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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 is the most common one? - Melanoma in dark - skinned persons
VSD
Rifampin
Internal iliac nodes
Acral - lentiginous melanoma

2. What is the effect of insulin on protein storage?
Prinzmetal variant angina
Henoch - Sch
Insulin increases total body stores of protein - fat - and CHOs. When you think insulin - you think storage.
Molluscum contagiosum

3. Which type of cerebral herniation is associated with CN III palsy?
FSH and testosterone
1. Steroids 2. Alcohol 3. Scuba diving 4. Sickle cell anemia
Proportionate mortality rate
Transtentorial (uncal)

4. 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?
Escherichia coli
Indirect hernia passes in the inguinal canal; a direct hernia passes directly through Hesselbach's triangle.
Obstructive lung disorders. The opposite changes (where you see decrease exchange it for increase and vice versa) are seen in a restrictive pattern.
Eisenmenger syndrome - which can also occur with any left - to - right shunt

5. Name the Hgb - O2 binding site based on the following information: x Least affinity for O2; requires the highest PO 2 levels for attachment (approx. 100 mm Hg)
Gastric carcinoma
Chemotaxis
Site 4
HBcAb IgM

6. How much dietary iodine is necessary to maintain normal thyroid hormone secretion?
150 mcg/day is the minimal daily intake needed. Most people ingest 500 mcg/day.
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.
APocrinE glands (APES is my memory aid) Axilla - Areola - and Anus all begin with A. APES are hairy (associated with hair follicles). They smell (odor production) - and if confronted by an APE - your Adrenergic nervous system would be firing (innerva
Constipation and miosis

7. What ocular muscle x Elevates and abducts the eyeball?
Inferior Oblique (CN III) (LR6 SO4)3
Rotavirus
FSH
As sample size increases - the lower the chance of error.

8. What is the first formal IQ test used today for children aged 2 to 18?
C1 inhibitor (C1- INH)
HPV serotypes 16 - 18 - 31 - and 33
Stanford - Binet Scale - developed in 1905 - is useful in the very bright - the impaired - and children less than 6 years old.
Fluconazole

9. What cells are atypical on a peripheral blood smear in heterophil - positive mononucleosis?
Scrofula
T cells - not B cells
Reticulocyte
Simple diffusion; it does not use protein - mediated transport

10. Why is there an increase in prolactin if the hypothalamic - pituitary axis was severed?
A positive AV difference indicates that a substance is extracted by the organ - and a negative difference indicates that it is produced by the organ.
PTH
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.
Arterial PCO2 levels are proportional to cerebral blood flow.

11. What is the most common one? - Tumor arising within the bone
Onion skinning
Pseudomonas aeruginosa
Multiple myeloma
Serratus anterior

12. When a person goes from supine to standing - what happens to the following? - Cardiac output
Decreases Remember - the carotid sinus reflex attempts to compensate by increasing both TPR and heart rate.
Carcinoid tumor
Right - sided
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.)

13. What two AAs have a pKa of 4?
CD40
1. Cytosine 2. Uracil (only in RNA) 3. Thymidine
Aspartic acid and glutamic acid
Meningococcus (Gonococcus does not)

14. What two PGs are used to induce labor?
Osteoarthritis
Tetany
PGE2 and PGF2a
GH

15. Which of the following characteristics accurately describe fungi - bacteria - viruses - or parasites? - Eukaryotic cell - 15 to 25 microns - 80S ribosomes - no cell walls - replicates via cytokinesis with mitosis and meiosis
Parasites
Brief psychotic disorder. (In schizophreniform disorder the symptoms last longer than 6 months.)
Hypnozoite
PGE and intrauterine or neonatal asphyxia maintain patency of the ductus arteriosus. Indomethacin - ACh - and catecholamines promote closure of the ductus arteriosus.

16. Name the antidote - Ethylene glycol
BPH. Although an argument can be made for prostatic cancer (you should expect a much higher PSA result) - these are buzzwords for BPH. Prostatic cancer is usually silent until late in the disease - when obstructive symptoms begin to occur.
Ciliary ganglion
Ethyl alcohol
P wave

17. Describe What type of fluid is either gained or lost with the following changes in body hydration for the ECF volume - ICF volume - and body osmolarity - respectively: x ECF - decrease; ICF - no change; body - no change
Constipation and miosis
The lateral vestibular nucleus
Loss of isotonic fluid (diarrhea - vomiting - hemorrhage)
Acetyl CoA carboxylase

18. Name the most common type - Psychiatric disorder in women of all ages
Small cell carcinoma (oat cell)
Anxiety disorders; for men it is substance abuse.
Massive influx of calcium
Amiloride

19. Which two negative sense RNA viruses have neuraminidase enzymes?
Mumps and influenza virus
GABA - quantitatively
S2 - S3 - S4
Arterioles

20. If inserting a needle to perform a pleural tap or insertion of a chest tube - do you use the inferior or the superior border of a rib as your landmark? Why?
Copper
They are all formed by the fifth month of fetal life.
Yes. It is also a cause of cancers of the lung - esophagus - ureter - and kidney - just to Name a few.
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.

21. Name the cancer associated with the following tumor markers. (Some may have more than one answer.) x CA-125
Filtration; if hydrostatic pressure is less than oncotic pressure - reabsorption is promoted.
Hypersegmented neutrophils
Chromosome 1
Ovarian cancer

22. Name the cancer associated with the following tumor markers. (Some may have more than one answer.) x CA-19.9 and CEA
Leukemias
Pancreatic cancer
CD28
Gametocytes

23. Is the bound form or free form of a lipid - soluble hormone responsible for the negative feedback activity?
Primary sclerosing cholangitis
Free form determines hormone activity and is responsible for the negative feedback loop.
Thyroid hormones are necessary for conversion of carotene to vitamin A.
absorption

24. What is the most widely used class of antidepressants?
Being a white male
1. Increased synthesis and secretion of oxytocin 2. Increased release of PIF by the hypothalamus 3. Inhibition of GnRH (suppressing FSH/LH) 4. Milk secretion
Gynecomastia
SSRIs

25. Name the cancer associated with the following chemical agents. (Some may have more than one answer.) x Polycyclic aromatic hydrocarbons
Two major or one major and two minor
Bronchogenic carcinoma
Methylene blue
Niclosamide

26. What are the adult remnants of the following structures? - Ductus venosus
Kidney
Ligamentum venosum
Borderline
Clostridium perfrigens

27. What adrenergic receptors use inositol triphosphate (IP3) and diacylglycerol (DAG) for their second messenger system?
Type II hypersensitivity reaction
Glucose
The thyroid gland
a1- Receptors

28. Are the following responses associated with histamines H1 or H2 receptor activation? - Inotropic action and automaticity
Profound (I.Q. range < 20)
Histamine
H 2
Vitamin B 6 (pyridoxine)

29. Senile plaques
Preductal (infantile)
The entire tubule barring the thick ascending limb
True hermaphrodism
Alzheimer disease

30. What is the size of a positive PPD test for the following? (Reactive) x IV drug abuser
Achalasia. (Think Chagas disease if it presents in a person from Central or South America.)
Embolic
The small subunit (40S) binds first.
>10 mm

31. What malabsorption syndrome produces abdominal distention - bloating - flatulence - diarrhea - steatorrhea - and weight loss shortly after eating bread products?
The cupola of the lung is posterior to the subclavian artery and vein. It is the reason one must be cautious when performing subclavian venipuncture.
Celiac sprue (gluten - sensitive enteropathy)
Sucralfate
Inactivated; glucose results in decreased cAMP levels and therefore blocks protein binding between cAMP and CAP.

32. What is the term for days 1 to 7 of the female cycle?
The right kidney is lower in the abdominal cavity because of the amount of space the liver occupies.
Megaloblastic anemia (decreased absorption of vitamin B12 and folic acid)
Menses
Granulosa/thecal cell tumor of the ovary

33. What are the two most common AAs found in histones?
Lysine and arginine
Diazepam is longest acting and midazolam is shortest acting.
Rationalization
Pyruvate carboxylase

34. What AA is a precursor of the following substances? - Serotonin
Hypotonic - because NaCl is reabsorbed in the salivary ducts
Tryptophan
16S subunit
Crude mortality rate

35. Name the muscle type based on the histological features: x Actin and myosin in sarcomeres; striated; uninuclear; gap junctions; troponin:calcium binding complex; T tubules and SR forming dyadic contacts; voltage - gated calcium channels
Corynebacterium diphtheriae
Cardiac muscle
Osteoarthritis
None; they are the storage sites for ADH and oxytocin.

36. What is the term for a RBC that has a peripheral rim of Hgb with a dark central Hgb - containing area?
Increases Remember - the carotid sinus reflex attempts to compensate by increasing both TPR and heart rate. -------------------------------------------------------------------------------
C5- C8 deficiency
RBCs
Target cell

37. Does the heart rate determine the diastolic or systolic interval?
Posterior interventricular artery
Heart rate determines the diastolic interval - and contractility determines the systolic interval.
Subacute combined degeneration - Which is bilateral below the level of the lesion.
Friedreich ataxia

38. Which form of melanoma carries the worst prognosis?
Nodular melanoma
Transverse abdominis
0157:H7
Tetracycline

39. Which drugs bind to the 30S ribosomal subunit and interfere with the initiation complex - causing a misreading of mRNA?
Obsessive - compulsive
Graves disease
Apoptosis (Remember - there is a lack of inflammatory response.)
Aminoglycosides

40. What is the size of a positive PPD test for the following? (Reactive) x Posttransplantation patient taking immunosuppressive agents
Probenecid
Tetracycline
Griseofulvin
>5 mm

41. What are the primary neurotransmitters at the following sites? - All motor neurons - postganglionic parasympathetic neurons
During stage 3 and 4 (remember - it is called deep sleep.)
Labioscrotal swelling
ACh
Dysplasia

42. Which bacteria are associated with the following pigment production? - Pyocyanin (blue - green)
C3 - C4 - and C5 keep the diaphragm alive!
Pseudomonas aeruginosa
G0 phase
Dopamine is converted into NE in the vesicle via the enzyme dopamine - Beta - hydroxylase.

43. What leukemia is characterized by Philadelphia chromosomal translocation (9;22); massive splenomegaly; peripheral leukocytosis (commonly > 100 - 00); decreased LAP levels; and nonspecific symptoms of fatigue - malaise - weight loss - and anorexia?
CML
Functions of hepatocytes
Atrial contraction Atrial - Contraction - Venous
Primary hypocortisolism (Addison's disease)

44. What disorder of aldosterone secretion is characterized by x Increased total body sodium - ECF volume - plasma volume - BP - and pH; decreased potassium - renin and AT II activity; no edema?
Picornaviridae
With an increased rate of breathing the total ventilation is greater than the alveolar ventilation. Rapid - shallow breathing increases dead space ventilation with little change in alveolar ventilation. (This is hypoventilation).
Clofazimine
Primary hyperaldosteronism (Conn syndrome)

45. What is the term for diffusion of water across a semipermeable or selectively permeable membrane?
Osmosis; water will diffuse from higher to lower water concentrations.
Chloramphenicol
Helicase (requires ATP for energy)
Cardiac output

46. What disorder is characterized by autoantibodies to IF?
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.)
a -1 - 6 transferase
Pernicious anemia
Triazolam

47. What structure or structures cross the diaphragm at x T12 level?
Aorta - azygos vein - and thoracic duct Remember: 1 at T8 - 2 at T10 - and 3 at T12
Rib 7 articulates with T7 and T8. Each rib articulates with the corresponding numerical vertebral body and the vertebral body below it.
Phase III. It is considered the definitive test.
In the JG cells of the kidney

48. What muscles in the hand adduct the fingers?
Cerebellum
Hypothyroidism. (TSH levels must be monitored.)
The Palmar interosseus ADducts - whereas the Dorsal interosseus ABducts (PAD and DAB)
CN I

49. Name the primary vesicle the following structures are derived from (proencephalon - mesencephalon - or rhombencephalon) - Hypothalamus
Motor nucleus of CN V
11- Beta - Hydroxylase deficiency results in excess production of 11- deoxycorticosterone - a weak mineralocorticoid. It increases BP - Na+ - and ECF volume along with production of adrenal androgens.
Proencephalon diencephalon derivative
Corynebacterium diphtheriae

50. Name the cancer associated with the following tumor markers. (Some may have more than one answer.) x alpha - Fetoprotein
Hepatoma and nonseminomatous testicular germ cell tumors
Echinococcus multilocularis
Clarke's nucleus
Cleft palate