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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. If you order a V/Q scan for suspected pulmonary emboli - is the filling defect seen on the ventilation or perfusion side?
B lymphocyte
Housemaid's knee
Chylomicrons
Ventilation of an unperfused lung segment is highly suspicious for pulmonary embolism.

2. What is the region of the fallopian tube where fertilization most commonly occurs?
Sulfonamides
Ampulla
TXA2
Aminoacyl - tRNA synthetase - which uses 2 ATPs for this reaction.

3. What type of anemia is the result of a deficiency in intrinsic factor?
H 2
Pernicious anemia (secondary to a lack of vitamin B12 absorption)
Muscle glycogen phosphorylase
Submandibular gland produces mainly serous and the sublingual gland produces mainly mucous secretions.

4. To What is the diffusion rate indirectly proportional?
Microglia (Microglia and mesoderm both begin with M)
1. What did the patient want? 2. What would the patient say? 3. What is in the patient's best interests?
Diffusion rate is indirectly proportional to membrane thickness and is directly proportional to membranes surface area.
Minocycline

5. What is the term for thymic induction of T cells with high - affinity Ag receptors for self that are programmed to undergo apoptosis?
Sacrococcygeal teratoma
Flurazepam
Negative selection. This helps to prevent autoimmune diseases.
Dopamine levels rise with waking; dopamine is associated with wakefulness.

6. What myeloid disorder is characterized by increased hematocrit - blood viscosity - basophils - and eosinophils; intense pruritus; and gastric ulcers due to histamine release from basophils - increased LAP - and plethora?
Polycythemia vera (Remember - polycythemia vera is a risk factor for acute leukemias.)
Sphingosine
GP IIb/IIIa - Which is why GP IIb/IIIa inhibitors are used in the treatment of acute coronary syndromes
Volume of distribution is decreased when a large percentage of drug is protein bound.

7. What is the term for failure of the testes to descend into the scrotum?
Cytosine
Arginine
Molluscum contagiosum
Cryptorchidism; normally the testes descend into the scrotum within 3 months of birth.

8. What is the major hormone produced in the following areas of the adrenal cortex? - Zona reticularis
Dihydrofolate reductase
Ampicillin and amoxicillin
Thioridazine
DHEA (androgens) Remember - from the outer cortex to the inner layer - Salt - Sugar - Sex. The adrenal cortex gets sweeter as you go deeper.

9. What embryonic structure forms the adult male structure? - Gubernaculum testes
Pulmonary shunt (i.e. - pulmonary embolism)
Yes. This is done to help prevent underreporting out of fear of lawsuit. Remember that it is your duty to protect the child first - not worry about legal responsibility.
Gubernaculum
Bile acid sequestrants (cholestyramine and colestipol) increase VLDL and triglyceride levels; therefore - they are not used if a patient has hypertriglyceridemia.

10. What CNS developmental abnormality is associated with 90% of syringomyelia?
Humerus with ulna (major) and radius (minor)
Competitive antagonist
Arnold - Chiari malformation type 2
Membranous glomerulonephritis

11. What is the MCC of the following endocarditis scenarios? - Following biliary infections
Venlafaxine. (It also has a mild dopaminergic effect.)
Poxvirus replicates its DNA in the cytoplasm.
Enterococcus faecalis
Double - blind study. It is the most scientifically rigorous study known.

12. What scale has a true zero point - graded into equal increments - and also orders them?
Roth spots - and they are seen in bacterial endocarditis.
Ratio scale
Biotin (only if eaten in large quantities)
>10 mm

13. What is the name of the tremor that occurs during movements and is absent while the person is at rest?
Intention tremor; it is a sign of cerebellar lesions. A tremor at rest (i.e. - pill rolling) is seen in basal ganglia lesions.
It is rare with normal grief; however - it is relatively common in depression
Chromosome 15
Degenerates

14. What is the renal compensation mechanism for acidosis?
Production of HCO3- - shifting the reaction to the left and thereby decreasing H+
Metaplasia (usually to a more protective cell type)
Nitroprusside
Sulfonamides

15. There are no persistent infections with...
DNA polymerase I
Spinal trigeminal nucleus
naked viruses
Temporal arteritis

16. What percent of sexual abuse cases are committed by family members?
Dihydrotestosterone
Immunogenicity; antigenicity refers to Ab/lymphocyte reaction to a specific substance.
50%. The uncles and older siblings are the most likely perpetrators - although stepfathers also have a high rate.
Because creatinine is filtered and a small amount is secreted

17. What occurs when the lower esophageal sphincter fails to relax during swallowing due to abnormalities of the enteric nervous plexus?
Sickle cell disease
Achalasia
Duchenne muscular dystrophy
IL-8. It not only is chemotactic - it also acts as an adhesive for neutrophils.

18. What is the term for the difference between systolic and diastolic pressures?
Subacute combined degeneration - Which is bilateral below the level of the lesion.
T wave
Marijuana
Pulse pressure

19. Name the Hgb - O2 binding site based on the following information: x Greatest affinity of the three remaining sites for attachment; requires PO2 levels of 26 mm Hg to remain attached
The superior border of the inferior intercostal rib is your landmark for a pleural tap because along the inferior border of each rib is the neurovascular bundle - and you would risk injury if you went below the rib.
Sj
Site 2
1. Concentration (greater concentration gradient - greater diffusion rate) 2. Surface area (greater surface area - greater diffusion rate) 3. Solubility (greater solubility - greater diffusion rate) 4. Membrane thickness (thicker the membrane - slowe

20. Where is the lesion that produces these symptoms when a patient is asked to look to the left? - Right eye can't look left - left eye nystagmus - and convergence is intact
Right medial longitudinal fasciculus
Asparagine
C3a - C4a - and C5a
Conjugated (direct) hyperbilirubinemia - a transport defect

21. What region of the Ig does not change with class switching?
Yohimbine
Hypervariable region
Histidine - because of the imidazole ring found in the R group - is basic.
Mitosis

22. Name the most common type or cause - Bronchiolitis in children
Bacteria
IgM
RSV
Bruton X- linked hypogammaglobinemia. Tyrosine kinase deficiency leads to inadequate B cell maturation.

23. What are the five hormones produced by Sertoli cells?
Potency
Head of the pancreas
Vitamin B12 deficiency and folate deficiency
1. Inhibin 2. Estradiol (E2) 3. Androgen - binding protein 4. Meiosis inhibiting factor (in fetal tissue) 5. Antim

24. What is the major Ig of the secondary immune response in the mucosal barriers?
IgA
The parasympathetic nervous system
Chromosome 22q
Lower lobe

25. When does most of the NREM sleep (stage 3 and 4) occur - in the first or second half of sleep?
CD28
Membrane depolarization is the stimulus to open these channels - which are closed in resting conditions.
Catatonic schizophrenia
The deepest sleep levels (stage 3 and 4) occur mostly in the first half of sleep.

26. What muscle or muscles are innervated by the following nerves? - Thoracodorsal nerve
Pasteurella - Brucella - Legionella - and Francisella (all of the - ellas)
Size
Mycoplasma pneumoniae
Latissimus dorsi

27. Name the compartment of the mediastinum associated with the following thoracic structures: Ascending aorta
Middle
hyperventilation
In the cytoplasm of the presynaptic nerve terminal; it is catalyzed by choline acetyltransferase.
Adenocarcinoma

28. What cell transports IgA - is secreted by plasma cells - and is in Peyer's patches to the gastrointestinal lumen?
Coronavirus
M- cells
MEN II and III syndromes
G-6- PD

29. If the radius of a vessel is decreased by half - what happens to the resistance?
LTC4 and LTD4
NO!! Remember - only a judge can commit a patient. A physician can detain a patient (maximum is for 48 hours).
The resistance increases 16- fold.
Primary sclerosing cholangitis

30. What is the term for the total percentage of correct answers selected on a screening test?
Accuracy (think of it as all the trues - because they are the ones correctly identified)
Right brachiocephalic artery
Multiple myeloma
Affinity decreases; they are inversely proportional.

31. Which hepatitis B Ag correlates with infectivity and viral proliferation?
TXA2
HBeAg
Vitamin D
Adult polycystic kidney disease

32. What prokaryotic positioning enzyme in translation is blocked by the following? - Streptomycin
External abdominal oblique
IF-2 of the 30S subunit
pK (think of it as where half is base and half is acid)
Osteoma

33. What part of the heart forms x Apex?
Anticipation
Arsenic - thorotrast - and vinyl chloride
Tip of the left ventricle
S phase

34. What is the name of the monoclonal antibody used in the treatment of Crohn disease and rheumatoid arthritis?
Infliximab
Enkephalins
Risperidone
9 kcal/g from fat metabolism; 4 kcal/g from both CHO and protein metabolism

35. Name the type of regeneration (i.e. - labile - stable - or permanent) based on the following examples - Liver
Mitochondria
Stable
PGD2 - PGE2 - and PGF 2
CD19

36. What two drugs inhibit the release of neurotransmitters from storage granules?
12 ATPs per acetyl CoA that enter the tricarboxylic acid (TCA) cycle (Krebs cycle)
Hirschsprung disease (aganglionic megacolon)
Plasmodium malariae
Guanethidine and bretylium

37. Name the hypochromic microcytic anemia based on the following laboratory values - Normal iron - TIBC - percent saturation - and ferritin
Craniopharyngioma
Aminoglycosides
Kl
Thalassemia minor

38. What is the term for the amount of blood in the ventricle after maximal contraction?
Complex 4
Coronary circulation
Hepatitis A
Residual volume

39. After a longstanding left - to - right shunt reverses - causing cyanosis - and becomes a right - to - left shunt - What is it termed?

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40. What subtype of IgG does not bind to staphylococcal A protein?
G0 phase
Rib 7 articulates with T7 and T8. Each rib articulates with the corresponding numerical vertebral body and the vertebral body below it.
IgG3
Motor nucleus of CN V

41. Name the macrophage based on its location: x Brain macrophages
Microglia
Human chorionic somatomammotropin (hCS) or human placental lactogen (hPL)
Trypanosoma cruzi
Bulla

42. Name four major risk factors for atherosclerosis.
Neisseria gonorrhoeae
CD8
Erythema marginatum
DM - hypercholesterolemia - smoking - and HTN are major risk factors. Being male - obesity - sedentary lifestyle - homocysteine elevation - oral contraceptive pills - and genetics are minor risk factors for atherosclerosis.

43. How many pairs of spinal nerves are associated with x Coccygeal vertebrae?
Paradoxic emboli most commonly enter the arteries through a patent septal defect in the heart.
Asparagine
Osteoblast (Remember - blasts make - clasts take)
One pair with three to five coccygeal vertebrae. Totaling 31 pairs of spinal nerves.

44. Anatomical and alveolar dead spaces together constitute what space?
Flutamide
Substantia nigra
Parietal lobe
Physiologic dead space is the total dead space of the respiratory system.

45. Which genus of dermatophytes is associated with the following sites of infection? - Hair and skin only
Affinity
The triad of respiratory depression - pinpoint pupils - and coma in an IV drug abuser suggests opioid overdose (e.g. - heroin) - and you should give naloxone.
IgG3
Microsporum

46. What virus produces koilocytic cells on a Papanicolaou (Pap) smear?
T and B- cells belong to the adaptive branch - whereas PMNs - NK cells - eosinophils - macrophages - and monocytes belong to the innate branch.
C3 - C4 - and C5 keep the diaphragm alive!
HPV
Flea - bitten kidney (can also be seen in pyelonephritis)

47. What form of estrogen is of placental origin?
Alkaline phosphatase
Estriol
Serocystadenocarcinoma
A loss of afferent activity indicates a decrease in BP - and an increase in afferent activity indicates an increase in BP.

48. What DNA replication enzyme breaks the hydrogen bond of base pairing - forming two replication forks?
Pancreatic cancer
Escherichia coli
Helicase (requires ATP for energy)
The urea cycle

49. How many days prior to ovulation does LH surge occur in the menstrual cycle?
gp120
Varicella virus and influenza virus
Plasmodium vivax
1 day prior to ovulation

50. Which dopamine receptor excites the direct pathway of the basal ganglia?
CLL (B- cell origin)
Leucine and lysine
D1 receptor; inhibition of the direct pathway occurs through the D2 receptors.
Type IV hypersensitivity reaction (delayed type because of the 48-96 hour latency)