Sample Step 1 Exam

A 70-year-old man is brought to the neurologist by his son. The patient has been developing sudden, wild flinging movements of his right upper limb over the last few weeks. An MRI indicated that he has a tumor involving the basal ganglia.  In which of the following would infarction most likely be found?

A 62-year-old-female was diagnosed with cerebellar movement disorders. The clinical and radiological exams indicated a focal lesion of the dentate nucleus in the white matter of the cerebellum. The dentate neuron fibers would project directly to which of the following?

A 66 year old woman has systemic atherosclerosis with intermittent claudication, 2 coronary artery stents and a recent transient ischemic attack. She has now been discovered to have a 7.2 cm abdominal aortic aneurysm. The vascular surgeon orders an hsCRP (high sensitivity C reactive protein) level to assess the degree of inflammation in her plaques.

The inflammatory cells migrate to the plaques through a damage associated molecular pattern signal (DAMP) derived from

During a cardiac evaluation a 3D transthoracic echocardiogram is done to measure cardiac function in a patient suspected to have CHF. The measurements taken are found below.

Left ventricle wall thickness: .5cm-1cm (apex to base)

End systolic volume: 131 ml

End diastolic volume: 190 ml

CO: 5000 mL/min

HR: 84 BPM

LAD: 88% patent

PDA: 90% patent

LCX: 80% patent

What is the ejection fraction of the patient?

A patient goes to the physician complaining of having a dry mouth. In addition, there was a very weak gag response noticed during the exam. A lesion to which of the following could be the basis for the dry mouth?

A 58 year old male presents to his doctor with a 4 week history of blurry vision. The patient has had Type II diabetes mellitus for 12 years, now requiring treatment with insulin.

Laboratory testing:

• Urine albumin: 300 mg/24 hours
• HbA1c: 11.2%

Fundoscopic examination:

The most likely pathophysiologic explanation for the findings is

A mother brings her 3 year old son into the clinic because he has difficulty walking. He did not start walking until age 2 years. He now has an unstable gait and often trips and falls. He cannot yet run and has to be helped up stairs.

Physical examination confirms these symptoms. The child walks on his toes and cannot hop. He has disproportionally large calf muscles.

Laboratory testing shows an elevated creatine kinase.

The first life-threatening complication in this patient can best be anticipated by assessing

A 70 kg male patient on the general medicine ward is being treated for lower extremity cellulitis. He has not shown any improvement in his infective symptoms or redness for last 24 hours with oral amoxicillin-clavulanic acid and he is now tachycardic and febrile with rising white blood cell count. It is decided to switch antibiotics to vancomycin and the loading dose needs to be calculated. The desired plasma concentration is 20mg/L following bolus, knowing that it will take 4 half-lives to reach steady state and can’t wait that long to be in the therapeutic range. The inherent volume of distribution of vancomycin is 1L/kg. What dose of vancomycin should be given?

An Rh-negative woman goes to see her Ob/Gyn expressing a desire to have a second child.  Her first, Rh+ child was born uneventfully, and the mother was given RhOGAM therapy as prescribed at 28 weeks and at parturition.  Which of the following would be the best test to determine if she has become sensitized to the Rh antigen of her husband?

A 32 year old male presents to his physician’s office with new onset headaches.  He is concerned because these are associated with blurring of his vision and a recent nosebleed. He has otherwise been well.

Vital signs: BP 188/132 mmHg; HR 101 /min; RR: 15 /min; Temperature: 98.9 F; SpO2: 97% on room air

Physical examination shows papilledema.

Laboratory testing:

• Urinalysis:
  • Protein: 2+
  • Hemoglobin: 1+
  • Leukocyte esterase: negative
  • Nitrites: negative
  • Sediment: no casts seen
• Chemistry:
  • Creatinine: 2.3
  • eGFR: 28 mL/min

Biopsy of the kidney would most likely show