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 actions increase venous return?
Squatting - sitting - lying supine - passive leg raising
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Hereditary angioedema; ACE inhibitors
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

2. Where does lysyl oxidase act? What is the cofactor for that?
Smoking
Another type of aldosterone antagonist (like spironolactone)
In the extracellular space for collagen cross linking; zinc
Sudden loss of muscle tone without loss of consciousness; narcolepsy

3. What is somatomedin C?
facultative intracellular
I is more benign and can present later in adulthood
Because of the low output from heart failure - they will have increased aldosterone levels
Insulin like growth factor 1 (just another name)

4. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Hyperkalemia; potassium sparing diuretics - potassium supplements
S. aureus
Vagus (auricular branch); vasovagal syncope!
No and yes

5. why are beta thal major patients asymptomatic at birth?
Leukotriene precursor and does neutrophil chemotaxis
Because gamma chains replace beta chains and then gamma chain formation wanes
Well trained athletes and children
Primary

6. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Medial circumflex artery; avascular necrosis
RBC mass; epo levels (secondary has high)
Clindamycin; covers anaerobic oral flora and aerobic bacteria
CMV - HSV 1 - Candida

7. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
Increases
Increase in permeability of two ions with equal and opposite equilibrium potentials
Secretin stimulates the exocrine pancrease; S enteroendocrine cells in duodenal mucosa in response to acid secrete secretin (HCL is most potent stimulus for secretin release)
Octreotide

8. What type of vision is myopia? In What type of patients does it improve?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Closer to head; closer to diaphragm
Standing suddenly from supine position; valsalva maneuver
Bronchogenic carcinoma

9. What is the Na/Ca exchange used for?
To pump calcium out in cardiac myocytes so that relaxation occurs
Increases cytokine production
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

10. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
Faulty positioning of the genital tubercle
P53 mutation; DCC is also required for adenoma to carcinoma
Multiple miscarriages d/t hypercoaguability
In the extracellular space

11. What is the most common initital symptom of ADPKD? what else?
AV node slowest - to allow time for diastole
APP on chrom 21 (this is why downs more susceptible)
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
CMV - HSV 1 - Candida

12. what protein is increased in Crohns disease? What does it do?
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Abnormal closing of the urethral folds
NF- KB; responsible for cytokine production
Serum FFA and serum triglyceride levels

13. at one year of age - What are the social - fine motor - gross motor and language developments?
Nocardia
S3 gallop; S2 to opening snap interval
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Initiation - pointing; pincer grasp; walking; mama/dada

14. If a patient has higher levels of HbF - What does this mean?
Duration and extent of disease
Hereditary angioedema; ACE inhibitors
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Think Hb deformation diseases

15. What is cataplexy and When is it seen?
When it invades the bm; carcinoma in situ
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
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Sickle cell; G6PD

16. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Nocardia
E. coli; staphylococcus saprophyticus
Downs; regurgitant AV valves - ASDs
To pump calcium out in cardiac myocytes so that relaxation occurs

17. What is a cord factor and Which bugs have it? How do they appear on culture?
25; 25
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Paramyxo and influenza
2 -3 BPG; glycolysis - instead of ATP; erythrocytes because want to right shift the oxygen dissociation curve so that oxygen is released from RBCs into tissue

18. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
200-500
(urine PAH x urine flow rate)/plasma PAH
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Hereditary angioedema; ACE inhibitors

19. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
INTRApartum Abs (ampicillin/penicillin)
Sickle cell; G6PD
OCPs - multiparity - breast feeding
SVT; increases vagal tone; rectus abdominis

20. What is omalizumab and What is it used for?
DIC; TTP- HUS dont bleed that much
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
8 (myc protein) with 2 - 14 - 22 (iG chains)
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

21. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
SSRI; erectile dysfunction
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Fat - fertile - forty - female
On cardiac tissue and renal juxtaglomerular cells

22. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Increase lymphatic drainage!
Squatting - sitting - lying supine - passive leg raising
Pan colitis and right sided colitis (more than left sided and proctitis)
SVT; increases vagal tone; rectus abdominis

23. What does C1 esterase do other than inhibiting complement pathway?
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
No; yes
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Inactivates kallikrein which activates kininogen into bradykinin

24. other than increasing HDL levels - what else does niacin do?
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
Covalent (between two cysteines)- allows protein to withstand denaturation
Prevents hepatic VLDL production
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

25. What can too much IgA in serum produces?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Insulin like growth factor 1 (just another name)
Trauma to stereociliated hair cells of the organ of corti
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

26. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
Medial circumflex artery; avascular necrosis
LT (LTD4 - E4 - C4) - and Ach
Diabetic microangiopathy
RER; RER

27. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
Neisseria induced small cell vasculitis (including hands and soles)
chronic urticaria and allergic symptoms
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
women

28. What does extended consumption of appetite suppressants lead to?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Pulmonary hypertension
Rabies encephalitis from cave bats; rabies killed vaccines
Brief psychotic disorder; schizophreniform; schizophrenia

29. in B12 deficiency - what levels in blood rise very quickly and then drop?
RBC mass; epo levels (secondary has high)
Large stroke volumes with ventricular contraction; aortic regurg
Reticulocytes
ANCA because of lack of Ig and C3 deposits on IF

30. what drugs causes the red man syndrome? how does it occur?
When it invades the bm; carcinoma in situ
Purkinje system; AV node
Vancomycin; histamine mediated
CMV - HSV 1 - Candida

31. What are pancreatic pseudocysts called pseudo rather than true cysts?
Not lined by epithelium
V fib; v. failure
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin

32. What are two indicators of chronic alcohol consumption?
Hypertension - edema - and proteinuria
Elevated GGT and macrocytosis
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Increases bronchial and vascular smooth muscle reactivity to catecholamines

33. what kind of drug is sertraline? What is a common side effect?
SSRI; erectile dysfunction
V fib; v. failure
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

34. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
Sydenham chorea
Hexokinase
RBF= PAH clearance/(1- hematocrit)
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

35. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
Highly negative resting potential
Increase by 50% in urine osmolality
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

36. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
Neisseria induced small cell vasculitis (including hands and soles)
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
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
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

37. what enzyme converts procarcinogens into carcinogens?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
TSh (in testicular tumors can cause hyperthyroidism)
GI tract; mood!
P450 mitochondrial monooxygenase

38. What are the three predominant symptoms of VHL? What is its mode of inheritance?
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
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
8; 12

39. 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?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Neisseria induced small cell vasculitis (including hands and soles)
women
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

40. what induces bronchial squamous metaplasia?
SVT; increases vagal tone; rectus abdominis
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Smoking

41. What can chronic vit A toxicity cause?
chronic urticaria and allergic symptoms
Fibrosis; macrophages
GI malignancies and Insulin resistance (acromegal for ex)
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

42. why is glucagon used in beta blocker toxicitiy?
S3 gallop; S2 to opening snap interval
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
PDA open
Vagus (auricular branch); vasovagal syncope!

43. Which is slower AV node or ventricular muscle?
AV node slowest - to allow time for diastole
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Inactivates kallikrein which activates kininogen into bradykinin
Dissolved in plasma and attached to Hgb

44. What is the preferred treatment for DKA?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Tzanck smear
Regular insulin (Not fast acting - regular better)

45. Where does complement bind on the Fc region of Ig chains?
Folic acid treatment!
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

46. what locations of UC increase the risk of Colon cancer?
Pan colitis and right sided colitis (more than left sided and proctitis)
Syncope - angina - dyspnea (SAD)
When it invades the bm; carcinoma in situ
Amiadarone

47. What is the mc location for avascular necrosis? What is it associated with?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
SSRI
Boiling - bleach - formalin - UV irradiation
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

48. within the right atrium - What is the maximum pressure? left atrium?
Coagulation factors are made in the liver
8; 12
Raphe
On cardiac tissue and renal juxtaglomerular cells

49. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Protamine sulfate
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
When it invades the bm; carcinoma in situ

50. What is the mc manifestation of CMV in HIV patient? immunocompetent?
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Retinitis; mononucleosis
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis