UWSA 1 2021 For USMLE Step 1 Exam

UWSA 1 2021 For USMLE Step 1 Exam Sample
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1. Zly0&§ (?)©©
00:07vmv
A32-year-oldmancomestotheofficeduetoasubcutaneousnoduleonthedorsumofhisrighthand.Hesaysthe
noduleispainlessandhasbeenslowlyenlargingoverthelastseveralweeks.Thepatient’spastmedicalhistoryis
insignificant,buthisfatherdiedofaheartattackatage38despitebeinganonsmoker.Hismotherhasdiabetes
mellitus.Onexamination,hehas2or3small,flatsubcutaneousnodulesonthedorsumofhisrighthand,anda
largernoduleattheAchillestendonarea.Healsohasafewsmallyellowishpapulesonhisrightlowereyelid.
Whichofthefollowingismostlikelydecreasedinthispatient?
A.HDLparticles
B.Homocysteine
G.LDLreceptors
@D.Lipoproteinlipase
E.Triglycerides
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2. ^
0&6
(?)©©
59:592/40v
A52-year-oldmancomestotheclinicwithfrequentmid-abdominalpain.Hedescribesthepainasgnawing.It
wakeshimduringthenightandcanberelievedbyeatingalightmeal.Thepatienthasalsobeenusingover-the-
counteribuprofenforrelief.Threeweeksago,hewasstartedonomeprazolewithsomeimprovementofhis
symptoms.Medicalhistoryisinsignificant.Thepatientworksasamissionaryandtravelsacrossthecountryand
abroad.Hedoesnotusetobaccoordrinkalcohol.Theabdomenismildlytenderondeeppalpationinthe
epigastricarea.Thereisnoreboundtendernessorrigidity.Ureabreathtestisnegative.Uppergastrointestinal
endoscopyisperformedandrevealsaduodenalulcer.GastricbiopsiesareconsistentwithHelicobacterpylori
infection.Whichofthefollowingbestexplainsthenegativeureabreathtestinthispatient?
()A.Bcell-mediatedimmuneresponsetoHelicobacterpyloriantigens
B.Nonurease-producingHpyloriinfection
(
~
)C.SubepitheliafinvasionbyHpylori
()D.Useofibuprofenpriortotesting
(

)E.Useofomeprazolepriortotesting
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3. ^
0
^
6
(?)Jo}©
59:503/40v
A52-year-oldimmigrantfromEasternEuropepresentstotheoutpatientcliniccomplainingofdyspneaonexertion
thathasbeenincreasinginseverityoverthepastseveralweeks.Shealsodescribesnocturnaldyspneaanda
coughthatoccasionallyproducesblood-tingedsputum.Whenthepatientliesintheleftlateraldecubitusposition
andexhalesfully,youheara!ow-pitchedrmid-diastolicmurmuratthecardiacapex.Whichofthefollowingmost
likelyunderliesherconditionandsymptoms?
A.Tuberculosis
B.Infectiveendocarditis
C.Uncontrolledhypertension
Atherosclerosis
E.Rheumaticfever
F.Dilatedcardiomyopathy
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4. Zly0&§ ©®©
59:484/40^
A12-year-oldboyisbroughttotheofficeafterdevelopingbloodystools.Heisadoptedandhisfamilyhistoryis
unknown.Vitalsignsarewithinnormallimits.Physicalexaminationrevealsconjunctivalpallorandblood-streaked
stoolwithintherectalvault.Thepatient’slipsareshownintheimagebelow:
Whichofthefollowingisthemostlikelycauseofthispatient'sbleeding?
A.Angiodysplasia
B.Hamartoma
C.Meckeldiverticulum
D.Small-vesselvasculitis
E.Tubularadenoma
F.Ulcerativecolitis
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5. ^
0
^
6
(?)Jo}©
59:455/40^
A44-year-oldmancomestotheofficeduetoatendermassintherightbuttockthathasprogressivelyexpanded
overthepastseveralmonths.Hehasnoknownpastmedicalhistory.Temperatureis37.1C(93.8F).
Examinationrevealsawell-circumscribed9x5cmmassinvolvingtherightbuttockarea.Abiopsyofthelesionis
performed.Histopathologyrevealsmanyroundcellswithmultiplemitoses.Somecellshaveroundclear
cytoplasmicvacuolesscallopingthenucleus.Whichofthefollowingisthemostlikelydiagnosisinthispatient?
A.Desmoidtumor
B.Fibrosarcoma
C.Lipoma
D.Liposarcoma
E.Rhabdomyoma
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6. ^
0&6
(?)SgJ©
59:426/40v
A62-year-oldmancomestotheofficeduetoskinlesionsonhistrunkandextremitiesforthepast2weeks.He
hasbullaethatruptureeasily,particularlyinareasexposedtoregularfriction,andsubsequentlybecomepainful
erosions.Healsohaspainfulsoresinhismouth.Onexaminationoftheskin,severalflaccidbullaearenoted;
theyextendlaterallyintosurroundingskinwithdirectpressure.Largeareasoferosionalsoarepresentintheoral
cavity.Histologicanalysisofthepatient'sskinwillmostlikelyshowimmunoglobulindepositsinwhichofthe
followinglocations?
A.Alongthebasementmembrane
B.Arounddermalbloodvessels
C.Aroundmelanocytes
D.Atthepapillaryregionofthedermis
@E.Betweenkeratinocytes
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7. ^
0&6
(?)©©
59:397/40v
Anewbornboyisadmittedtotheneonatalintensivecareunitduetorespiratorydistress.Hewasborntoa34-
year-oldmotherwitha10-yearhistoryofpoorlycontrolleddiabetesmeliitus.Theinfantfailedtodescendafter8
hoursoflabor,andacesareandeliverywasperformed.Heweighs4700g(10lb6oz).Physicalexamination
immediatelyafterdeliveryshowstachypnea,nasalflaring,andintercostalretractions.Pulseoximetryshows78%
onroomair.Theinfantisintubatedandmechanicalventilationisstarted.Highpressuresarerequiredtoachieve
normaltidalvolumeandkeepthealveoliinflated.Thisinfant'sconditioniscausedbydysfunctionofwhichofthe
following?
0
A.Fibroblasts
B.Macrophages
C.Type1pneumocytes
D.Type2pneumocytes
E.Vascularsmoothmuscle
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8. Zly0&§ ©®©
59:378/40^
A65-year-oldmancomestotheofficeduetopersistentrightshoulderpainandrighthandclumsiness.Hehas
difficultypickingupobjectswiththerighthand.Hiswifeaddsthatthepatienthasbeencoughingexcessivelyfor
thepastseveralmonthsbutrefusestoquitsmoking.Hehassmoked11/2packsofcigarettesdailyfor40years.
Rightshoulderexaminationisunremarkable,butthepatienthasweaknessoftherighthandintrinsicmuscles.His
eyesareasymmetricandhaveanisocoria.Thereisnoweaknessorsensorylossinotherextremities.Hischestx-
rayisshownintheimagebelow.
DtspfMyeuwithpermissionfromCurrentMowoineGroupLLC©TS9G-
involvementofwhichofthefollowingstructuresIsthemostlikelycauseoftheeyefindingsinthispatient?
A.Cervicalganglion
B.Cervicalspinalcord
C.Ciliaryganglion
D.Facialnerve
E.Oculomotornerve
ROticganglion
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9. U0&6
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59:349/40v
A46-year-oldhomelessmanwithalonghistoryofseverealcoholusedisordercomestotheemergency
departmentduetofrequentfallsoverthelast2-3weeks.Hehasmadeattemptstocutdownonhisdrinking,but
thefallshavecontinued.Inadditionto"feelingunsteady."henotesoccasionalblurredvision.Thepatientdoesnot
useillicitdrugs.Reviewofhospitalrecordsrevealspreviousadmissionsforpancreatitis,severegastritis,and
alcoholwithdrawal.Physicalexaminationrevealsacoarse,rhythmic,posturaltremoraffectinghisfingersand
arms.Thisfindingismostlikelytheresultofpathologyinvolvingwhichofthefollowingbrainstructures?
(§)A.Cerebellum
B.Mammillarybodies
C.Subcorticalwhitematter
D.Substantianigra
E.Thalamus
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10. ^
0&6
(?)©©
59:2410/40v
A27-year-oldwomanwithahistoryofdepressionishospitalizedforanepisodeofelatedmood,poorsleep,and
agitation.Thepatienthasafamilyhistoryofmooddisorder.Sheisstartedontheappropriatetreatmentand
dischargedfromthehospital.Fourweekslater,thepatientreportsfeelingbetterandresumesregularactivities.
However,shealsoreportsexcessivethirstanddrymouth.Onexamination,herbloodpressureis110/80mmHg
andpulseis84/min.Mucousmembranesappeardry.Urinespecificgravityis<1.003.Nosignificantchangeis
seenafter4hoursofwaterdeprivation.Whichofthefollowingisthemostlikelycauseofthispatient'scurrent
symptoms?
A.Dysfunctionofthecollectingtubules
B.Glucoseintolerance
C.Hyperparathyroidism
D.impairedvasopressinproduction
E.Psychogenicpolydipsia
F.Renalglomerularinjury
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