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 does anti phospholipid syndrome in SLE patients predispose them to?
Raphe
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Multiple miscarriages d/t hypercoaguability

2. What is the sole neurologic manifestation of acute rheumatic fever?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
DIC; TTP- HUS dont bleed that much
To pump calcium out in cardiac myocytes so that relaxation occurs
Sydenham chorea

3. 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?
Relfex tachycardia; giving beta blockers
I is more benign and can present later in adulthood
Increases
46 - 4N; 23 2N

4. what receptors do first generation anti histamines block?
Hexokinase
GI tract; mood!
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Syncope - angina - dyspnea (SAD)

5. If a patient has higher levels of HbF - What does this mean?
PDA open
Joints d/t increased purine production and thus uric acid production
Think Hb deformation diseases
Selective alpha 1 (increases SVR)

6. What is the most common location of colonization of all s. aureus types?
Highly negative resting potential
Thymic tumor
Anterior nares
IgE

7. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
OCPs - multiparity - breast feeding
...
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Class I

8. What is easiest way to treat nephrolithiasis?
Drink plenty of fluids
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Increases cytokine production
SVC and IVC; right below the aortic knob

9. 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
Octreotide
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
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

10. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
No and yes
Turners`
Serum creatine kinase; reperfusion injury causes necrosis
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

11. In what view of CXR is anterior part of heart best seen? anterior part of heart is formed by?right border of heart is formed by? left border?
Selective alpha 1 (increases SVR)
Lateral; RV; RA; LV
ZDV or AZT
...

12. what enzyme converts procarcinogens into carcinogens?
gram positive organisms
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Elevated GGT and macrocytosis
P450 mitochondrial monooxygenase

13. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
Barium enema
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
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
HSV ( also in utero: chlymadia - neisseria - group B strep)

14. What type of drug is alendronate?
High potassium conductance and some sodium conductance
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Biphosphonate
Increase in permeability of two ions with equal and opposite equilibrium potentials

15. What does 'oxygen' content in blood refer to?
Amiadarone
Prevents hepatic VLDL production
(urine PAH x urine flow rate)/plasma PAH
Dissolved in plasma and attached to Hgb

16. which opponens muscle does ulnar innervate?
(urine PAH x urine flow rate)/plasma PAH
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Adductor
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

17. What are the three causes of acute MI in context of normal coronary arteries ?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Barium enema
C3 decreased after 5-10 days; sulfonamides
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

18. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
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)
Intussusception
Increased reticulocytes
DIC; TTP- HUS dont bleed that much

19. What is the primary histologic finding in patients with eczematous dermatitis?
Spongiosis
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)
Insulin like growth factor 1 (just another name)

20. What does Rb protein do? what chrom is it on?
P450 mitochondrial monooxygenase
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Hyperkalemia; potassium sparing diuretics - potassium supplements
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

21. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
Curlings ulcers
When it invades the bm; carcinoma in situ
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Fat - fertile - forty - female

22. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
Anterior circumflex (and axillary nerve)
CGD; t cell dysfxn (diGeorge)
Gluteus medius and minimus; positive trendelenberg
C3 decreased after 5-10 days; sulfonamides

23. What is used to compare means? categorical outcomes?
chronic urticaria and allergic symptoms
T test; chi squared
Inhaled animal dander allergens
Underestimation of gestational age

24. What does the severity of leprosy depend on?
Strength of cell mediated immune response
Large stroke volumes with ventricular contraction; aortic regurg
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)
HSV and VZV

25. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Become beta pleated and then form neurofibrillary tangle!
transcription activation/suppression

26. which headaches are seen mostly in men - are severe - unilateral - periorbital - episodic (around same time every day) - temporal pain - with lacrimation - nasal congestion and ptosis?
RBC mass; epo levels (secondary has high)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Cluster
Chlorpheniramine and diphenhydramine

27. What are two indicators of chronic alcohol consumption?
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Increase lymphatic drainage!
Elevated GGT and macrocytosis

28. Where does 90% of serotonin lie? What is this NT responsible?
No; yes
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Atrial
GI tract; mood!

29. What is the most important prognostic indicator in patients with malignant melanoma?
Lateral; RV; RA; LV
Strength of cell mediated immune response
Acute gastric mucosal defects (superficial or full thickness)
Measure of depth invasion (vertical!)

30. metabolism of 1 gram of protein produces How many calories? carb? fat?
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)
4 - 4 - 9
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
Not lined by epithelium

31. What are the two mcc of focal brain lesions in HIV positive patients?
Single adenomatous ones
Turners`
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
liver specific

32. What is best to prevent GBS infection in a baby?
INTRApartum Abs (ampicillin/penicillin)
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Localized dermatologic pain that persists for more than one month after zoster eruption
Env genes (for getting into target cells)

33. How do you calculate atributable risk percent?
Tissue redistribution (out of plasma) rather than metabolism
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Drink plenty of fluids
RR-1/RR

34. What is the cause of rapid plasma decay of thiopental?
Leukotriene precursor and does neutrophil chemotaxis
INTRApartum Abs (ampicillin/penicillin)
Tissue redistribution (out of plasma) rather than metabolism
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

35. how can HAV be inactivated?
Neisseria induced small cell vasculitis (including hands and soles)
Boiling - bleach - formalin - UV irradiation
GI tract; mood!
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

36. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
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
Chorda tympani branch
P53 mutation; AD

37. What is achalasia and how would this correlate on the esophageal mannometry?
APP on chrom 21 (this is why downs more susceptible)
C3 decreased after 5-10 days; sulfonamides
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
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

38. What three factors effect total oxygen content of blood?
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Curlings ulcers
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

39. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
Adductor
MAO inhibitors; wine and cheese
Syringomelia
Standing suddenly from supine position; valsalva maneuver

40. what should you think of in 'smear of an oral ulcer base'?
Chlorpheniramine and diphenhydramine
Serum creatine kinase; reperfusion injury causes necrosis
Tzanck smear
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

41. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
Hypothyroidism
Well trained athletes and children
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
MAC complex (C5b - C9 complement deficiency)

42. PDAs are often asymptomatic. How do you treat?
Close but purkinje system to ensure contraction in a bottom up fashion
Syringomelia
indomethacin
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

43. What actions increase venous return?
Squatting - sitting - lying supine - passive leg raising
Bronchogenic carcinoma
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Barium enema

44. at four years of age - What are the social - fine motor - gross motor - and language developments?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Vagus (auricular branch); vasovagal syncope!
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

45. What is Tzanck smear used to detect?
facultative intracellular
Smoking
Close but purkinje system to ensure contraction in a bottom up fashion
HSV and VZV

46. What is the immune deficinecy seen in ataxia telangactasia?
Syringomelia
Dihydropyridine sensitive Ca channels (L type)
ATP binding (resets the myosin head to contract again for next binding)
Ig A deficiency

47. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Relfex tachycardia; giving beta blockers
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Anti centromere; anti DNA topoisomerase

48. What is hypospadias caused by?
Nocardia
Abnormal closing of the urethral folds
G to T in p53; HCC
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

49. What triggers the neoplastic changes that are associated with HBV infecton?
Integration of viral DNA into genome of host hepatocytes
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Joints d/t increased purine production and thus uric acid production
Ig A deficiency

50. do patients with cor pulmonale have increased or decreased levels of aldosterone?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Valproate
hyponatremia (aldosterone activation equilibrates body volume)
Because of the low output from heart failure - they will have increased aldosterone levels