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. Name the compartment of the lower extremity and the nerve based on its movements - Extend the hip and flex the knee
Posterior compartment of the thigh - tibial nerve
Streptococcus pneumoniae - Klebsiella pneumoniae - Haemophilus influenzae - Pseudomonas aeruginosa - and Neisseria meningitidis; also Cryptococcus neoformans - a fungus
Nucleus ambiguus - resulting in the uvula deviating away from the side of the lesion.
Alzheimer disease


2. What is the term that refers to the number of channels open in a cell membrane?
Neurologic symptoms Renal failure Thrombocytopenia Fever Microangiopathic hemolytic anemia (Don't forget it. When I was an intern - my senior resident asked me this question more times than I would like to remember.)
Scavenger receptor (SR- B1)
Membrane conductance (think conductance = channels open)
Area 17


3. What is the most common precipitin test used in clinical medicine?
Dominant temporal lobe
Radial Immuno Diffusion (RID) for Ig levels.
Corynebacterium diphtheriae
CN II is the sensory limb and CN III is the motor component through parasympathetic stimulation.


4. What is the term for the degree to which a test measures what it is intended to measure?
Area 4
Validity (remember - reliability is necessary but not the only thing needed for validity)
The thyroid gland
L4 to S3 (L2 to L4 - thigh; L4 to S3 - leg)


5. Name four chemotactic factors for neutrophils.
N- formyl - methionine LTB4 C5a IL-8
Interferons
Superior Oblique (CN IV) (LR6 SO4)3
Inactivated; glucose results in decreased cAMP levels and therefore blocks protein binding between cAMP and CAP.


6. What is the site of action for carbonic anhydrase inhibitors?
Proximal tubule
Filovirus
Cones (C for color and cones)
Lesch - Nyhan syndrome


7. Lewy bodies
Hydroxyproline
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).
Increased erection and libido
Parkinson disease


8. What family do the following viruses belong to? - Ebola
Membranous septal defects are interventricular; a persistent patent ovale results in an interatrial septal defect.
Bipolar disorder (manic - depressive disorder)
Niclosamide
Filovirus


9. Name the most common type or cause - Right heart failure
Crude mortality rate
Left heart failure
Wernicke's encephalopathy
On the superior body of the posterior wall of the uterus


10. What component of the trigeminal nuclei x Receives sensory input (all but pain and temperature) from the face - scalp - dura - and the oral and nasal cavities?
Spinal trigeminal nucleus
Enkephalins
Blastomyces dermatitidis
Histamine


11. At the level of rib 6 - the internal thoracic artery divides into What two arteries?
Functions of hepatocytes
Cyanide
ATP/ADP Translocase
Musculophrenic and superior epigastric arteries


12. What are the longest - acting and shortest - acting benzodiazepines?
Preganglionic sympathetic neurons
Myasthenia gravis
Diazepam is longest acting and midazolam is shortest acting.
Nodes of Ranvier


13. Name the T- cell CD marker: x Interacts with MHC class I molecules
Left anterior descending artery
All (nearly 15-20 times the normal risk)
CD8
Cancer of the lung - stomach - colon - and breast


14. Neurofibrillary tangles
Gabapentin
Fibroadenoma
HBeAg
Alzheimer disease


15. What topoisomerase makes ssDNA cuts - requires no ATP - relaxes supercoils - and acts as the swivel in front of the replication fork?
The pulmonary vein - which carries oxygenated blood from the lung to the left atrium.
Gonorrhea
Topoisomerase I (Relaxase)
Dihydrofolate reductase


16. What ganglion receives preganglionic sympathetic fibers from T1 to L1-2 and innervates smooth muscle - cardiac muscle - glands - head - thoracic viscera - and blood vessels of the body wall and limbs?
>5 mm
Sympathetic chain ganglion
The internal laryngeal nerve supplies sensory information from above the vocal cords while the recurrent laryngeal nerve supplies sensory information below.
Uracil and orotic acid levels increase with ornithine transcarbamoylase deficiency and are normal in carbamoyl phosphate synthetase deficiency.


17. What is the term for an abnormal amount of collagen type III that produces a large bulging scar - seen primarily in blacks?
Subarachnoid hematoma
Stratum granulosum
The central vein of the liver lobule
Keloid


18. What is the term for having fantasies or dressing in female clothes for sexual arousal by heterosexual men?
Transvestite fetishism
Streptococcus pyogenes
Primary follicle (in the white pulp)
Cirrhosis


19. What two drugs - when mixed - can lead to malignant hyperthermia?
S phase
wave
Left coronary artery
Succinylcholine and halothane (Treatment is with dantrolene.)


20. Name the B- cell CD marker: x Used clinically to count B cells in blood
Coprophilia
CD19
Beta- Blockers
Penicillamine - EDTA (calcium disodium edetate) - or dimercaprol


21. What malignant neoplasm of the bone is associated with Homer - Wright pseudorosettes; onion skinning of the periosteum on radiographs of the femur - pelvis - and tibia; and chromosome 11;22 translocation?

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22. What is the term for a benign melanocytic tumor associated with sun exposure that presents as tan - to - brown colored and has sharply defined well - circumscribed borders?
1. Picornavirus 2. Calicivirus 3. Reovirus (Remember PCR)
Benign nevus (mole)
Marfan syndrome
Foramen of Monro


23. What condition results in the following CSF results? - Opening pressure 250 mm H2O; WBCs 250 (90% lymphocytes); glucose 35; protein 100
They are directly related; the greater the preload - the greater the passive tension in the muscle and the greater the prestretch of a sarcomere.
Lower extremity and lower trunk information travels in the dorsal spinocerebellar tract. The upper trunk and extremity information travels in the cuneocerebellar tract. (Cuneocerebellar and fasciculus cuneatus both apply to upper extremities.)
TB meningitis
Serratia


24. What is the only neuroleptic that does not cause an increase in weight or appetite?
Streptococcus agalactiae
Muscle glycogen phosphorylase
Molindone
SHIP: Shifting of the aorta - Hypertrophy of the right ventricle - Interventricular septal defect - Pulmonary stenosis


25. What is the term for making up stories regarding past experiences because of an inability to retrieve them?

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26. What nucleus - found in the intermediate zone of the spinal cord - sends unconscious proprioception to the cerebellum?

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27. Which way will the O2 dissociation curve shift with the addition of 2 - 3- bisphosphoglycerate (2 - 3- BPG) to adult hemoglobin (Hgb)?
Shifts it to the right
Yes. It increases the rate of suicide to nearly 50 times that of the general population.
Mallory- Weiss syndrome
Osteoblasts - which in turn stimulate osteoclasts to break down bone - releasing Ca2+ into the interstitium. (Remember - blasts make - clasts take.)


28. What is the largest nucleus in the midbrain?
Antigenic determinant (epitope). (Idiotypes bind to epitopes.)
Farnesyl pyrophosphate (FPP)
The substantia nigra is the largest nucleus in the midbrain. It contains melanin and uses GABA and dopamine as its neurotransmitters.
Buffers (remember that buffers are best when they are used in a pH range near its pK)


29. What is the most common form of dementia?

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30. What malignant bone tumor is associated with familial retinoblastoma?
Intention tremor; it is a sign of cerebellar lesions. A tremor at rest (i.e. - pill rolling) is seen in basal ganglia lesions.
Criterion - referenced tests. You need a certain number correct to pass (e.g. - the USMLE).
Osteosarcoma
Effective dose for 50% of drug takers (median effective dose)


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

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32. What cell surface marker is found on activated helper T cells?
Alcohol abuse
Nephroblastoma
Surface tension - the force to collapse the lung - is greatest at the end of inspiration.
CD40


33. What prion - associated CNS pathology produces rapidly progressive dementia with myoclonus - involuntary movements - and death within 6 to 12 months?
Creutzfeldt - Jakob disease
Listeria monocytogenes
Mees lines
Sacrococcygeal teratoma


34. Why will turbulence first appear in the aorta in patients with anemia?
Because it is the largest vessel and has the highest velocity in systemic circulation
Metabolic rate and alveolar ventilation (main factor)
Acute tubular necrosis
Stage 3 and 4


35. Are antineoplastic agents that work on actively proliferating cells schedule or dose dependent?
DNA polymerases
Pantothenic acid
Simple diffusion; it does not use protein - mediated transport
Schedule dependent; antineoplastic agents that work on nonproliferating cells are dose dependent


36. Describe the organism based on the following information: x Beta - hemolytic Streptococcus sensitive to bacitracin
Streptococcus pyogenes
Methylphenidate (Ritalin)
Diverticulosis
Regression


37. What condition results from a 46XX karyotype and female internal organs with virilized external genitalia?
Xanthine oxidase
Streptococcus pyogenes
Hyperacute rejection
Female pseudohermaphrodite


38. What AR disease involves a defect in AA 508 on chromosome 7 - causing a defect in Cl - transportation that leads to recurrent pulmonary infections and an increase in viscid mucoid secretions along with pancreatic insufficiencies?
Because the large drop in TPR is accompanied by a large increase in cardiac output - resulting in a minimal change in BP.
Uracil and orotic acid levels increase with ornithine transcarbamoylase deficiency and are normal in carbamoyl phosphate synthetase deficiency.
Somatoform disorder
Cystic fibrosis. (Parents are usually the first to find out because the baby tastes salty.)


39. Circulating levels of what hormone cause the cervical mucus to be thin and watery - allowing sperm an easier entry into the uterus?
Leiomyoma
Estrogen
Cytochrome c
CN V1 - the occulomotor division of the trigeminal nerve - is the sensory component of the corneal reflex.


40. Which sodium channel blocker is used to treat lithium - induced diabetes insipidus?
Ribozymes
Rhombencephalon
Amiloride
Homocysteine methyl transferase


41. What is absorbed in the gallbladder to concentrate bile?
Paget disease (osteitis deformans)
Water
The rate of infusion
From the wall of the yolk sac


42. On the venous pressure curve - What do the following waves represent? - V wave?
Eight pairs through seven cervical vertebrae. Totaling 31 pairs of spinal nerves.
Hepatitis B
Atrial filling (venous filling) Atrial - Contraction - Venous
Gubernaculum


43. What adrenergic receptors use inositol triphosphate (IP3) and diacylglycerol (DAG) for their second messenger system?
Pseudomonas aeruginosa
Light regulates the activity of the pineal gland via the retinal - suprachiasmatic - pineal pathway.
a1- Receptors
Glycogen synthase


44. What variant of polyarteritis nodosa is associated with bronchial asthma - granulomas - and eosinophilia?
Thymus gland. (Thymus gland is essential for T cell maturation.)
Beta2- integrins
Churg - Strauss syndrome
Hypocalcemia and hypophosphatemia


45. What happens to O2 affinity with a decrease in p50?
Isotypes
Pulse pressure
Diphyllobothrium latum
O2 affinity increases with a decrease in the p50 - making O2 more difficult to remove from the Hgb molecule.


46. What enzyme is used to remove the hairpin loop during production of cDNA from mRNA?
S1 nuclease
Clavicle - acromion - and glenoid fossa of the scapula and the humerus
Shifts it to the right
Housemaid's knee


47. What three lung measurements must be calculated because they cannot be measured by simple spirometry?
Hyperkalemia
D- Penicillamine
H 1
TLC - FRC - and RV have to be calculated. (Remember - any volume that has RV as a component has be calculated.)


48. Which two cephalosporins cross the blood - brain barrier?
T4; because of the greater affinity for the binding protein - T4 has a significantly (nearly fifty times) longer half - life than T3.
Cefuroxime and cefaclor
The venae recta maintain the gradient via countercurrent flow.
Oligodendroglioma


49. As what compound do the carbons for fatty acid synthesis leave the mitochondria?
Middle cerebral artery
Submandibular gland produces mainly serous and the sublingual gland produces mainly mucous secretions.
Citrate - via the citrate shuttle
Vesicle (e.g. - poison ivy)


50. Name the type of necrosis - Seen as dead tissue with coagulative necrosis
Negative reinforcement
Gangrenous necrosis
Viscosity and resistance are proportionally related. The greater the viscosity - the greater the resistance is on the vessel.
Eosinophils