Test your basic knowledge |

USMLE Prep 2

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 Na/Ca exchange used for?
chronic urticaria and allergic symptoms
Diabetic microangiopathy
Vascular endothelium; protease
To pump calcium out in cardiac myocytes so that relaxation occurs

2. Where does the aorta lie in relation to the pulmonary artery in transposition of the great arteries (is this right to left or left to right shunt?)?
Right heart failure
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Diabetic microangiopathy
Around 70 (normal measured diastolic pressures); 9--

3. metabolism of 1 gram of protein produces How many calories? carb? fat?
Relfex tachycardia; giving beta blockers
Abnormal closing of the urethral folds
When it invades the bm; carcinoma in situ
4 - 4 - 9

4. What are examples of action that decrease venous return to the heart?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Right before diastole (filling begins)
Standing suddenly from supine position; valsalva maneuver
Hereditary angioedema; ACE inhibitors

5. what receptors do first generation anti histamines block?
Because of the low output from heart failure - they will have increased aldosterone levels
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
46 - 4N; 23 2N
H. influenzae type B; polyribosyl phosphate (PRP); cherry red uvula - dysphagia - stridor (sometimes) - difficulty breathing - fever - drooling - positive 'thumbs up sign' on lateral xray of cervical region d/t swollen epiglottis

6. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Terminal bronchioles; small bronchi
Smoking
Spongiosis
Joints d/t increased purine production and thus uric acid production

7. carnitine deficiency impairs production of What and how?
Anterior circumflex (and axillary nerve)
Ketone body production by preventing fatty acids into the mitochondria
Serum FFA and serum triglyceride levels
Elastance

8. In what form are mitochondrial DNA? What do they transcribe?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
SVC and IVC; right below the aortic knob
Circular - outside nucleus; transport proteins - rRNA - tRNA
Turbulence

9. What are the skin presentation in sarcoid?
Increase in permeability of two ions with equal and opposite equilibrium potentials
Varying; erythema nodosum is common
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

10. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
OCPs - multiparity - breast feeding
Ig A deficiency
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Turbulence

11. Which nerve lies in close proximity to the inferior thyroid artery?
Inhaled animal dander allergens
Headaches and facial flushing; vasodilation in meninges and skin
Recurrent larygneal
Bronchogenic carcinoma

12. What is a clara cell?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Bronchial dilation (bronchiectasis)
Vancomycin
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

13. What are diastolic (lowest) pressures in aorta? LV?
High potassium conductance and some sodium conductance
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Skin flushing and warmth; prostaglandins; give with aspirin
Around 70 (normal measured diastolic pressures); 9--

14. h1 receptor anatagonists are not effective in treatment of asthma only for...
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
To pump calcium out in cardiac myocytes so that relaxation occurs
chronic urticaria and allergic symptoms
Right heart failure

15. What are two common side effects of both acute and long acting nitrates? What causes them?
Turbulence
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Integration of viral DNA into genome of host hepatocytes
Headaches and facial flushing; vasodilation in meninges and skin

16. what has the greatest effect on prognosis when treating c. diptheriae?
IgE
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Downs; regurgitant AV valves - ASDs
Permissive - sensitizes vasoconstrictive response from catecholamines - doesnt actually act on them but increases transcription of some genes that creates permissive effect (not additive or synergistic becuase cortisol alone doesnt have any effect on

17. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Class I
Apocrine; eccrine
Vagus nerve stimulation
Duration and extent of disease

18. What is the sole neurologic manifestation of acute rheumatic fever?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
...
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Sydenham chorea

19. what dissolves the lipid bilayer of a viral envelope?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Ether and other organic solvents
SSRI; erectile dysfunction

20. What is the most common initital symptom of ADPKD? what else?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Myasthenia gravis
Atrial
V fib; v. failure

21. What are some side effects seen in TCAs?
Drink plenty of fluids
Radial nerve and deep brachial artery
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
The time interval between S2 and OS- the shorter the interval - the more intense

22. What are the three predominant symptoms of VHL? What is its mode of inheritance?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Medullary
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Minimal change disease

23. What is hypospadias caused by?
TCAs and prazosin
Radial nerve and deep brachial artery
Hydrogen bonds dictate alpha or beta structure
Abnormal closing of the urethral folds

24. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
transcription activation/suppression
Medial circumflex artery; avascular necrosis
Superior larygeal; cricothyroid; recurrent laryngeal
Increases bronchial and vascular smooth muscle reactivity to catecholamines

25. What is the neurologic manifestation of ADPKD?
Amiloride - spironolactone - triamterene
Well
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

26. why should you not use ACE inhibitors with someone who had hereditary angioedema?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Because ACE blocks breakdown of bradykinin and hereditary angioedema patients have high levels of bradykinin; high levels of bradykinin - C3a - and C5a mediate edema by increasing vascular permeability and vasodilation
Increase lymphatic drainage!
No (unlike adenomyosis); yes

27. What are the primary determinants of colon cancer risk in UC patients
Medial part
Intussusception
Duration and extent of disease
chronic urticaria and allergic symptoms

28. what hormone is structurally similar to hCG?
Medial circumflex artery; avascular necrosis
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
TSh (in testicular tumors can cause hyperthyroidism)
women

29. What is a primary HSV 1 infection like?
Pulmonary hypertension
Lateral; RV; RA; LV
Chrom 8
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

30. When does opening snap begin?
On cardiac tissue and renal juxtaglomerular cells
Right before diastole (filling begins)
An invagination of portion of intestine into the lumen of the adjacent intestinal segment; can lead to impaired venous return from the invaginated segment of the bowel which can cause ischemia and subsequent necrosis
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

31. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Gluteus medius and minimus; positive trendelenberg
Reiter syndrome; B27
Inhaled animal dander allergens
Opiate anti diarrheal that binds to mu opiate receptors in GI tract and slows motility; meperidine; low doses - but therapeutic doses combined with atropine (under marked brand name lomotil)

32. What would a deflection of the membrane potential to near zero indicate?
glycerol kinase
Increase; decreased
46 - 4N; 23 2N
Increase in permeability of two ions with equal and opposite equilibrium potentials

33. What is omalizumab and What is it used for?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Relfex tachycardia; giving beta blockers
Another type of aldosterone antagonist (like spironolactone)
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

34. what bursa is affected when on knees like a maid/gardner?
Tissue redistribution (out of plasma) rather than metabolism
Prepatellar
Mean greater than median greater than mode
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

35. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
P53 mutation; DCC is also required for adenoma to carcinoma
Class I

36. What are the first generation anti histamines?
low in serum
Chlorpheniramine and diphenhydramine
Because ACE blocks breakdown of bradykinin and hereditary angioedema patients have high levels of bradykinin; high levels of bradykinin - C3a - and C5a mediate edema by increasing vascular permeability and vasodilation
Anterior nares

37. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Increase by 50% in urine osmolality
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
MAO inhibitors; wine and cheese

38. What is mcc of death pre hospital phase of MI? in hospital phase?
Hereditary angioedema; ACE inhibitors
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
V fib; v. failure
Ketone body production by preventing fatty acids into the mitochondria

39. What type of vision is myopia? In What type of patients does it improve?
Bile salt accumulation in urine
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Reticulocytes
Curlings ulcers

40. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
DIC; TTP- HUS dont bleed that much
Vagus (auricular branch); vasovagal syncope!
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Primary

41. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Single adenomatous ones
Phencyclidine (PCP)
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
SSRI

42. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
Aromatase deficiency in child
No and yes
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

43. What three pathogens cause infectious esophagitis in HIV positive patients?
Hydrogen bonds dictate alpha or beta structure
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Pain reliever - reduces pain by locking substance P in the PNS
CMV - HSV 1 - Candida

44. when do ghon complexes form - primary or secondary TB?
RBC mass; epo levels (secondary has high)
Vagus (auricular branch); vasovagal syncope!
NF- KB; responsible for cytokine production
Primary

45. What is the presentation of angioedema? Where is most commonly affected?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
GI malignancies and Insulin resistance (acromegal for ex)
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

46. What are three symptoms in s.typhi?
CGD; t cell dysfxn (diGeorge)
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

47. What are the two growth factors associated with angiogenesis?
Dihydropyridine sensitive Ca channels (L type)
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
FGF and VEGF

48. are there signs of inflammation in avascular necrosis? then How do you diagnose?
No; MRI
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Transported to liver - glycerol kinase converts it to glycerol 3 phosphate Which is then converted to DHAP which can either join glycolysis for ATP or be used to make glucose
Normally close to systolic

49. What does L/S stand for in fetal lung maturity? When does maturity occur?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Brief psychotic disorder; schizophreniform; schizophrenia

50. Is there edema in primary Conns? secondary hyperaldosteronism? why?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases