USMLE Step 1 Question of the Week #11

A 27-year-old woman comes to the clinic and complains of difficulty with sexual intercourse. History taking proves to be difficult as she is very unwilling to discuss her perceived reasons for the difficulties. She claims that she is in a new relationship and met her current partner two weeks ago. In addition, she reports that she has never had any problem in initiating and maintaining sexual activity in her past relationships and that the lack of desire has also never been a problem. Apart from this, she states that she was sexually abused when she was a child but does not want to talk about it at all. Her chief complaint is that she has pain and stiffness during intercourse and that this has started only with this relationship. On examination, the physiciannotices some resistance during vaginal examination and the patient also complains of pain when he attempts this examination. What is the most likely diagnosis?

A. Dyspareunia

B. Vaginismus

C. Hypoactive sexual disorder

D. Sexual aversion disorder

E. Female sexual arousal disorder

QID #809


USMLE Step 1 Question of the Week #10

A 64-year-old post-menopausal woman has been recently diagnosed with breast cancer stage II. After necessary investigations, surgical excision of the tumor was performed and the excised tissue was sent for histopathological examination, which showed that her tumor cells were positive for estrogen receptors. She was prescribed combination of tamoxifen and cytotoxic chemotherapy. On her follow up after 6 weeks, she complained of hot flashes and vaginal bleeding. The physician explained that the symptoms were due to side effects of tamoxifen. After complete physical examination, her blood sample was sent for follow up laboratory examination, which showed an electrolyte imbalance.

Provided that her other medications are not interfering with electrolyte balance, which of the following electrolyte defects is most likely caused by tamoxifen?

A. Hypercalcemia
B. Hypernatremia
C. Hyperkalemia
E. Hypermagnesemia

QID #895

USMLE Step 1 – Question of the Week#1

Q1. A 27-year-old man presents to physician with complain of pain in left thigh for last one month. Physical examination shows presence of a painful swelling just above left knee joint. Radiogram of left leg shows a radio-lucent lesion which is located eccentrically near lower end of femur. The lesion is surrounded by a thin rim of bone and soap-bubble appearance is present.


After necessary evaluation, en bloc resection of the lesion is performed and is sent for microscopic examination. Histology of the lesion shows multi-nuclear giant cells in network of sheets of oval mononuclear cells. Necrosis and mitotic activity are present in the lesion and reactive bone is present at the periphery.

Which of the following mechanisms best describe pathogenesis of the bone lesion?

A. Dysregulation of RANKL-RANK signaling cascade

B. Increased production of 2-hydroxyglutarate

C. Defective diffusion of Indian hedgehog factor

D. Inactivating mutation of a tumor suppressor gene

E. Activation of Gs protein and increased production of cyclic adenosine monophosphate (cAMP)