Sample Step 1 Exam

A mother brings her 3-year-old son into the clinic because he has difficulty walking. He did not start walking until age 2 years. He now has an unstable gait and often trips and falls. He cannot yet run and has to be helped when ascending or descending stairs.

Physical examination confirms these symptoms. The child walks on his toes and cannot hop. His calf muscles appear disproportionately larger than his other leg muscles.

Laboratory testing shows an elevated creatine kinase.

The first life-threatening complication in this patient can best be anticipated by assessing

A 70kg male patient on the general medicine wards is being treated for lower extremity cellulitis, but is not showing any improvement in his infective symptoms or redness for last 24 hours with oral amoxicillin-clavulanic acid. He is now tachycardic and febrile with rising white blood cell count. You decide to switch antibiotics to vancomycin and are calculating his loading dose. You want his goal plasma concentration to be roughly 20mg/L following the bolus, as you know it will take 4 half-lives to reach steady state and can’t wait that long to be in the therapeutic range. The inherent volume of distribution of vancomycin is 1L/kg. What dose of vancomycin should you give?

An Rh-negative woman goes to see her Ob/Gyn expressing a desire to have a second child.  Her first, Rh+ child was born uneventfully, and the mother was given RhOGAM therapy as prescribed at 28 weeks and at parturition.  Which of the following would be the best test to determine if she has become sensitized to the Rh antigen of her husband?

A 32-year-old male presents to his physician’s office with new onset headaches. He is concerned because these are associated with blurring of his vision and a recent nosebleed. He has otherwise been well.

Vital signs: BP 188/132 mmHg; HR 101 /min; RR: 15 /min; Temperature: 98.9 F; SpO2: 97% on room air

Physical examination shows papilledema.

Laboratory testing:

• Urinalysis:
  • Protein: 2+
  • Hemoglobin: 1+
  • Leukocyte esterase: negative
  • Nitrites: negative
  • Sediment: no casts seen
• Chemistry:
  • Creatinine: 2.3
  • eGFR: 28 mL/min

Biopsy of the kidney would most likely show