KAPLAN USMLE STEP 1 QBANK
ASSESSMENT QUESTIONS AND
CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026
Q&A |LATEST EXAM UPDATE
2026/2027..
Question 1
A 55-year-old man with a history of hypertension presents with sudden
onset of severe, tearing chest pain radiating to the back. Blood pressure
is 180/100 mm Hg in the right arm and 140/80 mm Hg in the left arm.
Which of the following is the most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Correct Answer: C) Aortic dissection
Rationale: Aortic dissection classically presents with acute, severe,
tearing chest pain radiating to the back, with a discrepancy in blood
pressure between arms. This occurs due to a tear in the aortic intima
allowing blood to enter the media and propagate along the vessel. Risk
factors include hypertension, connective tissue disorders (Marfan,
,Ehlers-Danlos), and bicuspid aortic valve. Immediate management
includes blood pressure control and surgical consultation.
Question 2
A 68-year-old man with a history of coronary artery disease presents
with worsening shortness of breath, orthopnea, and peripheral edema.
On auscultation, S3 gallop is heard. Which of the following is the most
likely diagnosis?
A. Heart failure with reduced ejection fraction (HFrEF)
B. Chronic obstructive pulmonary disease
C. Pulmonary embolism
D. Liver cirrhosis
Correct Answer: A) Heart failure with reduced ejection fraction
(HFrEF)
Rationale: Dyspnea on exertion, orthopnea, paroxysmal nocturnal
dyspnea, and peripheral edema are classic symptoms of heart failure. An
S3 gallop is a hallmark finding in HFrEF, indicating increased left
ventricular filling pressures and volume overload. Treatment includes
ACE inhibitors, beta-blockers, diuretics, and possibly aldosterone
antagonists.
Question 3
A 45-year-old woman presents with palpitations, heat intolerance,
weight loss, and tremors. On examination, she has a fine tremor and a
,diffusely enlarged thyroid gland. Which of the following is the most likely
diagnosis?
A. Hypothyroidism
B. Graves' disease
C. Hashimoto's thyroiditis
D. Thyroid nodule
Correct Answer: B) Graves' disease
Rationale: Graves' disease is an autoimmune cause of hyperthyroidism
presenting with palpitations, heat intolerance, weight loss, tremors, and
a diffusely enlarged thyroid gland (goiter). It is caused by thyroid-
stimulating immunoglobulin (TSI) that activates the TSH receptor. Other
features include ophthalmopathy (exophthalmos) and pretibial
myxedema. Treatment includes antithyroid medications (methimazole,
propylthiouracil), radioactive iodine ablation, or thyroidectomy.
Question 4
A 60-year-old man presents with chest pain that is worse when lying flat
and improves when sitting forward. A friction rub is heard on
auscultation. Which of the following is the most likely diagnosis?
A. Myocardial infarction
B. Pericarditis
C. Pulmonary embolism
D. Aortic dissection
Correct Answer: B) Pericarditis
, Rationale: Pericarditis presents with chest pain that is pleuritic, worse
when lying flat, and improves when sitting forward (leaning forward). A
pericardial friction rub is a classic finding. Causes include viral infections
(most common), uremia, myocardial infarction (Dressler syndrome),
autoimmune diseases, and malignancy. ECG shows diffuse ST-segment
elevation and PR depression. Treatment includes NSAIDs and
colchicine.
Question 5
A 72-year-old woman with atrial fibrillation is on warfarin. Her INR is 4.5.
She has no signs of bleeding. Which of the following is the most
appropriate management?
A. Continue warfarin at the same dose
B. Hold warfarin and restart when INR is therapeutic
C. Administer vitamin K
D. Administer fresh frozen plasma
Correct Answer: B) Hold warfarin and restart when INR is therapeutic
Rationale: For an INR of 4.5 without bleeding, the warfarin should be
held and restarted at a lower dose when the INR is in the therapeutic
range (2.0-3.0 for atrial fibrillation). Vitamin K is indicated for INR >5.0
without bleeding or any INR with bleeding. Fresh frozen plasma is
indicated for life-threatening bleeding or emergency reversal.
ASSESSMENT QUESTIONS AND
CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026
Q&A |LATEST EXAM UPDATE
2026/2027..
Question 1
A 55-year-old man with a history of hypertension presents with sudden
onset of severe, tearing chest pain radiating to the back. Blood pressure
is 180/100 mm Hg in the right arm and 140/80 mm Hg in the left arm.
Which of the following is the most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Correct Answer: C) Aortic dissection
Rationale: Aortic dissection classically presents with acute, severe,
tearing chest pain radiating to the back, with a discrepancy in blood
pressure between arms. This occurs due to a tear in the aortic intima
allowing blood to enter the media and propagate along the vessel. Risk
factors include hypertension, connective tissue disorders (Marfan,
,Ehlers-Danlos), and bicuspid aortic valve. Immediate management
includes blood pressure control and surgical consultation.
Question 2
A 68-year-old man with a history of coronary artery disease presents
with worsening shortness of breath, orthopnea, and peripheral edema.
On auscultation, S3 gallop is heard. Which of the following is the most
likely diagnosis?
A. Heart failure with reduced ejection fraction (HFrEF)
B. Chronic obstructive pulmonary disease
C. Pulmonary embolism
D. Liver cirrhosis
Correct Answer: A) Heart failure with reduced ejection fraction
(HFrEF)
Rationale: Dyspnea on exertion, orthopnea, paroxysmal nocturnal
dyspnea, and peripheral edema are classic symptoms of heart failure. An
S3 gallop is a hallmark finding in HFrEF, indicating increased left
ventricular filling pressures and volume overload. Treatment includes
ACE inhibitors, beta-blockers, diuretics, and possibly aldosterone
antagonists.
Question 3
A 45-year-old woman presents with palpitations, heat intolerance,
weight loss, and tremors. On examination, she has a fine tremor and a
,diffusely enlarged thyroid gland. Which of the following is the most likely
diagnosis?
A. Hypothyroidism
B. Graves' disease
C. Hashimoto's thyroiditis
D. Thyroid nodule
Correct Answer: B) Graves' disease
Rationale: Graves' disease is an autoimmune cause of hyperthyroidism
presenting with palpitations, heat intolerance, weight loss, tremors, and
a diffusely enlarged thyroid gland (goiter). It is caused by thyroid-
stimulating immunoglobulin (TSI) that activates the TSH receptor. Other
features include ophthalmopathy (exophthalmos) and pretibial
myxedema. Treatment includes antithyroid medications (methimazole,
propylthiouracil), radioactive iodine ablation, or thyroidectomy.
Question 4
A 60-year-old man presents with chest pain that is worse when lying flat
and improves when sitting forward. A friction rub is heard on
auscultation. Which of the following is the most likely diagnosis?
A. Myocardial infarction
B. Pericarditis
C. Pulmonary embolism
D. Aortic dissection
Correct Answer: B) Pericarditis
, Rationale: Pericarditis presents with chest pain that is pleuritic, worse
when lying flat, and improves when sitting forward (leaning forward). A
pericardial friction rub is a classic finding. Causes include viral infections
(most common), uremia, myocardial infarction (Dressler syndrome),
autoimmune diseases, and malignancy. ECG shows diffuse ST-segment
elevation and PR depression. Treatment includes NSAIDs and
colchicine.
Question 5
A 72-year-old woman with atrial fibrillation is on warfarin. Her INR is 4.5.
She has no signs of bleeding. Which of the following is the most
appropriate management?
A. Continue warfarin at the same dose
B. Hold warfarin and restart when INR is therapeutic
C. Administer vitamin K
D. Administer fresh frozen plasma
Correct Answer: B) Hold warfarin and restart when INR is therapeutic
Rationale: For an INR of 4.5 without bleeding, the warfarin should be
held and restarted at a lower dose when the INR is in the therapeutic
range (2.0-3.0 for atrial fibrillation). Vitamin K is indicated for INR >5.0
without bleeding or any INR with bleeding. Fresh frozen plasma is
indicated for life-threatening bleeding or emergency reversal.
