USMLE STEP 1 COLLECTED TESTS
REVIEW OUTCOME ASSESSMENT
SCRIPT 100 PERCENT ACCURATE
◍ Serotonin Synd. Answer: confusion, agitation,tremor, tachycardia,
htn, clonus, hyperreflexia, hyperthermia, diaphoresis
TX: Cyproheptadine= 1st gen histamine antag, nonspec 5-HT1 and 5-
HT2 rec antag
◍ Tensilon Test. Answer: -Cholinergic Crisis: muscles stop
responding to the bombardment of ACh, leading to flaccid paralysis,
respiratory failure, and other signs and symptoms reminiscent of
organophosphate poisoning. Other symptoms include increased
sweating, salivation, bronchial secretions along with miosis.-- Flaccid
paralysis resulting from cholinergic crisis can be distinguished from
myasthenia gravis by the use of the drug edrophonium (Tensilon),
which worsens the paralysis caused by cholinergic crisis, but
strengthens the muscle in the case of myasthenia gravis.
(Edrophonium is an cholinesterase inhibitor hence increases the
concentration of acetylcholine present).
under-tx'd MG pt presents with exaggerated MG sx, and when infused
with edrophonium the sx subside it indicates that the MG treatment
(AChE inhib) need to increase in dose
,◍ Opioid action on mu rec. Answer: -g-protein coupled activation of
K+ efflux= hyperpol and pain transmission termination
-inhib adenylyl cyclase
-inhib Ca2+ conductance
-inhib transmitter release
◍ neonatal intravascular hemorrhage. Answer: -mc in fragile
germinal matrix
-inc freq with decreased age and birth wt
-mc complication would be long term neurodev impairment (alt
consciousness, hypotonia, dec spont mvmnt)
-s/sx of bleed: bulging ant frontanelle, hypotension, decerebrate
posturing, tonic-clonic seizures, irreg respirations, coma
◍ Acute Rheumatic fever. Answer: -endemic in dev countries
-molecular mimicry: anti group a strep ab attack host antigens on
cardiac and neuronal tissue approx 2-4 weeks post acute pharyngitis
(aka cross reactivity of ab against bacterial and host antigens)
-acute/subacute: migratory arthritis, pancarditis, Sydenham chorea
-Chr: mitral regurg/ stenosis
-tx: PCN
◍ Spironolactone + HF. Answer: improve survival of CHF pts with
low LV ejection fraction
-block aldosterone's effect on heart and decrease fibrosis and
ventricular remodeling
,-used with ace-inhib and beta-blockers
◍ Common S/E of Thiazide Diuretics. Answer: acute kidney injury,
decreased Na+ and K+, hyperuricemia/ acute gout, elevated glu and
cholesterol levels
◍ Common S/E of ACE-Inhib. Answer: cough, angioedema, inc K+
◍ CCB (diphenhydropine) S/E. Answer: periph edema, dizziness/
lightheadedness
◍ Beta Blocker S/E. Answer: bronchospasm, bradycardia, fatigue,
sexual dysfunction
◍ HTN and at risk for Osteoporosis. Answer: THIAZIDES! increased
bone mineral density b/c increase in Ca2+ abs in DCT
◍ Methylmalonyl-CoA mutase Def. Answer: -AR
-increased urine: methylmalonic acid and propionic acid
-hyperammonemia, ketotic hypoglycemia, and metab acidosis
-newborns present with lethargy, vomiting, and tachypnea
◍ TCA Effect on Cardiac Na+ Channel. Answer: BLOCKS cardiac
fast Na+ channels= QT and QRS prolongation and arrhythmias
-treated with Sodium Bicarb
, ◍ MC Complication post Subarachnoid Hemorrhage. Answer: SAH
sx: thunderclap ha, confusion, fever, nuchal rigidity
MC Compl: VASOSPASM!
-vessels surrounding ruptured aneurysm
-cerebral ischemia and new onset confusion and/or focal neuro
deficits (paresthesia, weakness, etc) 4-12 days post SAH
-mech of vasospasm is related to impaired brain autoreg
-not seen on CT, need transcranial color doppler
-Nimodipine prescribed to prevent vasospasm post-SAH
◍ Most Serious Compl of SAH. Answer: REBLEED!
-sudden dev of severe confusion, HA, N/V, decreased consciousness,
focal neuro deficits
-seen on CT
◍ t(8;14). Answer: Burkitt lymphoma (c-myc activation)
-cmyc is an oncogene
-very aggressive, rapid proliferation of cell growth
◍ t(9;22) aka Philadelphia chromosome. Answer: CML (BCR-ABL
hybrid), rarely ALL
-constitutive expression of tyrosine kinase
-poor prognosis when expressed in ALL
REVIEW OUTCOME ASSESSMENT
SCRIPT 100 PERCENT ACCURATE
◍ Serotonin Synd. Answer: confusion, agitation,tremor, tachycardia,
htn, clonus, hyperreflexia, hyperthermia, diaphoresis
TX: Cyproheptadine= 1st gen histamine antag, nonspec 5-HT1 and 5-
HT2 rec antag
◍ Tensilon Test. Answer: -Cholinergic Crisis: muscles stop
responding to the bombardment of ACh, leading to flaccid paralysis,
respiratory failure, and other signs and symptoms reminiscent of
organophosphate poisoning. Other symptoms include increased
sweating, salivation, bronchial secretions along with miosis.-- Flaccid
paralysis resulting from cholinergic crisis can be distinguished from
myasthenia gravis by the use of the drug edrophonium (Tensilon),
which worsens the paralysis caused by cholinergic crisis, but
strengthens the muscle in the case of myasthenia gravis.
(Edrophonium is an cholinesterase inhibitor hence increases the
concentration of acetylcholine present).
under-tx'd MG pt presents with exaggerated MG sx, and when infused
with edrophonium the sx subside it indicates that the MG treatment
(AChE inhib) need to increase in dose
,◍ Opioid action on mu rec. Answer: -g-protein coupled activation of
K+ efflux= hyperpol and pain transmission termination
-inhib adenylyl cyclase
-inhib Ca2+ conductance
-inhib transmitter release
◍ neonatal intravascular hemorrhage. Answer: -mc in fragile
germinal matrix
-inc freq with decreased age and birth wt
-mc complication would be long term neurodev impairment (alt
consciousness, hypotonia, dec spont mvmnt)
-s/sx of bleed: bulging ant frontanelle, hypotension, decerebrate
posturing, tonic-clonic seizures, irreg respirations, coma
◍ Acute Rheumatic fever. Answer: -endemic in dev countries
-molecular mimicry: anti group a strep ab attack host antigens on
cardiac and neuronal tissue approx 2-4 weeks post acute pharyngitis
(aka cross reactivity of ab against bacterial and host antigens)
-acute/subacute: migratory arthritis, pancarditis, Sydenham chorea
-Chr: mitral regurg/ stenosis
-tx: PCN
◍ Spironolactone + HF. Answer: improve survival of CHF pts with
low LV ejection fraction
-block aldosterone's effect on heart and decrease fibrosis and
ventricular remodeling
,-used with ace-inhib and beta-blockers
◍ Common S/E of Thiazide Diuretics. Answer: acute kidney injury,
decreased Na+ and K+, hyperuricemia/ acute gout, elevated glu and
cholesterol levels
◍ Common S/E of ACE-Inhib. Answer: cough, angioedema, inc K+
◍ CCB (diphenhydropine) S/E. Answer: periph edema, dizziness/
lightheadedness
◍ Beta Blocker S/E. Answer: bronchospasm, bradycardia, fatigue,
sexual dysfunction
◍ HTN and at risk for Osteoporosis. Answer: THIAZIDES! increased
bone mineral density b/c increase in Ca2+ abs in DCT
◍ Methylmalonyl-CoA mutase Def. Answer: -AR
-increased urine: methylmalonic acid and propionic acid
-hyperammonemia, ketotic hypoglycemia, and metab acidosis
-newborns present with lethargy, vomiting, and tachypnea
◍ TCA Effect on Cardiac Na+ Channel. Answer: BLOCKS cardiac
fast Na+ channels= QT and QRS prolongation and arrhythmias
-treated with Sodium Bicarb
, ◍ MC Complication post Subarachnoid Hemorrhage. Answer: SAH
sx: thunderclap ha, confusion, fever, nuchal rigidity
MC Compl: VASOSPASM!
-vessels surrounding ruptured aneurysm
-cerebral ischemia and new onset confusion and/or focal neuro
deficits (paresthesia, weakness, etc) 4-12 days post SAH
-mech of vasospasm is related to impaired brain autoreg
-not seen on CT, need transcranial color doppler
-Nimodipine prescribed to prevent vasospasm post-SAH
◍ Most Serious Compl of SAH. Answer: REBLEED!
-sudden dev of severe confusion, HA, N/V, decreased consciousness,
focal neuro deficits
-seen on CT
◍ t(8;14). Answer: Burkitt lymphoma (c-myc activation)
-cmyc is an oncogene
-very aggressive, rapid proliferation of cell growth
◍ t(9;22) aka Philadelphia chromosome. Answer: CML (BCR-ABL
hybrid), rarely ALL
-constitutive expression of tyrosine kinase
-poor prognosis when expressed in ALL
