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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. What primary acid - base disturbance is caused by an increase in alveolar ventilation (decreasing CO2 levels) resulting in the reaction shifting to the left and decreasing both H+ and HCO3- levels?
Neisseria gonorrhoeae
Respiratory alkalosis (summary: low CO2 - low H+ - slightly low HCO3-)
Type I (makes sense - since they have a predisposition for fractures and type I collagen is associated with bones and tendons)
Quinolones

2. What is the most common one? - Primary CNS tumor in children
Early distal tubule
Negative
Medulla blastoma
Water - soluble hormones are considered fast - acting hormones.

3. Name the lung measurement based on the following descriptions: x Volume in the lungs at the end of passive expiration
In the supraoptic nuclei of the hypothalamus; it is stored in the posterior pituitary gland.
Functional residual capacity (FRC)
Ixodes (also the vector for Lyme disease)
Decrease (5- HT and dopamine levels do the same)

4. What vasculitis affects a 30-year - old Asian female having visual field deficits - dizziness - decreased blood pressure - and weakened pulses in the upper extremities?
Takayasu arteritis (medium - size to large vessels)
HGPRT
Amyl nitrate - sodium nitrate - or sodium thiosulfate
CD8+ T cells

5. What form of antimicrobial therapy is best for an immunocompromised patient?
L2 to L4 (L2 to L4 - thigh; L4 to S3 - leg)
Type III
Bactericidal
Cystadenoma

6. Name the area of the cerebral cortex affected by the description of the effects - symptoms - and results of the lesion - Withdrawn - fearful - explosive moods - violent outbursts - and loss of inhibitions
Simple diffusion; it does not use protein - mediated transport
Parallel circuit
Orbitomedial frontal lobe
Cocaine - induced coronary ischemia

7. Which serotypes of HPV are associated with plantar warts?
Rubor (red) - dolor (pain) - calor (heat) - tumor (swelling); also sometimes there is loss of function
Punishment
Type I hypersensitivity (anaphylactic)
HPV serotypes 1 and 4

8. What enzyme of the TCA cycle catalyzes the substrate level phosphorylation?
Succinyl CoA synthetase
In the PNS - myelin is produced by Schwann cells - in the CNS by oligodendrocytes.
Lysine and arginine
Afferent pupillary defect (CN II lesion); in an efferent pupillary defect (CN III) - B/L constrict when light is shined in the unaffected eye and consentual pupil constriction occurs when light is shined in the affected eye.

9. What is the most potent NMJ blocker and also has no cardiovascular side effects?
Water
Depolarization (i.e. - Na+ influx)
Doxacurium
Indirect or unconjugated

10. Name the type of necrosis - Seen as dead tissue with coagulative necrosis
Type III
Hepatitis A (infectious)
Peau d'orange
Gangrenous necrosis

11. Which form of melanoma carries the best prognosis?
Risk factors for breast cancer
Polycystic ovaries
The alveoli at the base are small and very compliant - so there is a large change in their size and volume and therefore a high level of alveolar ventilation.
Lentigo maligna melanoma

12. What form of hormone is described as having membrane - bound receptors that are stored in vesicles - using second messengers - and having its activity determined by free hormone levels.
Water - soluble hormones are considered fast - acting hormones.
Antisocial personality
IgM
Accuracy (think of it as all the trues - because they are the ones correctly identified)

13. What dementia is associated with dilated ventricles with diffuse cortical atrophy - decreased parietal lobe blood flow - and a decrease in choline acetyl transferase activity?

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14. Circulating levels of what hormone cause the cervical mucus to be thin and watery - allowing sperm an easier entry into the uterus?
Lipid - soluble hormones are considered slow - acting hormones.
Estrogen
Barbiturate overdose and benzodiazepine withdrawal carry the highest mortality rates.
Dopamine

15. What are the most common causes of osteomyelitis x Overall?
Citrate - via the citrate shuttle
Phase 4
Staphylococcus aureus
CO

16. In what stage of sleep is it hardest to arouse a sleeping individual?
The cat
During stage 3 and 4 (remember - it is called deep sleep.)
The internal laryngeal nerve supplies sensory information from above the vocal cords while the recurrent laryngeal nerve supplies sensory information below.
Brain - spleen - and kidney

17. What is the name for inability to stop a movement at the intended target?
Histoplasma capsulatum infects the cells of the RES and can result in hepatosplenomegaly.
Dysmetria; this is seen in a finger - to - nose test.
Antigenic determinant (epitope). (Idiotypes bind to epitopes.)
Parkinson's disease

18. Name the most common type or cause - Sudden cardiac death
It forms a germinal tube at 37
LGB (think EYES)
Ventricular fibrillation (V fib)
Autoimmune hemolytic anemia

19. What subset of T cells recognizes the MHC class II Ags?
CN IX
MI
ELISA test
CD4+ T cells (helper)

20. What area of the GI tract has the highest activity of brush border enzymes?
Jejunum (upper)
Bordetella pertussis
100%; the percentage of blood flow through the pulmonary and systemic circulations are equal.
Major

21. What Ig is associated with Ag recognition receptor on the surface of mature B cells?
Omphalocele and gastroschisis
IgD; IgM is also correct.
hyperventilation
Herpesvirus

22. Name these mature defense mechanisms: x Converting an unacceptable impulse to a socially acceptable form (Hint: it is the most mature of all defense mechanisms)
The dose of glipizide must be decreased in hepatic dysfunction. Glyburide's dose must be decreased in renal dysfunction.
Rapid cycling bipolar disorder
Plasmodium falciparum
Sublimation

23. The opening of what valve indicates the termination of isovolumetric relaxation phase of the cardiac cycle?
Opening of the mitral valve indicates the termination of the isovolumetric relaxation phase and the beginning of the ventricular filling phase.
HPV serotypes 6 and 11
Chlamydia; gonorrhea is second (Remember - it is mandatory to report STDs to the CDC.)
Brief psychotic disorder. (In schizophreniform disorder the symptoms last longer than 6 months.)

24. Name the antidote - Carbon monoxide (CO)
Metronidazole
Valproic acid
Pulmonary infections
Oxygen

25. What is the term for conversion of a dsDNA molecule to the base sequence of an ssRNA molecule?
Transcription (C comes before L in the alphabet - and transCription comes before transLation)
A left CN X lesion results in the uvula deviating to the right. (Uvula points away from the affected side.)
Neurologic symptoms Renal failure Thrombocytopenia Fever Microangiopathic hemolytic anemia (Don't forget it. When I was an intern - my senior resident asked me this question more times than I would like to remember.)
Bone deposition increases with increased Ca2+ or PO 4- concentrations - whereas resorption (breakdown) is increased when there are low levels of Ca2+ or PO4-.

26. What enzyme catalyzes the rate - limiting step in fatty acid synthesis?
Vancomycin
Toxic dose for 50% of drug takers (median toxic dose)
Previous suicide attempt
Acetyl CoA carboxylase

27. What is the bioactive form of thyroid hormone?
C5- C8 deficiency
Androgen - binding protein
Amygdala; it helps imprint an emotional response in memory.
T3

28. What limb of the internal capsule is not supplied by the middle cerebral artery?
Beta- Hydroxybutyrate
The oncotic pressure of plasma promotes reabsorption and is directly proportional to the filtration fraction.
Where the cell bodies for the DCML and spinothalamic sensory systems are...
Anterior limb of the internal capsule is supplied by the anterior cerebral artery.

29. What oxygen - dependent killing enzyme requires hydrogen peroxide and halide (Cl -) to produce hypochlorous acid?
CSF H+ levels - with acidosis being the main central drive - resulting in hyperventilation (the opposite being true with alkalosis)
Myeloperoxidase
Lipoprotein lipase
Squamous cell carcinoma

30. What is the name of the benzodiazepine antagonist used in the treatment of an overdose?
6 years old
Flumazenil
Anterior hypothalamic zone; lesions here result in hyperthermia.
Exogenous steroids suppress LH release and result in Leydig cell atrophy. Testosterone - produced by Leydig cells - is needed for spermatogenesis.

31. Name the compartment of the mediastinum associated with the following thoracic structures: Thoracic duct
Superior and posterior
Flucytosine
Stylopharyngeus muscle is innervated by CN IX; all other pharyngeal muscles are innervated by CN X.
Positive predictive value

32. What is the only glycosaminoglycan (GAG) that binds to the linker portion of the proteoglycan?
Recall bias. These problems arise in retrospective studies.
Disulfiram
When it crosses the teres major
Hyaluronic acid (all sulfates bind to the core protein)

33. What is the greatest component of lung recoil?
Primary hyperparathyroidism
Coma - convulsions - and cardiotoxicity
When it crosses the teres major
Surface tension; in the alveoli - it is a force that acts to collapse the lung.

34. What is the most common one? - Malignant thyroid tumor
Free - unprocessed Ag
Neurologic symptoms Renal failure Thrombocytopenia Fever Microangiopathic hemolytic anemia (Don't forget it. When I was an intern - my senior resident asked me this question more times than I would like to remember.)
Papillary carcinoma of the thyroid
Microglia

35. What enzyme of the purine salvage pathway is deficient in the following? - Selective T- cell immunodeficiency
Succinyl CoA
Steroid synthesis - drug detoxification - triglyceride resynthesis - and Ca2+handling
Need 3 panic attacks over 3 weeks (remember - they come out of the blue.)
Purine nucleoside phosphorylase

36. What enzyme of purine synthesis is inhibited by allopurinol and 6- mercaptopurine?
GABA - quantitatively
PRPP aminotransferase
Red blood cell distribution width index (RDW)
Squamous cell carcinoma

37. What disease is diagnosed by findings of ANAs and anti - SCL-70 antibodies?
NADPH oxidase
Budd - Chiari syndrome
Scleroderma
Prostatic carcinoma

38. With what stage of sleep are night terrors associated?
Hydroxyproline (breakdown product of collagen)
NREM sleep. Night terrors are dreams that we are unable to recall.
Autoimmune hemolytic anemia
Shifts it to the right

39. What phase of the cell cycle are the following antineoplastic agents specific for? - Hydroxyurea
Squamous cell carcinoma
S phase
There is a difference; it takes about 7 to 8 half - lives to reach mathematical steady state and 4 to 5 half - lives to reach clinical steady state.
common variable hypogammaglobinemia

40. What are the adult remnants of the following structures? - Ductus arteriosus
Meclizine
Ligamentum arteriosum
The death of a spouse. The higher the score - the greater the risk of developing an illness in the next 6 months.
Citrate - via the citrate shuttle

41. Are the following conditions associated with a negative or positive nitrogen balance? - Pregnancy
Positive
Voltage - gated sodium channel
Isoleucine - leucine - and valine
Pedophilia

42. Are the following major or minor Jones criteria of rheumatic fever? - Subcutaneous nodules
Dendritic cells - macrophages - and thymic epithelial cells
1. TTP 2. Lipoic acid 3. Coenzyme A from pantothenate 4. NAD(H) (from niacin or tryptophan) 5. FADH2 (from riboflavin)
Major
It both begins and ends at T4 (sternal angle [of Louis]).

43. With What thoracic vertebra or vertebrae does rib 7 articulate?
Rib 7 articulates with T7 and T8. Each rib articulates with the corresponding numerical vertebral body and the vertebral body below it.
2 ATPs - because RBCs use only anaerobic metabolism.
Primary hyperparathyroidism
Arnold - Chiari malformation type 2

44. In what syndrome does the patient have angiomatosis; renal cell carcinomas; pheochromocytomas; retinal - cerebellar - medulla - or spinal cord hemangioblastomas; and epidermal cysts?
von Hippel - Lindau syndrome
Zona fasciculata and zona reticularis
C5a
Rhombencephalon

45. Name the product or products of arachidonic acid: x Pain and fever
PGE2
Left CN XII lesion would result in the tongue pointing to the left (points at the affected side).
17- alpha - Hydroxylase deficiency
Rickets prior to fusion - osteomalacia if the deficiency occurs after epiphyseal fusion.

46. What phase of the female reproductive cycle is 14 days long?
Lesser curvature of the antrum of the stomach
Procainamide
Glucagon and epinephrine
The secretory phase is progesterone - dependent and 14 days long - whereas the length of the proliferative phase varies

47. What is the most common one? - Congenital heart defect in adults
Integument (skin and its derivatives)
Male pseudohermaphrodite (dude looks like a lady!)
Streptococcus pneumoniae - Klebsiella pneumoniae - Haemophilus influenzae - Pseudomonas aeruginosa - and Neisseria meningitidis; also Cryptococcus neoformans - a fungus
ASD

48. What is the most common one? - Route of spread in pyogenic osteomyelitis
Coxsackie A
Ewing sarcoma
1. Decrease concentrations of Ag levels 2. Administer IgG in high concentrations 3. Inhibit B cells with Ag bound to IgG (complexes) 4. Turn off the original T or B cell with anti - Ab
Hematogenous

49. What pH (acidotic or alkalotic) is needed for pepsinogen to pepsin conversion?
Vitelline fistula
Candida
Acid is needed for the activation of pepsin and therefore needed for protein digestion.
ACh

50. What AA is classified as basic even though its pK is 6.5 to 7?
Histidine - because of the imidazole ring found in the R group - is basic.
Gluteus maximus
Ataxia - telangiectasia
LTB4