USMLE Step 1 Prep

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 three organs are necessary for the production of vitamin D3(cholecalciferol)?
The right gonadal vein drains into the inferior vena cava directly - and the left gonadal vein drains into the left renal vein.
Skin - liver - and kidneys
Doxycycline
GP Ib


2. Name the cancer associated with the following chemical agents. (Some may have more than one answer.) x Naphthylamine
Reye syndrome
Bladder cancer
Pompe's disease
Cleft lip


3. Which encapsulated fungus is found in soil enriched with pigeon droppings?
G0 phase
Spasms of the uterus - bladder - and the biliary tree occur with all of the opioids except meperidine.
Hydatidiform mole
Cryptococcus neoformans


4. Name the product or products of arachidonic acid: x Vasodilation
Follicular lymphoma
Methicillin
UMP
PGD2 - PGE2 - and PGF 2


5. What skin condition is a localized proliferation of melanocytes presenting as small - oval - light brown macules?
Mitral insufficiency
Benign lentigo
Doxycycline and minocycline
Double - blind study. It is the most scientifically rigorous study known.


6. What nonmotile gram - negative - non - lactose - fermenting facultative anaerobic rod uses the human colon as its only reservoir and is transmitted by fecal - oral spread?
Argyll Robertson pupils
Minor
Thymus - independent Ags
Shigella


7. Name the muscle type based on these descriptions: x Involuntary contraction - uninuclear nonstriated fibers - actin and myosin not forming banding pattern; lack of T tubules - gap junctions - and calmodulin.
CML and All
Smoking
Smooth muscle
Microglia. All others are neuroectodermal derivatives.


8. What mushroom poisoning is associated with fulminant hepatitis with extensive liver necrosis?
Competitive antagonist
Amanita phalloides
Pentoxifylline
Labile


9. Name the type of mutation: x New codon specifies for a stop codon
Borrelia burgdorferi
Nonsense
Thymidylate synthase
IL-4 is secreted to activate B cells. This begins the second step in the immune response - known as Activation. CD4 T cells secrete INF- alpha to activate macrophages


10. Which immunoglobulin is secreted by the plasma cells in the gastrointestinal tract?
The concentration of plasma proteins determines effective osmolarity because capillary membranes are freely permeable to all substances except proteins.
Bacillus anthracis
Radial nerve and the profunda brachii artery
IgA


11. What is the term for having fantasies or dressing in female clothes for sexual arousal by heterosexual men?
Transvestite fetishism
Bronchogenic carcinoma
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.
Papule


12. Metformin is contraindicated in ________ because of weight gain as its side effect.
Obese patients
Lewy bodies
Ovarian cancer
Respiratory depression


13. What three organs are responsible for peripheral conversion of T4 to T3?

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14. What pancreatic islet cell secretes somatostatin?
Twelve pairs through twelve thoracic vertebrae. Totaling 31 pairs of spinal nerves.
Seasonal affective disorder (treat with bright light therapy)
Metastatic
delta - Cells; somatostatin has an inhibitory effect on alpha - and Beta - islet cells.


15. What is the main mechanism for exchange of nutrients and gases across a capillary membrane?
Simple diffusion; it does not use protein - mediated transport
Stereocilia
Neuroblastoma
1. Tight junctions 2. Capillaries that lack fenestration 3. Very selective pinocytosis by the capillaries


16. Name the cancer associated with the following chemical agents. (Some may have more than one answer.) x Vinyl chloride
Wernicke's aphasia
Angiosarcoma of the liver
Simple diffusion; it does not use protein - mediated transport
Niemann - Pick and Tay- Sachs diseases


17. What enzyme is deficient in alkaptonuria?
1. Decrease alpha -1 activity 2. Increase Beta -2 activity 3. Increase ACh levels
Agents that decrease ACh function reduce tremors and rigidity - not bradykinesias.
Homogentisic oxidase
Pneumococcus


18. Kaiser - Fleischer rings - abnormal copper metabolism - and ceruloplasmin deficiency characterize what disease - which may include symptoms of dementia when severe?

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19. Name the most common type or cause - Meningitis in renal transplantation patients
1. Increased tube radius 2. Increased velocity 3. Decreased viscosity 4. Increased number of branches 5. Narrowing of an orifice
Swan - neck deformities
Listeria monocytogenes
Because incidence is defined as new events; treatment does not decrease the number of new events. It does decrease the number of individuals with the event (prevalence would decrease).


20. What lymphoma is associated with bleeding and cryoglobulin precipitation at low temperatures - headache and confusion due to hyperviscosity - IgM M- protein spike on serum electrophoresis - and Russell bodies?
ydroxyproline
Rickets
Waldenstr
Epinephrine


21. What are the adult remnants of the following structures? - Ductus arteriosus
Copper
Gastric cancer
Squamous cell carcinoma
Ligamentum arteriosum


22. What medication is used to help alcoholics avoid relapse by decreasing glutamate receptor activity?
Superior
Acamprosate (the number of glutamate receptors increases with chronic alcohol abuse)
Gaucher disease
Both Neisseria and Moraxella are gram - negative cocci.


23. What molecule that is needed to trigger T cell activation is noncovalently linked to TCR?
IgE. It attaches via receptor for the Fc region of the heavy epsilon chain
CD3 molecule. It transmits signals to the inside of the T cell to trigger activation
Carbamazepine
No change in length


24. Does Cushing syndrome or Cushing disease have elevated ACTH levels and cortisol suppression with dexamethasone?

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25. What bacterium found in poorly preserved canned food causes flaccid paralysis?
Clostridium botulinum
Proteus
Francisella tularensis
1. Notify police. 2. Try to detain the person making the threat. 3. Notify the threatened victim.


26. There is an inverse relationship between fat content and...
Atracurium
They innervate skeletal muscle.
total body water
>5 mm


27. What segments of the lumbosacral plexus form the following nerves? - Femoral nerve
Id
L2 to L4 (L2 to L4 - thigh; L4 to S3 - leg)
Succinylcholine and halothane (Treatment is with dantrolene.)
Yes


28. Name the most common type or cause - Lung abscess
Teeth grinding is associated with stage 2 sleep.
Medial rectus (CN III) (LR6 SO4)3
Prolyl and lysyl hydroxylases
Aspiration


29. What is the term to describe the soft - flabby feel and diminished reflexes seen in patients with acute cerebellar injury to the deep cerebellar nuclei?
Erythema multiforme
In children - the fourth ventricle; in adults - the lateral ventricle or spinal cord
Hypocalcemia and hypophosphatemia
Hypotonia (rag doll appearance)


30. What syndrome that is due to an adrenal gland adenoma produces excess aldosterone resulting in HTN - hypokalemia - and low rennin levels?
Selection bias
Vitelline fistula
Caplan syndrome
Conn syndrome (primary hyperaldosteronism)


31. What three circumstances allow a child to be committed to institutional care?

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32. What is the most common one? - Malignant carcinoma of the ovaries
4 years old
Hepatic adenomas
Intrinsic factor (IF)
Cystadenocarcinoma


33. What are the glycoprotein receptors that platelets and fibrinogen cross - link to when forming a thrombus?
>5 mm
delta - Cells; somatostatin has an inhibitory effect on alpha - and Beta - islet cells.
GP IIb and IIIa receptors
Methylation of bacterial DNA


34. In the systemic circulation - what blood vessels have the largest pressure drop? Smallest pressure drop?
The kidneys excrete the excess nitrogen from the body as urea in the urine.
Humerus with ulna (major) and radius (minor)
IL-5. It also stimulates eosinophil proliferation.
Arterioles have the largest drop - whereas the vena cava has the smallest pressure drop in systemic circulation.


35. What linkage of complex CHOs does pancreatic amylase hydrolyze? What three complexes are formed?
Down syndrome (it is slightly more common than fragile X syndrome.)
Amylase hydrolyzes alpha -1 - 4- glucoside linkages - forming alpha - limit dextrins - maltotriose - and maltose.
4.5 years old (Alphabetic order except with a diamond last: circle - cross - rectangle - square - triangle)
The gut rotates clockwise around the superior mesenteric artery.


36. Name the four components of the narcoleptic tetrad.
Onion skinning
Propranolol
Extrahepatic biliary atresia
1. Sleep paralysis 2. Hypnagogic hallucinations (while falling asleep) 3. Sleep attacks with excessive daytime sleepiness 4. Cataplexy (pathognomonic) Narcolepsy is a disorder of REM sleep - with REM occurring within 10 minutes of sleep.


37. What malignant tumor of the skin is associated with Birbeck granules?
C5- C9
Constrictor pupillae and ciliary muscles
Histiocytosis X
Primary hyperaldosteronism (Conn syndrome)


38. If the radius of a vessel is decreased by half - what happens to the resistance?
Multiple sclerosis
VLDL
The resistance increases 16- fold.
Beta- Endorphin


39. What enzyme is deficient in the following glycogen storage disease? - McArdle's disease
IF-2 of the 30S subunit
3- Phosphoglycerate kinase and pyruvate kinase; this produces two ATPs per enzyme (total four ATPs)
Muscle glycogen phosphorylase
Antisocial personality


40. What is the best measure of total body vitamin D if you suspect a deficiency?
Serum 25- hydroxy- vitamin D (25- OH- D)
Trichuris trichiura is treated with albendazole.
Rotavirus
Series circuit


41. What two arteries join to form the superficial and deep palmar arches of the hand?
Ulnar and radial arteries (ulnar is the main supplier)
Foods rich in tyramine (e.g. - cheese - dried fish - sauerkraut - chocolate - avocados - and red wine) should be avoided. Hypertensive crisis occurs when tyramine and MAOIs are mixed.
Histidine
H 2


42. What three cephalosporins inhibit vitamin K- dependent factors?
Cefamandole - cefoperazone - and moxalactam
Breast cancer
Hypercortisolism (Cushing syndrome)
The lung will expand; also the opposite is true.


43. What condition results in the following CSF results? - Opening pressure 400 mm H2O; WBCs 8500 (90% PMNs); glucose 15; protein 120
When the pH is more acidic than the pI - it has a net positive charge - and when the pH is more basic than the pI - it has a net negative charge.
Antisocial
Bacterial meningitis
Cestodes


44. Can an acute MI be diagnosed only by looking at an ECG?
Filtration is greater than excretion for net reabsorption to occur.
No. Remember - tests do not diagnose - they confirm or refute your diagnosis. Also - diagnosis of MI requires two of three criteria: chest pain consistent and characteristic of MI - elevated cardiac enzymes consistent with MI - and ST segment elevati
ELISA. It detects anti - p24 IgG.
Stibogluconate


45. What enzyme is inhibited by propylthiouracil (PTU)?

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46. What general pattern of sleep is described by slowing of EEG rhythms (high voltage and slower synchronization) - muscle contractions - and lack of eye movement or mental activity?
Fat necrosis
The sandfly
Occipital lobe (Anton's syndrome if it is due to bilateral posterior cerebral artery occlusions)
NREM sleep. Remember awake body - sleeping brain


47. In what compartment of the thigh is the profundus femoris artery found?

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48. What are the three carboxylase enzymes that require biotin?
Pyruvate - acetyl CoA - and propionyl CoA carboxylase
Common and internal carotid arteries
Type I symptoms (positive); schizophrenics have them - but otherwise healthy persons do not.
Pulmonary infections


49. What is the term for a large - immature RBC that is spherical - blue - and without a nucleus?
Stratum spinosum
Positive reinforcement
Coma - convulsions - and cardiotoxicity
Reticulocyte


50. What type II hypersensitivity disorder is defined as x Autoantibodies directed against ACh receptors?
BPH
The enzyme phenyl ethanolamine N- methyltransferase (PNMT) - used in the conversion of epinephrine - is regulated by cortisol. Removing the anterior pituitary gland decreases ACTH and therefore cortisol.
Decreases
Myasthenia gravis