Step 1 includes only single questions with one best answer. This is the traditional, most frequently used multiple-choice format. These items consist of a statement or question followed by three to eleven response options arranged in alphabetical or logical order. A portion of the questions involves interpretation of graphic or pictorial materials. The response options for all questions are lettered (eg, A, B, C, D, E). Examinees are required to select the best answer to the question. Other options may be partially correct, but there is only ONE BEST answer.
A 32-year-old woman with type 1 diabetes mellitus has had progressive renal failure over the past 2 years. She has not yet started dialysis. Examination shows no abnormalities. Her hemoglobin concentration is 9 g/dL, hematocrit is 28%, and mean corpuscular volume is 94 µm3. A blood smear shows normochromic, normocytic cells. Which of the following is the most likely cause?
(Answer D)