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 are the skin presentation in sarcoid?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Varying; erythema nodosum is common
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
liver specific

2. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
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)
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Leukotriene precursor and does neutrophil chemotaxis
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac

3. What is a keloid?
Excessive collagen formation during tissue repair in susceptible individuals
Classical conditioning
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Increase lymphatic drainage!

4. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
On cardiac tissue and renal juxtaglomerular cells
Gluteus maximus; difficulty getting up from seated position and climbing chair
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Cluster

5. What type of calcium channels dictate the plateau in cardiac myocyte?
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Dihydropyridine sensitive Ca channels (L type)
Proteasome inhibitor; treatment for MM and waldenstroms
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

6. What is the most common cause of pyelonephritis in both adults and childre?
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Class I
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
E. coli

7. What is the stabilizing force for the secondary structure of proteins?
Hydrogen bonds dictate alpha or beta structure
Anti cholinergic effects of pupil dilation and lack of accomodation
SSRI; erectile dysfunction
11 aa polypeptide; pain NT in CNS and PNS

8. What are fenfluramine - phentermine?
Appetite suppressants
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
25; 25
Barium enema

9. ___________ is liver specific
GI tract; mood!
46 - 4N; 23 2N
glycerol kinase
Valproate

10. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
C3 decreased after 5-10 days; sulfonamides
Common peroneal; bony fractures and compression; sciatic
E. coli; staphylococcus saprophyticus
Ceftriaxone; azithromycin

11. which cells produce surfactant? which ones mediate gas exchange?
Bile salt accumulation in urine
II; I (I more abundant)
200-500
Initiation - pointing; pincer grasp; walking; mama/dada

12. What translocations can cause c - myc overexpression?
Extrinsic def; instrinsic def; platelet def
8 (myc protein) with 2 - 14 - 22 (iG chains)
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

13. what clinical findings help distinguish small cell carcinoma?
Increase; decreased
Aromatase deficiency in child
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

14. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
By vascular permeability and vasodilation
Recurrent larygneal
Right before diastole (filling begins)

15. where are Beta 1 receptors found?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Susceptible; soluble (unable to be cultured in bile)
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
On cardiac tissue and renal juxtaglomerular cells

16. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Vancomycin
RR-1/RR
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
S. saprophyticus - and s. epidermidis; novobiocin

17. 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?
Abnormal closing of the urethral folds
S. aureus
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)
E. coli; staphylococcus saprophyticus

18. Where is aromatase used?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Squatting - sitting - lying supine - passive leg raising
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
Bronchogenic carcinoma

19. What is the Na/Ca exchange used for?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
To pump calcium out in cardiac myocytes so that relaxation occurs
HSV and VZV
Ceftriaxone; azithromycin

20. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
Radial nerve and deep brachial artery
Curlings ulcers
Dissolved in plasma and attached to Hgb
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin

21. what hernia has a similar mechanism to hydrocele?
Inhaled animal dander allergens
Dissolved in plasma and attached to Hgb
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

22. Which is slower AV node or ventricular muscle?
Chorda tympani branch
Around 70 (normal measured diastolic pressures); 9--
Insulin like growth factor 1 (just another name)
AV node slowest - to allow time for diastole

23. how does increased ICP result in curlings ulcers?
When it invades the bm; carcinoma in situ
Medullary
Vagus nerve stimulation
MAO inhibitors; wine and cheese

24. What are the two mcc of focal brain lesions in HIV positive patients?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Decreases both
8; 12
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

25. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Well trained athletes and children
Because of vasodiation to skeletal muscles
Cluster
Squatting - sitting - lying supine - passive leg raising

26. what defines hypoxemia?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
SaO2 <92%
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

27. What is epispadias caused by?
Faulty positioning of the genital tubercle
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
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)
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

28. When is an S4 sound normal?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Well trained athletes and children
Measles and M3 AML`
As a CO2 carrier with the carboxylase enzyme

29. What is the most common location of colonization of all s. aureus types?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Anterior nares
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

30. how does eos release MBP to kill protozoa etc?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
25; 25

31. What is medullary sponge kidney disease and how does it present? What does it lead to?
In the extracellular space
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Amiadarone
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)

32. What actions increase venous return?
Smoking
Close but purkinje system to ensure contraction in a bottom up fashion
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
Squatting - sitting - lying supine - passive leg raising

33. What causes release of myosin head from the actin filament?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Spongiosis
ATP binding (resets the myosin head to contract again for next binding)
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

34. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Sarcoid

35. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
Syringomelia
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Susceptible; soluble (unable to be cultured in bile)
4 - 4 - 9

36. when arrested in prophase of meiosis I - What are primary oocytes chrom number? What about the secondary oocytes that are stuck in metaphase of Meiosis II?
S3 gallop; S2 to opening snap interval
Atrial
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
46 - 4N; 23 2N

37. How do you treat gonococcal infection? chlymadia?
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
Ceftriaxone; azithromycin
RER; RER
On cardiac tissue and renal juxtaglomerular cells

38. what drugs causes the red man syndrome? how does it occur?
HSV and VZV
Superior larygeal; cricothyroid; recurrent laryngeal
Well
Vancomycin; histamine mediated

39. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
Closer to head; closer to diaphragm
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)
Right before diastole (filling begins)
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)

40. which staphylococci can do mannitol fermaentation?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
46 - 4N; 23 2N
S. aureus

41. What is the neurologic manifestation of ADPKD?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Joints d/t increased purine production and thus uric acid production
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
SVT; increases vagal tone; rectus abdominis

42. why does variocele occur more in left side?
SVC and IVC; right below the aortic knob
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Ig A deficiency
RBC mass; epo levels (secondary has high)

43. 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?
Apocrine; eccrine
Dissolved in plasma and attached to Hgb
Demargination of neutrophils from the vessel walls
Sickle cell; G6PD

44. Where does 90% of serotonin lie? What is this NT responsible?
11
GI tract; mood!
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

45. the rate of blood flow of which two circulations must equal each other at all times?
8; 12
frameshift mutations (missense is substitution)
Pulmonic and systemic!
IgE

46. other than mycobacterim wha other bacteria is acid fast?
Sickle cell; G6PD
Nocardia
Env genes (for getting into target cells)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

47. What is the precursor protein to beta amyloid and On what chromosome is it found?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
APP on chrom 21 (this is why downs more susceptible)
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
High potassium conductance and some sodium conductance

48. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
No and yes
Increases bronchial and vascular smooth muscle reactivity to catecholamines
S. saprophyticus - and s. epidermidis; novobiocin

49. how much percent of sodium is excreted? urea? glucose?
<1% - 55% - concentration dependent
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Because of vasodiation to skeletal muscles

50. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
E. coli; staphylococcus saprophyticus
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic