Usmle step 1 Sample Test Questions
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- Bu səhifədəki naviqasiya:
- Thyroid-stimulating Total Thyroxine Free Thyroid-binding
- Answer Form for USMLE Step 1 Sample Test Questions Block 1 (Questions 1-40)
- Answer Key for USMLE Step 1 Sample Test Questions
- Block 2 (Questions 41-80)
- Block 3 (Questions 81-117)
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Type I Pneumocytes Type II Pneumocytes Fibroblasts (A)
↑ ↑ ↑ (B) ↑ ↑ ↓ (C)
↑ ↓ ↑ (D) ↑ ↓ ↓ (E)
↓ ↑ ↑ (F) ↓ ↑ ↓ (G)
↓ ↓ ↑ (H) ↓ ↓ ↓
94.
A 14-year-old girl has had nausea, intermittent diarrhea, and a 2.2-kg (5-lb) weight loss over the past 4 weeks. Examination shows a migrating serpiginous pruritic perianal rash. Her leukocyte count is 8000/mm 3 with 20% eosinophils. Which of the following tests is most likely to yield an accurate diagnosis?
(A) Blood smear (B) Bone marrow biopsy (C) KOH preparation (D) Microscopic examination of the stool (E) Skin snip
A 73-year-old woman comes to the physician because of a 2-month history of diffuse weakness and tingling of her arms and legs. Neurologic examination shows weakness of the extensor and flexor muscles of the lower extremities. Knee and ankle deep tendon reflexes are exaggerated. Sensation to vibration and position is decreased in all extremities, but the decrease is more prominent in the lower extremities than in the upper extremities. This patient most likely has a deficiency of which of the following vitamins?
(A) Niacin (B) Vitamin B 1 (thiamine) (C) Vitamin B 2 (riboflavin) (D) Vitamin B 6 (pyridoxine) (E) Vitamin B 12 (cyanocobalamin)
96. A 60-year-old woman develops fever and chills 1 week after completing cytotoxic induction chemotherapy for acute myelogenous leukemia. Her temperature is 39°C (102.2°F). Her leukocyte count is 100/mm 3 (25% neutrophils and 75% lymphocytes). Physical examination and an x-ray of the chest show no abnormalities. This patient's profound granulocytopenia is most likely to predispose her to infection with which of the following organisms?
(A) Bacteria (B) Dimorphic fungi (C) Nontuberculous mycobacteria (D) Protozoa (E) Viruses
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97.
A 42-year-old woman comes to the physician because of anxiety, tremor, and a 5-kg (11-lb) weight loss over the past 4 months despite good appetite. Physical examination shows fine thin hair, exophthalmos, goiter, and warm moist skin. Cardiac examination shows tachycardia and a widened pulse pressure. Which of the following sets of laboratory values is most likely in this patient's serum?
Thyroid-stimulating Total Thyroxine Free Thyroid-binding
(T 4 ) Thyroxine Globulin (A)
↑ ↑ ↑ ↑ (B)
↑ ↑ normal ↓ (C)
↑ normal
↑ ↓ (D) ↓ ↑ ↑ normal (E)
↓ normal
normal ↑ (F) ↓ normal
normal normal
98. A 42-year-old man comes to the physician for a follow-up examination. Four months ago, he underwent repair of a Dupuytren contracture. Physical examination shows decreased range of motion in the affected hand. The patient is upset that his hand has not fully healed, and he files a malpractice suit against the physician. Which of the following is the most likely precipitating factor in this patient's decision to file a malpractice suit?
(A) The patient's perception that the physician is incompetent (B) The patient's perception that the physician is uncaring (C) The patient's socioeconomic status (D) The physician's amount of experience in the medical field (E) The physician's inability to screen out problem patients
An investigator is studying the incidence of the common cold among medical students at various time points during the school year. Results show an increased incidence of upper respiratory tract infections among these students during finals week. It is hypothesized that the stress of studying for examinations adversely affects the immune system, making the students more susceptible to infection. Which of the following laboratory findings in these students during examination week is most likely to support this hypothesis?
(A) Decreased AM serum cortisol concentration (B) Decreased macrophage activity (C) Increased basophil count (D) Increased lymphocyte count (E) Increased natural killer cell activity
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100.
A 28-year-old man comes to the physician because of a 1-year history of pain with urination that has increased in severity during the past month. He also has had episodes of blood in his urine during the past 5 years. He lived in sub-Saharan Africa until he came to the USA 6 months ago for graduate school. His temperature is 38°C (100.4°F), pulse is 80/min, respirations are 16/min, and blood pressure is 110/84 mm Hg. Physical examination shows suprapubic tenderness. Laboratory studies show:
Hemoglobin 12.3 g/dL Hematocrit 37% Leukocyte count 13,400/mm 3
Segmented neutrophils 65%
Bands 5%
Eosinophils 5%
Lymphocytes 22%
Monocytes 3%
Serum
Urea nitrogen 75 mg/dL Creatinine 3.8 mg/dL Urine
Blood
3+ RBC
200/hpf WBC
100/hpf RBC casts absent WBC casts absent
Imaging studies show bilateral hydroureter and hydronephrosis and foci of calcification in the region of the bladder. A biopsy specimen of the bladder shows marked chronic inflammation with fibrosis and scattered granulomas. Which of the following best explains the biopsy findings?
(A) Exposure to a chemical toxin (B) Interstitial cystitis (C) Malacoplakia (D) Schistosomiasis (E) Vesicoureteral reflux
A 2-day-old male newborn delivered at term develops mild jaundice and scleral icterus. Pregnancy and delivery were uncomplicated. His vital signs are within normal limits. Physical examination shows no other abnormalities. This patient most likely has an excess amount of which of the following in his blood?
(A) Biliverdin (B) Direct bilirubin (C) Indirect bilirubin (D) Stercobilin (E) Urobilin (F) Urobilinogen
102.
A 29-year-old man is brought to the physician for removal of a cast from his left leg. He sustained a fracture of the left lower extremity 6 weeks ago and was immobilized in a cast that extended from just below the knee to the foot. At the time of injury, there was severe pain but normal strength in the extremity. When the cast is removed today, physical examination shows a pronounced left footdrop with paresthesia and sensory loss over the dorsum of the left foot and lateral leg. Injury to which of the following nerves is the most likely cause of this patient's condition?
(A) Common fibular (peroneal) (B) Femoral (C) Obturator (D) Sciatic (E) Tibial
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103.
A 16-year-old boy is admitted to the emergency department because of a knife wound to the left side of his chest. An x-ray of the chest shows an air-fluid level in the left side of the chest, partial collapse of the left lung, and elevation of the stomach bubble. The mediastinum is in the midline. Which of the following is the most likely diagnosis?
(A) Hemopneumothorax, not under tension (B) Hemothorax, not under tension (C) Pneumothorax, not under tension (D) Tension hemopneumothorax (E) Tension hemothorax (F) Tension pneumothorax
104.
A 56-year-old man comes to the emergency department because of a 4-day history of colicky right flank pain that radiates to the groin and hematuria. Ultrasound examination of the kidneys shows right-sided hydronephrosis and a dilated ureter. Which of the following is most likely to be found on urinalysis?
(A) Erythrocyte casts (B) Glucose (C) Leukocyte casts (D) Oval fat bodies (E) Uric acid crystals
A 17-year-old girl has never had a menstrual period. Physical examination shows a normal female body habitus, normal breast development, and normal appearing external genitalia. She has no axillary or pubic hair. The patient refuses to have a pelvic or rectal examination. Which of the following is the most likely explanation for the clinical presentation?
(A) Androgen insensitivity (B) Congenital adrenal hyperplasia (C) Ectodermal dysplasia (D) A psychiatric disorder (E) A sex chromosome mosaicism
A 52-year-old man with recently diagnosed type 2 diabetes mellitus comes to the physician for a follow-up examination. Physical examination shows no abnormalities. Laboratory studies show an increased hemoglobin A 1c despite patient compliance with diet and exercise recommendations. Treatment with a sulfonylurea is started. Which of the following is most likely to occur in this patient?
(A) Decreased entry of glucose into the muscle cells (B) Decreased production of glucose from the liver (C) Decreased secretion of insulin from the pancreas (D) Decreased speed of carbohydrate absorption from the intestines (E) Increased entry of glucose into the muscle cells (F) Increased production of glucose from the liver (G) Increased secretion of insulin from the pancreas (H) Increased speed of carbohydrate absorption from the intestines
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107.
A 2-year-old boy is brought to the emergency department because of shortness of breath and left-sided abdominal pain for 3 hours. He appears pale. Physical examination shows hypotension and tachycardia. There is splenomegaly with the spleen tip palpated 8 cm below the left costal margin. Laboratory studies show:
Hemoglobin 5.1 g/dL (N=12.1–14.9) Hematocrit 16% (N=37%–44.4%) Leukocyte count 4500/mm 3
Platelet count 87,000/mm 3 (N=150,000–400,000) A photomicrograph of a Wright-stained peripheral blood smear is shown. Which of the following is the most likely cause of this patient's current condition?
(A) Aplastic crisis (B) Autoimmune hemolysis (C) Congestive heart failure (D) Salmonellal sepsis (E) Splenic sequestration
A 42-year-old woman comes to the physician for a routine examination. She says that she has felt well except for occasional episodes of constipation, abdominal discomfort, and mild fatigue. She was treated for a renal calculus 10 years ago and was told she had a "lazy gallbladder." Her pulse is 82/min, and blood pressure is 150/80 mm Hg. Physical examination shows no other abnormalities. Laboratory studies show:
Erythrocyte count 3 million/mm 3
Serum
K +
4.5 mEq/L Cl –
107 mEq/L Ca
2+
12 mg/dL Phosphorus 2.2 mg/dL Alkaline phosphatase 95 U/L
The most likely cause of this patient's condition is a small, well-defined nodule in which of the following locations?
(A) Adrenal gland (B) Anterior pituitary gland (C) Gallbladder (D) Kidney (E) Parathyroid gland (F) Thymus
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109.
A 24-year-old woman comes to the physician for a follow-up examination. One week ago, she was treated in the emergency department after she accidentally spilled hot grease on her left leg while working at a fast-food restaurant. Examination of the left lower extremity shows a 7-cm, pink, soft, granular, edematous wound. The formation of this tissue was most likely caused by increased activity of which of the following?
(A) Complement C3b (B) Glycosylation-dependent cell adhesion molecule-1 (C) P-selectin (D) Stromelysin (E) Vascular endothelial growth factor
A 37-year-old woman with right lower extremity edema is evaluated because of the sudden onset of shortness of breath and pleuritic chest pain. A diagnosis of pulmonary embolism is made. Which of the following signs, if present on physical examination, would be the most specific indicator of pulmonary arterial hypertension in this patient?
(A) Increased jugular venous pressure (B) P 2 louder than A 2 (C) Peripheral edema (D) Presence of an S 3 (E) Pulmonary crackles
111. Vascular control is studied in an intact hind extremity of an anesthetized experimental animal. After a normal control period, the blood flow to the extremity is completely occluded for 1 minute. When the occlusion is released, blood flow increases abruptly and exceeds the control value for several minutes (reactive hyperemia). After an appropriate recovery period, the procedure is repeated and the extremity is actively exercised during the occlusion period. Which of the following best describes the reactive hyperemia after the second occlusion compared with that after the first occlusion?
(A) Abolished (B) Decreased but not abolished (C) Increased (D) Unchanged
112.
A 72-year-old man collapses while playing golf. He has a 5-year history of angina and type 2 diabetes mellitus. Paramedics arrive in 10 minutes. Examination shows no respirations or blood pressure; an ECG shows asystole. Cardiopulmonary resuscitation is attempted for 10 minutes without success. Which of the following is the most likely cause of death in this patient?
(A) Cardiac tamponade (B) Embolus to the right middle cerebral artery (C) Necrosis of the myocardium (D) Rupture of the papillary muscle (E) Ventricular fibrillation
A previously healthy 3-month-old boy is brought to the physician because of a runny nose and a dry cough for 2 days. Physical examination shows tachypnea, a nasal discharge, and wheezing. An x-ray of the chest shows hyperexpansion but no infiltrates. The causal virus was most likely transmitted by which of the following routes?
(A) Blood transfusion (B) Ingestion of contaminated formula (C) Inoculation onto mucous membranes (D) Insect bite (E) Transplacental transfer
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114.
An 18-year-old man is brought to the emergency department 30 minutes after sustaining a closed head injury in a motor vehicle collision. Twenty-four hours later, he is noted to be excreting large amounts of urine with an osmolality of 100 mOsmol/kg. His serum sodium concentration is 154 mEq/L. Which of the following portions of the kidney is the most likely site of the excessive loss of fluid in this patient?
(A) Afferent arterioles (B) Collecting duct (C) Efferent arterioles (D) Glomeruli (E) Proximal convoluted tubule
A 46-year-old woman receives a non–T-lymphocyte-depleted, allogeneic bone marrow transplant from a matched, unrelated donor. Immunosuppressive therapy with cyclosporine is started. One month later, she has fever. Cytolytic destruction of the skin, gastrointestinal tract, and liver is seen, with associated dermatitis, enteritis, and hepatitis. Which of the following best explains these findings?
(A) C3b deposition (B) Cytomegalovirus infection (C) Graft-versus-host disease (D) Tolerance induction (E) Type I (immediate) hypersensitivity
A 33-year-old woman comes to the physician because of a 2-day history of mild nausea, increased urinary urgency and frequency, and constipation. She also has had a 4.5-kg (10-lb) weight loss during the past 2 weeks and a 3-week history of vaginal bleeding. Pelvic examination shows a nodular cervix with an irregular, friable posterior lip, and a rock-hard, irregular, immobile pelvic mass that extends across the pelvis. Examination of biopsy specimens from the cervix and anterior wall of the vagina show well-differentiated keratinizing squamous cell carcinoma. Which of the following best describes the pathogenesis of this patient's disease?
(A) Inactivation of cellular p53 (B) Insertion of viral promotors adjacent to cellular growth factor genes (C) Specialized transduction (D) Transactivation of cellular growth factor genes by TAX (E) Translocation of CMYC to an Ig gene promoter
A 5-year-old girl is brought to the physician by her father because of a 6-week history of an increasingly severe itchy rash confined to the crease of the elbows and the back of the knees. She has had intermittent episodes of a similar rash since infancy. Examination of the rash shows erythematous papules and vesicles overlying an erythematous base. Dermal scrapings are negative for fungi and ectoparasites. After a short course of a potent topical corticosteroid, treatment with pimecrolimus cream is begun. Which of the following is the primary mechanism of action of this drug?
(A) Blockade of histamine-1 receptors on tissue mast cells (B) Blockade of leukotriene receptors in inflamed tissue (C) Blockade of sodium channels in peripheral sensory nerves (D) Inhibition of IgE binding to tissue mast cells and basophils (E) Inhibition of phospholipase A activity in cell membranes (F) Inhibition of proinflammatory cytokine formation by T lymphocytes
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Answer Form for USMLE Step 1 Sample Test Questions
Block 1 (Questions 1-40)
1.
___ 11.
___ 21.
___ 31.
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2. ___
12. ___
22. ___
32. ___
3. ___ 13.
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4. ___
14. ___
24. ___
34. ___
5. ___ 15.
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6. ___
16. ___
26. ___
36. ___
7. ___ 17.
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___ 37.
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8. ___
18. ___
28. ___
38. ___
9. ___ 19.
___ 29.
___ 39.
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10. ___
20. ___ 30. ___ 40. ___
Block 2 (Questions 41-80)
41. ___
51. ___
61. ___
71. ___
42.
___ 52.
___ 62.
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43. ___ 53.
___ 63.
___ 73.
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44. ___ 54.
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45. ___ 55.
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46. ___ 56.
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47. ___ 57.
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48. ___ 58.
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49. ___ 59.
___ 69.
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50. ___ 60.
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Block 3 (Questions 81-117)
81. ___
91. ___
101. ___
111. ___
82. ___ 92.
___ 102.
___ 112.
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83. ___
93. ___
103. ___
113. ___
84. ___ 94.
___ 104.
___ 114.
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85. ___
95. ___
105. ___
115. ___
86. ___ 96.
___ 106.
___ 116.
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87. ___
97. ___
107. ___
117. ___
88. ___ 98.
___ 108.
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89. ___
99. ___
109. ___
90. ___ 100.
___ 110.
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Answer Key for USMLE Step 1 Sample Test Questions
Block 1 (Questions 1-40)
1. D 2. A
3. A 4. D
5. B 6. A
7. C 8. B
9. G 10. C
11. B 12. C
13. C 14. D
15. B 16. B
17. B 18. A
19. C 20. A
21. A 22. E
23. E 24. A
25. B 26. D
27. A 28. C
29. B 30. A
31. C 32. B
33. D 34. D
35. C 36. B
37. D 38. B
39. C 40. A
41. D 42. D 43. F
44. E 45. B
46. C 47. D
48. B 49. A
50. C 51. C
52. B 53. F
54. B 55. A
56. D 57. A
58. A 59. A
60. D 61. E
62. E 63. C
64. E 65. E
66. D 67. G
68. D 69. A
70. A 71. C
72. B 73. C
74. B 75. E
76. D 77. E
78. E 79. C
80. D
82. C 83. B
84. A 85. A
86. D 87. B
88. C 89. B
90. D
91. E 92. A
93. E 94. D
95. E 96. A
97. D 98. B
99. B 100. D
101. C 102. A 103. A
104. E 105. A
106. G 107. E
108. E 109. E
110. B
111. C 112. E
113. C 114. B
115. C 116. A
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