USMLE 2014 Step 1 sample questions

1. A 25-year-old woman is brought to the
emergency department 1 hour after she fainted.
She has had mild intermittent vaginal bleeding,
sometimes associated with lower abdominal
pain, during the past 3 days. She has had severe
cramping pain in the right lower abdomen for
12 hours. She has not had a menstrual period for
3 months; previously, menses occurred at regular
28-day intervals. Abdominal examination shows
mild tenderness to palpation in the right lower
quadrant. Bimanual pelvic examination shows a
tender walnut-sized mass in the right
parametrium. Which of the following is the most
likely diagnosis?

(A) Appendicitis
(B) Cancer of the ovary
(C) Ectopic pregnancy
(D) Endometriosis
(E) Ovarian cyst
(F) Placenta previa

2. A 12-year-old girl with a 1-year history of
systemic lupus erythematosus is brought to the
physician for a routine follow-up examination.
During the past year she has done well with the
exception of occasional mild frontal headaches,
fatigue, and arthralgias; the results of regular
laboratory evaluations have been stable. She has
missed 20 days of school in the past 4 months.
Her parents express concern that sending her to
school might cause her to be exposed to children
with contagious diseases that might exacerbate
their daughter’s condition. The girl tells the
physician that she misses seeing her many
friends at school. Passive motion of the elbows,
wrists, and knees produces mild discomfort.
Physical examination shows no other
abnormalities. Which of the following is the
most likely cause of this patient’s excessive
school absences?

(A) Lupus arthritis
(B) Lupus cerebritis
(C) Malingering
(D) School phobia
(E) Vulnerable child syndrome

3. A 4-year-old boy has delayed motor
development and choreoathetosis. He had normal
development at birth. He chews his fingers and
lips, which has resulted in tissue loss. He has
arthritis. Serum and urine uric acid
concentrations are increased. Which of the
following abnormalities is the most likely cause
of these findings?

(A) Adenine phosphoribosyltransferase
(B) Hypoxanthine-guanine 
(C) Increased cellular turnover of nucleic
(D) Increased conversion of hypoxanthine
to inosine monophosphate
(E) Phosphoribosylpyrophosphate
synthetase deficiency

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