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 a primary HSV 1 infection like?
Standing suddenly from supine position; valsalva maneuver
hyponatremia (aldosterone activation equilibrates body volume)
frameshift mutations (missense is substitution)
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

2. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
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
Close but purkinje system to ensure contraction in a bottom up fashion
Downs; regurgitant AV valves - ASDs
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

3. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
Well
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)
No and yes
Measles and M3 AML`

4. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Hypothyroidism
Bronchogenic carcinoma
P53 mutation; DCC is also required for adenoma to carcinoma

5. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
GI malignancies and Insulin resistance (acromegal for ex)
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
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
CGD; t cell dysfxn (diGeorge)

6. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Hypothyroidism
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

7. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
Secretin stimulates the exocrine pancrease; S enteroendocrine cells in duodenal mucosa in response to acid secrete secretin (HCL is most potent stimulus for secretin release)
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Because gamma chains replace beta chains and then gamma chain formation wanes
Close but purkinje system to ensure contraction in a bottom up fashion

8. what happens to capacitance with age?
Anti cholinergic effects of pupil dilation and lack of accomodation
Spongiosis
In the extracellular space
...

9. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
When it invades the bm; carcinoma in situ
Right heart failure
By vascular permeability and vasodilation
Intussusception

10. What type of drug is alendronate?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Apocrine; eccrine
Biphosphonate
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

11. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
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
Skin flushing and warmth; prostaglandins; give with aspirin
Hydrogen bonds dictate alpha or beta structure
Right before diastole (filling begins)

12. what kind of drug is sertraline? What is a common side effect?
SSRI; erectile dysfunction
Neisseria induced small cell vasculitis (including hands and soles)
Ketone body production by preventing fatty acids into the mitochondria
Raphe

13. What is achalasia and how would this correlate on the esophageal mannometry?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
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
Excessive collagen formation during tissue repair in susceptible individuals
S. aureus

14. what virus causes pharyngoconjuctival fever?
Adeno
Bronchogenic carcinoma
T test; chi squared
Chlorpheniramine and diphenhydramine

15. Where is conduction in heart fastest? slowest?
Bronchogenic carcinoma
Purkinje system; AV node
Circular - outside nucleus; transport proteins - rRNA - tRNA
Vancomycin

16. what hormone is structurally similar to hCG?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Minimal change disease
TSh (in testicular tumors can cause hyperthyroidism)

17. when do ghon complexes form - primary or secondary TB?
Standing suddenly from supine position; valsalva maneuver
Primary
Large stroke volumes with ventricular contraction; aortic regurg
RER; RER

18. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Phencyclidine (PCP)
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Inactivates kallikrein which activates kininogen into bradykinin
(urine PAH x urine flow rate)/plasma PAH

19. What is epleronone?
Not lined by epithelium
Another type of aldosterone antagonist (like spironolactone)
Atrial
Sudden loss of muscle tone without loss of consciousness; narcolepsy

20. How is dobutamine better than dopamine?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Lateral; RV; RA; LV
SaO2 <92%
Multiple miscarriages d/t hypercoaguability

21. What actions increase venous return?
Gluteus medius and minimus; positive trendelenberg
Squatting - sitting - lying supine - passive leg raising
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
glycerol kinase

22. how long is substance P? What does it do?
Atrial
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
11 aa polypeptide; pain NT in CNS and PNS
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

23. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Tibial
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Hereditary angioedema; ACE inhibitors
E. coli

24. a patient fearing all white coats is a phenomenon of what?
Medial part
Classical conditioning
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
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

25. 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?
Leukotriene precursor and does neutrophil chemotaxis
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
AV node slowest - to allow time for diastole

26. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
E. coli; staphylococcus saprophyticus
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Amiloride - spironolactone - triamterene
SVT; increases vagal tone; rectus abdominis

27. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
Inactivates kallikrein which activates kininogen into bradykinin
Reiter syndrome; B27
differentiate
low in serum

28. what bursa is affected when on knees like a maid/gardner?
Both sides
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)
Drink plenty of fluids
Prepatellar

29. 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?
Common peroneal; bony fractures and compression; sciatic
Clindamycin; covers anaerobic oral flora and aerobic bacteria
SSRI
Medullary

30. What are some of the permissive effects of cortisol?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Sickle cell; G6PD
Hereditary angioedema; ACE inhibitors
INTRApartum Abs (ampicillin/penicillin)

31. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Gluteus medius and minimus; positive trendelenberg
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Well

32. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
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
HSV ( also in utero: chlymadia - neisseria - group B strep)
Diabetic microangiopathy
Right heart failure

33. What is easiest way to treat nephrolithiasis?
only up to bronchi
Drink plenty of fluids
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Minimal change disease

34. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
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
Turners`
INTRApartum Abs (ampicillin/penicillin)

35. When is an S4 sound normal?
Well trained athletes and children
TSh (in testicular tumors can cause hyperthyroidism)
Syncope - angina - dyspnea (SAD)
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

36. What antibodies are present in CREST? What is the most specific?
Anti centromere; anti DNA topoisomerase
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Vancomycin; histamine mediated

37. which two virus families have hemagluttinin on their surface?
Paramyxo and influenza
ANCA because of lack of Ig and C3 deposits on IF
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

38. what murmur is enhanced by decreased blood flow to the heart?
Ketone body production by preventing fatty acids into the mitochondria
RBC mass; epo levels (secondary has high)
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Folic acid treatment!

39. What type of vision is myopia? In What type of patients does it improve?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Prostate tumor and increased osteoclast activity
By vascular permeability and vasodilation

40. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
Hexokinase
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Adeno

41. How do you explain the selective proteinuria of loss to albumin only in MCD?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
RBC mass; epo levels (secondary has high)
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Squatting - sitting - lying supine - passive leg raising

42. What is used to compare means? categorical outcomes?
T test; chi squared
Prevents hepatic VLDL production
Anterior circumflex (and axillary nerve)
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

43. Where is aromatase used?
Think Hb deformation diseases
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Pain reliever - reduces pain by locking substance P in the PNS
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

44. How do you calculate RPF from urine PAH?
Headaches and facial flushing; vasodilation in meninges and skin
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
To pump calcium out in cardiac myocytes so that relaxation occurs
(urine PAH x urine flow rate)/plasma PAH

45. hypertonicity and hyperreflexity are ________________ of hydrocephalus
Decreases both
Increased reticulocytes
Localized dermatologic pain that persists for more than one month after zoster eruption
manifestations - congenital (stretching of periventricular pyrimadal fibers)

46. What is hyaline arteriosclerosis usually a sign of ?
SSRI; erectile dysfunction
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Diabetic microangiopathy

47. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Secretin stimulates the exocrine pancrease; S enteroendocrine cells in duodenal mucosa in response to acid secrete secretin (HCL is most potent stimulus for secretin release)
Chrom 8
Fibronectin - laminin - collagen
When it invades the bm; carcinoma in situ

48. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
Vagus nerve stimulation
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
No (unlike adenomyosis); yes
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

49. What are two common side effects of both acute and long acting nitrates? What causes them?
Around 70 (normal measured diastolic pressures); 9--
Headaches and facial flushing; vasodilation in meninges and skin
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
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

50. what nerve and artery course along the posterior aspect of the humerus?
Radial nerve and deep brachial artery
Amiadarone
Coagulation factors are made in the liver
Right before diastole (filling begins)