USMLE Step 1 LATEST VERSION [QUESTIONS AND ANSWERS] WITH
PRACTICE EXAM DETAILED AND VERIFIED FOR GUARANTEED
PASS- LATEST UPDATE 2025 GRADED A
Congenital Deficiency of Propionyl CoA Carboxylase - CORRECT 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 - CORRECT 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 - CORRECT ANSWER Thiamine def=
suppression of GNG (pyruvate DH) and TCA cyle (alpha-KG DH)
MCC of Hypoglycemia in advanced renal insuff - CORRECT ANSWER impaired
clearance of insulin
Avoid Nitrates in Hypertrophic Cardiomyopathy bc... - CORRECT 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 - CORRECT 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 - CORRECT ANSWER Commonly presents in young,
asymptomatic patient with soft systolic ejection at right 2nd ICS
-can cause aortic regurg
MCC of Vaginal Candidiasis - CORRECT 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 - CORRECT ANSWER -Carbamazepine
-Cyclophosphamide
-SSRI
MC Ankle Sprain due to inversion of plantar-flexed foot - CORRECT ANSWER -
Ant Talofibular Lig dmg
-ecchymosis at the ant-lat aspect of the ankle
Upper Brachial Plexus Injury - CORRECT ANSWER - Musculocutaneous and
Suprascapular N.
- dystocia mc in neonates; severe trauma mc in adults
- should adduction, elbow extension, and forearm pronation
Patent foramen ovale - CORRECT ANSWER -failure of septum primum and
septum secundum to fuse after birth
-can lead to paradoxical emboli
Ventricular Septal Defect - CORRECT ANSWER -MC occurs in membranous
septum
-Acyanotic at birth bc of L to R shunt
Coronary Blood Flow Peak - CORRECT ANSWER -at Early Diastole
-coronary perfusion driven by diastolic pressure
-tachycardia will decrease coronary perfusion
Right Dom Heart - CORRECT ANSWER majority of people
-PDA comes off RCA
-SA and AV nodes supplied by RCA
Left Dom Heart - CORRECT ANSWER -PDA comes off of LCX
- SA and AV node supplied by LCX
,Increased Pulse Pressure - CORRECT ANSWER hyperthyroidism, aortic
regurgitation, aortic stiffening (isolated systolic hypertension in elderly), obstructive
sleep apnea ( sympathetic tone), exercise (transient)
Decreased Pulse Pressure - CORRECT ANSWER aortic stenosis, cardiogenic
shock, cardiac tamponade, advanced heart failure (HF)
Causes of Spontaneous Depol causing Tachyarrhythmias - CORRECT ANSWER
Hypokalemia, 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 - CORRECT 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 - CORRECT ANSWER - CNS med
decrease in BP
- decreased intraocular pressure
- decreased lipolysis
- decreased presyn NE release
- increased platelet aggregation
S. epidermidis - CORRECT ANSWER - coag neg
-novobiocin sens
- infective endocarditis and infective arthritis in prosthetic pts
Asymptomatic heart defect in turner's synd - CORRECT ANSWER -nonstenotic
bicuspid aortic valve
-early systolic , high frequency click over right second IC space
Cardiac Changes w/ Normal Aging - CORRECT 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 - CORRECT ANSWER Characterized 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) - CORRECT ANSWER medial fibroplasia, absent
internal elastic lamina in areas of aneurysmal dilation
Paget's Disease associate Bone Tm - CORRECT ANSWER OSTEOSARCOMA!
arising from tibia, femur, humerus, and other bones
-pain doesnt resolve with OTC analgesics
DNA Laddering (Gel Electrophoresis) - CORRECT ANSWER - DNA fragments in
multiples of 180 bp each
- sensitive indicator of APOPTOSIS
- laddering done by specific endonucleases during haryorrhexis, cleaving DNA at
interucleosomal linker regions
- this is not seen in cancer cells, since they evade apoptosis
Warburg Effect - CORRECT ANSWER malignant cells undergo high rates of
glycolysis to produce macromolecules necessary to sustain rapid cellular growth
Risk Factors of Endometritis - CORRECT ANSWER -C-section delivery
-chorioamnionitis
-group B strep colonization
-intrauterine instrumentation
-preterm delivery
-prolonged labor
-prolonged ruptured membranes
-retained products of conception
SIGNS AND SX OF POSTPARTUM ENDOMETRITIS
-fever
-leukocytosis
-uterine tenderness
-foul smelling vaginal discharge
Metabolic derangements assoc with DKA - CORRECT ANSWER metabolic
acidosis, ketonemia, hyperglycemia, hyperkalemia, hyponatremia
-hyperammonemia can be observed due to muscle degradation
Pulmonary Embolism - CORRECT ANSWER V/Q Mismatch, causes hypoxemia
that increases ventilation and HR via a chemoreceptor reflex
PRACTICE EXAM DETAILED AND VERIFIED FOR GUARANTEED
PASS- LATEST UPDATE 2025 GRADED A
Congenital Deficiency of Propionyl CoA Carboxylase - CORRECT 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 - CORRECT 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 - CORRECT ANSWER Thiamine def=
suppression of GNG (pyruvate DH) and TCA cyle (alpha-KG DH)
MCC of Hypoglycemia in advanced renal insuff - CORRECT ANSWER impaired
clearance of insulin
Avoid Nitrates in Hypertrophic Cardiomyopathy bc... - CORRECT 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 - CORRECT 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 - CORRECT ANSWER Commonly presents in young,
asymptomatic patient with soft systolic ejection at right 2nd ICS
-can cause aortic regurg
MCC of Vaginal Candidiasis - CORRECT 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 - CORRECT ANSWER -Carbamazepine
-Cyclophosphamide
-SSRI
MC Ankle Sprain due to inversion of plantar-flexed foot - CORRECT ANSWER -
Ant Talofibular Lig dmg
-ecchymosis at the ant-lat aspect of the ankle
Upper Brachial Plexus Injury - CORRECT ANSWER - Musculocutaneous and
Suprascapular N.
- dystocia mc in neonates; severe trauma mc in adults
- should adduction, elbow extension, and forearm pronation
Patent foramen ovale - CORRECT ANSWER -failure of septum primum and
septum secundum to fuse after birth
-can lead to paradoxical emboli
Ventricular Septal Defect - CORRECT ANSWER -MC occurs in membranous
septum
-Acyanotic at birth bc of L to R shunt
Coronary Blood Flow Peak - CORRECT ANSWER -at Early Diastole
-coronary perfusion driven by diastolic pressure
-tachycardia will decrease coronary perfusion
Right Dom Heart - CORRECT ANSWER majority of people
-PDA comes off RCA
-SA and AV nodes supplied by RCA
Left Dom Heart - CORRECT ANSWER -PDA comes off of LCX
- SA and AV node supplied by LCX
,Increased Pulse Pressure - CORRECT ANSWER hyperthyroidism, aortic
regurgitation, aortic stiffening (isolated systolic hypertension in elderly), obstructive
sleep apnea ( sympathetic tone), exercise (transient)
Decreased Pulse Pressure - CORRECT ANSWER aortic stenosis, cardiogenic
shock, cardiac tamponade, advanced heart failure (HF)
Causes of Spontaneous Depol causing Tachyarrhythmias - CORRECT ANSWER
Hypokalemia, 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 - CORRECT 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 - CORRECT ANSWER - CNS med
decrease in BP
- decreased intraocular pressure
- decreased lipolysis
- decreased presyn NE release
- increased platelet aggregation
S. epidermidis - CORRECT ANSWER - coag neg
-novobiocin sens
- infective endocarditis and infective arthritis in prosthetic pts
Asymptomatic heart defect in turner's synd - CORRECT ANSWER -nonstenotic
bicuspid aortic valve
-early systolic , high frequency click over right second IC space
Cardiac Changes w/ Normal Aging - CORRECT 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 - CORRECT ANSWER Characterized 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) - CORRECT ANSWER medial fibroplasia, absent
internal elastic lamina in areas of aneurysmal dilation
Paget's Disease associate Bone Tm - CORRECT ANSWER OSTEOSARCOMA!
arising from tibia, femur, humerus, and other bones
-pain doesnt resolve with OTC analgesics
DNA Laddering (Gel Electrophoresis) - CORRECT ANSWER - DNA fragments in
multiples of 180 bp each
- sensitive indicator of APOPTOSIS
- laddering done by specific endonucleases during haryorrhexis, cleaving DNA at
interucleosomal linker regions
- this is not seen in cancer cells, since they evade apoptosis
Warburg Effect - CORRECT ANSWER malignant cells undergo high rates of
glycolysis to produce macromolecules necessary to sustain rapid cellular growth
Risk Factors of Endometritis - CORRECT ANSWER -C-section delivery
-chorioamnionitis
-group B strep colonization
-intrauterine instrumentation
-preterm delivery
-prolonged labor
-prolonged ruptured membranes
-retained products of conception
SIGNS AND SX OF POSTPARTUM ENDOMETRITIS
-fever
-leukocytosis
-uterine tenderness
-foul smelling vaginal discharge
Metabolic derangements assoc with DKA - CORRECT ANSWER metabolic
acidosis, ketonemia, hyperglycemia, hyperkalemia, hyponatremia
-hyperammonemia can be observed due to muscle degradation
Pulmonary Embolism - CORRECT ANSWER V/Q Mismatch, causes hypoxemia
that increases ventilation and HR via a chemoreceptor reflex
