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.
As students reach the final phases of their Step 1 prep, we’ve compiled a list of the Top 5 most-read Step 1 stumpers. You can check out all posts in this series.
Which drug to blame for woman’s symptoms?
- A 33-year-old woman is brought to the physician because of profound nausea, vomiting, headache, sweating, tachycardia, blurred vision and dizziness. Her temperature is 37.8 °C (100 °F), pulse is 120 beats per minute, blood pressure is 104/66 mm Hg, and respirations are 19 per minute.
What is causing teenager’s abdominal pain?
- A 16-year-old girl is brought to the emergency department because of acute abdominal pain and diarrhea. She has had three similar episodes, but no cause has been found. She also complains of burning on urination. The patient appears diaphoretic and in pain. Her temperature is 102 °F (38.8 °C) and pulse is 95 beats per minute. Physical examination shows there is diffuse abdominal tenderness, especially around the suprapubic area. First percussion over the costovertebral angle elicits exquisite pain on the right.
What’s the most likely change in serologic findings?
- A 39-year-old man comes to the physician because of anorexia, malaise, dark urine and upper abdominal discomfort. His temperature is 37.9ºC (100.2ºF). Physical examination shows scleral icterus and moderate right upper quadrant tenderness. The liver is palpable below the right costal margin.
What drug worsens severe low back pain?
- A 66-year-old woman comes to the physician because of severe lower back pain. She is otherwise healthy with well-controlled hypertension and hyperlipidemia. She does not drink, but has smoked one pack of cigarettes per day for the past 20 years. An x-ray of the lumbar spine shows an anterior wedge compression fracture of L1. Results of dual-energy X-ray absorptiometry (DEXA) scan shows substantially decreased bone density in the region of L3 to S1. Laboratory studies show serum calcium of 9.2 mg/dL, serum phosphorus of 3.7 mg/dL, and serum parathyroid hormone of 42 pg/mL (normal range: 10-60 pg/mL).
Which test for patient with rheumatoid arthritis?
- A 54-year-old man comes to the physician for a follow-up examination because of progressive rheumatoid arthritis unresponsive to high dose nonsteroidal anti-inflammatory drugs (NSAIDs). Treatment with prednisone and hydroxychloroquine was started six weeks earlier. The patient is concerned about steroid-induced osteoporosis, because his father, a type 2 diabetic, recently fell and broke his hip. Laboratory studies and a DEXA test of the spine and hip are ordered to address the patient's concerns.
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