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. In What type of nephritis would you see high serum eos count?
Common peroneal; bony fractures and compression; sciatic
S3 gallop; S2 to opening snap interval
Drug induced interstitial nephritis
Anterior circumflex (and axillary nerve)

2. If a patient has higher levels of HbF - What does this mean?
Think Hb deformation diseases
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
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
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

3. which two drug types can cause orthostatic hypotension (think depression and BPH)?
Tzanck smear
Cluster
TCAs and prazosin
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

4. why are beta thal major patients asymptomatic at birth?
Because gamma chains replace beta chains and then gamma chain formation wanes
S. aureus
Normal; low
Measles and M3 AML`

5. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Increase by 50% in urine osmolality
Hypo or hyper pigmentations; after tanning
Large stroke volumes with ventricular contraction; aortic regurg
Medial part

6. What is diphenoxylate and What is it used for? what drug is it structurally similar to? What allows for potent anti diarrheal effect without signigicant opiate effects?
Tzanck smear
G to T in p53; HCC
liver specific
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)

7. what induces bronchial squamous metaplasia?
ANCA because of lack of Ig and C3 deposits on IF
Smoking
Prevents hepatic VLDL production
SSRI

8. why does hypothyroidism cause increased CPK levels?
High potassium conductance and some sodium conductance
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Little effect on cell and no change
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

9. What is the neurologic manifestation of ADPKD?
TSh (in testicular tumors can cause hyperthyroidism)
By vascular permeability and vasodilation
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Hydrogen bonds dictate alpha or beta structure

10. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
RER; copper
Rabies encephalitis from cave bats; rabies killed vaccines
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Valproate

11. what makes bruits?
Brief psychotic disorder; schizophreniform; schizophrenia
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Turbulence

12. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Medullary
Initiation - pointing; pincer grasp; walking; mama/dada
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

13. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
RBC mass; epo levels (secondary has high)
Radial nerve damage
P53 mutation; AD

14. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Not lined by epithelium
Joints d/t increased purine production and thus uric acid production
SSRI
Relfex tachycardia; giving beta blockers

15. What can long term leg cast wearing cause?
Injury to common peroneal nerve (d/t trauma or sustained pressure to neck of fibula) causing pain and numbness on dorsum of foot and inability to dorsiflex
Gluteus maximus; difficulty getting up from seated position and climbing chair
P53 mutation; AD
Sarcoid

16. What is capsaicin? Where does it work?
Pain reliever - reduces pain by locking substance P in the PNS
Turners`
Adductor
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

17. What does nitroprusside do to afterload? preload?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Decreases both
Normally close to systolic
Anterior nares

18. carnitine deficiency impairs production of What and how?
Vascular endothelium; protease
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
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Ketone body production by preventing fatty acids into the mitochondria

19. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
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
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

20. what defines hypoxemia?
ST become atrophic and hyalinized (temp induced damage) and depressed sperm count becuase of that; hormonal function not impaired (test and LH levels normal) because Leydig cells not as temp sensitive so secondary sexual characteristics and sexual pe
SaO2 <92%
Both sides
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

21. What is the precursor protein to beta amyloid and On what chromosome is it found?
Kallmans
IgE
hyponatremia (aldosterone activation equilibrates body volume)
APP on chrom 21 (this is why downs more susceptible)

22. what organ would an activating mutation in PRPP synthetase effect?
Joints d/t increased purine production and thus uric acid production
Anterior nares
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

23. what happens to sperm count and semineferous tubules in patient with cryptoorchidism? hormonal function? why do they need to be surgically descended?
To pump calcium out in cardiac myocytes so that relaxation occurs
Single adenomatous ones
ST become atrophic and hyalinized (temp induced damage) and depressed sperm count becuase of that; hormonal function not impaired (test and LH levels normal) because Leydig cells not as temp sensitive so secondary sexual characteristics and sexual pe
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

24. What agonists reduce the gradient across the LV outflow tract?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Large stroke volumes with ventricular contraction; aortic regurg
Selective alpha 1 (increases SVR)
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase

25. other than parvo B19 - what else is associated with red cell aplasia?
G to T in p53; HCC
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Thymic tumor
P450 mitochondrial monooxygenase

26. 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?
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

27. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

28. What does Rb protein do? what chrom is it on?
Ether and other organic solvents
Downs; regurgitant AV valves - ASDs
Tibial
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

29. What is it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
Inhibits it
Vertical diplopia
Hypertension - edema - and proteinuria
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

30. What is easiest way to treat nephrolithiasis?
Drink plenty of fluids
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
Ceftriaxone; azithromycin
Nocardia

31. What does 'oxygen' content in blood refer to?
Anterior nares
E. coli
Dissolved in plasma and attached to Hgb
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

32. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
NF- KB; responsible for cytokine production
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Standing suddenly from supine position; valsalva maneuver
Class I

33. What are some side effects seen in TCAs?
GI malignancies and Insulin resistance (acromegal for ex)
Radial nerve and deep brachial artery
Anti cholinergic effects of pupil dilation and lack of accomodation
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

34. What is used to compare means? categorical outcomes?
T test; chi squared
No and yes
GI tract; mood!
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

35. after a thrombus extraction - what serum enzyme shoots up and why?
Joints d/t increased purine production and thus uric acid production
Pan colitis and right sided colitis (more than left sided and proctitis)
Serum creatine kinase; reperfusion injury causes necrosis
Initiation - pointing; pincer grasp; walking; mama/dada

36. What are two common side effects of both acute and long acting nitrates? What causes them?
Headaches and facial flushing; vasodilation in meninges and skin
Paramyxo and influenza
GI malignancies and Insulin resistance (acromegal for ex)
Acute interstitial nephritis

37. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Increased reticulocytes
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
manifestations - congenital (stretching of periventricular pyrimadal fibers)

38. where are the vegetations on the valves of a libman sacks endocarditis?
Well
Kallmans
The time interval between S2 and OS- the shorter the interval - the more intense
Both sides

39. what drug is useful for secretory diarrhea?
Anti centromere; anti DNA topoisomerase
Octreotide
In ER of bile canaliculi
Chrom 8

40. which cells produce surfactant? which ones mediate gas exchange?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Both sides
II; I (I more abundant)
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

41. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Hyperkalemia; potassium sparing diuretics - potassium supplements
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
P53 mutation; DCC is also required for adenoma to carcinoma
Prepatellar

42. do patients with cor pulmonale have increased or decreased levels of aldosterone?
Spongiosis
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Because of the low output from heart failure - they will have increased aldosterone levels
AV node slowest - to allow time for diastole

43. What is damaged in early syringomelia? later?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Single adenomatous ones
Well trained athletes and children
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

44. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Regular insulin (Not fast acting - regular better)
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Valproate
Syncope - angina - dyspnea (SAD)

45. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
NF- KB; responsible for cytokine production
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Hereditary angioedema; ACE inhibitors

46. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Apocrine; eccrine
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase

47. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
Another type of aldosterone antagonist (like spironolactone)
Serum FFA and serum triglyceride levels
P53 mutation; DCC is also required for adenoma to carcinoma
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

48. in B12 deficiency - what levels in blood rise very quickly and then drop?
Standing suddenly from supine position; valsalva maneuver
Reticulocytes
200-500
Well

49. other than increasing HDL levels - what else does niacin do?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Prevents hepatic VLDL production
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Minimal change disease

50. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Adeno
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Medial circumflex artery; avascular necrosis
Vertical diplopia