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USMLE Step 1 Prep

Subjects : health-sciences, usmle-step-1

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. A Japanese man has weight loss - anorexia - early satiety - epigastric abdominal pain - and a palpable left supraclavicular lymph node. On endoscopy you find a large - irregular ulcer with elevated margins on the lesser curvature of the stomach. What
Gastric carcinoma
Increased ACh to decreased NE levels. (NE pathway begins in the pons and regulates REM sleep.)
CD19
Amantadine

2. A 20-year - old black woman goes to you with nonspecific joint pain - fever - and a malar rash over the bridge of her nose and on her cheeks. This is a classic example of What autoimmune disease? What are three autoantibody tests you could order to m
The p50 value does not change in either anemia or polycythemia; the main change is the carrying capacity of the blood.
Osler nodes
SLE; ANA - anti - dsDNA and anti - Sm (anti - Smith)
MGN

3. What type of mortality rate is defined as the number of deaths x From a specific cause per number of persons with the disease?
Carbidopa and benserazide
Clofazimine
Hypotonia (rag doll appearance)
Case fatality rate

4. What are the top three causes of infant mortality?
By causing rebound insomnia and decrease in REM sleep
Gilbert's syndrome
Mitosis
Birth defects - low birth weight (< 1500 g) with neonatal respiratory distress syndrome (NRDS) - and SIDS

5. What T cell line arises from low affinity for self - MHC class I Ags in the thymus?
Endometriosis
Superior
Streptococcus viridans
CD8+ T cells

6. What is the term for drug removal per unit of time in a given volume of blood?
C4 (the upper border of the thyroid cartilage)
Clearance
The first trimester
CN IX - X - and XII

7. What myopathy due to autoantibodies to ACh receptors can present with thymic abnormalities - red cell aplasia - and muscle weakness?
Alcohol abuse
The basilar artery is formed at the pontomedullary junction.
Myasthenia gravis
Linoleic acid and linolenic acid

8. What glycoprotein allows platelets to adhere to von Willebrand factor?
Posterior cruciate ligament
GP Ib
Sorbitol (resulting in cataracts)
The vermis

9. What is the rate - limiting enzyme of the HMP shunt?
Thoracic and sacral
G-6- PD
Parafollicular C cells
Radial nerve

10. Name the eukaryotic RNA polymerase based on the following: x Synthesizes hnRNA - mRNA - and snRNA
Coxsackie B
M
RNA polymerase II
Lumbar splanchnics

11. What stage of male development is characterized by the following LH and testosterone levels? - LH secretion drives testosterone production - with both levels paralleling each other.
CN IX
Diverticulosis
<2
Adulthood

12. Which sodium channel blocker is used to treat lithium - induced diabetes insipidus?
Eclipse period
Crohn disease
BPH
Amiloride

13. Birbeck granules
Histiocytosis X
C1 inhibitor (C1- INH)
Trypanosoma cruzi
VIP is an inhibitory parasympathetic neurotransmitter that results in relaxation of the lower esophageal sphincter.

14. Goodpasture Ag is a component of What type of collagen?
Transvestite fetishism
Type IV collagen
Diastole. During systole the left ventricle contracts - resulting in intramyocardial vessel compression and therefore very little blood flow in the coronary circulation.
1. Fat 2. Forty 3. Female 4. Familial 5. Fertile

15. What AD disease associated with chromosome 19 involves a defect in the LDL receptors that leads to skin and tendon xanthomas?
Invariant chain
Stereocilia
Familial hypercholesterolemia
Selegiline

16. What pituitary hormone is inhibited during sleep?
Endometrial cancer
TSH. 5- HT and prolactin increase during sleep - and dopamine levels decrease during sleep.
Necrophilia
HDL

17. Name the laryngeal muscle described by the following: x Adducts the vocal ligaments - closes the air passageway during swallowing - and allows phonation
Permanent
Lateral cricoarytenoid muscles
Membranous septal defects are interventricular; a persistent patent ovale results in an interatrial septal defect.
Berry aneurysm

18. Name the muscle type based on the histological features: x Actin and myosin in sarcomeres; striated; multinuclear; lacks gap junctions; troponin:calcium binding; T tubules and SR forming triadic contacts; highest ATPase activity; no calcium channels
CN III - VII - IX - and X
For the USMLE Step 1 the answer is no - but if the information would do more harm than good - withhold. This is very rare but it does occur.
CN V2
Skeletal muscle

19. What skin condition is a localized proliferation of melanocytes presenting as small - oval - light brown macules?
Spironolactone (binds to aldosterone receptors)
A Ghon focus is a TB tubercle - whereas a Ghon complex is a focus with hilar lymph node involvement.
Benign lentigo
Epinephrine

20. What is the only antifungal agent to penetrate CSF?
Fluconazole
Pseudohyphae
When the intra - alveolar pressure equals zero - there is no airflow.
Case control studies cannot assess incidence or prevalence - but they can determine causal relationships.

21. What is the most widely used class of antidepressants?
90% of benign myxomas arise within the left atrium near the fossa ovalis.
SSRIs
Secondary hypothyroidism/pituitary (Low TSH results in low T4 and increased TRH because of lack of a negative feedback loop.)
Superior

22. Name the type of exudate - given the following examples - Sunburn
Serous exudates
apo A-1
Congenital heart disease
2% of population - 2 cm long - 2 feet from ileocecal valve - 2 years old - and 2% of carcinoid tumors

23. What AA is a precursor of the following substances? - NAD
Positive
Varicella virus and influenza virus
They are inversely proportional to each other; as pulse pressure increases - compliance decreases.
Tryptophan

24. Two weeks after her son has a throat infection - a mother takes the boy to the ER because he has fever - malaise - HTN - dark urine - and periorbital edema. What is your diagnosis?
Apneustic center (deep breathing place)
1. Neisseria meningitidis 2. Haemophilus influenzae 3. Streptococcus pneumoniae
Chromosome 12
Poststreptococcal GN

25. What tract carries unconscious proprioceptive information from the Golgi tendon organs and muscle spindles to the cerebellum - helping monitor and modulate muscle movements?
1. Epinephrine synthesis 2. Phosphatidyl choline 3. Creatine 4. Methylation of cytosine 5. N- methyl cap of mRNA
Lower extremity and lower trunk information travels in the dorsal spinocerebellar tract. The upper trunk and extremity information travels in the cuneocerebellar tract. (Cuneocerebellar and fasciculus cuneatus both apply to upper extremities.)
Polycystic kidney disease of childhood
Lithium

26. What water - soluble vitamin deficiency results in pellagra?
C1 - C2 - or C4 deficiency
Niacin (B3)
Erythema marginatum
Carbidopa and benserazide

27. Name the macrophages by location: x CNS
Cause - specific mortality rate
Microglial cells
Parasites
Preload. It is the load on a muscle Prior to contraction.

28. Should information flow from the patient to the family or vice versa?

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29. What form of immunity is responsible for removal of intracellular infections?
Ionized drugs are water soluble - and since only lipid - soluble drugs can cross biomembranes - an ionized drug cannot cross them without the help of a carrier.
Cell - mediated immunity
Subarachnoid hematoma
Single - strand DNA binding protein

30. At what stage of cognitive development (according to Piaget) do children x Have abstract thinking?
The CD4 T cell; the APC is the first cell in the immune response.
Formal operations (> 12 years)
Red pulp (Remember - Red pulp and RBCs begin with R.)
Serocystadenocarcinoma

31. Which extravascular chemoreceptor detects low NaCl concentrations?
Both Neisseria and Moraxella are gram - negative cocci.
Without children (but don't think about this one for too long)
Macula densa
Ventral posterolateral nucleus

32. Are the following responses associated with histamines H1 or H2 receptor activation? - Bronchial smooth muscle activity
Burr cells (echinocytes)
H 1
Hemophilia A
Cushing's ulcers

33. What CNs are responsible for the sensor and motor components of the light reflex?
Extravascular hemolysis if it occurs in the spleen; if in the liver - it results in hepatomegaly.
Pyridoxine (B6)
CN II is the sensory limb and CN III is the motor component through parasympathetic stimulation.
Splenomegaly and anemia (with a high index of suspicion)

34. Regarding the viral growth curve - is the internal virus present before or after the eclipse period?
Plasmodium ovale
After the eclipse period
Desipramine
G0 phase

35. What is the lecithin:sphingomyelin ratio in respiratory distress syndrome of newborns?
Positive correlation
Oblique fissure
Ego syntonic
<2

36. DNA replication occurs During what phase of the cell cycle?
Patau syndrome (trisomy 13)
S phase
1. Dilation of the afferent arteriole 2. Constriction of the efferent arteriole 3. Inhibition of reabsorption of sodium and water in the collecting ducts
Ependymoma

37. At the base of the lung - What is the baseline intrapleural pressure - and what force does it exert on the alveoli?
Superior
Apneustic center (deep breathing place)
Intrapleural pressure at the base is -2.5 cm H2O (more positive than the mean) - resulting in a force to collapse the alveoli.
Fixed ratio (rewards set behaviors)

38. What is the only laryngeal muscle innervated by the external laryngeal nerve?
Phase 1
Birth defects - low birth weight (< 1500 g) with neonatal respiratory distress syndrome (NRDS) - and SIDS
Cricothyroid muscle; all other laryngeal muscles are innervated by the recurrent laryngeal nerve.
Bordetella pertussis

39. Name the valve abnormality based on the following criteria: x Back - filling into the left atrium during systole; increased v - wave - preload - left atrial volume - and left ventricular filling
T4 - as long as T4 levels remain constant - TSH will be minimally effected by T3.
HPV serotypes 6 and 11
Mitral insufficiency
Medulla blastoma

40. What neuronal cell bodies are contained in the intermediate zone of the spinal cord? (T1- L2)
The small subunit (40S) binds first.
Preganglionic sympathetic neurons
Gonads
Pancreatic insufficiency

41. What two monosaccharides are produced when lactose is hydrolyzed?
Epinephrine
Theca cell
Galactose and glucose
Metabolic acidosis (summary: low pH - high H+ - and low HCO3-)

42. What adrenal enzyme deficiency results in hypertension - hypernatremia - increased ECF volume - and decreased adrenal androgen production?
17- alpha - Hydroxylase deficiency
There would be two Fab and Fc regions.
Penicillin G (benzylpenicillin)
Pearson correlation

43. What benign cardiac tumor is associated with tuberous sclerosis?
Rhabdomyoma
Squamous cell carcinoma (skin - lung) and angiosarcoma of the liver
Primary hypoaldosteronism (Addison's disease)
Doxycycline and minocycline

44. Starry sky appearance of macrophages is pathognomonic of what lymphoma?
Ovarian cancer
Burkitt lymphoma
X- linked recessive
Waldeyer's ring

45. Name the most common type or cause - Sinusitis and otitis media in children
Selenium (Se)
Graves disease
Pneumococcus
Anemic patients have a depressed O2 content because of the reduced concentration of Hgb in the blood. As for polycythemic patients - their O2 content is increased because of the excess Hgb concentrations.

46. Does REM deprivation interfere with performance on simple tasks?
Jejunum (upper)
Second M PITS for pharyngeal pouch derivatives
LC4 - LD4 - and LE 4
No - but it does interfere with performing complex tasks and decreases attention to detail. (Be careful post call!)

47. Name the cancer associated with the following oncogenes. (Some may have more than one answer) x sis
Spinal trigeminal nucleus
At least 30% blast in the bone marrow
Immature B cells
Astrocytoma

48. What nerve is associated with the following functions? - Innervation of the flexor carpi ulnaris - flexor digiti profundus (pinky and ring fingers) - and the intrinsic muscles of the hand
antiemetic
Vibrio vulnificus
Ulnar nerve
Frotteurism

49. What is the most common one? - Malignant tumor of the breast
Social learning theory
2.0 or greater
Ependymoma
Invasive ductal carcinoma

50. In the water deprivation test - does a patient with reduced urine flow have primary polydipsia or diabetes insipidus?
d - Tubocurarine
Macula densa
Fungiform papillae
Primary polydipsia; patients with diabetes insipidus will continue to produce large volumes of dilute urine.