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Anatomy — Step 1 practice questions
102 questions in this area, with an explanation for every answer choice.
Three samples below, free and without an account.
How this shows up on Step 1
Anatomy on Step 1 is clinical rather than descriptive: nerve injuries, vascular territories, and the embryological origins of malformations. Questions ask what is damaged given a deficit, not what runs where.
Sample questions
Sample question 1
A patient has sudden unilateral hearing loss. Weber test lateralizes to the AFFECTED ear, and Rinne test shows bone conduction greater than air conduction on that side. Which of the following types of hearing loss is most likely?
Explanations
A. Normal hearing
These findings indicate abnormal, not normal, hearing function.
B. Sensorineural hearing loss
Sensorineural hearing loss would show Weber lateralizing to the UNAFFECTED (better-hearing) ear and Rinne showing air conduction still greater than bone conduction (though both reduced), the opposite pattern.
C. Presbycusis exclusively
Presbycusis is a form of SENSORINEURAL hearing loss (age-related), which would show the opposite Weber/Rinne pattern from what is described.
D. Central auditory processing disorder
Central auditory processing disorder does not classically produce this specific lateralization pattern on Weber/Rinne testing.
E. Conductive hearing loss · correct
Weber lateralizing TO the affected ear, combined with bone conduction greater than air conduction (abnormal Rinne) on that side, is classic for conductive hearing loss, in which an outer/middle ear problem impairs air conduction more than bone conduction.
Sample question 2
A 12-year-old girl has a rib hump on forward bending and a Cobb angle of 28 degrees. She is premenarchal with open growth plates. Which of the following is the most appropriate management?
Explanations
A. No follow-up is needed once a curve is identified
Serial monitoring through skeletal maturity is essential.
B. Immediate surgical fusion
Surgery is reserved for larger curves.
C. Bracing, since curves between roughly 25 and 45 degrees in a skeletally immature patient are likely to progress and bracing reduces that risk · correct
Adolescent idiopathic scoliosis is assessed by the Adams forward bend test, which reveals the rib hump of vertebral ROTATION, and quantified by the Cobb angle. Management depends on curve magnitude and remaining GROWTH: curves under about 25 degrees are observed, curves of roughly 25–45 degrees in skeletally immature patients are BRACED to prevent progression, and curves beyond about 45–50 degrees are considered for surgical fusion. Progression risk is greatest during the pubertal growth spurt, so premenarchal status with open physes signals high risk.
D. Observation alone regardless of skeletal maturity
Skeletal immaturity with a moderate curve predicts progression.
E. Physical therapy alone, which corrects structural curves
Exercise improves function but does not correct structural curves.
Sample question 3
A patient has ischemic injury involving the distal transverse colon at the splenic flexure. Which of the following best explains why this region is particularly vulnerable?
Explanations
A. It has the richest collateral circulation of the entire colon
Watershed zones have the LEAST reliable collateral perfusion.
B. It is supplied exclusively by the celiac trunk with no collateral flow
The celiac trunk supplies the foregut, well proximal to the splenic flexure.
C. It is a watershed zone between the superior and inferior mesenteric artery territories, marking the embryologic midgut-hindgut junction · correct
The gut derives its blood supply by embryologic segment: the CELIAC trunk supplies foregut (to the second part of the duodenum), the SUPERIOR MESENTERIC artery the midgut (to the proximal two-thirds of the transverse colon), and the INFERIOR MESENTERIC artery the hindgut. The SPLENIC FLEXURE lies at the SMA-IMA junction and the rectosigmoid at the IMA-internal iliac junction, making both WATERSHED zones dependent on collateral flow — hence their vulnerability to hypoperfusion in ischemic colitis, which typically presents with abdominal pain and bloody diarrhea in older patients after a hypotensive episode.
D. It is supplied by the internal iliac artery
The internal iliac contributes to the distal rectum.
E. Watershed areas are not clinically significant in the colon
Watershed anatomy explains the distribution of ischemic colitis.
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