USMLE Step 1 Study Review Test with Answers Graded A
Heterophile ab NEGATIVE Mono-like syndromes
- -*CMV
HHV-6
HIV Avoid Nitrates in Hypertrophic Cardiomyopathy
Toxoplasmosis bc... - -Nitrates decrease preload, which
will increase the LV outflow tract... BUT since the
ventricle is abnormally shaped, there is an
outflow obstruction
Wernicke's Aphasia - --word salad: well-
articulated, nonsensical speech paired with lack
of lang comprehension
-aud association cortex: post part of sup Mets through BM - -Clonal proliferation of
temporal gyrus cells can invade/ metastasize*
- supplied by MCA 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
Congenital Deficiency of Propionyl CoA release metalloproteinases (e.g., collagenases,
Carboxylase - --prevents conversion of stromelysins, gelatinases) to degrade the
propionyl CoA to methylmalonyl CoA basement membrane and other enzymes to
-propionyl CoA derived from= val, ile, met, thr, degrade the interstitial connective tissue- tissue
odd # FA, cholesterol side chains inhibitors of metalloproteinases neutralize these
-Propionic Acidemia: poor feeding, vomiting, tumor-produced enzymes and limit the degree of
hypotonia, lethargy, dehydration, anion gap invasion
acidosis 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
Down Synd Comorbidities - -Neuro: MR, stimulate locomotion, so that they can move
early onset Alzheimer's through basement membranes and the
Cardio: complete AV septal defect, VSD, ASD intracellular and extracellular matrices
GI: duodenal atresia, hirschprung disease
Endo: hypothyroid, DM1, obesity
Heme: ALL (> 5 yo) and AML (<5 yo)
Rheumatology: atlantoaxial stability Bicuspid Aortic Valve - -Commonly
presents in young, asymptomatic patient with soft
systolic ejection at right 2nd ICS
-can cause aortic regurg
MCC of Hypoglycemia in EtOH-ics - -
Thiamine def= suppression of GNG (pyruvate
DH) and TCA cyle (alpha-KG DH)
MCC of Vaginal Candidiasis - -1. Abx use=
reduces lactobacilli pop
2. High estrogen levels- preg
MCC of Hypoglycemia in advanced renal insuff - 3. System corticosteroid therapy
-impaired clearance of insulin 4. Uncontrolled DM
,USMLE Step 1 Study Review Test with Answers Graded A
5. Immunosuppression, including HIV -SA and AV nodes supplied by RCA
Drug causes of SIADH - --Carbamazepine Left Dom Heart - --PDA comes off of LCX
-Cyclophosphamide - SA and AV node supplied by LCX
-SSRI
Increased Pulse Pressure - -
MC Ankle Sprain due to inversion of plantar- hyperthyroidism, aortic regurgitation, aortic
flexed foot - --Ant Talofibular Lig dmg stiffening (isolated systolic hypertension in
-ecchymosis at the ant-lat aspect of the ankle elderly), obstructive sleep apnea ( sympathetic
tone), exercise (transient)
Upper Brachial Plexus Injury - --
Musculocutaneous and Suprascapular N. Decreased Pulse Pressure - -aortic
- dystocia mc in neonates; severe trauma mc in stenosis, cardiogenic shock, cardiac tamponade,
adults advanced heart failure (HF)
- should adduction, elbow extension, and
forearm pronation
Causes of Spontaneous Depol causing
Tachyarrhythmias - -Hypokalemia,
Patent foramen ovale - --failure of septum Hypermagnesemia, or prolonged QT interval
primum and septum secundum to fuse after birth = all cause spontaneous depol of ventricles in
-can lead to paradoxical emboli phase 3 or 4 and it will cause an extra AP in
heart
Ventricular Septal Defect - --MC occurs in
membranous septum Direct alpha 1 agonist mediated effects - --
-Acyanotic at birth bc of L to R shunt vasc smooth muscle contraction= increased
afterload and venous return= increased DBP +
SBP causes reflexive increase in vagal tone= dec
HR and slowed AV conduction
Coronary Blood Flow Peak - --at Early - mydriasis
Diastole - increased internal urethral sphincter tone and
-coronary perfusion driven by diastolic pressure prostate contraction
-tachycardia will decrease coronary perfusion
Direct alpha 2 agonist mediated effects - --
Right Dom Heart - -majority of people CNS med decrease in BP
-PDA comes off RCA - decreased intraocular pressure
, USMLE Step 1 Study Review Test with Answers Graded A
- decreased lipolysis PCWP
- decreased presyn NE release
- increased platelet aggregation
Renal Artery Stenosis (histo) - -medial
fibroplasia, absent internal elastic lamina in areas
S. epidermidis - -- coag neg of aneurysmal dilation
-novobiocin sens
- infective endocarditis and infective arthritis in
prosthetic pts
Paget's Disease associate Bone Tm - -
OSTEOSARCOMA! arising from tibia, femur,
humerus, and other bones
Asymptomatic heart defect in turner's synd - -pain doesnt resolve with OTC analgesics
--nonstenotic bicuspid aortic valve
-early systolic , high frequency click over right
second IC space
DNA Laddering (Gel Electrophoresis) - --
DNA fragments in multiples of 180 bp each
- sensitive indicator of APOPTOSIS
Cardiac Changes w/ Normal Aging - -- - laddering done by specific endonucleases
decreased left ventricular chamber size during haryorrhexis, cleaving DNA at
- shortened base- to- apex dimension interucleosomal linker regions
- ventricular septum becomes sigmoid and - this is not seen in cancer cells, since they evade
shape, with basilar portion bulging into LV apoptosis
outflow tract
- atrophy of myocardium causes increased
interstitial connective tissue, often with
concomitant extracellular amyloid deposition Warburg Effect - -malignant cells undergo
- lipofucin pigment accumulation within high rates of glycolysis to produce
cardiomyocytes macromolecules necessary to sustain rapid
cellular growth
ARDS - -Characterized by the
development of hypoxemia and bilateral Risk Factors of Endometritis - --C-section
pulmonary infiltrates in the absence of heart delivery
failure -chorioamnionitis
-begins with initial injury of pul alveoli (smoke -group B strep colonization
inhal) or pul endothelium (sepsis) which leads to -intrauterine instrumentation
the recruitment of neutrophils- this worsens the -preterm delivery
situation and leads to intraalveolar accumulation -prolonged labor
and hyaline membrane formation -prolonged ruptured membranes
-retained products of conception
-decreased lung compliance, increased work of
breathing, worsened V/Q mismatch, and normal SIGNS AND SX OF POSTPARTUM
Heterophile ab NEGATIVE Mono-like syndromes
- -*CMV
HHV-6
HIV Avoid Nitrates in Hypertrophic Cardiomyopathy
Toxoplasmosis bc... - -Nitrates decrease preload, which
will increase the LV outflow tract... BUT since the
ventricle is abnormally shaped, there is an
outflow obstruction
Wernicke's Aphasia - --word salad: well-
articulated, nonsensical speech paired with lack
of lang comprehension
-aud association cortex: post part of sup Mets through BM - -Clonal proliferation of
temporal gyrus cells can invade/ metastasize*
- supplied by MCA 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
Congenital Deficiency of Propionyl CoA release metalloproteinases (e.g., collagenases,
Carboxylase - --prevents conversion of stromelysins, gelatinases) to degrade the
propionyl CoA to methylmalonyl CoA basement membrane and other enzymes to
-propionyl CoA derived from= val, ile, met, thr, degrade the interstitial connective tissue- tissue
odd # FA, cholesterol side chains inhibitors of metalloproteinases neutralize these
-Propionic Acidemia: poor feeding, vomiting, tumor-produced enzymes and limit the degree of
hypotonia, lethargy, dehydration, anion gap invasion
acidosis 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
Down Synd Comorbidities - -Neuro: MR, stimulate locomotion, so that they can move
early onset Alzheimer's through basement membranes and the
Cardio: complete AV septal defect, VSD, ASD intracellular and extracellular matrices
GI: duodenal atresia, hirschprung disease
Endo: hypothyroid, DM1, obesity
Heme: ALL (> 5 yo) and AML (<5 yo)
Rheumatology: atlantoaxial stability Bicuspid Aortic Valve - -Commonly
presents in young, asymptomatic patient with soft
systolic ejection at right 2nd ICS
-can cause aortic regurg
MCC of Hypoglycemia in EtOH-ics - -
Thiamine def= suppression of GNG (pyruvate
DH) and TCA cyle (alpha-KG DH)
MCC of Vaginal Candidiasis - -1. Abx use=
reduces lactobacilli pop
2. High estrogen levels- preg
MCC of Hypoglycemia in advanced renal insuff - 3. System corticosteroid therapy
-impaired clearance of insulin 4. Uncontrolled DM
,USMLE Step 1 Study Review Test with Answers Graded A
5. Immunosuppression, including HIV -SA and AV nodes supplied by RCA
Drug causes of SIADH - --Carbamazepine Left Dom Heart - --PDA comes off of LCX
-Cyclophosphamide - SA and AV node supplied by LCX
-SSRI
Increased Pulse Pressure - -
MC Ankle Sprain due to inversion of plantar- hyperthyroidism, aortic regurgitation, aortic
flexed foot - --Ant Talofibular Lig dmg stiffening (isolated systolic hypertension in
-ecchymosis at the ant-lat aspect of the ankle elderly), obstructive sleep apnea ( sympathetic
tone), exercise (transient)
Upper Brachial Plexus Injury - --
Musculocutaneous and Suprascapular N. Decreased Pulse Pressure - -aortic
- dystocia mc in neonates; severe trauma mc in stenosis, cardiogenic shock, cardiac tamponade,
adults advanced heart failure (HF)
- should adduction, elbow extension, and
forearm pronation
Causes of Spontaneous Depol causing
Tachyarrhythmias - -Hypokalemia,
Patent foramen ovale - --failure of septum Hypermagnesemia, or prolonged QT interval
primum and septum secundum to fuse after birth = all cause spontaneous depol of ventricles in
-can lead to paradoxical emboli phase 3 or 4 and it will cause an extra AP in
heart
Ventricular Septal Defect - --MC occurs in
membranous septum Direct alpha 1 agonist mediated effects - --
-Acyanotic at birth bc of L to R shunt vasc smooth muscle contraction= increased
afterload and venous return= increased DBP +
SBP causes reflexive increase in vagal tone= dec
HR and slowed AV conduction
Coronary Blood Flow Peak - --at Early - mydriasis
Diastole - increased internal urethral sphincter tone and
-coronary perfusion driven by diastolic pressure prostate contraction
-tachycardia will decrease coronary perfusion
Direct alpha 2 agonist mediated effects - --
Right Dom Heart - -majority of people CNS med decrease in BP
-PDA comes off RCA - decreased intraocular pressure
, USMLE Step 1 Study Review Test with Answers Graded A
- decreased lipolysis PCWP
- decreased presyn NE release
- increased platelet aggregation
Renal Artery Stenosis (histo) - -medial
fibroplasia, absent internal elastic lamina in areas
S. epidermidis - -- coag neg of aneurysmal dilation
-novobiocin sens
- infective endocarditis and infective arthritis in
prosthetic pts
Paget's Disease associate Bone Tm - -
OSTEOSARCOMA! arising from tibia, femur,
humerus, and other bones
Asymptomatic heart defect in turner's synd - -pain doesnt resolve with OTC analgesics
--nonstenotic bicuspid aortic valve
-early systolic , high frequency click over right
second IC space
DNA Laddering (Gel Electrophoresis) - --
DNA fragments in multiples of 180 bp each
- sensitive indicator of APOPTOSIS
Cardiac Changes w/ Normal Aging - -- - laddering done by specific endonucleases
decreased left ventricular chamber size during haryorrhexis, cleaving DNA at
- shortened base- to- apex dimension interucleosomal linker regions
- ventricular septum becomes sigmoid and - this is not seen in cancer cells, since they evade
shape, with basilar portion bulging into LV apoptosis
outflow tract
- atrophy of myocardium causes increased
interstitial connective tissue, often with
concomitant extracellular amyloid deposition Warburg Effect - -malignant cells undergo
- lipofucin pigment accumulation within high rates of glycolysis to produce
cardiomyocytes macromolecules necessary to sustain rapid
cellular growth
ARDS - -Characterized by the
development of hypoxemia and bilateral Risk Factors of Endometritis - --C-section
pulmonary infiltrates in the absence of heart delivery
failure -chorioamnionitis
-begins with initial injury of pul alveoli (smoke -group B strep colonization
inhal) or pul endothelium (sepsis) which leads to -intrauterine instrumentation
the recruitment of neutrophils- this worsens the -preterm delivery
situation and leads to intraalveolar accumulation -prolonged labor
and hyaline membrane formation -prolonged ruptured membranes
-retained products of conception
-decreased lung compliance, increased work of
breathing, worsened V/Q mismatch, and normal SIGNS AND SX OF POSTPARTUM
