Over the years, the AMA has run dozens of example questions from Kaplan Medical. If you're preparing for the United States Medical Licensing Examination® (USMLE®) Step 1 exam, you might want to know which questions are most often missed by test-prep takers. We've compiled four cases from Kaplan Medical involving middle-aged adult patients—those between 36 and 65 years old. Each question comes with an expert explanation of the answer. You can check out all posts in this series.

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Think you can answer these questions involving middle-aged adult patients? Find out now.

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  1. Which serum markers will be found?

    A 62-year-old woman with a history of arthritis comes to the physician for follow-up examination. Physical examination of the hands shows decreased range of motion bilaterally and marked ulnar deviation of the fingers. An X-ray shows joint erosions. She tells the physician that she recently had seven dental caries filled, which was unusual, because she has had very few dental problems in the past. Physical examination shows asymmetrical bilateral parotid gland enlargement.  
  2. Tender blisters on man's arm and side

    A 60-year-old man comes to the physician because of tender blisters on his arm and flank, worsening over the last few months. His medical history includes hypertension and hyperlipidemia. He is taking atorvastatin and hydrochlorothiazide for these conditions. Physical examination shows blisters and flaccid bullae; a few have ruptured, leaving red, sore, denuded areas. Pathologic examination reveals acantholysis and few lymphocytes. Which of the findings is most likely in this patient?
  3. What's next when NSAIDs are ineffective?

    A 54-year-old man comes to the physician for a follow-up examination because of progressive rheumatoid arthritis unresponsive to high dose NSAIDs. Treatment with prednisone and hydroxychloroquine began six weeks earlier. He is concerned about steroid-induced osteoporosis, because his father, a type 2 diabetic, recently fell and broke his hip. Laboratory studies and a dual energy X-ray absorptiometry test of the spine and hip are ordered to address the patient's concerns. Which of the following additional tests would be recommended for this patient?
  4. Man has increased urination frequency

    A 45-year-old man comes to the physician because of increased frequency of urination. He voids approximately 12 times a day and three times each night. He describes the inability to maintain an erection but reports no decrease in libido. Physical examination shows that he is oriented to person and place, but not to time. Which of the blood laboratory findings in serum is most likely in this patient?

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For more prep questions on USMLE Steps 1, 2 and 3, view other posts in this series.

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