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. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
Bile soluble which means they are bile sensitive
gram positive organisms
Duration and extent of disease
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

2. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Circular - outside nucleus; transport proteins - rRNA - tRNA
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Fibronectin - laminin - collagen

3. Where is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
Because of the low output from heart failure - they will have increased aldosterone levels
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
The term used to describe decreased drug responsiveness with repeated administration
Trauma to stereociliated hair cells of the organ of corti

4. How do left sided colon adenocarcinomas present? right sided?
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
To pump calcium out in cardiac myocytes so that relaxation occurs
ZDV or AZT
SVC and IVC; right below the aortic knob

5. How do bradykinin - C3a and C5a cause edema?
Ether and other organic solvents
By vascular permeability and vasodilation
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Measure of depth invasion (vertical!)

6. what has the greatest effect on prognosis when treating c. diptheriae?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

7. what makes bruits?
Turbulence
Class I
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

8. how does achalasia present? What does barium swallow show on dilated esophagus?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Hypo or hyper pigmentations; after tanning
Squatting - sitting - lying supine - passive leg raising
MAC complex (C5b - C9 complement deficiency)

9. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
MAO inhibitors; wine and cheese
Mean greater than median greater than mode
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

10. What is used to prevent vertical transmission of HIV?
Southern - western
ZDV or AZT
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
Medial circumflex artery; avascular necrosis

11. Where is the base of the heart? apex?
When it invades the bm; carcinoma in situ
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
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)
Closer to head; closer to diaphragm

12. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
Spongiosis
Coagulation factors are made in the liver
SVC and IVC; right below the aortic knob
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

13. Which is slower AV node or ventricular muscle?
Neisseria induced small cell vasculitis (including hands and soles)
Dissolved in plasma and attached to Hgb
Trochlear nerve (IV); abducens nerve (VI)
AV node slowest - to allow time for diastole

14. What causes release of myosin head from the actin filament?
RER; RER
Multiple miscarriages d/t hypercoaguability
Closer to head; closer to diaphragm
ATP binding (resets the myosin head to contract again for next binding)

15. What three pathogens cause infectious esophagitis in HIV positive patients?
CMV - HSV 1 - Candida
Serum creatine kinase; reperfusion injury causes necrosis
Amiloride - spironolactone - triamterene
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

16. What does sustained hand grip do to the C/V system?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
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
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

17. What are the two coagulase negative staphylococci? How do you distinguish them?
Prepatellar
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Highly negative resting potential
S. saprophyticus - and s. epidermidis; novobiocin

18. what phase do adenosine and acetylcholine act on? doing what?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Strength of cell mediated immune response

19. What is the neurologic manifestation of ADPKD?
Primary
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Retinitis; mononucleosis

20. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
Trochlear nerve (IV); abducens nerve (VI)
Amiloride - spironolactone - triamterene
Mean greater than median greater than mode
Little effect on cell and no change

21. which virus inactivates both Rb and p53?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
NF- KB; responsible for cytokine production
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

22. What is achalasia and how would this correlate on the esophageal mannometry?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Not lined by epithelium
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

23. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Turbulence
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
HSV ( also in utero: chlymadia - neisseria - group B strep)
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

24. which are the only glycosylated proteins in HIV virus?
Env genes (for getting into target cells)
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
Pulmonic and systemic!
Syringomelia

25. What pulmonary structural change can kartageners syndrome cause?
11 aa polypeptide; pain NT in CNS and PNS
Serum creatine kinase; reperfusion injury causes necrosis
Bronchial dilation (bronchiectasis)
No; MRI

26. which staphylococci can do mannitol fermaentation?
Abnormal closing of the urethral folds
MAO inhibitors; wine and cheese
S. aureus
ATP binding (resets the myosin head to contract again for next binding)

27. in B12 deficiency - what levels in blood rise very quickly and then drop?
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)
Reticulocytes
Phencyclidine (PCP)
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

28. what murmur is enhanced by decreased blood flow to the heart?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
On cardiac tissue and renal juxtaglomerular cells
Demargination of neutrophils from the vessel walls
Bronchial dilation (bronchiectasis)

29. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Close but purkinje system to ensure contraction in a bottom up fashion
Downs; regurgitant AV valves - ASDs
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

30. What is the mainstay treatment for acute mania?
Sydenham chorea
Recurrent larygneal
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Amiadarone

31. What would a deflection of the membrane potential to near zero indicate?
G to T in p53; HCC
Increase in permeability of two ions with equal and opposite equilibrium potentials
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
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

32. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
S. aureus
Tibial
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Susceptible; soluble (unable to be cultured in bile)

33. why is glucagon used in beta blocker toxicitiy?
Class I
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
SSRI

34. What is hypospadias caused by?
Kallmans
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)
4 - 4 - 9
Abnormal closing of the urethral folds

35. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Increase; decreased
Hypo or hyper pigmentations; after tanning
Leukotriene precursor and does neutrophil chemotaxis

36. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Southern - western
ATP binding (resets the myosin head to contract again for next binding)

37. Which nerve lies in close proximity to the inferior thyroid artery?
On cardiac tissue and renal juxtaglomerular cells
Recurrent larygneal
Paramyxo and influenza
Reiter syndrome; B27

38. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Prepatellar
Valproate
Extrinsic def; instrinsic def; platelet def
C3 decreased after 5-10 days; sulfonamides

39. Would alpha 1 agonists cause flushing? muscarinic antagonist?
Trochlear nerve (IV); abducens nerve (VI)
No; yes
SS +rNA
Think Hb deformation diseases

40. What does p53 do? what chrom is it on?
S. aureus
RER; copper
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Env genes (for getting into target cells)

41. in overweight individuals What is thought to contribute to insulin resistance?
indomethacin
Serum FFA and serum triglyceride levels
No (unlike adenomyosis); yes
HSV ( also in utero: chlymadia - neisseria - group B strep)

42. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Sydenham chorea
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Regular insulin (Not fast acting - regular better)

43. What is the primary histologic finding in patients with eczematous dermatitis?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Spongiosis
RER; RER

44. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
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
Excessive collagen formation during tissue repair in susceptible individuals
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

45. prostaglandin synthesis keeps...
PDA open
Not lined by epithelium
Lateral; RV; RA; LV
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

46. What is intussusception? how does ischemia and necrosis occur?
Localized dermatologic pain that persists for more than one month after zoster eruption
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
Vancomycin
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

47. how much percent of sodium is excreted? urea? glucose?
<1% - 55% - concentration dependent
Relfex tachycardia; giving beta blockers
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Medullary

48. why should you not use ACE inhibitors with someone who had hereditary angioedema?
glycerol kinase
HSV and VZV
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
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

49. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Prevent phagocytosis
Right heart failure
Reiter syndrome; B27

50. other than mycobacterim wha other bacteria is acid fast?
Rabies encephalitis from cave bats; rabies killed vaccines
Medial circumflex artery; avascular necrosis
Classical conditioning
Nocardia