USMLE Step 1 - MEDSTUDENTS

Questions 1 and 2
A homeless middle-aged male patient presents in the emergency room in a state of intoxication. You note that he is behaviorally disinhibited and rowdy. He tells you that he has recently consumed about a pint of a red-colored liquid that his friends were using to "get high". He complains that his vision has blurred and that it is "like being in a snowstorm". His breath smells a bit like formaldehyde. The most likely cause of his intoxicated state is the ingestion of

A ethylene glycol

B ethanol

C isopropanolol

D methanol

E hexane

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Question 2

Your management of this patient may include all of the following, EXCEPT

A airway and respiratory support if needed

B administration of activated charcoal a higher perfusion rate

C administration of bicarbonate to counteract metabolic acidosis

D administration of ethanol before laboratory diagnosis is confirmed

E initiation of dialysis procedures, since it is likely to be an important step in the management of this patient

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Question 3
A patient must be evaluated because of thrombocytopenia. The patient is a 55-year-old, previously well man, who was admitted to the hospital yesterday because of pneumonia. Antibiotic therapy was started; and, although his temperature continues to spike, it is lower than it was on admission. On admission his hemoglobin was reported to be 13 g/dL, his white blood cell count was 9000/(L, and his platelet count was 70000/(L. The next laboratory study that should be done is

A bone marrow aspiration

B bleeding time

C examination of peripheral smear

D platelet aggregation studies

E antiplatelet antibody detection tests

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Question 4

A 45 year-old woman who usually drinks two cups of coffee each morning is hospitalized and placed on intravenous fluids. After 2 days, this patient is most likely to complain of all of the following signs EXCEPT

A headache

B insomnia

C depression

D hunger

E lethargy

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Question 5

Each of the following statements regarding IgA is correct EXCEPT

A Secretory IgA in the gastrointestinal tract limits the attachment of bacteria to the gut mucosa

B People with an IgA deficiency have an increased number of respiratory infections

C IgA fixes complement, thereby enhancing phagocytosis by neutrophils

D IgA is the main immunoglobulin in mother's milk

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Question 6
Your patient is a 70 year-old man with a long history of smoking who now has fever and a cough productive of greenish sputum. You suspect pneumonia and a chest x-ray confirms the diagnosis. If a Gram stain of the sputum reveals gram-negative rods and there is no growth on a blood agar but colonies do grow on chocolate agar supplemented with NAD and heme, which of the following bacteria is the MOST likely cause?

A Chlamydia pneumoniae

B Legionella pneumphlia

C Mycoplasma pneumoniae

D Haemophilus influenzae

E Streptococcus pneumoniae

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Question 7 and 8

A 5 year-old child has a severe sore throat, high fever and cervical adenopathy. It is suspected that the causative agent is Streptococcus pyogenes. Which of the following is involved in producing fever in the child?

A Increased production of IL-1

B Decreased production of prostaglandin

C Decreased set-point temperature in the hypothalamus

D Decreased metabolic rate

E Vasodilatation of blood vessels in the skin

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Question 8

Prior to initiation of antibiotic therapy, the child is given aspirin to reduce fever. The mechanism of fever reduction by aspirin is

A shivering

B stimulation of cyclo-oxigenase

C inhibition of prostaglandin synthesis

D shunting of blood from the surface of skin