DIT Questions

1. Where would you expect to find B cells in a lymph node? Where would you find T cells, plasma cells, and macrophages? (FA13 p192) (FA14 p196) (SU14 p258) (Phys p427)

2. The protein derived from what gene serves as a transcription factor for the development and function of regulatory T cells? (R p796-797)

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3. What is the female homologue to each of the following male structures? (FA13 p513) (FA14 p562) (SU14 p199-200) Male Corpus spongiosum

Female

Cowper’s glands (bulbourethral glands)

Prostate

Glans penis

Ventral penile shaft

Scrotum

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4. What important intracellular proteins are common to both the extrinsic and intrinsic apoptotic pathways? (FA13 p212) (FA14 p220)

5. What ratio indicates fetal lung maturity? What is the proper name for the main component of pulmonary surfactant? (FA13 p544) (FA14 p594) (SU14 p98) (Phys p468)

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6. What amino acids are necessary for purine synthesis? (FA13 p64) (FA14 p66) (SU14 p292)

7. You start a patient on a drug that has been on the market for five years. It has excellent efficacy. However, your patient begins to have an annoying side effect one month after initiation of this drug. She contacts the manufacturer about it; and they, in turn, contact you to gather data on her course while on the drug. In what phase of the clinical trial would this example fall? (FA13 p50) (FA14 p50)

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8. What nutrient deficiency is associated with spooning of the nails (koilonychia)? (H p846)

9. What is the equation for determining a drug’s clearance? (FA13 p227) (FA14 p239) (SU14 p388)

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10. Which bacteria are well known for being obligate intracellular bacteria? Why can’t these bacteria replicate extracellularly? (FA13 p121) (FA14 p123) (SU14 p260-261)

*Page references are as follows: FA13: First Aid for the USMLE Step 1 2013 FA14: First Aid for the USMLE Step 1 2014 SU14: Step-Up to USMLE Step 1 2014 R: Robbins and Cotran Pathologic Basis of Disease, 8th ed. (2010) Phys: Guyton and Hall Textbook of Medical Physiology, 12th ed. (2011) H: Harrison’s Principles of Internal Medicine, 18th ed. (2012) COA: Clinically Oriented Anatomy, 6th ed. (2010) GG: Goodman and Gilman Pharmacological Basis of Therapeutics, 12th ed. (2011)

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1. You have a patient who is experiencing progressive difficulty with swallowing liquids and solid food. Subsequently, the patient undergoes a barium swallow that reveals stenosis of the lower esophageal sphincter. What is the diagnosis associated with this barium swallow finding? What are some common causes of this diagnosis? (FA13 p324) (FA14 p349)

2. In the lower extremity, what are some of the clinical differences between peripheral vascular disease (PVD, also known as peripheral artery disease (PAD)) and deep venous thrombosis (DVT)? (H p2066, 2170)

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3. A 22-year-old man suffers a stabbing injury to the chest. He has lost a lot of blood, and you are concerned that his cardiac output is low. What are the two equations for cardiac output? (FA13 p253) (FA14 p266) (SU14 p70)

4. A 66-year-old man currently taking warfarin for atrial fibrillation is instructed to avoid food products that contain vitamin K to optimize anticoagulation. For what coagulation factors is vitamin K necessary? (FA13 p95) (FA14 p96) (SU14 p272)

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5. Your 46-year-old male patient is asking your advice on whether to take a daily aspirin. How does taking an aspirin a day prevent platelet aggregation and myocardial infarction? Which two arachidonic acid products affect platelet aggregation? (FA13 p404) (FA14 p439) (SU14 p245-246, 274)

6. A 5-year-old boy is treated with mebendazole for a pinworm infection. Mebendazole acts on microtubules to inhibit the pinworms. What other medications act on microtubules? What syndrome demonstrates a defect in microtubule polymerization? (FA13 p76, 207) (FA14 p78, 213)

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7. Thiazolidinediones (TZDs) increase expression of one type of GLUT receptors—those in adipose tissue—as one of their antidiabetic actions. Which GLUT receptors would you expect to find on skeletal muscle and fat? (FA13 p288) (FA14 p308) (SU14 p311)

8. What is compartment syndrome, and how is it treated? (SU14 p244) (COA p540)

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9. An 18-year-old woman has seasonal allergies. She complains that her eyes water and her nose runs constantly during the spring. Which cell type is responsible for her symptoms, and what drug inhibits these cells’ action? What WBCs descend from the myeloblast (granulocyte) lineage? (FA13 p345-346) (FA14 p374-375) (SU14 p257, 266)

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10. Which GI ligaments match the following descriptions? (FA13 p310) (FA14 p336) Description

GI ligament

Separates the greater and lesser sacs

May be cut during surgery to access the lesser sac

2 ligaments that connect the spleen to other structures

Contains the portal triad

Connects liver to the anterior abdominal wall

*Page references are as follows: FA13: First Aid for the USMLE Step 1 2013 FA14: First Aid for the USMLE Step 1 2014 SU14: Step-Up to USMLE Step 1 2014 R: Robbins and Cotran Pathologic Basis of Disease, 8th ed. (2010) Phys: Guyton and Hall Textbook of Medical Physiology, 12th ed. (2011) H: Harrison’s Principles of Internal Medicine, 18th ed. (2012) COA: Clinically Oriented Anatomy, 6th ed. (2010) GG: Goodman and Gilman Pharmacological Basis of Therapeutics, 12th ed. (2011)

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1. What are the characteristics of narcolepsy? What is the treatment for narcolepsy? (FA13 p62) (FA14 p513) (SU14 p45)

2. What is the first-line treatment for a patient with erectile dysfunction? (FA13 p541) (FA14 p592) (SU14 p224, 227) (H p377)

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3. With what physical exam finding must you presume scaphoid fracture despite a normal initial x-ray? What might result in a proximal fracture of the scaphoid if left untreated? (COA p686)

4. A patient with Crohn disease fails traditional therapy (5-ASA, steroids, and immunosuppressants). What other drugs are used to treat Crohn disease that target TNF-α? (FA13 p210) (FA14 p217) (SU14 p143)

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5. During what week of fetal development will the fetus reach the following landmarks? (FA13 p504) (FA14 p552) Fetal Landmark

Week(s)

implantation

organogenesis

heart begins to beat

can distinguish male or female genitalia

gastrulation

formation of primitive streak and neural plate

6. What is a cholesteatoma, and how does it present? (H p249) (R p754)

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7. What are the adverse reactions of exogenous testosterone in males? (FA13 p519) (FA14 p573) (SU14 p226)

8. What is the initial medical treatment for the arrhythmia known as torsades de pointes? (FA13 p261) (FA14 p277) (SU14 p70-71) (H p1892)

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9. What structures give rise to the blood brain barrier? (FA13 p413) (FA14 p449)

10. Which diuretics are most appropriate for patients with hyperaldosteronism? What are their important side effects? (FA13 p501) (FA14 p548) (SU14 p166-167)

*Page references are as follows: FA13: First Aid for the USMLE Step 1 2013 FA14: First Aid for the USMLE Step 1 2014 SU14: Step-Up to USMLE Step 1 2014 R: Robbins and Cotran Pathologic Basis of Disease, 8th ed. (2010) Phys: Guyton and Hall Textbook of Medical Physiology, 12th ed. (2011) H: Harrison’s Principles of Internal Medicine, 18th ed. (2012) COA: Clinically Oriented Anatomy, 6th ed. (2010) GG: Goodman and Gilman Pharmacological Basis of Therapeutics, 12th ed. (2011)

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1. Homocystinuria is one of the few diseases that can result in subluxation of the lens. What are the different causes of homocystinuria? How does the treatment differ for each? (FA13 p109) (FA14 p111) (SU14 p306)

2. Diagram the pathway by which the cochlea communicates a signal to the primary auditory cortex. (Phys p639)

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3. A 20-year-old Italian woman complains of weakness and fatigue. A CBC reveals a microcytic, hypochromic anemia with a normal iron panel. What type of thalassemia does this patient most likely have? What is the structure of HbH? What disease results in HbH production? What is the structure of Hb Bart’s? What disease results in Hb Bart’s production? (FA13 p352-353) (FA14 p382-383) (SU14 p281-282)

4. A 34-year-old obese white woman develops urinary retention after undergoing a laparoscopic cholecystectomy. Which cholinergic agonist can be used to treat post-op ileus and urinary retention? What conditions can be made worse by using cholinomimetic agents? (FA13 p233) (FA14 p246) (SU14 p401)

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5. For what conditions is hyperbaric oxygen therapy particularly helpful? (SU14 p17-18) (Phys p540)

6. A 23-year-old man undergoes a splenectomy due to splenic rupture from blunt abdominal trauma. What would you expect to find on this patient’s peripheral RBC smear after the splenectomy? (FA13 p351) (FA14 p381) (SU14 p286) Asplenic patients are susceptible to which encapsulated organisms? (FA13 p193) (FA14 p197) (SU14 p282) What vaccines for these encapsulated organisms should be given to asplenic patients? (FA13 p121) (FA14 p123)

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7. If stroke volume determines cardiac output, and contractility determines stroke volume, what determines contractility? (FA13 p254) (FA14 p267) (Phys p231)

8. What is the pressure in the potential spaces of the body including the pleural cavity, the joint spaces, and the pericardial cavity? (Phys p300)

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9. How does standard deviation differ from standard error of the mean? (FA13 p54) (FA14 p56) Which one is used in calculating confidence intervals? (FA13 p55) (FA14 p57)

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10. A 48-year-old man presents to your office with a persistent cough that has begun to become bloody. CXR reveals a coin lesion within the lung parenchyma. Further work up reveals that the patient has the most common type of lung cancer in non-smokers. Which cancer is this? What other lung cancers are not associated with smoking? Which lung cancers are associated with smoking, and where are they located, centrally or peripherally? (FA13 p558) (FA14 p609) (SU14 p116)

*Page references are as follows: FA13: First Aid for the USMLE Step 1 2013 FA14: First Aid for the USMLE Step 1 2014 SU14: Step-Up to USMLE Step 1 2014 R: Robbins and Cotran Pathologic Basis of Disease, 8th ed. (2010) Phys: Guyton and Hall Textbook of Medical Physiology, 12th ed. (2011) H: Harrison’s Principles of Internal Medicine, 18th ed. (2012) COA: Clinically Oriented Anatomy, 6th ed. (2010) GG: Goodman and Gilman Pharmacological Basis of Therapeutics, 12th ed. (2011)

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1. What is the fibrous band attached to the testis and scrotum that aids in normal testicular descent? What is this structure called in females? (FA13 p514) (FA14 p562) (SU14 p200-202)

2. What is Osler-Weber-Rendu syndrome? (FA13 p85) (FA14 p87) (SU14 p92) (R p744) (H p409)

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3. What is the difference between a case-control study, a cohort study, and a clinical trial? (FA13 p50) (FA14 p50) (SU14 p19-20) Which studies use odds ratios, and which use relative risks? (FA13 p52) (FA14 p50, 53) (SU14 p20)

4. What are the effects of NSAIDs’ inhibition of PGE2? (FA13 p404) (FA14 p440) (SU14 p245) What role do prostaglandins and angiotensin II play on the renal arterioles? (FA13 p485) (FA14 p526, 528) (SU14 p150)

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5. A female infant is brought to the clinic for evaluation of her genitalia. On exam, clitoromegaly and labial fusion is noted. Lab studies reveal elevated 17-hydroxyprogesterone levels. What is the most common form of adrenal hyperplasia? Which hormone levels are altered as a result of this enzyme deficiency? What are the clinical manifestations of this enzyme deficiency? (FA13 p291) (FA14 p312) (SU14 p170, 188)

6. T cells are found in the paracortex of the lymph node between the follicles and the medulla. Which cytokines are secreted by the two different types of helper T cells (Th1 and Th2)? (FA13 196) (FA14 p201) (SU14 p261)

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7. A 25-year-old man complains of a scrotal mass and pain made worse by coughing or sneezing. A scrotal exam reveals a palpable scrotal protrusion with the Valsalva maneuver. What type of hernia is this patient experiencing? What type of hernia protrudes through Hesselbach’s triangle? What structures form Hesselbach’s triangle? (FA13 p318) (FA14 p344) (SU14 p252-253)

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8. What is the mechanism of action of the following antiemetics? (FA13 p234, 342) (FA14 p247, 372) (SU14 p141-143) (GG p1341-1344)

Scopolamine

Promethazine

Prochlorperazine

Metoclopramide

Ondansetron

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9. What are the 3 endogenous androgens, in order from the most potent to the least potent? (FA13 p519) (FA14 p573) (SU14 p171)

10. How does a decrease in renal artery pressure cause an increase in blood pressure? (FA13 p485) (FA14 p530) (SU14 p149)

*Page references are as follows: FA13: First Aid for the USMLE Step 1 2013 FA14: First Aid for the USMLE Step 1 2014 SU14: Step-Up to USMLE Step 1 2014 R: Robbins and Cotran Pathologic Basis of Disease, 8th ed. (2010) Phys: Guyton and Hall Textbook of Medical Physiology, 12th ed. (2011) H: Harrison’s Principles of Internal Medicine, 18th ed. (2012) COA: Clinically Oriented Anatomy, 6th ed. (2010) GG: Goodman and Gilman Pharmacological Basis of Therapeutics, 12th ed. (2011)

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1. Which drugs are known to cause aplastic anemia? What is the treatment for aplastic anemia? (FA13 p240, 355) (FA14 p253, 385) (SU14 p282)

2. What physiologically is taking place in decompression sickness? (Phys p538)

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3. A 34-year-old woman develops a painful right eye with decreased visual acuity. Exam demonstrates a firm right eye. What type of glaucoma is the patient experiencing? What is the difference between the mechanism of closed- and open-angle glaucoma? What is the fundoscopic finding associated with glaucoma? What is the treatment for closed- and open-angle glaucoma? (FA13 p438-439, 449) (FA14 p478, 490) (SU14 p39)

4. Is a 34-year-old schizophrenic patient having active hallucinations, who is not oriented to time, place, or person, able to legally agree to a plan of care? What factors must be in place in order for a patient to have the capacity to make a decision? (FA13 p57) (FA14 p60) (SU14 p23)

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5. A 32-year-old man is being treated for alcohol dependence with disulfiram. One night he begins drinking, and later has severe nausea and vomiting. What is the mechanism of action of disulfiram? What other drugs have a disulfiram-like effect? (FA13 p95) (FA14 p97) (SU14 p318) (GG p643-644)

6. A 1-year-old boy is brought to the clinic for evaluation of his skin. The patient’s skin was normal at birth but now is erythematous, scaly, and has many new freckles. Work-up and an astute attending reveal that this child has xeroderma pigmentosum. What cancers will this child be at higher risk of developing? (FA13 p220) (FA14 p231) (SU14 p255)

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7. The thalamus is a relay station that conducts signals to and from the brain. Which thalamic nuclei are the relay stations for each of the following body sensations/activities? (FA13 p415) (FA14 p452) (SU14 p42) •

Auditory sensation

•

Visual sensation

•

Motor to the body

•

Facial sensation

•

Body sensation

8. What is PPAR-γ? How is it relevant to the treatment of diabetes mellitus? (FA13 p305) (FA14 p330331) (SU14 p183) (R p1137)

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9. A 23-year-old man comes to your clinic with a fever of 39°C, a headache, and myalgias. This is the second fever he has had in the last two weeks. He recently finished treatment to eradicate the lice infestation that he acquired during a recent trip to Mexico. What organism might be responsible for this man’s recurrent fever? (FA13 p139) (FA14 p142)

10. A 40-year-old man arrives at your clinic for his first physical in 20 years. He reeks of cigarette smoke and you notice his jacket bears the logo of his favorite tobacco company. He proudly informs you that he got this great jacket by redeeming his cigarette cartons. At what stage of change in overcoming his smoking habit is this man? (FA13 p470) (FA14 p513)

*Page references are as follows: FA13: First Aid for the USMLE Step 1 2013 FA14: First Aid for the USMLE Step 1 2014 SU14: Step-Up to USMLE Step 1 2014 R: Robbins and Cotran Pathologic Basis of Disease, 8th ed. (2010) Phys: Guyton and Hall Textbook of Medical Physiology, 12th ed. (2011) H: Harrison’s Principles of Internal Medicine, 18th ed. (2012) COA: Clinically Oriented Anatomy, 6th ed. (2010) GG: Goodman and Gilman Pharmacological Basis of Therapeutics, 12th ed. (2011)

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1. In which phase of meiosis is a primary oocyte arrested until just prior to ovulation? In which phase of meiosis is an oocyte arrested until fertilization? (FA13 p522) (FA14 p569) (SU14 p201, 207)

2. In performing a lumbar puncture to obtain a sample of CSF, what structures are pierced, starting with the most exterior? (COA p505)

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3. A 65-year-old woman with COPD is in severe respiratory distress, has cyanosis and signs of right-sided heart failure. What medications are used in the treatment of pulmonary hypertension? What is its mechanism of action? (FA13 p564) (FA14 p614)

4. Does the notochord become the neural tube? (FA13 p408) (FA14 p444)

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5. From where does the amygdala receive inputs? To where does it send output? (Phys p719)

6. A 35-year-old man develops hallucinations just before sleep, episodes of excessive sleepiness, and cataplexy during times of laughter and sadness. Narcoleptic sleep episodes begin with what stage of sleep? What are the different stages of normal sleep? How do they differ from one another? (FA13 p61) (FA14 p451) (SU14 p45)

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7. The body uses both the cell-mediated and humoral immune response to fight infection. Which T cell type regulates the humoral response? (FA13 p196) (FA14 p201)

8. What are some of the reasons a woman might have primary amenorrhea? (SU14 p206, 209) (H p385)

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9. What is a syringomyelia? What symptoms are commonly seen in patients with syringomyelia? (FA13 p410) (FA14 p446) (SU14 p41)

10. Coal miners are at an increased risk of skin cancer because of their exposure to arsenic. What type of skin cancer is associated with this exposure? (FA13 p403) (FA14 p438)

*Page references are as follows: FA13: First Aid for the USMLE Step 1 2013 FA14: First Aid for the USMLE Step 1 2014 SU14: Step-Up to USMLE Step 1 2014 R: Robbins and Cotran Pathologic Basis of Disease, 8th ed. (2010) Phys: Guyton and Hall Textbook of Medical Physiology, 12th ed. (2011) H: Harrison’s Principles of Internal Medicine, 18th ed. (2012) COA: Clinically Oriented Anatomy, 6th ed. (2010) GG: Goodman and Gilman Pharmacological Basis of Therapeutics, 12th ed. (2011)

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1. A child arrives at the ER in hypotensive shock after taking his dad’s phenoxybenzamine. The intern on call orders the nurse to get her a pressor STAT. The nurse informs the intern that there are two pressors available in the ER, epinephrine and phenylephrine. Which one will be able to increase the blood pressure of this pediatric patient? (FA13 p237) (FA14 p250) (SU14 p79)

2. You recommend that your patient, a 51-year-old woman, begin taking a calcium and vitamin D supplement in order to prevent osteoporosis. What are the steps in the conversion of vitamin D to its active form in the body? By what mechanism does vitamin D help prevent osteoporosis? (FA13 p294) (FA14 p315) (SU14 p176)

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3. What landmarks are used when placing an internal jugular central venous catheter? (COA p1011)

4. At times bupropion can be added to a selective serotonin reuptake inhibitor (SSRI) for treatmentresistant depression. What can occur if a MAO inhibitor (MAOI) is added to an SSRI? What is the treatment for this condition? (FA13 p475) (FA14 p519) (SU14 p57)

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5. Clavulanic acid, sulbactam, and tazobactam aid penicillins in their activity against bacteria through what mechanism? (FA13 p177) (FA14 p180) (SU14 p350)

6. A patient presents with a 1cm painless, mobile mass in her right parotid gland. You inform the patient that most tumors in the parotid gland are benign. What is the most common benign tumor of the salivary gland? What is a Warthin’s tumor? What cranial nerve goes through the parotid gland? (FA13 p324, 434) (FA14 p349, 472) (SU14 p43, 121)

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7. Membranous glomerular diseases involve thickening of what structure? (FA13 p489) (FA14 p535) (SU14 p154, 158)

8. Which bacteria are most commonly responsible for sialadenitis? What condition most commonly predisposes a patient to sialadenitis? (SU14 p121) (R p756-757)

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9. What important secretory products are secreted from the following cells of the GI tract? (FA13 p319320) (FA14 p345-346) (SU14 p119, 121) Source G cells

Secretory products

I cells S cells D cells Parietal cells Chief cells

10. An 88-year-old man arrives at the ER after he fell and struck his head. He has a history of atrial fibrillation, for which he takes warfarin. Noncontrast CT of the head reveals subarachnoid hemorrhage. What is the antidote for warfarin anticoagulation or warfarin overdose? For heparin overdose? (FA13 p239, 368) (FA14 p252, 400) (SU14 p272)

*Page references are as follows: FA13: First Aid for the USMLE Step 1 2013 FA14: First Aid for the USMLE Step 1 2014 SU14: Step-Up to USMLE Step 1 2014 R: Robbins and Cotran Pathologic Basis of Disease, 8th ed. (2010) Phys: Guyton and Hall Textbook of Medical Physiology, 12th ed. (2011) H: Harrison’s Principles of Internal Medicine, 18th ed. (2012) COA: Clinically Oriented Anatomy, 6th ed. (2010) GG: Goodman and Gilman Pharmacological Basis of Therapeutics, 12th ed. (2011)

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1. A 45-year-old woman presents to the ER with complaints of chest pain, a racing heart beat, and dizziness. Examination reveals a heart rate of 120 beats/minute, BP of 116/74, and 20 respirations/minute. The patient is diaphoretic and anxious. An initial EKG reveals ventricular tachycardia with shifting sinusoidal waveforms. What is this classic EKG finding? What are the possible causes of this patient’s condition? (FA13 p261) (FA14 p277) (SU14 p71) (R p147)

2. How does MRI differ from CT imaging? (COA p67-70)

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3. What enzymes do obligate anaerobes lack? (FA13 p121) (FA14 p123) (SU14 p331)

4. A patient of yours with recent complaints of weakness, pallor, craving for ice chips and tachycardia has a history of chronic hemorrhoids. What do you immediately suspect is the cause of this patient’s anemia and how do you treat it? (FA13 p352) (FA14 p382) (SU14 p281)

5. What is the antidote for digoxin toxicity? (FA13 p210) (FA14 p217) (SU14 p70)

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6. What embryological structural abnormalities might account for multiple miscarriages? What structures arise from the paramesonephric ducts? What other name is given to the paramesonephric ducts? (FA13 p512) (FA14 p561) (SU14 p198, 203) (R p1007)

7. Hydatidiform mole is the most common precursor of what ovarian germ tumor? What tumor marker is monitored after the dilation and curettage of a hydatidiform mole? (FA13 p525) (FA14 p576) (SU14 p213)

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8. What are some of the circumstances in which information is HIPAA-exempt, meaning that your health information can be shared with another party?

9. A young woman complaining of easy bleeding and menorrhagia was referred by her OB/GYN for workup of her bleeding disorder. Your preceptor tasks you with determining the cause of the patient’s condition. Compare the clinical findings of platelet disorders to those of coagulation factor defects. (FA13 p359) (FA14 p389) (SU14 p277-279) Bleeding time

PT and PTT

Platelet disorder

Coagulation factor defect

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Clinical features

10. You are reading a research article about the prostate specific antigen test, and it mentions that the PSA blood test is associated with a high false positive frequency. In your own words, explain what false positive means. (FA13 p51) (FA14 p51) (SU14 p18-19)

*Page references are as follows: FA13: First Aid for the USMLE Step 1 2013 FA14: First Aid for the USMLE Step 1 2014 SU14: Step-Up to USMLE Step 1 2014 R: Robbins and Cotran Pathologic Basis of Disease, 8th ed. (2010) Phys: Guyton and Hall Textbook of Medical Physiology, 12th ed. (2011) H: Harrison’s Principles of Internal Medicine, 18th ed. (2012) COA: Clinically Oriented Anatomy, 6th ed. (2010) GG: Goodman and Gilman Pharmacological Basis of Therapeutics, 12th ed. (2011)

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1. A 30-year-old man is undergoing the Schilling test to investigate his B12 deficiency. What must be present in the enteric system in order for vitamin B12 to be absorbed? (FA13 p93) (FA14 p348) (SU14 p121)

2. Describe the flow of blood into and out of the thyroid gland. (COA p1018-1020)

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3. What is the definition of first-degree heart block? What are the symptoms of first-degree heart block? (FA13 p262) (FA14 p278-279) (SU14 p72)

4. The part of the brain responsible for attention and alertness has been implicated in schizophrenia, PTSD, Parkinson disease, narcolepsy, progressive supranuclear palsy, depression, and ADHD. What part of the brain is this? (Hint: Lesion results in coma.) (FA13 p419) (FA14 p456) (SU14 p47)

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5. What potentially fatal autoimmune skin disorder is caused by IgG antibodies against desmosomes? What is the difference between a desmosome and a hemidesmosome? (FA13 p378, 398) (FA14 p410, 434-435) (SU14 p253-255)

6. What are the main differences between delirium and dementia? Which is more commonly reversible? (FA13 p462) (FA14 p504) (SU14 p49-50)

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7. A 66-year-old man is involved in a motorcycle accident and suffers a head injury that leaves him in a coma. Prior to this injury the man met with his lawyer to write out specific instructions in case an event like this happened. What are these instructions called? (FA13 p57) (FA14 p60) (SU14 p23-24)

8. What is the classic presentation of granuloma annulare? (H p2988)

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9. A 45-year-old woman who has been taking prednisone for control of rheumatoid arthritis symptoms has recently been diagnosed with Cushing syndrome. Other than exogenous steroids, what else can cause Cushing syndrome? How does the level of ACTH help differentiate the etiology? (FA13 p296) (FA14 p317) (SU14 p187)

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10. An 18-year-old man is brought to your office for delayed onset of puberty. Physical exam confirms a small penis and testicles for his age, as well as lack of facial, pubic, and underarm hair. The patient also reveals that he has never been able to smell. What is the likely diagnosis? (FA13 p525) (FA14 p575) (SU14 p203)

*Page references are as follows: FA13: First Aid for the USMLE Step 1 2013 FA14: First Aid for the USMLE Step 1 2014 SU14: Step-Up to USMLE Step 1 2014 R: Robbins and Cotran Pathologic Basis of Disease, 8th ed. (2010) Phys: Guyton and Hall Textbook of Medical Physiology, 12th ed. (2011) H: Harrison’s Principles of Internal Medicine, 18th ed. (2012) COA: Clinically Oriented Anatomy, 6th ed. (2010) GG: Goodman and Gilman Pharmacological Basis of Therapeutics, 12th ed. (2011)

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1. What renal pathology is characteristic of RBC casts and proteinuria? (FA13 p489, 492) (FA14 p534, 538) (SU14 p106, 156) (R p918, Table 20-5)

2. What nerve is damaged when a patient presents with the following symptom (upper extremity)? (FA13 p381-383) (FA14 p414-415) (SU14 p240-241) (Answers given for self study) Symptom Claw hand Ape hand Wrist drop Scapular winging Unable to wipe bottom/anus Loss of forearm pronation Cannot abduct or adduct fingers Loss of arm abduction Weak lateral rotation of arm Loss of arm and forearm flexion Loss of forearm extension Trouble initiating arm abduction Unable to abduct arm beyond 10 degrees Unable to raise arm above horizontal

Nerve Ulnar Median Radial Long thoracic Thoracodorsal Median Ulnar Axillary Suprascapular and/or axillary Musculocutaneous Radial Suprascapular Axillary Long thoracic

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3. A 56-year-old man develops right lower extremity edema after a returning from Europe from a business trip. An exam of the right lower extremity demonstrates a red, warm, lower leg with a positive Homan’s sign. What is the patient’s diagnosis? What is a positive Homan's sign? What is Virchow’s triad? What is the most common inherited hypercoagulability syndrome? (FA13 p360, 553) (FA14 p602) (SU14 p105)

4. In which pulmonary disease would you see an increased Reid index? (FA13 p554) (FA14 p604) (SU14 p106)

5. What enzyme catalyzes the rate-limiting step in cholesterol synthesis? What class of drugs inhibits this enzyme? (FA13 p114) (FA14 p99) (SU14 p125)

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6. Which adrenergic antagonists can be used to treat hypertension as well as urinary retention in patients with benign prostatic hyperplasia (BPH)? What is the difference between the prostate exam findings in BPH versus adenocarcinoma of the prostate? (FA13 p237, 535-536) (FA14 p586) (SU14 p78)

7. Many factors are involved in the proper morphogenesis of organs in utero. In the case of oligohydramnios, lack of fluid flowing in and out of the fetal lungs leads to pulmonary hypoplasia. This is an example of which type of error in organ morphogenesis? (FA13 p505) (FA14 p553) (SU14 p146)

Page 3 of 5

8. What arteries supply the adrenal glands? From what arteries do these arteries arise? (COA p296)

9. Which neoplasm is most commonly responsible for the following paraneoplastic effects? (FA13 p223) (FA14 p235) (SU14 p117, 165) Syndrome or Effect

Neoplasm

ACTH  Cushing’s syndrome

PTH-related peptide  hypercalcemia

Erythropoietin  polycythemia

ADH  SIADH

Page 4 of 5

10. Given the following scenarios describe the corresponding complement deficiency? (FA13 p199) (FA14 p204) (SU14 p264) Clinical scenario Frequent Neisseria infections

Complement deficiency

Frequent pyogenic respiratory tract infections

Paroxysmal nocturnal hemoglobinuria

Increased frequency of type III hypersensitivity reaction

*Page references are as follows: FA13: First Aid for the USMLE Step 1 2013 FA14: First Aid for the USMLE Step 1 2014 SU14: Step-Up to USMLE Step 1 2014 R: Robbins and Cotran Pathologic Basis of Disease, 8th ed. (2010) Phys: Guyton and Hall Textbook of Medical Physiology, 12th ed. (2011) H: Harrison’s Principles of Internal Medicine, 18th ed. (2012) COA: Clinically Oriented Anatomy, 6th ed. (2010) GG: Goodman and Gilman Pharmacological Basis of Therapeutics, 12th ed. (2011)

Page 5 of 5

STEP 1 REVIEW COURSE – Part 1, Set 12 1. Women with polycystic ovarian syndrome can have a decreased sex hormone-binding globulin (SHBG), which causes hirsutism. What can an increased SHBG cause in men? What is the general mechanism of action of the steroid/thyroid hormones? (FA13 p295, 530) (FA14 p316, 581)

2. A patient comes to your clinic because he has not been able to extend his wrist for the last 3 days. Upon further questioning, you discover that 4 days ago the patient passed out drunk for an entire night while his arm was draped over a chair. What is this patient’s condition? (FA13 p382) (FA14 p414) (SU14 p240) (COA p54, 743) Does the regeneration of neurons occur in both the CNS and PNS? (SU14 p25-26, 241) (R p1260) What is the rate of growth of a new axon in the PNS? (R p1260)

Page 1 of 5

STEP 1 REVIEW COURSE – Part 1, Set 12 3. A 36-year-old malnourished woman comes to the ER with abdominal pain. She has a fever, abdominal tenderness (without rebound tenderness) and anorexia. Her WBC count is markedly elevated and her RDW is high. The patient reports having had a bowel movement this morning and is not nauseated. A small bowel follow through reveals “skip” lesions (discontinuous areas of focal narrowing) and a “string” sign (significant narrowing) in the terminal ileum. What disease does this patient likely have? What drugs can be used to treat it? (FA13 p328) (FA14 p354) (SU14 p130-131, 143)

4. What is the equation for determining a drug’s volume of distribution? What types of disease would alter the volume of distribution of a highly protein-bound drug such as ceftriaxone? (FA13 p227) (FA14 p239) (SU14 p14) (Phys p376-378)

Page 2 of 5

STEP 1 REVIEW COURSE – Part 1, Set 12 5. The parents of a 5-year-old girl are concerned because their daughter has night terrors, sleepwalking, and enuresis (bedwetting). In which stage of sleep do these occur? What medications shorten this stage of sleep, and thus are useful in treating night terrors, sleepwalking, and enuresis? (FA13 p61) (FA14 p451) (SU14 p44-45)

6. A 30-year-old man begins to develop shortness of breath and cyanosis even at rest. Exam reveals clubbing and a systolic murmur. He mentions that he has had a murmur since childhood. Further work-up reveals a large ventricular septal defect and pulmonary hypertension. The patient is diagnosed with Eisenmenger’s syndrome. Describe how this syndrome develops. (FA13 p266) (FA14 p283) (SU14 p66)

Page 3 of 5

STEP 1 REVIEW COURSE – Part 1, Set 12 7. A 48-year-old woman who has taken oral contraceptive pills for the past 15 years is concerned because she is not experiencing menopausal symptoms like the rest of her friends her age. What is the primary reason why menopausal women experience symptoms? Why might this patient not be experiencing menopausal symptoms? What symptoms/conditions are attributed to the changes that take place in menopause? (FA13 p523, 540) (FA14 p571, 590) (SU14 p210-211, 227)

8. What medications are known for causing erectile dysfunction? (H p375)

Page 4 of 5

STEP 1 REVIEW COURSE – Part 1, Set 12 9. A newly married couple was enjoying a honeymoon on a Caribbean beach in Mexico. A few days into the trip, the two began complaining of abdominal cramps and watery diarrhea. They did not have a fever. Which type of Escherichia coli causes the very common “Traveler’s diarrhea”? (FA13 p135) (FA14 p139) (SU14 p129)

10. What is the rule of 2s associated with a Meckel diverticulum? (FA13 p330) (FA14 p356) (SU14 p120)

*Page references are as follows: FA13: First Aid for the USMLE Step 1 2013 FA14: First Aid for the USMLE Step 1 2014 SU14: Step-Up to USMLE Step 1 2014 R: Robbins and Cotran Pathologic Basis of Disease, 8th ed. (2010) Phys: Guyton and Hall Textbook of Medical Physiology, 12th ed. (2011) H: Harrison’s Principles of Internal Medicine, 18th ed. (2012) COA: Clinically Oriented Anatomy, 6th ed. (2010) GG: Goodman and Gilman Pharmacological Basis of Therapeutics, 12th ed. (2011)

Page 5 of 5

STEP 1 REVIEW COURSE – Part 1, Set 13 1. What is the most common renal malignancy in adults? What is the associated gene deletion with this malignancy? (FA13 p494) (FA14 p540) (SU14 p165)

2. What does the Eustachian (auditory) tube connect? What is its purpose? What drug is commonly prescribed for Eustachian tube dysfunction? (H p248-249)

Page 1 of 5

STEP 1 REVIEW COURSE – Part 1, Set 13 3. A 24-year-old young man is fired from his job, and when explaining the chain of events to his roommate, he says that “it doesn’t really matter. I didn’t even need that job.” His roommate is perplexed, wondering how they will pay their rent. Of which immature ego defense could this be an example? (FA13 p459) (FA14 p501) (SU14 p61)

4. A pediatric patient presents with a noticeable right flank mass. The patient’s mother also reports blood in the patient’s urine. What malignancy would be most likely in this scenario? What is the WAGR complex? (FA13 p494) (FA14 p541) (SU14 p165)

Page 2 of 5

STEP 1 REVIEW COURSE – Part 1, Set 13 5. A 22-year-old man who recently immigrated from a developing country is seen at the county health clinic with a complaint of a chronic but recently worsening productive cough and sinusitis symptoms (i.e., headache). He also mentions to you privately that he and his wife have not been able to have children despite trying for two years. While you note this last complaint, you order a CXR out of concern this man may have TB given his immigration status. The CXR appears backwards on the display, but you realize this man’s heart is actually on the opposite side of his chest. What is the primary defect in this syndrome, and what are the characteristic symptoms/signs? (FA13 p76) (FA14 p78) (SU14 p104)

6. What is the definition of tidal volume, residual volume, and vital capacity? (FA13 p546) (FA14 p596) (SU14 p97)

Page 3 of 5

STEP 1 REVIEW COURSE – Part 1, Set 13 7. When screening a population for a particular disease, would you rather have a high sensitivity or a high specificity? (FA13 p51) (FA14 p51) (SU14 p18) What test is used to screen for HIV? What test is used to confirm a positive HIV screen? (FA13 p164) (FA14 p167) (SU14 p366)

8. A mutation in which proto-oncogene is most commonly associated with Hirschsprung disease? (R p766)

Page 4 of 5

STEP 1 REVIEW COURSE – Part 1, Set 13 9. Amyloidosis and sarcoidosis are associated with which cardiomyopathy? What are some other diseases or conditions associated with this cardiomyopathy? (FA13 p272) (FA14 p290) (SU14 p91)

10. How do primary and secondary hyperaldosteronism differ in their effect on plasma renin levels? What agent is used to treat primary hyperaldosteronism? (FA13 p296) (FA14 p318) (SU14 p187, 167)

*Page references are as follows: FA13: First Aid for the USMLE Step 1 2013 FA14: First Aid for the USMLE Step 1 2014 SU14: Step-Up to USMLE Step 1 2014 R: Robbins and Cotran Pathologic Basis of Disease, 8th ed. (2010) Phys: Guyton and Hall Textbook of Medical Physiology, 12th ed. (2011) H: Harrison’s Principles of Internal Medicine, 18th ed. (2012) COA: Clinically Oriented Anatomy, 6th ed. (2010) GG: Goodman and Gilman Pharmacological Basis of Therapeutics, 12th ed. (2011)

Page 5 of 5

STEP 1 REVIEW COURSE – Part 1, Set 14

1. How does the treatment of acute gout differ from the treatment of chronic gout? Why is allopurinol sometimes used in patients with leukemia and lymphoma? (FA13 p391) (FA14 p425) (SU14 p235)

2. When performing a femoral arterial line placement or femoral venous catheter placement, it is important to palpate the femoral artery to determine where the inguinal structures are located. What structures are found under and just inferior to the inguinal ligament? List them in order from lateral to medial. (FA13 p316) (FA14 p342) (SU14 p252)

Page 1 of 6

STEP 1 REVIEW COURSE – Part 1, Set 14

3. A 54-year-old man presents with blood pressure of 200/160, and the examination reveals right-sided abdominal bruit suggestive of renal artery stenosis. What is the mechanism by which renal artery stenosis causes hypertension? What are some other common causes of secondary hyperaldosteronism? (FA13 p296) (FA14 p318) (SU14 p187)

4. Sertoli cells release a substance that acts on the paramesonephric ducts in order to prevent the formation of what structures in a normal male fetus? What other name is given to the paramesonephric ducts? (FA13 p512) (FA14 p561) (SU14 p200)

Page 2 of 6

STEP 1 REVIEW COURSE – Part 1, Set 14

5. What is the mechanism of action for methylphenidate? (FA13 p472) (FA14 p516) (SU14 p60) (GG p298) What are the signs of intoxication of amphetamine? (FA13 p471) (FA14 p514) (SU14 p54)

6. A 38-year-old man’s AIDS is being managed by his infectious disease physician, who has decided to start him on trimethoprim-sulfamethoxazole (TMP-SMX). Why would you place an AIDS patient on TMP-SMX when his CD4 count drops below 200? (FA13 p146) (FA14 p149) (SU14 p370)

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STEP 1 REVIEW COURSE – Part 1, Set 14

7. What medication targets CD3 and is used to prevent acute transplant rejection? (FA13 p210) (SU14 p271)

8. What are the effects of stimulating the amygdala? (Phys p719)

Page 4 of 6

STEP 1 REVIEW COURSE – Part 1, Set 14

9. A 50-year-old roofing worker develops a cough for the past month that is now associated with hemoptysis. The patient denies a smoking history or prolonged exposure to second-hand smoke. An X-ray reveals a left-sided lower lung coin-shaped lesion. What type of lung cancer is suspected in this individual? What is the appearance of asbestos fibers in the lung? What cancers are associated with asbestosis? (FA13 p555, 559) (FA14 p606, 610) (SU14 p110)

Page 5 of 6

STEP 1 REVIEW COURSE – Part 1, Set 14

10. Given each of the following deficits, list the corresponding affected artery. (FA13 p422) (FA14 p460) (SU14 p33) Clinical Presentation

Affected Cerebral Artery

Loss of motor and sensation of leg and foot Visual field deficits

Aphasia with generalized sensory and motor dysfunction Loss of motor and sensation of the face

Loss of motor and sensation of the arms

*Page references are as follows: FA13: First Aid for the USMLE Step 1 2013 FA14: First Aid for the USMLE Step 1 2014 SU14: Step-Up to USMLE Step 1 2014 R: Robbins and Cotran Pathologic Basis of Disease, 8th ed. (2010) Phys: Guyton and Hall Textbook of Medical Physiology, 12th ed. (2011) H: Harrison’s Principles of Internal Medicine, 18th ed. (2012) COA: Clinically Oriented Anatomy, 6th ed. (2010) GG: Goodman and Gilman Pharmacological Basis of Therapeutics, 12th ed. (2011)

Page 6 of 6

STEP 1 REVIEW COURSE – Part 1, Set 15 1. A 60-year-old male long-time patient of yours comes to your office complaining of sexual dysfunction. What is the differential diagnosis? What drugs are known for causing sexual dysfunction? (FA13 p60) (FA14 p512) (SU14 p223)

2. What organisms are particularly known for causing infective endocarditis? (FA13 p128-129, 145) (FA14 p130-131, 148) (SU14 p89) (H p1052) (R p566)

Page 1 of 5

STEP 1 REVIEW COURSE – Part 1, Set 15 3. Which type of lymphoma has a presentation that is very similar to CLL and fewer constitutional signs/symptoms? (FA13 p364) (FA14 p394) (SU14 p280)

4. A 44-year-old woman is seen in the ER for shortness of breath, malaise, and high fever. CXR reveals a right-sided consolidation and her labs reveal a WBC count of 12,000. Which organism is overall the most common cause of lobar pneumonia? What organisms are the most common causes of interstitial (walking) pneumonia? (FA13 p560) (FA14 p611) (SU14 p111)

Page 2 of 5

STEP 1 REVIEW COURSE – Part 1, Set 15 5. What is the difference between a promoter region and an enhancer region? (FA13 p70) (FA14 p72) (SU14 p297)

6. A 30-year-old man is at an inpatient facility for opioid addiction. What symptoms might this patient experience while discontinuing opioids? (FA13 p470) (FA14 p514) (SU14 p55)

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STEP 1 REVIEW COURSE – Part 1, Set 15 7. What are the signs of right-sided heart failure? What are the signs of left-sided heart failure? What is most often the cause of right-sided heart failure? (FA13 p273) (FA14 p291) (SU14 p85-88)

8. What medications are considered first-line in the treatment of ADHD? (GG p303)

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STEP 1 REVIEW COURSE – Part 1, Set 15 9. How many umbilical vessels are there? Which umbilical vessel has the highest oxygen content? (FA13 p508) (FA14 p557) (SU14 p65)

10. What abnormal lab values would lead you to suspect alcoholic hepatitis? (FA13 p334) (FA14 p361) (SU14 p138)

*Page references are as follows: FA13: First Aid for the USMLE Step 1 2013 FA14: First Aid for the USMLE Step 1 2014 SU14: Step-Up to USMLE Step 1 2014 R: Robbins and Cotran Pathologic Basis of Disease, 8th ed. (2010) Phys: Guyton and Hall Textbook of Medical Physiology, 12th ed. (2011) H: Harrison’s Principles of Internal Medicine, 18th ed. (2012) COA: Clinically Oriented Anatomy, 6th ed. (2010) GG: Goodman and Gilman Pharmacological Basis of Therapeutics, 12th ed. (2011)

Page 5 of 5

STEP 1 REVIEW COURSE – Part 1, Set 16 1. The dorsal root ganglion is considered gray matter within the spinal cord. From what embryological derivative are the dorsal root ganglia derived? (FA13 p505) (FA14 p553) (SU14 p25)

2. At what positive G force does visual “black-out” occur? Why does this occur? (Phys p531)

Page 1 of 5

STEP 1 REVIEW COURSE – Part 1, Set 16 3. Which complement protein is an opsonin? Which complement protein aids in neutrophil chemotaxis? Which complement proteins form the membrane attack complex? (FA13 p199) (FA14 p204) (SU14 p262-263)

4. A 40-year-old woman treated with lisinopril for stage I hypertension becomes pregnant. Why are ACE inhibitors contraindicated in pregnancy? What centrally acting α2-agonist is often used to treat hypertension in pregnancy? (FA13 p236) (FA14 p249) (SU14 p78)

Page 2 of 5

STEP 1 REVIEW COURSE – Part 1, Set 16 5. An elderly patient fell and struck his head on a coffee table. His family brought him to the ER. He is currently conscious and at his neurological baseline. Non-contrast CT of the head reveals a crescent shaped radiopacity that follows the contour of the skull crossing suture lines. What type of intracranial hemorrhage might this be and which vessel(s) would be involved? (FA13 p424) (FA14 p462) (SU14 p31-32)

6. A 42-year-old obese man presents with a complaint of severe pain in his right knee. He believes he injured it while dancing at his cousin’s wedding last night. You suspect gout. How would you differentiate between gout and pseudogout upon exam of synovial fluid aspirate? (FA13 p391) (FA14 p425) (SU14 p235) (R p1243-1246)

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STEP 1 REVIEW COURSE – Part 1, Set 16 7. A child presents with nephritis, deafness and ocular dysfunction. What is the diagnosis? A gene defect in what type of collagen contributes to the dysfunctions associated with this syndrome? What type of collagen organizes bone, skin and tendons? What type of collagen organizes cartilage? (FA13 p77, 79) (FA14 p79, 81) (SU14 p156)

8. Where is most of the cerebrospinal fluid (CSF) generated? What is the function of CSF? (Phys p746)

Page 4 of 5

STEP 1 REVIEW COURSE – Part 1, Set 16 9. What is the composition of a nucleosome? Which histone ties nucleosomes together? (FA13 p64) (FA14 p66) (SU14 p294)

10. A child is noticed to be yellow by a visiting relative, so he was brought to the clinic. His exam revealed jaundice and splenomegaly. The patient’s lab results reveal anemia and spherocytes. What test is used to confirm the diagnosis of hereditary spherocytosis? What findings are associated with hereditary spherocytosis? (FA13 p356) (FA14 p386) (SU14 p283)

*Page references are as follows: FA13: First Aid for the USMLE Step 1 2013 FA14: First Aid for the USMLE Step 1 2014 SU14: Step-Up to USMLE Step 1 2014 R: Robbins and Cotran Pathologic Basis of Disease, 8th ed. (2010) Phys: Guyton and Hall Textbook of Medical Physiology, 12th ed. (2011) H: Harrison’s Principles of Internal Medicine, 18th ed. (2012) COA: Clinically Oriented Anatomy, 6th ed. (2010) GG: Goodman and Gilman Pharmacological Basis of Therapeutics, 12th ed. (2011)

Page 5 of 5

STEP 1 REVIEW COURSE – Part 1, Set 17 1. A 3-year-old patient presents with a fever of 102°F for the last three days. On the fourth day the patient develops a red macular rash over the entire trunk and her fever resolves abruptly. What viral infection is most likely in this case? (FA13 p155-156, 161) (FA14 p158-159) (SU14 p358)

2. What are the mechanisms of action of the following toxins? (SU14 p29) (H p1197, 1200, 3580) Strychnine

Tetanus toxin

Black widow spider toxin

Botulinum toxin

Alpha-bungarotoxin

Page 1 of 5

STEP 1 REVIEW COURSE – Part 1, Set 17 3. What phase of drug metabolism do geriatric patients lose first? Which phase of drug metabolism makes a slightly polar metabolite by oxidation, reduction, or hydrolysis? (FA13 p228) (FA14 p240) (SU14 p16)

4. What is the difference between malingering and factitious disorder? (FA13 p467) (FA14 p510) (SU14 p60)

Page 2 of 5

STEP 1 REVIEW COURSE – Part 1, Set 17 5. Which cancers can cause the paraneoplastic syndrome Lambert-Eaton syndrome? (FA13 p223) (FA14 p235) (SU14 p117)

6. A patient complains of intense thirst and profuse urination. After further testing, you suspect diabetes insipidus. What urine specific gravity and serum osmolality findings would you see in a patient with diabetes insipidus? (FA13 p301) (FA14 p325) (SU14 p187) (Phys p354)

Page 3 of 5

STEP 1 REVIEW COURSE – Part 1, Set 17 7. What is the most common tumor of the urinary tract? What is the usual presenting complaint of a patient with this tumor? What substance exposures increase the risk of developing this tumor? (FA13 p494) (FA14 p541) (SU14 p165)

8. What is a conductive hearing loss, and what are some causes? (H p248)

Page 4 of 5

STEP 1 REVIEW COURSE – Part 1, Set 17 9. Which conditions are associated with oligohydramnios, and which are associated with polyhydramnios? (FA13 p527) (FA14 p579) (SU14 p146) What is Potter syndrome? (FA13 p478) (FA14 p522) (SU14 p146)

10. What pulmonary artery pressures indicate pulmonary hypertension? (FA13 p549) (FA14 p599, 608)

*Page references are as follows: FA13: First Aid for the USMLE Step 1 2013 FA14: First Aid for the USMLE Step 1 2014 SU14: Step-Up to USMLE Step 1 2014 R: Robbins and Cotran Pathologic Basis of Disease, 8th ed. (2010) Phys: Guyton and Hall Textbook of Medical Physiology, 12th ed. (2011) H: Harrison’s Principles of Internal Medicine, 18th ed. (2012) COA: Clinically Oriented Anatomy, 6th ed. (2010) GG: Goodman and Gilman Pharmacological Basis of Therapeutics, 12th ed. (2011)

Page 5 of 5

STEP 1 REVIEW COURSE – Part 1, Set 18 1. What problem/abnormality is associated with the following buzzwords? • Calf pseudohypertrophy (FA13 p86) (FA14 p616) (SU14 p251)

•

Gower maneuver (FA13 p86) (FA14 p89) (SU14 p251)

•

Subluxation of lenses (FA13 p85) (FA14 p87) (SU14 p238)

•

Café-au-lait spots (FA13 p85) (FA14 p87)

•

Tuft of hair on lower back (FA13 p409) (FA14 p445) (SU14 p26)

2. A patient comes to the clinic complaining of severe low back pain that radiates down the back of her leg. What is the most likely explanation for her pain? (COA p474)

Page 1 of 5

STEP 1 REVIEW COURSE – Part 1, Set 18 3. A 59-year-old man with a 50-pack-year history sees you for management of his COPD. What is the clinical definition of chronic bronchitis? (FA13 p554) (FA14 p604) (SU14 p106)

4. What type of cell differentiation and maturation takes place at the thymus? (FA13 p193) (FA14 p197) (SU14 p257-258) The thymus also functions to positively restrict major histocompatibility complex (MHC) at the corticomedullary junction. On which cells would you expect to find MHC I? MHC II? (FA13 p194) (FA14 p198) (SU14 p260-261)

Page 2 of 5

STEP 1 REVIEW COURSE – Part 1, Set 18 5. In your own words, describe what type I () error is. (FA13 p54) (FA14 p57) (SU14 p21)

6. A 50-year-old woman develops a new onset of lower back pain without a specific injury. A lumbar Xray reveals lytic lesions which raise suspicion for multiple myeloma. What is the characteristic finding on electrophoresis with multiple myeloma? What is the classic finding in the urine of a patient with multiple myeloma? (FA13 p363) (FA14 p393) (SU14 p269)

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STEP 1 REVIEW COURSE – Part 1, Set 18 7. A 30-year-old man who is experiencing shortness of breath is diagnosed with obstructive lung disease on pulmonary function test. The patient does not have a history of asthma and has never smoked. The patient is subsequently diagnosed with α1-antitrypsin deficiency. How does the emphysema caused by smoking differ from the emphysema caused by α1-antitrypsin deficiency? (FA13 p335, 554) (FA14 p363, 604) (SU14 p107)

8. What trace element is essential to the function of carbonic anhydrase and lactic dehydrogenase? (Phys p856)

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STEP 1 REVIEW COURSE – Part 1, Set 18 9. You are performing a radical mastectomy and exercise extreme caution as you dissect laterally along the serratus anterior muscle. You do this in order to avoid severing which motor nerve, which would result in what sequela? (FA13 p383) (FA14 p413) (SU14 p241)

10. In what clinical scenarios would you see a “nutmeg” liver? (FA13 p273, 335) (FA14 p291, 362) (SU14 p86, 137)

*Page references are as follows: FA13: First Aid for the USMLE Step 1 2013 FA14: First Aid for the USMLE Step 1 2014 SU14: Step-Up to USMLE Step 1 2014 R: Robbins and Cotran Pathologic Basis of Disease, 8th ed. (2010) Phys: Guyton and Hall Textbook of Medical Physiology, 12th ed. (2011) H: Harrison’s Principles of Internal Medicine, 18th ed. (2012) COA: Clinically Oriented Anatomy, 6th ed. (2010) GG: Goodman and Gilman Pharmacological Basis of Therapeutics, 12th ed. (2011)

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STEP 1 REVIEW COURSE – Part 1, Set 19 1. You are performing a well-child examination on a 4-year-old girl. The patient was recently adopted after being removed from the biological mother for abandonment. What changes might you see in your evaluation? What are the effects seen in an infant when there is long-term deprivation of affection? (FA13 p459) (FA14 p502)

2. A person eating fugu sashimi in Japan is at risk of what toxicity? What is the mechanism of this toxicity?

Page 1 of 6

STEP 1 REVIEW COURSE – Part 1, Set 19 3. A 25-year-old woman presents to the clinic with severe pelvic pain that is always associated with menses. What diagnosis is characteristic of this type of pain and often results in infertility? What is the classic finding on the ovary that is associated with this diagnosis? (FA13 p528) (FA14 p580) (SU14 p208-209)

4. Which antifungal drugs cause gynecomastia and by what mechanism? What diuretic drug causes gynecomastia and by what mechanism? (FA13 p185-186, 501) (FA14 p190, 548) (SU14 p218, 425, 447)

Page 2 of 6

STEP 1 REVIEW COURSE – Part 1, Set 19 5. How many half-lives does it take for a drug infused at a constant rate to reach 94% of steady state? What variables determine the half-life of a drug? (FA13 p227) (FA14 p239) (SU14 p388)

6. What are the early cyanotic heart diseases? What are the late cyanotic heart diseases? (FA13 p265) (FA14 p282-283) (SU14 p66)

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STEP 1 REVIEW COURSE – Part 1, Set 19 7. What is the mechanism of action of penicillin? Is it a bacteriostatic or bactericidal antibiotic? (FA13 p176, 180) (FA14 p179) (SU14 p350)

8. Describe the anatomical layers of the penis. (COA p419-420)

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STEP 1 REVIEW COURSE – Part 1, Set 19 9. A 37-year-old patient with refractory peptic ulcer disease undergoes an esophagogastric duodenoscopy (EGD). Biopsies of the duodenum reveal hypertrophied submucosal glands. What are these glands? What are Peyer’s patches? How can these structures help you identify the location from which a histological specimen was taken? (FA13 p321, 323) (FA14 p347-348)

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STEP 1 REVIEW COURSE – Part 1, Set 19 10. What is the adult remnant of the following fetal structures? (FA13 p252, 505, 514) (FA14 p265, 553, 562) (SU14 p63, 198) Fetal Structure

Adult Remnant

Gubernaculum (female)

Processus vaginalis (male)

Foramen ovale

Notochord

*Page references are as follows: FA13: First Aid for the USMLE Step 1 2013 FA14: First Aid for the USMLE Step 1 2014 SU14: Step-Up to USMLE Step 1 2014 R: Robbins and Cotran Pathologic Basis of Disease, 8th ed. (2010) Phys: Guyton and Hall Textbook of Medical Physiology, 12th ed. (2011) H: Harrison’s Principles of Internal Medicine, 18th ed. (2012) COA: Clinically Oriented Anatomy, 6th ed. (2010) GG: Goodman and Gilman Pharmacological Basis of Therapeutics, 12th ed. (2011)

Page 6 of 6

STEP 1 REVIEW COURSE – Part 1, Set 20 1. A unilateral lesion to the lateral corticospinal tract results in motor deficits ipsilateral to the lesion. Where in the lateral corticospinal tract is the motor innervation to the legs located? (FA13 p427) (FA14 p465) (SU14 p35)

2. What are some of the possible causes of pericarditis? (FA13 p275) (FA14 p293) (SU14 p93) (R p581)

Page 1 of 6

STEP 1 REVIEW COURSE – Part 1, Set 20 3. A 22-year-old man recently lost his leg in a tragic accident involving alcohol and heavy machinery. Just prior to discharge, a vigilant nurse informs you that the patient has been very depressed about his lost limb, and she overheard him talking to a friend about just ending his life with his dad’s gun when he gets out of the hospital. What needs to be done? (FA13 p58) (FA14 p61)

4. In cystic fibrosis thick, mucous secretions inhibit digestive enzymes, which can lead to malabsorption of fat and fat-soluble vitamins. What are the fat-soluble vitamins? What are the corresponding symptoms of fat-soluble vitamin deficiency? (FA13 p90-95, 326) (FA14 p91-96, 353) (SU14 p115, 454) Fat-Soluble Vitamins

Deficiency Symptoms

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STEP 1 REVIEW COURSE – Part 1, Set 20 5. What class of drugs can be used to treat estrogen receptor-positive breast cancer? What is another use for these drugs? What is the main concern when using tamoxifen? (FA13 p373) (FA14 p406) (SU14 p226, 290-291)

6. What branchial arch derivative abnormality causes facial abnormalities by affecting Meckel’s cartilage? What cranial nerves are affected in this abnormality? From what germ layers are the branchial arches derived? (FA13 p509, 511) (FA14 p558-560) (SU14 p228-229)

Page 3 of 6

STEP 1 REVIEW COURSE – Part 1, Set 20 7. Which primary bone tumor fits each of the following descriptions? (FA13 p363, 389) (FA14 p393, 422423) (SU14 p233, 385) 

Most common malignancy arising within bone



11;22 translocation



Soap-bubble appearance on x-ray



Onion-skin appearance of bone (layers of new bone in periosteum)



Codman’s triangle (periosteal elevation) on x-ray



May arise from osteochondroma or appear as a primary tumor



Anaplastic small cells, aggressive mets, good chemo response



Most common malignant bone tumor in children

Page 4 of 6

STEP 1 REVIEW COURSE – Part 1, Set 20 8. How does an anterior shoulder dislocation present differently than a posterior shoulder dislocation? (COA p814) Anterior Dislocation

Posterior Dislocation

Arm position

Neurovascular compromise

Classic scenario

Physical exam

9. You are treating a 63-year-old woman with small cell lung cancer who develops SIADH. She becomes disoriented secondary to hyponatremia. Consequently, you rapidly correct the low serum sodium with demeclocycline and water restriction. The patient’s sodium level and disorientation improve, but several days later the patient develops diplopia. What is the cause of this patient’s diplopia? (FA13 p419, 486-487) (FA14 p457, 531-532)

Page 5 of 6

STEP 1 REVIEW COURSE – Part 1, Set 20 10. A 45-year-old woman receives a kidney transplant and receives cyclosporine as part of her antirejection regimen. What is the mechanism of action of cyclosporine? (FA13 p209) (FA14 p215) (SU14 p270)

*Page references are as follows: FA13: First Aid for the USMLE Step 1 2013 FA14: First Aid for the USMLE Step 1 2014 SU14: Step-Up to USMLE Step 1 2014 R: Robbins and Cotran Pathologic Basis of Disease, 8th ed. (2010) Phys: Guyton and Hall Textbook of Medical Physiology, 12th ed. (2011) H: Harrison’s Principles of Internal Medicine, 18th ed. (2012) COA: Clinically Oriented Anatomy, 6th ed. (2010) GG: Goodman and Gilman Pharmacological Basis of Therapeutics, 12th ed. (2011)

Page 6 of 6

STEP 1 REVIEW COURSE – Part 1, Set 21 1. What are the Jones criteria for the diagnosis of acute rheumatic fever? (FA13 p129) (FA14 p131) (SU14 p89-90)

2. What is the cause of hypertrophic cardiomyopathy? (FA13 p272) (FA14 p290) (SU14 p91) (R p576)

Page 1 of 6

STEP 1 REVIEW COURSE – Part 1, Set 21 3. What is the mechanism of action of the following cholinergic agents? (FA13 p233-234) (FA14 p246247) (SU14 p78, 400-401, 403, 434, 439) Cholinergic Agent

Mechanism of Action

pralidoxime

neostigmine

bethanechol

hexamethonium

atropine

carbachol

Page 2 of 6

STEP 1 REVIEW COURSE – Part 1, Set 21 4. During fetal development what structure traps the inferior poles of the kidney resulting in a horseshoe kidney? Do patients with horseshoe kidneys have abnormal renal function? (FA13 p478) (FA14 p523) (SU14 p146)

5. An adult trauma patient begins to experience shortness of breath on day 3 of his hospital stay. The patient had an open reduction internal fixation of a right femur fracture. You are concerned the patient’s shortness of breath might be attributed to an embolus. What type of embolus is this patient at risk of getting? What are the different types of emboli? (FA13 p553) (FA14 p603) (SU14 p105)

Page 3 of 6

STEP 1 REVIEW COURSE – Part 1, Set 21 6. A 25-year-old man is evaluated in the clinic for red, swollen, and painful right wrist and left knee joint. During the exam, the patient brags about his sexual conquests. What sexually-transmitted organism can cause osteomyelitis as well as this patient’s septic arthritis? (FA13 p169) (FA14 p172) (SU14 p237)

7. What is the site of action of each of the following diuretics? (FA13 p499) (FA14 p546) (SU14 p150, 166) 

Thiazide diuretics-



Loop diuretics-



Carbonic anhydrase inhibitors-



Osmotic diuretics-



Potassium-sparing diuretics-

Page 4 of 6

STEP 1 REVIEW COURSE – Part 1, Set 21 8. How can a skull fracture at the base of the brain lead to pulsating exophthalmos (protrusion of the eye)? (H p237)

9. The different hereditary hyperbilirubinemias can all present with jaundice and scleral icterus. What is the underlying cause in the following hyperbilirubinemias, and what form of bilirubin is elevated in the serum in each disease? (FA13 p336) (FA14 p364) (SU14 p134) Hereditary Hyperbilirubinemia

Cause

Bilirubin (unconjugated or conjugated)

Gilbert syndrome

Crigler-Najjar syndrome, type I

Dubin-Johnson syndrome

Page 5 of 6

STEP 1 REVIEW COURSE – Part 1, Set 21 10. In patients with a prolactinoma, what pharmacologic agent can be used to inhibit the release of prolactin? In normal physiology, how is prolactin secretion regulated? (FA13 p290) (FA14 p310) (SU14 p172, 186)

*Page references are as follows: FA13: First Aid for the USMLE Step 1 2013 FA14: First Aid for the USMLE Step 1 2014 SU14: Step-Up to USMLE Step 1 2014 R: Robbins and Cotran Pathologic Basis of Disease, 8th ed. (2010) Phys: Guyton and Hall Textbook of Medical Physiology, 12th ed. (2011) H: Harrison’s Principles of Internal Medicine, 18th ed. (2012) COA: Clinically Oriented Anatomy, 6th ed. (2010) GG: Goodman and Gilman Pharmacological Basis of Therapeutics, 12th ed. (2011)

Page 6 of 6

STEP 1 REVIEW COURSE – Part 1, Set 22 1. Which cardiac valve is most commonly involved in infective endocarditis and acute rheumatic fever? (FA13 p274) (FA14 p292) (SU14 p89)

2. What disorders can cause cotton-wool spots on the retina? (H p231)

Page 1 of 5

STEP 1 REVIEW COURSE – Part 1, Set 22 3. What neurotransmitter levels in the brain are either increased or decreased in each of the following disorders? (FA13 p461) (FA14 p503) 

Schizophrenia



Parkinson disease



Alzheimer disease



Huntington disease



Anxiety



Depression

4. Name the syndromes below that are common causes of anovulation. (FA13 p296, 529-530) (FA14 p317, 581) (SU14 p209-210)  Elevated cortisol, central obesity  Amenorrhea + hirsutism + obesity

Page 2 of 5

STEP 1 REVIEW COURSE – Part 1, Set 22 5. A type 2 diabetic with a HgbA1c of 10% presents to your clinic with many complaints. You are concerned about the effect of the patient’s long term hyperglycemia. What diabetic complications can be attributed to sorbitol-induced osmotic damage? What enzyme converts glucose to sorbitol? (FA13 p105) (FA14 p107)

6. What is the underlying cause of DiGeorge syndrome? What are the manifestations of DiGeorge syndrome? (FA13 p89, 206) (FA14 p91, 212, 560) (SU14 p169, 268)

Page 3 of 5

STEP 1 REVIEW COURSE – Part 1, Set 22 7. In your own words, describe what type II () error is. (FA13 p54) (FA14 p57) (SU14 p21)

8. What efferent fibers carry input from the brain that influences the outer hair cells (OHCs) of the cochlea in much the same way that gamma motor neurons influence muscle spindles? What is the result of this input? (SU14 p36) (Phys p639) (H p248) What is the result of damaging the OHCs (as with antibiotics such as gentamicin and streptomycin)? (H p250)

Page 4 of 5

STEP 1 REVIEW COURSE – Part 1, Set 22 9. What are the risk factors for osteosarcoma? (FA13 p389) (FA14 p422) (SU14 p233)

10. A child in India is brought to the doctor with symptoms of muscle weakness, malaise, headache, fever, and hyporeflexia. For the past few weeks he had been swimming in a water way known to contain sewage. You think this boy has contracted a pathogen via the fecal-oral route. What area of the body is this pathogen attacking to give the neurologic symptoms seen? (FA13 p429) (FA14 p467) (SU14 p47)

*Page references are as follows: FA13: First Aid for the USMLE Step 1 2013 FA14: First Aid for the USMLE Step 1 2014 SU14: Step-Up to USMLE Step 1 2014 R: Robbins and Cotran Pathologic Basis of Disease, 8th ed. (2010) Phys: Guyton and Hall Textbook of Medical Physiology, 12th ed. (2011) H: Harrison’s Principles of Internal Medicine, 18th ed. (2012) COA: Clinically Oriented Anatomy, 6th ed. (2010) GG: Goodman and Gilman Pharmacological Basis of Therapeutics, 12th ed. (2011)

Page 5 of 5

STEP 1 REVIEW COURSE – Part 1, Set 23 1. What agent can be given as an inhaled drug to loosen mucus plugs, can be given orally to treat acetaminophen overdose, and can be given orally as prophylaxis against IV contrast-induced nephropathy in those with preexisting renal disease? (FA13 p239, 563-564) (FA14 p252, 613-614) (SU14 p115-116)

2. What synthetic agent is used both as a pituitary hormone analog and as a treatment for von Willebrand disease? (SU14 p191) (GG p712) (H p927)

3. What viral illness is associated with Burkitt lymphoma? Is Burkitt lymphoma a neoplasm of mature Tor B-cells? (FA13 p362) (FA14 p392) (SU14 p280) Where are T-cells found in the spleen? Where are Bcells found in the spleen? (FA13 p193) (FA14 p197) (SU14 p258-259) (R p633)

Page 1 of 6

STEP 1 REVIEW COURSE – Part 1, Set 23 4. Which type of diabetes mellitus fits the following descriptions? (FA13 p303) (FA14 p328) (SU14 p181) (R p1132) 

Associated with obesity



May cause ketoacidosis



Strong genetic predisposition



Associated with HLA DR 3 & 4

5. When is a fetus most susceptible to damage from teratogens? What drug used in the treatment of hypertension is a teratogen? What effect does this have on the fetus? (FA13 p507) (FA14 p554) (SU14 p78, 203)

Page 2 of 6

STEP 1 REVIEW COURSE – Part 1, Set 23 6. In which lobes of the brain would you find the following brain functions? (FA13 p418) (FA14 p455) (SU14 p33) Function Lobe Broca’s area (motor speech)

Wernicke’s area (speech understanding)

Primary auditory cortex

Principal visual cortex

Principal sensory areas

Primary motor cortex

Premotor cortex

Page 3 of 6

STEP 1 REVIEW COURSE – Part 1, Set 23 7. What is the most common gynecologic neoplasm? What is the typical histological pattern? Is it benign or malignant? (FA13 p529) (FA14 p581) (SU14 p217)

8. How is the body affected by a prolonged stay in space at zero gravity? (Phys p533)

Page 4 of 6

STEP 1 REVIEW COURSE – Part 1, Set 23 9. How are the following relative component levels in the blood of a polycythemia vera patient different from normal: plasma volume, RBC mass, O2 saturation, and endogenous erythropoietin? (FA13 p366) (FA14 p398) (SU14 p287)

Page 5 of 6

STEP 1 REVIEW COURSE – Part 1, Set 23 10. Describe how the following diuretics affect the nephron function. (FA13 p500-501) (FA14 p547-548) (SU14 p167-168) Diuretic Nephron Effect Acetazolamide

Mannitol

Furosemide

Hydrochlorothiazide (thiazides)

Potassium sparing

ADH antagonists

*Page references are as follows: FA13: First Aid for the USMLE Step 1 2013 FA14: First Aid for the USMLE Step 1 2014 SU14: Step-Up to USMLE Step 1 2014 R: Robbins and Cotran Pathologic Basis of Disease, 8th ed. (2010) Phys: Guyton and Hall Textbook of Medical Physiology, 12th ed. (2011) H: Harrison’s Principles of Internal Medicine, 18th ed. (2012) COA: Clinically Oriented Anatomy, 6th ed. (2010) GG: Goodman and Gilman Pharmacological Basis of Therapeutics, 12th ed. (2011)

Page 6 of 6

STEP 1 REVIEW COURSE – Part 1, Set 24 1. A 53-year-old man has just been diagnosed with peptic ulcer disease (PUD) visualized on endoscopy. Ranitidine and lansoprazole are the medications available on your hospital formulary for treatment of PUD. Describe the different ways in which ranitidine and lansoprazole decrease parietal cell acid secretion. Why is ranitidine preferred over cimetidine? What other conditions can you treat with lansoprazole and ranitidine? (FA13 p341) (FA14 p371) (SU14 p141-142)

2. How much does the H&H change in a person that has acclimatized to a hypoxic environment for weeks? (Phys p529)

Page 1 of 6

STEP 1 REVIEW COURSE – Part 1, Set 24 3. Wallenberg syndrome is an injury of the lateral medulla that presents with a constellation of neurologic symptoms, including difficulty with swallowing (dysphagia), hoarseness and difficulty with palate elevation. Which part of the lateral medulla is responsible for swallowing and palate elevation? What other cranial nerves can be involved with this region? (FA13 p422) (FA14 p460) (SU14 p34)

4. What are some extrapulmonary causes of restrictive lung disease? (FA13 p555) (FA14 p605) (SU14 p100)

Page 2 of 6

STEP 1 REVIEW COURSE – Part 1, Set 24 5. What are the essential amino acids? (FA13 p106) (FA14 p108) (SU14 p305)

6. What muscles compose the rotator cuff? (FA13 p379) (FA14 p411)

Page 3 of 6

STEP 1 REVIEW COURSE – Part 1, Set 24 7. What mature structures arise from each of the following embryologic structures? (FA13 p250) (FA14 p262) (SU14 p63-64) Embryologic Structures Bulbus cordis

Mature Structure

Left horn of sinus venosus

Primitive atrium

Truncus arteriosus

Primitive ventricle

Right horn of sinus venosus

Right common and anterior cardinal veins

Page 4 of 6

STEP 1 REVIEW COURSE – Part 1, Set 24 8. What medications are commonly used for the treatment of insomnia? (GG p477)

9. A 50-year-old man crashes on a motorcycle on the highway and sustains a right anterior hip dislocation and knee trauma. Now he cannot adduct his hip or plantar flex on that side. Which nerves are injured? (FA13 p384) (FA14 p416) (SU14 p243)

Page 5 of 6

STEP 1 REVIEW COURSE – Part 1, Set 24 10. Describe the rash presentation (timing, description, location) associated with each of the following diseases. (FA13 p172) (FA14 p175) (SU14 p462, 465, 467-468) Disease Rubella

Rash Presentation

Herpes zoster

HHV-6

Parvovirus B19

Coxsackievirus type A

Streptococcus pyogenes

*Page references are as follows: FA13: First Aid for the USMLE Step 1 2013 FA14: First Aid for the USMLE Step 1 2014 SU14: Step-Up to USMLE Step 1 2014 R: Robbins and Cotran Pathologic Basis of Disease, 8th ed. (2010) Phys: Guyton and Hall Textbook of Medical Physiology, 12th ed. (2011) H: Harrison’s Principles of Internal Medicine, 18th ed. (2012) COA: Clinically Oriented Anatomy, 6th ed. (2010) GG: Goodman and Gilman Pharmacological Basis of Therapeutics, 12th ed. (2011)

Page 6 of 6

STEP 1 REVIEW COURSE – Part 1, Set 25 1. A 35-year-old woman is being treated with leuprolide for infertility issues. Her father is also being treated with leuprolide for prostate cancer. Describe how variations in administration of leuprolide can modify its effects and, therefore, usage. (FA13 p539) (FA14 p590) (SU14 p227)

2. What effect does stress have on adipocytes? (Phys p825)

Page 1 of 6

STEP 1 REVIEW COURSE – Part 1, Set 25 3. What feature distinguishes a thyroglossal duct cyst from a branchial cleft cyst? What is the remnant of the thyroglossal duct? Explain the development of the thyroid gland. (FA13 p286) (FA14 p306) (SU14 p169-170)

4. A chronic alcoholic with cirrhosis begins to experience a tremor and blurred vision. You feel like these symptoms might be due to his progressive liver disorder and associated with hyperammonemia. What is another hereditary cause of hyperammonemia? What are some other findings with hyperammonemia? (FA13 p107) (FA14 p109) (SU14 p311)

Page 2 of 6

STEP 1 REVIEW COURSE – Part 1, Set 25 5. Does a partial agonist always have a lower maximal efficacy than a full agonist? Does a partial agonist always have a lower potency than a full agonist? (FA13 p229) (FA14 p242) (SU14 p14-16)

6. A 46-year-old schizophrenic woman has been treated with an atypical antipsychotic with good results for several years. Routine labs reveal a precipitous drop in her WBCs. Which drug is this patient likely taking, and how frequently must her labs be drawn to watch for this problem? (FA13 p473) (FA14 p517) (SU14 p56) (GG p330)

Page 3 of 6

STEP 1 REVIEW COURSE – Part 1, Set 25 7. What are the common causes of metabolic acidosis with an elevated anion gap? (FA13 p488) (FA14 p533) (SU14 p152)

8. How is cystic fibrosis diagnosed? (FA13 p86) (FA14 p88) (SU14 p115) (H p2149)

Page 4 of 6

STEP 1 REVIEW COURSE – Part 1, Set 25 9. Given the following clinical situations, classify each as type I, II, III, or IV hypersensitivity. (FA13 p204) (FA14 p209) (SU14 p266) Clinical Situation Asthma exacerbation

Type of Hypersensitivity

Poison ivy dermatitis

Goodpasture syndrome

Arthus reaction

Anaphylaxis

Serum sickness

Autoimmune hemolytic anemia

Liver transplant rejection

Rh incompatibility (erythroblastosis fetalis) TB skin test (PPD)

Page 5 of 6

STEP 1 REVIEW COURSE – Part 1, Set 25 10. You are conducting a study trying to determine the reduction in risk of developing a relapsing depressive episode with antidepressant X when compared to a placebo treatment. What is this determination called? What is attributable risk, and how is it calculated? (FA13 p52) (FA14 p53) (SU14 p388)

*Page references are as follows: FA13: First Aid for the USMLE Step 1 2013 FA14: First Aid for the USMLE Step 1 2014 SU14: Step-Up to USMLE Step 1 2014 R: Robbins and Cotran Pathologic Basis of Disease, 8th ed. (2010) Phys: Guyton and Hall Textbook of Medical Physiology, 12th ed. (2011) H: Harrison’s Principles of Internal Medicine, 18th ed. (2012) COA: Clinically Oriented Anatomy, 6th ed. (2010) GG: Goodman and Gilman Pharmacological Basis of Therapeutics, 12th ed. (2011)

Page 6 of 6

STEP 1 REVIEW COURSE – Part 1, Set 26 1. While thiazide and loop diuretics are known for wasting potassium in the urine, there are other diuretics that conserve it. Which diuretics are these? What are their mechanisms of action? What are their important side effects? (FA13 p501) (FA14 p548) (SU14 p167)

2. What substances compose the matrix of the bone? (Phys p957)

Page 1 of 6

STEP 1 REVIEW COURSE – Part 1, Set 26 3. What risk factors are associated with cholesterol gallstones? What risk factors are associated with pigment gallstones? (FA13 p339) (FA14 p367) (SU14 p137)

4. A 66-year-old woman is being treated in the ER for an acute MI. Nitroglycerin is given with the expectation that it will vasodilate which vessels preferentially? Another patient in the ICU is on hydralazine for acute treatment of his severe hypertension. How does hydralazine function? (FA13 p279-280) (FA14 p298-299) (SU14 p79)

Page 2 of 6

STEP 1 REVIEW COURSE – Part 1, Set 26 5. Which immune response is responsible for hyperacute, acute and chronic transplant rejection? What is the time frame for each? (FA13 p208) (FA14 p214) (SU14 p267)

6. A 35-year-old woman with multiple sclerosis presents to clinic with internuclear ophthalmoplegia. What is internuclear ophthalmoplegia? (FA13 p442) (FA14 p482) (SU14 p37)

Page 3 of 6

STEP 1 REVIEW COURSE – Part 1, Set 26 7. For which infections is vancomycin a good choice? How does vancomycin resistance develop? (FA13 p179) (FA14 p182) (SU14 p351)

8. What is the treatment for digoxin toxicity? (FA13 p239) (FA14 p252) (SU14 p70) (GG p803)

Page 4 of 6

STEP 1 REVIEW COURSE – Part 1, Set 26 9. A 67-year-old man with new-onset hepatic failure and normal renal function is currently taking a drug metabolized and excreted by the kidneys. Would you need to change the loading dose or maintenance dose of this medication because of this hepatic failure? If this patient were to develop hepatorenal failure, would you need to change the loading dose or maintenance dose of the medicine? (FA13 p227) (FA14 p239) (SU14 p388)

Page 5 of 6

STEP 1 REVIEW COURSE – Part 1, Set 26 10. Do atypical antipsychotics primarily address the negative or positive symptoms of schizophrenia? How does the mechanism of action of typical antipsychotics differ from the mechanism of action of the atypical antipsychotics? (FA13 p463, 473) (FA14 p505, 517) (SU14 p55)

*Page references are as follows: FA13: First Aid for the USMLE Step 1 2013 FA14: First Aid for the USMLE Step 1 2014 SU14: Step-Up to USMLE Step 1 2014 R: Robbins and Cotran Pathologic Basis of Disease, 8th ed. (2010) Phys: Guyton and Hall Textbook of Medical Physiology, 12th ed. (2011) H: Harrison’s Principles of Internal Medicine, 18th ed. (2012) COA: Clinically Oriented Anatomy, 6th ed. (2010) GG: Goodman and Gilman Pharmacological Basis of Therapeutics, 12th ed. (2011)

Page 6 of 6

STEP 1 REVIEW COURSE – Part 1, Set 27 1. Metastasis to the brain, liver, and bone commonly come from which locations? (FA13 p224) (FA14 p236) (SU14 p52) Brain

Liver

Bone

2. A central line is often placed in the subclavian vein to administer fluids and medications or to measure central venous pressure. What landmarks are used when placing a subclavian central line? (COA p1008)

Page 1 of 5

STEP 1 REVIEW COURSE – Part 1, Set 27 3. What is the mechanism of organophosphate poisoning? What are the symptoms of cholinergic excess? (FA13 p230, 233-234) (FA14 p243, 246-247) (SU14 p395)

4. Which glycogen storage disease fits the following features? (FA13 p111) (FA14 p113) (SU14 p315-317) Features Severe hypoglycemia with elevated blood lactate

Glycogen storage disease

Hypoglycemia without elevated blood lactate

Cardiomegaly

Myoglobinuria associated with exercise

Page 2 of 5

STEP 1 REVIEW COURSE – Part 1, Set 27 5. What are the most common locations of lung cancer metastases? (FA13 p558-559) (FA14 p609) (SU14 p116)

6. What is the treatment of a pulmonary embolism? (FA13 p367) (FA14 p603) (SU14 p276-277) (R p706)

Page 3 of 5

STEP 1 REVIEW COURSE – Part 1, Set 27 7. What is the characteristic fetal complication associated with lithium use in pregnancy? What other agents used to treat bipolar disorder can be teratogenic, and what are their corresponding fetal effects? (FA13 p506-507) (FA14 p554-555) (SU14 p60, 390)

8. What are some of the functions of bile produced by hepatocytes and stored in the gallbladder? (Phys p783) What hormone is the most potent stimulator of gallbladder contractions? (Phys p785)

Page 4 of 5

STEP 1 REVIEW COURSE – Part 1, Set 27 9. What are the common causes of Erb-Duchenne palsy? Where is the brachial plexus insult with ErbDuchenne palsy? (FA13 p381-382) (FA14 p413) (SU14 p240)

10. What anatomic structures are found in the retroperitoneum? (FA13 p309) (FA14 p335)

*Page references are as follows: FA13: First Aid for the USMLE Step 1 2013 FA14: First Aid for the USMLE Step 1 2014 SU14: Step-Up to USMLE Step 1 2014 R: Robbins and Cotran Pathologic Basis of Disease, 8th ed. (2010) Phys: Guyton and Hall Textbook of Medical Physiology, 12th ed. (2011) H: Harrison’s Principles of Internal Medicine, 18th ed. (2012) COA: Clinically Oriented Anatomy, 6th ed. (2010) GG: Goodman and Gilman Pharmacological Basis of Therapeutics, 12th ed. (2011)

Page 5 of 5

STEP 1 REVIEW COURSE – Part 1, Set 28 1. What physiology accounts for the automaticity of the AV and SA nodes? (FA13 p260) (FA14 p275) (SU14 p64-65) (Phys p111-112)

2. What test is used to detect corneal abrasions?

3. A patient with an epilepsy diagnosis is pregnant with her first child. She is concerned that her child may also have seizures. What are the most common causes of seizures in children? In adults? In the elderly? (FA13 p445) (FA14 p485) (SU14 p46)

Page 1 of 5

STEP 1 REVIEW COURSE – Part 1, Set 28 4. What is p value? What is an acceptable p value? (FA13 p54) (FA14 p57) (SU14 p21)

5. What organism causes Hansen disease? What animal serves as the reservoir for this organism in the US? Where in the body does this organism live? (FA13 p133) (FA14 p135) (SU14 p460-461)

Page 2 of 5

STEP 1 REVIEW COURSE – Part 1, Set 28 6. Which diuretics lower serum calcium levels? What is the mechanism by which this patient developed hypocalcemia? (FA13 p500-501) (FA14 p547-548) (SU14 p166-167)

7. A 9-year-old child is brought into the clinic for evaluation of a right wrist drop and confusion. Physical exam reveals a bluish line on the gingivae. What peripheral smear finding is consistent with lead poisoning? What is the treatment for lead poisoning in this patient? (FA13 p350, 353) (FA14 p380, 383) (SU14 p281)

Page 3 of 5

STEP 1 REVIEW COURSE – Part 1, Set 28 8. What is BNP, and how is it useful in cases of heart failure? (FA14 p279) (H p2216)

9. A kidney transplant patient begins to experience renal failure seven years after receiving her kidney transplant. What type of rejection is this, and how is it mediated? (FA13 p208) (FA14 p214) (SU14 p267)

Page 4 of 5

STEP 1 REVIEW COURSE – Part 1, Set 28 10. A 62-year-old man complains of weak urine stream and hesitancy when trying to urinate. His physician prescribes finasteride. How does this agent treat benign prostatic hyperplasia? (FA13 p539) (FA14 p591) (SU14 p219, 225) (GG p1205)

*Page references are as follows: FA13: First Aid for the USMLE Step 1 2013 FA14: First Aid for the USMLE Step 1 2014 SU14: Step-Up to USMLE Step 1 2014 R: Robbins and Cotran Pathologic Basis of Disease, 8th ed. (2010) Phys: Guyton and Hall Textbook of Medical Physiology, 12th ed. (2011) H: Harrison’s Principles of Internal Medicine, 18th ed. (2012) COA: Clinically Oriented Anatomy, 6th ed. (2010) GG: Goodman and Gilman Pharmacological Basis of Therapeutics, 12th ed. (2011)

Page 5 of 5

STEP 1 REVIEW COURSE – Part 1, Set 29 1. What type of immunodeficiency disorder is caused by DiGeorge syndrome? (FA13 p206) (FA14 p212) (SU14 p268) Development of what branchial pouches are affected in DiGeorge syndrome? (FA13 p511) (FA14 p560) (SU14 p169)

2. What are Cheyne-Stokes respirations? (FA13 p568) (FA14 p618) (SU14 p103) (H p1904) (Phys p512)

Page 1 of 5

STEP 1 REVIEW COURSE – Part 1, Set 29 3. The E4 variant of Apo E is a known risk factor for Alzheimer’s disease. What is the primary function of the following major apoproteins? (FA13 p115) (FA14 p118) (SU14 p321) •

Apo A-I

•

Apo B-48

•

Apo B-100

•

Apo C-II

•

Apo E

4. What drugs and endogenous hormones regulate the secretion of gastric acid? (FA13 p319) (FA14 p345) (SU14 p121)

Page 2 of 5

STEP 1 REVIEW COURSE – Part 1, Set 29 5. What are the positive symptoms of schizophrenia (adding a symptom)? What are the negative symptoms of schizophrenia (removing a normal finding/trait)? (FA13 p463) (FA14 p505) (SU14 p55)

6. Name five or more drugs that inhibit acetylcholinesterase. What is the clinical application for each? (FA13 p233) (FA14 p246) (SU14 p251, 413-414, 434, 442)

Page 3 of 5

STEP 1 REVIEW COURSE – Part 1, Set 29 7. Describe the anatomy of the femoral sheath. When placing a femoral line for central venous access you palpate a femoral pulse. Where do you place the guide needle in relation to this pulse: medially or laterally? (FA13 p316) (FA14 p342)

8. What is HIPAA?

Page 4 of 5

STEP 1 REVIEW COURSE – Part 1, Set 29 9. What long-term complication is associated with having to receive multiple blood transfusions? (FA13 p360) (FA14 p391)

10. What area of the brain is damaged in Kluver-Bucy syndrome? What are the symptoms of Klüver-Bucy syndrome? (FA13 p419) (FA14 p456) (SU14 p33)

*Page references are as follows: FA13: First Aid for the USMLE Step 1 2013 FA14: First Aid for the USMLE Step 1 2014 SU14: Step-Up to USMLE Step 1 2014 R: Robbins and Cotran Pathologic Basis of Disease, 8th ed. (2010) Phys: Guyton and Hall Textbook of Medical Physiology, 12th ed. (2011) H: Harrison’s Principles of Internal Medicine, 18th ed. (2012) COA: Clinically Oriented Anatomy, 6th ed. (2010) GG: Goodman and Gilman Pharmacological Basis of Therapeutics, 12th ed. (2011)

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STEP 1 REVIEW COURSE – Part 1, Set 30 1. A 35-year-old man is seen in the office for his chronic, recurrent peptic ulcer disease. It has been refractory to conventional treatment with PPIs. Your attending mentions that this might be caused by a tumor. What type of tumor may be responsible for this condition? If this patient also presented with renal stones and signs of hypogonadism, what syndrome might you suspect? (FA13 p304) (FA14 p329) (R p782, 1162)

2. How is thyroid hormone made and stored? (SU14 p192) (Phys p907) (H p2913)

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STEP 1 REVIEW COURSE – Part 1, Set 30 3. A 49-year-old trauma patient comes into the ER unconscious and in need of surgery. What are the exceptions to informed consent? (FA13 p56) (FA14 p59) (SU14 p23-24)

4. What is the role of clomiphene in the treatment of PCOS? What is the mechanism of action of clomiphene? (FA13 p540) (FA14 p590) (SU14 p226)

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STEP 1 REVIEW COURSE – Part 1, Set 30 5. Ceftriaxone is used for the treatment of sexually-transmitted N. gonorrhea infections. What generation of cephalosporin is ceftriaxone? Which generation of cephalosporins is effective against Pseudomonas? Are cephalosporins bacteriostatic or bactericidal? (FA13 p178) (FA14 p181) (SU14 p350-351)

6. What are the side effects of amiodarone, and what testing should be performed periodically on patients taking it? (FA13 p284) (FA14 p303) (SU14 p74-75)

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STEP 1 REVIEW COURSE – Part 1, Set 30 7. A patient is undergoing treatment with recombinant interferon for his Hepatitis C. In what ways do interferons interfere with viral protein synthesis? (FA13 p201) (FA14 p205-206) (SU14 p265)

8. A 35-year-old white woman presents with a dull ache in her jaw that is made worse by chewing. She states that this pain corresponds to her recent promotion and increase in responsibilities. What is the most likely diagnosis? (H p269)

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STEP 1 REVIEW COURSE – Part 1, Set 30 9. In regard to seizures, what do the terms partial, generalized, simple and complex mean? (FA13 p445) (FA14 p485) (SU14 p46)

10. Your patient develops a cough with the new antihypertensive drug you prescribed her. What are some other side effects associated with this medication? (FA13 p502) (FA14 p549) (SU14 p78-79, 86)

*Page references are as follows: FA13: First Aid for the USMLE Step 1 2013 FA14: First Aid for the USMLE Step 1 2014 SU14: Step-Up to USMLE Step 1 2014 R: Robbins and Cotran Pathologic Basis of Disease, 8th ed. (2010) Phys: Guyton and Hall Textbook of Medical Physiology, 12th ed. (2011) H: Harrison’s Principles of Internal Medicine, 18th ed. (2012) COA: Clinically Oriented Anatomy, 6th ed. (2010) GG: Goodman and Gilman Pharmacological Basis of Therapeutics, 12th ed. (2011)

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STEP 1 REVIEW COURSE – Part 1, Set 31 1. A 6-year-old boy is receiving poor grades in school. His teachers and parents report that he has normal intelligence but that he is very distractible and full of excess energy. What medication might help this boy? (FA13 p460) (FA14 p502) (SU14 p60)

2. What are the carpal bones of the wrist from radial to ulnar? (COA p674)

3. On which cells would you find CD4 molecules? On which cells would you find CD8 molecules? What actions do the CD8+ cells accomplish? (FA13 p196-197) (FA14 p201-202) (SU14 p260)

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STEP 1 REVIEW COURSE – Part 1, Set 31 4. Why is diphenhydramine (Benadryl) a poor medication choice in the elderly and those with BPH? (FA13 p231, 562) (FA14 p244, 613) (SU14 p114)

5. Clopidogrel (Plavix) and ticlopidine are commonly used after MI or cardiac cath with stent placement. What is the mechanism of these drugs? (FA13 p368) (FA14 p400) (SU14 p276)

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STEP 1 REVIEW COURSE – Part 1, Set 31 6. What breast pathology fits the following description? (FA13 p533-535) (FA14 p584-586) (SU14 p218) •

Most common breast tumor in women under 25

•

Most common breast mass in postmenopausal women

•

Most common breast mass in premenopausal women

•

Most common form of breast cancer

7. What common over-the-counter medication is used to remove excess thick sputum by stimulating the vagus nerve to generate low viscosity secretions in the bronchial tree? (FA13 p563) (FA14 p613) (SU14 p115)

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STEP 1 REVIEW COURSE – Part 1, Set 31 8. What are some of the signs and symptoms of pericarditis? (FA13 p275) (FA14 p292) (SU14 p93) (R p582)

9. A 30-year-old Asian woman presents to your clinic with a variety of complaints. Upon completion of her exam you are suspicious of Takayasu arteritis. What were likely some of the patient’s presenting complaints? (FA13 p276) (FA14 p296) (SU14 p92)

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STEP 1 REVIEW COURSE – Part 1, Set 31 10. What are other examples of encapsulated bacteria that have a preventative vaccine? What test can be used to detect encapsulated bacteria? (FA13 p121) (FA14 p123) (SU14 p331)

*Page references are as follows: FA13: First Aid for the USMLE Step 1 2013 FA14: First Aid for the USMLE Step 1 2014 SU14: Step-Up to USMLE Step 1 2014 R: Robbins and Cotran Pathologic Basis of Disease, 8th ed. (2010) Phys: Guyton and Hall Textbook of Medical Physiology, 12th ed. (2011) H: Harrison’s Principles of Internal Medicine, 18th ed. (2012) COA: Clinically Oriented Anatomy, 6th ed. (2010) GG: Goodman and Gilman Pharmacological Basis of Therapeutics, 12th ed. (2011)

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STEP 1 REVIEW COURSE – Part 1, Set 32 1. What anticonvulsants are used to treat absence seizures? What anticonvulsants are used to treat status epilepticus? (FA13 p451) (FA14 p492) (SU14 p46-47)

2. What is the mechanism of action and clinical use for varenicline? (FA13 p471) (FA14 p514) (SU14 p60) (GG p272)

3. Which diuretics are most appropriate for patients with hyperaldosteronism? What are their important side effects? (FA13 p501) (FA14 p548) (SU14 p166-167)

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STEP 1 REVIEW COURSE – Part 1, Set 32 4. What asthma medication fits each of the following statements? (FA13 p563) (FA14 p614) (SU14 p108) Statement

Medication

Inhaled treatment of choice for chronic asthma

Inhaled treatment of choice for acute exacerbations

Narrow therapeutic index, drug of last resort

Blocks conversion of arachidonic acid to leukotriene

Inhibits mast cell release of mediators, used for prophylaxis only

Inhaled treatment that blocks muscarinic receptors

Inhaled long-acting β2-agonist

Blocks leukotriene receptors

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STEP 1 REVIEW COURSE – Part 1, Set 32 5. What is the difference between mean, median, and mode? What are their relationships in a positively-skewed curve and a negatively-skewed curve? (FA13 p54) (FA14 p56) (SU14 p21)

6. What is the mechanism of action of neomycin? What are the toxicities with this class of medication? (FA13 p180) (FA14 p184) (SU14 p434)

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STEP 1 REVIEW COURSE – Part 1, Set 32 7. When an infant is born and takes its first breath, the lungs expand and create negative pressure that draws blood into the pulmonary circulation. Because the pressure in the pulmonary circulation is lower than that in the aorta, blood preferentially flows into the pulmonary circulation and the ductus arteriosus closes. What other fetal blood vessels are closed in the adult circulation? (FA13 p252) (FA14 p265) (SU14 p63-64) (Phys p269-271)

8. What foods, typically high in mercury, should be avoided during pregnancy? (R p407-408)

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STEP 1 REVIEW COURSE – Part 1, Set 32 9. What artery supplies the distal third of the colon? What artery supplies the proximal two-thirds of the colon? From what embryonic structures are the distal third and proximal two-thirds of the colon derived? (FA13 p312) (FA14 p338) (SU14 p118)

10. You are rotating with an anesthesiologist and learning to calculate dosages of anesthetics with her. How does the rate of elimination differ between zero-order elimination and first-order elimination? Which type of elimination behaves as though the enzymes responsible for the elimination are saturated? (FA13 p228) (FA14 p240) (SU14 p16)

*Page references are as follows: FA13: First Aid for the USMLE Step 1 2013 FA14: First Aid for the USMLE Step 1 2014 SU14: Step-Up to USMLE Step 1 2014 R: Robbins and Cotran Pathologic Basis of Disease, 8th ed. (2010) Phys: Guyton and Hall Textbook of Medical Physiology, 12th ed. (2011) H: Harrison’s Principles of Internal Medicine, 18th ed. (2012) COA: Clinically Oriented Anatomy, 6th ed. (2010) GG: Goodman and Gilman Pharmacological Basis of Therapeutics, 12th ed. (2011)

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STEP 1 REVIEW COURSE – Part 1, Set 33 1. A 67-year-old male CHF patient lost his job and medical insurance, so he stops buying and taking his digoxin, and develops dyspnea. What will this do to his cardiac output (CO)? What are the mechanisms behind his development of dyspnea? (FA13 p254, 273) (FA14 p268, 291) (SU14 p73, 86)

2. What is Kallman syndrome? (FA13 p525) (FA14 p575) (SU14 p203) (H p2878)

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STEP 1 REVIEW COURSE – Part 1, Set 33 3. A 31-year-old man is post-op day 1 after an exploratory laparotomy. The surgery was performed emergently for intraperitoneal hemorrhage after a motor cycle crash. His creatinine today is elevated to 2.0 mg/dL. His pain is currently uncontrolled. Explain why an NSAID could lead to a potential complication in this patient. (FA13 p481, 485) (FA14 p526, 529) (SU14 p245-246)

4. A 17-year-old girl is brought to the emergency room for abdominal pain and vomiting. She has a fever, and further questioning and exam reveal that the pain is in the right lower quadrant and has rebound tenderness. She says the pain began around the umbilicus. She is very nauseated and vomits again during the exam. What must be ruled out prior to coming to the final diagnosis in this patient? (FA13 p329) (FA14 p355) (SU14 p120, 127)

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STEP 1 REVIEW COURSE – Part 1, Set 33 5. What is the mechanism of action of local anesthetics? Which nerve fibers are blocked first with local anesthesia? (FA13 p454) (FA14 p495)

6. Which phagocyte dysfunction disease increases patient susceptibility to S. aureus and E. coli? What is the cause of this disease? (FA13 p207) (FA14 p213) (SU14 p269)

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STEP 1 REVIEW COURSE – Part 1, Set 33 7. What are the 3 different eukaryotic RNA polymerases? What type of RNA does each make? (FA13 p70) (FA14 p73) (SU14 p297)

8. What medications are used in the treatment of urge incontinence? (GG p232)

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STEP 1 REVIEW COURSE – Part 1, Set 33 9. What are the layers of the epidermis beginning with the most superficial layer? What is Auspitz sign? (FA13 p378, 397) (FA14 p410, 432) (SU14 p253-254)

10. A 45-year-old obese woman comes to your clinic with complaint of polyuria and polydipsia. Glucose tolerance tests are abnormally elevated. Which cell types do not require insulin for the uptake of glucose? (FA13 p288) (FA14 p308) (SU14 p176)

*Page references are as follows: FA13: First Aid for the USMLE Step 1 2013 FA14: First Aid for the USMLE Step 1 2014 SU14: Step-Up to USMLE Step 1 2014 R: Robbins and Cotran Pathologic Basis of Disease, 8th ed. (2010) Phys: Guyton and Hall Textbook of Medical Physiology, 12th ed. (2011) H: Harrison’s Principles of Internal Medicine, 18th ed. (2012) COA: Clinically Oriented Anatomy, 6th ed. (2010) GG: Goodman and Gilman Pharmacological Basis of Therapeutics, 12th ed. (2011)

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STEP 1 REVIEW COURSE – Part 1, Set 34 1. A 40-year-old man is beginning to have symptoms of a resting tremor, postural instability, and masklike (expressionless) facies. Name the antiviral drug and its mechanism of action that could be used against this disease. (FA13 p455) (FA14 p496) (SU14 p48) (GG p614)

2. What are the symptoms of decompression sickness? (Phys p538)

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STEP 1 REVIEW COURSE – Part 1, Set 34 3. A 55-year-old alcoholic is admitted to the hospital for upper GI bleed. A ruptured esophageal varicose is found to be the cause. What is the preferred medical treatment for this condition? (FA13 p341) (FA14 p371) (SU14 p121)

4. A 28-year-old man is being treated with combination of bleomycin, etoposide and cisplatin for metastatic non-seminoma testicular cancer. The patient develops SOB during the course of treatment. Pulmonary function testing indicates that the patient has a restrictive lung disease. Which of the chemotherapy agents is responsible for this restrictive lung disease? Which of the chemotherapy agents in the above regimen work by inducing free radicals to interfere with DNA structure? (FA13 p372) (FA14 p404) (SU14 p290)

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STEP 1 REVIEW COURSE – Part 1, Set 34 5. How does flutamide differ from finasteride in terms of clinical use and mechanism of action? (FA13 p539) (FA14 p591) (SU14 p225)

6. A 3-day-old preterm infant delivered at 34-weeks gestational age develops respiratory distress syndrome (RDS). What types of pneumocytes are affected in RDS? What is the mechanism that leads to poor O2-CO2 exchange at the gas exchange barrier in preterm infants with RDS? What structures make up the gas exchange barrier? How would you increase surfactant production in the pre-term neonate? (FA13 p544, 555) (FA14 p594, 606) (SU14 p98, 103-104)

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STEP 1 REVIEW COURSE – Part 1, Set 34 7. What might you observe in a patient who presents to the emergency room with PCP intoxication? (FA13 p471) (FA14 p515) (SU14 p55)

8. Which bone is commonly fractured when a person hits something with the knuckles of a clenched fist, causing deep pain in the anatomical snuffbox? (SU14 p244, 385) (COA p686)

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STEP 1 REVIEW COURSE – Part 1, Set 34 9. How does the mechanism of action of benzodiazepines differ from the mechanism of action of barbiturates? What toxicities of barbiturates can be fatal? (FA13 p452-453) (FA14 p493) (SU14 p46)

10. IFN-γ stimulates macrophages and inhibits T2 helper cells. What cell type releases IFN-γ? (FA13 p196) (FA14 p201) (SU14 p261)

*Page references are as follows: FA13: First Aid for the USMLE Step 1 2013 FA14: First Aid for the USMLE Step 1 2014 SU14: Step-Up to USMLE Step 1 2014 R: Robbins and Cotran Pathologic Basis of Disease, 8th ed. (2010) Phys: Guyton and Hall Textbook of Medical Physiology, 12th ed. (2011) H: Harrison’s Principles of Internal Medicine, 18th ed. (2012) COA: Clinically Oriented Anatomy, 6th ed. (2010) GG: Goodman and Gilman Pharmacological Basis of Therapeutics, 12th ed. (2011)

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