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

These 10 quick USMLE review questions test high-yield facts that show up again and again on the exam: esophageal candidiasis, colon cancer screening, myxedema coma, UTI risk factors, anthrax, pilonidal abscess, Barrett esophagus, pancreatitis prognosis, eczema and thiazide-induced gout. 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 is the best initial management of esophageal candidiasis in an HIV patient?

A- Intravenous amphotericin
B- Oral fluconazole
C- Oral nystatin
D- Upper endoscopy

B- Oral fluconazole- is the best initial treatment. Upper endoscopy is performed if it’s not effective followed by IV amphotericin if confirmed. Oral nystatin is used locally for oral thrush.
The correct answer is B

 

Question 2. Which of the following is the best screening test for colon cancer?

A- Barium enema
B- Blood in stool (FOBT)
C- Colonoscopy
D- Sigmoidoscopy

C- Colonoscopy- Colon cancer usually starts proximal to the rectum so, sigmoidoscopy is incorrect. Other choices could be false positive and they have no chance to remove polyps.
The correct answer is C

 

Question 3. A 62-year-old woman presents to the ER in coma. Examination reveals temp of 90 F, pulse of 50, blood pressure of 100/60 and diffuse hyporeflexia. Thyroid gland is enlarged. What is the best next step?

A- Begin intravenous fluids
B- Intravenous levothyroxine and glucocorticoid
C- Obtain T4 and TSH and wait for results
D- Rapid rewarming

B- Intravenous levothyroxine and glucocorticoid- This is a case of myxedema coma. It is an emergency. IV thyroid hormone and corticoid should be administered as soon as possible. T4 and TSH should be done first but it is wrong choice because we cannot wait for the results. Slow rewarming, not rapid is also important and intravenous fluids should be following as well.
The correct answer is B

 

Question 4. Which of the following is the LEAST factor can lead to urinary tract infection?

A- Diabetes mellitus
B- Pregnancy
C- Prolonged tetracycline therapy
D- Urinary tract obstruction

C- Prolonged tetracycline therapy- This leads to frequency of urination and large amount of urine rather than urinary tract infection.
The correct answer is C

 

Question 5. Which of the following is the currently drug of choice for the treatment of cutaneous anthrax?

A- Azithromycin
B- Ciprofloxacin
C- Gentamicin
D- Penicillin

B- Ciprofloxacin- It is the most recent treatment. Penicillin used to be In the past but not anymore because of allergy and effectiveness of ciprofloxacin.
The correct answer is B

 

Question 6. A 35-year-old man complains of pain and swelling in the sacro-coccygeal region. Which of the following is the most likely diagnosis?

A- Liposarcoma
B- Perianal abscess
C- Pilonidal abscess
D- Suppurative hidradenitis

C- Pilonidal abscess- This is the most common infection at this region. It is associated with pain, swelling, sweating and purulent exudate. Other conditions could occur at this region but less likely.
The correct answer is C

 

Question 7. Which of the following procedures is used in case of Barrett esophagus without dysplasia?

A- Endoscopy and biopsy every 3 months
B- Endoscopy and biopsy every 6 months
C- Endoscopy and biopsy every 3 years
D- Endoscopic eradication

C- Endoscopy and biopsy every 3 years- If there is dysplasia, this procedure should be done every 3-6 months to evaluate malignant transformation. In this case with no dysplasia, evaluation every 3 years is appropriate.
The correct answer is C

 

Question 8. Which of the following is a poor prognostic sign of acute pancreatitis a day after initiation of hydration and appropriate treatment?

A- Blood urea nitrogen (BUN) rises 6 mg/dL
B- Hematocrit drops by 4%
C- Random serum glucose of 70 mg/dL
D- Serum amylase of 900 IU/L

A- Blood urea nitrogen (BUN) rises 6 mg/dL- Poor prognostic signs of acute pancreatitis 24-hour after hydration and treatment are increased BUN by 5% or more, decreased hematocrit value by 10% and high serum glucose. Serum amylase is not considered a prognostic sign.
The correct answer is A

 

Question 9. A patient presents with itching on his arms and legs for 2 weeks. Erythematous plaques covered with silvery scales are seen on his legs and the back of his arms. Which of the following treatments most likely improves this condition?

A- Oral acetaminophen
B- Oral amoxicillin
C- Topical betamethasone
D- Topical mupirocin

C- Topical betamethasone- This is most likely a case of psoriasis which is characterized by hyperproliferation of keratinocytes and inflammatory cellular infiltrate. It is treated by topical steroids such as betamethasone.
The correct answer is C

 

Question 10. A 48-year-old man complains of acute pain in his right big toe. He has a history of gout and takes treatment for it. Recently, he was diagnosed with hypertension and started treatment 2 weeks ago. Which one of these drugs is most likely responsible for his recent complaint?

A- Captopril
B- Hydrochlorothiazide
C- Metoprolol
D- Verapamil

B- Hydrochlorothiazide- Side effects of thiazide diuretics are hyperglycemia, hyperuricemia and hypercalcemia. Acute exacerbation of gout is triggered by hyperuricemia.
The correct answer is B

 

High-yield points from this set

  • Esophageal candidiasis in HIV: oral fluconazole first.
  • Myxedema coma: IV levothyroxine plus glucocorticoids.
  • Barrett esophagus without dysplasia: endoscopy every 3–5 years.
  • Thiazides can trigger gout by raising uric acid.

Keep practicing

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