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USMLE Step 1 Prep

Subjects : health-sciences, usmle-step-1

Instructions:

Answer 50 questions in 15 minutes.
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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 artery supplies the right atrium - right ventricle - sinoatrial and atrioventricular nodes?
Right coronary artery
Oligodendroglioma
For males - HTN; for females - pregnancy.
Churg - Strauss syndrome

2. What microaerophile is a motile gram - negative curved rod with polar flagella that causes infectious diarrhea at low doses (<500)?
Ag - Ab complexes. The alternative pathway protects without use of Abs; the pathogen is the stimulus.
TLC - FRC - and RV have to be calculated. (Remember - any volume that has RV as a component has be calculated.)
Campylobacter jejuni
Heparin - intrinsic pathway - PTT; warfarin - extrinsic pathway - PT (mnemonic: hPeT - wPiTT)

3. Name the compartment of the lower extremity and the nerve based on its movements - Plantar flex the foot and evert the foot
Lateral compartment of the leg - superficial peroneal nerve
N- formyl - methionine LTB4 C5a IL-8
FSH and testosterone
Projective drawing. The artistic form is irrelevant - but the size - placement - erasures - and distortions are relevant.

4. Why is the liver unable to metabolize ketone bodies?
Schatzki ring
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
Hepatocytes lack the enzyme succinyl CoA acetoacetyl CoA transferase (thiophorase).
Psammoma bodies

5. What organism is commonly associated with a cellulitis from an animal bite?
Trazodone
Mycoplasma pneumoniae
Need 3 panic attacks over 3 weeks (remember - they come out of the blue.)
Pasteurella multocida

6. What protozoal parasite forms flasked - shaped lesions in the duodenum - is transmitted via fecal - oral route - and is commonly seen in campers who drank stream water?
Oxytocin
Four
Paget disease (osteitis deformans)
Giardia lamblia (treat with metronidazole)

7. What determines the rate of reaction?
Eosin
1. Sartorius 2. Gracilis 3. Semitendinous
Ligamentum arteriosum
The energy of activation

8. What type of jaundice is seen in Dubin - Johnson syndrome?
Third week
Histrionic
Conjugated (direct) hyperbilirubinemia - a transport defect
Small cell carcinoma (oat cell)

9. What are the two factors that affect alveolar PCO2 levels?
Plasma cell (mature B lymphocyte)
IgA
Metabolic rate and alveolar ventilation (main factor)
SER

10. What cycle is responsible for converting to glucose in the liver the lactate produced in the RBCs?
Frontal eye field (Brodmann area 8)
Cori cycle
Lower lobe
Hemophilia A

11. What sided muscle weakness is seen in an UMN corticospinal tract injury above the pyramidal decussation?
BPH
The urine becomes hypertonic because of water reabsorption in the collecting duct.
Contralateral muscle weakness when above the decussation - whereas an UMN injury below the pyramidal decussation results in ipsilateral muscle weakness.
T4; because of the greater affinity for the binding protein - T4 has a significantly (nearly fifty times) longer half - life than T3.

12. What is the FiO2 of room air?
MGB
0.21; it is a fancy way of saying 21% of the air is O2.
Increased REM sleep - decreased REM latency - and decreased stage 4 sleep - leading to early morning awakening
One pair with three to five coccygeal vertebrae. Totaling 31 pairs of spinal nerves.

13. What two AAs have a pKa of 4?
Pregnancy
Adipose tissue
Aspartic acid and glutamic acid
HMP shunt

14. What aphasia is seen as an inability to comprehend spoken language and speaking in a word salad?
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.
Receptive aphasia is due to a lesion in Brodmann areas 22 - 39 - and 40; generally the patient is unaware of the deficit.
The gut rotates clockwise around the superior mesenteric artery.
Sheehan syndrome

15. What subset of CD4 helper T cells stimulate B- cell division and differentiation?
Mast cells
Burkitt lymphoma
Hypnopompic hallucinations occur during awakening - whereas hypnagogic hallucinations occur while one is falling asleep.
Th2

16. Name the structure that enters or exits the following foramina: x Foramen ovale
Previous suicide attempt
1. Malate dehydrogenase 2. Isocitrate dehydrogenase 3. a - Ketoglutarate dehydrogenase
CN V3 and the lesser petrosal nerve
Ch

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

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18. What does hepatitis D virus need from hepatitis B virus to be infective?
T3 has a greater affinity for the nuclear receptor and therefore is considered the active form.
Fusobacterium
HBsAg as its envelope
The concentration of plasma proteins determines effective osmolarity because capillary membranes are freely permeable to all substances except proteins.

19. What is the leading cause of school dropout?
Subdural hematoma is a rupture of the cerebral veins where they enter the superior sagittal sinus.
Pregnancy
Centriacinar worse in upper lobes; panacinar worse in base of lower lobes
The number of Ags that the Ab can bind

20. What embryonic structure forms the adult male structure? - Urinary bladder - urethra - prostate gland - bulbourethral gland
Urogenital sinus
Tyrosine
Cushing's disease (pituitary) has elevated ACTH and cortisol suppression with dexamethasone - whereas Cushing's syndrome (adrenal adenoma) has decreased ACTH and no cortisol suppression with dexamethasone.
By causing rebound insomnia and decrease in REM sleep

21. What enzyme has a 5' to 3' synthesis of the Okazaki fragments - 3' exonuclease activity - and 5' exonuclease activity?
Day 14
DNA polymerase I
Mycosis fungoides (cutaneous T- cell lymphoma)
Tip of the loop of Henle (1200 mOsm/L)

22. What complement factor deficiency leads to x Increased susceptibility to pyogenic infections?
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.
Down syndrome
Inspiratory reserve volume (IRV)
C3 deficiency

23. How many months in How many years must a person cough with copious sputum production for the diagnosis of chronic bronchitis to be made?
Adenosine deaminase (ADA) deficiency
Hairy cell leukemia
Neisseria gonorrhoeae and Chlamydia trachomatis
3 months of symptoms in 2 consecutive years

24. Name the lipoprotein based on the following characteristics - apo E
IDL
Diffusion rate is indirectly proportional to membrane thickness and is directly proportional to membranes surface area.
Preload. It is the load on a muscle Prior to contraction.
Microsporum

25. Name the DNA virus: x Partially dsDNA circular; enveloped; virion - associated polymerases; has RNA intermediate; replicates in the nucleus
Epstein - cardiac anomaly of the tricuspid valve
Hepadnavirus
Lysine and tyrosine
Eaton - Lambert syndrome

26. What AD disease associated with chromosome 19 involves a defect in the LDL receptors that leads to skin and tendon xanthomas?
Borderline
Familial hypercholesterolemia
Estrogen
HBc Ab

27. What are the pharmacologic effects seen sexually with x Beta- Blockers?
The stomach
Acetaldehyde dehydrogenase. When this enzyme is blocked - acetaldehyde builds up - and its presence in excess results in nausea and hypotension.
Impotence
Motor

28. What generate anterograde transport of information in a neuron?
Invariant chain. This is essential because the CD4 T cells have antigen receptors only for peptides bound to the MHC II molecule. (MHC restriction)
Turcot syndrome
Glutamine and aspartate
Kinesins. Dynein generates retrograde transportation of information.

29. What nerve is compromised in carpal tunnel syndrome?
Thiamine
Being a white male
Median nerve
Major

30. Is the carotid sinus sensitive to pressure or oxygen?

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31. When is the first arrested stage of development in the female reproductive cycle?
pK (think of it as where half is base and half is acid)
Fibrous pericardium
Prophase of meiosis I (between 12th and 22nd week in utero)
1. Fructokinase 2. Glucokinase 3. Glycerol kinase 4. PEPCK 5. Pyruvate carboxylase 6. Galactokinase 7. Fructose -1 - 6- bisphosphatase 8. Glucose -6- phosphatase

32. What is the most common one? - Vasculitis
Temporal arteritis
Secretin stimulates the pancreas to secrete a HCO3-- rich solution to neutralize the acidity of the chyme entering the duodenum.
Achondroplasia
Ch

33. What is the volume of distribution (increased or decreased) of a drug when a large percentage is protein bound?
Klinefelter syndrome
Volume of distribution is decreased when a large percentage of drug is protein bound.
Ipsilateral loss at and below the level of the lesion
Schedule dependent; antineoplastic agents that work on nonproliferating cells are dose dependent

34. What pneumoconiosis is associated with exposure to the following occupations or materials? - Miners - metal grinders - and sandblasters

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35. What hormone is characterized by the following renal effects? - Calcium reabsorption - phosphate reabsorption
Pyridoxine
One pair with three to five coccygeal vertebrae. Totaling 31 pairs of spinal nerves.
Vitamin D3
Wernicke's encephalopathy

36. What operant conditioning therapy or modification is described as x Removing a reinforcement (without the patient knowing) gradually over time to stop a condition?
Schizoid
Fading
It increases Ca2+ excretion from the kidney and increases bone mineralization.
Meclizine

37. An 80-year - old woman presents to you with right - sided temporal headache - facial pain and blurred vision on the affected side - and an elevated ESR. Your diagnosis?
Temporal arteritis (giant cell arteritis)
1. Short attention span 2. Impulsivity 3. Hyperactivity
Phentolamine and phenoxybenzamine
C1 - C2 - or C4 deficiency

38. In what disease is there a genetic absence of UDP- glucuronate transferase - resulting in an increase in free unconjugated bilirubin?
As the name indicates - there is no change in volume but there is an increase in pressure.
Stereocilia
Crigler - Najjar syndrome
The rectouterine pouch (of Douglas)

39. What is associated with prolonged lithium use?
Medial compartment of the thigh - obturator nerve
Meningocele All except occulta cause elevated - fetoprotein levels.
Hypothyroidism. (TSH levels must be monitored.)
Aminoacyl - tRNA synthetase - which uses 2 ATPs for this reaction.

40. What form of alcohol causes blindness?
Methanol (wood alcohol)
Chorda tympani of CN VII
Stable
d - ALA synthase

41. Senile plaques
M 1 and nicotinic receptors are excitatory in the CNS and M 2 receptor is inhibitory.
Somatization
Ristocetin
Alzheimer disease

42. What picornavirus is associated with hand - foot - and - mouth disease?
Venous pressure above the heart is subatmospheric - so a puncture there has the potential to introduce air into the system.
Coxsackie A
Occipital lobe
Crossover study

43. What stage of sleep is associated with somnambulism?
Squamous cell carcinoma
EF-2 and GTP
Sleepwalking is associated with stage 4 and occurs most often in the first third of sleep.
Acanthosis nigricans

44. What is the major inorganic component of bone?
Stylopharyngeus muscle is innervated by CN IX; all other pharyngeal muscles are innervated by CN X.
Truncus (1) arteriosus Transposition of the (2) great vessels Tri(3)cuspid atresia Tetra(4)logy of Fallot They all begin with T
Buffers (remember that buffers are best when they are used in a pH range near its pK)
Hydroxyapatite

45. What are the three characteristics of autoregulation?
Senile plaques - neurofibrillary tangles - and granulovascular changes in neurons
1. Flow independent of BP 2. Flow proportional to local metabolism 3. Flow independent of nervous reflexes
Increased ACh to decreased NE levels. (NE pathway begins in the pons and regulates REM sleep.)
>5 mm

46. Arrange the following layers in the correct sequence through which a needle must pass in a lumbar puncture - Skin x Subarachnoid space x Interspinous ligament x Dura mater x Deep fascia x Epidural space x Superficial fascia x Interlaminar space x Su
During a lumbar puncture the needle passes through the interlaminar space in the midline of L3- L4 - with the tip of the iliac crest in the flexed position as the landmark. Order of puncture: 1. Skin 2. Superficial fascia 3. Deep fascia 4. Supraspino
T3
14 days in most women (Remember - the luteal phase is always constant.)
Thoracic and sacral

47. What renal disease in diabetic patients is seen as a halo of capillaries around the mesangial nodules?
The pulsatile release of GnRH
Allelic exclusion. It is to ensure that one B cell produces only one Ab.
Kimmelstiel - Wilson disease
Microsporum

48. What potentially fatal disease occurs in children who are given aspirin during a viral illness?
Reye syndrome
Ulcerative colitis
Osler nodes
Serotonin

49. What negative sense RNA virus is associated with intracytoplasmic inclusion bodies called Negri bodies?
Reverse transcriptase
Rabies
Omega -3 fatty acids
Native Americans

50. What two requirements must be met for the Lac operon to be activated?
Microglial cells
Mean
Lactose must be present and glucose must be absent
Plasmodium malariae

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USMLE Step 1 Prep

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