USMLE Step 1 Question of the Week #7

A 24-year-old woman presents to physician with complain of cough and wheezing for three days. She mentions that she has been experiencing similar episodes for last two years and the episodes are more frequent in winter months as compared to other seasons. Cough is usually non-productive or with scanty expectoration. Use of inhaled salbutamol, as prescribed by his physician one year back, quickly relieves her symptoms. Her mother is a known case of allergic rhinitis. On physical examination, her temperature is 98.4ºF (36.9ºC), pulse rate is 84/minute, blood pressure is 128/80 mm Hg, and respirations are 22/minute. Auscultation of her lungs shows presence of end-expiratory wheezing bilaterally. Her peak expiratory flow rate is 70% of expected for her age, which improves to 90% of expected for her age after use of inhaled salbutamol. The physician suggests her a few laboratory investigations for diagnostic evaluation. Her differential white blood cell count show 9% of eosinophils and microscopic examination of her sputum shows numerous eosinophils and crystals.

Which of the following proteins is most likely to be present in the crystals?

A. Spondin-1

B. Protein

C. E-selectin

D. Galectin-10

E. Laminin

QID # 2311

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USMLE Step 1 Question of the Week #6

6. A 48-year-old Japanese man presents to the clinic with multiple skin lesions as seen in the image:

question_1516709137

He also complains of unintentional loss of weight even on a good diet and a healthy appetite. He denies smoking or alcohol abuse. On examination, the lesions are flat, velvety, hyperpigmented well defined lesions with a stuck-on appearance. The rest of the physical examination is unremarkable. Which of the following is the best investigation to be considered next in this patient?

A. Biopsy of lesion

B. Chest x-ray

C. Chest CT

D. Abdominal CT

E. Electrolytes

QID#961

USMLE Step 1 Question of the Week #5

A 68-year-old male, a recent immigrant from Africa, and a known case of hypertension for the last five years, presents in emergency with a complaint of difficulty in vision for last one day. The patient had similar episodes in the past, but they resolved by themselves. He was taking antihypertensive medications for last three years, and his blood pressure has been under control. His father died due to road accident when he was only seven years old. All other family members are healthy. On examination, his pulse is 104 beats/mins, BP 140/80 mmHg, respiratory rate is 17 breath/min. Chest and cardiovascular examinations are normal. Abdominal examination reveals a mass in left lumbar region. Laboratory studies show:

Hemoglobin:                18.8 g/dL

Leukocytes:                 9200/mm3

Platelet count:              259000 /mm3

Random Blood Sugar: 107 mg//dL

Blood Urea Nitrogen:   19 mg/dL

Serum Creatinine:        1.4 mg/dL

Serum Sodium:                        140 mEq/L

Serum Potassium:        4.0 mEq/L

Serum Calcium:           8.9 mg/dL

Serum Magnesium:      1.6 mEq/L

Serum Bicarbonate:     24 mEq/L

Serum Cholesterol:      210 mg/dL

HbA1c:                        6.3

After CT scan brain, the patient underwent a whole body imaging. Images are shown below:

question_222

Which of the following genes are responsible for this disease from which patient is suffering?

A. VHL suppressor gene

B. FGFR3 gene

C. CFTR gene

D. CNBP and DMPK genes

E. COL1A

Ref: Q.ID #953

USMLE Step 1 – Question of the Week #4

A 40-year-old female patient presents with soft nodules on the volar aspect of her fourth and fifth fingertips. The nodules are painful on flexion and interfere with her day to day work. She recounts being bitten by a stray dog, about one year back, on these same fingertips. At that time, she was treated with painkillers, anti-rabies injection and antibiotics. The wound had healed well and there were no complaints until recently. On examination, there is a soft fleshy mass about 1.0 cm in diameter on the volar aspect of both the fourth and fifth fingertips. The mass was surgically excised and was histologically found to be a neuroma of a peripheral sensory receptor.

question_1530768632.png

Which of these receptors is most likely involved?

A. Merkel cells

B. Muscle spindles

C. Meissner corpuscles

D. Free nerve endings

E. Pacinian corpuscles

USMLE Step 1 – Question of the Week #3

A 25-year- old healthy male participated in a running competition. After finishing running, his heart rate was 140/minute, blood pressure was 136/90 mm Hg, and respiratory rate was 20/minute. Also, he had perspired significantly.

Which of the following changes in renal hemodynamics is not expected due to activation of sympathetic nervous system?

A. Decreased renal plasma flow

B. Decreased hydrostatic pressure in glomerular capillaries

C. Decreased glomerular filtration rate

D. Decreased filtration fraction
E. Decreased hydrostatic pressure in peritubular capillaries

USMLE Step 1 – Question of the Week #2

A 38-year-old man presents to physician with complains of excessive thirst and excessive passage of urine for last one week. He also mentions that he has to get up at night for urination, which was not a problem a few days before. He is an otherwise healthy man with no known medical condition. Physical examination of the man is normal. Important findings in laboratory evaluation are as follows:

Urine osmolality          175 mOsmol/kg H2O

Urine specific gravity  1.002

Serum osmolality        290 mOsmol/kg H2O

The man was advised to undergo water deprivation test, which confirmed that urine osmolality remained less than 300 mOsmol/kg H2O and it did not improve after administration of antidiuretic hormone.  After appropriate laboratory evaluation, the physician confirms that the man’s condition is due to an electrolyte abnormality. Which of the following electrolyte abnormalities is known to cause the condition the man is suffering from? Access full Qbank at https://ArcherReview.com – 30 day free trial. 

A. Hypokalemia

B. Hypochloremia

C. Hypocalcemia

D. Hypomagnesemia

E. Hyponatremia

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.

STEP1PIC2

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)