USMLE Education Corner - Step 1 Quiz (March 2020) | Lincoln American University
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Question 1: 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/mm3 with 20% eosinophils. Which of the following tests is most likely to yield an accurate diagnosis?
Bone marrow biopsy
Microscopic examination of the stool
Question 2: A 63-year-old man is brought to the emergency department because of a 4-day history of increasingly severe left leg pain and swelling of his left calf. He also has a 1-month history of increasingly severe upper midthoracic back pain. During this time, he has had a 9-kg (20-lb) weight loss despite no change in appetite. He has no history of major medical illness. His only medication is ibuprofen. He is 180 cm (5 ft 11 in) tall and weighs 82 kg (180 lb); BMI is 25 kg/m2. His vital signs are within normal limits. On examination, lower extremity pulses are palpable bilaterally. The remainder of the physical examination shows no abnormalities. An x-ray of the thoracic spine shows no abnormalities. A CT scan of the abdomen shows a 3-cm mass in the body of the pancreas; there are liver metastases and encasement of the superior mesenteric artery. Ultrasonography of the left lower extremity shows a femoropopliteal venous clot. Which of the following is the most likely cause of this patient’s symptoms?
Hypercoagulability from advanced malignancy
Multiple endocrine neoplasia
Splenic artery aneurysm and embolic disease of the left lower extremity
Superior mesenteric artery syndrome
Question 3: A new blood test to detect prostate cancer is evaluated in 300 male volunteers. A needle biopsy of the prostate gland is done on all men with serum prostate-specific antigen concentrations greater than 5 ng/mL (N<4). One hundred men undergo biopsy procedures; 90 are found to have prostate cancer, and five are found to have chronic prostatitis. Which of the following is necessary to calculate the sensitivity of this test?
Incidence of chronic prostatitis in the general population
Number of men with test results greater than 5 ng/mL and a normal biopsy specimen
Prevalence of chronic prostatitis in the general population
Prostate biopsies of men with test results equal to or below 5 ng/mL
Question 4: 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?
Inactivation of cellular p53
Insertion of viral promotors adjacent to cellular growth factor genes
Transactivation of cellular growth factor genes by TAX
Translocation of CMYC to an Ig gene promoter
Question 5: A 35-year-old man comes to the physician because of pain and swelling of his right arm where he scraped it on a tree branch 2 days ago. His temperature is 38.3°C (101°F). Examination of the right forearm shows edema around a fluctuant erythematous lesion at the site of trauma. The area is extremely tender to palpation. Which of the following is most likely the primary mechanism of the development of edema in this patient?
Degranulation of eosinophils
Disruption of vascular basement membranes
Increased hydrostatic pressure
Release of thromboxane
Separation of endothelial junctions
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The questions included in this Quiz are selected from the sample test questions issued by the Federation of State Medical Boards of the United States, Inc. (FSMB), and the National Board of Medical Examiners® (NBME®) who holds the copyright of the Sample Test Questions. Selected questions are included in the quiz only for educational purpose under Fair use doctrine.
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