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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 is the name of the superficial subcutaneous fascia of the abdomen containing fat?

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2. What two post - transcriptional enzymes in collagen synthesis require ascorbic acid to function properly?
Two Lateral foramina of Luschka and 1 Medial foramen of Monroe (L for Lateral and M for Medial)
Chloramphenicol
1. CNS 2. Renal tubules 3. Beta Islet cells of the pancreas 4. RBCs 5. GI mucosa
Prolyl and lysyl hydroxylases

3. What adenocarcinoma presents with elevated levels of acid phosphatase - dihydrotestosterone - PSA - and bone pain?
MGB
The systemic veins have the largest blood volume - and the pulmonary veins have the second largest blood volume in the cardiovascular system. They represent the reservoirs of circulation.
Priapism
Prostatic carcinoma

4. What is the ratio of T4:T3 secretion from the thyroid gland?
Subacute combined degeneration - Which is bilateral below the level of the lesion.
20:1T4T3. There is an increase in the production of T3 when iodine becomes deficient.
0157:H7
C3 deficiency

5. What is the effect of LH on the production of adrenal androgens?
Phallus
LH has no effect on the production of adrenal androgens; ACTH stimulates adrenal androgen production.
IL-8. It not only is chemotactic - it also acts as an adhesive for neutrophils.
Hormone - sensitive lipase

6. What are the only two picornaviruses that do not lead to aseptic meningitis?
>3.5 g/day of protein - along with generalized edema - hypoalbuminemia - and hyperlipidemia
Vitamin C
The JG cells
Rhinovirus and hepatitis A virus

7. What are the primary neurotransmitters at the following sites? - Autonomic preganglionic neurons
Neuroblastoma
Macula densa
Projective test. Most tests with a wide range of possibilities for the answers are projective.
ACh

8. What is the most common one? - Cardiac anomaly in children
Malignancy
Levator palpebrae superioris
Type III hypersensitivity reaction
PDA

9. If the family member of a patient asked you to withhold information - would you?
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.
Methanol (wood alcohol)
HPV infection
The renal circulation has the smallest AV O2 (high venous PO2) difference in the body because of the overperfusion of the kidneys resulting from filtration.

10. What hormone causes milk letdown?
Hematogenous
Oxytocin
Succinylcholine and halothane (Treatment is with dantrolene.)
gram positive

11. What is the only laryngeal muscle innervated by the external laryngeal nerve?
Cricothyroid muscle; all other laryngeal muscles are innervated by the recurrent laryngeal nerve.
Filovirus
Prostatic carcinoma
Cortisol Remember - from the outer cortex to the inner layer - Salt - Sugar - Sex. The adrenal cortex gets sweeter as you go deeper.

12. In What area of the GI tract does iron get absorbed?
Humerus with ulna (major) and radius (minor)
PRPP aminotransferase
Insulin
Duodenum

13. Name these anxiety defense mechanisms: x Separating oneself from the experience. The facts are accepted but the form is changed for protection.
Dissociation
T4 - as long as T4 levels remain constant - TSH will be minimally effected by T3.
Isovolumetric contraction
Treacher Collins syndrome

14. Are the following parameters associated with an obstructive or restrictive lung disorder: decreased FEV1 - FVC - peak flow - and FEV1/FVC; increased TLC - FRC - and RV?
The alveolar PO2 and PCO2 levels
HBcAb IgG - HBV- DNA - HBeAg - HBsAg
Obstructive lung disorders. The opposite changes (where you see decrease exchange it for increase and vice versa) are seen in a restrictive pattern.
Ciliary ganglion producing a tonic pupil

15. 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)
There would be two Fab and Fc regions.
Filtered and secreted: Cx > Cin (i.e. - PAH). Filtered and reabsorbed: Cx < Cin (i.e. - glucose) - where Cx = clearance of a substance and Cin = clearance of inulin.
Acebutolol and Pindolol
Sublimation

16. What three steps of the TCA cycle generate NADH?
1. Malate dehydrogenase 2. Isocitrate dehydrogenase 3. a - Ketoglutarate dehydrogenase
1. What did the patient want? 2. What would the patient say? 3. What is in the patient's best interests?
0.21; it is a fancy way of saying 21% of the air is O2.
Chromosome 18

17. In a parallel circuit - what happens to resistance when a resistor is added in parallel
Resistance decreases as resistors are added in parallel.
7
By causing rebound insomnia and decrease in REM sleep
Schistosoma haematobium

18. What endotoxin receptor is the best marker for macrophages?
Small to medium - sized cerebral vessels
CD14
Coxiella burnetii
Medial medullary syndrome

19. Name the MCC of death - In neonates
Spinal trigeminal nucleus
M:F 4:1 committing - but M:F ratio of attempts is 1:3 (males commit more but females try it more)
Neonatal respiratory distress syndrome (NRDS)
HHV 8

20. What is the term for occlusion of a blood vessel due to an intravascular mass that has been carried downstream?
IL-3 (3 face down is an M)
Sarcoplasmic reticulum
Autosomal dominant
Embolism

21. How many carbons do estrogens have?
Staphylococcus aureus
Estrogens are 18- carbon steroids. (Removal of one carbon from an androgen produces an estrogen.)
Trisomy 12 (nearly 50% of patients with CLL have abnormal karyotypes.)
If a carboxyl group is the R group - it is acidic; if an amino group is the R group - it is said to be basic.

22. What are the three polymorphonuclear leukocytes? Be specific.
The death of a spouse. The higher the score - the greater the risk of developing an illness in the next 6 months.
Legionella
Metaphase of meiosis II (in the oocyte of the graafian follicle)
Neutrophils - eosinophils - and basophils

23. Based on operant conditioning - What type of reinforcement is described when x Adding a stimulus reinforces a behavior?
Type IV hypersensitivity (cell - mediated)
Positive reinforcement
Yes - because they both activate the BZ1- receptors - which can be reversed by flumazenil.
The granule cell. Its neurotransmitter is glutamic acid - Which is also the principal neurotransmitter of the visual pathways.

24. What happens to flow and pressure in capillaries with arteriolar dilation? Arteriolar constriction?
Axis II
Day 14
Osteoarthritis
Capillary flow and pressure increase with arteriolar dilation and decrease with arteriolar constriction.

25. What percentage of nephrons is cortical?
Somatization disorder
Leukemias and lymphomas
Constriction of afferent arteriole
Seven - eighths of nephrons are cortical - with the remainder juxtamedullary.

26. What is the term for diffusion of water across a semipermeable or selectively permeable membrane?
Lesch - Nyhan syndrome
Selegiline
Osmosis; water will diffuse from higher to lower water concentrations.
Endocardial cushion defect

27. What lymphoid organ has the following characteristics: outer and inner cortical areas - encapsulation - germinal centers - and high endothelial venules?
A low - resistance system is formed by resistors added in parallel.
Lymph nodes
Right - sided
Calcitriol

28. Name the associated chromosomal translocation - Adult familial polyposis
Negative
Childhood
Chromosome 5 - 21
1. Posterior auricular vein 2. Posterior division of the retromandibular vein

29. What is the first branch of the abdominal artery?
Proud flesh
Reaction formation
There are 10 bronchopulmonary segments on the right and 8 on the left.
Inferior phrenic artery

30. What is the MCC of the following endocarditis scenarios? - Non - IV drug user
Sacrococcygeal teratoma
CN V1 carries the sensory and CN VII carries the motor component of the blink reflex.
>15 mm
Staphylococcus aureus

31. What is the most potent stimulus for glucagon secretion? Inhibition?
In the cytoplasm of the presynaptic nerve terminal; it is catalyzed by choline acetyltransferase.
Streptococcus pyogenes
1. Fat 2. Forty 3. Female 4. Familial 5. Fertile
Hypoglycemia for secretion and hyperglycemia for inhibition

32. What vein drains the lower third of the thoracic wall?
Papovavirus
Hepatitis - with or without necrosis
Left: stomach - spleen - and left kidney; right: liver - duodenum - and right kidney
Hemiazygous vein

33. What is the most common one? - Female genital tract malignancy resulting in death
Ovarian cancer
Chylomicrons
Nodular sclerosis
Chromosome 4p

34. What illicit drug can cause amyloidosis and focal segmental glomerulosclerosis in the kidney?
DNA polymerase - d
Glycine/arginine
Heroin
Medial meniscus

35. How many ATPs are generated per acetyl coenzyme A (CoA)?
Griseofulvin
1. Increased solubility 2. Increased concentration gradient 3. Decreased thickness of the membrane
12 ATPs per acetyl CoA that enter the tricarboxylic acid (TCA) cycle (Krebs cycle)
Light regulates the activity of the pineal gland via the retinal - suprachiasmatic - pineal pathway.

36. Describe the organism based on the following information: x Alpha - hemolytic Streptococcus; not lysed by bile; not sensitive to Optochin
Left homonymous hemianopsia
Primary hypothyroidism (Low T4 has a decreased negative feedback loop - resulting in both the hypothalamus and the anterior pituitary gland to increase TRH and TSH release - respectively.)
Streptococcus viridans
Promotes systemic venous return into the chest and increases the caliber and volume of the pulmonary vessels

37. What is the term for excessive production of collagen that flattens out and does not extend beyond the site of the injury?
Hypertrophic scar
Elongation factor - G and GTP
Erythema nodosum
Increases Remember - the carotid sinus reflex attempts to compensate by increasing both TPR and heart rate. -------------------------------------------------------------------------------

38. What artery travels with the following veins? - Small cardiac vein
No enzymes are needed. When the stop codon reaches the A site - it results in termination.
Acetoacetate - acetone - and Beta- hydroxybutyrate
Right coronary artery
Cohort studies determine incidence and causality - not prevalence.

39. What thyroid abnormality has the following? - TRH decreased - TSH decreased - T4 increased
Biotin - ATP - and CO2
Secondary hyperthyroidism (Increased TSH results in increased T4 production and increased negative feedback on to hypothalamus and decreased release of TRH.)
Mature B cell; the memory B cell can have IgG - IgA - or IgE on its surface.
Zero - order elimination

40. Has analgesic and antipyretic activities but lacks anti - inflammatory effects.
Pyridoxine
NADPH and molecular O 2
Acetaminophen
Type IV hypersensitivity reaction (delayed type because of the 48-96 hour latency)

41. How does L- tryptophan affect sleep?
Cerebral aqueduct
No. It is abnormal only if it interferes with normal sexual or occupational function.
It increases REM and total sleep time.
Anemia

42. What class of pharmaceuticals are inactive until they are metabolized to their active products?
Prodrugs
Pergolide
Trisomy 12 (nearly 50% of patients with CLL have abnormal karyotypes.)
Test - retest reliability

43. From what pharyngeal pouch is the following structure derived? - Middle ear
Enterohepatic cycling
First M PITS for pharyngeal pouch derivatives
Extracellular
Hyperpolarization (i.e. - K+ influx)

44. What hormone - produced by the syncytiotrophoblast - stimulates the production of progesterone by the corpus luteum?
Stimulus control
hCG
Schistosoma have separate males and females.
The vaccine contains 23 capsular polysaccharides.

45. What cells are atypical on a peripheral blood smear in heterophil - positive mononucleosis?
Internal carotid artery and sympathetic plexus
Physiologic antagonism
T cells - not B cells
Berry aneurysm

46. Near the end of pregnancy - what hormone's receptors increase in the myometrium because of elevated plasma estrogen levels?
Oxytocin
Crigler - Najjar syndrome
Areas 5 and 7
The affinity of the drug for its receptor

47. Name the structure that enters or exits the following foramina: x Internal auditory meatus
Primary erectile disorder
The conversion of tyrosine to dopamine in the cytoplasm
CN VII and VIII
Aldolase B deficiencies are treated by eliminating fructose from the diet.

48. If free water clearance (CH2O) is positive - What type of urine is formed? And if it is negative?
Plasma cell (mature B lymphocyte)
RNA polymerase I
If positive - hypotonic urine (osmolarity <300 mOsm/L); if negative - hypertonic urine (osmolarity > 300 mOsm/L)>>
Ceramide

49. What disease is seen in the 20- to 40-year - old age group - is more prevalent in women than men - involves diarrhea with or without bloody stools - starts in the rectum and ascends without skipping areas - includes pseudopolyps - and has a thickness
The odontoid process of C2
Ipsilateral loss at and below the level of the lesion
Ulcerative colitis
X- linked dominant

50. At ovulation - In what stage of meiosis II is the secondary oocyte arrested?
Esophagus and esophageal nerve plexus (CN X) Remember: 1 at T8 - 2 at T10 - and 3 at T12
Waldeyer's ring
Metaphase II
Plasma cell