USMLE Step 1 Sample Test Questions - Block 1
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Questions and Answers

Match the following anatomical terms with their corresponding descriptions:

Lesser peritoneal cavity = A space between layers of peritoneum Mesometrium = Part of the broad ligament of the uterus Pouch of Douglas = Cul-de-sac between the uterus and rectum Uterine cavity = The inside of the uterus Vagina = The canal leading from the external genitals to the uterus

In the case of a 46-year-old woman with ankylosing spondylitis whose previous treatments were ineffective, which drug mechanism is the most appropriate next step?

  • Epidermal growth factor
  • Tumor necrosis factor α (correct)
  • Cytotoxic T-lymphocyte antigen 4
  • CD20
  • Interleukin-1 (IL-1)
  • Cyclooxygenase-2
  • What is the likely cause of jaundice in a patient who ingested acetaminophen?

  • Increased hemolysis
  • Increased serum glutathione concentration
  • Decreased generation of urobilinogen
  • Decreased bilirubin conjugation (correct)
  • Activation of biliverdin reductase
  • In a 72-year-old woman showing symptoms and a dullness on percussion over her lung, what is the most likely cause of her condition?

    <p>Aspiration (B)</p> Signup and view all the answers

    Based on the findings in a 62-year-old man with an uncooperative demeanor, which response should the physician make?

    <p>You sound upset. Tell me a little more about that. (C)</p> Signup and view all the answers

    A 54-year-old man with fainting episodes likely suffers from which diagnosis based on his symptoms?

    <p>Second-degree atrioventricular block, type II (E)</p> Signup and view all the answers

    What is the most likely cause of a patient's condition with elevated calcium levels and the provided lab values?

    <p>Parathyroid gland (E)</p> Signup and view all the answers

    What is the likely diagnosis for a 72-year-old woman exhibiting left-sided hemiparesis and slurred speech?

    <p>Ischemic stroke (C)</p> Signup and view all the answers

    In an end-stage renal disease patient on dialysis expressing frustration, which response is most appropriate?

    <p>It is tough to change your diet and fluid intake, but what sorts of things were you doing at first when you were following the recommendations? (A)</p> Signup and view all the answers

    What does Southern blot analysis demonstrate when probing with a cDNA clone for an immunoglobulin-constant region?

    <p>Gene rearrangement (B)</p> Signup and view all the answers

    What condition is indicated by a 17-year-old girl with no menstrual periods and no secondary sexual characteristics?

    <p>Androgen insensitivity (E)</p> Signup and view all the answers

    What organism is likely found in peritoneal fluid of a patient with perforated appendicitis?

    <p>Escherichia coli (D)</p> Signup and view all the answers

    What medication is likely prescribed for a 45-year-old woman experiencing symptoms of menopause?

    <p>Hormone therapy (B)</p> Signup and view all the answers

    What is the best representation of absolute risk reduction for vomiting among patients in the azithromycin group compared to erythromycin in a clinical trial?

    <p>0.2 (C)</p> Signup and view all the answers

    What mechanism is likely causing ongoing hepatocyte injury in a 34-year-old woman with hepatitis C showing lymphocytic infiltration and early fibrosis?

    <p>Self-peptides bound to class I MHC molecules are recognized by CD8+ T lymphocytes (D)</p> Signup and view all the answers

    If a patient has untreated hypertension, which of the following is most likely to decrease over time?

    <p>Left ventricular stiffness during diastole (E)</p> Signup and view all the answers

    In comparing pulmonary function testing before and after biopsy for chronic inflammatory interstitial pneumonitis, which pattern is most likely observed?

    <p>↓, ↑, ↑ (G)</p> Signup and view all the answers

    What virulence factor is likely produced by a gram-positive organism causing necrotizing wound infections?

    <p>α-Toxin (E)</p> Signup and view all the answers

    What is the most likely cause of rash in a 4-month-old boy with severe combined immunodeficiency post-bone marrow transplant?

    <p>Graft-versus-host disease (B)</p> Signup and view all the answers

    Which of the following is the most likely mechanism of action of the additional antibiotic on bacteria?

    <p>Competition with p-aminobenzoic acid (A)</p> Signup and view all the answers

    Which of the following additional findings is most likely in this patient?

    <p>Decreased activity of UDP glucuronosyltransferase (B)</p> Signup and view all the answers

    Which of the following types of drugs is most likely to produce effects most similar to those of drug X?

    <p>Cholinesterase inhibitor (A)</p> Signup and view all the answers

    This treatment is most likely to prevent which of the following in this mother?

    <p>Formation of antibodies to RhD (D)</p> Signup and view all the answers

    Physical examination is most likely to show which of the following findings?

    <p>85/60 mm Hg, increased jugular venous pressure, increased pulsus paradoxus (B)</p> Signup and view all the answers

    Which of the following drugs was most likely prescribed for this patient?

    <p>Metformin (B)</p> Signup and view all the answers

    Which of the following physical findings is most likely in this patient?

    <p>Petechiae (C)</p> Signup and view all the answers

    Which of the following is the most likely cause of these symptoms?

    <p>Polyclonal T-lymphocyte activation (B)</p> Signup and view all the answers

    Which of the following is the most appropriate initial action by the physician?

    <p>Reassure the patient that her chance of becoming addicted to narcotics is minuscule (C)</p> Signup and view all the answers

    Which of the following ligand → receptor pairs most likely played a primary role in the proliferation of the T lymphocytes present at the site of the rash?

    <p>CD28 on T lymphocytes → CD80 on epidermal Langerhans cells (D)</p> Signup and view all the answers

    Which of the following processes in these subjects is most likely inhibited by the increased malonyl-CoA concentration?

    <p>Fatty acid oxidation (A)</p> Signup and view all the answers

    This study is best described as which of the following?

    <p>Open-labeled clinical trial (D)</p> Signup and view all the answers

    Which of the following is the most likely cause of this patient’s symptoms?

    <p>Hypercoagulability from advanced malignancy (B)</p> Signup and view all the answers

    Which of the following best describes this mass?

    <p>Sertoli-Leydig tumor (D)</p> Signup and view all the answers

    Which of the following is most likely the primary mechanism of the development of edema in this patient?

    <p>Separation of endothelial junctions (A)</p> Signup and view all the answers

    This patient most likely has impairment of which of the following oculomotor functions?

    <p>Upward gaze (B)</p> Signup and view all the answers

    Which of the following is the strongest predisposing risk factor for this patient's condition?

    <p>Type 2 diabetes mellitus (D)</p> Signup and view all the answers

    The infectious agent causing these findings most likely began to proliferate in which of the following locations?

    <p>Hair follicle (A)</p> Signup and view all the answers

    Which of the following processes is most likely to be involved in this case?

    <p>Elaboration of proteases and urease with local tissue destruction (B)</p> Signup and view all the answers

    Which of the following nerves is most likely injured?

    <p>Common fibular (peroneal) (D)</p> Signup and view all the answers

    Fluid from this rupture will most likely be found in which of the following locations?

    <p>Retroperitoneal space (E)</p> Signup and view all the answers

    In a 46-year-old woman with active ankylosing spondylitis who has not improved with NSAIDs or sulfasalazine, which drug should be administered next?

    <p>Tumor necrosis factor α (C)</p> Signup and view all the answers

    In a 55-year-old man with widespread blisters due to adhesion failure, which structure is most likely involved?

    <p>Basement membrane (D)</p> Signup and view all the answers

    What is the most likely explanation for jaundice following an acetaminophen overdose treatment in a 17-year-old girl?

    <p>Decreased bilirubin conjugation (D)</p> Signup and view all the answers

    In a 72-year-old woman with respiratory symptoms and dullness over the right lung, what is the most likely cause of her condition?

    <p>Aspiration (C)</p> Signup and view all the answers

    What is the most appropriate response by the physician to a patient who is uncooperative during an interview?

    <p>&quot;You sound upset. Tell me a little more about that.&quot; (D)</p> Signup and view all the answers

    In a 54-year-old man with a history of fainting, what is the most likely diagnosis considering his presented symptoms?

    <p>Second-degree atrioventricular block, type II (A)</p> Signup and view all the answers

    What is the most likely cause of the condition in a 42-year-old woman with abnormal laboratory results?

    <p>Parathyroid gland (E)</p> Signup and view all the answers

    In a 72-year-old woman with sudden neurological symptoms, which brain stem area is likely damaged?

    <p>Area C (B)</p> Signup and view all the answers

    What is the most appropriate initial response by a physician to a patient frustrated with dialysis treatments?

    <p>&quot;It is tough to change your diet and fluid intake, but what sorts of things were you doing at first when you were following the recommendations?&quot; (B)</p> Signup and view all the answers

    What does a Southern blot analysis primarily demonstrate?

    <p>Gene rearrangement (E)</p> Signup and view all the answers

    What is the most likely explanation for a 17-year-old girl who has never had a menstrual period?

    <p>Androgen insensitivity (B)</p> Signup and view all the answers

    In a 16-year-old boy with abdominal pain and vomiting, what organism is likely found in peritoneal fluid from a perforated appendix?

    <p>Escherichia coli (C)</p> Signup and view all the answers

    What is the next most appropriate physician statement regarding hormone therapy for menopause symptoms?

    <p>&quot;Could you tell me your thoughts about the hormone treatment option we have discussed?&quot; (B)</p> Signup and view all the answers

    What is the absolute risk reduction for vomiting among patients in the azithromycin group in a trial with 5 patients vs. 15 patients vomiting?

    <p>0.2 (E)</p> Signup and view all the answers

    What is the most likely mechanism causing ongoing hepatocyte injury in a patient with hepatitis C?

    <p>Self-peptides bound to class I MHC molecules are recognized by CD8+ T lymphocytes (E)</p> Signup and view all the answers

    If left untreated, which of the following will likely decrease in a patient with chronic hypertension?

    <p>Left ventricular stiffness during diastole (A)</p> Signup and view all the answers

    In a 62-year-old man with chronic inflammatory interstitial pneumonitis, what pattern in lung cell populations is most likely observed?

    <p>↓, ↑, ↑ (G)</p> Signup and view all the answers

    What virulence factor is most likely produced by the organism causing a foul-smelling wound in a diabetic patient?

    <p>α-Toxin (C)</p> Signup and view all the answers

    What is the most likely cause of a rash in a 4-month-old boy after a bone marrow transplant?

    <p>Graft-versus-host disease (C)</p> Signup and view all the answers

    Which of the following is the most likely mechanism of action of the additional antibiotic on bacteria?

    <p>Competition with p-aminobenzoic acid (B)</p> Signup and view all the answers

    Which of the following additional findings is most likely in this patient?

    <p>Decreased activity of UDP glucuronosyltransferase (A)</p> Signup and view all the answers

    Which of the following types of drugs is most likely to produce effects similar to those of drug X?

    <p>Cholinesterase inhibitor (C)</p> Signup and view all the answers

    This treatment is most likely to prevent which of the following in this mother?

    <p>Formation of antibodies to RhD (A)</p> Signup and view all the answers

    Physical examination is most likely to show which of the following findings?

    <p>Blood Pressure 85/60, Jugular Venous Pulse increased, Pulsus Paradoxus increased (A)</p> Signup and view all the answers

    Which of the following drugs was most likely prescribed for this patient?

    <p>Metformin (B)</p> Signup and view all the answers

    Which of the following physical findings is most likely in this patient?

    <p>Petechiae (C)</p> Signup and view all the answers

    Which of the following is the most likely cause of these symptoms?

    <p>Polyclonal T-lymphocyte activation (C)</p> Signup and view all the answers

    Which of the following initial actions by the physician is most appropriate?

    <p>Reassure the patient that her chance of becoming addicted to narcotics is minuscule (C)</p> Signup and view all the answers

    Which of the following ligand → receptor pairs most likely played a primary role in the proliferation of the T lymphocytes present at the site of the rash in this patient?

    <p>CD28 on T lymphocytes → CD80 on epidermal Langerhans cells (D)</p> Signup and view all the answers

    The increased malonyl-CoA concentration most likely directly inhibits which of the following processes in these subjects?

    <p>Fatty acid oxidation (C)</p> Signup and view all the answers

    This study is best described as which of the following?

    <p>Open-labeled clinical trial (E)</p> Signup and view all the answers

    Which of the following is the most likely cause of this patient’s symptoms?

    <p>Hypercoagulability from advanced malignancy (C)</p> Signup and view all the answers

    Which of the following best describes this mass?

    <p>Sertoli-Leydig tumor (C)</p> Signup and view all the answers

    Which of the following is most likely the primary mechanism of the development of edema in this patient?

    <p>Separation of endothelial junctions (E)</p> Signup and view all the answers

    This patient most likely has impairment of which of the following oculomotor functions?

    <p>Upward gaze (A)</p> Signup and view all the answers

    Which of the following is the strongest predisposing risk factor for this patient's condition?

    <p>Hypertension (D)</p> Signup and view all the answers

    The infectious agent causing these findings most likely began to proliferate in which of the following locations?

    <p>Eccrine gland (E)</p> Signup and view all the answers

    Which of the following processes is most likely to be involved?

    <p>Hyperacidity and gastric ulcer development (D)</p> Signup and view all the answers

    Which of the following nerves is most likely injured?

    <p>Common fibular (peroneal) (B)</p> Signup and view all the answers

    Fluid from this rupture will most likely be found in which of the following locations?

    <p>Abdominal cavity (B)</p> Signup and view all the answers

    Flashcards

    Bicuspid aortic valve infection

    A 67-year-old woman with a bicuspid aortic valve develops fever and chills, diagnosed with viridans streptococci infection.

    Intermittent jaundice

    12-year-old girl with intermittent yellowing of eyes/skin, normal haptoglobin, AST, and ALT.

    Smooth muscle response to Drug X

    Drug X increases smooth muscle tension in response to acetylcholine, but not norepinephrine.

    Rh-negative mother, Rh-positive father

    28-week pregnant Rh-negative woman with Rh-positive partner, Rho(D) immune globulin recommendation.

    Signup and view all the flashcards

    Low voltage ECG, electrical alternans

    55-year-old man with shortness of breath, confusion, low voltage ECG with electrical alternans.

    Signup and view all the flashcards

    Type 2 diabetes, decreased hepatic glucose

    52-year-old diabetic woman, pharmacotherapy decreases hepatic glucose output and increases tissue glucose uptake.

    Signup and view all the flashcards

    HIV infection, low blood counts

    44-year-old asymptomatic man with HIV infection, low Hemoglobin, Hematocrit, Leukocytes, and Platelets.

    Signup and view all the flashcards

    Antithymocyte globulin, adverse effects

    23-year-old woman with bone marrow failure, antithymocyte globulin treatment causing fever, lymphadenopathy, arthralgia, and rash.

    Signup and view all the flashcards

    Pain, addiction concern

    42-year-old woman with multiple injuries, morphine concern for addiction despite no history of it.

    Signup and view all the flashcards

    Skin rash, hair dye link

    22-year-old woman with rash linked to recent hair dye use - likely allergic reaction.

    Signup and view all the flashcards

    Hyperglycemia, malonyl-CoA

    Increased malonyl-CoA during hyperglycemia, inhibits fatty acid oxidation.

    Signup and view all the flashcards

    Clinical trial design

    Study of tyrosine kinase inhibitor in chronic myeloid leukemia patients, progressive dose increase.

    Signup and view all the flashcards

    Leg pain, weight loss, pancreas mass

    63-year-old man with leg pain, swelling, upper back pain, and weight loss, linked to pancreatic tumor.

    Signup and view all the flashcards

    Facial hair growth, ovarian mass

    40-year-old woman with increased facial hair and clitoral enlargement. Diagnosed with ovarian tumor.

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    Edema, scraped arm

    35-year-old man with scraped arm edema. Likely inflammatory process.

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    Headache, oculomotor dysfunction

    14-year-old with headache, vomiting, papilledema, pineal tumor, impacting brain stem and leading to hydrocephalus.

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    Abdominal pain, kidney enlargement

    52-year-old man with abdominal pain, enlarged kidney, possible related to history of renal issues and risk factors.

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    Rash, Caribbean cruise

    24-year-old man from Caribbean cruise, rash that may be linked related to water exposure and infection.

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    Epigastric heartburn, occult blood

    45-year-old man with epigastric heartburn, weight loss, and occult blood in stool, possible ulcer or other inflammatory problems.

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    Foot Drop, nerve injury

    14-year-old boy hit on leg below knee, unable to dorsiflex foot, suggestive of common fibular nerve injury.

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    Ankylosing Spondylitis Treatment

    Treatment for ankylosing spondylitis that is resistant to NSAIDs and sulfasalazine involves targeting IL-1 or TNF-α.

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    Recurrent Blister Formation

    Recurrent, widespread blisters, especially in flexural areas (armpits, groin), not easily breaking, are often due to basement membrane adhesion failure.

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    Acetaminophen Poisoning Jaundice

    Acetaminophen overdose, especially with late-stage complications like severe liver damage, can cause jaundice due to decreased bilirubin conjugation.

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    Pneumonia Cause (Case Study)

    A patient with pneumonia in the lower right lung, fever, dyspnea, and hypoxemia, is likely to have aspirated something.

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    Patient Non-Cooperation (Case Study)

    To effectively address a patient who responds with monosyllabic or sarcastic answers and avoids eye contact, use a compassionate approach, focusing on understanding their feelings.

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    Fainting Episodes (Case Study)

    Fainting, fatigue, and cannon a waves, along with a low pulse rate and an apparent dissociation between P-wave and R-wave rates, suggest third-degree atrioventricular block.

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    Constipation and Fatigue (Case Study)

    High calcium, low phosphorus levels, along with constipation and mild fatigue, can indicate a parathyroid issue.

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    Stroke Symptoms (Case Study)

    Sudden-onset difficulty walking and speaking with hemiparesis (one-sided weakness), along with tongue deviation, indicates a stroke.

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    Poor Dialysis Adherence

    A patient with end-stage renal disease and fluid overload due to poor adherence to diet and fluid restrictions needs empathy and support.

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    Southern Blot Analysis

    Southern blot analysis, using restriction enzymes and cDNA probes to identify and differentiate DNA sequences present in different organs.

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    Primary Amenorrhea (Case Study)

    Absence of menstruation in a girl with typical female physical development and external genitalia, along with a lack of pubic/axillary hair, suggests a hormonal or genetic disorder, not a mental health issue.

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    Peritoneal Fluid Infection

    A perforated appendix, due to infection, leads to typical peritoneal fluid contamination with bacteria, specifically with gram-positive rods.

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    Menopause Symptoms

    Menopause-like symptoms that include hot flashes, night sweats, and insomnia, with a negative pregnancy test, likely require hormone therapy.

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    Azithromycin and Vomiting

    Azithromycin in pertussis treatment has a lower absolute risk of vomiting compared to erythromycin.

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    Hepatitis C and Hepatocyte Injury (Case Study)

    Ongoing hepatocyte damage in chronic Hepatitis C patients is usually caused by a cellular immune response to foreign peptides presented by class I-MHC molecules activating CD8+ T lymphocytes or T cells.

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    Bicuspid aortic valve infection

    A 67-year-old woman with a bicuspid aortic valve, experiencing fever and chills, diagnosed with viridans streptococci infection.

    Signup and view all the flashcards

    Intermittent jaundice

    12-year-old girl with intermittent yellowing of eyes/skin, normal haptoglobin, AST, and ALT.

    Signup and view all the flashcards

    Smooth muscle response to Drug X

    Drug X increases smooth muscle tension in response to acetylcholine, but not norepinephrine.

    Signup and view all the flashcards

    Rh-negative mother, Rh-positive father

    28-week pregnant Rh-negative woman with Rh-positive partner, Rho(D) immune globulin recommended to prevent Rh incompatibility issues.

    Signup and view all the flashcards

    Low voltage ECG, electrical alternans

    55-year-old man with shortness of breath, confusion, low voltage ECG with electrical alternans.

    Signup and view all the flashcards

    Type 2 diabetes, decreased hepatic glucose

    52-year-old diabetic woman, pharmacotherapy leads to decreased hepatic glucose output and increased tissue glucose uptake.

    Signup and view all the flashcards

    HIV infection, low blood counts

    44-year-old asymptomatic man with HIV infection, low Hemoglobin, Hematocrit, Leukocytes, and Platelets.

    Signup and view all the flashcards

    Antithymocyte globulin, adverse effects

    23-year-old woman with bone marrow failure, antithymocyte globulin treatment causes fever, lymphadenopathy, arthralgia, and rash.

    Signup and view all the flashcards

    Pain, addiction concern

    42-year-old woman with multiple injuries, morphine concern for addiction despite no history of it.

    Signup and view all the flashcards

    Skin rash, hair dye link

    22-year-old woman with rash linked to recent hair dye use, likely allergic reaction.

    Signup and view all the flashcards

    Hyperglycemia, malonyl-CoA

    Increased malonyl-CoA during hyperglycemia, directly inhibits fatty acid oxidation.

    Signup and view all the flashcards

    Clinical trial design

    Study of tyrosine kinase inhibitor in chronic myeloid leukemia patients, progressive dose increase.

    Signup and view all the flashcards

    Leg pain, weight loss, pancreas mass

    63-year-old man with leg pain, swelling, upper back pain, and weight loss, linked to pancreatic tumor.

    Signup and view all the flashcards

    Lesser peritoneal cavity

    A smaller part of the peritoneal cavity, a space surrounded by the peritoneum, the membrane lining the abdominal cavity.

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    Mesometrium

    Part of the broad ligament of the uterus.

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    Pouch of Douglas

    The lowest part of the female peritoneal cavity, between the rectum and the uterus.

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    Uterine cavity

    The inside space of the uterus.

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    Vagina

    The female genital canal, connecting the uterus to the exterior of the body.

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    Ankylosing Spondylitis Treatment

    Treatment resistant to NSAIDs and sulfasalazine requires targeting Interleukin-1 or Tumor Necrosis Factor α.

    Signup and view all the flashcards

    Recurrent Blister Formation

    Skin blisters, especially in skin folds, caused by basement membrane adhesion problems.

    Signup and view all the flashcards

    Acetaminophen Poisoning Jaundice

    Liver damage from acetaminophen overdose leads to reduced bilirubin conjugation, resulting in jaundice.

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    Pneumonia Cause (Case Study)

    Pneumonia in the lower right lung, fever, and shortness of breath suggests aspiration.

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    Patient Non-Cooperation (Case Study)

    Responding to a non-cooperative patient with monosyllabic or sarcastic answers and avoiding eye contact requires a compassionate, understanding approach.

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    Fainting Episodes (Case Study)

    Fainting and fatigue, along with abnormal heart rhythms suggest an atrioventricular (AV) block (specifically, third-degree AV block).

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    Constipation and Fatigue (Case Study)

    High calcium, low phosphorus levels might indicate a parathyroid issue, causing constipation and fatigue.

    Signup and view all the flashcards

    Stroke Symptoms (Case Study)

    Sudden-onset difficulty walking and talking, one-sided weakness, and tongue deviation indicate a stroke.

    Signup and view all the flashcards

    Study Notes

    USMLE Step 1 Sample Test Questions - Block 1, Items 1-40

    • Question 1: A 67-year-old woman with a bicuspid aortic valve has a 2-day history of fever and chills. Blood cultures show viridans streptococci susceptible to penicillin. An additional antibiotic, synergistic to penicillin, is administered. The most likely mechanism of action of the additional antibiotic is inhibition of DNA gyrase.

    • Question 2: A 12-year-old girl has intermittent jaundice. Total bilirubin is 3 mg/dL, with a direct component of 1 mg/dL. Haptoglobin, AST, and ALT are normal. Decreased activity of UDP glucuronosyltransferase is likely.

    • Question 3: Drug X is added to a muscle bath containing smooth muscle. The table shows effects of various agonists on muscle tension before and after adding drug X. A similar drug's effect would be an a₁-adrenergic antagonist.

    • Question 4: A 30-year-old woman, gravida 2, at 28 weeks' gestation, is Rh-negative and her partner is Rh-positive. Rho(D) immune globulin prevents the development of antibodies to RhD in the mother.

    • Question 5: A 55-year-old man presents with shortness of breath, confusion, and an ECG showing low voltage with electrical alternans. Increased or decreased blood pressure and increased or decreased jugular venous pressure are likely found.

    • Question 6: A 52-year-old woman with type 2 diabetes mellitus begins pharmacotherapy. Four weeks later, hepatic glucose output is decreased and target tissue glucose uptake is increased. Metformin is likely prescribed.

    • Question 7: A 44-year-old man with HIV is found to have low hemoglobin, low hematocrit, low leukocyte count, low platelets, prolonged prothrombin time, and prolonged partial thromboplastin time. Petechiae are likely.

    • Question 8: A 23-year-old woman with bone marrow failure is treated with rabbit antithymocyte globulin. Immune complex deposition in tissues is the likely cause for fever, lymphadenopathy, arthralgias, and erythema.

    • Question 9: A 42-year-old female undergoes multiple surgeries. She is receiving morphine via a PCA pump. Reassuring the patient about the low chance of addiction is appropriate.

    • Question 10: A 22-year-old woman has an itchy rash on her right forearm after using new hair dye. CD40L on T lymphocytes → CD40 on epidermal Langerhans cells is the likely ligand-receptor pair.

    • Question 11: Six healthy subjects have hyperglycemia and hyperinsulinemia induced. Fatty acid oxidation is likely inhibited by the increased malonyl-CoA concentration.

    • Question 12: A study of chronic myeloid leukemia in blast crisis uses a tyrosine kinase inhibitor. The study type is best described as an open-labeled clinical trial.

    • Question 13: A 63-year-old man presents with left leg pain and swelling, weight loss, and back pain. He has a 3-cm pancreatic mass and liver metastases. Hypercoagulability from advanced malignancy is a likely cause.

    • Question 14: A 40-year-old woman has increased facial hair growth, amenorrhea for 4 months. Pelvic examination shows clitoral enlargement and increased serum testosterone levels. A 12-cm ovarian mass is likely a Sertoli-Leydig tumor.

    • Question 15: A 35-year-old man has a wound infection on his arm. Increased hydrostatic pressure from inflammation is likely to cause edema.

    • Question 16: A 12-year-old boy has headaches and nausea. MRI shows a tumor in the pineal region compressing the brain stem. Upward gaze is most likely impaired.

    • Question 17: A 52-year-old man has nausea, vomiting, and abdominal pain. His history includes diabetes, hyperlipidemia, hypertension, and atrial fibrillation, and smoking. Past smoking history is the strongest predisposing risk factor for his condition.

    • Question 18: A 24-year-old man has a red, itchy rash on his buttocks and legs after a Caribbean cruise with pool and hot tub use. Hair follicle is the most likely location for the causative agent to proliferate.

    • Question 19: A 45-year-old man has epigastric heartburn, weight loss, and a positive stool occult blood test. Hyperacidity and gastric ulcer development is likely.

    • Question 20: A 14-year-old boy is injured below his knee, and cannot dorsiflex his foot. The common fibular (peroneal) nerve is injured.

    • Question 21: A 26-year-old woman has severe back and abdominal pain, vaginal bleeding, and pelvic abnormalities in a pregnancy. Pouch of Douglas is the likely location for fluid.

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    Test your knowledge with this sample quiz featuring 40 questions based on USMLE Step 1 content. The questions cover various topics including pharmacology, microbiology, and pathology. Perfect for medical students preparing for their exams.

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