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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. Name the type of regeneration (i.e. - labile - stable - or permanent) based on the following examples - Cardiac muscle
1. Glucose 2. Amino acid (arginine) 3. Gastrin inhibitory peptide (GIP) 4. Glucagon 5. Beta- Agonists 6. ACh
Permanent
Decreases
Actually - yes. You should encourage your patient to try other forms of medicine as long as they are not contraindicated with the patient's preexisting illness. You must be able to accept the health beliefs of your patients - even if you don't agree.

2. What thyroiditis presents as a tender - enlarged - firm thyroid gland - usually preceded by an upper respiratory viral illness?
CMV - Toxoplasma gondii - and Listeria
Absolute refractory period is due to voltage inactivation of sodium channels.
de Quervain thyroiditis
Wernicke's aphasia

3. What subset of CD4 T cells is responsible for mast cell and eosinophil precursor proliferation?
GP IIb and IIIa receptors
Urogenital folds
Juxtaglomerular (JG) cell
Th2 cells

4. What serves as a marker of endogenous insulin secretion?
Varicella
Anorgasmia. (The overall prevalence is 30%.)
C- peptide levels
Metabolic alkalosis (summary: high pH - low H+ and high HCO3-)

5. Is the pH of CSF acidotic - alkalotic - or neutral?
Superior
The ECF compartment always enlarges when there is a net gain in total body water and decreases when there is a loss of total body water. Hydration status is named in terms of the ECF compartment.
They are directly related; the greater the preload - the greater the passive tension in the muscle and the greater the prestretch of a sarcomere.
The pH of CSF is 7.33 - acidotic.

6. What type of correlation is defined as x Two variables that go together in the same direction?
Positive correlation
Lead
Fructose -1 - 6- bisphosphatase
Negative reinforcement

7. Name the area of the cerebral cortex affected by the description of the effects - symptoms - and results of the lesion - Dysphoria - irritability - musical and visual abilities decreased
hyperventilation
Primary intention
Area 4
Nondominant temporal lobe

8. Aschoff bodies
Escherichia coli
ydroxyproline
Negative reinforcement
Rheumatic fever

9. What bacterium is a gram - negative - oxidase - positive aerobic rod that produces a grapelike odor and pyocyanin pigmentation?
Pseudomonas aeruginosa
B cells are mainly found in the peripheral white pulp and germinal centers in the spleen.
Efficacy
The right gonadal vein drains into the inferior vena cava directly - and the left gonadal vein drains into the left renal vein.

10. What is the term for a congenital absence of the ganglionic cells of the Auerbach and Meissner plexus in the rectum and sigmoid colon?
Hirschsprung disease (aganglionic megacolon)
Neuroblastoma
Mesothelioma and bronchogenic carcinoma
HBcAb IgM - HBV- DNA - HBeAg - HBsAg

11. What is the most common one? - Stromal tumor of the ovary
There are 10 bronchopulmonary segments on the right and 8 on the left.
Ovarian fibroma
Femoral hernias
Gestational trophoblastic neoplasia (GTN or choriocarcinoma)

12. Which protein prevents internal binding of self proteins within an MHC class II cell?
The chief cells of the parathyroid gland release PTH in response to hypocalcemia.
Chromosome 13
Parvovirus (it is the only ssDNA virus)
Invariant chain

13. What enzyme is inhibited by trimethoprim?
Dihydrofolate reductase
Breast
0157:H7
Raynaud's phenomenon

14. In high altitudes - What is the main drive for ventilation?
NAVEL: Femoral Nerve - Artery - Vein - Empty space - and Lymphatics/Lacunar ligament
The main drive shifts from central chemoreceptors (CSF H+) to peripheral chemoreceptors monitoring low PO2 levels.
The right and left pulmonary arteries - the only arteries that carry deoxygenated blood
Clostridium botulinum

15. What percent of unwed mothers are teenagers?
Histiocytes
Coarctation of the aorta
White muscle; short term too
50% - with 50% of them having the child

16. What attaches the cusps of the valves to the papillary muscles in the heart?
>5 mm
Chordae tendineae
Urinary trigone
For the USMLE Step 1 the answer is no - but if the information would do more harm than good - withhold. This is very rare but it does occur.

17. Is GH considered a gluconeogenic hormone?
Centriacinar worse in upper lobes; panacinar worse in base of lower lobes
Yes - it decreases fat and muscle uptake of glucose - thereby increasing blood glucose levels.
Obese patients
Secondary hypocortisolism (pituitary)

18. From what pharyngeal pouch is the following structure derived? - Middle ear
Tetany
Sjogren's syndrome - active hepatitis - systemic lupus erythematosus (with HLA- DR2) and type 1 diabetes (with HLA- DR4)
First M PITS for pharyngeal pouch derivatives
G2 phase

19. What is the term for a large VSD that leads to pulmonary HTN - RVH - and cyanosis due to right - to - left reversal of the shunt?
Ceramide
CN II is the sensory limb and CN III is the motor component through parasympathetic stimulation.
Eisenmenger syndrome - which can also occur with any left - to - right shunt
Chromosome 15q

20. Neurofibrillary tangles
Alzheimer disease
CD19
Preload (the load on the muscle in the relaxed state)
ACL

21. What is the pyrimidine intermediate that joins PRPP (5- Phosphoribosyl -1- Pyrophosphate)?
PGI 2
Orotic acid (purine metabolism)
Negative
1. Sustained release 2. IV drip 3. Phenytoin 4. Alcohol 5. Aspirin toxicity

22. What cell in the heart has the highest rate of automaticity?
The coding strand is identical to mRNA - and the template strand is complementary and antiparallel.
Intrinsic factor (IF)
Transketolase and transaldolase. The reactions they catalyze are reversible.
SA node; it is the reason it is the primary pacemaker of the heart.

23. What antimuscarinic is used as an inhalant for asthma?
Secondary hyperthyroidism (Increased TSH results in increased T4 production and increased negative feedback on to hypothalamus and decreased release of TRH.)
LTC4 and LTD4
Serocystadenocarcinoma
Ipratropium

24. What purine base is contained in inosine monophosphate?
Superior
The portal tract of the liver lobule
Hypoxanthine (remember - IMP is a precursor for AMP and GMP)
Histiocytosis X

25. What tract is responsible for voluntary refined movements of distal extremities?
Inferior pancreaticoduodenal - middle colic - right colic - ileocolic - and 10 to 15 intestinal arteries
Corticospinal tract
Leiomyoma
Ego dystonic

26. What oxygen - dependent killing enzyme requires hydrogen peroxide and halide (Cl -) to produce hypochlorous acid?
Myeloperoxidase
Staphylococcus aureus
Sleepwalking is associated with stage 4 and occurs most often in the first third of sleep.
Complex 4

27. What area of the spleen consists of splenic cords of Billroth and phagocytoses RBCs?
C3a - C4a - C5a
Clostridium tetani
Vertebra prominens (C7 in 70% of cases - C6 in 20% - T1 in 10%)
Red pulp (Remember - Red pulp and RBCs begin with R.)

28. Acts as the vertebral body of C1 allowing lateral rotation of the head. The first cervical vertebra has no vertebral body.
During REM sleep
GH deficiency
Autoimmune hemolytic anemia
The odontoid process of C2

29. What type of binding occurs with one Fab or one idiotype of IgG?
Lesch - Nyhan syndrome
A right CN V lesion results in weakened muscles of mastication - and the jaw deviates to the right.
Affinity
Yes

30. What childhood pathology involves anterior bowing of the tibia - epiphyseal enlargements - and costochondral widening - with the endochondral bones being affected?
Dysgerminoma
Silent
Thymus gland. (Thymus gland is essential for T cell maturation.)
Rickets

31. Birbeck granules
Histiocytosis X
Paranoid schizophrenia
Vitamin D
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 name of violent projectile movements of a limb resulting from a lesion in the subthalamic nuclei of the basal ganglia?
Trimethoprim/sulfamethoxazole (TMP- SMX)
Hemiballismus
Nicotine (but it sure has a nasty withdrawal!)
Shifts it to the right

33. What type of hypersensitivity is a result of high circulating levels of soluble immune complexes made up of IgG or IgM Abs?
Prefrontal cortex; it is in front of the premotor area.
Polycythemia vera (Remember - polycythemia vera is a risk factor for acute leukemias.)
Type III hypersensitivity reaction
ASD

34. Name the most common type or cause - Cellular injury
Hypoxia
Phase 0
Meningococcus grows on chocolate agar - and Gonococcus grows on Thayer - Martin medium.
Thymic epithelial cells - dendritic cells - and macrophages

35. The DSM- IV- TR is scored on the basis of five axes of diagnosis. In What axis would you place x Medical or physical ailments?
CN III - IV - and VI
Light regulates the activity of the pineal gland via the retinal - suprachiasmatic - pineal pathway.
Excretion is greater than filtration for net secretion to occur.
Axis III

36. What component of the vascular system is most sensitive to the effects of calcium channel blockers?
A Ghon focus is a TB tubercle - whereas a Ghon complex is a focus with hilar lymph node involvement.
2.0 or greater
Squamous cell carcinoma
Arterioles

37. What type of questions should you begin with when a patient seeks your medical opinion?
Immature B cells
Supraoptic nuclei; lesions here result in diabetes insipidus.
It is best to begin with open - ended questions - allowing patients to describe in their own words What troubles them. You can then move to closed - ended questions when narrowing the diagnosis.
1. What did the patient want? 2. What would the patient say? 3. What is in the patient's best interests?

38. What are the four exceptions to requirements for informed consent?
1. Incompetent patient (determined by the courts) 2. Therapeutic privilege (in the best interest of the patient when he or she is unable to answer) 3. Waiver signed by the patient 4. Emergency
The AR form is malignant and AD is benign.
The primitive streak grows caudal to rostral.
Psoas major

39. What hormone disorder is characterized by the following abnormalities in sex steroids? - LH? - and FSH?? - Sex steroids - LH - FSH ?
Primary hypogonadism (postmenopausal women)
Glycine and succinyl - CoA
Stanford - Binet Scale - developed in 1905 - is useful in the very bright - the impaired - and children less than 6 years old.
Parasites

40. Are two different receptors with two different agonists characteristic of pharmacologic or physiologic antagonism?
These are the gross pathologic changes associated with Alzheimer's disease.
t the end of the PCT 25% of Na+ - Cl - - K+ is left
Physiologic antagonism
Thiazide diuretics

41. What is the name of the postganglionic parasympathetic ganglion that innervates x The parotid gland?
The otic ganglion. (These fibers are carried in CN IX. Remember it like this: the - oti - is in both otic ganglion and parotid gland.)
Streptococcus pneumoniae
Enkephalins
de Quervain thyroiditis

42. Is the Salk polio vaccine inactivated?
Rho-immunoglobin
Yes
Leukemias and lymphomas
Infiltrating ductal carcinoma

43. What are the three anatomic characteristics that differentiate the large bowel from the small bowel and the rectum?
IQ
The increased H+ moves intracellularly and is buffered by K+ leaving the cells - resulting in intracellular depletion and serum excess. (Intracellular hypokalemia is the reason you supplement potassium in diabetic ketoacidosis - even though the serum
1. Tinea coli 2. Haustra 3. Epiploic appendages
Turner syndrome

44. What serotonin reuptake inhibitor's major sexual side effect is priapism?
Trazodone
Osteoclasts
Hypocalcemia and hypophosphatemia
Extrahepatic biliary atresia

45. Name the type of mutation: x New codon specifies for a stop codon
Nonsense
The left is a branch of the aortic arch - while the right is a branch of the brachiocephalic trunk.
The ECF compartment always enlarges when there is a net gain in total body water and decreases when there is a loss of total body water. Hydration status is named in terms of the ECF compartment.
Diverticulosis

46. Which group of antihypertensive agents best decreases left ventricular hypertrophy?
Alcohol abuse
LH
Thiazide diuretics
Fentanyl

47. At what vertebral level does the trachea bifurcate?
Renin
Sympathetic chain ganglion
T4 vertebral level posteriorly and anteriorly at the sternal angle (angle of Louis).
Bronchioloalveolar carcinoma

48. What hemoflagellate species is the cause of Chagas disease?
Reinforcement
Gubernaculum
Trypanosoma cruzi
Microglia. All others are neuroectodermal derivatives.

49. What are the two ways that nitrogen can enter into the urea cycle?
Increased ACh to decreased NE levels. (NE pathway begins in the pons and regulates REM sleep.)
Aspartate and carbomoyl PO4
Order of attachment is site 1 - 2 - 3 - 4 - and for release is 4 - 3 - 2 - 1.
Edrophonium

50. What growth factors are chondrogenic - working on the epiphyseal end plates of bone?
Epispadia
G1 phase (gap 1)
Somatomedins (IGF-1)
Rho-immunoglobin