USMLE STEP 1 QUESTIONS AND
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2024, EXAMS OF NURSING
A 53-year-old man comes to the physician because of a dry scaly
rash on his body for the past year. He has had a 15- kg (33-lb)
weight loss during the past year. He is 178 cm (5 ft 10 in) tall and
now weighs 54 kg (120 lb); BMI is 17 kg/m2 . His stools have a
large volume and float. Which of the following nutrient deficiencies
is most likely? Correct Answer Vitamin A
In screening for prostate cancer, the current serum prostate-
specific antigen concentration at which biopsy is recommended is
4.1 ng/mL. If the threshold for recommending a biopsy procedure
were lowered to 2.0 ng/mL, which of the following changes would
occur to the positive and negative predictive values of the test?
Correct Answer G
In informing a couple that their newborn has Down syndrome,
there is a specific, relatively limited amount of information that the
consulting physician should give immediately. The rest can be
discussed at a later time. Which of the following best explains the
purpose of using this approach to disclosure? Correct Answer
Disclosing the most important information so that it can be
understood as fully as possible
A 25-year-old man volunteers to participate in a study of exercise.
The solid curves in the graph show the relationship between right
atrial pressure and cardiac output (cardiac function curves). The
dashed lines show the relationship between cardiac output and
right atrial pressure (vascular function curves). Point X is the pre-
exercise equilibrium point. Which of the following labeled areas is
,the most likely new cardiac and vascular equilibrium point during
exercise in this subject? Correct Answer H
A 62-year-old man comes to the physician because of a 6-month
history of urinary hesitancy and dribbling after urination. He has to
urinate two to three times nightly. Physical examination shows a
diffusely enlarged, firm, and nontender prostate. Which of the
following is most likely to have contributed to the development of
this patient's condition? Correct Answer Conversion of
testosterone to dihydrotestosterone
An 18-year-old woman with sickle cell disease is brought to the
emergency department by her parents because of a 2- hour
history of severe abdominal pain and nausea. Her parents say
that she had a cheeseburger, milk shake, and chocolate bar for
lunch. Her temperature is 37°C (98.6°F). Physical examination
shows tenderness over the right upper quadrant of the abdomen,
radiating to the right shoulder. Ultrasonography of the right upper
quadrant of the abdomen shows gallstones. Which of the
following is the most likely underlying cause of this patient's
current condition? Correct Answer Overload of unconjugated
bilirubin
A 45-year-old man is brought to the emergency department 30
minutes after the sudden onset of crushing chest pain. His father,
maternal aunt, and paternal uncle all died of myocardial
infarctions under the age of 50 years. Physical examination
shows tendinous xanthomas on the hands and thickened Achilles
tendons. Serum lipid studies show a total cholesterol
concentration of 410 mg/dL, HDL-cholesterol concentration of 30
mg/dL, and triglyceride concentration of 140 mg/dL. The
diagnosis of myocardial infarction is made. This patient most likely
has a deficiency of which of the following? Correct Answer LDL
receptor
, An experimental animal is created in which the germinal centers
of the reactive lymph nodes show shrinkage of cells, cytoplasmic
budding, no adjacent inflammation, and intact plasma
membranes. These cellular findings are most likely caused by
which of the following mechanisms? Correct Answer Caspase
activation
Investigators conduct a study that evaluates the effect of
finasteride on the incidence of prostate cancer in 500 patients.
The investigators recruit an additional 1000 patients for the study.
Which of the following effects will this have on the research
study? Correct Answer Less chance of a Type II error
A 76-year-old man dies of a massive cerebral infarction shortly
after admission to the hospital. During the past 10 years, he has
had several smaller cerebral infarctions and two transient
ischemic attacks. Examination of a cerebral cortex specimen
obtained at autopsy shows extensive gliosis. This finding is most
likely caused by the growth and proliferation of which of the
following? Correct Answer Astrocytes
A 65-year-old woman is brought to the emergency department
because of a 10-minute history of chest tightness and severe pain
of her left arm. Physical examination shows jugular venous
distention. Crackles are heard over the lung fields. An ECG
shows ST-segment elevation greater than 1 mm in leads V4
through V6 and new Q waves. Serum studies show an increased
troponin I concentration. Which of the following labeled points in
the graph best represents the changes in cardiac function that
occurred during the first 10 seconds after the onset of pain in this
patient? Correct Answer W → Z
A previously healthy 52-year-old woman comes to the physician
because of a 2-month history of fatigue, constipation, and
frequent urination. Her temperature is 37.1°C (98.8°F), pulse is
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