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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 glycoprotein allows platelets to adhere to von Willebrand factor?
Pancreatic cancer
Hemangioma (benign)
GP Ib
An elevated serum osteocalcin level

2. What are the three benzodiazepines that do not undergo microsomal oxidation?
Factors II - VII - IX - and X and proteins C and S.
Oxazepam - temazepam - and lorazepam (OTL) (mnemonic: Outside The Liver). They undergo glucuronide conjugation - not via the cytochrome p450 system.
Ultraviolet B (UVB) sunlight
Renal plasma flow (decrease flow - increase FF)

3. In prokaryotes - What is the term for a set of structural genes that code for a select group of proteins and the regulatory elements required for the expression of such gene?
Internal carotid artery
Operon
Rifampin
Agents that decrease ACh function reduce tremors and rigidity - not bradykinesias.

4. Name the ocular lesion; be specific - A right LGB lesion (in the thalamus)
C5- C8 deficiency
Left homonymous hemianopsia
Pseudomembranous exudates
Parafollicular C cells

5. Is a side effect of cimetidine.
Gynecomastia
Duodenal ulcer
Formal operations (> 12 years)
Chronic rejection

6. Where in the kidney are the long loops of Henle and the terminal regions of the collecting ducts?
Five pairs through five sacral vertebrae. Totaling 31 pairs of spinal nerves.
Voltage - gated sodium channel
In the medulla; all the other structures are cortical.
Adaptive branch. The adaptive branch of the immune system has a slow initiation with rapid responses thereafter.

7. What lower extremity nerve is described by the following motor loss? - Loss of adduction of the thigh
Caseous necrosis
The lateral vestibular nucleus
Streptococcus agalactiae
Obturator nerve

8. What is the triad of Felty syndrome?
Nimodipine
Neutropenia - splenomegaly - and rheumatoid arthritis
LARP: Left goes Anterior and Right goes Posterior (because of the rotation of the gut; remember your embryology!)
Medullary carcinoma of the thyroid

9. If you order a V/Q scan for suspected pulmonary emboli - is the filling defect seen on the ventilation or perfusion side?
Ventilation of an unperfused lung segment is highly suspicious for pulmonary embolism.
Axis III
VLDL
Ptosis (eyelid drooping) - miosis (pupillary constriction) - and anhydrosis (lack of sweating) occur when the preganglionic sympathetic fibers from T1- to T4 are obstructed.

10. 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)
X- linked recessive
Raloxifene
Zona fasciculata and zona reticularis
Sublimation

11. What bacterium is diagnosed using the Dieterle silver stain?
Nucleolus. Ribosomal assembly also takes place in the nucleolus.
Legionella
Pseudomonas aeruginosa
EF- Tu and EF- Ts of the 30S ribosomal subunit

12. Do the following structures pick up stain from hematoxylin or eosin? - Collagen
Phase 3
Gastric carcinoma
Eosin
Mesothelioma and bronchogenic carcinoma

13. What is the most common one? - Primary CNS tumor
The lung will expand; also the opposite is true.
Flucytosine
Glioblastoma multiforme
Schedule dependent; antineoplastic agents that work on nonproliferating cells are dose dependent

14. Name the macrophages by location: x CNS
Microglial cells
Folic acid deficiency
Ostium secundum defects
HPV serotypes 1 and 4

15. Can a patient refuse life - saving treatment for religious reasons?

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16. What T- cell surface projection recognizes and reacts to foreign Ags (presented by APCs)?
Vibrio parahaemolyticus
a - Blockers (- zosins)
Week four - and they remain dormant there until puberty.
TCR

17. What parasympathetic nucleus is found on the floor of the fourth ventricle and supplies preganglionic fibers innervating the terminal ganglias of the thorax - foregut - and midgut?
Poststreptococcal GN
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.)
Progestins
Dorsal motor nucleus of CN X

18. How many segments in a neutrophilic nucleus are necessary for it to be called hypersegmented?
Esophagus - SVC - vagus nerve - azygos vein - thoracic duct - thymus - and phrenic nerve
apo B-48
Dihydrofolate reductase
At least 5 lobes

19. Which is the conditioned response - the conditioned stimulus - the unconditioned response - the unconditioned stimulus in this case? A patient has blood withdrawn and faints. The next time she goes to have blood taken - she faints at the sight of the
Insulin increases total body stores of protein - fat - and CHOs. When you think insulin - you think storage.
The blood withdrawn is the unconditioned stimulus - inducing the unconditioned response (fainting). The needle is part of the blood - drawing procedure and is the conditioned stimulus (unconditioned and conditioned stimuli are paired) resulting in th
Hyaluronic acid (all sulfates bind to the core protein)
extrapyramidal dysfunction

20. What subtype of IgG does not bind to staphylococcal A protein?
Four high energy bonds - two from ATP in AA activation and two from GTP
Janeway lesions
IgG3
Staphylococcus aureus (but they are more prone to salmonella infections)

21. Match the chromosome and haploid number with the stage of sperm development - spermatid - spermatocyte (primary or secondary) - spermatogonia (type A or B): x 23/1n
1. Cefamandole 2. Cefoperazone 3. Moxalactam
C3 deficiency
Temporal lobes
Spermatid

22. Name the primary vesicle the following structures are derived from (proencephalon - mesencephalon - or rhombencephalon) - Thalamus
Right nasal hemianopsia
Chromosome 14 - 18
Proencephalon
The fasciculus cuneatus

23. What structure is derived from the prochordal plate?
Polycystic ovary disease (Stein - Leventhal syndrome)
1. IgA receptor 2. Transport of IgA across epithelial barriers 3. Protection of IgA from degradative proteases
The mouth
Cestodes

24. Name the primary vesicle the following structures are derived from (proencephalon - mesencephalon - or rhombencephalon) - Neurohypophysis
Carbonic anhydrase inhibitors (acetazolamide and dorzolamide)
CN VII
Hydroxyproline (breakdown product of collagen)
Proencephalon diencephalon derivative

25. What substrate gets built up in Gaucher's disease?
Alzheimer disease
Melatonin. It is a light - sensitive hormone that is associated with sleepiness.
Minocycline
Glucosyl cerebroside

26. What cell type of the epidermis functions as antigen - presenting cells?
Superior
Langerhans cells (found in the stratum spinosum)
Staphylococcus aureus
10% are bilateral - 10% malignant - and 10% familial - 10% in children - and 10% outside the adrenal gland

27. What enveloped RNA retrovirus infects CD4 T cells and uses the enzyme reverse transcriptase?
HIV
Undoing
CN XI - vertebral arteries
Terminal bronchioles. (No gas exchange occurs here.)

28. Starry sky appearance of macrophages is pathognomonic of what lymphoma?
Carbonic anhydrase inhibitors (acetazolamide and dorzolamide)
Dysmetria; this is seen in a finger - to - nose test.
Excess lead
Burkitt lymphoma

29. 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
Polycythemia vera (Remember - polycythemia vera is a risk factor for acute leukemias.)
Enterokinase
Lateral compartment of the leg - superficial peroneal nerve

30. What is needed to initiate translation?
IF and GTP (eIF for eukaryotes)
Thymidylate synthetase
Diphyllobothrium latum
Giant cell bone tumor (osteoclastoma)

31. Name the three ketone bodies.
For males - HTN; for females - pregnancy.
Breast and lung cancer - respectively.
Acetoacetate - acetone - and Beta- hydroxybutyrate
Conjugated (direct) hyperbilirubinemia

32. Are the quadrate and caudate lobes of the liver functionally part of the left or right lobe?
Ordinal scale (e.g. - faster/slower - taller/shorter)
Posterior interventricular artery
100%; the percentage of blood flow through the pulmonary and systemic circulations are equal.
Functionally they are part of the left lobe of the liver because they receive their blood supply from the left hepatic artery. Anatomically they are considered part of the right lobe of the liver.

33. Name the compartment of the lower extremity and the nerve based on its movements - Adduct the thigh and flex the hip
Catalase - negative bacteria secrete H2O2 as a byproduct (remember - catalase breaks down H2O2) - allowing the neutrophils to use it as the substrate for the other toxic metabolites. Patients with CGD are prone to catalase - positive bacterial infect
Esophagus and esophageal nerve plexus (CN X) Remember: 1 at T8 - 2 at T10 - and 3 at T12
Upper outer quadrant (left more than right)
Medial compartment of the thigh - obturator nerve

34. What AD syndrome produces hamartomatous polyps in the small intestine and pigmentation of the lips and oral mucosa?
unprocessed Ags
Peutz - Jeghers syndrome
AT II
Lateral medullary (Wallenberg's) syndrome

35. Name the antimicrobial agent whose major side effect is listed - Dental staining in children
Preganglionic sympathetic neurons
Tetracycline
Phase I
Folate deficiency (very common in the elderly)

36. Stimulate hair cells at the base of the cochlea.
Log - kill hypothesis (follows first order kinetics)
Semicircular canal
High - frequency sound waves
Testosterone

37. What endocrine abnormality is characterized by the following changes in PTH - Ca2+ - and inorganic phosphate (Pi)? - PTH increased - Ca2+ increased - Pi decreased
Ionized drugs are water soluble - and since only lipid - soluble drugs can cross biomembranes - an ionized drug cannot cross them without the help of a carrier.
von Gierke's disease
Primary hyperparathyroidism
1. Temporal 2. Zygomatic 3. Buccal 4. Mandibular 5. Cervical (Two Zebras Bit My Clavicle.)

38. What are the five effects of insulin on fat metabolism?
1. Increased glucose uptake by fat cells 2. Increased triglyceride uptake by fat cells 3. Increased conversion of CHOs into fat 4. Decreased lipolysis in fat tissue 5. Decreased ketone body formation
Ergosterol
Second M PITS for pharyngeal pouch derivatives
Marrow failure - cancer - and leukemia

39. What lymphoid organ is characterized by germinal centers - plasma cells that secrete IgA - and no encapsulation?

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40. What infection is associated with ring - enhancing lesions seen on computed tomography (CT) of the brain in an HIV- positive individual?
Collecting ducts - which make them readily permeable to water reabsorption.
CD15 and CD30
Toxoplasmosis (although you should rule out cerebral abscess due to other organisms)
Cyanocobalamin (B12) deficiency (Folic acid deficiency has only homocystinuria as a sign.)

41. What is the most likely organism causing cellulitis in a patient who was cut by an oyster shell?
ASD
Al - Anon
Mesencephalic nucleus
Vibrio vulnificus

42. What are the nonoxidative enzymes of the HMP shunt? Are the reactions they catalyze reversible or irreversible?
Cleft palate
Dissociation
Transketolase and transaldolase. The reactions they catalyze are reversible.
Brushfield spots

43. What are the primary neurotransmitters at the following sites? - All motor neurons - postganglionic parasympathetic neurons
Takayasu arteritis (medium - size to large vessels)
Affinity decreases; they are inversely proportional.
ACh
Adulthood

44. What are the three rules of clonal selection?
Rapidly progressive glomerulonephritis (RPGN)
They are in the grey matter of the CNS.
RNA polymerase II
1. One cell type 2. One Ab type 3. Random selection of hypervariable regions - and only cells with bound Ag undergo clonal expansion

45. What parasite is associated with squamous cell carcinoma of the urinary bladder?
Cortisol Remember - from the outer cortex to the inner layer - Salt - Sugar - Sex. The adrenal cortex gets sweeter as you go deeper.
Subatmospheric pressure acts to expand the lung; positive pressure acts to collapse the lung.
Schistosoma haematobium
Sjogren's syndrome - active hepatitis - systemic lupus erythematosus (with HLA- DR2) and type 1 diabetes (with HLA- DR4)

46. How many days prior to ovulation does LH surge occur in the menstrual cycle?
1 day prior to ovulation
a -1 - 6 transferase
DiGeorge syndrome
Spermatogonia (type A)

47. What is the most common form of dementia?

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48. What sex cell tumor causes precocious puberty - masculinization - gynecomastia in adults - and crystalloids of Reinke?
Pneumococcus
The Halsted - Reitan battery. It consists of finger oscillation - speech sound perception - rhythm - tactual - and category testing.
Somatoform pain disorder
Leydig cell tumor

49. What substrate is built up in Niemann - Pick disease?
Kidney
Sphingomyelin
Graves disease (Increased T4 decreases TRH and TSH through negative feedback.)
Intussusception

50. Name the lipoprotein based on the following characteristics - apo A-1 - apo E - apo C- II
Anterior wall of the first part of the duodenum
Hemophilia A
HDL
>10 mm