Prepping for USMLE? See this year’s top test-prep stumpers

If you’re preparing for the United States Medical Licensing Examination® (USMLE®) Step 1, Step 2 or Step 3 exam, you might want to know which questions are most often missed by test-prep takers. Throughout the year, AMA Wire® offered examples from Kaplan Medical. The questions below are most-viewed USMLE prep stories of 2017.

USMLE Step 1: Which metabolite is most linked with bony lesions? A 75-year-old man comes to the physician because of nocturia, urinary urgency and a feeling that he cannot completely empty his bladder. He voids six times per day and four times per night. He has a strong desire to void, and when he reaches the toilet he can only void with a weakened stream with straining. Digital rectal examination shows a firm, enlarged prostate measuring approximately 30 grams. Post-void residual by ultrasound is 300 mL. Bone scan shows multiple osteoblastic lesions in the vertebral bodies. Elevation of which bone metabolites is most strongly associated with these lesions?

USMLE Step 2: Diagnose the cause of diarrhea, fatigue, dyspnea A 54-year-old lawyer presents to the emergency department with diarrhea for the past two months. He has associated fatigue, shortness of breath and weight loss. He has lost approximately 10 pounds over the last few months, during which time the symptoms have worsened. He has no related medical history and does not smoke or drink. He takes no medications. On examination his blood pressure is 115/75 mm Hg and his pulse is 108 per minute. His skin is pale. Neurologic examination reveals loss of vibration sense, spasticity and a positive Babinski sign.

USMLE Step 3: What’s the next step for a patient with testicular pain? A 15-year-old boy with no past medical history is brought to the emergency department with a five-hour history of right testicular pain. He states that the pain began after football practice this afternoon, but does not remember any trauma. He appears to be in a significant amount of pain. His blood pressure is 128/80 mm Hg and pulse is 110 beats per minute. Physical examination shows an erythematous, swollen right scrotum with significant tenderness to palpation on that side. Cremasteric reflex is absent on the right side. Urinalysis is negative. What is the most appropriate next step in the management of this patient?

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

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