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 clara cell?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Downs; regurgitant AV valves - ASDs
V fib; v. failure

2. how does increased ICP result in curlings ulcers?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Atrial
Underestimation of gestational age
Vagus nerve stimulation

3. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
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)
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Env genes (for getting into target cells)
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

4. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Headaches and facial flushing; vasodilation in meninges and skin
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
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Susceptible; soluble (unable to be cultured in bile)

5. ___________ is liver specific
Because gamma chains replace beta chains and then gamma chain formation wanes
Pulmonary hypertension
Elevated GGT and macrocytosis
glycerol kinase

6. What antibodies are present in CREST? What is the most specific?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Anti centromere; anti DNA topoisomerase
RR-1/RR
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase

7. at four years of age - What are the social - fine motor - gross motor - and language developments?
Bile salt accumulation in urine
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
OCPs - multiparity - breast feeding

8. why does variocele occur more in left side?
RBF= PAH clearance/(1- hematocrit)
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
(urine PAH x urine flow rate)/plasma PAH
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

9. is Rifampin ever used as monotherapY? why either way?
Octreotide
Turners`
In the extracellular space for collagen cross linking; zinc
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

10. what drugs causes the red man syndrome? how does it occur?
Vancomycin; histamine mediated
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Well trained athletes and children

11. What causes vertical diplopia? horizontal?
liver specific
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Enterococci (e. faecalis)- found on genitalia area
Trochlear nerve (IV); abducens nerve (VI)

12. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
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
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
On cardiac tissue and renal juxtaglomerular cells
Class I

13. What does sustained hand grip do to the C/V system?
Circular - outside nucleus; transport proteins - rRNA - tRNA
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
46 - 4N; 23 2N
Integration of viral DNA into genome of host hepatocytes

14. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Valproate
E. coli
Downs; regurgitant AV valves - ASDs
ATP binding (resets the myosin head to contract again for next binding)

15. What are diastolic (lowest) pressures in aorta? LV?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Initiation - pointing; pincer grasp; walking; mama/dada
Proteasome inhibitor; treatment for MM and waldenstroms
Around 70 (normal measured diastolic pressures); 9--

16. Which is faster atrial muscle or ventricular muscle?
Atrial
No; yes
CGD; t cell dysfxn (diGeorge)
Fat - fertile - forty - female

17. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Hexokinase
Anti - apoptotic (prevents going into apoptosis)- 18; 14
<1% - 55% - concentration dependent
I is more benign and can present later in adulthood

18. what bursa is affected when on knees like a maid/gardner?
Sarcoid
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)
Faulty positioning of the genital tubercle
Prepatellar

19. What is somatomedin C?
Insulin like growth factor 1 (just another name)
Atrial
Smoking
Multiple miscarriages d/t hypercoaguability

20. What is difference between Arnold Chiari type I and II?
I is more benign and can present later in adulthood
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Retinitis; mononucleosis
Clindamycin; covers anaerobic oral flora and aerobic bacteria

21. What is congestive hepatomegaly specific for?
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
Increases
Right heart failure
Become beta pleated and then form neurofibrillary tangle!

22. What is the sole neurologic manifestation of acute rheumatic fever?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Sydenham chorea
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
46 - 4N; 23 2N

23. in the LV and aorta - What are the pressures?
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
V fib; v. failure
Normally close to systolic
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

24. What causes the blurry vision side effects in first generation anti histamines?
Chrom 8
Anti cholinergic effects of pupil dilation and lack of accomodation
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Barium enema

25. What type of bond is a disulfide bond?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Covalent (between two cysteines)- allows protein to withstand denaturation
Measure of depth invasion (vertical!)
Right before diastole (filling begins)

26. What are two indicators of chronic alcohol consumption?
Elevated GGT and macrocytosis
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Biphosphonate
Increases cytokine production

27. What are fenfluramine - phentermine?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Appetite suppressants
Serum creatine kinase; reperfusion injury causes necrosis
Aromatase deficiency in child

28. SIADH patients have normal blood volume but...
hyponatremia (aldosterone activation equilibrates body volume)
Inhaled animal dander allergens
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Enterococci (e. faecalis)- found on genitalia area

29. What is the mc location of brain germinomas?What are the classic symptoms?
Integration of viral DNA into genome of host hepatocytes
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
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
Tibial

30. What can too much IgA in serum produces?
Vancomycin
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

31. the rate of blood flow of which two circulations must equal each other at all times?
Thymic tumor
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
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Pulmonic and systemic!

32. What is contraindicated in toxic mega colon?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Cluster

33. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Mean greater than median greater than mode
Rabies encephalitis from cave bats; rabies killed vaccines
Trauma to stereociliated hair cells of the organ of corti
Boiling - bleach - formalin - UV irradiation

34. What is the presentation of angioedema? Where is most commonly affected?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
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

35. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Valproate
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
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

36. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Pulmonary hypertension
<1% - 55% - concentration dependent
By vascular permeability and vasodilation
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

37. What is hyaline arteriosclerosis usually a sign of ?
Prepatellar
Ketone body production by preventing fatty acids into the mitochondria
Bronchogenic carcinoma
Diabetic microangiopathy

38. what hernia has a similar mechanism to hydrocele?
Abnormal closing of the urethral folds
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

39. What is a cell surface marker seen in liver angiosarcoma?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Varying; erythema nodosum is common
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

40. at one year of age - What are the social - fine motor - gross motor and language developments?
Lateral; RV; RA; LV
Initiation - pointing; pincer grasp; walking; mama/dada
Decreases both
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

41. What is omalizumab and What is it used for?
200-500
Primary
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

42. What actions increase venous return?
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
Rare complication of measles (years later)- thought to be d/t certain type that doesnt have surface M protein antigen so goes unseen into CNS
MAC complex (C5b - C9 complement deficiency)
Squatting - sitting - lying supine - passive leg raising

43. in overweight individuals What is thought to contribute to insulin resistance?
Serum FFA and serum triglyceride levels
Because of the low output from heart failure - they will have increased aldosterone levels
Minimal change disease
The term used to describe decreased drug responsiveness with repeated administration

44. If a patient has higher levels of HbF - What does this mean?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
G to T in p53; HCC
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Think Hb deformation diseases

45. What is normal fibrinogen levels?
Extrinsic def; instrinsic def; platelet def
Anti centromere; anti DNA topoisomerase
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
200-500

46. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Tibial
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Right before diastole (filling begins)

47. What is the most important prognostic indicator in patients with malignant melanoma?
Measure of depth invasion (vertical!)
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Closer to head; closer to diaphragm

48. where are the two classical places that the ulnar nerve can be injured?

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183

49. What are the long term consequences of hydrocephalus?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Prevent phagocytosis
DIC; TTP- HUS dont bleed that much
Biphosphonate

50. What causes release of myosin head from the actin filament?
Paramyxo and influenza
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
ATP binding (resets the myosin head to contract again for next binding)
Hypertension - edema - and proteinuria