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Step 1 First Aid Casebook
View all posted Step 1 cases
Most Recent:
- A 56-year-old homeless man with a history of alcohol abuse is found unconscious on a street corner. He is brought into the emergency department for monitoring. He is found to have a temperature of 38.9°C (102°F). X-ray of the chest is significant for pleural effusion, empyema, and cavitation of his right upper lobe. As he [...] - A third-year clerk on medical rounds notices that a large majority of his patients have either hypertension or congestive heart failure. He realizes that in treating both of these conditions, one class of drugs is commonly used.
What class of drugs is commonly used for these two conditions? List examples of drugs within this class?
These two [...] - A 47-year-old man presents to his physician for his annual check-up. He reports that he does not smoke, consumes a reasonable diet, exercises regularly, and drinks less than one drink per week. He does not take any medications or supplements. Family history is notable for the death of his father at age 55 years from [...] - A 70-year-old man with type 2 diabetes mellitus (DM) and benign prostatic hyperplasia (BPH) is rushed to the emergency department after being found by his weekly visiting nurse to be lethargic, disoriented, and barely conscious. She found that his pill box was full of last week’s diabetes and BPH medications. On physical examination, the patient [...] - A 35-year-old nurse presents to the emergency department complaining of heart palpitations. She has also been jittery, hot, and sweaty for several hours. She has lost 15 lb (6.8 kg) in the past 2 months, missed her period in the last month, and has had frequent bouts of diarrhea ever since her fiancé cheated on [...] - A woman rushes her 65-year-old husband into the emergency department after he said he felt crushing chest pain while eating a steak. Blood work is ordered and the physician finds that the man’s cholesterol is very high and that the man most likely had an acute myocardial infarction because of the finding of elevated enzymes. [...] - A 42-year-old man suffers a high-speed motor vehicle collision with a tree and police quickly respond to the scene to find the man with an extremely faint pulse. The man is rushed to the emergency department. The patient is slipping in and out of consciousness, and the attending physician quickly gives the man hexamethonium because [...] - A 56-year-old man presents to the emergency department with fevers, chills, and a feeling of malaise. He states that the onset of symptoms was gradual. His past medical history is significant for replacement of his aortic valve 6 months ago. On physical examination, there is a 2/6 systolic ejection murmur that was not noted previously. [...] - A 35-year-old woman presents to clinic with acute onset of fever and chills that come and go throughout the day. On physical examination, there are notable track marks on her arms. She also has a grade III/VI regurgitant systolic ejection murmur that is best heard at the left sternal border. No splinter hemorrhages are noted.
What [...] - An 18-year-old woman who recently adopted a puppy developed abdominal pain, followed by 3 days of diarrhea that then became bloody. She was having up to 10 watery stools per day, was unable to remain sufficiently hydrated, and lost 3.2 kg (7 lb) in the 3 preceding days. She presents to the emergency department and [...]
Step 1 USMLERx Questions
View all posted Step 1 USMLERx Questions
Most Recent:
- A 67-year-old man presents to the emergency department because of acute chest pain that began more than 6 hours ago. ECG shows elevated ST-segments in three consecutive leads. If a biopsy of the affected tissue were taken at this point, bands would be visible under the microscope. What is the best explanation for the presence [...] - A 25-year-old man comes to the physician with constipation, polyuria, polydipsia, hyporeflexia, and lethargy. Laboratory studies confirm an abnormality in calcium handling. Which of the following drugs would most likely alleviate these symptoms?
A. Acetazolamide
B. Furosemide
C. Hydrochlorothiazide
D. Mannitol
E. Parathyroid hormone
The correct answer is B. This patient displays the signs and symptoms of hypercalcemia. The loop diuretics [...] - A 42-year-old man presented to his primary care physician several months ago with complaints of fatigue, loss of appetite, difficulty concentrating, decreased sleep, and feelings of worthlessness. He has been receiving pharmacologic treatment for these symptoms and has now begun to develop symptoms of urinary retention, blurred vision, constipation, and aggravation of his glaucoma. Which [...] - An infant is born prematurely at 34 weeks’ gestation. At birth he exhibits a grimace and has a pink trunk with blue extremities, a pulse of 85/min, some muscle tone, and a respiratory rate of 25/min. What is the infant’s Apgar score?
A. 5
B. 6
C. 7
D. 8
E. 9
The correct answer is B. The Apgar score is [...] - The diagram shows a cross-section of normal human skin. Pemphigus vulgaris patients suffer from production of autoantibodies against which of the following labeled layers in this image?
A. A
B. B
C. C
D. D
E. E
The correct answer is C. C is the epidermis. Pemphigus vulgaris is an autoimmune disorder in which pathogenic antibodies are directed against a cell-cell [...] - After a brain tumor resection, a right-handed patient comes to the office with this wife. The wife reports that her husband can no longer balance his checkbook or count his money. Recently he has also had difficulty identifying individual fingers and confuses his left and right sides. Additionally, she reports that although he can read [...] - A 3-year-old boy is brought to the pediatrician because of decreased vision and pain in his right eye. Past medical history is significant for the diagnosis of glaucoma shortly after birth that has been refractory to standard medical therapies. Focused physical examination reveals iris hamartomas. Which of the following additional signs is most likely on [...] - A 38-year-old woman comes to the physician with a 4-month history of episodic nausea and a sensation of abnormal motion that lasts for 4-5 minutes. Her symptoms have intensified over the past week, and the episodes now last more than an hour. A particularly severe episode this morning resulted in vomiting and buzzing in her [...] - Myasthenia gravis is an autoimmune disorder that affects approximately 3 in 100,000 people. Individuals with mysasthenia gravis classically present with complaints of muscle weakness and fatigue secondary to the formation of autoantibodies directed against the acetylcholine receptors at neuromuscular junctions. The most accurate method of diagnosis involves the detection of these autoantibodies. On average, this [...] - Sympathetic effects on the heart are activated via the neurotransmitter norepinephrine acting on ?1-receptors. The effects are manifest in positive chronotropy, dromotropy, and inotropy. Which of the following sympathetic effects is correctly paired with its physiologic mechanism?
A. Chronotropic effect: decreased inward Na+ current
B. Chronotropic effect: increased inward Ca2+ current
C. Dromotropic effect: increased inward Ca2+ current
D. [...]
Step 2CK Casebook
View all posted Step 2CK cases
Most Recent:
- Case 19 – A 27-year-old woman with fever and cough
A 27-year-old woman presents to her physician because of 5 days of fever and cough. She has no significant past medical history but has been “fighting colds” for the past 3 months, which she attributed to the winter season. She began having low-grade fevers as well [...] - Case 18 – A 60-year-old man with significant bleeding
A 60-year-old man presents to the emergency department complaining of a persistent nosebleed. His nose began bleeding spontaneously about 3 hours ago, and he has not been able to get it to stop despite direct pressure and ice packs. He denies trauma, blood disorders, cancer, or a [...] - Case 17 – A 29-year-old woman with substance dependence
A 26-year-old G7P3 woman at 34 weeks’ gestation presents to the emergency department because she feels she is beginning to experience contractions and does not have an obstetrician to consult. On examination her pupils are dilated and she appears agitated and nervous. She then changes her mind [...] - Case 16 – A 19-year-old man with substance abuse
A 19-year-old student is being evaluated at his student health center. The physician notes the young man is tachycardic at 101/min with a blood pressure of 145/93 mm Hg. His pupils are constricted and there is a fine tremor in his hands. The patient appears agitated and [...] - Case 15 – A 25-year-old man after a motor vehicle accident
A 25-year-old man is brought to the emergency department by ambulance after a motor vehicle accident. The paramedics report that his vehicle, which was not equipped with airbags, hit a telephone pole at a speed of approximately 35 mph. His temperature is 37.0°C (98.6°F), heart [...] - Case 14 – A 68-year-old man with lower abdominal pain
A 68-year-old man presents to the emergency department with severe lower abdominal pain. He has a constant desire to urinate but can only produce a small amount of urine. His past medical history is unremarkable, but he says he has experienced hesitancy before the onset of [...] - Case 13 – A 70-year-old man with narcotic overdose
A 70-year-old man with a history of chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), myasthenia gravis, and chronic back pain is recovering after a motor vehicle accident. The patient fractured both tibiae and multiple ribs, but remains without serious internal organ injury. His problem during [...] - Case 12 – A 35-year-old man with opioid withdrawal
A 35-year-old homeless man is admitted to the medical ward for treatment of an acute asthma exacerbation. He has a medical history significant for chronic severe asthma with multiple hospital admissions as well as tobacco use, heroin abuse, hypertension, and chronic, untreated tinea corporis infection. He is [...] - Case 11 – A 45-year-old woman with disseminated disease
A 45-year-old woman from Cincinnati presents to her physician complaining of cough, dyspnea, fevers, and weight loss. She has been HIV positive for 20 years and has been using highly active antiretroviral therapy for the past decade. Although she continues to take her medications, this past year [...] - Case 10 – A 47-year-old man with suicidal ideation
A 47-year-old man was diagnosed with AIDS 3 years ago. Shortly after his diagnosis, he informed his partner of 8 years over the phone; she subsequently hung up on him and refused to speak with him again. Since then he had become progressively more socially isolated from [...]
Step 2CK USMLERx Questions
View all posted Step 2CK USMLERx Questions
Most Recent:
- A 26-year-old woman who is 32 weeks’ pregnant with her first child presents to her obstetrician for a routine visit. Her pregnancy has been uneventful and she has been feeling well, although somewhat anxious over the arrival of her first child. She has blood drawn for glucose levels following a 1-hour glucose tolerance test, but [...] - A 31-year-old woman is brought to the emergency department after a motor vehicle crash. According to the paramedics, her left arm was pinned between the steering wheel and the door, so extrication was prolonged. The patient is fully oriented and complaining of severe pain in her upper arm. She is holding her arm in a [...] - A 63-year-old postmenopausal woman is referred to the gynecologic clinic by her primary care physician for evaluation of genital pruritus of 1 months’ duration. She has a remote history of human papillomavirus infection. She denies changes in vaginal discharge or vaginal bleeding. She also denies constitutional symptoms or weight loss. On examination she is in [...] - An investigator wishes to assess whether vaccination increases the incidence of developmental diseases such as autism. He asks parents of recently diagnosed cases about their child’s vaccination history and compares their responses to those of parents of children who have not been diagnosed with autism. What is the most significant type of potential bias present [...] - A 38-year-old man is brought to the emergency department with crushing chest pain radiating to his left arm and mild shortness of breath that began approximately 30 minutes ago. ECG showed ST-segment elevation in leads II, III, AVF, and V4-V6 and a threefold increase in cardiac enzyme levels. His medical history is negative, but he [...] - A 30-year-old woman presents to a primary care physician for a new patient visit. She reports recurrent episodes of pneumonia, bronchitis, and otitis over the past 4 years. Although her vaccinations were up to date, she developed tetanus following a foot laceration last year. Her lymph nodes and tonsils are enlarged. Laboratory testing reveals low [...] - A 32-year-old man is stabbed in the left chest and presents to the emergency department in distress. His pulse is 130/min, blood pressure is 70/50 mm Hg, and respiratory rate is 39/min. The stab wound is in the left fifth intercostal space in the midaxillary line. On examination his trachea is deviated to the right, [...] - Which of the following laboratory findings are characteristic of hemophilia B? PT refers to prothrombin time and aPTT refers to activated partial thromboplastin time.
A. A
B. B
C. C
D. D
E. E
The correct answer is B. This profile is consistent with hemophilia B. Hemophilia B (Christmas disease) is an X-linked recessive coagulopathy involving a deficiency of coagulation factor [...] - A 53-year-old woman with a history of polycystic kidney disease undergoes a renal transplant from a cadaveric donor. She experiences several bouts of acute rejection that are controlled by appropriate increases in immunosuppression during the first year posttransplant. During her fourth posttransplant year her creatinine is rising gradually. Transcutaneous biopsy reveals architectural distortion and sclerosis [...] - A 42-year-old stock broker with coronary artery disease presents to the emergency department with complaints of worsening chest pain that he began to experience during his walk earlier that morning. His wife insisted that he see a physician because he has been experiencing palpitations, dyspnea, and angina over the past 3 days. His blood pressure [...]
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