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Repeated USMLE Questions Step 1- Review- 46

Q- An old man with a long history of diabetes develops an ulcer on his left big toe which is not healed in 3 months. His blood glucose level is within normal limits.

Which of the following is the most accurate test to explain this condition?

A- Anti-insulin antibodies detection

B- Hemoglobin A1C level

C- Plasma insulin

D- Urine ketones

B- Hemoglobin A1C level- This is the only test on the list that determines a long-time control of diabetes. This patient’s history may reveal that he is not compliant with treatment or with the treatment plan. It his level is low then; we should look for something else such as any vascular disorder.



Q- It is approved that increased serum level of homocysteine is associated with increased risk of atherosclerosis. Which one of the following vitamins is an important cofactor in the metabolism of homocysteine?

A- Ascorbic acid

B- Niacin

C- Pyridoxine

D- Riboflavin

C- Pyridoxine- Vitamin B6, also known as pyridoxine, is an important cofactor in the metabolism of homocysteine by assisting it to convert back to methionine by adding its methyl group.



Q- A patient with a long history of atherosclerosis develops dry gangrene in his foot and toes. Which of the following types of necrosis predominates in this condition?

A- Coagulative necrosis

B- Fat necrosis

C- Fibrinoid necrosis

D- Liquefactive necrosis

A- Coagulative necrosis- This type of necrosis develops due to sudden impairment of vascular supply to the organs except the brain which develops liquefactive necrosis due to vascular damage.



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