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
transcription activation/suppression
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

2. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
RBF= PAH clearance/(1- hematocrit)
Increase; decreased
In the extracellular space
Drug induced interstitial nephritis

3. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
As a CO2 carrier with the carboxylase enzyme
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Extrinsic def; instrinsic def; platelet def
8 (myc protein) with 2 - 14 - 22 (iG chains)

4. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
frameshift mutations (missense is substitution)
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
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
ZDV or AZT

5. What is used to compare means? categorical outcomes?
Bronchial dilation (bronchiectasis)
Chlorpheniramine and diphenhydramine
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
T test; chi squared

6. What causes curlings ulcers?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
HSV and VZV

7. What is a common complication of acute pancreatitis? What is it?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Vancomycin
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
SVC and IVC; right below the aortic knob

8. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
No; MRI
Coagulation factors are made in the liver
46 - 4N; 23 2N
Anti - apoptotic (prevents going into apoptosis)- 18; 14

9. which viruses require a protease?
SSRI; erectile dysfunction
Hereditary angioedema; ACE inhibitors
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
SS +rNA

10. in overweight individuals What is thought to contribute to insulin resistance?
E. coli; staphylococcus saprophyticus
Adductor
Serum FFA and serum triglyceride levels
The LES is supposed to relax when food comes its way (from above) and in achalasia - a motor dysfunction - LES doesnt relax and seen as elevated pressure on the esophageal mannometry

11. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
AV node slowest - to allow time for diastole
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Increase by 50% in urine osmolality
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

12. How can renal blood flow be calculated from RPF?
Primary
Radial nerve and deep brachial artery
RBF= PAH clearance/(1- hematocrit)
Covalent (between two cysteines)- allows protein to withstand denaturation

13. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
Normal; low
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Varying; erythema nodosum is common
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

14. why should you not use ACE inhibitors with someone who had hereditary angioedema?
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
Terminal bronchioles; small bronchi
Appetite suppressants
Because of the low output from heart failure - they will have increased aldosterone levels

15. What is the diagnosis in delayed puberty plus anosmia?
Kallmans
Ceftriaxone; azithromycin
Env genes (for getting into target cells)
To pump calcium out in cardiac myocytes so that relaxation occurs

16. What is a cell surface marker seen in liver angiosarcoma?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
4 - 4 - 9
Gluteus maximus; difficulty getting up from seated position and climbing chair
Vagus (auricular branch); vasovagal syncope!

17. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
High potassium conductance and some sodium conductance
No; yes
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
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

18. What can chronic vit A toxicity cause?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
No; yes
Terminal bronchioles; small bronchi
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

19. a patient fearing all white coats is a phenomenon of what?
C3 decreased after 5-10 days; sulfonamides
Hereditary angioedema; ACE inhibitors
Classical conditioning
Measles and M3 AML`

20. other than parvo B19 - what else is associated with red cell aplasia?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Thymic tumor
ZDV or AZT

21. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Vancomycin; histamine mediated
When it invades the bm; carcinoma in situ
Echinococcus granulosus; anaphylaxis

22. What is capsaicin? Where does it work?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Pain reliever - reduces pain by locking substance P in the PNS
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Raphe

23. which two drug types can cause orthostatic hypotension (think depression and BPH)?
Increase lymphatic drainage!
TCAs and prazosin
Reiter syndrome; B27
Turbulence

24. How is dobutamine better than dopamine?
Selective alpha 1 (increases SVR)
In the extracellular space for collagen cross linking; zinc
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Smoking

25. what virus causes pharyngoconjuctival fever?
Adeno
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Medial circumflex artery; avascular necrosis
Appetite suppressants

26. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Reiter syndrome; B27
Minimal change disease
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
11

27. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
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
ANCA because of lack of Ig and C3 deposits on IF
Increase by 50% in urine osmolality
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

28. What effects does cortisol have on catecholamines?
Prostate tumor and increased osteoclast activity
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
4 - 4 - 9
Varying; erythema nodosum is common

29. in B12 deficiency - what levels in blood rise very quickly and then drop?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Phencyclidine (PCP)
Reticulocytes

30. What can cause aortic regurg? What is the heart sound you hear?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
TSh (in testicular tumors can cause hyperthyroidism)
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
TCAs and prazosin

31. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
Bile soluble which means they are bile sensitive
Diabetic microangiopathy
Selective alpha 1 (increases SVR)
Hexokinase

32. what locations of UC increase the risk of Colon cancer?
Localized dermatologic pain that persists for more than one month after zoster eruption
Pan colitis and right sided colitis (more than left sided and proctitis)
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

33. What is the triad seen in pre eclampsia?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Hypertension - edema - and proteinuria
By vascular permeability and vasodilation
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

34. What is Bortezomib and What is it used for?
Varying; erythema nodosum is common
Inhaled animal dander allergens
Chrom 8
Proteasome inhibitor; treatment for MM and waldenstroms

35. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
Curlings ulcers
P53 mutation; DCC is also required for adenoma to carcinoma
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Relfex tachycardia; giving beta blockers

36. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Downs; regurgitant AV valves - ASDs
Mean greater than median greater than mode
Appetite suppressants

37. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Multiple miscarriages d/t hypercoaguability
Sickle cell; G6PD
11 aa polypeptide; pain NT in CNS and PNS

38. What type of mutation does aflatoxin cause? what cancer does this increase for?
G to T in p53; HCC
No only for prophylaxis (even for treating staphylococcal endocarditis its as multi drug); this is to prevent drug resistance from spontaneous mutations by DNA dependent RNA polymerase
Common and benign congenital disorder characterized by cystic dilation of the medullary collecting ducts (cortex is spared); painless hematuria or asymptomatic; mc is development of kidney stones (benign disease)
Pain reliever - reduces pain by locking substance P in the PNS

39. What type of endocarditis is cytoscopy induced?
transcription activation/suppression
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Enterococci (e. faecalis)- found on genitalia area
E6 and E7 of HPV knock off p53 and Rb suppressor genes

40. 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?
G to T in p53; HCC
SVT; increases vagal tone; rectus abdominis
Purkinje system; AV node
Cluster

41. What does Rb protein do? what chrom is it on?
No only for prophylaxis (even for treating staphylococcal endocarditis its as multi drug); this is to prevent drug resistance from spontaneous mutations by DNA dependent RNA polymerase
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
OCPs - multiparity - breast feeding
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

42. do Class IC agents prolong the QT interval?
INTRApartum Abs (ampicillin/penicillin)
No
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Classical conditioning

43. When does neovascularization granulation tissue begin to form after severe ischemia and MI? what happens in 12-24 hours? 2 weeks to 2 months? 1-5 days? 0-4 hours? when do you see edema - hemorrhage - wavy fibers?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Inhaled animal dander allergens
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
(urine PAH x urine flow rate)/plasma PAH

44. What type of disease has selective proteinuria? What is found in urine? What is not?
<1% - 55% - concentration dependent
Because of the low output from heart failure - they will have increased aldosterone levels
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Not lined by epithelium

45. What is the mutation type in thalassemias? what process is defective because of this?
Nonsense; mRNA processing
The time interval between S2 and OS- the shorter the interval - the more intense
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Terminal bronchioles; small bronchi

46. how can HAV be inactivated?
Trauma to stereociliated hair cells of the organ of corti
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Additive is equal to the sum of the two actions (lets say agonists at a receptor) and synergistic is when the sum is greater than just their two effects together
Boiling - bleach - formalin - UV irradiation

47. which nerve is at risk when ligating the superior thyroid artery? Which is the only muscle this nerve innervates? what nerve innervates all the other laryngeal muscles?
Superior larygeal; cricothyroid; recurrent laryngeal
Mean greater than median greater than mode
Reiter syndrome; B27
PDA open

48. What does L/S stand for in fetal lung maturity? When does maturity occur?
GI tract; mood!
Increase in permeability of two ions with equal and opposite equilibrium potentials
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
ANCA because of lack of Ig and C3 deposits on IF

49. what would be a sign of absence of cardiogenic pulm edem?
Strength of cell mediated immune response
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Dihydropyridine sensitive Ca channels (L type)
Elastance

50. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
Sarcoid
Hydrogen bonds dictate alpha or beta structure
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Varying; erythema nodosum is common