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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 are the two precursors of heme?
Vanillylmandelic acid (VMA)
The enzyme lysyl oxidase requires Cu2+and O2 to function properly.
Wiskott - Aldrich syndrome
Glycine and succinyl - CoA

2. What skin carcinoma is a superficial dermal infiltrate of T lymphocytes seen in males more than 40 years old and presents as scaly red patches or plaques?
Glutamine and aspartate
epithelial lining
Mycosis fungoides (cutaneous T- cell lymphoma)
Metastatic

3. By What age should children be able to draw the following figures? - Rectangle
Juxtaglomerular (JG) cell
4.5 years old (Alphabetic order except with a diamond last: circle - cross - rectangle - square - triangle)
Phenylalanine hydroxylase
LDL

4. What condition results in the following CSF results? - Opening pressure 250 mm H2O; WBCs 250 (90% lymphocytes); glucose 35; protein 100
Ferritin
Stranger anxiety
TB meningitis
Cyanocobalamin (B12) deficiency (Folic acid deficiency has only homocystinuria as a sign.)

5. What syndrome is associated with the following brainstem lesions? - Posterior cerebral artery occlusion resulting in a contralateral corticospinal tract signs - contralateral corticobulbar signs to the lower face - and ipsilateral CN III palsy

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6. What is the MCC of the following meningitides? - In those 12 months to 6 years of age
Plasmodium falciparum
Haemophilus influenzae type B
Tryptophan
Nitroblue tetrazolium reduction test (NBT). It is negative in patients with CGD because there is no production of oxygen radicals.

7. Where does Beta - oxidation of very long chain fatty acids begin?
16S subunit
1. Glycine 2. Aspartate 3. Glutamine
In the peroxisome until it is 10 carbons long; the rest is completed in the mitochondria.
Wiskott - Aldrich syndrome

8. What is the most common complement deficiency?
When the pH is more acidic than the pI - it has a net positive charge - and when the pH is more basic than the pI - it has a net negative charge.
C2 deficiency
7 to 14 days
Projective drawing. The artistic form is irrelevant - but the size - placement - erasures - and distortions are relevant.

9. What embryonic structure forms the adult female structures? - Urinary bladder - urethra - greater vestibular glands - vagina
Cirrhosis
hypophosphatemia
Urogenital sinus
Pirenzepine

10. Name the structure that enters or exits the following foramina: x Optic canal
1. Malate dehydrogenase 2. Isocitrate dehydrogenase 3. a - Ketoglutarate dehydrogenase
CN II and ophthalmic artery
JC virus
Elevated ASO titers and serum complement levels

11. What tumor constitutes 40% of testicular tumors in children?
Transmembrane potential (an absolute number)
IgA nephropathy (Berger disease)
Teratoma
Medial pontine syndrome

12. Based on operant conditioning - What type of reinforcement is described when x Adding a stimulus reinforces a behavior?
Ventral anterior nucleus
Polysome. Ribosomes read from the 5' to the 3' end of the mRNA.
Leydig cells produce testosterone. LH stimulates Leydig cells. (Both start with L.)
Positive reinforcement

13. Name these mature defense mechanisms: x Easing anxiety with laughter
Humor
Confidence interval. It is a way of admitting estimation for the population.
Metaphase of meiosis II (in the oocyte of the graafian follicle)
CN X

14. What enzyme is deficient in congenital erythropoietic porphyria?
Cancer of the lung - stomach - colon - and breast
Uroporphyrinogen III cosynthase
Transketolase and transaldolase. The reactions they catalyze are reversible.
Bordetella pertussis

15. What five cofactors and coenzymes are required by pyruvate dehydrogenase?
Increase enzyme concentrations
1. TTP 2. Lipoic acid 3. Coenzyme A from pantothenate 4. NAD(H) (from niacin or tryptophan) 5. FADH2 (from riboflavin)
During REM sleep
There would be a Fab' region; thus - it would still be able to participate in precipitation and agglutination.

16. What enzyme is inhibited by sulfonamides?
Dihydropteroate synthetase
Chromosome 19
Bronchogenic carcinoma
Dorsal spinocerebellar tract; the accessory cuneate nucleus is the second nucleus for the cuneocerebellar tract.

17. Which form of emphysema is associated with an alpha1- antitrypsin deficiency?
Panacinar
Gastrin - releasing peptide (GRP) stimulates G cells to release Gastrin. (All G's)
The larger the volume of distribution - the lower the plasma concentration of a drug.
Phase 1

18. Macro - ovalocytes in the peripheral blood smear are formed From what cell in the bone marrow?
Megaloblasts
The CD4 T cell; the APC is the first cell in the immune response.
No - it is used in chronic treatment of gout to decrease the uric acid pools in the body.
Fructose; both glucose and galactose are actively absorbed via secondary active transport.

19. What happens to total and alveolar ventilation with x Increased depth of breathing?
Sulfonamides
Masochism
Ganglioside
With an increased depth of breathing both the total and alveolar ventilation increase. This concept is always tested on the boards - so remember it.

20. What three things are needed to produce a double bond in a fatty acid chain in the endoplasmic reticulum?
The hairpin loop made by reverse transcriptase at the 3' end of the first strand is the primer.
NADPH - O2 - and cytochrome b5
Autoimmune thrombocytopenia purpura
Cortisol Remember - from the outer cortex to the inner layer - Salt - Sugar - Sex. The adrenal cortex gets sweeter as you go deeper.

21. What lysosomal enzyme is deficient in x Niemann - Pick disease?
Lead poisoning
Copper
Iodine (I)
Sphingomyelinase

22. At the end of each round of Beta- oxidation - What is released?
Chronic alcoholic
Acetyl CoA - FADH2 - and NADH
Cirrhosis
Turner syndrome

23. What mineral is a component of cytochrome a/a3?
Copper
Congenital heart disease
Fibrillary protein - amyloid protein - and glycosaminoglycans (heparin sulfate mainly)
Urinary 17- ketosteroids

24. What enzyme is deficient in the following glycogen storage disease? - Hers' disease
Ewing sarcoma
Temporal arteritis
catalase - negative
Hepatic glycogen phosphorylase

25. What CN is associated with the sensory innervation of x Laryngopharynx?
In bone; nearly 99% of Ca2+ is stored in the bone as hydroxyapatite.
Alternative hypothesis (What is left after the null has been defined)
GnRH pulsatile infusion
Vagus nerve

26. What vitamin is a component of the enzymes fatty acid synthase and acyl CoA?
Urogenital sinus
Pantothenic acid
The secretory phase is progesterone - dependent and 14 days long - whereas the length of the proliferative phase varies
Azathioprine

27. Is marital satisfaction higher for couples with or without children?

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28. What Ab is an indication of recurrent disease for hepatitis?
>3.5 g/day of protein - along with generalized edema - hypoalbuminemia - and hyperlipidemia
HBc Ab
The parafollicular cells of the thyroid (C cells) release calcitonin in response to hypercalcemia.
Opposite the second upper molar tooth

29. What is the DOC for CMV retinitis?
eEF-2 is the site where Pseudomonas and Diphtheria toxins work.
Granulosa/thecal cell tumor of the ovary
Ganciclovir
Submandibular gland produces mainly serous and the sublingual gland produces mainly mucous secretions.

30. Which agent used in the treatment of asthma is a selective inhibitor of the lipoxygenase pathway?
Decreases Remember - the carotid sinus reflex attempts to compensate by increasing both TPR and heart rate. -------------------------------------------------------------------------------
All
Free polysomes. Membrane - associated polysomes are the site of protein synthesis destined to leave the cell.
Zileuton

31. Name the phase of the ventricular muscle action potential based on the following information: x Fast channels open - then quickly close - and sodium influx results in depolarization
Phase 0
C5b - C9
The carotid body - which monitors arterial blood directly
Breast cancer

32. Name the most common type or cause - Meningitis in renal transplantation patients
Third week; they are derived from the wall of the yolk sac.
HBsAb IgG
Listeria monocytogenes
Isovolumetric contraction

33. Where are the lowest resting PO2 levels in a resting individual?
Coronary circulation
T9
The cat
Free - unprocessed Ag

34. Name the DNA virus: x Partially dsDNA circular; enveloped; virion - associated polymerases; has RNA intermediate; replicates in the nucleus
Cholera toxin
NSAIDs
Hepadnavirus
Left abducens nerve

35. What nematode is known as hookworms? What is the treatment?
The junction where the anterior communicating and anterior cerebral arteries join. As the aneurysm expands - it compresses the fibers from the upper temporal fields of the optic chiasm - producing bitemporal inferior quadrantanopia
Necator americanus is treated with mebendazole and iron therapy.
Yolk sac tumor
Minimal change disease

36. What lower extremity nerve is described by the following motor loss? - Loss of adduction of the thigh
Type I pneumocytes
Kupffer cells
Estriol
Obturator nerve

37. In men - At What embryonic week do the primordial germ cells migrate to the indifferent gonad?
The left gastric - splenic - and common hepatic arteries
Polycystic kidney disease of childhood
Week four - and they remain dormant there until puberty.
Squamous cell carcinoma of the lung

38. What organism causes Q fever?
Hepatitis E
Bacillus anthracis
Coxiella burnetii
Small to medium - sized cerebral vessels

39. What syndrome arises from mutation in the fibrillin gene (FBN1) on chromosome 15q21?
Infrapatellar bursa
Marfan syndrome
Plasmodium ovale
Dysgerminoma

40. How many ATPs are hydrolyzed every time a skeletal muscle cross - bridge completes a single cycle?
Alternative hypothesis (What is left after the null has been defined)
Sorbitol (resulting in cataracts)
One - and it provides the energy for mechanical contraction.
Isovolumetric contraction

41. What hormone acts on Granulosa cells?
FSH
S phase
1. Big 2. Bilateral 3. Berry aneurysm
Chlortetracycline

42. Name the compartment of the lower extremity and the nerve based on its movements - Extend the hip and flex the knee
C4 (the upper border of the thyroid cartilage)
GABA and glutamic acid
Suprachiasmatic nucleus
Posterior compartment of the thigh - tibial nerve

43. What organism would you suspect in a patient with diarrhea after eating rice?
Paneth cells
Duchenne muscular dystrophy (Remember - Becker's is slower in progress - less severe - later in onset - and lacks cardiac involvement.)
Aspartate transcarbamylase
Bacillus cereus

44. Multiple pregnancies - early age of intercourse - multiple sexual partners - OCP use - smoking - HIV - and STDs.
Risk factors for cervical cancer
Transference. When it is from the physician to the patient it is called countertransference.
The DCML system. (Remember - everything but pain and temperature.)
Left ventricle and auricle of left atrium

45. A depressive patient who is taking paroxetine goes to the ER with pain and is given meperidine. Shortly afterward she develops diaphoresis - myoclonus - muscle rigidity - hyperthermia - and seizures. What is your diagnosis?
Case fatality rate
1. Pinpoint pupils 2. Decreased respiratory rate 3. Coma
Serotonergic crisis may be precipitated when an SSRI is mixed with MAOIs - TCADs - dextromethorphan - and meperidine. Treat it with cyproheptadine.
Shortens

46. What is the term for the copper corneal deposits found in Wilson's disease?
T4; because of the greater affinity for the binding protein - T4 has a significantly (nearly fifty times) longer half - life than T3.
Kayser - Fleischer rings
Granulosa cell tumor of the ovary
Mesencephalon

47. What is the term for neurologic signs consistent with a cerebrovascular accident but lasting 24 hours with full recovery?
Osteogenesis imperfecta
Transient ischemic attack
Metronidazole
Hypervariable region (three per light chain; three per heavy chain)

48. Lacks glycerol kinase.
IF
Nystagmus is named by the fast component - Which is the corrective attempt made by the cerebral cortex in response to the initial slow phase.
Omega -3 fatty acids
Adipose tissue

49. A unilateral lesion In what nucleus will produce ipsilateral paralysis of the soft palate?
Ribavirin
Nucleus ambiguus - resulting in the uvula deviating away from the side of the lesion.
Ataxia - telangiectasia
Acarbose

50. What disorder is associated with decreased platelet count - prolonged PT and PTT - decreased fibrinogen - and increased fibrin split products (D- dimers)?
After the latent period
Disseminated intravascular coagulation (DIC)
Serotonergic crisis may be precipitated when an SSRI is mixed with MAOIs - TCADs - dextromethorphan - and meperidine. Treat it with cyproheptadine.
If positive - hypotonic urine (osmolarity <300 mOsm/L); if negative - hypertonic urine (osmolarity > 300 mOsm/L)>>