Repeated USMLE Questions Step 1- Review- 82

Q- A 12-year-old girl complains of fatigue, shortness of breath for 3 days. A week ago, she developed running nose, cough and sore throat and all her symptoms resolved spontaneously in 3 days. She has no history of major illness or surgeries and receives no treatment. Examination reveals a gallop, soft first heart sound and a high pitched holosystolic murmur. There are no joint pains or effusions.

Which of the following is the most likely diagnosis?

A- Lobar pneumonia

B- Rheumatic fever

C- Systemic lupus erythematosus

D- Viral myocarditis

D- Viral myocarditis- History is typical for this condition. Viral myocarditis leads to mitral regurgitation as in this case. There is no history suggesting other conditions.

Q- Which of the following is the most common bacterium found in community-acquired pneumonia?

A- Chlamydia

B- Mycoplasma

C- Staphylococcus aureus

D- Streptococcus pneumoniae

D- Streptococcus pneumoniae- It is the common bacterium involved in community-acquired pneumonia. Other types of bacteria can cause pneumonia but not as common as pneumococcus.

Q- Which one of these components of food is most likely responsible for developing a painful episode of gouty arthritis?

A- Carbohydrates

B- Protein

C- Purines

D- Triglycerides

C- Purines- Gout is a very important topic in USMLE.  Food rich in nucleic acids can precipitate to acute episode of gout. Other mentioned sources of food do not include purines which are converted to uric acid and trigger this episode.

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