E – Zoster is caused by a reactivation of latent varicella virus (aka chickenpox) from dorsal root ganglion.None of the other choices are fatty acid oxidation disorders (and consequently associated with a build-up of fatty acids) These disorders can be fatal, as affected individuals cannot break down fats into usable energy during times of fasting/starvation. C – Thankfully, painful biochemistry really isn’t all that common on Step 1.In the lower extremity, that’s foot to knee to groin. C – Lymphatic spread of disease moves through lymphatic channels from distal to proximal.Handwashing with soap is necessary, and equipment should be autoclaved to clean it. Alcohol-based rubs are not sufficient to kill the spores. D – Antibiotic-associated diarrhea caused by clostridium difficile can be tenacious, difficult to treat, and even fatal.Superior rectal varices cause internal hemorrhoids. Periumbilical varices can cause caput medusa. B – Esophageal varices are a big deal and can be fatal.Paracoccidioidomycosis from Mexico and South America. Histoplasmosis is endemic to Ohio River valley. Coccidiomycosis comes from the southwest (i.e. B – You don’t necessarily have to know a ton clinically about differentiating endemic fungal diseases, but you do have to know which areas they come from and what they look like.Thankfully, there’s a vaccine for that now. D – HPV (particularly strains 16 and 18) causes squamous cell carcinoma of the cervix.This can be done by saturating the alcohol dehydrogenase enzyme with intravenous alcohol or through the use of fomepizole (a competitive inhibitor). The trick in treatment is to prevent the conversion of the original alcohols into their toxic metabolites. A – Naughty alcohols–methanol (wood alcohol), ethylene glycol (antifreeze), and isopropyl alcohol (rubbing alcohol)–cause terrible damage through their metabolites (formic acid, oxalic acid, and acetone, respectively).It’s the most important cause of neonatal sepsis and meningitis. Group B streptococcus can be part of the flora of the mother’s vagina (which babies are exposed to during vaginal birth). A – Gram-positive cocci in pairs and chains means streptococcus.If it’s keratinocytes at play (and not melanocytes), that leaves you with either squamous cell or basal cell carcinoma.

E – A chronic “heaped up” ulcerative lesion of the skin, especially on sun-exposed areas in people who spend time outdoors, means cancer.Korsakoff’s Syndrome on the boards invariably includes anterograde amnesia with confabulation (making things up). E – Wernicke–Korsakoff syndrome causes degeneration of the mammillary bodies (important fact).Malacoplakia causes GU papules/ulcers, typically of the bladder (not super important). Tumor-like growth, upper urinary tract infection, and (this is key) lipid-laden foamy macrophages make this neither acute pyelo nor cancer. E – Xanthogranulomatous pyelonephritis (XGP) is a rare form of chronic pyelonephritis, especially associated with Proteus infection.The body wants to retain fluid and maintain blood pressure, so there is a compensatory increase in anti-diuretic hormone (ADH/vasopressin). D – Volume loss (secondary to vomiting in this case) causes hypovolemic hyponatremia.My explanations can be found here.įor those who have done the more recent set, a list of the questions unique to the 2013-14 practice materials are found in this footnote. The newest set of official questions (2014-2015) has been released. I can’t reproduce the questions themselves of course as they’re copyrighted. From the official 2013-14 “Step 1 Content Description and General Information” booklet (archived here), I’ve listed the correct answer for each question with a brief explanation ± take home points.

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