Repeated USMLE Step 1 Questions- 1

These are some repeated questions written by students who passed USMLE Step 1

I will post remembered questions written by students who passed USMLE Step 1 in series.
Please add this page to your favorites and bookmarks in order to check it for new added
questions.

1– A high school student is brought to the clinic by his parents for daytime sleepiness, multiple
phone calls from teachers for sleeping during classes, repeated falling due to temporary leg
weakness and frightening hallucinations at sleep time. What is the diagnosis and management?

This is a case of narcolepsy, which is characterized by cataplexy and daytime sleep.

Amphetamine derivatives such as methylphenidate and modafinil which are also used in ADHD
are used in this case as well.

2– A 23 year-old woman presents with fever and cough. During the exam, you find unexplained
bruises on her chest. After further questioning, you realize that this is a case of domestic violence
and abuse. What should you do to this patient? and what is Tarasoff decision?

You should respect her right to confidentiality and explain to the patient all the resources to keep
her safe. Most common wrong answers are: call the police, talk to her husband, talk to her family
or mandatory report the abuse. Mandatory reporting is applied to minors and elderly (older than
65 years old) suspect of abuse. Tarasoff decision is a law requiring a health care provider to
protect potential victims from harm. If you suspect an impending murder or major act, you
should inform and try your best to protect potential victims.

3– A 4-month-old girl is brought to the clinic because of having a seizure. History is significant
of vomiting and restlessness between meals which improves after feeding. Examination reveals
small size for her age, hepatomegaly and multiple xanthomas. Laboratory investigations show
low serum glucose and high uric acid. What is your diagnosis? What are the most common
complications and treatment?

The most likely diagnosis is Von Gierke disease, a type 1 glycogen storage disease. It is caused
by glucose-6-phosphatase deficiency which leads to fasting hypoglycemia. The most common
complications are gout, pancreatitis, platelet dysfunction, liver adenomas and nephropathy.
Treatment is frequent meals to avoid fasting hypoglycemia. Allopurinol is used in cases of gout.
4– A 50-year-old man complains of fatigue, palpitations and shortness of breath for 3 months.
There is no history of previous episodes or any serious illnesses. He takes no medication.
Examination reveals a holosystolic murmur over the apex. What is your diagnosis?

This is a case of mitral regurgitation. The holosystolic murmur over the apex is specific to this
case. Causes of mitral regurgitation are myocardial infarction, rheumatic heart disease and mitral
valve prolapse.