USMLE STEP 1 CK COMPREHENSIVE
MEDICAL REVISION QUESTIONS AND
VERIFIED ANSWERS| GRADED A+|
BRAND NEW!
Benign, low risk for complete heart block. Observation in asymptomatic patients and correction
of reversible causes. - Answer
Atrial Fibrillation - Answer no organized atrial activity
impulses conducted in a random and unpredictable manner.
absence of any discernible P waves and irregularly irregular rhythm with varying R-R interval.
third degree or complete AV block - Answer P waves are entirely unrelated to QRS.
First degree AV block - Answer prolonged PR interval >0.20 sec
PR interval remains constant and there is a QRS for every P wave
Myoglobinuria from rhabdomyolysis post tonic-clonic seizures leading to acute renal failure -
Answer large amount of blood on urinalysis with relative absence of RBCs on urine microscopy
Types of headaches - Answer
analgesics (ibuprofen, aspirin)
More frequent headaches that last longer periods or are disabling should be considered for
prophylactic medication (AMITRIPRTYLINE, NORTRIPTYLINE), and CBT - Answer Patients
with intermittent tension type headaches (<1day/month) can use
,Anticholinergic toxicity from medications like antihistamines (diphenhydramine)
Tx: Physostigmine, cholinesterase inhibitor - Answer Dry mouth/skin (dry as a bone)
Blurry vision/mydriasis (blind as a bat)
Hyperthermia (hot as a hare)
urinary retention (full as a flask)
Decreased bowel sounds
cutaneous vasodilation (red as a beet)
delirium or hallucinations (mad as a hatter)
Theophylline - Answer seizure, hyperthermia, cardiac arrhythmia, tachycardia, hypotension. due
to intoxication with?
Ischemic stroke symptoms progress in a stuttering fashion. - Answer hypertensive
intraparenchymal brain hemorrhage, presents with sudden focal neurological defects that worsen
over minutes to hours.
Basal ganglia (putamen) always involves adjacent internal capsule. Leads to contralateral
hemiparesis, hemianesthesia, and conjugate gaze deviation.
anal fissure tx by anesthetic ointment and stool softeners
-Constipation, prolonged diarrhea, anal sex, IBD (Crohns), malignancy
Tx: High fiber diet and adequate fluid intake, Stool softness, sits bath, topical anesthetics &
vasodilators (Nifedipine, nitroglycerine) - Answer #
pain with bowel movements, bright red blood on toilet paper or stool surface, chronic fissures
may have skin tags at distal end.
most appropriate next step in management?
,Immunosuppresant
Inhibits transcription of IL-2 and T-helper lymphocytes.
Side effects:
1. Nephrotoxicity: reversible acute azotemia or irreversible progressive renal disease.
Hyperuricemia, gout, hyperkalmia, hypophosphatemia, hypomag.
2. HTN: renal vasoconstriction and sodium retention (tx: CCB)
3. Neurotoxicity: headache, visual disturb, seizures, tremor, akinetic mutism
4. Glucose intolerance
5. Infection
6. Malignancy: SCC
7. Gingival Hypertrophy and hirsutism
8. GI: anorexia, nausea, vomit, diarrhea - Answer Cyclosporine
Macrolide antibiotic produced by fungi
Like cyclosporine inhibits transcription of IL-2 and T-helper cells.
same toxic profile of nephrotoxicity but does NOT have gum hypertrophy, and higher incidence
of neurotoxicity, diarrhea and glucose intolerance. - Answer Tacrolimus
Inhibits purine synthesis
toxicity: diarrhea, leukopenia, hepatotoxicity - Answer Azathioprine
, reversible inhibitor of inosine monophosphate dehydrogenase rate limiting enzyme in de novo
purine synthesis
toxicity: bone marrow suppression - Answer mycophenolate
ischemic colitis
Older individual with atherosclerotic disease
most commonly involved segments of colon = SPLENIC FLEXURE at watershed line between
superior and inferior mesenteric arteries & RECTOSIGMOID JUNCTION
NEED CT ASAP: Colonic wall thickening, fat stranding
Endoscopy to confirm diagnosis: Edematous & friable mucosa
Tx: IV fluids & bowel rest, Abx with enteric coverage, colonic resection if necrosis develops -
Answer Acute abdominal pain followed by lower GI bleeding after an episode of hypotension
small bowel mesenteric ischemia due to atheroembolic (endovascular procedure) or
thromboembolic (atrial fibrillation) - Answer severe pain out of proportion to exam findings.
poorly localized. CT: focal or segmental bowel wall thickening and mesenteric stranding.
ACE inhibitors
can occur at ANYTIME, not just within weeks of starting medication. It is due to pro
inflammatory action of bradykinin. Promotes inflammation, edema, and sensation of pain.
STOP ACEi, Subcutaneous epinephrine if airway compromise and if fail then emergency
tracheostomy - Answer Acquired Angioedema
MEDICAL REVISION QUESTIONS AND
VERIFIED ANSWERS| GRADED A+|
BRAND NEW!
Benign, low risk for complete heart block. Observation in asymptomatic patients and correction
of reversible causes. - Answer
Atrial Fibrillation - Answer no organized atrial activity
impulses conducted in a random and unpredictable manner.
absence of any discernible P waves and irregularly irregular rhythm with varying R-R interval.
third degree or complete AV block - Answer P waves are entirely unrelated to QRS.
First degree AV block - Answer prolonged PR interval >0.20 sec
PR interval remains constant and there is a QRS for every P wave
Myoglobinuria from rhabdomyolysis post tonic-clonic seizures leading to acute renal failure -
Answer large amount of blood on urinalysis with relative absence of RBCs on urine microscopy
Types of headaches - Answer
analgesics (ibuprofen, aspirin)
More frequent headaches that last longer periods or are disabling should be considered for
prophylactic medication (AMITRIPRTYLINE, NORTRIPTYLINE), and CBT - Answer Patients
with intermittent tension type headaches (<1day/month) can use
,Anticholinergic toxicity from medications like antihistamines (diphenhydramine)
Tx: Physostigmine, cholinesterase inhibitor - Answer Dry mouth/skin (dry as a bone)
Blurry vision/mydriasis (blind as a bat)
Hyperthermia (hot as a hare)
urinary retention (full as a flask)
Decreased bowel sounds
cutaneous vasodilation (red as a beet)
delirium or hallucinations (mad as a hatter)
Theophylline - Answer seizure, hyperthermia, cardiac arrhythmia, tachycardia, hypotension. due
to intoxication with?
Ischemic stroke symptoms progress in a stuttering fashion. - Answer hypertensive
intraparenchymal brain hemorrhage, presents with sudden focal neurological defects that worsen
over minutes to hours.
Basal ganglia (putamen) always involves adjacent internal capsule. Leads to contralateral
hemiparesis, hemianesthesia, and conjugate gaze deviation.
anal fissure tx by anesthetic ointment and stool softeners
-Constipation, prolonged diarrhea, anal sex, IBD (Crohns), malignancy
Tx: High fiber diet and adequate fluid intake, Stool softness, sits bath, topical anesthetics &
vasodilators (Nifedipine, nitroglycerine) - Answer #
pain with bowel movements, bright red blood on toilet paper or stool surface, chronic fissures
may have skin tags at distal end.
most appropriate next step in management?
,Immunosuppresant
Inhibits transcription of IL-2 and T-helper lymphocytes.
Side effects:
1. Nephrotoxicity: reversible acute azotemia or irreversible progressive renal disease.
Hyperuricemia, gout, hyperkalmia, hypophosphatemia, hypomag.
2. HTN: renal vasoconstriction and sodium retention (tx: CCB)
3. Neurotoxicity: headache, visual disturb, seizures, tremor, akinetic mutism
4. Glucose intolerance
5. Infection
6. Malignancy: SCC
7. Gingival Hypertrophy and hirsutism
8. GI: anorexia, nausea, vomit, diarrhea - Answer Cyclosporine
Macrolide antibiotic produced by fungi
Like cyclosporine inhibits transcription of IL-2 and T-helper cells.
same toxic profile of nephrotoxicity but does NOT have gum hypertrophy, and higher incidence
of neurotoxicity, diarrhea and glucose intolerance. - Answer Tacrolimus
Inhibits purine synthesis
toxicity: diarrhea, leukopenia, hepatotoxicity - Answer Azathioprine
, reversible inhibitor of inosine monophosphate dehydrogenase rate limiting enzyme in de novo
purine synthesis
toxicity: bone marrow suppression - Answer mycophenolate
ischemic colitis
Older individual with atherosclerotic disease
most commonly involved segments of colon = SPLENIC FLEXURE at watershed line between
superior and inferior mesenteric arteries & RECTOSIGMOID JUNCTION
NEED CT ASAP: Colonic wall thickening, fat stranding
Endoscopy to confirm diagnosis: Edematous & friable mucosa
Tx: IV fluids & bowel rest, Abx with enteric coverage, colonic resection if necrosis develops -
Answer Acute abdominal pain followed by lower GI bleeding after an episode of hypotension
small bowel mesenteric ischemia due to atheroembolic (endovascular procedure) or
thromboembolic (atrial fibrillation) - Answer severe pain out of proportion to exam findings.
poorly localized. CT: focal or segmental bowel wall thickening and mesenteric stranding.
ACE inhibitors
can occur at ANYTIME, not just within weeks of starting medication. It is due to pro
inflammatory action of bradykinin. Promotes inflammation, edema, and sensation of pain.
STOP ACEi, Subcutaneous epinephrine if airway compromise and if fail then emergency
tracheostomy - Answer Acquired Angioedema
