USMLE STEP 1 COMPREHENSIVE
PRACTICE EXAM: HIGH-YIELD QUESTIONS
WITH DETAILED ANSWERS GRADED
A+(2026/2027) BRAND NEW VERSION
1. Cavernous hemangioma risk?
bleeding
2. Tryptophan --> what two pathways? 2 mnemonics
"tripped on his nice nads" B2, B6 cofactors ---> NAD+
and
"tripped on Sir-o-tony's Melons" B4, B6 cofactors ---> serotonin--- hydroxyindole
transferase --->MELANIN
3. hyperosmotic volume CONTRACTION (losing water, osm up in plasma)
caused by...
SWEATING OR DI
4. primary polydipsia results in what fluid changes?
expands both ICF ECF with decreased osmolarity
5. adrenal insufficiency volume changes?
,ECF down ICF up!
6. what reaction forms PORPHYRIN? Cofactor?
Glycine --> B6 cofactor --> Porphyrin
7. treat P. aerug with...
cefaPime
8. Alkaptonuria defect and accumulation
Cannot synthesize MALEYLACETOACETIC ACID, so precursor
HOMOGENISTIC acid accumulates. Urine turns BLACK on sitting.
9. which drug given after benzos to STOP REUCRRENCE OF tonic clonic
seizures?
PHENYTOIN
10.glutamine metabolism yeilds?
part of BICARB and AMMONIA so useful for ALKYLIZING THINGS!
ALANINE AND ASPARTATE FUNCTION IN WHAT PATHWAY?
, GLUCONEOGENESIS!
11.it ain't an ULCER until?
it gets to the SUBMUCOSA
12.Brain infarct timing and histology
1d = red dead (eosinophilic, loss of nissl)
then NEUTROPHILS
1w = MACs come clean up and start LIQUEFACTIVE NECROSIS
2w = gliosis and vascular proliferation
1 month = GLIAL SCAR
13.Drugs causing stephen johnson syndrome/Toxic epidermal necrosis?
"Steven Johnson has TEN funny barbie cars"
14.Phenytoin
Phenobarbitol
Carbamazepime
15.Alpha 1 =
Alpha 2 =
B1 =
PRACTICE EXAM: HIGH-YIELD QUESTIONS
WITH DETAILED ANSWERS GRADED
A+(2026/2027) BRAND NEW VERSION
1. Cavernous hemangioma risk?
bleeding
2. Tryptophan --> what two pathways? 2 mnemonics
"tripped on his nice nads" B2, B6 cofactors ---> NAD+
and
"tripped on Sir-o-tony's Melons" B4, B6 cofactors ---> serotonin--- hydroxyindole
transferase --->MELANIN
3. hyperosmotic volume CONTRACTION (losing water, osm up in plasma)
caused by...
SWEATING OR DI
4. primary polydipsia results in what fluid changes?
expands both ICF ECF with decreased osmolarity
5. adrenal insufficiency volume changes?
,ECF down ICF up!
6. what reaction forms PORPHYRIN? Cofactor?
Glycine --> B6 cofactor --> Porphyrin
7. treat P. aerug with...
cefaPime
8. Alkaptonuria defect and accumulation
Cannot synthesize MALEYLACETOACETIC ACID, so precursor
HOMOGENISTIC acid accumulates. Urine turns BLACK on sitting.
9. which drug given after benzos to STOP REUCRRENCE OF tonic clonic
seizures?
PHENYTOIN
10.glutamine metabolism yeilds?
part of BICARB and AMMONIA so useful for ALKYLIZING THINGS!
ALANINE AND ASPARTATE FUNCTION IN WHAT PATHWAY?
, GLUCONEOGENESIS!
11.it ain't an ULCER until?
it gets to the SUBMUCOSA
12.Brain infarct timing and histology
1d = red dead (eosinophilic, loss of nissl)
then NEUTROPHILS
1w = MACs come clean up and start LIQUEFACTIVE NECROSIS
2w = gliosis and vascular proliferation
1 month = GLIAL SCAR
13.Drugs causing stephen johnson syndrome/Toxic epidermal necrosis?
"Steven Johnson has TEN funny barbie cars"
14.Phenytoin
Phenobarbitol
Carbamazepime
15.Alpha 1 =
Alpha 2 =
B1 =
