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 difference between Arnold Chiari type I and II?
Syncope - angina - dyspnea (SAD)
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
I is more benign and can present later in adulthood
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

2. What is the most common cause of pyelonephritis in both adults and childre?
Syringomelia
Sickle cell; G6PD
E. coli; staphylococcus saprophyticus
E. coli

3. What does sustained hand grip do to the C/V system?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
SVC and IVC; right below the aortic knob
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
LT (LTD4 - E4 - C4) - and Ach

4. What is hypospadias caused by?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Abnormal closing of the urethral folds
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Underestimation of gestational age

5. What is the presentation of sever aortic stenosis?
Syncope - angina - dyspnea (SAD)
Hypertension - edema - and proteinuria
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
Proteasome inhibitor; treatment for MM and waldenstroms

6. What is diphenoxylate and What is it used for? what drug is it structurally similar to? What allows for potent anti diarrheal effect without signigicant opiate effects?
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)
In ER of bile canaliculi
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Syringomelia

7. What does hypocapnia cause in teh brain? What is hypocapnia?
11 aa polypeptide; pain NT in CNS and PNS
Elevated GGT and macrocytosis
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

8. What is gardeners mydriasis? How is it treated?
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)
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Sudden loss of muscle tone without loss of consciousness; narcolepsy

9. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
ZDV or AZT
IgE
LT (LTD4 - E4 - C4) - and Ach
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

10. what kind of drug is sertraline? What is a common side effect?
SSRI; erectile dysfunction
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
SaO2 <92%

11. How do you calculate excretion rate of a substance? How do you calculate the filtration rate of a substance? clearance of what substance estimates the GFR?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Initiation - pointing; pincer grasp; walking; mama/dada
ANCA because of lack of Ig and C3 deposits on IF
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

12. what dictates the resting membrane potential of most cells?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
High potassium conductance and some sodium conductance
Acute interstitial nephritis
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)

13. what nerve and artery course along the posterior aspect of the humerus?
Elastance
Anterior circumflex (and axillary nerve)
Myasthenia gravis
Radial nerve and deep brachial artery

14. how does increased ICP result in curlings ulcers?
Vagus nerve stimulation
Headaches and facial flushing; vasodilation in meninges and skin
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
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

15. What is a keloid?
Excessive collagen formation during tissue repair in susceptible individuals
SaO2 <92%
hyponatremia (aldosterone activation equilibrates body volume)
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

16. Is there edema in primary Conns? secondary hyperaldosteronism? why?
Kallmans
Drug induced interstitial nephritis
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Measure of depth invasion (vertical!)

17. What can chronic vit A toxicity cause?
E. coli; staphylococcus saprophyticus
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Myasthenia gravis
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

18. What are two indicators of chronic alcohol consumption?
Multiple miscarriages d/t hypercoaguability
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Elevated GGT and macrocytosis
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

19. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
Hereditary angioedema; ACE inhibitors
IgE
transcription activation/suppression
To pump calcium out in cardiac myocytes so that relaxation occurs

20. How is dobutamine better than dopamine?
Selective alpha 1 (increases SVR)
Diabetic microangiopathy
Think Hb deformation diseases
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

21. What is the most common neurologic complication of VZV reactivation?
Localized dermatologic pain that persists for more than one month after zoster eruption
Duration and extent of disease
Inhibits it
Well trained athletes and children

22. What is the diagnosis in delayed puberty plus anosmia?
Anterior circumflex (and axillary nerve)
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
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Kallmans

23. What does the severity of leprosy depend on?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
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)
Tibial
Strength of cell mediated immune response

24. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Measure of depth invasion (vertical!)
Bronchial dilation (bronchiectasis)
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Hypertension - edema - and proteinuria

25. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Radial nerve and deep brachial artery
Varying; erythema nodosum is common

26. What is somatomedin C?
Insulin like growth factor 1 (just another name)
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
gram positive organisms

27. What antibiotic is best to treat alcoholic pulm infections? why?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Common peroneal; bony fractures and compression; sciatic
CMV - HSV 1 - Candida
<1% - 55% - concentration dependent

28. What type of mutation does aflatoxin cause? what cancer does this increase for?
G to T in p53; HCC
Measure of depth invasion (vertical!)
RER; RER
Curlings ulcers

29. What translocations can cause c - myc overexpression?
Another type of aldosterone antagonist (like spironolactone)
Elevated GGT and macrocytosis
8 (myc protein) with 2 - 14 - 22 (iG chains)
RR-1/RR

30. why does variocele occur more in left side?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Increases cytokine production
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

31. What does TGF beta do? What produces it?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Fibrosis; macrophages
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

32. when do ghon complexes form - primary or secondary TB?
SSRI
Echinococcus granulosus; anaphylaxis
Hyperkalemia; potassium sparing diuretics - potassium supplements
Primary

33. how does achalasia present? What does barium swallow show on dilated esophagus?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Retinitis; mononucleosis
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

34. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
11
Medullary
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
...

35. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Rabies encephalitis from cave bats; rabies killed vaccines
No
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Biphosphonate

36. How do you calculate RPF from urine PAH?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
When it invades the bm; carcinoma in situ
(urine PAH x urine flow rate)/plasma PAH

37. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
CGD; t cell dysfxn (diGeorge)
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Inhibits it

38. other than increasing HDL levels - what else does niacin do?
Medullary
Prevents hepatic VLDL production
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Measure of depth invasion (vertical!)

39. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Circular - outside nucleus; transport proteins - rRNA - tRNA
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Skin flushing and warmth; prostaglandins; give with aspirin
Leukotriene precursor and does neutrophil chemotaxis

40. What would a deflection of the membrane potential to near zero indicate?
The term used to describe decreased drug responsiveness with repeated administration
Increase in permeability of two ions with equal and opposite equilibrium potentials
Rabies encephalitis from cave bats; rabies killed vaccines
Phencyclidine (PCP)

41. Where is conduction in heart fastest? slowest?
Purkinje system; AV node
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Because of vasodiation to skeletal muscles
hyponatremia (aldosterone activation equilibrates body volume)

42. within the right ventricle - What are maximum pressures? the pulm arter?
Reiter syndrome; B27
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
25; 25
Atrial

43. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Lateral; RV; RA; LV
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
RER; RER
Pulmonary hypertension

44. which nucleus releases serotonin?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
11 aa polypeptide; pain NT in CNS and PNS
Underestimation of gestational age
Raphe

45. What are the acute effects of corticosteroids on the CBC?
Hereditary angioedema; ACE inhibitors
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Increased reticulocytes
Extrinsic def; instrinsic def; platelet def

46. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Fibronectin - laminin - collagen
Become beta pleated and then form neurofibrillary tangle!
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Vascular endothelium; protease

47. What are two common side effects of both acute and long acting nitrates? What causes them?
Headaches and facial flushing; vasodilation in meninges and skin
Amiadarone
Nocardia
SSRI; erectile dysfunction

48. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
Initiation - pointing; pincer grasp; walking; mama/dada
Curlings ulcers
Hypertension - edema - and proteinuria
Integration of viral DNA into genome of host hepatocytes

49. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
Recurrent larygneal
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
V fib; v. failure
Amiadarone

50. In what view of CXR is anterior part of heart best seen? anterior part of heart is formed by?right border of heart is formed by? left border?
Appetite suppressants
Bronchogenic carcinoma
Joints d/t increased purine production and thus uric acid production
Lateral; RV; RA; LV