USMLE Prep Center

Kaplan USMLE Step 1: Do cardiovascular function curves stump you?

The graph shows two sets of cardiovascular function curves. The solid lines describe the cardiovascular performance of a 60-year-old man, with point "N" indicating normal resting conditions. The two broken lines describe cardiovascular performance in the same man six months after he suffered a myocardial infarction. Auscultation of his chest reveals moderate rales bilaterally.

He takes daily walks as recommended by his cardiologist, but he tires easily and coughs excessively whenever he attempts to walk rapidly. His resting cardiac output is now 4.5 L per minute.

Which of the following is most likely his right atrial pressure at rest?

A. 0 mm Hg.

B. 1 mm Hg.

C. 4 mm Hg.

D. 7 mm Hg.

E. 9 mm Hg.

F. 11 mm Hg.

Click on the link below to learn about the answer:
American Medical Association. (n.d.). Kaplan USMLE Step 1: Do cardiovascular function curves stump you? [online] Available at: https://www.ama-assn.org/medical-students/usmle-step-1-2/kaplan-usmle-step-1-do-cardiovascular-function-curves-stump-you [Accessed 8 Nov. 2022].

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Kaplan USMLE Step 1: Patient with asthma develops seizures

A 23-year-old man with a history of resistant asthma is brought to the emergency department because of an acute onset of shortness of breath and dyspnea. He had treated himself with medication at home prior to calling for help. While in the emergency department, he develops palpitations, agitation and a tremor in both his hands.

His temperature is 37.2 °C (98.9 °F), pulse is 120 beats a minute, respirations are 22 breaths per minute, blood pressure is 132/87 mm Hg, and oxygen saturation is 95% on room air. An ECG is shown. Before acute asthma treatment is started, the patient suddenly develops seizures.

The drug most likely responsible for this patient's symptoms acts by which of the following mechanisms?

A. β2-receptor agonism.

B. Competitive blockade of muscarinic receptors.

C. Inactivation of NF-κB transcription factor.

D. Inhibition of phosphodiesterase and adenosine receptors.

E. Mast cell stabilization.

Click on the link below to learn about the answer:
American Medical Association. (n.d.). Kaplan USMLE Step 1: Patient with asthma develops seizures. [online] Available at: https://www.ama-assn.org/medical-students/usmle-step-1-2/kaplan-usmle-step-1-patient-asthma-develops-seizures

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Kaplan USMLE Step 2 prep: Older adult man unable to urinate

A 71-year-old man comes to the physician because of problems with urination. He reports that over the past two weeks his urine stream has become weaker. Over the last 24 hours, he has been unable to urinate at all and is becoming extremely uncomfortable. There is no history of dysuria, hematuria, fever, or chills. He has a history of benign prostatic hyperplasia (BPH), for which he takes tamsulosin.

He takes diltiazem for hypertension and had a cholecystectomy 20 years ago. He denies any use of over-the-counter medications. His temperature is 37.4 ºC (99.3 ºF), pulse is 86 beats per minute, and blood pressure is 164/88 mmHg. He is in moderate distress. The abdomen is soft with lower abdominal distension and suprapubic discomfort on palpation and percussion. On digital re**al examination, the prostate is estimated to be 50 grams in size, nontender and without nodularity.

When an attempt is made to place a Foley urinary catheter, resistance is met and no urine comes out. Blood then begins to ooze from the urethral meatus. Which of the following is the best next step in management?

A. Insert bilateral percutaneous nephrostomy tubes.

B. Perform retrograde urethrogram.

C. Perform suprapubic tube placement.

D. Plan emergency ileal conduit creation.

E. Schedule emergent transurethral resection of the prostate.

Click on the link below to learn about the answer:
American Medical Association. (n.d.). Kaplan USMLE Step 2 prep: Older adult man unable to urinate. [online] Available at: https://www.ama-assn.org/medical-students/usmle-step-1-2/kaplan-usmle-step-2-prep-older-adult-man-unable-urinate

Image Reference:
Huy Phan (2016). man sitting on brown wooden bench. [online] Unsplash.com. Available at: https://unsplash.com/photos/QCF2ykBsC2I

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Kaplan USMLE Step 2 prep: What does this bone marrow biopsy reveal?

A 55-year-old man is brought to his physician because of a feeling of pressure and fullness on the left side of his abdomen. He has also had a gradual onset of fatigue. On physical examination, his spleen is 6 cm below the left costal margin and firm.

In addition, the liver edge is palpable below the right costal margin; there is no adenopathy. A complete blood count shows a hematocrit of 27% and a white blood cell count of 3,800/µL with 2,200 neutrophils/µL and 50 monocytes/µL. The lymphocyte count is normal. Platelet count is 60,000/µL.

A bone marrow aspirate is unable to be obtained and the findings from a subsequent bone marrow biopsy is shown. The cells express the CD11c and CD22 antigens on immunophenotyping.

Which of the following is the most likely diagnosis?

A. Aplastic anemia.

B. Fanconi anemia.

C. Hairy cell leukemia.

D. Non-Hodgkin lymphoma.

E. Waldenstrom macroglobulinemia.

Click on the link below to learn about the answer:
American Medical Association. (n.d.). Kaplan USMLE Step 2 prep: What does this bone marrow biopsy reveal? [online] Available at: https://www.ama-assn.org/medical-students/usmle-step-1-2/kaplan-usmle-step-2-prep-what-does-bone-marrow-biopsy-reveal

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Kaplan USMLE Step 3 prep: Is an echocardiogram needed in this case?

A 36-year-old man goes to his physician for preoperative evaluation prior to an elective rotator cuff repair. Arthroscopic repair has been recommended by his orthopedic surgeon and as per the anesthesiologist, he is at minimal risk for any major complication. Because of the patient’s past medical history of mitral valve pr*****ed, the anesthesiologist had asked if the patient ever had an echocardiogram.

The patient is requesting this test today. He is otherwise healthy, with a negative review of systems and no regular medications. No heart murmur is present on physical examination. The procedure is scheduled for tomorrow.

Which of the following is the most appropriate management?

A. Advise the patient that antibiotic prophylaxis is necessary.

B. Obtain a transthoracic echocardiogram and delay the surgery until results are available.

C. Order blood cultures preoperatively.

D. Proceed with surgery.

E. Obtain a transesophageal echocardiogram.

Click on the link below to learn about the answer:
American Medical Association. (n.d.). Kaplan USMLE Step 3 prep: Is an echocardiogram needed in this case? [online] Available at: https://www.ama-assn.org/medical-residents/usmle-step-3/kaplan-usmle-step-3-prep-echocardiogram-needed-case [Accessed 15 Sep. 2022].

Image Reference:
Unsplash (n.d.). Photo by Tim Cooper on Unsplash. [online] unsplash.com. Available at: https://unsplash.com/photos/BvS7q4yFQt4

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Kaplan USMLE Step 3 prep: What’s next for patient with volvulus?

After a transatlantic flight, a 52-year-old business executive is admitted to the hospital with complaints of increasing abdominal distension and discomfort. He reports that he has had similar episodes twice in the past, one of which spontaneously resolved. During the second episode, he was admitted to a hospital and underwent "untwisting of a bowel loop by means of a tube in his re**um."

His abdominal examination and abdominal X-ray are diagnostic of sigmoid volvulus, which is easily decompressed by a re**al tube. Now he is feeling much better and repeat abdominal X-rays have confirmed the disappearance of the volvulus. He asks to be discharged from the hospital so that he can complete his business transaction and fly back to London tomorrow. He promises to visit his surgeon at the earliest opportunity once he returns to England.

Which of the following is the appropriate advice for this patient?

A. Bed rest for one week before flying.

B. Go ahead with his plans.

C. He should not fly without permanently fixing his volvulus problem.

D. Seek a second opinion.

E. Undergo emergency surgery.

Click on the link below to learn about the answer:
American Medical Association. (n.d.). Kaplan USMLE Step 3 prep: What’s next for patient with volvulus? [online] Available at: https://www.ama-assn.org/medical-residents/usmle-step-3/kaplan-usmle-step-3-prep-what-s-next-patient-volvulus

Image Reference:
Unsplash (n.d.). Photo by National Cancer Institute on Unsplash. [online] unsplash.com. Available at: https://unsplash.com/photos/ac2bAkjzCX4

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Kaplan USMLE Step 2 prep: Older adult man unable to urinate

A 71-year-old man comes to the physician because of problems with urination. He reports that over the past two weeks his urine stream has become weaker. Over the last 24 hours, he has been unable to urinate at all and is becoming extremely uncomfortable. There is no history of dysuria, hematuria, fever, or chills. He has a history of benign prostatic hyperplasia (BPH), for which he takes tamsulosin.

He takes diltiazem for hypertension and had a cholecystectomy 20 years ago. He denies any use of over-the-counter medications. His temperature is 37.4 ºC (99.3 ºF), pulse is 86 beats per minute, and blood pressure is 164/88 mmHg. He is in moderate distress. The abdomen is soft with lower abdominal distension and suprapubic discomfort on palpation and percussion. On digital re**al examination, the prostate is estimated to be 50 grams in size, nontender and without nodularity.

When an attempt is made to place a Foley urinary catheter, resistance is met and no urine comes out. Blood then begins to ooze from the urethral meatus. Which of the following is the best next step in management?

A. Insert bilateral percutaneous nephrostomy tubes.

B. Perform retrograde urethrogram.

C. Perform suprapubic tube placement.

D. Plan emergency ileal conduit creation.

E. Schedule emergent transurethral resection of the prostate.

Click on the link below to learn about the answer:
American Medical Association. (n.d.). Kaplan USMLE Step 2 prep: Older adult man unable to urinate. [online] Available at: https://www.ama-assn.org/medical-students/usmle-step-1-2/kaplan-usmle-step-2-prep-older-adult-man-unable-urinate [Accessed 13 Sep. 2022].

Image Reference:
Unsplash (n.d.). Photo by Muhammad Hicham on Unsplash. [online] unsplash.com. Available at: https://unsplash.com/photos/AZDVF4fEcY4 [Accessed 13 Sep. 2022].

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Kaplan USMLE Step 2 prep: Barium e***a reveals multiple polyps

A 58-year-old woman comes to the physician for a follow-up examination two weeks after undergoing a barium e***a. She denies fever, weight loss, re**al bleeding, or fatigue. She has a four-year history of hypertension controlled with hydrochlorothiazide. Examination shows no abnormalities. The barium e***a shows four to five polyps scattered throughout her colon, ranging in size from 4 mm to 1.1 cm.

Which of the following is the most appropriate next step in management?

A. Colonoscopy.

B. F***l DNA testing.

C. Repeat barium e***a in six months.

D. Screening colonoscopy for her 25-year-old son.

E. Upper gastrointestinal barium study.

Click on the link below to learn about the answer:
American Medical Association. (n.d.). Kaplan USMLE Step 2 prep: Barium e***a reveals multiple polyps. [online] Available at: https://www.ama-assn.org/medical-students/usmle-step-1-2/kaplan-usmle-step-2-prep-barium-e***a-reveals-multiple-polyps [Accessed 12 Sep. 2022].

Image Reference:
Unsplash (n.d.). Photo by National Cancer Institute on Unsplash. [online] unsplash.com. Available at: https://unsplash.com/photos/tl447mekwuQ

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Kaplan USMLE Step 1: Patient with asthma develops seizures

A 23-year-old man with a history of resistant asthma is brought to the emergency department because of an acute onset of shortness of breath and dyspnea. He had treated himself with medication at home prior to calling for help. While in the emergency department, he develops palpitations, agitation and a tremor in both his hands.

His temperature is 37.2 °C (98.9 °F), pulse is 120 beats a minute, respirations are 22 breaths per minute, blood pressure is 132/87 mm Hg, and oxygen saturation is 95% on room air. An ECG is shown. Before acute asthma treatment is started, the patient suddenly develops seizures.

The drug most likely responsible for this patient's symptoms acts by which of the following mechanisms?

A. β2-receptor agonism.

B. Competitive blockade of muscarinic receptors.

C. Inactivation of NF-κB transcription factor.

D. Inhibition of phosphodiesterase and adenosine receptors.

E. Mast cell stabilization.

Click on the link below to learn about the answer:
American Medical Association. (n.d.). Kaplan USMLE Step 1: Patient with asthma develops seizures. [online] Available at: https://www.ama-assn.org/medical-students/usmle-step-1-2/kaplan-usmle-step-1-patient-asthma-develops-seizures [Accessed 6 Sep. 2022].

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Kaplan USMLE Step 2 prep: Next step for patient with groin pain

A 55-year-old man comes to the urgent care clinic because of groin pain. He describes the pain as intense, constant and dull. He also thinks he noticed a new bulge in his groin. Past medical history is significant for hypertension. There is no surgical history.

His temperature is 38 ºC (100.4 ºF), pulse is 98 beats a minute, respirations are 16 breaths per minute, and blood pressure is 138/80 mm Hg. Examination of the groin shows mild right-sided erythema, and a mildly tender mass can be felt when the examiner's finger is placed in the internal inguinal ring. The size and presence of the mass are unaffected by cough or strain. The remainder of the examination is otherwise unremarkable.

Which of the following is the most appropriate next step in the management of this patient?

A. Elective surgical repair.

B. Emergent puncture and drainage of the inguinal abscess.

C. Emergent surgical repair.

D. Reassurance, ice compresses and rest.

E. Ultrasonography of the mass.

Click on the link below to learn about the answer:
American Medical Association. (n.d.). Kaplan USMLE Step 2 prep: Next step for patient with groin pain. [online] Available at: https://www.ama-assn.org/medical-students/usmle-step-1-2/kaplan-usmle-step-2-prep-next-step-patient-groin-pain [Accessed 5 Sep. 2022].

Image Reference:
Unsplash (n.d.). Photo by Usman Yousaf on Unsplash. [online] unsplash.com. Available at: https://unsplash.com/photos/eUSCGHW-uZw.

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Kaplan USMLE Step 2 prep: Patient says his skin is crawling

A 50-year-old man comes to the emergency department because of bilateral hand tremor, diaphoresis, anxiety, nausea, headache and the sensation that “my skin is crawling.” His medical history is significant for hypertension that is treated with hydrochlorothiazide and enalapril.

He also has bipolar disorder and anxiety, which is treated with three medications prescribed by his psychiatrist. He ran out of these three medications 3 days ago. His temperature is 37.0 ºC (98.6 ºF), blood pressure is 150/100 mm Hg, pulse is 115 beats per minute, and respirations are 20 breaths a minute. Physical examination is notable for diaphoresis and tremulousness.

Administration of which of the following is the most appropriate initial step in this patient's care?

A. Clonidine.

B. Diazepam.

C. Haloperidol.

D. Hydrochlorothiazide.

E. Prochlorperazine.

Click on the link below to learn about the answer:
American Medical Association. (n.d.). Kaplan USMLE Step 2 prep: Patient says his skin is crawling. [online] Available at: https://www.ama-assn.org/medical-students/usmle-step-1-2/kaplan-usmle-step-2-prep-patient-says-his-skin-crawling [Accessed 2 Sep. 2022].

Image Reference:
Unsplash (n.d.). Photo by Tim Doerfler on Unsplash. [online] unsplash.com. Available at: https://unsplash.com/photos/dYNar7pk9_Y [Accessed 2 Sep. 2022].

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Kaplan USMLE Step 1: Which factor is involved in the pathogenesis?

A 48-year-old woman comes to the emergency department because of a 16-hour history of confusion, dizziness, and fatigue. The patient has a history of HIV and is currently on antiretroviral therapy. Her temperature is 38.3°C (101.0°F), pulse is 98 beats per minute, respirations are 20 breaths a minute, and blood pressure is 110/72 mm Hg. Physical examination shows petechiae on her lower extremities. Laboratory studies show:

Leukocyte count: 13,000/mm3.
Hemoglobin: 8.1 g/dL.
Platelet count: 75,000/mm3.
Haptoglobin: 38 mg/dL.
Lactate dehydrogenase (LDH): 305 U/L.
Activated partial thromboplastin time (aPTT): 35 seconds.
Prothrombin time (PT): 14 seconds
Blood urea nitrogen: 29 mg/dL.
Peripheral blood smear shows multiple schistocytes. Which of the following factors is most likely involved in the pathogenesis of this patient's diagnosis?

A. Factor VIII.

B. Fibrinogen.

C. Glycoprotein Ib.

D. Glycoprotein IIb/IIIa.

E. Von Willebrand factor.

Click on the link below to learn about the answer:
American Medical Association. (n.d.). Kaplan USMLE Step 1: Which factor is involved in the pathogenesis? [online] Available at: https://www.ama-assn.org/medical-students/usmle-step-1-2/kaplan-usmle-step-1-which-factor-involved-pathogenesis [Accessed 26 Aug. 2022].

Image Reference:
Unsplash (n.d.). Photo by Patty Brito on Unsplash. [online] unsplash.com. Available at: https://unsplash.com/photos/Y-3Dt0us7e0.

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