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 the preferred treatment for DKA?
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Thymic tumor
Regular insulin (Not fast acting - regular better)
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

2. Where is aromatase used?
Squatting - sitting - lying supine - passive leg raising
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
E. coli

3. What is hyaline arteriosclerosis usually a sign of ?
<1% - 55% - concentration dependent
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Biphosphonate
Diabetic microangiopathy

4. What is used to prevent vertical transmission of HIV?
Multiple miscarriages d/t hypercoaguability
Medullary
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
ZDV or AZT

5. What does hypocapnia cause in teh brain? What is hypocapnia?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
HSV and VZV
Leukotriene precursor and does neutrophil chemotaxis
Serum creatine kinase; reperfusion injury causes necrosis

6. What does TGF beta do? What produces it?
Drink plenty of fluids
Elevated GGT and macrocytosis
Sickle cell; G6PD
Fibrosis; macrophages

7. What is the triad seen in pre eclampsia?
OCPs - multiparity - breast feeding
Primary
NF- KB; responsible for cytokine production
Hypertension - edema - and proteinuria

8. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
ANCA because of lack of Ig and C3 deposits on IF
Highly negative resting potential
Hereditary angioedema; ACE inhibitors

9. how does noise induced hearing loss occur?
Trauma to stereociliated hair cells of the organ of corti
Hypo or hyper pigmentations; after tanning
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

10. How do you explain the selective proteinuria of loss to albumin only in MCD?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Normally close to systolic
Well trained athletes and children
low in serum

11. which are the only glycosylated proteins in HIV virus?
IgE
Env genes (for getting into target cells)
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Sydenham chorea

12. what drug is useful for secretory diarrhea?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Octreotide
Hypo or hyper pigmentations; after tanning
8; 12

13. What antibiotic is best to treat alcoholic pulm infections? why?
NF- KB; responsible for cytokine production
Clindamycin; covers anaerobic oral flora and aerobic bacteria
CGD; t cell dysfxn (diGeorge)
S. saprophyticus - and s. epidermidis; novobiocin

14. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
Well trained athletes and children
Acute gastric mucosal defects (superficial or full thickness)
C3 decreased after 5-10 days; sulfonamides
Cluster

15. What are diastolic (lowest) pressures in aorta? LV?
II; I (I more abundant)
Around 70 (normal measured diastolic pressures); 9--
Duration and extent of disease
SVC and IVC; right below the aortic knob

16. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
CGD; t cell dysfxn (diGeorge)
Sickle cell; G6PD
No and yes
By vascular permeability and vasodilation

17. What is the mcc of extrinsic allergic asthma?
Inhaled animal dander allergens
RER; copper
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Coagulation factors are made in the liver

18. What is epispadias caused by?
Faulty positioning of the genital tubercle
FGF and VEGF
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Nonsense; mRNA processing

19. What can cause aortic regurg? What is the heart sound you hear?
Aromatase deficiency in child
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Localized dermatologic pain that persists for more than one month after zoster eruption

20. What is suggestive of complete central DI?
RBC mass; epo levels (secondary has high)
Prevents hepatic VLDL production
Increase by 50% in urine osmolality
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

21. What would a deflection of the membrane potential to near zero indicate?
Increase in permeability of two ions with equal and opposite equilibrium potentials
Radial nerve damage
LT (LTD4 - E4 - C4) - and Ach
Intussusception

22. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Ceftriaxone; azithromycin
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Apocrine; eccrine

23. What are the acute effects of corticosteroids on the CBC?
Radial nerve damage
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Little effect on cell and no change
Ig A deficiency

24. other than proteinuria - What can cause foamy froathy urine?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Bile salt accumulation in urine
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

25. Where is the base of the heart? apex?
Closer to head; closer to diaphragm
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Serum FFA and serum triglyceride levels
Measure of depth invasion (vertical!)

26. What is the primary histologic finding in patients with eczematous dermatitis?
No
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Spongiosis
Abnormal closing of the urethral folds

27. What is a cord factor and Which bugs have it? How do they appear on culture?
MAC complex (C5b - C9 complement deficiency)
Vancomycin
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

28. What is the most common location of colonization of all s. aureus types?
The term used to describe decreased drug responsiveness with repeated administration
Anterior nares
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Nocardia

29. at one year of age - What are the social - fine motor - gross motor and language developments?
Elevated GGT and macrocytosis
Proteasome inhibitor; treatment for MM and waldenstroms
Initiation - pointing; pincer grasp; walking; mama/dada
manifestations - congenital (stretching of periventricular pyrimadal fibers)

30. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Increase lymphatic drainage!
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

31. what has the greatest effect on prognosis when treating c. diptheriae?
Right heart failure
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
S3 gallop; S2 to opening snap interval

32. What does anti phospholipid syndrome in SLE patients predispose them to?
200-500
Multiple miscarriages d/t hypercoaguability
Sarcoid
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

33. What is best to prevent GBS infection in a baby?
Inhaled animal dander allergens
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
INTRApartum Abs (ampicillin/penicillin)
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

34. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
CGD; t cell dysfxn (diGeorge)
OCPs - multiparity - breast feeding
Biphosphonate
Right heart failure

35. What causes the blurry vision side effects in first generation anti histamines?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
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
Anti cholinergic effects of pupil dilation and lack of accomodation
Myasthenia gravis

36. Where does lysyl oxidase act? What is the cofactor for that?
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Prevent phagocytosis
In the extracellular space for collagen cross linking; zinc
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

37. Where does conjugation of bilirubin take place?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
In ER of bile canaliculi
Sickle cell; G6PD

38. What can too much IgA in serum produces?
Right before diastole (filling begins)
LT (LTD4 - E4 - C4) - and Ach
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Increase lymphatic drainage!

39. What is the difference between additive and synergistic?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Relfex tachycardia; giving beta blockers
AV node slowest - to allow time for diastole
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

40. What is the most common cause of pyelonephritis in both adults and childre?
glycerol kinase
E. coli
Syringomelia
Sickle cell; G6PD

41. why should you not use ACE inhibitors with someone who had hereditary angioedema?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
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
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Apocrine; eccrine

42. What is a keloid?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Normally close to systolic
Excessive collagen formation during tissue repair in susceptible individuals
Leukotriene precursor and does neutrophil chemotaxis

43. within the right ventricle - What are maximum pressures? the pulm arter?
25; 25
Right before diastole (filling begins)
Ether and other organic solvents
Enterococci (e. faecalis)- found on genitalia area

44. What triggers the neoplastic changes that are associated with HBV infecton?
Integration of viral DNA into genome of host hepatocytes
Normally close to systolic
Acute interstitial nephritis
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

45. How do you calculate atributable risk percent?
Trochlear nerve (IV); abducens nerve (VI)
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
RR-1/RR
Vagus (auricular branch); vasovagal syncope!

46. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
Hydrogen bonds dictate alpha or beta structure
AV node slowest - to allow time for diastole
P450 mitochondrial monooxygenase
Curlings ulcers

47. 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
Sudden loss of muscle tone without loss of consciousness; narcolepsy
RBC mass; epo levels (secondary has high)
E. coli

48. How do you treat gonococcal infection? chlymadia?
High potassium conductance and some sodium conductance
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Ceftriaxone; azithromycin
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

49. what induces bronchial squamous metaplasia?
Enterococci (e. faecalis)- found on genitalia area
Smoking
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
(urine PAH x urine flow rate)/plasma PAH

50. What is the best indicator for the severity of mitral stenosis?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
MAC complex (C5b - C9 complement deficiency)
Diabetic microangiopathy
The time interval between S2 and OS- the shorter the interval - the more intense