FIRST AID FOR THE USMLE PRACTICE
EXAMINATION 2026 QUESTIONS WITH
ANSWERS GRADED A+
◍ ________ helps close a PDA.
Answer: Indomethacin
◍ U wave.
Answer: caused by hypokalemia, bradycardia.
◍ Ductus arteriosus.
Answer: Deoxygenated blood from the SVC passes through the RA -> RV
-> main pulmonary artery through patent ductus arterioles -> patent
descending aorta; shunt is due to high fetal pulmonary artery resistance (due
partly to low O2 tension).
◍ What murmurs are increased in the left lateral decubitus position?.
Answer: mitral stenosis/regurgitationleft sided S3/S4
◍ Contractility (and SV) decrease with?.
Answer: -β1-blockade (decrease cAMP)-HF with systolic dysfunction
-Acidosis-Hypoxia/hypercapnia (decrease Po2/ increase
Pco2)-Non-dihydropyridine Ca2+ channel blockers
◍ Diffuse Proliferative GlomerulonephritisLM:IF:EM:Epi:Symptoms:Other:.
Answer: due to SLE or membranoproliferative glomerulonephritisLM: "wire
looping" of capillariesIF: granular (full house deposition: IgG, IgA, IgM,
C1q, C4, C3)EM: subendothelial and sometimes intramembranous
IgG-based ICs often with C3 depositionOther:- common cause of death in
SLE- note that DPGN and MPGN often present at nephrotic syndrome and
nephritic syndrome concurrently- may have serologic findings consistent
with SLE (ANA, anti-DS DNA, hypocomplementemia)
,◍ Location of Pulmonic area?.
Answer: left 2nd intercostal space adjacent to sternum
◍ What is nephritic syndrome?Findings (give grams of protein excreted):What
are the glomerular disease that cause nephritic syndrome?.
Answer: *What is nephritic syndrome?*- due to disruption of the glomerular
basement membrane- remember nephritic syndrome is due to an
*INFLAMMATORY PROCESS!**Findings*- hematuria- RBCs in urine-
proteinuria in the subnephrotic range (< 3.5 g/day)also --> azotemia,
oliguria, hypertension (2/2 salt retention)*What are the glomerular disease
that cause nephritic syndrome?*- post-streptococcal glomerulonephritis-
rapidly progressive glomerulonephritis- IgA nephropathy (Berger disease)-
Alport Syndrome- membranoproliferative glomerulonephritis
◍ Hepatomegaly (nutmeg liver).
Answer: central venous pressure resistance to portal flow. Rarely, leads
to "cardiac cirrhosis"
◍ Sounds best heard at tricuspid area.
Answer: -Pansystolic murmur: tricuspid regurgitation, VSD-Diastolic
murmur: tricuspid stenosis, ASD
◍ What increases myocardial oxygen demand?.
Answer: -Increased Contractility -Increased Afterload -Increased heart
Rate-Increased Diameter of ventricle (increased wall
tension)"myoCARDial"
◍ What is systole?.
Answer: ventricles contract
◍ __________ keeps the PDA open..
Answer: PGE1 and PGE2**Prostaglandins dilate vessels"E1 & E2 kEEp
PDA open"
◍ Pulsus paradoxus.
Answer: in amplitude of systolic BP by > 10 mmHg during inspiration.
, Seen in cardiac tamponade, asthma, obstructive sleep apnea, pericarditis,
croup.**exaggerated decrease in BP by more than 10 mmHg during
inspiration (Normally BP drops a little during inspiration b/c of the decrease
in intra-thoracic pressure as blood fills the right side of the heart pushing the
septum to the left & decreasing LV size, which results in less volume being
usher out of the LV)
◍ Mitral/tricuspid regurgitation(MR/TR).
Answer: -Holosystolic (AKA "pan" throughout systole), high-pitched
"blowing murmur."-Mitral—loudest at APEX and radiates toward AXILLA.
MR is often due to ischemic heartdisease (post-MI), MVP, LV
dilatation.-Tricuspid—loudest at TRICUSPID area and radiates to right
STERNAL border. TR commonly caused by RV dilatation. -Rheumatic
fever and infective endocarditis can cause either MR or TR.**seen in IVDU
◍ T wave.
Answer: T wave—ventricular depolarization (ventricle recovery so they can
be depolarized again).
◍ Hand grip and vr.
Answer: Inc
◍ Examples of renal /renovascular disease seen in secondary HTN.
Answer: chronic kidney diseaserenal artery stenosisfibromuscular dysplasia
(non-atherosclerotic/non-inflammatory disease that causes abnormal growth
within the wall of an artery-> most commonly the renal & carotid arteries )
w/ "string of beads" appearance usually found in younger women1°
hyperaldosteronism
◍ Edema (capillary fluid exchange related).
Answer: Edema—excess fluid outflow into interstitium commonly caused
by: - capillary pressure ( Pc; e.g. HF d/t the blood backing up into the
systemic venous circulation causing an increase in central venous pressure
forcing fluid into the interstitium)- plasma proteins ( πc; e.g.,
nephrotic syndrome, liver failure, protein malnutrition)- capillary
permeability ( Kf ; e.g., toxins, infections, burns)-> Histamine &
, Bradykinin are released making blood vessels leaky- interstitial fluid
colloid osmotic pressure ( πi; e.g., lymphatic blockage)-> normally,
plasma proteins in the interstitium are taken up by lymphatics & put back
into circulation by the Thoracic Duct
◍ What is the diagnosis? What causes it?Fatigue, anorexia, elevated BUN/Cr,
RBC casts in the urinePath: crescents of fibrin and macrophages on light
microscopy, Granular IF staining.
Answer: Type II RPGN (type III hypersensitivity reaction with immune
complex deposition)Post-strep GN or SLE DPGN can progress to RPGN
◍ What does squatting do in a infant who has Tetralogy of Fallot?.
Answer: SVR, right-to-left shunt, improvescyanosis.**kid squats
down to relieve cyanosis
◍ Treatment of atrial fibrillation.
Answer: Treatment includes anticoagulation therapy (e.g., warfarin), rate
control (β-blocker, non-dihydropyridine Ca2+ channel blocker, digoxin),
rhythm control (class IC or III antiarrhythmics), and/or cardioversion
(pharmacological or electrical).**cardioversion for acute less than 48 hours
A-fib**Rest for chronic A-fib (greater than 48 hours)
◍ What is right-dominant circulation?.
Answer: PDA arises from RCA (occurs 85% of the time)"most people are
right-handed"
◍ What are the large-vessel vasculitis?.
Answer: Temporal (giant cell) arteritis & Takayasu arteritis
◍ Remaining 10% of HTN is mostly __° to ________ disease and
___________..
Answer: 2°, renal /renovascular disease **pic is of fibromuscular dysplasia
◍ With regard to kidney embryology:What tissue is it?What are the three
kidney systems? What is the uteric bud? What does it give rise to? What is
the metanephrine mesenchyma? What does it do?.
Answer: What tissue is it?- derived from intermediate mesoderrm on the
EXAMINATION 2026 QUESTIONS WITH
ANSWERS GRADED A+
◍ ________ helps close a PDA.
Answer: Indomethacin
◍ U wave.
Answer: caused by hypokalemia, bradycardia.
◍ Ductus arteriosus.
Answer: Deoxygenated blood from the SVC passes through the RA -> RV
-> main pulmonary artery through patent ductus arterioles -> patent
descending aorta; shunt is due to high fetal pulmonary artery resistance (due
partly to low O2 tension).
◍ What murmurs are increased in the left lateral decubitus position?.
Answer: mitral stenosis/regurgitationleft sided S3/S4
◍ Contractility (and SV) decrease with?.
Answer: -β1-blockade (decrease cAMP)-HF with systolic dysfunction
-Acidosis-Hypoxia/hypercapnia (decrease Po2/ increase
Pco2)-Non-dihydropyridine Ca2+ channel blockers
◍ Diffuse Proliferative GlomerulonephritisLM:IF:EM:Epi:Symptoms:Other:.
Answer: due to SLE or membranoproliferative glomerulonephritisLM: "wire
looping" of capillariesIF: granular (full house deposition: IgG, IgA, IgM,
C1q, C4, C3)EM: subendothelial and sometimes intramembranous
IgG-based ICs often with C3 depositionOther:- common cause of death in
SLE- note that DPGN and MPGN often present at nephrotic syndrome and
nephritic syndrome concurrently- may have serologic findings consistent
with SLE (ANA, anti-DS DNA, hypocomplementemia)
,◍ Location of Pulmonic area?.
Answer: left 2nd intercostal space adjacent to sternum
◍ What is nephritic syndrome?Findings (give grams of protein excreted):What
are the glomerular disease that cause nephritic syndrome?.
Answer: *What is nephritic syndrome?*- due to disruption of the glomerular
basement membrane- remember nephritic syndrome is due to an
*INFLAMMATORY PROCESS!**Findings*- hematuria- RBCs in urine-
proteinuria in the subnephrotic range (< 3.5 g/day)also --> azotemia,
oliguria, hypertension (2/2 salt retention)*What are the glomerular disease
that cause nephritic syndrome?*- post-streptococcal glomerulonephritis-
rapidly progressive glomerulonephritis- IgA nephropathy (Berger disease)-
Alport Syndrome- membranoproliferative glomerulonephritis
◍ Hepatomegaly (nutmeg liver).
Answer: central venous pressure resistance to portal flow. Rarely, leads
to "cardiac cirrhosis"
◍ Sounds best heard at tricuspid area.
Answer: -Pansystolic murmur: tricuspid regurgitation, VSD-Diastolic
murmur: tricuspid stenosis, ASD
◍ What increases myocardial oxygen demand?.
Answer: -Increased Contractility -Increased Afterload -Increased heart
Rate-Increased Diameter of ventricle (increased wall
tension)"myoCARDial"
◍ What is systole?.
Answer: ventricles contract
◍ __________ keeps the PDA open..
Answer: PGE1 and PGE2**Prostaglandins dilate vessels"E1 & E2 kEEp
PDA open"
◍ Pulsus paradoxus.
Answer: in amplitude of systolic BP by > 10 mmHg during inspiration.
, Seen in cardiac tamponade, asthma, obstructive sleep apnea, pericarditis,
croup.**exaggerated decrease in BP by more than 10 mmHg during
inspiration (Normally BP drops a little during inspiration b/c of the decrease
in intra-thoracic pressure as blood fills the right side of the heart pushing the
septum to the left & decreasing LV size, which results in less volume being
usher out of the LV)
◍ Mitral/tricuspid regurgitation(MR/TR).
Answer: -Holosystolic (AKA "pan" throughout systole), high-pitched
"blowing murmur."-Mitral—loudest at APEX and radiates toward AXILLA.
MR is often due to ischemic heartdisease (post-MI), MVP, LV
dilatation.-Tricuspid—loudest at TRICUSPID area and radiates to right
STERNAL border. TR commonly caused by RV dilatation. -Rheumatic
fever and infective endocarditis can cause either MR or TR.**seen in IVDU
◍ T wave.
Answer: T wave—ventricular depolarization (ventricle recovery so they can
be depolarized again).
◍ Hand grip and vr.
Answer: Inc
◍ Examples of renal /renovascular disease seen in secondary HTN.
Answer: chronic kidney diseaserenal artery stenosisfibromuscular dysplasia
(non-atherosclerotic/non-inflammatory disease that causes abnormal growth
within the wall of an artery-> most commonly the renal & carotid arteries )
w/ "string of beads" appearance usually found in younger women1°
hyperaldosteronism
◍ Edema (capillary fluid exchange related).
Answer: Edema—excess fluid outflow into interstitium commonly caused
by: - capillary pressure ( Pc; e.g. HF d/t the blood backing up into the
systemic venous circulation causing an increase in central venous pressure
forcing fluid into the interstitium)- plasma proteins ( πc; e.g.,
nephrotic syndrome, liver failure, protein malnutrition)- capillary
permeability ( Kf ; e.g., toxins, infections, burns)-> Histamine &
, Bradykinin are released making blood vessels leaky- interstitial fluid
colloid osmotic pressure ( πi; e.g., lymphatic blockage)-> normally,
plasma proteins in the interstitium are taken up by lymphatics & put back
into circulation by the Thoracic Duct
◍ What is the diagnosis? What causes it?Fatigue, anorexia, elevated BUN/Cr,
RBC casts in the urinePath: crescents of fibrin and macrophages on light
microscopy, Granular IF staining.
Answer: Type II RPGN (type III hypersensitivity reaction with immune
complex deposition)Post-strep GN or SLE DPGN can progress to RPGN
◍ What does squatting do in a infant who has Tetralogy of Fallot?.
Answer: SVR, right-to-left shunt, improvescyanosis.**kid squats
down to relieve cyanosis
◍ Treatment of atrial fibrillation.
Answer: Treatment includes anticoagulation therapy (e.g., warfarin), rate
control (β-blocker, non-dihydropyridine Ca2+ channel blocker, digoxin),
rhythm control (class IC or III antiarrhythmics), and/or cardioversion
(pharmacological or electrical).**cardioversion for acute less than 48 hours
A-fib**Rest for chronic A-fib (greater than 48 hours)
◍ What is right-dominant circulation?.
Answer: PDA arises from RCA (occurs 85% of the time)"most people are
right-handed"
◍ What are the large-vessel vasculitis?.
Answer: Temporal (giant cell) arteritis & Takayasu arteritis
◍ Remaining 10% of HTN is mostly __° to ________ disease and
___________..
Answer: 2°, renal /renovascular disease **pic is of fibromuscular dysplasia
◍ With regard to kidney embryology:What tissue is it?What are the three
kidney systems? What is the uteric bud? What does it give rise to? What is
the metanephrine mesenchyma? What does it do?.
Answer: What tissue is it?- derived from intermediate mesoderrm on the
