![]() Eligibility periods will be extended automatically, requiring no action from examinees. The USMLE program extended eligibility periods to December 2020 for all examinees who had a USMLE Step 1, Step 2 CK, Step 3, or USMLE Practice Session scheduling permit with an unexpired eligibility period with an end date in 2020, regardless of the country in which they are testing. The USMLE program will continue this process for any newly issued scheduling permits. Please keep checking their website for updates, and the USMLE program will continue to share new information. Prometric plans to expand testing capacity through increased test center hours and days of operation. Their statement explains that random selection of canceled appointments will occur, and impacted candidates will be notified by Prometric starting today. To do this, Prometric plans to cancel a significant number of upcoming scheduled appointments. To conform with social distancing guidelines and keep separation between examinees, there will be a reduction of active workstations in Prometric testing rooms. More information about Prometric’s updated procedures, including enhanced test center measures, can be found on their website. The United States Medical Licensing Examination ® (USMLE ®) is considered an essential program, and certain centers will still be able to resume testing in accordance with local social distancing guidelines on May 1, 2020. A biopsy specimen of the bladder shows marked chronic inflammation with fibrosis and scattered granulomas.Prometric announced their extended closure of test centers until with the exception of a limited set of essential services programs. Imaging studies show bilateral hydroureter and hydronephrosis and foci of calcification in the region of the bladder. Physical examination shows suprapubic tenderness. Temperature is 38.0☌ (100.4☏), pulse is 80/min, respirations are 16/min, and blood pressure is 110/84 mm Hg. He lived in sub-Saharan Africa until he came to the USA 6 months ago for graduate school. ![]() He also has had episodes of blood in his urine during the past 5 years. It is most appropriate to obtain specific additional history regarding which of the following in this patient?Ī 28-year-old man comes to the office because of a 1-year history of pain with urination that has increased in severity during the past month. Deep tendon reflexes are absent throughout. He moves all extremities in a limited, guarded manner. There is marked swelling and tenderness to palpation of the elbow, wrist, knee, and ankle joints. Multiple ecchymoses and petechiae are noted over the trunk and all extremities. Dentition is poor, and gingivae bleed easily to touch. Examination of the scalp shows erythematous hair follicles. On examination, he appears alert but does not speak or make eye contact. Use of acetaminophen has provided minimal relief of his pain. ![]() His mother says he has lost six baby teeth and has been irritable during this time. (E) Ovarian stromal cells dividing and multiplying rapidlyĪ 6-year-old boy is brought to the office by his mother because of a 1-month history of bleeding gums after brushing his teeth, increasingly severe muscle and joint pain, fatigue, and easy bruising. (D) Failure of functional ovarian cysts to regress after the release of an ovum (C) Endometrium growing outside the uterus (B) Endometrium growing into the myometrium (A) Benign monoclonal tumors arising from smooth muscle cells Which of the following is the most likely cause of the patient's symptoms? Physical examination discloses an enlarged, irregularly shaped uterus with nodularity. The patient is 163 cm (5 ft 4 in) tall and weighs 75 kg (165 lb) BMI is 28 kg/m 2. Her mother and sister underwent hysterectomy at the ages of 39 and 43 years, respectively, because of abnormal uterine bleeding. She has no other history of serious illness and takes no medications. She used an oral contraceptive from the age of 17 years to 40 years, but she discontinued use after she was diagnosed with deep venous thrombosis of the right lower extremity. ![]() Use of acetaminophen and ibuprofen has provided minimal relief. During the past year, menstrual periods have occurred at 21- to 28-day intervals and lasted 10 to 12 days with increasingly severe pain. Previously, menses occurred at regular 28-day intervals and lasted 3 days with minimal cramping. A 42-year-old nulligravid woman comes to the office because of a 1-year history of increasingly irregular vaginal bleeding and menstrual cramps. ![]()
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