USMLE Step 1: Free Practice Quiz

A 50 years old patient comes with a history of acute onset of lip swelling, urticarial rash, and itching all over the body for the past two hours. He is a known patient of hypertension, diabetes, and osteoarthritis. He was recently diagnosed with chronic kidney disease. His antihypertensive medication was changed from amlodipine to Lisinopril because of the complaints of constipation. His medications include Lisinopril chlorthalidone, and ibuprofen.

Which of the following is the possible cause of the present condition of the patient?

A 70-year-old man with a history of hypertension and coronary artery disease presents to the emergency department with non-specific visual changes. Ophthalmoscopy revealed a normal eye exam. The visual field done showed the following result.

Researchers develop a novel drug to treat HIV infection. In an in vitro experiment, wild-type viral isolates are cultured with human CD T lymphocytes in the presence of the drug. Microscopic evaluation of these calls reveal no cytopathic changes, and no intracellular viral particles can be detected. Further analysis reveals that in the presence of the drug, the virus attaches to the cellular membrane, but the fusion of the virus and cell membranes does not occur.

Which of the following is the most likely target of this medication?

An unresponsive 60-year-old male is brought to the emergency department after sustaining a gunshot wound to the abdomen. Vital signs: Temperature is 99.0°F (37.2°C), blood pressure is 95/58 mmHg, the pulse is 115/min, and respirations are 20/min.  Abdominal examination reveals an entry wound in the left abdominal quadrant just inferior to the left lateral coastal border. Abdominal CT shows the bullet is lodged in a retroperitoneal structure. 

Which of the following structures has the bullet most likely penetrated?

A 70-year-old man is brought to the emergency department because of the sudden onset of pain on the right side of his chest following a deep cough. An X-ray of the chest shows a fractured rib, and a bone scan shows multiple osteoblastic lesions distributed primarily in the lumbar spine, pelvis, and ribs. A complete blood count and the result of a chemistry profiling, urinalysis, and protein electrophoresis are within the reference ranges.

Which of the following is the diagnosis?

A 50-year-old man presents to his primary care physician for pain in the epigastrium and has been persistent. He also complains of episodes of night sweats and unintentionally lost 20 pounds over the course of four months. He has a past medical history of H. pylori infection and a BMI of 30 kg/m2. Physical examination is notable for epigastric abdominal tenderness upon palpation. An upper endoscopy demonstrates an invasive ulcerative lesion in the stomach. A diagnosis of Gastric Adenocarcinoma is made. 

What complications should be considered with this diagnosis?

A 45 -year-old woman with a longstanding history of gastroesophageal reflux and hiatal hernia presents to the clinic for a routine checkup.  She complains of pain and a sticking sensation after swallowing solid foods, even a piece of bread for the past six months. She needs to drink water in order to swallow the food.  Her current medication is oral antacids, which lately have not been as effective. He denies any fever, change in bowel movements, or weight loss. 

What is the most likely diagnosis?

A 3-year-old girl is brought to the clinic complaining of dark red urine for the past two days. The patient was treated for facial impetigo six weeks ago. Blood pressure is 140/90 mmHg. Urinalysis reveals hematuria, mild proteinuria, and occasionally red blood cells.

What changes would you also see in the patient’s renal biopsy likely?

A 25-year-old man comes to your clinic with a history of increased shortness of breath and swelling on the feet and shins for the past 1 week. There is periorbital swelling of the left eye since morning. He recently returned from a trip to Mexico. There is no history of fever, abdominal pain, cough or hematemesis, or melena. His temperature is 37 degrees Celsius, blood pressure is 100/60 mmHg, heart rate is 100/min. There are jugular venous distention and bilateral pitting edema. A chest x-ray is shown as below:

Does echocardiography reveal diffuse hypokinesia with a low ejection fraction? This patient is at increased risk of which of the following?

A 30 years old male presents to your office with a history of intense itching in the web spaces of the hands and feet, and in the genitalia for the past 4 days. There is a history of an increase in the intensity of itching at night. He reveals that other family members of the family exhibit the same symptoms. On examination, there are excoriations due to itching and the presence of burrows at the sites of itching. 

What is the most common organism responsible for these symptoms?