USMLE Step 1 Pathology Questions
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Free USMLE Step 1 Pathology Questions

A 31-year-old female visits the clinic with the complaint of new-onset abnormal body movements. Her husband noticed it twice in the past week. There were jerky movements for roughly 15 seconds during her last episode. She has no history of recent trauma or fever. Her vital signs are blood pressure: 114/74 mm Hg, pulse: 81/min, temperature: 36.7°C (98.1°F) and respiratory rate: 10/min. On examination, there is no evidence of focal deficits. 

A basic metabolic panel is ordered which shows:

Sodium141 mEq/L
Potassium5.1 mEq/L
Chloride101 mEq/L
Bicarbonate24 mEq/L
Albumin4.3 mg/dL
Urea nitrogen11 mg/dL
Creatinine1.0 mg/dL
Uric Acid6.8 mg/dL
Calcium8.9 mg/dL
Glucose111 mg/dL

A contrast magnetic resonance imaging (MRI) of head is ordered which shows as the provided image. Which of the following cells are the origin of the lesion seen in this patient’s MRI?

  1. Meningothelial cells
  2. Ependymal cells
  3. Astrocytes
  4. Neurons
  5. Oligodendroglia
Pathology USMLE Step 1 Practice Question

Image: by Christaras A.: CC BY 2.5

A 51-year-old woman is brought to the emergency department due to an aggressive cough with lots of thick, foamy yellow-green sputum. She says she has had this cough for about 11 years with exacerbations, like today. Also, she reports that the cough is worse in the morning. She was evaluated multiple times in the past several years because of recurrent bouts of bronchitis that have required treatment with antibiotics. She is a non-smoker. On physical exam, her blood pressure in 125/78 mm Hg, pulse rate is 80/min, respiratory rate is 16/min and the temperature is 36.7°C (98.0°F). Chest auscultation reveals crackles and wheezing over the right middle lobe and the rest of physical examination shows normal findings. Chest X-ray shows irregular opacities in the right middle lobe and diffuse airway thickening. Based on this history and physical exam, which of the following is the most likely diagnosis?

  1. Tuberculosis
  2. Alpha-1-antitrypsin deficiency
  3. Bronchiectasis
  4. Chronic obstructive pulmonary disease
  5. Chronic bronchitis

A 32-year-old woman comes to the office with the complaints of intense anal pain every time she has a bowel movement and mild bright red bleeding per rectum. The pain has been present for the past 4 weeks and it is too intense during defecation. It is a dull and throbbing pain that is associated with slight bright red bleeding. She has no relevant past medical history. When asked about her sexual history, she admits practicing anal intercourse. Her vital signs are heart rate 98/min, respiratory rate 16/min, temperature 37.6°C (99.7°F) and blood pressure 110/66 mm Hg. On physical examination, the anal sphincter tone is markedly increased and it’s impossible to introduce the finger due to severe pain. What is the most diagnosis?

  1. Anorectal abscess
  2. Deterioration of the connective tissue that anchors hemorrhoids
  3. Rectal prolapse and paradoxical contraction of the puborectalis muscle
  4. Local anal trauma
  5. Inflammatory bowel disease

A 42-year-old patient approaches your office complaining about of 1 year long of persistent dysuria, increasingly discomfort with bladder filling and voiding, and suprapubic pain. She further comments she has been presenting abdominal cramps and alternating periods of diarrhea and constipation for the past 4 months. Her family medical history is negative for malignancies and hereditary disorders. Her personal history is relevant for various visits to the general practitioners for similar complains that resulted in multiple antimicrobial regimes for urinary tract infection, with the last prescription containing ciprofloxacin. At the moment she is not taking any medication. Physical examination shows variable suprapubic tenderness, as well as tender areas in the pelvic floor. Body temperature is 37C, heart rate 68/min, blood pressure is 120/58 mm Hg, and the respiratory rate is 13 /min. Vaginal examination is normal, no adnexal masses are detected and no secretions are noticed.

She brings an urinalysis and an urine culture from 1 week ago that show the following:

TestResultNormal Range
Urine cultureNegative< 100,000 CFU/mL to no bacterial growth in asymptomatic patients
UrianalysisDensity: 1.030; Leukocyte esterase (-); Nitrites (-); pH: 6.0, Presence of 4 RBCs per high power field.Density: 1.030 – 1.060; Leukocyte esterase (-), Nitrites (-), pH: 4.5 – 8.0

What is the most appropriate step in this case?

  1. Self-care and behavior modification
  2. Admission to the ER for intravenous antibiotic administration
  3. Urinary analgesia with phenazopyridine
  4. Conjugated estrogens
  5. Escalation to levofloxacin

A 32-year-old Caucasian woman goes to her family physician for a routine checkup for her new job. Presently, she is asymptomatic, and the physical examination is unremarkable. Her family history is negative for malignancies and inherited disorders. During the visit, she presents to her family physician the results of a Pap smear taken last week, which reports the presence of atypical squamous cells of undetermined significance (ASC-US), along a test for HPV, which came back negative. The Pap smear before this one was normal (negative for intraepithelial lesion or malignancy). When would you recommend her to take her next cervical test?

  1. Immediately
  2. 6 months
  3. 3 years
  4. 5 years
  5. 1 year

A 68-year-old-male from California presents to the office for a general health checkup. He does not have any complaints at the moment. He says that after his retirement at 50 he has tried to keep himself healthy and active by jogging and gardening. He adds that he spends his mornings in the park and afternoons in his garden every day. His past medical history is insignificant. He never smoked and drinks alcohol occasionally. On physical examination, the following lesion is seen on his scalp. Which of the following is the most likely diagnosis?

  1. Psoriasis
  2. Seborrheic keratosis
  3. Basal cell carcinoma
  4. Actinic keratosis
  5. Squamous cell carcinoma
Pathology USMLE Step 1 Practice Question

Image: by Future FamDoc, License: CC BY-SA 4.0

A 30-year-old male, BMI of 33.7 kg/m2, presented with severe pain in his right toe since morning. He had few beers last night at a friend’s party. On examination, the right toe looks swollen, warm, red and tender to touch. Joint aspiration was done. The examination of fluid will most probably reveal?

  1. Increased glucose
  2. Needle shaped, negative birefringent crystals on polarized light
  3. Rhomboid shaped positive birefringent crystals on polarized light
  4. Gram negative diplococci
  5. Anti-CCP

A 35-year-old female presents with a complaint of oral ulcers. It is the third recurrence of the ulcers in the last 8 months. She is sexually active and complains of dyspareunia. Examination shows the presence of uveitis. Which of the following antibodies are positive in this person?

  1. Anti-double stranded (dS)DNA
  2. ASCA
  3. ANCA
  4. Scl-70
  5. ANA

A 72-year-old woman complains of fatigue and pallor. She has mild tachycardia, but other than that, her physical is normal. 3 years ago, she tried to commit suicide by swallowing a caustic compound of unknown origin. Complete blood count (CBC) shows that she is anemic. On peripheral blood smear, megaloblasts can be seen along with hypersegmented neutrophils. What is the most likely diagnosis?

  1. Lead poisoning
  2. Pernicious anemia caused by the deficiency of intrinsic factor because of her caustic injury to the stomach
  3. Iron deficiency because of inadequate intake
  4. Hemolytic anemia
  5. Glucose-6-phosphate dehydrogenase deficiency (G6PD deficiency)
Pathology USMLE Step 1 Practice Question

Image: by Ed Uthman, License: CC BY 2.0

A 62-year-old man presents to his primary care physician after his wife and his friends noticed that he ‘looked yellow’. The patient has no complaints except for occasional mid upper abdominal pain relieved with Tylenol. Upon questioning, he recalls that he has lost some weight over the past several months but can not quantify the amount. His past medical history is significant for type 2 diabetes mellitus. He is known smoker and smokes 2 packs of cigarettes per day and has had this habit for 30 years. Vital signs are within normal limits and physical exam reveals mild jaundice and palpable gallbladder.

Blood work shows:

Total bilirubin13 mg/dL (normal 0–1.5 mg/dL)
Direct bilirubin:10 mg/dL (normal 0–0.3 mg/dL)
Alkaline phosphatase (ALP):560 IU/L (normal 39–117 IU/L)

Ultrasonography did not demonstrate biliary stones or any mass in liver but a hypoechoic mass in the epigastric region is noted. The patient is prepared for Computed Tomography angiography for further evaluation. Which of the following best describes this patient’s disease?

  1. Caffeine consumption is an established risk factor for this condition.
  2. The majority of cases are in the body of the pancreas.
  3. Patients with this condition often rapidly develop glucose intolerance and severe diabetes.
  4. CA 19-9 is a marker for this condition.
  5. This condition is most common in caucasians.

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