Marathon for USMLE Question papers Step 1 Download 2017

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Question 1
A 28-year- old man has a 2-week history of watery stools and a 2.2-kg
(5.0-Ib) weight loss. He has not traveled recently or taken antibiotics.
The patients father has a history of ‘inflammatory bowel disease.”
Physical examination reveals hyperactive bowel sounds and diffuse,
mild abdominal tenderness without guarding. Stool cultures show no
growth.
Which of the following would most strongly support the
diagnosis of Crohns disease rather than ulcerative colitis in this
patient?
A. Positive assay for antisaccharomyces cerevisiae antibody (ASCA);
negative assay for perinuclear antineutrophil cytoplasmic antibody (p-
ANCA)
B. Barium enema examination showing inflammation of the most distal
4 cm of ileum
C. Small bowel radiograph series showing inflammation of the most
distal 4 cm of ileum
D. Colonic biopsy specimens showing mucosal and submucosal
inflammation and crypt abscesses
E. The patients reporting that he stopped smoking 3 or 4 weeks ago

Question 2
A 21-year- old female college student has a 1-week history of malaise,
anorexia, nausea, and vomiting. Three weeks ago, she returned from
Guatemala, where she had engaged in missionary work.
On physical
examination, temperature is 37.9 C (100.2 F). There is mild jaundice
and a palpable, tender liver.
Laboratory studies:
H e ma t o c r i t 48%
Leukocyte count 9000/μL (normal differential)
INR 1.0
Serum alkaline phosphatase 110 U/L
Serum aspartate aminotransferase 1100 U/L
Serum alanine aminotransferase 1700 U/L
Serum total bilirubin 3.0 mg/dL
Which of the following laboratory tests is most likely to establish the
diagnosis?
A. Antibody to hepatitis B surface antigen (anti-HBs)
B. Antibody to hepatitis C virus (anti-HCV)
C. Indirect hemagglutination test for Entamoeba histolytica
D. IgM antibody to hepatitis A virus (1gM anti-HAV)
E. Epstein-Barr virus DNA

Question 3
An otherwise healthy 28-year- old man has a 4-month history of
epigastric discomfort and heartburn. Symptoms are usually
exacerbated postprandially, especially after eating spicy foods. The
patient denies dysphagia, weight loss, and decreased appetite. He has
an active lifestyle and takes no medications. Physical examination is
normal except for mild epigastric tenderness. Routine laboratory
studies are normal. Which of the following is most appropriate at this
time?
A. Upper endoscopy
B. Esophageal manometry
C. Ambulatory 24-hour esophageal pH monitoring
D. Barium swallow
E. Trial of acid suppressive therapy
Question 4
A 46-year- old man with a history of alcoholism and known cirrhosis
comes to the emergency department because of the abrupt onset of
hematemesis. On physical examination, he is obtunded and confused.
Temperature is 37.7 C (99.9 F), pulse rate is 100/min and regular,
respiration rate is 20/min, and blood pressure is 90/60 mm Hg. He is
not jaundiced. Rectal examination discloses black, tarry stool in the
rectal vault. Hemoglobin is 10.6 g/dL, the platelet count is 70,000/μL,
the INR is 2.4, and serum albumin is 3.0 g/dL.
Which of the following has the lowest priority in the initial
management of this patient ?
A. Immediate upper endoscopy
B. Fluid resuscitation
C. Endotracheal intubation
D. Transfer to the intensive care unit

Question 5
A 55-year- old man with chronic hepatitis C is being considered for liver
transplantation. The patient has cirrhosis that was documented by liver
biopsy 10 years ago. For the past 3 months, he has had ascites and
edema, which are poorly controlled with diuretics. Lactulose was
recently begun because of confusion. Which of the following
combinations of laboratory studies will be most helpful in estimating
his survival over the next 6 months?
A. Serum total bilirubin and INR
B. Serum aspartate aminotransferase and gamma globulin
C. Serum alanine aminotransferase and hepatitis C RNA (HCV RNA)
D. Serum alkaline phosphatase and ammonia
E. Serum albumin and γ-glutamyltransferase
Question 6
A 52-year- old man comes for a routine physical examination. He feels
well, has no significant medical history, takes no medications, and has
no family history of colorectal cancer. Physical examination and
complete blood count are normal. He returns three fecal occult blood
test cards (six windows), and one window tests positive for occult
blood.
Which of the following should be done next?
A. Colonoscopy
B. Flexible sigmoidoscopy
C. Barium enema examination
D. Digital rectal examination
E. Repeat fecal occult blood test

Question 7
A 71-year- old woman is hospitalized because of acute pancreatitis
complicated by acute respiratory distress syndrome and hypotension.
On the sixth day in the intensive care unit, her temperature increases
to 38.2 C (100.8 F), and her leukocyte count increases to 16,000/μL. A
CT scan of the abdomen with a rapid intravenous bolus of contrast
shows hypodense, nonenhancing areas involving at least 50% of the
pancreas. There is significant peripancreatic inflammation with diffuse
pancreatic enlargement and fluid in the right perinephric space. The
gallbladder is contracted and contains several small stones. The bile
duct is not dilated.
Which of the following is most appropriate at this time?
A. Imipenem
B. A fluoroquinolone
C. Cholecystectomy
D. Total parenteral nutrition
E. Therapeutic endoscopic retrograde cholangiopancreatography

 

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