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USMLE STEP 2ck McQ
MEDICINE 💊 💉 GENITOURINARY SYSTEM

A 57-year-old man arrives at the hospital with nausea, dark urine, and decreased urine output for 2 days.  For the past week, the patient has had generalized fatigue, muscle pain, and weakness.  He reports no recent fever, chills, sore throat, skin infection, or abdominal pain.  Medical history is significant for coronary artery disease with stenting to the right coronary artery, hypertension, gout, and obstructive sleep apnea.  Current medications include aspirin, ticagrelor, simvastatin, metoprolol, lisinopril, and colchicine.  The patient does not use alcohol, tobacco, or illicit drugs.  Temperature is 37 C (98.6 F), blood pressure is 140/90 mm Hg, pulse is 88/min, and respirations are 18/min.  There is no orthostasis.  Skin turgor is normal.  Oropharynx is clear.  Cardiopulmonary examination shows no abnormalities.  The abdomen is soft, nontender, and without bruit; there are no masses felt.  There is no peripheral edema.  The right great toe is slightly inflamed.  Laboratory studies reveal the following:

Complete blood count
    Hemoglobin 13.8 g/dL
    Platelets 260,000/mm3
    Leukocytes 11,000/mm3
Serum chemistry
    Sodium 136 mEq/L
    Potassium 5.6 mEq/L
    Chloride 94 mEq/L
    Bicarbonate 18 mEq/L
    Blood urea nitrogen 50 mg/dL
    Creatinine 4.2 mg/dL
    Glucose 100 mg/dL
Urinalysis
    Protein none
    Blood 3+
    White blood cells 1-2/hpf
    Red blood cells 1-2/hpf
Baseline laboratory studies conducted a month ago were normal.  Which of the following is most helpful to establish a diagnosis?

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7 hours ago | [YT] | 6

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USMLE STEP 1
Gout , Intellectual disability, self - mutilating behavior in a boy ; Most likely diagnosis:

2 months ago | [YT] | 12

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USMLE STEP 1 MCQ 📋
Biochemistry

A full-term male newborn has severe hypotonia. His 20-year-old mother shows little facial expression. When she shakes the physician's hand, she has difficulty releasing her grip. Which of the following genetic phenomena is the most likely cause of these findings?



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3 months ago | [YT] | 14

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USMLE STEP 1 MCQ 📋
MSK 💪🦶

A 51-year-old woman comes to the physician because of a 5-month history of occasional vague hip and thigh pain when working in her garden. Physical examination shows no abnormalities. Laboratory studies show an increased serum alkaline phosphatase activity. An x-ray of her right hip and upper leg shows a dense thickening of the bony cortex in the femur. Which of the following is the most likely diagnosis?



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3 months ago | [YT] | 16

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USMLE step 1 MCQ 📋
Renal system

Two days after admission to the hospital because of a sickle cell disease crisis, a 24-year-old man suddenly develops blood in his urine and flank pain. Laboratory studies at the time of admission showed that his hematocrit was decreased to 11% from his normal baseline of 25%. Urinalysis shows gross blood, rare WBCs, and no WBC casts. Which of the following is the most likely cause of the hematuria in this patient?


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3 months ago | [YT] | 14

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USMLE STEP 1 MCQ 📋
Endocrine system

A 40-year-old woman comes to the physician because of a 3-month history of continuous watery diarrhea that has gradually increased in severity; she has had an 11-kg (24-lb) weight loss during this period. Physical examination shows skin tenting and sunken eyes, and orthostatic hypotension. Tests of the stool are negative for ova, parasites, and Clostridium difficile. A CT scan of the abdomen shows a mass in the pancreas. Treatment with standard antidiarrheal medications is ineffective. Administration of a somatostatin analogue, octreotide, results in improvement of the diarrhea. This patient most likely has a tumor secreting which of the following agents?


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3 months ago | [YT] | 17

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USMLE STEP 1 MCQ 📋
GIT

A 34-year-old woman comes to the physician because of a 10-year history of constipation. She usually has fewer than three bowel movements weekly. She often has bloating and cramping, and she has to strain and apply perineal pressure to defecate. She says that she does not have problems with sleep, appetite, or energy. Palpation of the abdomen produces diffuse discomfort; bowel sounds are present. Which of the following is the most likely cause of this patient's gastrointestinal symptoms?


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3 months ago | [YT] | 12

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USMLE STEP 1 MCQ 📋
Microbiology 🔬

An 18-year-old man has had temperatures to 38.3°C (101°F), a sore throat, and cervical lymph node enlargement for 8 days. A latex agglutination test result for Epstein-Barr virus antibody is positive. Atypical cells with abundant lacey cytoplasm in the peripheral blood smear are most likely derived from which of the following types of cells?


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3 months ago | [YT] | 19

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USMLE STEP 1 MCQ 📋
Nervous System 🧠

A 27-year-old man comes to the emergency department because of a 3-day history of numbness and a 2-day history of increasing weakness in his arms and legs. He had a "bad cold" 2 weeks ago. He tells the physician that his oral examinations for graduate school are in 1 month and that he broke up with his girlfriend 1 week ago. His temperature is 37.1°C (98.8°F). Neurologic examination shows symmetrical weakness that is greater in his legs than in his arms. Muscle stretch reflexes are absent in all four extremities, and vibration sense and proprioception are diminished in his lower extremities. Which of the following is most likely the greatest contributor to his current symptoms?


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3 months ago | [YT] | 11

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USMLE step 1 MCQ 📋
Respiratory system 🫁


A 73-year-old man comes to the physician with his wife because of a 3-year history of daytime sleepiness. His wife says that he snores loudly. He is 183 cm (6 ft) tall and weighs 113 kg (250 lb); BMI is 34 kg/m2. His pulse is 84/min, respirations are 18/min, and blood pressure is 175/105 mm Hg. Physical examination shows congested conjunctivae and centripetal obesity. Serum studies show a glucose concentration of 250 mg/dL, creatinine concentration of 2 mg/dL, and uric acid concentration of 10.1 mg/dL. Polysomnography confirms the diagnosis, and treatment with nasal continuous positive airway pressure at night is started. This therapy will most likely cause a decrease in which of the following?


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3 months ago | [YT] | 16