USMLE STEPS

1)A diabetic patient complains to a physician of a sensation of walking on pebbles with bare feet. Physical examination demonstrates clawing of the toes with flexion of the interphalangeal joints and extension of the metatarsophalangeal joints. Atrophy of which of the following muscles is most likely responsible for the observed changes?

Options:
A. Flexor digitorum longus
B. Lumbricals and interossei
C. Peroneus longus
D. Tibialis anterior
E. Tibialis posterior

2)A leukemia patient who has undergone multiple courses of chemotherapy develops herpes simplex encephalitis. Which of the following would you expect a CT scan of the patient's brain to show?

Options:
A. Generalized volume loss
B. Volume loss selectively in the basal ganglia
C. Volume loss selectively in the brainstem
D. Volume loss selectively in the cerebellum
E. Volume loss selectively in the temporal and frontal lobes

3)A 50-year-old man undergoes biopsy of a reddish scaly plaque on the skin of his thigh. The biopsy is diagnosed as mycosis fungoides. Which of the following was seen on the biopsy?

Options:
A. Keratinocytes with cytoplasmic inclusions
B. Malignant-appearing lymphocytes
C. Nits
D. Septate hyphae
E. Vascular proliferation

4)An 80-year-old woman dies after a long history of progressive memory loss, apraxia, and recurrent episodes of confusion. In the last months of life she was bedridden and unable to recognize familiar faces and objects. The pathologist identifies numerous flame-shaped intracytoplasmic inclusions in neurons of the neocortex and hippocampus. These consist of paired helical filaments (PHFs) on electron microscopy. Which of the following biochemical changes most likely accounts for the development of PHFs in this condition?

Options:
A. Abnormal degradation of amyloid precursor protein (APP)
B. Abnormal phosphorylation of tau
C. Accumulation of advanced glycosylation end (AGE) products
D. Increased expression of APP
E. Precipitation of insoluble alpha-tubulin

5)A family consults a physician because all of the family members are experiencing severe itchiness at night. Examination of the various family members demonstrates large numbers of itchy papules, particularly at the flexor surfaces of the wrists and elbows, buttocks, along the belt line, and genitalia. Careful examination of these areas demonstrates scattered fine wavy lines up to 1 cm in length. A tiny dark dot is visible at one end of many of these lines. Which of the following is the most likely diagnosis?

Options:
A. Cutaneous larva migrans
B. Molluscum contagiosum
C. Pediculosis
D. Rosacea
E. Scabies

6)A patient experiences intermittent, severe pain in the right upper quadrant of the abdomen, especially after fatty meals. Ultrasound demonstrates multiple small opacities in the gall bladder that change with the patient's position. Which of the following is a risk factor for this patient's disorder?

Options:
A. 20 years of age
B. Male sex
C. Native American origin
D. Nulliparity
E. Thin build

USMLE STEPS

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lets start with respiratory system.
Clinical presentation:12 year old girl with 'symptomless' machinery murmur, heard anteriorly in the chest. see the xray and diagnose it




















1)A 37-year-old woman is in a serious automobile accident and sustains a closed head injury. She does not immediately seek medical attention, but is brought to the emergency room two hours later by her brother. On physical examination, there is mydriasis and loss of the pupillary light reflex. Several hours later, she is unable to follow a flashlight with her eyes. Which of the following types of herniation is most likely occurring in this patient?

Options:
A. Cerebellar tonsils into the foramen magnum
B. Cerebellum upward past the tentorium
C. Cingulate gyrus under the falx
D. Medulla into the foramen magnum
E. Temporal lobe under the tentorium

2)A five-year-old girl is brought to a pediatrician because she is developing breasts. Physical examination shows large hyperpigmented macules with irregular margins on one side of her back. Which of the following bony abnormalities would most be likely associated with these symptoms?

Options:
A. A combination of osteitis fibrosa cystica and osteomalacia
B. A generalized thinning of bony spicules
C. Excessive bony deposition with obliteration of marrow
D. Formation of new bone beneath the periosteum of phalanges
E. Multiple localized whorls of connective tissue

3)A 19-year-old sexually active female presents to urgent care with abdominal pain and nausea. Her last menstrual period began seven days ago. Physical examination is remarkable for fever and lower abdominal pain. Pelvic examination reveals a mucopurulent discharge, adnexal tenderness, and tenderness with cervical motion. A pregnancy test is negative; the patient's white count is elevated. Which of the following complications is associated with this disorder?

Options:
A. Ascites
B. Cervical carcinoma
C. Exsanguination
D. Infertility
E. Pseudomyxoma peritonei

4)A patient comes to medical attention after he sets off the metal detector at the airport, despite removing his watch, belt buckle, and every other obvious source of metal. Which of the following diseases might be responsible for this phenomenon?

Options:
A. Argyria
B. Gall stones
C. Hemochromatosis
D. Kidney stones
E. Wilson's disease

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