USMLE CERTIFICATION SCRIPT 2026
QUESTIONS WITH SOLUTIONS GRADED A+
◍ Sildenafil.
Answer: persistent pulmonary hypertension of the newborn treatment?
◍ adjustment disordertx of choice = Psychotherapy that focuses on improving
coping skills.
Answer: emotional or behavioral symptoms develop within 3 months of
exposure to an identifiable stressor and rarely last more than 6months after
the stressor ends.
◍ Meningioma.
Answer: tumor originating from the arachnoid cap cells. extra axial well
circumscribed dural based masses can be partially calcified. headache,
seizures, focal neurologic deficits due to mass effect.
◍ intussusceptionantecedent illness (Gastroenteritis) cause hypertrophy of
peyer patches in lymphoid rich terminal ileum, nidus for telescoping.
Inspissated stool in CF can serve as a lead pointBurkitt Lymphoma
aggressive rapidly growing B-cell tumor involve distal ileum HSP increase
risk by forming small bowel hematoma from autoimmune vasculitis.
Answer:
◍ nephrotic syndrome.
Answer: fatty casts
◍ BONE LOSS leading to Osteoporosis & increased risk of fractureExcess
Thyroid hormone -> Increase Osteoclast activity -> Hypercalcemia ->
Decrease PTH secretion -> (decrease renal calcium reabsorption) &
(Decrease conversion of 25 to 1,25-> Decrease GI calcium absorption and
decrease renal calcium absorption)-> Hypercalciuria, net calcium wasting.
Answer: Untreated Hyperthyroidism places the patients at greatest risk for
, developing what complication?
◍ STRICT BP CONTROLPatients with diabetic rephropathy should be treated
toward a target BP of 130/80ACEi or ARB preferred antihypertensive drugs
for patients with DM.
Answer: Most beneficial therapy to reduce progression of diabetic
nephropathy is?
◍ visual field defects.
Answer:
◍ Causes of pelvic pain= E.C.T.O.P.I.C..
Answer: Ectopic (mcc), Endometriosis Cyst rupture (corpus leutium cyst
rupture)Torsion of ovary (compromise ovarian bl flow) or cystOvulation
(mittelschmerz)PID, salpingitis, tubo-ovarian abscess Incomplete
abortionCystitis/pyelonephritis
◍ inter ventricular hemorrhage primary risk factor is prematurity, as preterm
infants have fragile vascular and more susceptible to acute changes in
cerebral perfusion (hypotension, swings in oxygenation or ventilation,
increased venous pressure)7-10 days of birth and can present with anemia,
tachycardia, apnea, seizures, focal neurological signs, bulging fontanelle.
Preterm infants should have regular screening CRANIAL
ULTRASOUNDSlong term sequelae is cerebral plays and intellectual
disability..
Answer:
◍ damage to tricuspid leaflet or inadequate leaflet computation can occur
leading to severe Tricuspid Regurg. Eventually leading to right HF.
Distended JV, pulsatile tender hepatomegaly, abdominal distention with
ascites, lower extremety edema. RV heave and holosystolic murmur best
heard at left sternal border. murmur intensifies with maneuvers that
increased right ventricular preload (deep inspiration, leg raise) Confirm
diagnosis on Echo.
Answer: right Ventricular lead of a trans venous implantable pacemaker
passes through the SVC into R. Atrium and then through tricuspid valve to
, terminate in the endocardium of RV.
◍ 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 invasion3.
cell receptors to attach to bronectin and other proteins in the extracellular
matrix (ECM) and to break it down4. malignant cells to produce cytokines
that stimulate locomotion, so that they can move through basement
membranes and the intracellular and extracellular matrices
◍ Standard dose adequate at 28 weeks gestationAfter delivery, placental
abruption or procedure, KLEIHAUER-BETKE test used to determine
wether a higher dose is needed due to increased risk of fetal blood cells
entering the maternal circulation. As most often women require a HIGHER
dose after delivery..
Answer: Anti-D Immune Globulin should be administered to any Rh
D-negative mother who delivers an Rh D-positive baby.
◍ Cocaine intoxicationTx: Oxygen & Benzo for BP and anxiety, Aspirin,
Nitroglycerine and Ca channel blockers for painBETA BLOCKERS
CONTRAINDICATED-cause unopposed alpha adrenergic stimulation and
worsen coronary vasoconstriction.
Answer: Psychomotor agitation, dilated pupils, atrophic nasal mucosa, HTN,
acute MI. Intoxication with? treat?
◍ Aortic Valve Infective Endocarditis ECG with conduction abnormalities 2:1
second degree AV block this raises suspicion for perivalvular abscess
leading to syncope..
Answer: IV drug abuse, fever, early diastolic murmur of Aortic
Regurgitation
, ◍ Salicylates, Furosemide, Heparin.
Answer: in patients with normal hypothalamic-pituitary feedback,
displacement of T4 from its binding proteins leads to decreased thyroid
hormone perfection and lower T4 levels with normal free hormone levels.
seen as an effect from what medications?
◍ sec-mins: Anaphylaxismin-hrs: Acute Hemolytic1-6hrs: Febrile
Nonhemolytic (fever, chills, malaise without hemolysis); prevent with
leukoreduction of donor blood helps also prevent HLA alloimmunization
and CMV transmission 2days-10days: Delayed Hemolytic.
Answer: Transfusion Reaction timeline
◍ 4 Ts1. Thymoma2. Teratoma (Mixed Germ Cell Tumor): HIGH AFP &
b-hCG = NON Seminomatous germ cell tumor (Vs. Seminomatous only has
elevated b-hcg)3. Thyroid Neoplasm4. Terrible Lymphoma.
Answer: Differential Diagnosis for anterior mediastinal mass
◍ Charcot joint (neurogenic arthropathy)decreased proprioception, pain,
temperature, lead to unknownigly traumatizing weight bearing joints.Vit
B12 def, DM, Peripheral; nerve damage, Spinal cord injury, syringomyelia,
tabes dorsalis (tertiary syphilis)Tx: Treat underlying condition, mechanical
devices, X-rays.
Answer: Deformed joints, arthritis, arthropathy, mild pain, fractures,
degenerative joint disease.
◍ ischemic colitis.
Answer: sudden onset of abdominal pain and tenderness followed by rectal
bleeding, due to inadequate perfusion of watershed areas (splenic flexure) in
setting of nonexclusive ischemia or surgical or endovascular interventions.
◍ rheumatic heart diseasegradual and progressivly worsening dyspnea or
orthopnea. Atrial fibrillation is a common complication and can cause rapid
decompensation. Long standing can cause severe left atrial enlargement
leading to an elevation of the left main bronchus on chest radiograph..
Answer: Mitral stenosis is most commonly due to?
QUESTIONS WITH SOLUTIONS GRADED A+
◍ Sildenafil.
Answer: persistent pulmonary hypertension of the newborn treatment?
◍ adjustment disordertx of choice = Psychotherapy that focuses on improving
coping skills.
Answer: emotional or behavioral symptoms develop within 3 months of
exposure to an identifiable stressor and rarely last more than 6months after
the stressor ends.
◍ Meningioma.
Answer: tumor originating from the arachnoid cap cells. extra axial well
circumscribed dural based masses can be partially calcified. headache,
seizures, focal neurologic deficits due to mass effect.
◍ intussusceptionantecedent illness (Gastroenteritis) cause hypertrophy of
peyer patches in lymphoid rich terminal ileum, nidus for telescoping.
Inspissated stool in CF can serve as a lead pointBurkitt Lymphoma
aggressive rapidly growing B-cell tumor involve distal ileum HSP increase
risk by forming small bowel hematoma from autoimmune vasculitis.
Answer:
◍ nephrotic syndrome.
Answer: fatty casts
◍ BONE LOSS leading to Osteoporosis & increased risk of fractureExcess
Thyroid hormone -> Increase Osteoclast activity -> Hypercalcemia ->
Decrease PTH secretion -> (decrease renal calcium reabsorption) &
(Decrease conversion of 25 to 1,25-> Decrease GI calcium absorption and
decrease renal calcium absorption)-> Hypercalciuria, net calcium wasting.
Answer: Untreated Hyperthyroidism places the patients at greatest risk for
, developing what complication?
◍ STRICT BP CONTROLPatients with diabetic rephropathy should be treated
toward a target BP of 130/80ACEi or ARB preferred antihypertensive drugs
for patients with DM.
Answer: Most beneficial therapy to reduce progression of diabetic
nephropathy is?
◍ visual field defects.
Answer:
◍ Causes of pelvic pain= E.C.T.O.P.I.C..
Answer: Ectopic (mcc), Endometriosis Cyst rupture (corpus leutium cyst
rupture)Torsion of ovary (compromise ovarian bl flow) or cystOvulation
(mittelschmerz)PID, salpingitis, tubo-ovarian abscess Incomplete
abortionCystitis/pyelonephritis
◍ inter ventricular hemorrhage primary risk factor is prematurity, as preterm
infants have fragile vascular and more susceptible to acute changes in
cerebral perfusion (hypotension, swings in oxygenation or ventilation,
increased venous pressure)7-10 days of birth and can present with anemia,
tachycardia, apnea, seizures, focal neurological signs, bulging fontanelle.
Preterm infants should have regular screening CRANIAL
ULTRASOUNDSlong term sequelae is cerebral plays and intellectual
disability..
Answer:
◍ damage to tricuspid leaflet or inadequate leaflet computation can occur
leading to severe Tricuspid Regurg. Eventually leading to right HF.
Distended JV, pulsatile tender hepatomegaly, abdominal distention with
ascites, lower extremety edema. RV heave and holosystolic murmur best
heard at left sternal border. murmur intensifies with maneuvers that
increased right ventricular preload (deep inspiration, leg raise) Confirm
diagnosis on Echo.
Answer: right Ventricular lead of a trans venous implantable pacemaker
passes through the SVC into R. Atrium and then through tricuspid valve to
, terminate in the endocardium of RV.
◍ 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 invasion3.
cell receptors to attach to bronectin and other proteins in the extracellular
matrix (ECM) and to break it down4. malignant cells to produce cytokines
that stimulate locomotion, so that they can move through basement
membranes and the intracellular and extracellular matrices
◍ Standard dose adequate at 28 weeks gestationAfter delivery, placental
abruption or procedure, KLEIHAUER-BETKE test used to determine
wether a higher dose is needed due to increased risk of fetal blood cells
entering the maternal circulation. As most often women require a HIGHER
dose after delivery..
Answer: Anti-D Immune Globulin should be administered to any Rh
D-negative mother who delivers an Rh D-positive baby.
◍ Cocaine intoxicationTx: Oxygen & Benzo for BP and anxiety, Aspirin,
Nitroglycerine and Ca channel blockers for painBETA BLOCKERS
CONTRAINDICATED-cause unopposed alpha adrenergic stimulation and
worsen coronary vasoconstriction.
Answer: Psychomotor agitation, dilated pupils, atrophic nasal mucosa, HTN,
acute MI. Intoxication with? treat?
◍ Aortic Valve Infective Endocarditis ECG with conduction abnormalities 2:1
second degree AV block this raises suspicion for perivalvular abscess
leading to syncope..
Answer: IV drug abuse, fever, early diastolic murmur of Aortic
Regurgitation
, ◍ Salicylates, Furosemide, Heparin.
Answer: in patients with normal hypothalamic-pituitary feedback,
displacement of T4 from its binding proteins leads to decreased thyroid
hormone perfection and lower T4 levels with normal free hormone levels.
seen as an effect from what medications?
◍ sec-mins: Anaphylaxismin-hrs: Acute Hemolytic1-6hrs: Febrile
Nonhemolytic (fever, chills, malaise without hemolysis); prevent with
leukoreduction of donor blood helps also prevent HLA alloimmunization
and CMV transmission 2days-10days: Delayed Hemolytic.
Answer: Transfusion Reaction timeline
◍ 4 Ts1. Thymoma2. Teratoma (Mixed Germ Cell Tumor): HIGH AFP &
b-hCG = NON Seminomatous germ cell tumor (Vs. Seminomatous only has
elevated b-hcg)3. Thyroid Neoplasm4. Terrible Lymphoma.
Answer: Differential Diagnosis for anterior mediastinal mass
◍ Charcot joint (neurogenic arthropathy)decreased proprioception, pain,
temperature, lead to unknownigly traumatizing weight bearing joints.Vit
B12 def, DM, Peripheral; nerve damage, Spinal cord injury, syringomyelia,
tabes dorsalis (tertiary syphilis)Tx: Treat underlying condition, mechanical
devices, X-rays.
Answer: Deformed joints, arthritis, arthropathy, mild pain, fractures,
degenerative joint disease.
◍ ischemic colitis.
Answer: sudden onset of abdominal pain and tenderness followed by rectal
bleeding, due to inadequate perfusion of watershed areas (splenic flexure) in
setting of nonexclusive ischemia or surgical or endovascular interventions.
◍ rheumatic heart diseasegradual and progressivly worsening dyspnea or
orthopnea. Atrial fibrillation is a common complication and can cause rapid
decompensation. Long standing can cause severe left atrial enlargement
leading to an elevation of the left main bronchus on chest radiograph..
Answer: Mitral stenosis is most commonly due to?
