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. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Appetite suppressants
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

2. What is the mainstay treatment for acute mania?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Close but purkinje system to ensure contraction in a bottom up fashion
ATP binding (resets the myosin head to contract again for next binding)
Decreases both

3. What is omalizumab and What is it used for?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Faulty positioning of the genital tubercle
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

4. What does prolonged PT indicated? aPTT? bleeding time?
When it invades the bm; carcinoma in situ
NF- KB; responsible for cytokine production
Extrinsic def; instrinsic def; platelet def
Ether and other organic solvents

5. What type of calcium channels dictate the plateau in cardiac myocyte?
Chorda tympani branch
Dihydropyridine sensitive Ca channels (L type)
Prostate tumor and increased osteoclast activity
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

6. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
Common peroneal; bony fractures and compression; sciatic
differentiate
Become beta pleated and then form neurofibrillary tangle!
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

7. 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)
To pump calcium out in cardiac myocytes so that relaxation occurs
Ig A deficiency
facultative intracellular

8. how does eos release MBP to kill protozoa etc?
Bile soluble which means they are bile sensitive
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Turbulence
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

9. what hormone is structurally similar to hCG?
TSh (in testicular tumors can cause hyperthyroidism)
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Initiation - pointing; pincer grasp; walking; mama/dada
Reticulocytes

10. what marker should be followed in a patient with cirrhosis?
GI malignancies and Insulin resistance (acromegal for ex)
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Highly negative resting potential

11. are there signs of inflammation in avascular necrosis? then How do you diagnose?
Superior larygeal; cricothyroid; recurrent laryngeal
No; MRI
P53 mutation; DCC is also required for adenoma to carcinoma
Inhibits it

12. 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
Minimal change disease
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
Right heart failure

13. What are two indicators of chronic alcohol consumption?
Enterococci (e. faecalis)- found on genitalia area
Elevated GGT and macrocytosis
By vascular permeability and vasodilation
Closer to head; closer to diaphragm

14. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Trochlear nerve (IV); abducens nerve (VI)
Because of vasodiation to skeletal muscles

15. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
In the extracellular space
Underestimation of gestational age
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

16. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
...
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Appetite suppressants
P53 mutation; AD

17. who bleed more DIC or TTP- HUS patients?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Gluteus maximus; difficulty getting up from seated position and climbing chair
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
DIC; TTP- HUS dont bleed that much

18. What is the fibrinogen level in patient with TTP- HUS? DIC?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Normal; low
In the extracellular space
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

19. there are mucus secreting cells in the bronchioles...
chronic urticaria and allergic symptoms
TSh (in testicular tumors can cause hyperthyroidism)
The term used to describe decreased drug responsiveness with repeated administration
only up to bronchi

20. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
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
INTRApartum Abs (ampicillin/penicillin)
Anti cholinergic effects of pupil dilation and lack of accomodation

21. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
CGD; t cell dysfxn (diGeorge)
chronic urticaria and allergic symptoms
Vancomycin; histamine mediated

22. what hernia has a similar mechanism to hydrocele?
Inhaled animal dander allergens
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

23. non ceruloplasmin deposition - ceruloplasmin is...
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Recurrent larygneal
low in serum
S. saprophyticus - and s. epidermidis; novobiocin

24. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Brief psychotic disorder; schizophreniform; schizophrenia
Selective alpha 1 (increases SVR)
Paramyxo and influenza

25. why does hypothyroidism cause increased CPK levels?
Measure of depth invasion (vertical!)
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Nonsense; mRNA processing

26. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
Increased reticulocytes
ANCA because of lack of Ig and C3 deposits on IF
LT (LTD4 - E4 - C4) - and Ach
Ketone body production by preventing fatty acids into the mitochondria

27. which are the only glycosylated proteins in HIV virus?
Env genes (for getting into target cells)
Turbulence
low in serum
Initiation - pointing; pincer grasp; walking; mama/dada

28. Where is aromatase used?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Because of vasodiation to skeletal muscles
Radial nerve and deep brachial artery

29. What is used to compare means? categorical outcomes?
T test; chi squared
Vagus nerve stimulation
NF- KB; responsible for cytokine production
frameshift mutations (missense is substitution)

30. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Hypo or hyper pigmentations; after tanning
frameshift mutations (missense is substitution)
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Acute interstitial nephritis

31. What actions increase venous return?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Squatting - sitting - lying supine - passive leg raising
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

32. In what form are mitochondrial DNA? What do they transcribe?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
CGD; t cell dysfxn (diGeorge)
Circular - outside nucleus; transport proteins - rRNA - tRNA
Strength of cell mediated immune response

33. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Decreases both

34. biotin is used By what in tissues responsible for gluconeogenesis
Radial nerve and deep brachial artery
As a CO2 carrier with the carboxylase enzyme
P53 mutation; DCC is also required for adenoma to carcinoma
Southern - western

35. What is damaged in early syringomelia? later?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
As a CO2 carrier with the carboxylase enzyme
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
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

36. What is epleronone?
Mean greater than median greater than mode
Another type of aldosterone antagonist (like spironolactone)
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
SaO2 <92%

37. What type of mutation does aflatoxin cause? what cancer does this increase for?
G to T in p53; HCC
Criggler Najjar (UGT enzyme in bilirubin glucoronidation) ; Dubin Johnson (transport protein lacking - Black liver) and Rotor syndrome - defects in hepatic uptake and excretion of bile (numerous defect)
Because of the low output from heart failure - they will have increased aldosterone levels
P53 mutation; AD

38. When does opening snap begin?
Because gamma chains replace beta chains and then gamma chain formation wanes
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
Right before diastole (filling begins)
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

39. What is used to prevent vertical transmission of HIV?
OCPs - multiparity - breast feeding
ZDV or AZT
Pulmonic and systemic!
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

40. What is acanthosis nigricans associated with?
Normally close to systolic
Standing suddenly from supine position; valsalva maneuver
E6 and E7 of HPV knock off p53 and Rb suppressor genes
GI malignancies and Insulin resistance (acromegal for ex)

41. What is the triad seen in pre eclampsia?
AV node slowest - to allow time for diastole
Hypertension - edema - and proteinuria
Underestimation of gestational age
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

42. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Gluteus medius and minimus; positive trendelenberg
The term used to describe decreased drug responsiveness with repeated administration
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

43. Where does 90% of serotonin lie? What is this NT responsible?
GI tract; mood!
SSRI
manifestations - congenital (stretching of periventricular pyrimadal fibers)
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

44. what happens to capacitance with age?
Dihydropyridine sensitive Ca channels (L type)
Highly negative resting potential
...
The term used to describe decreased drug responsiveness with repeated administration

45. What are fenfluramine - phentermine?
Appetite suppressants
Valproate
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Octreotide

46. How do bradykinin - C3a and C5a cause edema?
Not lined by epithelium
Nocardia
By vascular permeability and vasodilation
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

47. nucleotide deletions do not cause missense mutations - they cause...
No; MRI
T test; chi squared
Env genes (for getting into target cells)
frameshift mutations (missense is substitution)

48. why does liver dysfunction cause coagulation disorders?
G to T in p53; HCC
Coagulation factors are made in the liver
Primary
hyponatremia (aldosterone activation equilibrates body volume)

49. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Phencyclidine (PCP)
Pulmonary hypertension
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

50. in overweight individuals What is thought to contribute to insulin resistance?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Serum FFA and serum triglyceride levels
Skin flushing and warmth; prostaglandins; give with aspirin
Biphosphonate