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. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
Integration of viral DNA into genome of host hepatocytes
Ig A deficiency
No (unlike adenomyosis); yes
Large stroke volumes with ventricular contraction; aortic regurg

2. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Chorda tympani branch
chronic urticaria and allergic symptoms
Increased reticulocytes
IgE

3. What does the severity of leprosy depend on?
Strength of cell mediated immune response
liver specific
frameshift mutations (missense is substitution)
Not lined by epithelium

4. other than parvo B19 - what else is associated with red cell aplasia?
TSh (in testicular tumors can cause hyperthyroidism)
Radial nerve and deep brachial artery
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
Thymic tumor

5. What is it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
Enterococci (e. faecalis)- found on genitalia area
Vertical diplopia
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

6. What is a cell surface marker seen in liver angiosarcoma?
SS +rNA
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
RBC mass; epo levels (secondary has high)
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

7. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
ATP binding (resets the myosin head to contract again for next binding)
Class I
Well trained athletes and children
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

8. What is cataplexy and When is it seen?
SSRI; erectile dysfunction
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Echinococcus granulosus; anaphylaxis
Sudden loss of muscle tone without loss of consciousness; narcolepsy

9. Which is faster purkinje system or atrial muscle?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Close but purkinje system to ensure contraction in a bottom up fashion
Leukotriene precursor and does neutrophil chemotaxis
Medullary

10. which nerve is at risk when ligating the superior thyroid artery? Which is the only muscle this nerve innervates? what nerve innervates all the other laryngeal muscles?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Biphosphonate
Superior larygeal; cricothyroid; recurrent laryngeal
Vancomycin

11. what vessel would a fracture to the neck of the of the humerus damage?
women
Anterior circumflex (and axillary nerve)
Close but purkinje system to ensure contraction in a bottom up fashion
Prostate tumor and increased osteoclast activity

12. which RPGN is also called pauci immune GN? why?
ANCA because of lack of Ig and C3 deposits on IF
SSRI; erectile dysfunction
Increased reticulocytes
Single adenomatous ones

13. IL4 is used for isotypye switching to what?
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
Serum creatine kinase; reperfusion injury causes necrosis
IgE
Gluteus maximus; difficulty getting up from seated position and climbing chair

14. what indicates the severity of a mitral regurg ? mitral stenosis?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
S. aureus
S3 gallop; S2 to opening snap interval
AV node slowest - to allow time for diastole

15. What is epleronone?
Anti centromere; anti DNA topoisomerase
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)
Multiple miscarriages d/t hypercoaguability
Another type of aldosterone antagonist (like spironolactone)

16. What test would be best to determine if a gene is being transcribed? translated?
Hereditary angioedema; ACE inhibitors
Southern - western
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
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

17. What type of calcium channels dictate the plateau in cardiac myocyte?
Dihydropyridine sensitive Ca channels (L type)
Think Hb deformation diseases
Valproate
Abnormal closing of the urethral folds

18. neisseria are...
facultative intracellular
glycerol kinase
V fib; v. failure
FGF and VEGF

19. What pulmonary structural change can kartageners syndrome cause?
TSh (in testicular tumors can cause hyperthyroidism)
Fibrosis; macrophages
Bronchial dilation (bronchiectasis)
Syringomelia

20. What is the best indicator for the severity of mitral stenosis?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
The time interval between S2 and OS- the shorter the interval - the more intense
Increases cytokine production
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

21. In what form are mitochondrial DNA? What do they transcribe?
11
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
High potassium conductance and some sodium conductance
Circular - outside nucleus; transport proteins - rRNA - tRNA

22. Where does complement bind on the Fc region of Ig chains?
Increase by 50% in urine osmolality
transcription activation/suppression
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

23. What antibodies are present in CREST? What is the most specific?
Tibial
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Anti centromere; anti DNA topoisomerase

24. How do left sided colon adenocarcinomas present? right sided?
Nonsense; mRNA processing
Radial nerve and deep brachial artery
Headaches and facial flushing; vasodilation in meninges and skin
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

25. What does prolonged PT indicated? aPTT? bleeding time?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Classical conditioning
Extrinsic def; instrinsic def; platelet def
gram positive organisms

26. what organ would an activating mutation in PRPP synthetase effect?
Chorda tympani branch
Joints d/t increased purine production and thus uric acid production
Hypothyroidism
Headaches and facial flushing; vasodilation in meninges and skin

27. What is the cause of fixed splitting of S2? why?
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Vagus nerve stimulation
No; yes
Duration and extent of disease

28. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Both sides
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Terminal bronchioles; small bronchi
Common peroneal; bony fractures and compression; sciatic

29. Where does lysyl oxidase act? What is the cofactor for that?
Think Hb deformation diseases
Hypothyroidism
In the extracellular space for collagen cross linking; zinc
RBC mass; epo levels (secondary has high)

30. in the LV and aorta - What are the pressures?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Appetite suppressants
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Normally close to systolic

31. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
Hexokinase
Prepatellar
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Chlorpheniramine and diphenhydramine

32. where are the vegetations on the valves of a libman sacks endocarditis?
Both sides
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)
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Coagulation factors are made in the liver

33. What is best to prevent GBS infection in a baby?
INTRApartum Abs (ampicillin/penicillin)
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Gluteus maximus; difficulty getting up from seated position and climbing chair
MAC complex (C5b - C9 complement deficiency)

34. at 2 years of age - What are the social - fine motor - gross motor and language developments?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
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

35. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
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
LT (LTD4 - E4 - C4) - and Ach
Myasthenia gravis
IgE

36. what protein is increased in Crohns disease? What does it do?
NF- KB; responsible for cytokine production
P53 mutation; DCC is also required for adenoma to carcinoma
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Reticulocytes

37. hypertonicity and hyperreflexity are ________________ of hydrocephalus
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Drink plenty of fluids

38. at four years of age - What are the social - fine motor - gross motor - and language developments?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Inhibits it
Think Hb deformation diseases

39. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Become beta pleated and then form neurofibrillary tangle!
Downs; regurgitant AV valves - ASDs
In ER of bile canaliculi
Valproate

40. ___________ is liver specific
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
glycerol kinase
Downs; regurgitant AV valves - ASDs
200-500

41. name three pathological states that present with large tongues.
Inhibits it
Abnormal closing of the urethral folds
Congenital hypothyroidism - downs - amyloidosis - acromegaly
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

42. Where does the aorta lie in relation to the pulmonary artery in transposition of the great arteries (is this right to left or left to right shunt?)?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Excessive collagen formation during tissue repair in susceptible individuals
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

43. What is the difference between additive and synergistic?
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
Reiter syndrome; B27
When it invades the bm; carcinoma in situ
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

44. what happens with LDL receptor density in statin therapy?
Hereditary angioedema; ACE inhibitors
No (unlike adenomyosis); yes
Close but purkinje system to ensure contraction in a bottom up fashion
Increases

45. what virus causes pharyngoconjuctival fever?
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
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Adeno
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

46. nucleotide deletions do not cause missense mutations - they cause...
NF- KB; responsible for cytokine production
ZDV or AZT
frameshift mutations (missense is substitution)
RER; copper

47. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
P53 mutation; AD
Congenital hypothyroidism - downs - amyloidosis - acromegaly
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
S. aureus

48. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Vagus (auricular branch); vasovagal syncope!
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Hypothyroidism

49. What is the fibrinogen level in patient with TTP- HUS? DIC?
Curlings ulcers
Normal; low
Duration and extent of disease
S3 gallop; S2 to opening snap interval

50. how does neisseria cause a petechial rash?
Curlings ulcers
Multiple miscarriages d/t hypercoaguability
Neisseria induced small cell vasculitis (including hands and soles)
Gluteus medius and minimus; positive trendelenberg