(Updated Solution) USMLE Step 1 Rapid Review:
Guaranteed A+ Guide
Heterophile ab NEGATIVE Mono-like syndromes - ANSWER*CMV
HHV-6
HIV
Toxoplasmosis
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 - ANSWERNeuro: 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 - ANSWERThiamine def= suppression of GNG
(pyruvate DH) and TCA cyle (alpha-KG DH)
MCC of Hypoglycemia in advanced renal insuff - ANSWERimpaired clearance of
insulin
Avoid Nitrates in Hypertrophic Cardiomyopathy bc... - ANSWERNitrates decrease
preload, which will increase the LV outflow tract... BUT since the ventricle is
abnormally shaped, there is an outflow obstruction
Mets through BM - ANSWERClonal 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 - ANSWERCommonly presents in young, asymptomatic patient
with soft systolic ejection at right 2nd ICS
-can cause aortic regurg
MCC of Vaginal Candidiasis - ANSWER1. 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
Right Dom Heart - ANSWERmajority of people
-PDA comes off RCA
-SA and AV nodes supplied by RCA
Left Dom Heart - ANSWER-PDA comes off of LCX
- SA and AV node supplied by LCX
Increased Pulse Pressure - ANSWERhyperthyroidism, aortic regurgitation, aortic
stiffening (isolated systolic hypertension in elderly), obstructive sleep apnea
( sympathetic tone), exercise (transient)
, Decreased Pulse Pressure - ANSWERaortic stenosis, cardiogenic shock, cardiac
tamponade, advanced heart failure (HF)
Causes of Spontaneous Depol causing Tachyarrhythmias - ANSWERHypokalemia,
Hypermagnesemia, or prolonged QT interval
= all cause spontaneous depol of ventricles in phase 3 or 4 and it will cause an extra
AP in heart
Direct alpha 1 agonist mediated effects - ANSWER- vasc smooth muscle contraction=
increased afterload and venous return= increased DBP + SBP causes reflexive
increase in vagal tone= dec HR and slowed AV conduction
- mydriasis
- increased internal urethral sphincter tone and prostate contraction
Direct alpha 2 agonist mediated effects - ANSWER- CNS med decrease in BP
- decreased intraocular pressure
- decreased lipolysis
- decreased presyn NE release
- increased platelet aggregation
S. epidermidis - ANSWER- coag neg
-novobiocin sens
- infective endocarditis and infective arthritis in prosthetic pts
Asymptomatic heart defect in turner's synd - ANSWER-nonstenotic bicuspid aortic
valve
-early systolic , high frequency click over right second IC space
Cardiac Changes w/ Normal Aging - ANSWER- decreased left ventricular chamber size
- shortened base- to- apex dimension
- ventricular septum becomes sigmoid and shape, with basilar portion bulging into LV
outflow tract
- atrophy of myocardium causes increased interstitial connective tissue, often with
concomitant extracellular amyloid deposition
- lipofucin pigment accumulation within cardiomyocytes
ARDS - ANSWERCharacterized by the development of hypoxemia and bilateral
pulmonary infiltrates in the absence of heart failure
-begins with initial injury of pul alveoli (smoke inhal) or pul endothelium (sepsis)
which leads to the recruitment of neutrophils- this worsens the situation and leads
to intraalveolar accumulation and hyaline membrane formation
-decreased lung compliance, increased work of breathing, worsened V/Q mismatch,
and normal PCWP
Renal Artery Stenosis (histo) - ANSWERmedial fibroplasia, absent internal elastic
lamina in areas of aneurysmal dilation
Guaranteed A+ Guide
Heterophile ab NEGATIVE Mono-like syndromes - ANSWER*CMV
HHV-6
HIV
Toxoplasmosis
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 - ANSWERNeuro: 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 - ANSWERThiamine def= suppression of GNG
(pyruvate DH) and TCA cyle (alpha-KG DH)
MCC of Hypoglycemia in advanced renal insuff - ANSWERimpaired clearance of
insulin
Avoid Nitrates in Hypertrophic Cardiomyopathy bc... - ANSWERNitrates decrease
preload, which will increase the LV outflow tract... BUT since the ventricle is
abnormally shaped, there is an outflow obstruction
Mets through BM - ANSWERClonal 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 - ANSWERCommonly presents in young, asymptomatic patient
with soft systolic ejection at right 2nd ICS
-can cause aortic regurg
MCC of Vaginal Candidiasis - ANSWER1. 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
Right Dom Heart - ANSWERmajority of people
-PDA comes off RCA
-SA and AV nodes supplied by RCA
Left Dom Heart - ANSWER-PDA comes off of LCX
- SA and AV node supplied by LCX
Increased Pulse Pressure - ANSWERhyperthyroidism, aortic regurgitation, aortic
stiffening (isolated systolic hypertension in elderly), obstructive sleep apnea
( sympathetic tone), exercise (transient)
, Decreased Pulse Pressure - ANSWERaortic stenosis, cardiogenic shock, cardiac
tamponade, advanced heart failure (HF)
Causes of Spontaneous Depol causing Tachyarrhythmias - ANSWERHypokalemia,
Hypermagnesemia, or prolonged QT interval
= all cause spontaneous depol of ventricles in phase 3 or 4 and it will cause an extra
AP in heart
Direct alpha 1 agonist mediated effects - ANSWER- vasc smooth muscle contraction=
increased afterload and venous return= increased DBP + SBP causes reflexive
increase in vagal tone= dec HR and slowed AV conduction
- mydriasis
- increased internal urethral sphincter tone and prostate contraction
Direct alpha 2 agonist mediated effects - ANSWER- CNS med decrease in BP
- decreased intraocular pressure
- decreased lipolysis
- decreased presyn NE release
- increased platelet aggregation
S. epidermidis - ANSWER- coag neg
-novobiocin sens
- infective endocarditis and infective arthritis in prosthetic pts
Asymptomatic heart defect in turner's synd - ANSWER-nonstenotic bicuspid aortic
valve
-early systolic , high frequency click over right second IC space
Cardiac Changes w/ Normal Aging - ANSWER- decreased left ventricular chamber size
- shortened base- to- apex dimension
- ventricular septum becomes sigmoid and shape, with basilar portion bulging into LV
outflow tract
- atrophy of myocardium causes increased interstitial connective tissue, often with
concomitant extracellular amyloid deposition
- lipofucin pigment accumulation within cardiomyocytes
ARDS - ANSWERCharacterized by the development of hypoxemia and bilateral
pulmonary infiltrates in the absence of heart failure
-begins with initial injury of pul alveoli (smoke inhal) or pul endothelium (sepsis)
which leads to the recruitment of neutrophils- this worsens the situation and leads
to intraalveolar accumulation and hyaline membrane formation
-decreased lung compliance, increased work of breathing, worsened V/Q mismatch,
and normal PCWP
Renal Artery Stenosis (histo) - ANSWERmedial fibroplasia, absent internal elastic
lamina in areas of aneurysmal dilation
