2003 USMLE STEP 1 HI-YIELD TOPICS

AND REMEMBERED QUESTIONS

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Anatomy

1. Infant described w/hydrocele (transillumination etc), ?pathogenesis: patent processus

vaginalis*
2. Fx medial humeral epicondyle, ?nerve injury: ulnar nerve*
3. Ant compartment sy, lower extremity, ?damage: tibial artery*, deep peroneal nerve*
(2qs)
4. Pudendal block for delivery: landmark, ischial spine*
5. Injury upper trunk of brachial plexus, 2 qs
6. Stillborn, olygohydramnios, lung hypoplasia, ?most likely: kidneys’ agenesis* (Potter)
7. Hydronephrosis + hydroureter in newborn, ?pathogenesis →Post urethral valves BUT
they wrote instead: congenital stenosis of membranous urethra*
8. Pt lies supine, with flexed knee, we ask to raise his leg against R about his thigh, ?
which muscle are we testing: ?quadriceps femori, ?iliopsoas, etc
9. Dye passes between cells: connexons* (HY!)
10. S/p thyroidectomy, pt described w/tetany symptoms, ?Tx: give ca++ (*)
11. PTH, on surgery, found only 2 sup and 1 inf parathyroid glands, where to look for the
4th missing one? Thymus*
12. Barbiturates toxicity, pathology in liver? Incr SER*
13. Elderly pt with distended SB on AXR and large bowel just to mid –transverse colon,
lactic acidosis, ?most likely: SMA occlusion*
14. How we get retropneumoperitoneum, location of perforation: ascending colon*,
jejunum, ileum, cecum, sigmoid
15. Pt described w/huge hiatal hernia, ? associated symptoms: ?lymphatic obstruction*,
?incr vagal activity, ?DVT, varicocele etc(no GER, or GI symptoms mentioned)
16. Embriology middle ear, 1st arch?, 1st cleft?, 1st pouch?, 2nd arch?
17. Why females get more peritonitis from STD?, fallopian tubes open within the
peritoneum*
18. Meiosis I: 1o oocyte +- mitotic spindle? 2nd oocyte? Etc
19. Innervation by chorda tympani: 2/3 post tongue + submandibular+submaxill glands*
20. Macrophages of liver: Kupffer cells* (Kidney - mesangial cells/ Lungs - alveolar
macrophages/ Brain - microglial cells/ Lymph - circulating macrophages)
21. PDA closure noted on fetal US,? Drug mother took: indomethacin*
22. In which part of the adrenal gland mineralocorticoids are secreted? Zona
glomerulosa*
23. Description of 16 y old w/primary amenorrhea, short slightly overweighted (this
mentioned just in measurement), poor secondary sex charact, , if u biopsy ovaries,
what would u see? Atrophy?; polycystic ovaries?.etc (there were 2 qs one was clearly
Turner….the other might be polycystic ovaries as well…)
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Biochemistry:
1. Alkaptonuria, ?parents asked u about long term prognosis: ?arthritis*, ?renal calculi
2. Pathogenesis of CGD of childhood
3. Menkes disease, MOA
4. In which part of the cell removal of the introns from mRNA take place?: nuclei*?,
RER? Golgi? Etc
5. CF, MOA receptor, CF transmembrane conductance regulator gene → defect in Cl-
channels* (CF is HY, many qs)
6. SCD (but not in q stem), they said disease caused by substitution val for glu, question
about which type of bond of bond is affected….
7. Mother Hx of myelomeningocoele, son with MMC, which vitamin decreases risk for
this abnormality? Folate*
8. Hypercholesterolemia, ?pathogenesis: ans description of LDL receptor (Receptors
and second messengers r extremely HY!)
9. tRNA wobble diagram, asked to show site of different functions (2 qs..similar q in
retired or self test)
10. Fetal alcohol sy: 2 qs
11. Tx child with hyperammonemia, etc
12. ?Reason some pts get lactic acidosis post alcohol ingestion….know everything u can
about OH
13. McArdle’s described, ? enzyme: muscle phosphorilase
14. Von Gierke’s*, description disease
15. Drawing IG, where does the Ag bind?
16. Multiple skin ca (xeroderma pigmentosum), ?what’s wrong; DNA repair defect*
17. Mother has 2 y old son w/ MPS w/ decr iduronidase and w/N chromosomes, now she
is pregnant again, amniocentesis is done, demonstrated decr iduronidase, what else
is necessary to be done: ?check for MPS in amniotic fluid*, ?chromosomal analysis,
?fetal biopsy of the liver, ?mothers liver biopsy
18. Prader Willi sy, paternal imprinting, microdeletion 15q*
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Behavioral Sciences:
1. Pt described w/delirium* post cholecystectomy
2. Girl with IDDM, not compliant, feel embarrassed about disease, etc
3. Informed consent, 2qs
4. Calculate odds ratio, all values were not given in tables, u have to make ur own table
and understand where in the q stem u have to pick the values…very imp!! Lots of
qs…this is not difficult and worth knowing this..of course for everything sensitivity,
specificity, PPV, NPV etc
5. Asked about a new test, check values glucose many times, given the measurements,
what r u checking; ?precision*, ?accuracy
6. Test with high specificity is useful to confirm a diagnosis
7. Clinical trial described u have to choose it from the options
8. Power
9. Boy w/ADHD, last year at school, he did ok, present year not, who is ashamed:
?teacher, ?parents etc (doctor at least not mentioned)
10. Bipolar disorder (student says her project would save the world, doesn’t sleep, etc..1
y before, 1month depressed all time in bed..)
11. Adolescent pt w/symptoms of depression, highest risk for suicide attempt: previous
attempt w/ASA
12. Asked about narcissistic personality
13. Schyzoid pt? Schizophrenia?, etc
14. Woman doesn’t want to have sex more than once in 2 months; ?name of disorder
15. 8 y o girl with pain etc in introitum, doesn’t allow physician to check that area, starts
yelling not again, Dr asks about abuse, mother gets upset, wants to leave the room,
what do u do next: ?inform the mother that she has to stay until u check the girl
adequately, ?Call security….
16. 20 y o pt with ribs fractures, bruises etc while checking her she realized it’s late, and
she says she has to go back home, if not her husband gets very upset, how do u
approach her?
17. 30 + y o, mom of 3 kids, says she feel hopeless, cries all days, etc, ?TX
18. Pt referred for primary amenorrhea, eventually she is XY, and how do u explain this
to the patient?
19. Pt w/ breast lesion on palpation, what do u tell the patient: feel something there, u
don’t know what is it, so u would like her to have a mammo done (most reasonable
option)
20. Tx of bulimia
21. Pt w/certain ca type, according to statistics: 1y sv: 90%; 2y SV: 85%; 3y SV:80%;
4y:75%; 5y sv: 70%*; pt has this ca for 2 y, ?survival by 5y ….this is very simple
when u talk about survival u don’t have to make calculations….it doesn’t matter how
many years that pt has the disease…
22. Q about Chlamydia in students, prevalence decrease /increase of what? (options incl
they treat more pts, less awareness (don’t remember exactly…so they described u
several situations that might cause these changes…so u need to understand what
they r talking about, very HY epidemiology/stats!)
23. Old male with classical podagra symptoms, + incr ESR, u have to TX w/steroids, lots
of AE to this TX, what makes u decide to biopsy?: If it’s going to change
management*?, to show medical student? etc
24. Narcolepsy
25. Pt that does what she wants goes and chat all time at nurse station, etc, how do u
treat this pt? be assertive
26. Elderly pt recovered from CVA, pt speaks slowly, daughter says he is depressed, bad
mood, etc, ?what do u do next: ?ask the patient* (ALWAYS whenever possible), ?ask
the nurses etc
27. Person who committed brutal suicide, which NT is decr? Serotonin, ?NE
28. Scheme about sensitivity, etc similar to CD
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29. Phenotype mentally retarded, fragile X, at least 3 qs of fragile X.

30. Most important preventable cause of cancer: smoking
31. Depression
32. Normal grieving

Microbiology & Immunology:

1. Pt w/CF and bronchiectasis, gets pneumonia, ?bug: P. aeruginosa
2. HZV, why do u give acyclovir? To reduce duration and severity of symptoms of
present disease
3. virus: description disease, asked about etiology: virus not mentioned just morphologic
description: DNA/ RNA, double or single stranded, icosahedral, naked etc (3 or 4 qs
like this, 1 w/HSV, 1 w/mumps, 1w/exanthema subitum)
4. Female from NW USA, gets cardiomyopathy? Etiology? Viral? Bacterial…..
5. Nasopharyngeal ca a/w: EBV
6. Girl from rural area, no immunizations, doesn’t go to school, sore throat, high fever,
exudative membranes-likes (not pseudomemebarnes; ? diphtheria, ?Group A strep (it
seemed to b diphtheria..esp since they said no immunization, similar qs in Pretest
vignettes)
7. boy 13 y o, swims every morning, on physical exam, pain why u press tragus, pain
EAC, etc ?Bug; pseudomona
8. Nurse with sinusitis and air-fluid level on x-rays; bug needed factor V and X, ?source:
from hospital?, from patient? N flora from nares?, N flora from nasopharynx?
9. Ig A deficiency vs. Hyper Ig M syndrome
10. Boy and brother get meningococcus, ?deficiency (late Complement)
11. Pt described w/HZV, Gramm and Wright stains done?findings….multinucleated giant
cells…
12. Experimental mice w/Bruton’s tirosinase deficiency, which bug r they more prone to
get infections from?
13. CIN a/w HPV
14. Picture w/staghorn, ?bug: proteus
15. Mother gets a cold, her child gets a more compl disease a week later w/symptoms
like epiglottitis; ?bug: ?parainfluenza, ?RSV
16. Which bugs are used for quality control of a laboratory: ?E.coli + H.influenza, ?E.coli
+….
17. Pt went to Africa, came back w/malaria, given 2 drugs incl primaquine, ?why
18. Pregnant female gets CMV, ?perinatal infection, ?congenital infection etc
19. CGD described, pathogenesis?
20. HIV, why Tx w/3 drugs? For high frequency of mutational R
21. Giardia slide → malabsorption
22. CD4 → MHC II
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Pathology & Physiology

1. Pt described with hematuria, flank mass,?disease: Renal cell ca (hypernephroma*)

2. Pt with vertebral compression # + multiple blastic lesions, most likely? Metastatic
prostate adenoca
3. Pt w/Hx of working in an asbestos factory + heavy smoker, now SIADH + weight loss
?small cell* ?mesothelioma ?bronchioalveolar
4. Pt w/abn CSF, lymphocytosis, cranial nerve palsies,? most likely: TB meningitis*
5. Pt w/severe osteoporosis: arrows for PTH, ca++, P,etc know this table from BRS path
very well..at least 2 or 3 qs
6. Newborn at term, infant of diabetic mother, resp distress,?most likely: Meconium
aspiration sy
7. Described pt suffering from Horner’s sy, etc ?underlying disease: Lung ca*
8. Description child w/findings consistent w/ nephrotic sy , urinanalysis? ovoid fat cells*,
RBCcasts, WBC casts etc
9. Atrophic pancreas + calcifications on CT, ?underlying disease: ?alcoholism*,
?gallstones
10. Pt w/incr amylase, midepigastric pain, known cholelithiasis; ?etiology: ?cbd stone,
stone in ampulla?, stone in cystic duct?
11. Bartholin’s abscess
12. Pt w/hydatiform mola, ?karyotype
13. Pt a month after resection of hydatiform mola, incr hCG, ? chorioca ?residual
placenta
14. Type of diarrhea in AIDS pt
15. Type of diarrhea in Immunocompromised
16. AIDS pt +ring enhancing lesions on CT, abn CSF, +path slide; not India ink!,
?Nocardia, ? Toxoplasma ? Cryptococcus
17. Von Willebrand /ITP/TTP 3 or 4 qs w/different values of incr, decr or N PT, PTT, etc
know this well
18. Female 80 yo, on X-rays Dx of OA, pt with articular + muscular pain, given NSAID,
got better, ?mostlikely: ?polymyalgia rheumatica ?RA
19. Boy with large polyp in rectum containing different tissue types: ?hamartoma,
?Angiomyolipoma etc
20. What happens to GFR, RPF, etc if u constrict efferent arteriole (arrows)
21. Soccer player injured, ligamentous rupture; didn’t wan to move, died week
after,?most likely at autopsy: ?large PE*, ?small PE…
22. Female w/URI, a week after presented w/pain described to me sounding like (relieve
when she lies like muslin praying etc) pericarditis*
23. Pancreatic secretion as prohormone/proenzyme (don’t remember): insulin + peptide
C
24. Coupling actin/myosin, ryanodine receptor, at least 2 or 3 qs
25. Most precise for diagnosis of DIC? Incr fibrin degradation products*
26. Melanoma, ?worst prognosis: vertical growth*
27. s/p tear muscle, fibrosis at scar, what would be affected? Tension? relaxation? Etc
28. s/p terminal ileum resection, what would be affected? Lipid absorption*? Intrinsic
factor secretion?( READ the stems VERY carefully….many of u ans very
quickly…and I remember LOTS of qs that were like this one….vit B12 absorption
would be impaired but not secretion…..)
29. Pt w/HCCa, single test that would be most diagnostic: HCV* (no option w/HBV)
30. Infant with retinal hemorrhages, fell from sofa while mother boyfriend was taking care
of him: Shaken baby sy*(there’s an identical qs in webpath….)
31. Patient described w/bilateral hilar lymphadenopathy, bilateral parenchymal infiltrates,
epitheliod cells, no fever, etc (sarcoidosis *, TB not an option…similar q in BRS)
32. Pt w/testicular tu? Assessment spread, what’s better: ?CT abdo, ?CT pelvis,
(tricky/bad q)?palpate ingu. LN…etc
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33. Pregnant female w/Sheehan’s sy ?pathogenesis: ?ac interruption hypophyseal portal

system*, ?slow interruption etc
34. Inhibin regulates?: FSH*
35. N pt w incr pH (7.6), decr bicarb, what mixture is breathing:?20% O2, 75% CO2,
5%N2?; N2 75%, 5% CO2; 20% O2?
36. Hb shift to the right: Metabolic alkalosis, graph
37. Pt w/ systolic murmur, thrill apex, etc ?VSD*
38. Female from SE Asia, pregnant, murmur described as MVP, ?pathogenesis
39. Calculate SV from Fick’s principle
40. 16 yo girl w/1o amenorrhea, 1.40m 45kg, ?most likely ovarian appearance: ?atrophy*
(Turner’s), ?policystic
41. Endometrial ca
42. Pt w/known gralized complex sz; now described w/partial sz (only hand etc), where is
the focus? temporal lobe*
43. Pt goes for routine check up on thread mill, ST elevation, coronary art OK on
angiocath, ? which TX, with arrows: to decr afterload, decr CO etc
44. Headaches – types. Migraine…woman vomits, etc at least 3 or 4 qs about headaches
45. Cluster headache *: M.C in men
46. Barbiturates intoxication, ?typical liver findings on biopsy/autopsy: incr SER* (BRS
path)
47. To prevent reperfusion injury in mice (during experiment): give antioxidant 1h before,
just before injury etc
48. Factor XIIa*: links coagulation, kinin and complement
49. AAA incr risk for damage in/after surgery?, sigmoid colon?, jejunum?, ileum? cecum?
50. Length, tension, force velocity relationship
51. Calculate diffusion or not, given weird numbers of hydrostatic P, oncotic P etc
52. Hyperaldosteronism, different forms, many qs
53. HyperPTH, osteoporosis, ca++, P and PTH relationship w/arrows, at least 3qs
54. Diabetes, lots of qs, receptor for insulin, receptors for sulfonylureas,
glucophage/lactic acidosis, Tx etc, HY!
55. Child w/GI hemorrhage, chronic anemia, given H2 blocker, gets better, ?most likely
disease: GE reflux*
56. Ca thyroid → radiation exposure*
57. CF, ?receptor: transmembrane conductance regulator*
58. Constriction efferent arteriole, ?consequences: incr GFR, decr RPF, incr filtration
fraction (in arrows)
59. Drug which incr bronchial dilatation and decr heart rate, + other (?x)
etc?isoproterenol? other? Not mentioned on q stem name of first drug…..kinda weird
60. which option would incr concentration of 1 25 DHD3? Hypocalcemia*(similar in
Gannong)
61. Hypoxic vasoconstriction, ?Site: lungs*
62. Patient w/multiple skin ca types,? pathogenesis: defective dimers repair*
63. Decr FEV1sec/FEV relationship, in obstructive disease, asthma
64. Alcoholic + thyamine deficiency, ?findings in autopsy: destruction of mamillary
bodies*.
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Pharmacology:
1. Pt treated for severe trychophytosis w/griseofulvin, what other drug works at the
same timing? Paclitaxel
2. MOA acetazolamide
3. MOA tiazides
4. MOA loop diuretics (diuretics HY)
5. Male w/CHF, gets gynecomastia, ? drug: spironolactone
6. Tx: nephrogenic DI
7. Pt Tx w/captocril, can’t stand cough → Losartan
8. tricyclics + urinary retention
9. Pt w/agranulocytosis: Tx: G-CSF
10. Pt with documented severe allergic reaction to penicillin, what do u give?
Cephalosporins? Aztreonam? Vanco?
11. MOA Cyclosporine (asked which one suppresses IL-2….) Cyclosporin A - direct
suppressive effect of B and T helper cells.
12. Tx Hay fever; choose MOA DOC
13. MOA antihistaminic drug
14. MOA Sulfonylureas
15. INH → hepatitis
16. Procainamide + SLE
17. Flumazenil, diagram, ?competitive antagonist: chlordiazepoxide
18. heroin, now on methadone program, ?adverse effects; ?constipation, SE methadone:
constipation
19. Pt treated w/captopril, get cough, change to similar: losartan
20. Prophylaxis contacts w/meningococcus: Rifampin
21. Anions, cations, + acetazolamide
22. Classic: Nortryptiline + MAO inh
23. Nitrates MOA (molecular level) activate guanylate cyclase …NO
24. Amiodarone, AE: pulmonary fibrosis
25. Milrinone
26. Female 30w pregnant, on prenatal US ductus is closed, ?drug given: indomethacin
27. Showed diagram of stomach physiol….asked which drug acts on H2
receptors……cimetidine
28. Spindle poisons → plant alkaloids
29. Tx addison’s: fludrocortisone + glusocortic
30. tPA + MOA intrinsic plasminogen? Extrinsic? Exogenous….kinda confusing
31. 2 curves with effect of 2 drugs X and Y… why is Y steeper and lower than X?
because of quicker reabsorption/ elimination/ bioavailability… volume of distribution..
etc…
32. Antagonist drug response curve
33. Parathion poisoning;atropine + ? = Pralidoxime
34. Tx migraine in asthmatic
35. Description of pt. having Absence seizures, Tx? Ethosuxomide
36. Adverse effects of lovastatin → muscle pain
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Slides & Photos

• Quality of x-rays, great; quality of histo +-; quality of macro satisfactory; quality of
diagrams, too small (at least for me, extremely difficult to read letterheads); quality
of graphs (curves, drugs) simple and understandable
• * = right answer

1. CXR w/pneumothorax, also obvious from q stem

2. CTA, asked about liver perfusion, ?position intraart cath for injection: radiologist
inserted catheter through →fem artery, aorta, celiac → proper hepatic artery
3. Cerebral angiography; clinica of ACA infarct (leg), show artery on cerebral
angiography
4. Cervical rib - cervical spine x-ray, obvious symptoms from q stem
5. Calcific tenditinis on shoulder x-ray, ?calcification: ?supraspinatus* ?subscapularis
6. Infant w/Hx of perinatal infection, non communicating hydrocephalus, sagittal MRI,
show site of obstruction: →aqueductal stenosis*
7. Large SDH (acc to brain CT image); cannot exclude Epidural; however after
“following day/24h”…..LOC, interval pt was “lucid”, asked about what ruptured, both
choices: middle mening art (epi) and bridging veins (SDH); tricky…
8. Endometrial ca path micro (even not related to q); MOA estrogen* as carcinogen
9. 35 y o female, CIN slide, multiple partners, asked about assoc → HPV
10. Diarrhea, slide w/probably Giardia, asked about cause of malabsorption sy
11. History of HIV w/ abn CSF(meningitis like, lymphocytes etc) and multiple ring
enhancing lesions of varying sizes on CT (not showed, just described on q stem);
showed histo slide (not India ink), ?bug: ?nocardia, ?toxoplasma, ?cryptococcus
12. Brainstem lesion- gross, show area according to clinica
13. Arrow on aqueduct of Sylvius -gross anatomy, ?lesion at this level; non-
communicating hydrocephalus*
14. Diagram about protein translation
15. Drawing of alveolar wall (quite bad) which cell of the horrible diagram is a
pneumocyte type II
16. EM slide: asked about connexons
17. EM slide: show desmosome, asked about function
18. Multiple myeloma path micro, asked about pathogenesis
19. ECG with extrasystole, choose the strongest complex (immediate after extrasystole*)
20. Gross spinal lesion in dorsal columns (same as CD) asked about pathogenesis
21. LOTS of physio diagrams
22. Celiac disease; path slide; asked about protein malabsorption (?)
23. Gross kidney + staghorn calculus, asked about bug: Proteus*
24. Gross kidney, young boy + Tu: asked about tu supp gene: WT1
25. Picture of pt w/superficial varices in lower extremity, ?pathogenesis (?stasis, ?insuff
valves, ?chronic DVT)
26. Picture w/vesicles within great toe of kid….? Perhaps HSV, asked about virus: ans
incl shape, dna/rna, single/double strand but did not mention the virus
27. Pedigree of Duchenne’s in a girl (Mec of inheritance)
28. Picture with child w/blue sclera (OI), asked about pathogenesis
29. Funduscopy of diabetic pt
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Recent material from a test-taker:

Drawing of urea cycle. Point to area where NH4 enters the cycle.

What causes RBCs to form aggregates in Sickle Cell Disease?

A gene product is thought to produce tRNA. What characteristic tells you that it is tRNA?
1. presence of many modified bases
2. 7 methyl guanine cap
3. polyA tail

Drawing of glycolytic, gluconeogenic, glycogen synthesis pathways. Point to the part of the
drawing which is influenced by insulin.

G proteins and second messengers

Nitric oxide works thru which second messenger?
- cGMP

How would you distinguish the gene product translated from cDNA from that translated from
ordinary DNA?

Some questions on glycogen storage diseases, lysosomal diseases. They were pretty
straightforward. Study the pathways well.

Post-translational modifications, like capping and N-linked phosphorylation

Study also about lac operon, transcription, translation.

PHARMACOLOGY

This section is pretty ok except for those tracings. Antibiotics, the questions still tend to focus on
the action of the drug at the molecular level. So For example, how does tetracycline work? Ans:
by inhibiting attachment of tRNA to the ribosome. Something like that. Study also the AIDS drugs.
As usual, what action of drug at the molecular level.
I didn't get a lot of anti-cancer drugs. Study adverse effects. Same with all drugs, study the
common adverse effects. Drug for methotrexate
1. What drug is usually given as pre-treatment for leukemia chemotherapy?
- allopurinol
2. Drawing of nephron. Where does this diuretic act?
3. Which of the following anti-diuretics works by inhibiting the Na/K/2Cl transporter?
- furosemide

PATHOLOGY

Px with signs and symptoms of Goodpasture's Disease. What would LM show of a kidney
biopsy?
-crescents

Photomicrograph of a heart muscle form a patient who died of MI. Date the infarct

Photomicrograph of plasma cells. Patient with lytic lesions in the vertebrae. What is the disease?
-multiple myeloma

Mechanism of I cell Disease

Px who is HIV positive with CD4 count less than 200. Px presents with bloody diarrhea.
Colonoscopy showed reddish lesions with crypt abscesses. What is the associated pathology?
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adenoCA
Kaposi's sarcoma
(I couldn't decide between these two )

2 y.o. premature infarct dies after 2 days. Picture of blood clot in lateral ventricles. Cause?
1. SAH
2. Berry aneurysm
3. Intracranial bleed

57 y.o. female with back pain. Xray showed lytic lesions. What is the underlying malignancy?
1. breast CA
2. thyroid CA

Px with Grave's disease. What is the visual field defect?

16 y.o. girl with amenorrhea, shield-like chest. What is the karyotype?

-45 XO

Px with weakness, irritability, paresthesias. Photomicrograph showing basophilic stippling. To

what was he exposed?
-lead

Photomicrograph of hypersegmented neutrophils, what is the deficiency?

- Vit B12 or folic acid

In general, pathology is OK. Classic presentations. It would be good to be an expert in patho to

recover for hateful biochem. I got several photomicrographs of RBCs in Pxs with spherocytosis,
sickle cell. Picture of WBCs, lymphocytes. Familiarize yourself with monocytes, basophils, you
know

MICROBIOLOGY

1. 25 y.o male who went hiking in the woods 2 wks ago. He was treated with a penicillin drug for
throat infection. PE shows linear erythematous rashes over arms, legs, hands. What is the
cause?
- photosensitivity
- Varicella-Zoster
- Hypersensitivity
(I answered photosensitivity)
2. Px with inguinal lymphadenopathy, painless penile ulcer. What is the method of diagnosis?
-dark field microscopy
3. Px with annular erythematous rashes, migratory arthritis. Ab against which organism will be
elevated in the Px's serum?
- Borrelia burgdorferi
4. Px who went on a trip to Brazil developed cardiomyopathy. What is the etiologic agent?
- Trypanosoma cruzi
- Leishmania braziliensis
5. ss (+) RNA, non-encapsulated virus that causes meningoencephalitis. To what group does it
belong?
- Picornavirus
- Coronavirus
- Reovirus
- Etc
6. Px with greenish ear discharge, with a fruity smell. What is the antibiotic of choice?
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As with the other sections, micro is fine except that you have to jog your memory fast coz you're
under time pressure. viruses are tricky but luckily I just got one. Know the difference between
gram (+) and G (-) bugs, virulence factors of bugs esp. cholera, pertussis bugs that act thru G
proteins.

ANATOMY

1. Px with inattention, loss of drive. Point to the lesion. (Drawing of brain)

2. Px with injury to the knee. Point to the structure in the MRI that prevents excessive sliding of
the tibia anteriorly.

3. Hypothenar atrophy and impaired adduction of fingers. What nerve is affected?

4. Px with difficulty doing push ups, doing wrist flexion, extension of fingers. What nerve is
affected?

Study neuroanatomy well.

BEHAVIORAL SCIENCE

Lots of computations on odds ratio, relative risk, Hardy-Weinberg, values for sensitivity and
specificity of two studies and you will be asked to compare. May questions also about biases. The
study will be described and you have to determine what is the bias of study. Questions on alpha
and beta errors. Same thing as before, the study will be described and you'll be asked what error
is it. Questions on what is the best thing to say to a patient given a particular situation. For this
you have to study ethics.

PHYSIOLOGY

Most of the questions on physiology involve charts, graphs then interpret it. Acid base balance in
graph. You will also be given values of lung volumes and you'll be asked what disease the px
has. Obstructive vs restrictive or both obstructive and restrictive? Values of pressures and oxygen
content of each heart chamber, then you'll be asked what the pathology is - ASD, VSD, TOF etc.
Study also GI hormones, that's high yield. Graph on renal part of Kaplan that shows reabsorption
curves in nephron. ( Na K Cl glucose PAH etc). They will point to a line and ask what substance
that is. In my exam, high-yield are respiratory physio, renal, GI. Cardio: a lot of questions. Study
the action potential of nerves and cardiac muscles well. Like ryanodine receptors

1.What structure removes Ca from cytoplasm after contraction?

- ryanodine receptors??
- microtubules
2.What is responsible for depolarization in SA node
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More Remembered Topics

1.HIV (+) man with anemia. Slide of bone marrow shows large cells with numerous
intracytoplasmic inclusions. What’s the pathogen? (I remember one of the choices was
CMV.)
2.Adult female who had chemotherapy for AML. Developed fever and dry cough after one
week. Cxr was clear. BAL fluid microscopic slide: it looks like darkly staining organisms with
narrow based darkly staining bud, these are not inside macrophages or anything. What’s
the virulence factor? (choices I remembered are: large capsule, production of alveolar
exudates [but I swear it didn’t look like PCP], intracytoplasmic location [but I swear it’s not])
3.Adult male consulted for hereditary colonic CA with suggestive symptoms. Brother and
father died of same diagnosis. Work-up reveals colonic CA. wife implores to you not to tell
patient for fear of depression. What to do? (I can’t decide between telling patient outright or
asking patient first what he wants to know about the results? I answered the latter. Of
course whatever the wife says is immaterial.)
4.Cross section diagram of superior part of chest. What pointed structure is responsible for
mydriasis, eye opening, sweating/what structure if lesioned will produce Horner’s? (I chose
this bilateral structure very near and just lateral to the vertebral bodies, other choices were
several nerve like sections albeit unilateral just posterior & lateral to esophagus, and the
trachea) I know I’m supposed to look for the superior cervical ganglion but I haven’t
encountered this diagram before.
5.Very long intimidating question about drug given to young versus old. Young person’s VD
and CL are twice that of the old’s. T1/2 for young person is 24 hours. What’s the T1/2 for
the old person? (Without computing, I just answered 24 hours; should it have been higher
or lower? I mean, the VD and CL are half of the young person’s and the formula is 0.7
Vd/Cl anyway?)
6.Glyceraldehyde 6 P ßà DHAP, reaction in favor of DHAP. What’s the G of this reaction? (I
didn’t cover this in my review so I forgot about choices.)
7.4-year old boy got hit by an arrow in the sternum. (Oh yeah, they have really funny
situations in store for us.) What structure is just behind the sternum in the superior
mediastinum. (I answered thymus. The other choices were trachea, heart (obviously wrong)
and arch of the aorta.)

Lessons I learned &/or things that I should have done but I chose not to or didn’t have time:
1.Webpath, webpath & more webpath images!!!! I downloaded the images but didn’t have time to
view them. Maybe somebody should come out with an atlas for step 1.
2.Radiographic anatomy atlas or anything of that sort is a BIG must. I never bothered thinking I’m
just gonna get a few qs on them but whoa! I got like a block worth of those.
3.Don’t believe people who tell you that micro and pharma is underrepresented and that FA-1 for
these areas are enough. In fact, no single subject is underrepresented. Not even histology or
embryology! Study these thoroughly. And FA is not enough!!!!!
4.Memorize DNA and RNA viruses and replication. I got several questions with same choices. I
regret skipping this figure in Jawetz 6th ed p 170.
5. Learn synonyms of diseases/syndromes. The obvious names are out! The occult names are in.
6.Most clinical questions that have something to do with pharma begin with a case, but the
question is neither the diagnosis nor the DOC but the adverse reaction, drug interaction, or
adverse affects.
7.The questions with more than five choices are actually friendly, recall questions.

Super high yield topics:

1.AIDS, and infections/complications in immunosuppressed (e.g., s/p chemo) patients.
2.Study designs, statistical power, bias, probability. No need to compute but be prepared to think
beyond what’s given.
3.Alzheimer’s, Pick’s and all those dementias including Huntington’s.
4.The classic sporotrichosis question, by the way, did come out, along with a lot of fungal and
parasitic infections and their DOCs.
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5.Enzyme kinetics.
6.Hemoglobin dissociation curves
7.Molecular biology & genetics in Kaplan esp transcription, translation, translocations, mutations,
degeneracy, genetic diseases.
8.Down’s syndrome. This, plus AIDS are like the theme for most of my cases.
9.Pulmonary function tests.
10.Cardiac cycle, e.g., where do you have S4? Curves for CHF and the like.
11.Autonomic drugs given to tissues in petri dishes. Yes there was a piece of a heart & a frog’s
intestine amongst the others. But not so fast, two to three drugs were given and you need to
know all of em!
12.The second messengers, not just for aminergic but also for rhodopsin.
13.Cyclosporine’s MOA.
14.Nerve deficits, and two q about severe combined degeneration.