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 pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
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)
Regular insulin (Not fast acting - regular better)
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
Intussusception

2. What are the two coagulase negative staphylococci? How do you distinguish them?
By vascular permeability and vasodilation
Barium enema
Increases bronchial and vascular smooth muscle reactivity to catecholamines
S. saprophyticus - and s. epidermidis; novobiocin

3. Would alpha 1 agonists cause flushing? muscarinic antagonist?
ANCA because of lack of Ig and C3 deposits on IF
women
No; yes
Nocardia

4. What is the diagnosis in delayed puberty plus anosmia?
Mean greater than median greater than mode
Leukotriene precursor and does neutrophil chemotaxis
Kallmans
Circular - outside nucleus; transport proteins - rRNA - tRNA

5. why does variocele occur more in left side?
11 aa polypeptide; pain NT in CNS and PNS
The term used to describe decreased drug responsiveness with repeated administration
25; 25
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

6. what receptors do first generation anti histamines block?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Biphosphonate
Myasthenia gravis
Ceftriaxone; azithromycin

7. What is normal fibrinogen levels?
200-500
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
8; 12
Vagus (auricular branch); vasovagal syncope!

8. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Strength of cell mediated immune response
Myasthenia gravis

9. What is easiest way to treat nephrolithiasis?
Drink plenty of fluids
Terminal bronchioles; small bronchi
Anti centromere; anti DNA topoisomerase
Phencyclidine (PCP)

10. What is gardeners mydriasis? How is it treated?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Inactivates kallikrein which activates kininogen into bradykinin
only up to bronchi
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

11. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Rabies encephalitis from cave bats; rabies killed vaccines
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

12. What can too much IgA in serum produces?
IgE
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Spongiosis
Gluteus maximus; difficulty getting up from seated position and climbing chair

13. what happens to capacitance with age?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
P53 mutation; AD
...
CMV - HSV 1 - Candida

14. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
Fibrosis; macrophages
SVC and IVC; right below the aortic knob
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
P53 mutation; DCC is also required for adenoma to carcinoma

15. What does L/S stand for in fetal lung maturity? When does maturity occur?
MAC complex (C5b - C9 complement deficiency)
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
V fib; v. failure

16. What is the difference between paranoid personality disorder and delusional disorder?
P450 mitochondrial monooxygenase
Because of vasodiation to skeletal muscles
Elevated GGT and macrocytosis
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

17. What is an abortive viral infection?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Aromatase deficiency in child
As a CO2 carrier with the carboxylase enzyme
Little effect on cell and no change

18. What is a cord factor and Which bugs have it? How do they appear on culture?
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Bile soluble which means they are bile sensitive
Bronchogenic carcinoma
differentiate

19. other than parvo B19 - what else is associated with red cell aplasia?
Thymic tumor
GI malignancies and Insulin resistance (acromegal for ex)
Diabetic microangiopathy
Sydenham chorea

20. where are Beta 1 receptors found?
Both sides
Skin flushing and warmth; prostaglandins; give with aspirin
46 - 4N; 23 2N
On cardiac tissue and renal juxtaglomerular cells

21. What are some of the permissive effects of cortisol?
Phencyclidine (PCP)
Syringomelia
Increases bronchial and vascular smooth muscle reactivity to catecholamines
200-500

22. When does neovascularization granulation tissue begin to form after severe ischemia and MI? what happens in 12-24 hours? 2 weeks to 2 months? 1-5 days? 0-4 hours? when do you see edema - hemorrhage - wavy fibers?
Neisseria induced small cell vasculitis (including hands and soles)
Echinococcus granulosus; anaphylaxis
Dissolved in plasma and attached to Hgb
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

23. What is the immune deficinecy seen in ataxia telangactasia?
FGF and VEGF
Ig A deficiency
Enterococci (e. faecalis)- found on genitalia area
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin

24. How do left sided colon adenocarcinomas present? right sided?
SSRI; erectile dysfunction
Faulty positioning of the genital tubercle
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
Vagus nerve stimulation

25. 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)
Hydrogen bonds dictate alpha or beta structure
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

26. What is Tzanck smear used to detect?
HSV and VZV
IgE
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)
Pain reliever - reduces pain by locking substance P in the PNS

27. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Class I
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
C3 decreased after 5-10 days; sulfonamides
Kallmans

28. What actions increase venous return?
Pulmonic and systemic!
Squatting - sitting - lying supine - passive leg raising
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
Elevated GGT and macrocytosis

29. why are pregnant predisposed to cholelithiasis?
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
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Anterior circumflex (and axillary nerve)
Drug induced interstitial nephritis

30. other than proteinuria - What can cause foamy froathy urine?
Terminal bronchioles; small bronchi
Right before diastole (filling begins)
Medullary
Bile salt accumulation in urine

31. What is damaged in early syringomelia? later?
NF- KB; responsible for cytokine production
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Nonsense; mRNA processing
Dissolved in plasma and attached to Hgb

32. SIADH patients have normal blood volume but...
Primary
CGD; t cell dysfxn (diGeorge)
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
hyponatremia (aldosterone activation equilibrates body volume)

33. metabolism of 1 gram of protein produces How many calories? carb? fat?
In the extracellular space
4 - 4 - 9
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
S3 gallop; S2 to opening snap interval

34. What is the cause of fixed splitting of S2? why?
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
200-500
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
Appetite suppressants

35. What is epispadias caused by?
Measure of depth invasion (vertical!)
Faulty positioning of the genital tubercle
8 (myc protein) with 2 - 14 - 22 (iG chains)
No and yes

36. What is pickwickian syndrome? What are the lab findings?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Anterior nares
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Aromatase deficiency in child

37. What translocations can cause c - myc overexpression?
8 (myc protein) with 2 - 14 - 22 (iG chains)
By vascular permeability and vasodilation
Hereditary angioedema; ACE inhibitors
Become beta pleated and then form neurofibrillary tangle!

38. What are the skin presentation in sarcoid?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Varying; erythema nodosum is common
Nocardia
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

39. on which chromosome is wilms tumor found?
11
CGD; t cell dysfxn (diGeorge)
DIC; TTP- HUS dont bleed that much
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

40. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
S3 gallop; S2 to opening snap interval
CGD; t cell dysfxn (diGeorge)
Pan colitis and right sided colitis (more than left sided and proctitis)

41. what hormone is structurally similar to hCG?
Protamine sulfate
Ig A deficiency
TSh (in testicular tumors can cause hyperthyroidism)
Recurrent larygneal

42. What does anti phospholipid syndrome in SLE patients predispose them to?
Single adenomatous ones
Insulin like growth factor 1 (just another name)
Multiple miscarriages d/t hypercoaguability
...

43. why are beta thal major patients asymptomatic at birth?
Dissolved in plasma and attached to Hgb
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Because gamma chains replace beta chains and then gamma chain formation wanes

44. there are mucus secreting cells in the bronchioles...
As a CO2 carrier with the carboxylase enzyme
Drug induced interstitial nephritis
only up to bronchi
When it invades the bm; carcinoma in situ

45. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
In the extracellular space
Turners`
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

46. Acyl coA synthetase is not...
DIC; TTP- HUS dont bleed that much
The time interval between S2 and OS- the shorter the interval - the more intense
liver specific
Serum FFA and serum triglyceride levels

47. which nerve in the lower leg is easily injured and causes foot drop ? What are common causes? From what nerve does it branch off or?
No and yes
When it invades the bm; carcinoma in situ
Common peroneal; bony fractures and compression; sciatic
As a CO2 carrier with the carboxylase enzyme

48. PDAs are often asymptomatic. How do you treat?
Little effect on cell and no change
Increases cytokine production
indomethacin
Nocardia

49. What type of endocarditis is cytoscopy induced?
Enterococci (e. faecalis)- found on genitalia area
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Drug induced interstitial nephritis
RER; copper

50. sporadic colon cancer tend to arise From what type of polyps?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Acute gastric mucosal defects (superficial or full thickness)
Gluteus medius and minimus; positive trendelenberg
Single adenomatous ones