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 induces bronchial squamous metaplasia?
Smoking
Thymic tumor
Leukotriene precursor and does neutrophil chemotaxis
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

2. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
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
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Bile salt accumulation in urine

3. What is the mc location of brain germinomas?What are the classic symptoms?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Not lined by epithelium
Syringomelia
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

4. What are the two growth factors associated with angiogenesis?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
FGF and VEGF
Kallmans
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

5. What is difference between Arnold Chiari type I and II?
Sarcoid
I is more benign and can present later in adulthood
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

6. What is the presentation of sever aortic stenosis?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Spongiosis
Syncope - angina - dyspnea (SAD)
Curlings ulcers

7. what immune deficiency causes recurrent neisseria infections?
MAC complex (C5b - C9 complement deficiency)
Purkinje system; AV node
Syringomelia
Anterior circumflex (and axillary nerve)

8. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
P53 mutation; DCC is also required for adenoma to carcinoma
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
SVC and IVC; right below the aortic knob
Decreases both

9. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
RER; RER
Elastance
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
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

10. which headaches are seen mostly in men - are severe - unilateral - periorbital - episodic (around same time every day) - temporal pain - with lacrimation - nasal congestion and ptosis?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Cluster
indomethacin
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

11. why is crohns disease associated with oxaloacetate kidney stones?
Brief psychotic disorder; schizophreniform; schizophrenia
Lack of calcium to bind oxaloacetate; crohns prevents fat absorption from lack of bile reabsorption in the terminal illeum which leads to fats pulling calcium and lack of calcium reabsorption
Congenital hypothyroidism - downs - amyloidosis - acromegaly
46 - 4N; 23 2N

12. What is the neurologic manifestation of ADPKD?
TCAs and prazosin
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
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Elastance

13. what happens to capacitance with age?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
...
Radial nerve and deep brachial artery
Drink plenty of fluids

14. What is hypospadias caused by?
Abnormal closing of the urethral folds
Measles and M3 AML`
Myasthenia gravis
Reiter syndrome; B27

15. which cells produce surfactant? which ones mediate gas exchange?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Anterior circumflex (and axillary nerve)
II; I (I more abundant)
glycerol kinase

16. what phase do adenosine and acetylcholine act on? doing what?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Increases cytokine production
Sarcoid
Highly negative resting potential

17. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Primary
Criggler Najjar (UGT enzyme in bilirubin glucoronidation) ; Dubin Johnson (transport protein lacking - Black liver) and Rotor syndrome - defects in hepatic uptake and excretion of bile (numerous defect)
Hereditary angioedema; ACE inhibitors

18. How do you calculate RPF from urine PAH?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
glycerol kinase
Sickle cell; G6PD
(urine PAH x urine flow rate)/plasma PAH

19. what vessel would a fracture to the neck of the of the humerus damage?
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
PDA open
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Anterior circumflex (and axillary nerve)

20. on What part of the clavicle does the SCM attach?
Close but purkinje system to ensure contraction in a bottom up fashion
Medial part
Ketone body production by preventing fatty acids into the mitochondria
Octreotide

21. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
ZDV or AZT
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Aromatase deficiency in child
transcription activation/suppression

22. What is the preferred treatment for DKA?
Strength of cell mediated immune response
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Regular insulin (Not fast acting - regular better)
Neisseria induced small cell vasculitis (including hands and soles)

23. What type of vision is myopia? In What type of patients does it improve?
Obstruction because they infiltrate the intestinal wall and encircle causing decrease in size of lumen - constipation - abdominal distension - abdominal pain - changes in stool caliber; right sided are often exophytic masses iron def anemia and syste
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
OCPs - multiparity - breast feeding
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

24. carnitine deficiency impairs production of What and how?
Mean greater than median greater than mode
Increase lymphatic drainage!
Ketone body production by preventing fatty acids into the mitochondria
C3 decreased after 5-10 days; sulfonamides

25. What is the best indicator for the severity of mitral stenosis?
Nonsense; mRNA processing
Intussusception
The time interval between S2 and OS- the shorter the interval - the more intense
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

26. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
Bile soluble which means they are bile sensitive
Hexokinase
gram positive organisms
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

27. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
only up to bronchi
Right heart failure
transcription activation/suppression
Barium enema

28. When is an S4 sound normal?
G to T in p53; HCC
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Well trained athletes and children
Large stroke volumes with ventricular contraction; aortic regurg

29. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Gluteus maximus; difficulty getting up from seated position and climbing chair
Ether and other organic solvents
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Estrogen induced cholesterol hypersecretion (increase HMG CoA reductase activity) and progesterone induced gallbladder hypomotility (decreases bile acid secretion)-- both these conditions predispose cholesterole to insolubilize out

30. how long is substance P? What does it do?
Selective alpha 1 (increases SVR)
11 aa polypeptide; pain NT in CNS and PNS
Single adenomatous ones
11

31. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
Vertical diplopia
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

32. IL4 is used for isotypye switching to what?
Around 70 (normal measured diastolic pressures); 9--
IgE
Measles and M3 AML`
Increased reticulocytes

33. What is epispadias caused by?
Faulty positioning of the genital tubercle
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
By vascular permeability and vasodilation

34. What is the cause of rapid plasma decay of thiopental?
Tissue redistribution (out of plasma) rather than metabolism
Smoking
Because of vasodiation to skeletal muscles
Increases cytokine production

35. what happens to sperm count and semineferous tubules in patient with cryptoorchidism? hormonal function? why do they need to be surgically descended?
ST become atrophic and hyalinized (temp induced damage) and depressed sperm count becuase of that; hormonal function not impaired (test and LH levels normal) because Leydig cells not as temp sensitive so secondary sexual characteristics and sexual pe
Right before diastole (filling begins)
Appetite suppressants
Increases bronchial and vascular smooth muscle reactivity to catecholamines

36. what dictates the resting membrane potential of most cells?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
HSV ( also in utero: chlymadia - neisseria - group B strep)
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
High potassium conductance and some sodium conductance

37. What is the sole neurologic manifestation of acute rheumatic fever?
Sydenham chorea
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
RER; RER
Increases

38. What type of disease has selective proteinuria? What is found in urine? What is not?
RER; copper
AV node slowest - to allow time for diastole
The time interval between S2 and OS- the shorter the interval - the more intense
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

39. in the LV and aorta - What are the pressures?
No and yes
Normally close to systolic
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Spongiosis

40. who bleed more DIC or TTP- HUS patients?
Syringomelia
SVC and IVC; right below the aortic knob
DIC; TTP- HUS dont bleed that much
Relatively selective B1 adrenergic agonist; acute heart failure with decreased myocardial contractility (cardiogenic shock); increases myocardial contractility; can induce arrhythmias because increases cardiac conduction velocity

41. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
Reiter syndrome; B27
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Normal; low

42. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
LT (LTD4 - E4 - C4) - and Ach
No (unlike adenomyosis); yes
Minimal change disease
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase

43. erythema nodosum - elevated ACE - scattered granulomas - arthralgias - hilar lymphadenoapthy are indicative of what?
only up to bronchi
Highly negative resting potential
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
Sarcoid

44. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Think Hb deformation diseases
Increase; decreased
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
LT (LTD4 - E4 - C4) - and Ach

45. What is the triad seen in pre eclampsia?
Hypertension - edema - and proteinuria
Well
Strength of cell mediated immune response
Trochlear nerve (IV); abducens nerve (VI)

46. What can long term leg cast wearing cause?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
E. coli; staphylococcus saprophyticus
Injury to common peroneal nerve (d/t trauma or sustained pressure to neck of fibula) causing pain and numbness on dorsum of foot and inability to dorsiflex

47. What is the stabilizing force for the secondary structure of proteins?
Hypo or hyper pigmentations; after tanning
Hydrogen bonds dictate alpha or beta structure
Bronchial dilation (bronchiectasis)
hyponatremia (aldosterone activation equilibrates body volume)

48. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
gram positive organisms
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
TSh (in testicular tumors can cause hyperthyroidism)
No and yes

49. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
P53 mutation; AD
Hyperkalemia; potassium sparing diuretics - potassium supplements
Leukotriene precursor and does neutrophil chemotaxis
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

50. other than mycobacterim wha other bacteria is acid fast?
Nocardia
In the extracellular space for collagen cross linking; zinc
IgE
Boiling - bleach - formalin - UV irradiation