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 mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Decreases both
Leukotriene precursor and does neutrophil chemotaxis
Reiter syndrome; B27

2. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Increase; decreased

3. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

4. What is Bortezomib and What is it used for?
Sarcoid
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)
Proteasome inhibitor; treatment for MM and waldenstroms
Brief psychotic disorder; schizophreniform; schizophrenia

5. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
MAC complex (C5b - C9 complement deficiency)
Terminal bronchioles; small bronchi
Intussusception
Adductor

6. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Inactivates kallikrein which activates kininogen into bradykinin
Initiation - pointing; pincer grasp; walking; mama/dada
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

7. What is easiest way to treat nephrolithiasis?
Hypertension - edema - and proteinuria
GI tract; mood!
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Drink plenty of fluids

8. what organ would an activating mutation in PRPP synthetase effect?
Joints d/t increased purine production and thus uric acid production
Smoking
Serum creatine kinase; reperfusion injury causes necrosis
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

9. why does hypothyroidism cause increased CPK levels?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
RER; RER
Vancomycin; histamine mediated
Downs; regurgitant AV valves - ASDs

10. which opponens muscle does ulnar innervate?
Adductor
Ig A deficiency
Normal; low
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

11. What is the mc location of brain germinomas?What are the classic symptoms?
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
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Vancomycin; histamine mediated
Because gamma chains replace beta chains and then gamma chain formation wanes

12. What is capsaicin? Where does it work?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Pain reliever - reduces pain by locking substance P in the PNS
Amiloride - spironolactone - triamterene
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

13. What is the fibrinogen level in patient with TTP- HUS? DIC?
Radial nerve damage
Well
Drug induced interstitial nephritis
Normal; low

14. Acyl coA synthetase is not...
liver specific
Increase lymphatic drainage!
Right before diastole (filling begins)
DIC; TTP- HUS dont bleed that much

15. PDAs are often asymptomatic. How do you treat?
indomethacin
women
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Enterococci (e. faecalis)- found on genitalia area

16. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Measure of depth invasion (vertical!)
Folic acid treatment!
Gluteus medius and minimus; positive trendelenberg
Superior larygeal; cricothyroid; recurrent laryngeal

17. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
RER; copper
Vancomycin
Well
Increases bronchial and vascular smooth muscle reactivity to catecholamines

18. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
Smoking
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Myasthenia gravis
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)

19. What does the tuberoinfundibular pathway connect? What is it responsible for?
As a CO2 carrier with the carboxylase enzyme
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Proteasome inhibitor; treatment for MM and waldenstroms
Chrom 8

20. there are mucus secreting cells in the bronchioles...
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
only up to bronchi
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

21. Where is the base of the heart? apex?
Trochlear nerve (IV); abducens nerve (VI)
Hydrogen bonds dictate alpha or beta structure
Closer to head; closer to diaphragm
RER; copper

22. What is epispadias caused by?
Faulty positioning of the genital tubercle
P450 mitochondrial monooxygenase
Pulmonic and systemic!
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

23. What is the mainstay treatment for acute mania?
Vancomycin; histamine mediated
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
High potassium conductance and some sodium conductance
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

24. what indicates the severity of a mitral regurg ? mitral stenosis?
S3 gallop; S2 to opening snap interval
Terminal bronchioles; small bronchi
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Increases cytokine production

25. What is the best indicator for the severity of mitral stenosis?
Enterococci (e. faecalis)- found on genitalia area
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Nocardia
The time interval between S2 and OS- the shorter the interval - the more intense

26. What is it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
RER; copper
(urine PAH x urine flow rate)/plasma PAH
Vertical diplopia
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

27. do Class IC agents prolong the QT interval?
SS +rNA
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Selective alpha 1 (increases SVR)
No

28. What does nitroprusside do to afterload? preload?
Underestimation of gestational age
Decreases both
Think Hb deformation diseases
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

29. What type of disease has selective proteinuria? What is found in urine? What is not?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
LT (LTD4 - E4 - C4) - and Ach
Prevent phagocytosis
Leukotriene precursor and does neutrophil chemotaxis

30. Where does conjugation of bilirubin take place?
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
Around 70 (normal measured diastolic pressures); 9--
In ER of bile canaliculi
Selective alpha 1 (increases SVR)

31. 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?
In the extracellular space for collagen cross linking; zinc
In the extracellular space
Superior larygeal; cricothyroid; recurrent laryngeal
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

32. What is subacute sclerosisng encephalitis caused by?
On cardiac tissue and renal juxtaglomerular cells
Lateral; RV; RA; LV
Insulin like growth factor 1 (just another name)
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

33. what marker should be followed in a patient with cirrhosis?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Well trained athletes and children
facultative intracellular

34. What is the most common initital symptom of ADPKD? what else?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
RBC mass; epo levels (secondary has high)
Rabies encephalitis from cave bats; rabies killed vaccines
PDA open

35. 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?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Radial nerve damage
Susceptible; soluble (unable to be cultured in bile)

36. at four years of age - What are the social - fine motor - gross motor - and language developments?
TSh (in testicular tumors can cause hyperthyroidism)
Syringomelia
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Become beta pleated and then form neurofibrillary tangle!

37. What is the stabilizing force for the secondary structure of proteins?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Leukotriene precursor and does neutrophil chemotaxis
Appetite suppressants
Hydrogen bonds dictate alpha or beta structure

38. erythema nodosum - elevated ACE - scattered granulomas - arthralgias - hilar lymphadenoapthy are indicative of what?
High potassium conductance and some sodium conductance
Vancomycin; histamine mediated
On cardiac tissue and renal juxtaglomerular cells
Sarcoid

39. 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
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Coagulation factors are made in the liver

40. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
Intussusception
Folic acid treatment!
FGF and VEGF
Minimal change disease

41. What test would be best to determine if a gene is being transcribed? translated?
Single adenomatous ones
Southern - western
Hexokinase
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

42. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
Curlings ulcers
By vascular permeability and vasodilation
Single adenomatous ones
Leukotriene precursor and does neutrophil chemotaxis

43. What can worse neurologic dysfunction in cobalamic def?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Folic acid treatment!
Closer to head; closer to diaphragm
Retinitis; mononucleosis

44. hypertonicity and hyperreflexity are ________________ of hydrocephalus
manifestations - congenital (stretching of periventricular pyrimadal fibers)
II; I (I more abundant)
Classical conditioning
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

45. What are two common side effects of both acute and long acting nitrates? What causes them?
Right before diastole (filling begins)
Initiation - pointing; pincer grasp; walking; mama/dada
Downs; regurgitant AV valves - ASDs
Headaches and facial flushing; vasodilation in meninges and skin

46. What causes vertical diplopia? horizontal?
Become beta pleated and then form neurofibrillary tangle!
Trochlear nerve (IV); abducens nerve (VI)
No and yes
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

47. what chromosome is c - myc found on?
Anterior circumflex (and axillary nerve)
Chrom 8
Raphe
Medial part

48. Where does complement bind on the Fc region of Ig chains?
Nocardia
SaO2 <92%
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Drink plenty of fluids

49. within the right atrium - What is the maximum pressure? left atrium?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Leukotriene precursor and does neutrophil chemotaxis
8; 12
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

50. What three pathogens cause infectious esophagitis in HIV positive patients?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
low in serum
CMV - HSV 1 - Candida
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi