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 causes wrist drop?
SVT; increases vagal tone; rectus abdominis
Sickle cell; G6PD
Prepatellar
Radial nerve damage

2. What is a clara cell?
By vascular permeability and vasodilation
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
46 - 4N; 23 2N
Multiple miscarriages d/t hypercoaguability

3. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
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
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

4. What are three symptoms in s.typhi?
(urine PAH x urine flow rate)/plasma PAH
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
SaO2 <92%
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

5. nucleotide deletions do not cause missense mutations - they cause...
Anti cholinergic effects of pupil dilation and lack of accomodation
frameshift mutations (missense is substitution)
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Extrinsic def; instrinsic def; platelet def

6. what chromosome is c - myc found on?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
HSV ( also in utero: chlymadia - neisseria - group B strep)
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
Chrom 8

7. what dictates the resting membrane potential of most cells?
Dissolved in plasma and attached to Hgb
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
High potassium conductance and some sodium conductance
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

8. What is contraindicated in toxic mega colon?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Fibrosis; macrophages
High potassium conductance and some sodium conductance
RBF= PAH clearance/(1- hematocrit)

9. What is the preferred treatment for DKA?
Regular insulin (Not fast acting - regular better)
Spongiosis
Hyperkalemia; potassium sparing diuretics - potassium supplements
ZDV or AZT

10. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Rabies encephalitis from cave bats; rabies killed vaccines
LT (LTD4 - E4 - C4) - and Ach
Pulmonic and systemic!

11. 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?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

12. what drugs causes the red man syndrome? how does it occur?
Vancomycin; histamine mediated
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
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Sickle cell; G6PD

13. What do you treat s. epidermidis with?
Vancomycin
Downs; regurgitant AV valves - ASDs
RER; RER
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

14. hypertonicity and hyperreflexity are ________________ of hydrocephalus
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Headaches and facial flushing; vasodilation in meninges and skin
Become beta pleated and then form neurofibrillary tangle!

15. What is the mc manifestation of CMV in HIV patient? immunocompetent?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
transcription activation/suppression
Retinitis; mononucleosis

16. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Relfex tachycardia; giving beta blockers
RR-1/RR
Increase in permeability of two ions with equal and opposite equilibrium potentials
Adeno

17. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
APP on chrom 21 (this is why downs more susceptible)
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
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
No and yes

18. How can renal blood flow be calculated from RPF?
RBF= PAH clearance/(1- hematocrit)
I is more benign and can present later in adulthood
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Dihydropyridine sensitive Ca channels (L type)

19. How do you calculate atributable risk percent?
Downs; regurgitant AV valves - ASDs
CGD; t cell dysfxn (diGeorge)
RR-1/RR
indomethacin

20. What does VIP do to gastric acid secretion?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Enterococci (e. faecalis)- found on genitalia area
Inhibits it
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

21. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Well trained athletes and children
Increased reticulocytes
GI tract; mood!
RER; RER

22. What is the difference between paranoid personality disorder and delusional disorder?
When it invades the bm; carcinoma in situ
High potassium conductance and some sodium conductance
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
SaO2 <92%

23. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Relfex tachycardia; giving beta blockers
SVT; increases vagal tone; rectus abdominis

24. how does eos release MBP to kill protozoa etc?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Hexokinase
Trauma to stereociliated hair cells of the organ of corti
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

25. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
Enterococci (e. faecalis)- found on genitalia area
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
Right before diastole (filling begins)
Radial nerve damage

26. why does hypothyroidism cause increased CPK levels?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
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
Medial part
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

27. What almost exclusively causes Epliglottitis?What type of capsule does it have? What are the symptoms?

28. what locations of UC increase the risk of Colon cancer?
Extrinsic def; instrinsic def; platelet def
Pan colitis and right sided colitis (more than left sided and proctitis)
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
No; yes

29. other than mycobacterim wha other bacteria is acid fast?
Nocardia
Chrom 8
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Pan colitis and right sided colitis (more than left sided and proctitis)

30. what happens to capacitance with age?
Terminal bronchioles; small bronchi
...
Measure of depth invasion (vertical!)
E. coli

31. What is the most common initital symptom of ADPKD? what else?
Gluteus medius and minimus; positive trendelenberg
Anti cholinergic effects of pupil dilation and lack of accomodation
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
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

32. which antiarrythmic is associated with blue gray discoloration ?
Multiple miscarriages d/t hypercoaguability
Amiadarone
Hypo or hyper pigmentations; after tanning
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

33. carnitine deficiency impairs production of What and how?
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Demargination of neutrophils from the vessel walls
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Ketone body production by preventing fatty acids into the mitochondria

34. How do you explain the selective proteinuria of loss to albumin only in MCD?
Minimal change disease
LT (LTD4 - E4 - C4) - and Ach
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Bile salt accumulation in urine

35. What is the Na/Ca exchange used for?
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
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
To pump calcium out in cardiac myocytes so that relaxation occurs
LT (LTD4 - E4 - C4) - and Ach

36. What is normal fibrinogen levels?
200-500
Brief psychotic disorder; schizophreniform; schizophrenia
...
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

37. when arrested in prophase of meiosis I - What are primary oocytes chrom number? What about the secondary oocytes that are stuck in metaphase of Meiosis II?
Tzanck smear
Tissue redistribution (out of plasma) rather than metabolism
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
46 - 4N; 23 2N

38. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
Right heart failure
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

39. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
C3 decreased after 5-10 days; sulfonamides
In the extracellular space
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Inhaled animal dander allergens

40. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
MAC complex (C5b - C9 complement deficiency)
Recurrent larygneal
Because of vasodiation to skeletal muscles
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

41. which virus inactivates both Rb and p53?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
In the extracellular space for collagen cross linking; zinc
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

42. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Duration and extent of disease
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

43. What can cause virilization of a mother during pregnancy?
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
Aromatase deficiency in child
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Protamine sulfate

44. which are the only glycosylated proteins in HIV virus?
Env genes (for getting into target cells)
Proteasome inhibitor; treatment for MM and waldenstroms
On cardiac tissue and renal juxtaglomerular cells
Prevents hepatic VLDL production

45. What is the mc location for avascular necrosis? What is it associated with?
25; 25
C3 decreased after 5-10 days; sulfonamides
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
When it invades the bm; carcinoma in situ

46. How is dobutamine better than dopamine?
Measure of depth invasion (vertical!)
Drug induced interstitial nephritis
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Measles and M3 AML`

47. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
Tissue redistribution (out of plasma) rather than metabolism
Bile soluble which means they are bile sensitive
11 aa polypeptide; pain NT in CNS and PNS
RR-1/RR

48. What are two indicators of chronic alcohol consumption?
Decreases both
Hexokinase
Because gamma chains replace beta chains and then gamma chain formation wanes
Elevated GGT and macrocytosis

49. What is the most common location of colonization of all s. aureus types?
Anterior nares
Prostate tumor and increased osteoclast activity
11 aa polypeptide; pain NT in CNS and PNS
FGF and VEGF

50. How do you calculate RPF from urine PAH?
Chlorpheniramine and diphenhydramine
Biphosphonate
(urine PAH x urine flow rate)/plasma PAH
No (unlike adenomyosis); yes