Zl y 0 & § vm v (?) © © 00:07
A 32-year - old man comes to the office due to a subcutaneous nodule on the dorsum of his right hand. He says the
nodule is painless and has been slowly enlarging over the last several weeks . The patient’s past medical history is
insignificant, but his father died of a heart attack at age 38 despite being a nonsmoker. His mother has diabetes
mellitus. On examination, he has 2 or 3 small, flat subcutaneous nodules on the dorsum of his right hand, and a
larger nodule at the Achilles tendon area . He also has a few small yellowish papules on his right lower eyelid.
Which of the following is most likely decreased in this patient?
A . HDL particles
B . Homocysteine
G . LDL receptors
@ D . Lipoprotein lipase
E . Triglycerides
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, 0 & 6 © © 59:59
^ 2/ 40 v (?)
A 52-year - old man comes to the clinic with frequent mid- abdominal pain. He describes the pain as gnawing . It
wakes him during the night and can be relieved by eating a light meal . The patient has also been using over -the-
counter ibuprofen for relief. Three weeks ago, he was started on omeprazole with some improvement of his
symptoms. Medical history is insignificant. The patient works as a missionary and travels across the country and
abroad. He does not use tobacco or drink alcohol . The abdomen is mildly tender on deep palpation in the
epigastric area . There is no rebound tenderness or rigidity. Urea breath test is negative. Upper gastrointestinal
endoscopy is performed and reveals a duodenal ulcer. Gastric biopsies are consistent with Helicobacter pylori
infection. Which of the following best explains the negative urea breath test in this patient ?
( ) A . B cell-mediated immune response to Helicobacter pylori antigens
B . Nonurease-producing H pylori infection
~
( ) C . Subepitheliaf invasion by Hpylori
( ) D . Use of ibuprofen prior to testing
•
( ) E . Use of omeprazole prior to testing
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, 0 6 © 59:50
^ ^ 3/ 40 v (?) Jo}
A 52-year - old immigrant from Eastern Europe presents to the outpatient clinic complaining of dyspnea on exertion
that has been increasing in severity over the past several weeks. She also describes nocturnal dyspnea and a
cough that occasionally produces blood- tinged sputum. When the patient lies in the left lateral decubitus position
and exhales fully, you hear a !ow-pitchedr mid-diastolic murmur at the cardiac apex. Which of the following most
likely underlies her condition and symptoms?
A . Tuberculosis
B . Infective endocarditis
C . Uncontrolled hypertension
Atherosclerosis
E . Rheumatic fever
F. Dilated cardiomyopathy
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, Zl y 0 & § 4/ 40 ^ © ® © 59:48
A 12-year - old boy is brought to the office after developing bloody stools . He is adopted and his family history is
unknown . Vital signs are within normal limits . Physical examination reveals conjunctival pallor and blood-streaked
stool within the rectal vault. The patient’s lips are shown in the image below:
Which of the following is the most likely cause of this patient ' s bleeding?
A . Angiodysplasia
B . Hamartoma
C . Meckel diverticulum
D . Small-vessel vasculitis
E . Tubular adenoma
F. Ulcerative colitis
End :7n Suspend Feedback https://t.me/USMLEWorldStep1 Previous Next
A 32-year - old man comes to the office due to a subcutaneous nodule on the dorsum of his right hand. He says the
nodule is painless and has been slowly enlarging over the last several weeks . The patient’s past medical history is
insignificant, but his father died of a heart attack at age 38 despite being a nonsmoker. His mother has diabetes
mellitus. On examination, he has 2 or 3 small, flat subcutaneous nodules on the dorsum of his right hand, and a
larger nodule at the Achilles tendon area . He also has a few small yellowish papules on his right lower eyelid.
Which of the following is most likely decreased in this patient?
A . HDL particles
B . Homocysteine
G . LDL receptors
@ D . Lipoprotein lipase
E . Triglycerides
End Suspend Feedback https://t.me/USMLEWorldStep1 Previous Next
, 0 & 6 © © 59:59
^ 2/ 40 v (?)
A 52-year - old man comes to the clinic with frequent mid- abdominal pain. He describes the pain as gnawing . It
wakes him during the night and can be relieved by eating a light meal . The patient has also been using over -the-
counter ibuprofen for relief. Three weeks ago, he was started on omeprazole with some improvement of his
symptoms. Medical history is insignificant. The patient works as a missionary and travels across the country and
abroad. He does not use tobacco or drink alcohol . The abdomen is mildly tender on deep palpation in the
epigastric area . There is no rebound tenderness or rigidity. Urea breath test is negative. Upper gastrointestinal
endoscopy is performed and reveals a duodenal ulcer. Gastric biopsies are consistent with Helicobacter pylori
infection. Which of the following best explains the negative urea breath test in this patient ?
( ) A . B cell-mediated immune response to Helicobacter pylori antigens
B . Nonurease-producing H pylori infection
~
( ) C . Subepitheliaf invasion by Hpylori
( ) D . Use of ibuprofen prior to testing
•
( ) E . Use of omeprazole prior to testing
End Suspend Feedback https://t.me/USMLEWorldStep1 4 Previous Next -
, 0 6 © 59:50
^ ^ 3/ 40 v (?) Jo}
A 52-year - old immigrant from Eastern Europe presents to the outpatient clinic complaining of dyspnea on exertion
that has been increasing in severity over the past several weeks. She also describes nocturnal dyspnea and a
cough that occasionally produces blood- tinged sputum. When the patient lies in the left lateral decubitus position
and exhales fully, you hear a !ow-pitchedr mid-diastolic murmur at the cardiac apex. Which of the following most
likely underlies her condition and symptoms?
A . Tuberculosis
B . Infective endocarditis
C . Uncontrolled hypertension
Atherosclerosis
E . Rheumatic fever
F. Dilated cardiomyopathy
End Suspend Feedback https://t.me/USMLEWorldStep1 4 Previous Next -
, Zl y 0 & § 4/ 40 ^ © ® © 59:48
A 12-year - old boy is brought to the office after developing bloody stools . He is adopted and his family history is
unknown . Vital signs are within normal limits . Physical examination reveals conjunctival pallor and blood-streaked
stool within the rectal vault. The patient’s lips are shown in the image below:
Which of the following is the most likely cause of this patient ' s bleeding?
A . Angiodysplasia
B . Hamartoma
C . Meckel diverticulum
D . Small-vessel vasculitis
E . Tubular adenoma
F. Ulcerative colitis
End :7n Suspend Feedback https://t.me/USMLEWorldStep1 Previous Next
