USMLE Step 1 UPDATED ACTUAL
Exam Questions and CORRECT Answers
Heterophile ab NEGATIVE Mono-like syndromes - CORRECT ANSWER✔✔- *CMV
HHV-6
HIV
Toxoplasmosis
Wernicke's Aphasia - CORRECT 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 - 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
Exam Questions and CORRECT Answers
Heterophile ab NEGATIVE Mono-like syndromes - CORRECT ANSWER✔✔- *CMV
HHV-6
HIV
Toxoplasmosis
Wernicke's Aphasia - CORRECT 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 - 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
