I am going to answer the sample USMLE Step 1 Questions with Explanation. These questions are available at USMLE.org
Q- A 51-year-old man with a 10-year history of gastroesophageal reflux and suspected Barrett esophagus comes to the office because his omeprazole dose “doesn’t work around the Christmas holidays.” He states that he prides himself on having a large appetite and “holding his liquor” during the holidays. He currently takes the maximum dose of omeprazole. Which of the following is the most appropriate initial action by the physician?
(A) Ask the patient how much he is eating and drinking during the holidays
(B) Explain the hazards of untreated reflux in the presence of Barrett esophagus
(C) Order an upper endoscopy
(D) Refer the patient to a gastroenterologist
(E) Switch the omeprazole to pantoprazole
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Answer:
- The patient’s symptoms seem to worsen during the holiday season, when he mentions increased eating and alcohol consumption. These factors are well-known to exacerbate gastroesophageal reflux disease (GERD) symptoms. Therefore, understanding the quantity and type of food and alcohol consumed could provide valuable insights into his symptom exacerbation.
- Before considering other diagnostic tests or changing medications, it is essential to identify and address lifestyle factors that may be contributing to the worsening of his symptoms. Counseling on diet, alcohol consumption, and other lifestyle modifications might be an effective strategy to manage his GERD symptoms better.
- While the other options might eventually be considered, they are not the most immediate step to take based on the information provided.
The correct answer is A
More Repeated USMLE Questions Step 1
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