USMLE ACTUAL EXAM PAPER 2026
QUESTIONS WITH ANSWERS GRADED A+
◍ Abetalipoproteinemia vs dysbetalipoproteinemia.
Answer: abetalipo = lack of ApoB48 & B100 so no DLs, so can't absorb and
transport fats, so ADEK deficiency, failure to thrive. DYSBETA means you
don't have FUNCTIONAL ApoE, so can't get cholesterol or VLDLs INTO
THE LIVER, so your levels in the blood will be very high
◍ what provides cutaneous innervation to the lateral foreman.
Answer: musculocutaneous nerve
◍ nitroglycerine.
Answer: NO stimulates guanylate cyclase --> inc cGMP --> activation of
protein kinases --> dec intracellular Ca, inc MLCK --> smooth muscle
relaxation --> dilation of arteries > veins --> DECREASED PRELOAD
(angina, take with beta blocker to minimize reflex tachycardia)
◍ adenomyosis.
Answer: endometrial glandular tissue within myometrium, shows as
HEAVY MENSTRUAL BLEEDING, dysmenorrhea with UNIFORMLY
ENLARGED UTERUSseen in middle aged MULTIPAROUS women
◍ PTH inferior + ____ same arch?.
Answer: PTH inferior and THYMUS!
◍ Parkinsons changes in brain?.
Answer: destroy SUBSTANTIA NIGRA LOW DOPAMINE
◍ staph scalded skin toxin VS TEN which layers affected?.
Answer: STAPH = only GRANULOSUM TEN/SJ =
EPIDERMAL/DERMAL JUNCTION...STEPHEN JOHNSON IS
JUNCTIONAL
,◍ evidence of EXTRAMEDULLARY HEMOLYSIS?.
Answer: skeletal abnormalities (frontal bossing, etc.) and HYPERPLASTIC
MARROW usually CHRONIC HEMOLYTIC ANEMIA causes
EXTRAMED HEMATOPO
◍ what are the P40 inhibtors.
Answer: acute alcohol useritonaviramiodaronecimetidine/
ciprofloxicanketoconazoleisoniazid aka INHgrapefruit
juicequinidinemacrolides
◍ what is the function of red pulp in the spleen.
Answer: filter blood of antigens and bad thingstake out old RBC
◍ fragile x protein?.
Answer: FMR1 "farmer one" retardation protein
◍ Clarithramycin, Azithramycin, Erythramycin MOA?.
Answer: 50s inhibition
◍ Huntington's changes in brain.
Answer: D(ogs) can still HUNT, so INCREASED DOPAMINE but
DECREASED AcH and GABA
◍ what is the Pierre robin sequence.
Answer: micrognathia, glossoptosis, cleft palate, airway obstruction
◍ what is the gross anatomy of secondary TB.
Answer: simon focus- apex of the lung, gets there via primary TB spreading
by blood can be calcified
◍ What two things inhibit GnRH?.
Answer: octreotide/somatostatin & Glucose *treat pit adenoma with
octreotide (or pegvisomant, a GH analogue constitutively)
◍ what is the function of TPO aka thyroid peroxidase.
Answer: thyroglobulin iodination
◍ what symptoms can 1st generation anti-psychotics target.
, Answer: positive symtpoms
◍ what do we see with crohn disease with ileal resection.
Answer: bile acid malabsorption cannot absorb fat soluble vitaminscannot
get Vit K- impaired coagulation
◍ what is VIPoma, what are the action of VIP.
Answer: non alpha and non beta islet cell pancreatic tumorincrease intestinal
water and electrolyte secretion and increase relaxaion of intestinal smooth
muscle and spincters
◍ what is made by the myelencephalon.
Answer: medullalower 4th ventricle
◍ "CLOVIR" drugs need?.
Answer: NUCLEOSIDES but need phosphorylation once in cell
◍ what type of emphysema does alpha 1- antitrypsin deficiency happen.
Answer: panacinar emphysema
◍ CENTRAL vs NEPHROGENIC DI.
Answer: central = LOW ADH; "central corrects" with DDVAPnephro =
HIGH ADH
◍ what neuro tracts are affected in vitamin B 12 def.
Answer: spinocerebellar tractslateral corticospinal tractsdorsal column
◍ when do we see endometritis.
Answer: inflammation of the endometrium, seen with things staying in the
uterus that should not be therepromotes infection
◍ what is important to regenerate in the anaerobic cycle, what does this do.
Answer: we need to regenerate NAD+ we have convert glyceraldehyde 3
phos to 1,3 BPG
◍ benzos metabolized NOT in Liver?.
Answer: LOT = lorazepam, oxa, Tam
◍ antibody for RA.
, Answer: IgM antibody against Fc portion of IgGMORE specific- anti-cyclic
cirtullinated peptide antibody
◍ what is seen on light microscope 10-14 days after MI.
Answer: granulation tissue and neovascularization
◍ does excess IGF-1 aka somatomedin C accelerate closure epiphysis plate.
Answer: no
◍ AFFARENT corneal reflex = crying reflex = pupillary reflex = gag reflex =.
Answer: corneal CORN V1 (effarent is VII)crying CRY V1 (effarent is VII)
Pup PUP II (eff is III) Gag GAG 9 (eff is 10) alphabetical order A/E
◍ what will defective proline hydroxylase result in.
Answer: abnormal triple helix formation
◍ how do we treat DRUG-induced parkisonian symptoms?.
Answer: ANTICHOLINERGICs "TROPINE" durgs
◍ what causes spider angiomas in cirrhosis patient.
Answer: excess estrogen
◍ mechanism of action of barbiturates.
Answer: facilitate GABAa action by increase duration of Cl channel
opening
◍ what are the calcium findings is sarcoidosis.
Answer: hypercalcemia due to increase 1a hydroxylase mediated vitamin D
activation in macrophages
◍ what drugs end in -tilide.
Answer: class 3 anti-arrhythmic
◍ what is the cause of oxygen induced hypercapnia in COPD.
Answer: increase in physiologic dead space
◍ milrinone MOA?.
Answer: PDE-3 inhibitor causes VASODILATION and CONTRACTILITY
◍ where does positive selection happen in the thymus.
QUESTIONS WITH ANSWERS GRADED A+
◍ Abetalipoproteinemia vs dysbetalipoproteinemia.
Answer: abetalipo = lack of ApoB48 & B100 so no DLs, so can't absorb and
transport fats, so ADEK deficiency, failure to thrive. DYSBETA means you
don't have FUNCTIONAL ApoE, so can't get cholesterol or VLDLs INTO
THE LIVER, so your levels in the blood will be very high
◍ what provides cutaneous innervation to the lateral foreman.
Answer: musculocutaneous nerve
◍ nitroglycerine.
Answer: NO stimulates guanylate cyclase --> inc cGMP --> activation of
protein kinases --> dec intracellular Ca, inc MLCK --> smooth muscle
relaxation --> dilation of arteries > veins --> DECREASED PRELOAD
(angina, take with beta blocker to minimize reflex tachycardia)
◍ adenomyosis.
Answer: endometrial glandular tissue within myometrium, shows as
HEAVY MENSTRUAL BLEEDING, dysmenorrhea with UNIFORMLY
ENLARGED UTERUSseen in middle aged MULTIPAROUS women
◍ PTH inferior + ____ same arch?.
Answer: PTH inferior and THYMUS!
◍ Parkinsons changes in brain?.
Answer: destroy SUBSTANTIA NIGRA LOW DOPAMINE
◍ staph scalded skin toxin VS TEN which layers affected?.
Answer: STAPH = only GRANULOSUM TEN/SJ =
EPIDERMAL/DERMAL JUNCTION...STEPHEN JOHNSON IS
JUNCTIONAL
,◍ evidence of EXTRAMEDULLARY HEMOLYSIS?.
Answer: skeletal abnormalities (frontal bossing, etc.) and HYPERPLASTIC
MARROW usually CHRONIC HEMOLYTIC ANEMIA causes
EXTRAMED HEMATOPO
◍ what are the P40 inhibtors.
Answer: acute alcohol useritonaviramiodaronecimetidine/
ciprofloxicanketoconazoleisoniazid aka INHgrapefruit
juicequinidinemacrolides
◍ what is the function of red pulp in the spleen.
Answer: filter blood of antigens and bad thingstake out old RBC
◍ fragile x protein?.
Answer: FMR1 "farmer one" retardation protein
◍ Clarithramycin, Azithramycin, Erythramycin MOA?.
Answer: 50s inhibition
◍ Huntington's changes in brain.
Answer: D(ogs) can still HUNT, so INCREASED DOPAMINE but
DECREASED AcH and GABA
◍ what is the Pierre robin sequence.
Answer: micrognathia, glossoptosis, cleft palate, airway obstruction
◍ what is the gross anatomy of secondary TB.
Answer: simon focus- apex of the lung, gets there via primary TB spreading
by blood can be calcified
◍ What two things inhibit GnRH?.
Answer: octreotide/somatostatin & Glucose *treat pit adenoma with
octreotide (or pegvisomant, a GH analogue constitutively)
◍ what is the function of TPO aka thyroid peroxidase.
Answer: thyroglobulin iodination
◍ what symptoms can 1st generation anti-psychotics target.
, Answer: positive symtpoms
◍ what do we see with crohn disease with ileal resection.
Answer: bile acid malabsorption cannot absorb fat soluble vitaminscannot
get Vit K- impaired coagulation
◍ what is VIPoma, what are the action of VIP.
Answer: non alpha and non beta islet cell pancreatic tumorincrease intestinal
water and electrolyte secretion and increase relaxaion of intestinal smooth
muscle and spincters
◍ what is made by the myelencephalon.
Answer: medullalower 4th ventricle
◍ "CLOVIR" drugs need?.
Answer: NUCLEOSIDES but need phosphorylation once in cell
◍ what type of emphysema does alpha 1- antitrypsin deficiency happen.
Answer: panacinar emphysema
◍ CENTRAL vs NEPHROGENIC DI.
Answer: central = LOW ADH; "central corrects" with DDVAPnephro =
HIGH ADH
◍ what neuro tracts are affected in vitamin B 12 def.
Answer: spinocerebellar tractslateral corticospinal tractsdorsal column
◍ when do we see endometritis.
Answer: inflammation of the endometrium, seen with things staying in the
uterus that should not be therepromotes infection
◍ what is important to regenerate in the anaerobic cycle, what does this do.
Answer: we need to regenerate NAD+ we have convert glyceraldehyde 3
phos to 1,3 BPG
◍ benzos metabolized NOT in Liver?.
Answer: LOT = lorazepam, oxa, Tam
◍ antibody for RA.
, Answer: IgM antibody against Fc portion of IgGMORE specific- anti-cyclic
cirtullinated peptide antibody
◍ what is seen on light microscope 10-14 days after MI.
Answer: granulation tissue and neovascularization
◍ does excess IGF-1 aka somatomedin C accelerate closure epiphysis plate.
Answer: no
◍ AFFARENT corneal reflex = crying reflex = pupillary reflex = gag reflex =.
Answer: corneal CORN V1 (effarent is VII)crying CRY V1 (effarent is VII)
Pup PUP II (eff is III) Gag GAG 9 (eff is 10) alphabetical order A/E
◍ what will defective proline hydroxylase result in.
Answer: abnormal triple helix formation
◍ how do we treat DRUG-induced parkisonian symptoms?.
Answer: ANTICHOLINERGICs "TROPINE" durgs
◍ what causes spider angiomas in cirrhosis patient.
Answer: excess estrogen
◍ mechanism of action of barbiturates.
Answer: facilitate GABAa action by increase duration of Cl channel
opening
◍ what are the calcium findings is sarcoidosis.
Answer: hypercalcemia due to increase 1a hydroxylase mediated vitamin D
activation in macrophages
◍ what drugs end in -tilide.
Answer: class 3 anti-arrhythmic
◍ what is the cause of oxygen induced hypercapnia in COPD.
Answer: increase in physiologic dead space
◍ milrinone MOA?.
Answer: PDE-3 inhibitor causes VASODILATION and CONTRACTILITY
◍ where does positive selection happen in the thymus.
