USMLE EXAM SCRIPT VERIFIED QUESTIONS
WITH ACCURATE ANSWERS
●● Wernicke's Aphasia
Answer: -word salad: well-articulated, nonsensical speech paired with
lack of lang comprehension
-aud association cortex: post part of sup temporal gyrus
- supplied by MCA
●● Congenital Deficiency of Propionyl CoA Carboxylase
Answer: -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
●● Down Synd Comorbidities
Answer: Neuro: MR, early onset Alzheimer's
Cardio: complete AV septal defect, VSD, ASD
GI: duodenal atresia, hirschprung disease
Endo: hypothyroid, DM1, obesity
Heme: ALL (> 5 yo) and AML (<5 yo)
,Rheumatology: atlantoaxial stability
●● MCC of Hypoglycemia in EtOH-ics
Answer: Thiamine def= suppression of GNG (pyruvate DH) and TCA
cyle (alpha-KG DH)
●● MCC of Hypoglycemia in advanced renal insuff
Answer: impaired clearance of insulin
●● Avoid Nitrates in Hypertrophic Cardiomyopathy bc...
Answer: Nitrates decrease preload, which will increase the LV outflow
tract... BUT since the ventricle is abnormally shaped, there is an outflow
obstruction
●● Mets through BM
Answer: 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
●● Bicuspid Aortic Valve
Answer: Commonly presents in young, asymptomatic patient with soft
systolic ejection at right 2nd ICS
-can cause aortic regurg
●● MCC of Vaginal Candidiasis
Answer: 1. Abx use= reduces lactobacilli pop
2. High estrogen levels- preg
3. System corticosteroid therapy
4. Uncontrolled DM
5. Immunosuppression, including HIV
●● Drug causes of SIADH
Answer: -Carbamazepine
-Cyclophosphamide
-SSRI
, ●● MC Ankle Sprain due to inversion of plantar-flexed foot
Answer: -Ant Talofibular Lig dmg
-ecchymosis at the ant-lat aspect of the ankle
●● Upper Brachial Plexus Injury
Answer: - Musculocutaneous and Suprascapular N.
- dystocia mc in neonates; severe trauma mc in adults
- should adduction, elbow extension, and forearm pronation
●● Patent foramen ovale
Answer: -failure of septum primum and septum secundum to fuse after
birth
-can lead to paradoxical emboli
●● Ventricular Septal Defect
Answer: -MC occurs in membranous septum
-Acyanotic at birth bc of L to R shunt
●● Coronary Blood Flow Peak
Answer: -at Early Diastole
-coronary perfusion driven by diastolic pressure
-tachycardia will decrease coronary perfusion
WITH ACCURATE ANSWERS
●● Wernicke's Aphasia
Answer: -word salad: well-articulated, nonsensical speech paired with
lack of lang comprehension
-aud association cortex: post part of sup temporal gyrus
- supplied by MCA
●● Congenital Deficiency of Propionyl CoA Carboxylase
Answer: -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
●● Down Synd Comorbidities
Answer: Neuro: MR, early onset Alzheimer's
Cardio: complete AV septal defect, VSD, ASD
GI: duodenal atresia, hirschprung disease
Endo: hypothyroid, DM1, obesity
Heme: ALL (> 5 yo) and AML (<5 yo)
,Rheumatology: atlantoaxial stability
●● MCC of Hypoglycemia in EtOH-ics
Answer: Thiamine def= suppression of GNG (pyruvate DH) and TCA
cyle (alpha-KG DH)
●● MCC of Hypoglycemia in advanced renal insuff
Answer: impaired clearance of insulin
●● Avoid Nitrates in Hypertrophic Cardiomyopathy bc...
Answer: Nitrates decrease preload, which will increase the LV outflow
tract... BUT since the ventricle is abnormally shaped, there is an outflow
obstruction
●● Mets through BM
Answer: 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
●● Bicuspid Aortic Valve
Answer: Commonly presents in young, asymptomatic patient with soft
systolic ejection at right 2nd ICS
-can cause aortic regurg
●● MCC of Vaginal Candidiasis
Answer: 1. Abx use= reduces lactobacilli pop
2. High estrogen levels- preg
3. System corticosteroid therapy
4. Uncontrolled DM
5. Immunosuppression, including HIV
●● Drug causes of SIADH
Answer: -Carbamazepine
-Cyclophosphamide
-SSRI
, ●● MC Ankle Sprain due to inversion of plantar-flexed foot
Answer: -Ant Talofibular Lig dmg
-ecchymosis at the ant-lat aspect of the ankle
●● Upper Brachial Plexus Injury
Answer: - Musculocutaneous and Suprascapular N.
- dystocia mc in neonates; severe trauma mc in adults
- should adduction, elbow extension, and forearm pronation
●● Patent foramen ovale
Answer: -failure of septum primum and septum secundum to fuse after
birth
-can lead to paradoxical emboli
●● Ventricular Septal Defect
Answer: -MC occurs in membranous septum
-Acyanotic at birth bc of L to R shunt
●● Coronary Blood Flow Peak
Answer: -at Early Diastole
-coronary perfusion driven by diastolic pressure
-tachycardia will decrease coronary perfusion
