USMLE Step 1 Practice Exam Questions Latest
Update with Complete Solutions
1. MCC of Vaginal Candidiasis:
a) Abx use= reduces lactobacilli pop
b) High estrogen levels- preg
c) System corticosteroid therapy
d) Uncontrolled DM
e) Immunosuppression, including HIV
2. Drug causes of SIADH: -Carbamazepine
-Cyclophosphamide
-SSRI
3. MC Ankle Sprain due to inversion of plantar-flexed foot: -Ant Talofibular Lig dmg
-ecchymosis at the ant-lat aspect of the ankle
4. Upper Brachial Plexus Injury: - Musculocutaneous and Suprascapular N.
a. dystocia mc in neonates; severe trauma mc in adults
b. should adduction, elbow extension, and forearm pronation
5. Patent foramen ovale: -failure of septum primum and septum secundum to fuse after
birth
-can lead to paradoxical emboli
6. Ventricular Septal Defect: -MC occurs in membranous septum
-Acyanotic at birth bc of L to R shunt
7. Coronary Blood Flow Peak: -at Early Diastole
-coronary perfusion driven by diastolic pressure
-tachycardia will decrease coronary perfusion
8. Right Dom Heart: majority of people
-PDA comes off RCA
-SA and AV nodes supplied by RCA
9. Left Dom Heart: -PDA comes off of LCX
a. SA and AV node supplied by LCX
10. Increased Pulse Pressure: hyperthyroidism, aortic regurgitation, aortic stiffen- ing
(isolated systolic hypertension in elderly), obstructive sleep apnea ( sympathetic tone),
exercise (transient)
11. Decreased Pulse Pressure: aortic stenosis, cardiogenic shock, cardiac tam- ponade,
advanced heart failure (HF)
12. Causes of Spontaneous Depol causing Tachyarrhythmias: 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
13. Direct alpha 1 agonist mediated effects: - vasc smooth muscle contraction=
increased afterload and venous return= increased DBP + SBP causes reflexive increase in
vagal tone= dec HR and slowed AV conduction
, USMLE Step 1 Practice Exam Questions Latest
Update with Complete Solutions
a. mydriasis
b. increased internal urethral sphincter tone and prostate contraction
14. Direct alpha 2 agonist mediated effects: - CNS med decrease in BP
a. decreased intraocular pressure
b. decreased lipolysis
c. decreased presyn NE release
d. increased platelet aggregation
15. S. epidermidis: - coag neg
-novobiocin sens
a. infective endocarditis and infective arthritis in prosthetic pts
16. Asymptomatic heart defect in turner's synd: -nonstenotic bicuspid aortic valve
-early systolic , high frequency click over right second IC space
17. Cardiac Changes w/ Normal Aging: - decreased left ventricular chamber size
a. shortened base- to- apex dimension
b. ventricular septum becomes sigmoid and shape, with basilar portion bulging into LV
outflow tract
c. atrophy of myocardium causes increased interstitial connective tissue, often with
concomitant extracellular amyloid deposition
d. lipofucin pigment accumulation within cardiomyocytes
18. ARDS: Characterized by the development of hypoxemia and bilateral pulmonary
infiltrates in the absence of heart failure
-begins with initial injury of pul alveoli (smoke inhal) or pul endothelium (sepsis)
which leads to the recruitment of neutrophils- this worsens the situati toon and leads
intraalveolar accumulation and hyaline membrane formation
-decreased lung compliance, increased work of breathing, worsened V/Q mismatch, and
normal PCWP
19. Renal Artery Stenosis (histo): medial fibroplasia, absent intern na in al elastic lami-
areas of aneurysmal dilation
20. Paget's Disease associate Bone Tm: OSTEOSARCOMA! arising from tibia, femur,
humerus, and other bones
-pain doesnt resolve with OTC analgesics
21. DNA Laddering (Gel Electrophoresis): - DNA fragments in multiples of 180 bp each
a. sensitive indicator of APOPTOSIS
b. laddering done by specific endonucleases during haryorrhexis, cleaving DNA at
, USMLE Step 1 Practice Exam Questions Latest
Update with Complete Solutions
interucleosomal linker regions
c. this is not seen in cancer cells, since they evade apoptosis
22. Warburg Effect: malignant cells undergo high rates of glycolysis to produce
macromolecules necessary to sustain rapid cellular growth
23. Risk Factors of Endometritis: -C-section delivery
-chorioamnionitis
-group B strep colonization
-intrauterine instrumentation
-preterm delivery
-prolonged labor
-prolonged ruptured membranes
-retained products of conception
SIGNS AND SX OF POSTPARTUM ENDOMETRITIS
-fever
-leukocytosis
-uterine tenderness
-foul smelling vaginal discharge
24. Metabolic derangements assoc with DKA: metabolic acidosis, ketonemia,
hyperglycemia, hyperkalemia, hyponatremia
-hyperammonemia can be observed due to muscle degradation
25. Pulmonary Embolism: V/Q Mismatch, causes hypoxemia that increases venti- lation
and HR via a chemoreceptor reflex
-hypocapnia b/c hypervent, but unable to compensate for hypoxemia
-resp alkylosis= increased ph and decreased PaCO2
26. Acanthosis Nigracans: -Obesity/ insulin resistance
-Malignancy of GI or Lungs
27. Congenital Pyloric Stenosis: -thickening of stomach wall, hypertrophy of
smooth muscle pyloric stenosis
-palpable olive mass- epigastric region
-nonbilious projectile vomiting at 2-6 weeks of age
-assoc w/ Macrolides
-hypokalemia, hypochloremic, metab alkalosis
28. Vomiting: powerfully stimulates metabolic alkalosis through direct loss of Hþ, loss
of Cl , and volume depletion
29. Chronic diarrhea: may cause a metabolic alkalosis because of volume contrac- tion
30. Respiratory compensation for metabolic alkalosis: hypoventilatory capacity limited
owing to resulting hypoxemia
Update with Complete Solutions
1. MCC of Vaginal Candidiasis:
a) Abx use= reduces lactobacilli pop
b) High estrogen levels- preg
c) System corticosteroid therapy
d) Uncontrolled DM
e) Immunosuppression, including HIV
2. Drug causes of SIADH: -Carbamazepine
-Cyclophosphamide
-SSRI
3. MC Ankle Sprain due to inversion of plantar-flexed foot: -Ant Talofibular Lig dmg
-ecchymosis at the ant-lat aspect of the ankle
4. Upper Brachial Plexus Injury: - Musculocutaneous and Suprascapular N.
a. dystocia mc in neonates; severe trauma mc in adults
b. should adduction, elbow extension, and forearm pronation
5. Patent foramen ovale: -failure of septum primum and septum secundum to fuse after
birth
-can lead to paradoxical emboli
6. Ventricular Septal Defect: -MC occurs in membranous septum
-Acyanotic at birth bc of L to R shunt
7. Coronary Blood Flow Peak: -at Early Diastole
-coronary perfusion driven by diastolic pressure
-tachycardia will decrease coronary perfusion
8. Right Dom Heart: majority of people
-PDA comes off RCA
-SA and AV nodes supplied by RCA
9. Left Dom Heart: -PDA comes off of LCX
a. SA and AV node supplied by LCX
10. Increased Pulse Pressure: hyperthyroidism, aortic regurgitation, aortic stiffen- ing
(isolated systolic hypertension in elderly), obstructive sleep apnea ( sympathetic tone),
exercise (transient)
11. Decreased Pulse Pressure: aortic stenosis, cardiogenic shock, cardiac tam- ponade,
advanced heart failure (HF)
12. Causes of Spontaneous Depol causing Tachyarrhythmias: 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
13. Direct alpha 1 agonist mediated effects: - vasc smooth muscle contraction=
increased afterload and venous return= increased DBP + SBP causes reflexive increase in
vagal tone= dec HR and slowed AV conduction
, USMLE Step 1 Practice Exam Questions Latest
Update with Complete Solutions
a. mydriasis
b. increased internal urethral sphincter tone and prostate contraction
14. Direct alpha 2 agonist mediated effects: - CNS med decrease in BP
a. decreased intraocular pressure
b. decreased lipolysis
c. decreased presyn NE release
d. increased platelet aggregation
15. S. epidermidis: - coag neg
-novobiocin sens
a. infective endocarditis and infective arthritis in prosthetic pts
16. Asymptomatic heart defect in turner's synd: -nonstenotic bicuspid aortic valve
-early systolic , high frequency click over right second IC space
17. Cardiac Changes w/ Normal Aging: - decreased left ventricular chamber size
a. shortened base- to- apex dimension
b. ventricular septum becomes sigmoid and shape, with basilar portion bulging into LV
outflow tract
c. atrophy of myocardium causes increased interstitial connective tissue, often with
concomitant extracellular amyloid deposition
d. lipofucin pigment accumulation within cardiomyocytes
18. ARDS: Characterized by the development of hypoxemia and bilateral pulmonary
infiltrates in the absence of heart failure
-begins with initial injury of pul alveoli (smoke inhal) or pul endothelium (sepsis)
which leads to the recruitment of neutrophils- this worsens the situati toon and leads
intraalveolar accumulation and hyaline membrane formation
-decreased lung compliance, increased work of breathing, worsened V/Q mismatch, and
normal PCWP
19. Renal Artery Stenosis (histo): medial fibroplasia, absent intern na in al elastic lami-
areas of aneurysmal dilation
20. Paget's Disease associate Bone Tm: OSTEOSARCOMA! arising from tibia, femur,
humerus, and other bones
-pain doesnt resolve with OTC analgesics
21. DNA Laddering (Gel Electrophoresis): - DNA fragments in multiples of 180 bp each
a. sensitive indicator of APOPTOSIS
b. laddering done by specific endonucleases during haryorrhexis, cleaving DNA at
, USMLE Step 1 Practice Exam Questions Latest
Update with Complete Solutions
interucleosomal linker regions
c. this is not seen in cancer cells, since they evade apoptosis
22. Warburg Effect: malignant cells undergo high rates of glycolysis to produce
macromolecules necessary to sustain rapid cellular growth
23. Risk Factors of Endometritis: -C-section delivery
-chorioamnionitis
-group B strep colonization
-intrauterine instrumentation
-preterm delivery
-prolonged labor
-prolonged ruptured membranes
-retained products of conception
SIGNS AND SX OF POSTPARTUM ENDOMETRITIS
-fever
-leukocytosis
-uterine tenderness
-foul smelling vaginal discharge
24. Metabolic derangements assoc with DKA: metabolic acidosis, ketonemia,
hyperglycemia, hyperkalemia, hyponatremia
-hyperammonemia can be observed due to muscle degradation
25. Pulmonary Embolism: V/Q Mismatch, causes hypoxemia that increases venti- lation
and HR via a chemoreceptor reflex
-hypocapnia b/c hypervent, but unable to compensate for hypoxemia
-resp alkylosis= increased ph and decreased PaCO2
26. Acanthosis Nigracans: -Obesity/ insulin resistance
-Malignancy of GI or Lungs
27. Congenital Pyloric Stenosis: -thickening of stomach wall, hypertrophy of
smooth muscle pyloric stenosis
-palpable olive mass- epigastric region
-nonbilious projectile vomiting at 2-6 weeks of age
-assoc w/ Macrolides
-hypokalemia, hypochloremic, metab alkalosis
28. Vomiting: powerfully stimulates metabolic alkalosis through direct loss of Hþ, loss
of Cl , and volume depletion
29. Chronic diarrhea: may cause a metabolic alkalosis because of volume contrac- tion
30. Respiratory compensation for metabolic alkalosis: hypoventilatory capacity limited
owing to resulting hypoxemia
