I am going to answer the sample USMLE Step 1 Questions with Explanation. These questions are available at USMLE.org
Q- A 54-year-old woman comes to the physician because she would like to lose weight. She has been on numerous diets in the past with limited success. Both her parents have type 2 diabetes mellitus. She is 160 cm (5 ft 3 in) tall and weighs 69 kg (152 lb); BMI is 27 kg/m2. Her blood pressure is 140/90 mm Hg. Fasting serum glucose concentration is 102 mg/dL. Compared with a woman of the same age whose weight is normal, which of the following serum abnormalities is most likely in this patient?
(A) Decreased cholesterol excretion
(B) Decreased estrone concentration
(C) Decreased leptin concentration
(D) Increased fasting insulin concentration
(E) Increased growth hormone concentration
(F) Increased thyroid-stimulating hormone concentration
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Answer
This patient’s BMI of 27 kg/m² indicates she is overweight, and her fasting glucose of 102 mg/dL suggests impaired fasting glucose, which can be a sign of early insulin resistance. Insulin resistance is common in overweight individuals, especially those with a family history of type 2 diabetes mellitus, like this patient.
In overweight or obese individuals, the body often compensates for insulin resistance by increasing insulin production, leading to higher fasting insulin levels. This elevated insulin concentration helps maintain blood glucose levels within a relatively normal range but at the cost of further promoting fat storage and potentially worsening insulin resistance over time.
The correct answer is D