I am going to answer the sample USMLE Step 1 Questions with Explanation. These questions are available at USMLE.org
A 50-year-old man comes to the office for a follow-up examination. He has a 2-month history of headache and shortness of breath with exertion. He also has hypertension treated with hydrochlorothiazide for the past 2 years. His blood pressure is 180/105 mm Hg. Ophthalmoscopic examination is most likely to show which of the following in this patient?
(A) Arteriovenous nicking
(B) Melanocytes in the uvea
(C) Optic neuritis
(D) Posterior subcapsular cataracts
(E) Tractional retinal detachment
Copyright © 1996-2021 Federation of State Medical Boards (FSMB) and National Board of Medical Examiners (NBME). All rights reserved. The United States Medical Licensing Examination® (USMLE®) is a joint program of the FSMB and NBME.
Answer:
Arteriovenous (AV) nicking is a common finding in patients with chronic hypertension and occurs when the arteriole compresses the venule at the points where they cross each other, due to arteriolar thickening. This can be a sign of hypertensive retinopathy, which is consistent with the patient’s long-standing hypertension and elevated blood pressure.
Melanocytes are normally present in the uvea, the middle layer of the eye. This is not a pathological finding and is unrelated to the patient’s symptoms and hypertension.
Optic neuritis involves inflammation of the optic nerve, often associated with multiple sclerosis or other inflammatory conditions. It typically presents with visual symptoms like pain with eye movement and vision loss.
Cataracts are clouding of the lens, often related to aging, diabetes, or prolonged steroid use. Posterior subcapsular cataracts can cause glare and blurred vision.
Tractional retinal detachment is often associated with conditions like diabetic retinopathy or severe ocular trauma, where fibrous tissue pulls the retina away from the underlying tissue.
The correct answer is (A) Arteriovenous nicking
More Repeated USMLE Questions Step 1
Check this Review Book for Step 1