USMLE STEP 1 COMPREHENSIVE
EXAM 2025/2026 STUDY MATERIAL
QUESTIONS AND VERIFIED
DETAILED ANSWERS 100% PASS
1. Heterophile ab NEGATIVE Mono-like syndromes
*CMV
HHV-6
HIV
Toxoplasmosis
2. Wernicke's Aphasia
-word salad: well-articulated, nonsensical speech paired with lack of lang
comprehension
-aud association cortex: post part of sup temporal gyrus
- supplied by MCA
3. Congenital Deficiency of Propionyl CoA Carboxylase
-prevents conversion of propionyl CoA to methylmalonyl CoA
-propionyl CoA derived from= val, ile, met, thr, odd # FA, cholesterol side
chains
-Propionic Acidemia: poor feeding, vomiting, hypotonia, lethargy,
dehydration, anion gap acidosis
,4. Down Synd Comorbidities
Neuro: MR, early onset Alzheimer's
Cardio: complete AV septal defect, VSD, ASD
GI: duodenal atresia, hirschprung disease
Endo: hypothyroid, DM1, obesity
5. MCC of Hypoglycemia in EtOH-ics
Thiamine def= suppression of GNG (pyruvate DH) and TCA cyle (alpha-
KG DH)
6. MCC of Hypoglycemia in advanced renal insuff
impaired clearance of insulin
7. Avoid Nitrates in Hypertrophic Cardiomyopathy bc...
Nitrates decrease preload, which will increase the LV outflow tract... BUT
since the ventricle is abnormally shaped, there is an outflow obstruction
8. Mets through BM
Clonal proliferation of cells can invade/ metastasize*
1. malignant cells to lose their cell-to-cell adhesion molecules (cadherins)
2. cell receptors to attach to laminin (a glycoprotein) in the basement
membrane and to release metalloproteinases (e.g., collagenases,
stromelysins, gelatinases) to degrade the basement membrane and other
, enzymes to degrade the interstitial connective tissue- tissue inhibitors of
metalloproteinases neutralize these tumor-produced enzymes and limit the
degree of invasion
3. cell receptors to attach to bronectin and other proteins in the extracellular
matrix (ECM) and to break it down
4. malignant cells to produce cytokines that stimulate locomotion, so that they
can move through basement membranes and the intracellular and extracellular
matrices
9. Bicuspid Aortic Valve
Commonly presents in young, asymptomatic patient with soft systolic ejection
at right 2nd ICS
-can cause aortic regurg
10.MCC of Vaginal Candidiasis
1. Abx use= reduces lactobacilli pop
2. High estrogen levels- preg
3. System corticosteroid therapy
4. Uncontrolled DM
5. Immunosuppression, including HIV
11.Drug causes of SIADH
-Carbamazepine
-Cyclophosphamide
EXAM 2025/2026 STUDY MATERIAL
QUESTIONS AND VERIFIED
DETAILED ANSWERS 100% PASS
1. Heterophile ab NEGATIVE Mono-like syndromes
*CMV
HHV-6
HIV
Toxoplasmosis
2. Wernicke's Aphasia
-word salad: well-articulated, nonsensical speech paired with lack of lang
comprehension
-aud association cortex: post part of sup temporal gyrus
- supplied by MCA
3. Congenital Deficiency of Propionyl CoA Carboxylase
-prevents conversion of propionyl CoA to methylmalonyl CoA
-propionyl CoA derived from= val, ile, met, thr, odd # FA, cholesterol side
chains
-Propionic Acidemia: poor feeding, vomiting, hypotonia, lethargy,
dehydration, anion gap acidosis
,4. Down Synd Comorbidities
Neuro: MR, early onset Alzheimer's
Cardio: complete AV septal defect, VSD, ASD
GI: duodenal atresia, hirschprung disease
Endo: hypothyroid, DM1, obesity
5. MCC of Hypoglycemia in EtOH-ics
Thiamine def= suppression of GNG (pyruvate DH) and TCA cyle (alpha-
KG DH)
6. MCC of Hypoglycemia in advanced renal insuff
impaired clearance of insulin
7. Avoid Nitrates in Hypertrophic Cardiomyopathy bc...
Nitrates decrease preload, which will increase the LV outflow tract... BUT
since the ventricle is abnormally shaped, there is an outflow obstruction
8. Mets through BM
Clonal proliferation of cells can invade/ metastasize*
1. malignant cells to lose their cell-to-cell adhesion molecules (cadherins)
2. cell receptors to attach to laminin (a glycoprotein) in the basement
membrane and to release metalloproteinases (e.g., collagenases,
stromelysins, gelatinases) to degrade the basement membrane and other
, enzymes to degrade the interstitial connective tissue- tissue inhibitors of
metalloproteinases neutralize these tumor-produced enzymes and limit the
degree of invasion
3. cell receptors to attach to bronectin and other proteins in the extracellular
matrix (ECM) and to break it down
4. malignant cells to produce cytokines that stimulate locomotion, so that they
can move through basement membranes and the intracellular and extracellular
matrices
9. Bicuspid Aortic Valve
Commonly presents in young, asymptomatic patient with soft systolic ejection
at right 2nd ICS
-can cause aortic regurg
10.MCC of Vaginal Candidiasis
1. Abx use= reduces lactobacilli pop
2. High estrogen levels- preg
3. System corticosteroid therapy
4. Uncontrolled DM
5. Immunosuppression, including HIV
11.Drug causes of SIADH
-Carbamazepine
-Cyclophosphamide
