8 USMLE Step 1 Mixed Review Questions with Answers (Set 16)

These 8 quick USMLE review questions test high-yield facts that show up again and again on the exam: refusing treatment, goiter, ankylosing spondylitis, seizures and driving, endocarditis prophylaxis, sinusitis, acute bronchitis and rheumatoid eye disease. Each question includes the correct answer.

Written by Dr. Ray Makar, MD, author of the Repeated USMLE Questions eBook series.

Prefer video? Watch daily USMLE case questions on MedFocus by Dr. Ray on YouTube.

How to use this page: read the question, pick your answer, then tap Show Answer and Explanation.

Questions

Question 1. Which of the following will be your response to a patient refusing lifesaving treatment due to a religious belief?

A- Bring a court order
B- Contact his family to convince him to take his treatment
C- Do not treat him
D- Hide his treatment in his food

C- Do not treat him- Any patient has absolute right to refuse their treatment and should be respected by the treating physician.
The correct answer is C

 

Question 2. A symmetrically enlarged mass is felt during neck examination of 35-year-old woman. Her thyroid panel is normal. No thyroid peroxidase antibody is detected. Which of the following is the most likely diagnosis?

A- Anaplastic carcinoma
B- Follicular carcinoma
C- Graves’ disease
D- Nodular goiter

D- Nodular goiter- Carcinoma is not felt as a symmetrical mass. Graves’ shows abnormal thyroid panel. Most patients of nodular goiter show normal thyroid panel.
The correct answer is D

 

Question 3. Bamboo sign is a late finding of which one of the following osteoarthropathies?

A- Ankylosing spondylitis
B- Psoriatic arthritis
C- Reactive arthritis
D- Rheumatoid arthritis

A- Ankylosing spondylitis- The tissues that connect tendons and ligaments to bones become inflamed. Repeated inflammation and repair can lead to scarring and new bone formation showing as bamboo spine.
The correct answer is A

 

Question 4. A patient with a recent history of seizures asks you about his ability to drive his car to work. Which of the following is the appropriate response?

A- I am obligated to inform the authorities to confiscate your license
B- I recommend that you find an alternative way of transportation
C- I recommend that you find another person to accompany you when you drive
D- You can drive as long as you take your medications on time

B- I recommend that you find an alternative way of transportation- There is a risk that the patient have a seizure while driving which carry a major risk to their life. There is no obligation to report him to authorities. Being accompanied with another person won’t stop seizures and risk.
The correct answer is B

 

Question 5. Which one of the following conditions needs prophylactic antibiotics before dental procedures?

A- History of arrhythmia
B- History of congestive heart failure
C- History of infective endocarditis
D- History of myocardial infarction

C- History of infective endocarditis- It is the only condition on the list that needs prophylactic antibiotics before any dental procedure. Other conditions that need prophylaxis are prosthetic valve and cyanotic congenital heart diseases.
The correct answer is C

 

Question 6. A patient presents with acute sinusitis for 3 days. Which of the following is the appropriate treatment of this patient?

A- Amoxicillin
B- Doxycycline
C- Cephalexin
D- Symptomatic treatment

D- Symptomatic treatment- Most cases of acute sinusitis are due to viral infection. Antibiotics are only used if symptoms persist or worsen for more than 7 days.
The correct answer is D

 

Question 7. A middle-aged woman presents with fever, difficulty breathing and severe cough. Her COVID test is negative. She is diagnosed with acute viral bronchitis. Which of the following is the best next step of management?

A- Albuterol and antitussives
B- Broad-spectrum antibiotics
C- Corticosteroids
D- Sputum Gram stain

A- Albuterol and antitussives- Symptomatic treatment is the best next step for this patient. Antibiotics and Gram staining are not used unless this is a proof of bacterial infection. Corticosteroids can be used later if there will be no improvement.
The correct answer is A

 

Question 8. A 46-year-old woman with a history of rheumatoid arthritis presents with chronic eye pain and redness. There is no ocular discharge or edema. Slit lamp examination shows “cells and flare” in the anterior chamber. Which of the following is the most likely diagnosis?

A- Conjunctivitis
B- Keratitis
C- Iritis
D- Retinitis

C- Iritis- it is also known as anterior uveitis. It is usually associated with autoimmune diseases and other medical conditions. Cell and flare refer to inflammatory cells and foggy appearance by the protein leaked from inflamed blood vessels.
The correct answer is C

 

High-yield points from this set

  • Competent adults may refuse life-saving treatment.
  • Bamboo spine = ankylosing spondylitis.
  • Most acute sinusitis is viral: symptomatic treatment first.
  • Only high-risk heart conditions (such as prior endocarditis) need dental prophylaxis.

Keep practicing

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