FIRST AID FOR THE USMLE CERTIFICATION
SCRIPT 2026 QUESTIONS WITH SOLUTIONS
GRADED A+
◍ HTN emergency.
Answer: Severe hypertension with evidence of acute end-organ damage
(e.g., encephalopathy, stroke, retinal hemorrhages and exudates,
papilledema, MI, HF, aortic dissection, kidney injury, microangiopathic
hemolytic anemia, eclampsia).
◍ Glomus tumor.
Answer: -Benign, painful, red-blue tumor under fingernails. -Arises from
modified smooth muscle cells of the thermoregulatory glomus body.
◍ Carcinogenic impact of ethanol.
Answer: squamous cell carcinoma of the esophagus hepatocellular
carcinoma
◍ Invasive carcinoma.
Answer: Cells have invaded the basement membrane using collagenases and
hydrolases (metalloproteinases). Cell to cell contact is lost due to
inactivation of E-cadherin.
◍ c-kit.
Answer: produces cytokine receptorGI stromal tumor (GIST)
◍ Post capillary venule.
Answer: -Site of lymphocyte migration from blood-10-30 um in diameter;
directly connect to capillaries;-edema
◍ EF is ____ in systolic H
F. .
, Answer: Decreased
◍ 3° syphilis disrupts the __________ of the aorta with consequent atrophy of
vessel wall and dilatation of aorta and valve ring..
Answer: Vasa vasorum
◍ Cushing reaction.
Answer: Triad of hypertension, bradycardia, and respiratory
depression— intracranial pressure constricts arterioles cerebral ischemia
pCO2 and pH central reflex sympathetic in perfusion
pressure (hypertension) stretch peripheral reflex baroreceptor
induced-bradycardia.
◍ Features of lymphatic vessel system.
Answer: -Function: collect and drain interstitial fluid from the tissue into the
large veins (subclavian veins) of lymphatic capillaries, lymphatic vessels,
and lymphatic ducts-Lymphatic vessels can be found in most of the tissues
of the body except the CNS, the bone marrow, and the hard tissues
(cartilages, bones, and the hard tissues of the teeth)
◍ Carcinogenic impact of alkylating agents.
Answer: leukemia/lymphoma
◍ What is the biggest concern/risk in day 3-14 days post MI?.
Answer: Free wall rupture
◍ Acute pericarditis.
Answer: -Commonly presents with sharp pain, aggravated by inspiration,
and relieved by sitting up and *leaning forward. -Presents with friction rub.
-ECG changes include widespread ST-segment elevation and/or PR
depression.
◍ Phase 2 of myocardial action potential.
Answer: Phase 2 = plateau—Ca2+ influx through voltage-gated Ca2+
channels balances K+ efflux. Ca2+ influx triggers Ca2+ release from
sarcoplasmic reticulum and myocyte contraction.
,◍ Total resistance of vessels in series =.
Answer: TR = R1 + R2 + R3 . . .
◍ What stage of the cardiac cycle is altered most with increased HR?.
Answer: Diastole Less filling time = decreased CO (e.g., ventricular
tachycardia)
◍ Mean arterial pressure (MAP) =.
Answer: CO x total peripheral resistance (TPR)
◍ Treatment for Wegener (granulomatosis with polyangiitis).
Answer: Treat with cyclophosphamide, corticosteroids
◍ Progression of atherosclerosis.
Answer: -Inflammation important in pathogenesis: endothelial cell
dysfunction macrophage and LDL accumulation foam cell formation
fatty streaks smooth muscle cell migration (involves PDGF and FGF),
proliferation, and extracellular matrix deposition fibrous plaque
complex atheromas (see picture).
◍ Sudden cardiac death.
Answer: -Death from cardiac causes within 1 hour of onset of symptoms,
most commonly due to a lethal arrhythmia (e.g., ventricular fibrillation).
-Associated with CAD (up to 70% of cases), cardiomyopathy (hypertrophic,
dilated), and hereditary ion channelopathies (e.g., long QT syndrome,
Brugada syndrome).
◍ 90% of HTN is _______° and related to ______ CO and ______TP
R. .
Answer: Primary (essential), CO, and TPR
◍ Viscosity decreased in ________..
Answer: Anemia
◍ J point.
Answer: J point—junction between end of QRS complex and start of ST
segment.
, ◍ Kawasaki disease.
Answer: -Asian children < 4 years old. Mucocutaneous lymph node
syndrome:-Conjunctival injection, Rash (polymorphous desquamating),
Adenopathy (cervical), Strawberry tongue (oral mucositis) (see picture D) ,
Hand- foot changes (edema, erythema), fever.-May develop coronary artery
aneurysms (see picture E); thrombosis or rupture can cause death.
◍ Paroxysmal nocturnal dyspnea.
Answer: Breathless awakening from sleep: venous return from
redistribution of blood, reabsorption of edema, etc. LHF
◍ Coarctation location.
Answer: -95% of the lesions are located distal to the left subclavian artery
and proximal to the ductus arteriosus (preductal coarctation) or just at or
distal to the ductus (postductal coarctation).-5% of coarctations are located
proximal to the left subclavian artery, or rarely in the abdominal aorta.-In
some cases, coarctation presents as a long segment or a tubular
hypoplasia.-The stenosis is caused by an infolding of the left posterolateral
aspect of the aortic wall resulting in an eccentric narrowing.
◍ Xanthomas.
Answer: Plaques or nodules composed of lipid-laden macrophages in skin,
especially the eyelids
◍ Striated muscle tumors.
Answer: Benign = rhabdomyomaMalignant = rhabdomyosarcoma
◍ Buerger disease (thromboangiitis obliterans).
Answer: -Heavy smokers, males < 40 years old. Intermittent claudication
may lead to gangrene F , autoamputation of digits, superficial nodular
phlebitis. Raynaud phenomenon is often present.-Segmental thrombosing
vasculitis. -Treat with smoking cessation.
◍ What is temporal (giant cell) arteritis associated with?.
Answer: -Associated with polymyalgia rheumatica.
SCRIPT 2026 QUESTIONS WITH SOLUTIONS
GRADED A+
◍ HTN emergency.
Answer: Severe hypertension with evidence of acute end-organ damage
(e.g., encephalopathy, stroke, retinal hemorrhages and exudates,
papilledema, MI, HF, aortic dissection, kidney injury, microangiopathic
hemolytic anemia, eclampsia).
◍ Glomus tumor.
Answer: -Benign, painful, red-blue tumor under fingernails. -Arises from
modified smooth muscle cells of the thermoregulatory glomus body.
◍ Carcinogenic impact of ethanol.
Answer: squamous cell carcinoma of the esophagus hepatocellular
carcinoma
◍ Invasive carcinoma.
Answer: Cells have invaded the basement membrane using collagenases and
hydrolases (metalloproteinases). Cell to cell contact is lost due to
inactivation of E-cadherin.
◍ c-kit.
Answer: produces cytokine receptorGI stromal tumor (GIST)
◍ Post capillary venule.
Answer: -Site of lymphocyte migration from blood-10-30 um in diameter;
directly connect to capillaries;-edema
◍ EF is ____ in systolic H
F. .
, Answer: Decreased
◍ 3° syphilis disrupts the __________ of the aorta with consequent atrophy of
vessel wall and dilatation of aorta and valve ring..
Answer: Vasa vasorum
◍ Cushing reaction.
Answer: Triad of hypertension, bradycardia, and respiratory
depression— intracranial pressure constricts arterioles cerebral ischemia
pCO2 and pH central reflex sympathetic in perfusion
pressure (hypertension) stretch peripheral reflex baroreceptor
induced-bradycardia.
◍ Features of lymphatic vessel system.
Answer: -Function: collect and drain interstitial fluid from the tissue into the
large veins (subclavian veins) of lymphatic capillaries, lymphatic vessels,
and lymphatic ducts-Lymphatic vessels can be found in most of the tissues
of the body except the CNS, the bone marrow, and the hard tissues
(cartilages, bones, and the hard tissues of the teeth)
◍ Carcinogenic impact of alkylating agents.
Answer: leukemia/lymphoma
◍ What is the biggest concern/risk in day 3-14 days post MI?.
Answer: Free wall rupture
◍ Acute pericarditis.
Answer: -Commonly presents with sharp pain, aggravated by inspiration,
and relieved by sitting up and *leaning forward. -Presents with friction rub.
-ECG changes include widespread ST-segment elevation and/or PR
depression.
◍ Phase 2 of myocardial action potential.
Answer: Phase 2 = plateau—Ca2+ influx through voltage-gated Ca2+
channels balances K+ efflux. Ca2+ influx triggers Ca2+ release from
sarcoplasmic reticulum and myocyte contraction.
,◍ Total resistance of vessels in series =.
Answer: TR = R1 + R2 + R3 . . .
◍ What stage of the cardiac cycle is altered most with increased HR?.
Answer: Diastole Less filling time = decreased CO (e.g., ventricular
tachycardia)
◍ Mean arterial pressure (MAP) =.
Answer: CO x total peripheral resistance (TPR)
◍ Treatment for Wegener (granulomatosis with polyangiitis).
Answer: Treat with cyclophosphamide, corticosteroids
◍ Progression of atherosclerosis.
Answer: -Inflammation important in pathogenesis: endothelial cell
dysfunction macrophage and LDL accumulation foam cell formation
fatty streaks smooth muscle cell migration (involves PDGF and FGF),
proliferation, and extracellular matrix deposition fibrous plaque
complex atheromas (see picture).
◍ Sudden cardiac death.
Answer: -Death from cardiac causes within 1 hour of onset of symptoms,
most commonly due to a lethal arrhythmia (e.g., ventricular fibrillation).
-Associated with CAD (up to 70% of cases), cardiomyopathy (hypertrophic,
dilated), and hereditary ion channelopathies (e.g., long QT syndrome,
Brugada syndrome).
◍ 90% of HTN is _______° and related to ______ CO and ______TP
R. .
Answer: Primary (essential), CO, and TPR
◍ Viscosity decreased in ________..
Answer: Anemia
◍ J point.
Answer: J point—junction between end of QRS complex and start of ST
segment.
, ◍ Kawasaki disease.
Answer: -Asian children < 4 years old. Mucocutaneous lymph node
syndrome:-Conjunctival injection, Rash (polymorphous desquamating),
Adenopathy (cervical), Strawberry tongue (oral mucositis) (see picture D) ,
Hand- foot changes (edema, erythema), fever.-May develop coronary artery
aneurysms (see picture E); thrombosis or rupture can cause death.
◍ Paroxysmal nocturnal dyspnea.
Answer: Breathless awakening from sleep: venous return from
redistribution of blood, reabsorption of edema, etc. LHF
◍ Coarctation location.
Answer: -95% of the lesions are located distal to the left subclavian artery
and proximal to the ductus arteriosus (preductal coarctation) or just at or
distal to the ductus (postductal coarctation).-5% of coarctations are located
proximal to the left subclavian artery, or rarely in the abdominal aorta.-In
some cases, coarctation presents as a long segment or a tubular
hypoplasia.-The stenosis is caused by an infolding of the left posterolateral
aspect of the aortic wall resulting in an eccentric narrowing.
◍ Xanthomas.
Answer: Plaques or nodules composed of lipid-laden macrophages in skin,
especially the eyelids
◍ Striated muscle tumors.
Answer: Benign = rhabdomyomaMalignant = rhabdomyosarcoma
◍ Buerger disease (thromboangiitis obliterans).
Answer: -Heavy smokers, males < 40 years old. Intermittent claudication
may lead to gangrene F , autoamputation of digits, superficial nodular
phlebitis. Raynaud phenomenon is often present.-Segmental thrombosing
vasculitis. -Treat with smoking cessation.
◍ What is temporal (giant cell) arteritis associated with?.
Answer: -Associated with polymyalgia rheumatica.
