’s back pain?

A- Paraneoplastic disease

B- Metastases to the vertebral column

C- Muscular spasm of paravertebral muscles

D- Primary osteosarcoma




Answer:

Vertebral column is the most common site for metastases of lung cancer. Symptoms start when compression of spinal cord occurs. It causes neurological symptoms of the areas affected. Other choices are less likely associated with cancer lung.

The correct answer is B




USMLE Q Bank Step 1-11

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A 36 year-old man presents to the emergency room asking for removal of software implanted in his body by his neighbor. He tells you that his x-wife is hiring this neighbor to spy on him. For the last 6 years he has been hearing them talking about him and all details of his life. He lives alone and he does not have any friends. He has no kids and one sister who do not visit him anymore since he accused her of spying on him. His physical examination and laboratory studies are unremarkable. Drug test is negative. What is the most likely diagnosis?

A-Brief psychotic disorder

B-Bipolar disorder

C-Major depressive disorder

D-Schizophrenia

E-Schizophreniform disorder




Answer:

This patient has psychosis in the form of delusions and hallucinations for 6 years. Duration of these symptoms suggests the diagnosis of schizophrenia. Brief psychotic disorder has a time limit of 1 day to 1 month. Schizophreniform disorder is considered if symptoms continue from 1 month to 6 months. There are no signs of depression so; choices D and E are incorrect.

The correct answer is D




USMLE Q Bank Step 1 -10

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Congenital heart diseases are defects of the heart and/or great arteries that are present at birth. They may be manifested at birth or hidden until later in life. Cyanosis is an important sign to diagnose and differentiate between types of congenital heart disease. 

What is the most common congenital heart disease?

A- Atrial septal defect

B- Ventricular septal defect

C- Patent ductus arteriosus

D- Transposition of the great arteries

E- Tetralogy of Fallot




Answer:

Ventricular septal defect is the most common congenital heart disease. In most cases it is undiagnosed at birth but manifests 3-4 weeks after birth. It is acyanotic but if untreated, it can lead to severe complications such as  Eisenmenger’s syndrome.

The correct answer is B







USMLE Q Bank Step 1-9

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A 29 year-old man presents to his physician complaining of fatigue and lethargy for the past 3 days after he came back from a hiking trip in Northern California. During the trip, he noticed a rash on his left arm. The rash was smaller but now it’s expanding in size. On examination, the rash looks round with central clearing.

What is the most likely organism involved in this condition?

A- Meningococci

B- Staphylococcus aureus

C- Borrelia burgdorferi

D- Rickettsia prowazekii

E- Treponema pallidum




Answer:

This is most likely the characteristic rash of  Lyme disease. It is caused by borrelia burgdorferi infection transmitted by Ixodes tick. Other microorganisms don’t show this particular rash.

The correct answer is C




USMLE Q Bank Step 1-8

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A 38 year old man is brought to the emergency room because of palpitation and shortness of breath for 4 hours. He travelled to Brazil two years ago on a business trip. He was bitten there by a fly and was treated by analgesics for a few weeks due to fever and headaches. On examination, heart rate is 150 with shifting of the apex to the left. Imaging studies and further investigations show cardiomyopathy.

What is the organism most likely responsible for this condition?

A- Staphylococcus aureus

B- Streptococcus pyogenes

C- Ascaris lumbricoides

D- Trypanosoma cruzi

E- Trichophyton rubrum




Answer: 

This is a case of Chagas disease caused by Trypanosoma cruzi and also called American trypanosomiasis. It is spread to human through insects called Triatominae and also known as kissing bug. It lives in Central and South America. Infection with this microorganism causes severe myocarditis and leads to cardiomyopathy.

The correct answer is D




USMLE Q Bank Step 1-7

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A 46 year-old man underwent a kidney transplantation last week due to chronic renal failure. The surgery was successful and the transplanted kidney started to produce urine during the operation. Today, his urine examination shows high creatinine and low urinary output. He has no pain or fever. A biopsy taken from the transplanted kidney shows cellular infiltrate .

Which of these cells is responsible for this patient’s recent condition?

A- B Lymphocytes

B- Cytotoxic T cells

C- Fibrocytes

D- Plasma cells

E- T-helper cells




Answer: 

This is a case of acute rejection of kidney transplant.  It is caused by a T cell–mediated delayed hypersensitivity reaction to allograft histocompatibility antigens.

The correct answer is B




USMLE Q Bank Step 1-6

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A 65 year-old farmer presents to your clinic complaining of shortness of breath for 6 months. Last 2 weeks he noticed that he has to get up several times during the night to be able to breath. He proudly tells you that he had never visited a doctor before although he smokes and drinks every night. On physical examination, there is displaced point of his maximum impulse, rales over both lungs and enlarged liver. Echo shows both right and left ventricular dilation and EF 30%. Laboratory test are normal except high bilirubin, AST 245 and ALT 180.

What is the initial cause of this patient presentation?

A-Smoking

B-Alcohol

C-Lyme disease

D-Chronic hypertension

E-High cholesterol




Answer:

AST>ALT means the patient had chronic alcoholic abuse lead to cardiomyopathy with liver failure.

The  correct answer is B




USMLE Q Bank Step 1-5

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A 30 year-old woman with a history of Grave’s disease presents to her physician for a routine evaluation. She was treated 2 years ago with radioactive iodine. Three months later, she was prescribed levothyroxine 0.125 mg. On her last evaluation, six months ago, her doctor lowered her dose to 0.088 mg due to decrease of TSH level.

Today, her lab tests show increase in T4 and T3 and very low TSH and positive TSH receptor antibodies.

What is the most likely diagnosis?

A- Hashimoto’s disease

B- Radioactive induced thyrotoxicosis

C- Ectopic thyroid tissue

D- Incomplete ablation of thyroid gland

E- Cancer thyroid




Answer: 

This is a typical presentation of incomplete ablation of thyroid gland. The patient went through radioactive ablation of his thyroid gland 2 years ago. In some cases, there is some thyroid tissue could be left after radiotherapy and starts to grow in size until becomes able to cause hyperthyroidism in addition to the use of levothyroxine treatment.

The correct answer is D




USMLE Q Bank Step 1-4

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A 6 year old girl presents to the emergency room with her mother for a deep wound on her right forearm. Her mother tells you that her daughter was playing at school today and wounded herself when she fell on a big rock. When you ask her about her vaccination, she tells you that her daughter had all her vaccinations before the school started this year.

What is the most appropriate therapy for this girl?

A- Tetanus toxoid

B- Tetanus antitoxin

C- Both tetanus toxoid and antitoxin

D- Neither tetanus toxoid or antitoxin




Answer

This girl already received her vaccination before the school started this year. For this reason, there is no vaccination therapy needed for this girl at this time.

The correct answer is D