USMLE STEP 1 CUMULATIVE REVIEW
TEST SOLUTION COMPLETE GUIDE
GRADED A PLUS
◍ 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
◍ Right Dom Heart. Answer: majority 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. Answer: hyperthyroidism, aortic
regurgitation, aortic stiffening (isolated systolic hypertension in
elderly), obstructive sleep apnea ( sympathetic tone), exercise
(transient)
TEST SOLUTION COMPLETE GUIDE
GRADED A PLUS
◍ 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
◍ Right Dom Heart. Answer: majority 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. Answer: hyperthyroidism, aortic
regurgitation, aortic stiffening (isolated systolic hypertension in
elderly), obstructive sleep apnea ( sympathetic tone), exercise
(transient)
