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. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
<1% - 55% - concentration dependent
Skin flushing and warmth; prostaglandins; give with aspirin
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Chrom 8

2. which staphylococci can do mannitol fermaentation?
S. aureus
differentiate
(urine PAH x urine flow rate)/plasma PAH
Gluteus medius and minimus; positive trendelenberg

3. on which chromosome is wilms tumor found?
11
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
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)

4. what would be a sign of absence of cardiogenic pulm edem?
LT (LTD4 - E4 - C4) - and Ach
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Covalent (between two cysteines)- allows protein to withstand denaturation
Reticulocytes

5. What is normal fibrinogen levels?
GI malignancies and Insulin resistance (acromegal for ex)
200-500
Brief psychotic disorder; schizophreniform; schizophrenia
High potassium conductance and some sodium conductance

6. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
OCPs - multiparity - breast feeding
Fibrosis; macrophages
P53 mutation; DCC is also required for adenoma to carcinoma
Become beta pleated and then form neurofibrillary tangle!

7. what kind of drug is sertraline? What is a common side effect?
Measles and M3 AML`
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
SSRI; erectile dysfunction
Common peroneal; bony fractures and compression; sciatic

8. What is the neurologic manifestation of ADPKD?
Pulmonary hypertension
8; 12
Gluteus medius and minimus; positive trendelenberg
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

9. What is the difference between paranoid personality disorder and delusional disorder?
To pump calcium out in cardiac myocytes so that relaxation occurs
Syringomelia
low in serum
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

10. What are the potassium sparing diuretics?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Faulty positioning of the genital tubercle
Amiloride - spironolactone - triamterene
facultative intracellular

11. why is glucagon used in beta blocker toxicitiy?
Raphe
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
V fib; v. failure

12. What is the mcc of extrinsic allergic asthma?
Syringomelia
(urine PAH x urine flow rate)/plasma PAH
In the extracellular space
Inhaled animal dander allergens

13. what has the greatest effect on prognosis when treating c. diptheriae?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Anterior circumflex (and axillary nerve)
Anti centromere; anti DNA topoisomerase
Varying; erythema nodosum is common

14. which viruses require a protease?
Anterior nares
Downs; regurgitant AV valves - ASDs
SS +rNA
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

15. What is epleronone?
Another type of aldosterone antagonist (like spironolactone)
Aromatase deficiency in child
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
Vancomycin

16. What does L/S stand for in fetal lung maturity? When does maturity occur?
Covalent (between two cysteines)- allows protein to withstand denaturation
Chrom 8
Syncope - angina - dyspnea (SAD)
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

17. What type of bond is a disulfide bond?
Covalent (between two cysteines)- allows protein to withstand denaturation
Radial nerve and deep brachial artery
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
MAC complex (C5b - C9 complement deficiency)

18. What are examples of action that decrease venous return to the heart?
Standing suddenly from supine position; valsalva maneuver
CGD; t cell dysfxn (diGeorge)
Little effect on cell and no change
AV node slowest - to allow time for diastole

19. What is the mc location of brain germinomas?What are the classic symptoms?
Amiloride - spironolactone - triamterene
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Smoking
Env genes (for getting into target cells)

20. In what population does cholelithiasis occur?
Fat - fertile - forty - female
Terminal bronchioles; small bronchi
RER; RER
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

21. What are the lab findings in poststreptococcal GN?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Vancomycin
Boiling - bleach - formalin - UV irradiation

22. What is contraindicated in toxic mega colon?
Well
gram positive organisms
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Reiter syndrome; B27

23. if there are keratin swirls does that mean well or poorly differentiated?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Not lined by epithelium
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
Well

24. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
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
Medial circumflex artery; avascular necrosis
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
Sickle cell; G6PD

25. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Strength of cell mediated immune response
Coagulation factors are made in the liver
Become beta pleated and then form neurofibrillary tangle!

26. What type of calcium channels dictate the plateau in cardiac myocyte?
Prepatellar
Kallmans
Dihydropyridine sensitive Ca channels (L type)
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

27. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
LT (LTD4 - E4 - C4) - and Ach
Gluteus medius and minimus; positive trendelenberg
Pain reliever - reduces pain by locking substance P in the PNS
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

28. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
Prevent phagocytosis
Chrom 8
Minimal change disease
By vascular permeability and vasodilation

29. What is a cell surface marker seen in liver angiosarcoma?
Underestimation of gestational age
(urine PAH x urine flow rate)/plasma PAH
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
The term used to describe decreased drug responsiveness with repeated administration

30. Where is the base of the heart? apex?
Tibial
Intussusception
Retinitis; mononucleosis
Closer to head; closer to diaphragm

31. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
Increase; decreased
Intussusception
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
DIC; TTP- HUS dont bleed that much

32. What effects does cortisol have on catecholamines?
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
NF- KB; responsible for cytokine production
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Raphe

33. what chromosome is c - myc found on?
No (unlike adenomyosis); yes
G to T in p53; HCC
Chrom 8
manifestations - congenital (stretching of periventricular pyrimadal fibers)

34. What is hypospadias caused by?
Abnormal closing of the urethral folds
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Chorda tympani branch
Think Hb deformation diseases

35. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
S3 gallop; S2 to opening snap interval
Reiter syndrome; B27

36. What is the mc location for avascular necrosis? What is it associated with?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
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)

37. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
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)
Mean greater than median greater than mode
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

38. What is somatomedin C?
Class I
Insulin like growth factor 1 (just another name)
indomethacin
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

39. what happens to capacitance with age?
Selective alpha 1 (increases SVR)
Vagus (auricular branch); vasovagal syncope!
...
Octreotide

40. 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?
Vascular endothelium; protease
Drink plenty of fluids
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Sudden loss of muscle tone without loss of consciousness; narcolepsy

41. what immune deficiency causes recurrent neisseria infections?
Initiation - pointing; pincer grasp; walking; mama/dada
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Classical conditioning
MAC complex (C5b - C9 complement deficiency)

42. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
C3 decreased after 5-10 days; sulfonamides
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

43. What is the stabilizing force for the secondary structure of proteins?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Insulin like growth factor 1 (just another name)
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Hydrogen bonds dictate alpha or beta structure

44. What are the primary determinants of colon cancer risk in UC patients
Duration and extent of disease
Little effect on cell and no change
Localized dermatologic pain that persists for more than one month after zoster eruption
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

45. What does prolonged PT indicated? aPTT? bleeding time?
Extrinsic def; instrinsic def; platelet def
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
APP on chrom 21 (this is why downs more susceptible)
Chlorpheniramine and diphenhydramine

46. What does sustained hand grip do to the C/V system?
differentiate
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
By vascular permeability and vasodilation
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

47. What are the two growth factors associated with angiogenesis?
Sickle cell; G6PD
Turners`
Highly negative resting potential
FGF and VEGF

48. which has better side effect profile - SSRI or TCA?
Coagulation factors are made in the liver
IgE
SSRI
Class I

49. how does achalasia present? What does barium swallow show on dilated esophagus?
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
Because of vasodiation to skeletal muscles
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
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

50. name three pathological states that present with large tongues.
Not lined by epithelium
Valproate
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine