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USMLE STEP1 Exam Questions
Step1 (Page 24 )

Updated On: 31-Mar-2026
Page 24 of 171
PDF with 845 Questions

Your patient reports that several days earlier he "threw his back out" when he bent from the waist and picked up a very heavy package. The pain was immediate and extended from his hip, down the back of the thigh, and into his leg and foot. As he lies on the examining table, you raise his leg by the foot keeping the knee extended and elicit intense pain over the distribution of the sciatic nerve. An MRI scan confirms your conclusion that your patient has a herniated intervertebral disk between the fourth and fifth lumbar vertebrae.
Intervertebral disks may protrude or rupture in any direction, but they most commonly protrude in which direction?

  1. anteriorly
  2. anterolaterally
  3. laterally
  4. posteriorly
  5. posterolaterally

Answer(s): E

Explanation:

Intervertebral disks may protrude or rupture in any direction but do so most commonly in a posterolateral direction, just lateral to the strong central portion of the posterior longitudinal ligament. This is usually the weakest part of the disk, because the annulus is thinner here and is not supported by other ligaments.
Anteriorly (choice A) the intervertebral disks are supported by the broad and strong anterior ligament.
Herniation is less common in this direction. Anterolaterally (choice B) the intervertebral disk is supported by the broad anterior longitudinal ligament. The nucleus pulposus is also situated posteriorly in the disk, making herniation here less likely. Herniation of the intervertebral disk laterally (choice C) is not particularly common. Posteriorly (choice D) the intervertebral disks are supported by the posterior longitudinal ligament. Herniation is less common in this direction.



Your patient reports that several days earlier he "threw his back out" when he bent from the waist and picked up a very heavy package. The pain was immediate and extended from his hip, down the back of the thigh, and into his leg and foot. As he lies on the examining table, you raise his leg by the foot keeping the knee extended and elicit intense pain over the distribution of the sciatic nerve. An MRI scan confirms your conclusion that your patient has a herniated intervertebral disk between the fourth and fifth lumbar vertebrae.
Herniation of the intervertebral disk between the fourth and fifth lumbar vertebrae most likely impinges on the roots of which spinal nerve?

  1. L3
  2. L4
  3. L5
  4. S1
  5. S2

Answer(s): C

Explanation:

A bulging or protruded disk typically affects the traversing nerve root; that is, the nerve affected is one number greater than the number of the disk. The L3 spinal nerve (choice A) would be affected by protrusion of the L2 intervertebral disk. The L4 spinal nerve (choice B) would be affected by protrusion of the L3 intervertebral disk. The S1 spinal nerve (choice D) would be affected by protrusion of the L5 intervertebral disk. The S2 spinal nerve (choice E) exits through the foramina of the fused sacrum and, therefore, is not subject to compression by herniated intervertebral disks.



An opera singer, who has maintained a demanding work schedule, worries about the effect on her vocal cords. The epithelium covering the vocal cords is which of the following?

  1. pseudostratified ciliated
  2. simple columnar
  3. simple cuboidal
  4. simple squamous
  5. stratified squamous

Answer(s): E

Explanation:

A stratified squamous epithelium covers the vocal cords or folds. This epithelium protects the underlying tissue from the mechanical stress acting on the surface of the vocal cords. A simple squamous epithelium (choice D) is not suitable for protection. The rest of the larynx is covered with a pseudostratified ciliated epithelium (ie, a respiratory epithelium [choice A]). Simple columnar (choice B) and simple cuboidal (choice C) epithelia are found more commonly in organs with secretory or absorptive functions.



A patient suffers from Frey's syndrome manifested by perspiration of the skin covering the left parotid gland whenever the patient eats. On inquiry, the patient reveals that he suffered deep injuries on that side of his face and neck in an automobile accident. You explain to him that his syndrome results from abnormal connections between the great auricular nerve and parasympathetic secretomotor fibers, which normally innervate only the parotid gland. This abnormal reinnervation occurred during the healing period after the accident. The parasympathetic secretomotor fibers to the parotid gland are carried by which of the following?

  1. auriculotemporal nerve
  2. buccal branch of the facial nerve
  3. buccal nerve
  4. greater petrosal nerve
  5. lesser petrosal nerve

Answer(s): A

Explanation:

The auriculotemporal nerve is a branch of the mandibular division of the trigeminal nerve. It carries postganglionic parasympathetic fibers from the otic ganglion to the parotid gland. The buccal nerve (choice C) is a sensory branch of the mandibular division of the trigeminal nerve. It innervates the gingival adjacent to the two posterior molar teeth, the mucosa, and skin of the cheek. The buccal branch of the facial nerve (choice B) provides motor innervation to the muscles around the mouth. The greater petrosal nerve (choice D) is a branch of the facial nerve from the geniculate ganglion. It carries preganglionic parasympathetic fibers to the pterygopalatine ganglion. The lesser petrosal nerve (choice E) is a continuation of the tympanic branch of the glossopharyngeal nerve and carries preganglionic parasympathetic fibers to the otic ganglion.



Your young female patient has a large bulge on the anterior thigh below the inguinal ligament. You suspect an abdominal hernia that has passed through the femoral ring into the femoral sheath and then through the saphenous hiatus into the subcutaneous layer of the upper thigh. In addition to the hernia sac, you would expect the femoral canal to contain which of the following?

  1. connective tissue and lymph nodes
  2. femoral artery
  3. femoral nerve
  4. femoral vein
  5. great saphenous vein

Answer(s): A

Explanation:

The femoral canal, the medial compartment of the femoral sheath, contains only a slight amount of loose connective tissue and one or two lymphatic vessels and nodes. The femoral artery (choice B) is found in the lateral compartment of the femoral sheath with the genital branch of the genitofemoral nerve. The femoral nerve (choice C) is the most lateral structure in the femoral triangle, but it does not lie within the femoral sheath. The femoral vein (choice D) occupies the intermediate compartment of the femoral sheath.
The saphenous vein (choice E) is a superficial vein that passes through the saphenous hiatus to end in the femoral vein. It does not lie within the femoral canal.



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