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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 nerves provide sensory innervation above the vocal cords? Below the vocal cords?
Gerstmann's syndrome; spoken language is usually understood.
1. The lesser omentum (consisting of the hepatoduodenal and hepatogastric ligaments) 2. Falciform ligament 3. Coronary ligament of the liver 4. Triangular ligament of the liver Liver is ventral; all other ligaments are dorsal mesentery derivatives.
Splenomegaly and anemia (with a high index of suspicion)
The internal laryngeal nerve supplies sensory information from above the vocal cords while the recurrent laryngeal nerve supplies sensory information below.

2. From What embryonic structure are the following structures derived? - The sinus venarum - coronary sinus - and the oblique vein of the left atrium
Sinus venosus
The first trimester
Ventral lateral nucleus
Aspiration pneumonia

3. What is the term for the strength of association between multiple Abbinding sites and multiple antigenic determinants?
300 mOsm/L
Breast cancer
Avidity (more than one binding site)
Aorta - azygos vein - and thoracic duct Remember: 1 at T8 - 2 at T10 - and 3 at T12

4. What fungus is seen as colored cauliflower lesions?
Chromomycosis
1. Cough 2. Coryza 3. Conjunctivitis
Left colic - superior rectal - and sigmoidal arteries
The otic ganglion. (These fibers are carried in CN IX. Remember it like this: the - oti - is in both otic ganglion and parotid gland.)

5. What are the following changes seen in the luminal fluid by the time it leaves the PCT of the nephron? - Percentage of original filtered volume left in the lumen
Missense
Inferior rectus (CN III) (LR6 SO4)3
All
At the end of the PCT 25% of the original volume is left

6. Which type of hepatitis can cause hepatocellular carcinoma?
Sphingomyelinase
Permanent
Hepatitis B
B cells; macrophages and dendritic cells are nonspecific.

7. Why is spermatogenesis decreased with anabolic steroid therapy?
after abortion
Arginine
DiGeorge syndrome - Which is due to a failure of the third and fourth pharyngeal pouch development. Remember - B cell deficiencies are associated with extracellular infection. T cell deficiencies are associated with intracellular infections
Exogenous steroids suppress LH release and result in Leydig cell atrophy. Testosterone - produced by Leydig cells - is needed for spermatogenesis.

8. What AR CNS disorder presents early in childhood with gait ataxia - loss of deep tendon reflexes - impaired vibratory sensation - hand clumsiness - and loss of position sense?
Bender Visual Motor Gestalt Test
NREM sleep. Night terrors are dreams that we are unable to recall.
Naloxone or naltrexone
Friedreich ataxia

9. Which antimicrobial agent is used with pyrimethamine to treat toxoplasmosis?
Increased GABA levels decrease the likelihood of learned helplessness.
GP120
Clindamycin
2 NADPHs per acetyl CoA

10. What is the term for pus in the pleural space?
Empyema
Zanamivir and oseltamivir
CN II is the sensory limb and CN III is the motor component through parasympathetic stimulation.
Chromosome 1

11. What IL is important in myeloid cell development?
Potter facies
1. CHF 2. Vena caval obstruction or constriction 3. Hepatic cirrhosis 4. Renal artery stenosis
IL-3 (3 face down is an M)
Prevalence increases. (Remember - prevalence can decrease in only two ways - recovery and death.)

12. What enzyme of the purine salvage pathway is deficient in the following? - SCID
Spironolactone
Adenosine deaminase
Hypertrophy
Thiazide diuretics

13. Why is there an increase in prolactin if the hypothalamic - pituitary axis was severed?
Acetaminophen
Because the chronic inhibition of dopamine (PIF) on the release of prolactin from the anterior pituitary gland is removed - thereby increasing the secretion of prolactin.
Chief cells
Galactitol

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

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15. Which bacteria are associated with the following pigment production? - Pyocyanin (blue - green)
Megaloblasts
At 8 to 9 years of age. Prior to this age they view death as a form of punishment.
In the dorsal horn of the spinal cord on the primary afferent neurons
Pseudomonas aeruginosa

16. What pulmonary disease - most commonly associated with smoking - results in enlarged - overinflated lungs owing to the destruction of the alveolar walls with diminished elastic recoil?
Patients with cystic fibrosis have a mutation in the chloride channel protein in the CFTR gene on chromosome 7.
Emphysema
CHF
Fluconazole

17. Do the following structures pick up stain from hematoxylin or eosin? - Collagen
Ciliary ganglion producing a tonic pupil
Sickle cell disease
Adenocarcinoma
Eosin

18. What nucleus of the hypothalamus is the satiety center - regulating food intake?
Type II hypersensitivity (cytotoxic)
Brucella
Nissl substances; there is a great deal of RER in neuron cell bodies - indicating high protein synthesis.
Ventromedial nucleus; lesions here result in obesity.

19. What dementia is associated with dilated ventricles with diffuse cortical atrophy - decreased parietal lobe blood flow - and a decrease in choline acetyl transferase activity?

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20. What is the most common one? - Brain tumor
The splenic vein
Metastatic
Left ventricle and auricle of left atrium
Rabies

21. What is the most common one? - Joint affected in pseudogout
Kartagener's syndrome (also known as immotile cilia syndrome) -------------------------------------------------------------------------------
Knee
Streptococcus viridans
A left CN X lesion results in the uvula deviating to the right. (Uvula points away from the affected side.)

22. What hormone disorder is characterized by the following abnormalities in sex steroids? - LH? - and FSH?? - Sex steroids - LH - FSH
Early distal tubule
Because it is the largest vessel and has the highest velocity in systemic circulation
Pituitary hypogonadism
Sickle cell anemia - Caisson disease - chronic steroid use - and Gaucher disease

23. To What does failure to resolve separation anxiety lead?
School phobia
Stibogluconate
Polycythemia vera (Remember - polycythemia vera is a risk factor for acute leukemias.)
Dimercaprol - D- penicillamine

24. Depolarization of the postsynaptic membrane...
1. Iliocostalis 2. Longissimus 3. Spinalis ('I Love Science' muscles)
Right atrium
excites the neuron
They are inversely proportional to each other; as pulse pressure increases - compliance decreases.

25. What phase of the cell cycle are the following antineoplastic agents specific for? - Nitrosoureas
They block the midcycle surge of LH.
Ampicillin and amoxicillin
G0 phase
Zero - order elimination

26. What is the most common one? - Location of ependymomas in children
Hemiballismus
Waldeyer's ring
In children - the fourth ventricle; in adults - the lateral ventricle or spinal cord
The promoter indicates where transcription will begin.

27. What enzyme is deficient in alkaptonuria?
Second M PITS for pharyngeal pouch derivatives
No - therapeutic indices can tell which drug is safer - not more toxic.
Homogentisic oxidase
Direct pathway; a good example is Parkinson's disease.

28. What encephalitis is associated with the JC virus?
Physostigmine
Poliomyelitis; it is a bilateral LMN lesion.
Progressive multifocal leukoencephalopathy
IgG4

29. What type of binding occurs with one Fab or one idiotype of IgG?
Affinity
Ipratropium
Carcinoid tumor
Preganglionic sympathetic neurons

30. Name the cancer associated with the following chemical agents. (Some may have more than one answer.) x Arsenic
The substantia nigra is the largest nucleus in the midbrain. It contains melanin and uses GABA and dopamine as its neurotransmitters.
The carotid body - which monitors arterial blood directly
Displacement
Squamous cell carcinoma (skin - lung) and angiosarcoma of the liver

31. How much of a vessel must be stenosed to cause sudden cardiac death?
Beta- Blockers
More than 75% of the vessel
Vitamin D
Variola virus (Smallpox)

32. Name the most common type or cause - Urethritis in a young - newly sexually active individual
Staphylococcus saprophyticus
Deltoid
Cones (C for color and cones)
There would be a Fab' region; thus - it would still be able to participate in precipitation and agglutination.

33. What disease caused by decompression sickness leads to multiple foci of ischemic necrosis that affect the head of the femur - humerus - and tibia?
Stage 3 and 4
Caisson disease
They chronically inhibit ADH secretion; when there is a decrease in the blood volume - the stretch receptors send fewer signals - and ADH is secreted.
p -53

34. Are necessary for normal menstrual cycles.
They are preganglionic sympathetic axons. They are white because they are myelinated.
C3b
The number of cross - bridges cycling during contraction: the greater the number - the greater the force of contraction.
Thyroid hormones

35. What is the most common one? - Viral cause of myocarditis
No - it is not a mandatory reportable offense (if you can believe it). Child and elderly abuse are mandatory reportable offenses.
Coxsackie B
Lateral pontine syndrome
Flocculonodular lobe (one of my favorite words in all of medicine!)

36. What does the tunica intima of arteries have that veins do not?
The right gonadal vein drains into the inferior vena cava directly - and the left gonadal vein drains into the left renal vein.
Aedes (the same for yellow fever)
An internal elastic lamina
1. C5a 2. Leukotriene B4 3. IL-8 4. Bacterial peptides

37. What is the most common organ involved in amyloidosis?
Kidney
Huntington's chorea. (Death in 15-20 years - often via suicide.)
Syncytiotrophoblast. (The cytotrophoblast gets incorporated into the syncytiotrophoblast.)
Lumbar splanchnics

38. Name the product or products of arachidonic acid: x Vasodilation - bronchospasm - and increased vascular permeability
Cancer
Scleroderma
IgA
LTC4 - LTD4 - and LTE4

39. Name the most common type or cause - Infantile bacterial diarrhea
DNA polymerase I
Enteropathogenic Escherichia coli (Rotavirus is the MCC overall.)
MEN III (or IIb)
Adjustment disorder. It is a diagnosis of exclusion (used if no other choice).

40. Which class of antihypertensives is used in the treatment of BPH?
Squamous cell carcinoma
Liver
a - Blockers (- zosins)
Confounding bias

41. What is the DOC for CMV retinitis?
Ganciclovir
The Romberg sign is present if the patient sways or loses balance when standing with eyes open. In a dorsal column lesion - patients sway with eyes closed. (Don't forget this one.)
alpha - Motor neurons innervate extrafusal muscle fibers (a motor unit) - whereas gamma - motor neurons innervate intrafusal muscle fibers.
Because they do not block D2A receptors - they are antagonists of 5HT2 receptors.

42. What cell type is commonly elevated in asthma?
Allopurinol
Esophagus - SVC - vagus nerve - azygos vein - thoracic duct - thymus - and phrenic nerve
Eosinophil
The poly(A) site on the DNA

43. What is the most common site for implantation of the blastocyst?
Pulmonary alveolar macrophages
On the superior body of the posterior wall of the uterus
Physiologic antagonism
EBV

44. What thalamic relay nucleus do the mammillary bodies project to?
The anterior nucleus of the thalamus
Areas 1 - 2 - and 3
Glutamine and aspartate
Plasmodium ovale

45. How does the sympathetic nervous system affect insulin secretion?
5HT1D
Follicular adenoma
1. Picornavirus 2. Calicivirus 3. Reovirus (Remember PCR)
It decreases insulin secretion.

46. Name the correct artery - The right recurrent laryngeal nerve passes around it.
Palms - up before palms - down maneuvers
2 and 5HT3 receptors
Mean corpuscular hemoglobin (MCH)
Right brachiocephalic artery

47. Patients with sickle cell anemia are at increased risk for infection From what type of organisms?
Alanine and glutamine
1. Cytotrophoblast 2. Syncytiotrophoblast 3. Extraembryonic mesoderm
Encapsulated bacteria
Plasma concentration and excretion rate

48. What five factors promote turbulent flow?
Acanthosis nigricans
1. Increased tube radius 2. Increased velocity 3. Decreased viscosity 4. Increased number of branches 5. Narrowing of an orifice
The JG cells
No. Prions are infectious proteins - so antibiotics are useless.

49. A chronic alcohol abuser goes to the ER with weakness - a sore - beefy red tongue - loss of vibration and position sense - arm and leg dystaxia - elevated levels of methylmalonic acid in the urine - and anemia with an MCV above 105 fL. What is your d
Berylliosis
The scaphoid is the most commonly fractured and the lunate is the most commonly dislocated.
Cholera toxin irreversibly activates the cAMP- dependent chloride pumps of the small and large intestine - producing a large volume of chloride - rich diarrhea.
Subacute combined degeneration of the spinal cord is treated with IM vitamin B12 injections. If treatment is working - you will see an increased reticulocyte count on the peripheral smear in about 5 days.

50. What glycoprotein in the HIV virus is used for fusion?
CN VI - VII - and VIII
GP41
The deepest sleep levels (stage 3 and 4) occur mostly in the first half of sleep.
Conduction aphasia