1 | Page
STEP 1 USMLE QUESTIONS AND
ANSWERS 2025
Heterophile ab NEGATIVE Mono-like syndromes - correct
answer- *CMV
HHV-6
HIV
Toxoplasmosis
Wernicke's Aphasia - correct answer- -word salad: well-
articulated, nonsensical speech paired with lack of lang
comprehension
-aud association cortex: post part of sup temporal gyrus
- supplied by MCA
Congenital Deficiency of Propionyl CoA Carboxylase - correct
answer- -prevents conversion of propionyl CoA to
methylmalonyl CoA
-propionyl CoA derived from= val, ile, met, thr, odd # FA,
cholesterol side chains
-Propionic Acidemia: poor feeding, vomiting, hypotonia,
lethargy, dehydration, anion gap acidosis
,2 | Page
Down Synd Comorbidities - correct answer- Neuro: MR, early
onset Alzheimer's
Cardio: complete AV septal defect, VSD, ASD
GI: duodenal atresia, hirschprung disease
Endo: hypothyroid, DM1, obesity
Heme: ALL (> 5 yo) and AML (<5 yo)
Rheumatology: atlantoaxial stability
MCC of Hypoglycemia in EtOH-ics - correct answer- Thiamine
def= suppression of GNG (pyruvate DH) and TCA cyle (alpha-
KG DH)
MCC of Hypoglycemia in advanced renal insuff - correct
answer- impaired clearance of insulin
Avoid Nitrates in Hypertrophic Cardiomyopathy bc... - correct
answer- Nitrates decrease preload, which will increase the LV
outflow tract... BUT since the ventricle is abnormally shaped,
there is an outflow obstruction
Mets through BM - correct answer- Clonal proliferation of cells
can invade/ metastasize*
,3 | Page
1. malignant cells to lose their cell-to-cell adhesion molecules
(cadherins)
2. cell receptors to attach to laminin (a glycoprotein) in the
basement membrane and to release metalloproteinases (e.g.,
collagenases, stromelysins, gelatinases) to degrade the
basement membrane and other enzymes to degrade the
interstitial connective tissue- tissue inhibitors of
metalloproteinases neutralize these tumor-produced enzymes
and limit the degree of invasion
3. cell receptors to attach to bronectin and other proteins in the
extracellular matrix (ECM) and to break it down
4. malignant cells to produce cytokines that stimulate
locomotion, so that they can move through basement
membranes and the intracellular and extracellular matrices
Bicuspid Aortic Valve - correct answer- Commonly presents in
young, asymptomatic patient with soft systolic ejection at right
2nd ICS
-can cause aortic regurg
MCC of Vaginal Candidiasis - correct answer- 1. Abx use=
reduces lactobacilli pop
2. High estrogen levels- preg
3. System corticosteroid therapy
4. Uncontrolled DM
5. Immunosuppression, including HIV
, 4 | Page
Drug causes of SIADH - correct answer- -Carbamazepine
-Cyclophosphamide
-SSRI
MC Ankle Sprain due to inversion of plantar-flexed foot - correct
answer- -Ant Talofibular Lig dmg
-ecchymosis at the ant-lat aspect of the ankle
Upper Brachial Plexus Injury - correct answer- -
Musculocutaneous and Suprascapular N.
- dystocia mc in neonates; severe trauma mc in adults
- should adduction, elbow extension, and forearm pronation
Patent foramen ovale - correct answer- -failure of septum
primum and septum secundum to fuse after birth
-can lead to paradoxical emboli
Ventricular Septal Defect - correct answer- -MC occurs in
membranous septum
-Acyanotic at birth bc of L to R shunt
STEP 1 USMLE QUESTIONS AND
ANSWERS 2025
Heterophile ab NEGATIVE Mono-like syndromes - correct
answer- *CMV
HHV-6
HIV
Toxoplasmosis
Wernicke's Aphasia - correct answer- -word salad: well-
articulated, nonsensical speech paired with lack of lang
comprehension
-aud association cortex: post part of sup temporal gyrus
- supplied by MCA
Congenital Deficiency of Propionyl CoA Carboxylase - correct
answer- -prevents conversion of propionyl CoA to
methylmalonyl CoA
-propionyl CoA derived from= val, ile, met, thr, odd # FA,
cholesterol side chains
-Propionic Acidemia: poor feeding, vomiting, hypotonia,
lethargy, dehydration, anion gap acidosis
,2 | Page
Down Synd Comorbidities - correct answer- Neuro: MR, early
onset Alzheimer's
Cardio: complete AV septal defect, VSD, ASD
GI: duodenal atresia, hirschprung disease
Endo: hypothyroid, DM1, obesity
Heme: ALL (> 5 yo) and AML (<5 yo)
Rheumatology: atlantoaxial stability
MCC of Hypoglycemia in EtOH-ics - correct answer- Thiamine
def= suppression of GNG (pyruvate DH) and TCA cyle (alpha-
KG DH)
MCC of Hypoglycemia in advanced renal insuff - correct
answer- impaired clearance of insulin
Avoid Nitrates in Hypertrophic Cardiomyopathy bc... - correct
answer- Nitrates decrease preload, which will increase the LV
outflow tract... BUT since the ventricle is abnormally shaped,
there is an outflow obstruction
Mets through BM - correct answer- Clonal proliferation of cells
can invade/ metastasize*
,3 | Page
1. malignant cells to lose their cell-to-cell adhesion molecules
(cadherins)
2. cell receptors to attach to laminin (a glycoprotein) in the
basement membrane and to release metalloproteinases (e.g.,
collagenases, stromelysins, gelatinases) to degrade the
basement membrane and other enzymes to degrade the
interstitial connective tissue- tissue inhibitors of
metalloproteinases neutralize these tumor-produced enzymes
and limit the degree of invasion
3. cell receptors to attach to bronectin and other proteins in the
extracellular matrix (ECM) and to break it down
4. malignant cells to produce cytokines that stimulate
locomotion, so that they can move through basement
membranes and the intracellular and extracellular matrices
Bicuspid Aortic Valve - correct answer- Commonly presents in
young, asymptomatic patient with soft systolic ejection at right
2nd ICS
-can cause aortic regurg
MCC of Vaginal Candidiasis - correct answer- 1. Abx use=
reduces lactobacilli pop
2. High estrogen levels- preg
3. System corticosteroid therapy
4. Uncontrolled DM
5. Immunosuppression, including HIV
, 4 | Page
Drug causes of SIADH - correct answer- -Carbamazepine
-Cyclophosphamide
-SSRI
MC Ankle Sprain due to inversion of plantar-flexed foot - correct
answer- -Ant Talofibular Lig dmg
-ecchymosis at the ant-lat aspect of the ankle
Upper Brachial Plexus Injury - correct answer- -
Musculocutaneous and Suprascapular N.
- dystocia mc in neonates; severe trauma mc in adults
- should adduction, elbow extension, and forearm pronation
Patent foramen ovale - correct answer- -failure of septum
primum and septum secundum to fuse after birth
-can lead to paradoxical emboli
Ventricular Septal Defect - correct answer- -MC occurs in
membranous septum
-Acyanotic at birth bc of L to R shunt
