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 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
Duration and extent of disease
Valproate
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

2. What causes release of myosin head from the actin filament?
Class I
ATP binding (resets the myosin head to contract again for next binding)
Raphe
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

3. What is the mc malignancy in asbestosis?
Bronchogenic carcinoma
Hexokinase
HSV ( also in utero: chlymadia - neisseria - group B strep)
RBF= PAH clearance/(1- hematocrit)

4. What is extraocular muscle weakness a common symptom of?
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 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Thymic tumor
Myasthenia gravis

5. What is the most common location of colonization of all s. aureus types?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
glycerol kinase
Anterior nares
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

6. how can HAV be inactivated?
Prepatellar
Boiling - bleach - formalin - UV irradiation
Reticulocytes
Turners`

7. What are the skin presentation in sarcoid?
Well
4 - 4 - 9
Varying; erythema nodosum is common
Little effect on cell and no change

8. why does variocele occur more in left side?
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Acute gastric mucosal defects (superficial or full thickness)

9. what hormone is structurally similar to hCG?
Purkinje system; AV node
Sudden loss of muscle tone without loss of consciousness; narcolepsy
RER; RER
TSh (in testicular tumors can cause hyperthyroidism)

10. in the LV and aorta - What are the pressures?
hyponatremia (aldosterone activation equilibrates body volume)
Pan colitis and right sided colitis (more than left sided and proctitis)
Normally close to systolic
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

11. which nerve provides innervation for plantar flexion and inversion?
Tibial
SSRI
Vagus nerve stimulation
Both sides

12. after a thrombus extraction - what serum enzyme shoots up and why?
Serum creatine kinase; reperfusion injury causes necrosis
Right before diastole (filling begins)
Folic acid treatment!
Bronchogenic carcinoma

13. What causes curlings ulcers?
DIC; TTP- HUS dont bleed that much
Serum creatine kinase; reperfusion injury causes necrosis
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
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

14. what indicates the severity of a mitral regurg ? mitral stenosis?
Both sides
Vascular endothelium; protease
S3 gallop; S2 to opening snap interval
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

15. prostaglandin synthesis keeps...
PDA open
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
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
Hereditary angioedema; ACE inhibitors

16. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
P450 mitochondrial monooxygenase
Chorda tympani branch
HSV and VZV

17. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
CMV - HSV 1 - Candida
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

18. which nerve in the lower leg is easily injured and causes foot drop ? What are common causes? From what nerve does it branch off or?
Common peroneal; bony fractures and compression; sciatic
hyponatremia (aldosterone activation equilibrates body volume)
manifestations - congenital (stretching of periventricular pyrimadal fibers)
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

19. What translocations can cause c - myc overexpression?
8 (myc protein) with 2 - 14 - 22 (iG chains)
Bronchial dilation (bronchiectasis)
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

20. what induces bronchial squamous metaplasia?
TSh (in testicular tumors can cause hyperthyroidism)
Fibrosis; macrophages
Hypertension - edema - and proteinuria
Smoking

21. what locations of UC increase the risk of Colon cancer?
Retinitis; mononucleosis
Because of vasodiation to skeletal muscles
Pan colitis and right sided colitis (more than left sided and proctitis)
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

22. PDAs are often asymptomatic. How do you treat?
indomethacin
SVC and IVC; right below the aortic knob
Anti cholinergic effects of pupil dilation and lack of accomodation
Right before diastole (filling begins)

23. What are the two mcc of focal brain lesions in HIV positive patients?
Hypo or hyper pigmentations; after tanning
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)
By vascular permeability and vasodilation
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

24. What is a clara cell?
only up to bronchi
Echinococcus granulosus; anaphylaxis
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

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

26. What is the presentation of angioedema? Where is most commonly affected?
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
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
S. aureus
Serum FFA and serum triglyceride levels

27. What are the potassium sparing diuretics?
Amiloride - spironolactone - triamterene
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Vascular endothelium; protease
Measles and M3 AML`

28. How do left sided colon adenocarcinomas present? right sided?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Kallmans
Medial circumflex artery; avascular necrosis
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

29. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
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)
Elastance

30. What are the acute effects of corticosteroids on the CBC?
Vertical diplopia
frameshift mutations (missense is substitution)
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Ig A deficiency

31. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
Ceftriaxone; azithromycin
25; 25
E. coli; staphylococcus saprophyticus
Syringomelia

32. 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?
High potassium conductance and some sodium conductance
Diabetic microangiopathy
Reiter syndrome; B27
Cluster

33. which has better side effect profile - SSRI or TCA?
SSRI
Large stroke volumes with ventricular contraction; aortic regurg
Closer to head; closer to diaphragm
Highly negative resting potential

34. which type of glands produce an initially odorless secretion but can become malodorous secondary to bacterial decompisition on the skin surface? which glands are present throughout the skin except on lips and glans penis?
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
Valproate
OCPs - multiparity - breast feeding
Apocrine; eccrine

35. metabolism of 1 gram of protein produces How many calories? carb? fat?
Initiation - pointing; pincer grasp; walking; mama/dada
Vagus nerve stimulation
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
4 - 4 - 9

36. What is the mc location for avascular necrosis? What is it associated with?
Amiadarone
Well trained athletes and children
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences

37. What are some side effects seen in TCAs?
Close but purkinje system to ensure contraction in a bottom up fashion
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

38. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
P53 mutation; AD
P53 mutation; DCC is also required for adenoma to carcinoma
RER; copper
S. saprophyticus - and s. epidermidis; novobiocin

39. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Echinococcus granulosus; anaphylaxis
Circular - outside nucleus; transport proteins - rRNA - tRNA
The term used to describe decreased drug responsiveness with repeated administration
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

40. What is achalasia and how would this correlate on the esophageal mannometry?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
facultative intracellular
E. coli; staphylococcus saprophyticus
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

41. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
E. coli; staphylococcus saprophyticus
Normal; low
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Barium enema

42. why are beta thal major patients asymptomatic at birth?
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
Because gamma chains replace beta chains and then gamma chain formation wanes
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

43. other than in pyelonephritis - where else are WBC casts seen?
Anti centromere; anti DNA topoisomerase
gram positive organisms
Acute interstitial nephritis
Anterior circumflex (and axillary nerve)

44. What three factors effect total oxygen content of blood?
RBF= PAH clearance/(1- hematocrit)
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
SS +rNA
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

45. What is Bortezomib and What is it used for?
MAO inhibitors; wine and cheese
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Both sides
Proteasome inhibitor; treatment for MM and waldenstroms

46. at one year of age - What are the social - fine motor - gross motor and language developments?
Spongiosis
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Initiation - pointing; pincer grasp; walking; mama/dada
Turners`

47. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
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
RBC mass; epo levels (secondary has high)
Classical conditioning

48. In What type of nephritis would you see high serum eos count?
Rabies encephalitis from cave bats; rabies killed vaccines
Drug induced interstitial nephritis
Prostate tumor and increased osteoclast activity
Pan colitis and right sided colitis (more than left sided and proctitis)

49. when do ghon complexes form - primary or secondary TB?
women
Primary
HSV and VZV
Class I

50. 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
Ether and other organic solvents
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
only up to bronchi