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 triad seen in pre eclampsia?
The time interval between S2 and OS- the shorter the interval - the more intense
Downs; regurgitant AV valves - ASDs
Hypertension - edema - and proteinuria
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

2. What is the mainstay treatment for acute mania?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Bronchial dilation (bronchiectasis)
Vancomycin
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

3. what organ would an activating mutation in PRPP synthetase effect?
Curlings ulcers
Joints d/t increased purine production and thus uric acid production
APP on chrom 21 (this is why downs more susceptible)
Inhaled animal dander allergens

4. What are the skin presentation in sarcoid?
SVT; increases vagal tone; rectus abdominis
Varying; erythema nodosum is common
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Large stroke volumes with ventricular contraction; aortic regurg

5. What is the fibrinogen level in patient with TTP- HUS? DIC?
Class I
Normal; low
Measure of depth invasion (vertical!)
Primary

6. What is acanthosis nigricans associated with?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Intussusception
GI malignancies and Insulin resistance (acromegal for ex)
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

7. What causes wrist drop?
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
Initiation - pointing; pincer grasp; walking; mama/dada
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Radial nerve damage

8. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
IgE
Downs; regurgitant AV valves - ASDs
SVC and IVC; right below the aortic knob
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

9. at 2 years of age - What are the social - fine motor - gross motor and language developments?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
TCAs and prazosin
Common peroneal; bony fractures and compression; sciatic
Clindamycin; covers anaerobic oral flora and aerobic bacteria

10. What is the most common cause of pyelonephritis in both adults and childre?
Single adenomatous ones
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
E. coli
Demargination of neutrophils from the vessel walls

11. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
No; yes
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
OCPs - multiparity - breast feeding

12. what dissolves the lipid bilayer of a viral envelope?
Ether and other organic solvents
Little effect on cell and no change
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
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

13. In what population does cholelithiasis occur?
HSV and VZV
Dihydropyridine sensitive Ca channels (L type)
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Fat - fertile - forty - female

14. what hormone is structurally similar to hCG?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
TSh (in testicular tumors can cause hyperthyroidism)
Skin flushing and warmth; prostaglandins; give with aspirin
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

15. What is cataplexy and When is it seen?
Valproate
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Normal; low

16. What are three symptoms in s.typhi?
Anti cholinergic effects of pupil dilation and lack of accomodation
Common peroneal; bony fractures and compression; sciatic
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Aromatase deficiency in child

17. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
T test; chi squared
Neisseria induced small cell vasculitis (including hands and soles)
Terminal bronchioles; small bronchi
Regular insulin (Not fast acting - regular better)

18. What is the immune deficinecy seen in ataxia telangactasia?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Ig A deficiency
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

19. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
Rabies encephalitis from cave bats; rabies killed vaccines
Because gamma chains replace beta chains and then gamma chain formation wanes
MAO inhibitors; wine and cheese
Lateral; RV; RA; LV

20. What does VIP do to gastric acid secretion?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
ANCA because of lack of Ig and C3 deposits on IF
Inhibits it
Chlorpheniramine and diphenhydramine

21. Where does complement bind on the Fc region of Ig chains?
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)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Retinitis; mononucleosis
Fibronectin - laminin - collagen

22. What is gardeners mydriasis? How is it treated?
Because of vasodiation to skeletal muscles
In the extracellular space
only up to bronchi
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

23. What pulmonary structural change can kartageners syndrome cause?
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)
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Bronchial dilation (bronchiectasis)

24. what happens to capacitance with age?
Measles and M3 AML`
Pain reliever - reduces pain by locking substance P in the PNS
Apocrine; eccrine
...

25. why are pregnant predisposed to cholelithiasis?
25; 25
Smoking
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
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

26. What can too much IgA in serum produces?
Excessive collagen formation during tissue repair in susceptible individuals
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
25; 25
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

27. Which nerve lies in close proximity to the inferior thyroid artery?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Recurrent larygneal
P53 mutation; DCC is also required for adenoma to carcinoma
FGF and VEGF

28. in essential fructosuria - what enzyme do patients use to metabolize fructose?
<1% - 55% - concentration dependent
RBC mass; epo levels (secondary has high)
Hexokinase
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

29. What is the most common neurologic complication of VZV reactivation?
Ig A deficiency
Regular insulin (Not fast acting - regular better)
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Localized dermatologic pain that persists for more than one month after zoster eruption

30. there are mucus secreting cells in the bronchioles...
Thymic tumor
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)
only up to bronchi
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

31. how much percent of sodium is excreted? urea? glucose?
<1% - 55% - concentration dependent
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Intussusception
Superior larygeal; cricothyroid; recurrent laryngeal

32. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Vagus nerve stimulation
Protamine sulfate
CGD; t cell dysfxn (diGeorge)

33. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Medial circumflex artery; avascular necrosis
HSV ( also in utero: chlymadia - neisseria - group B strep)
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

34. Where is aromatase used?
TSh (in testicular tumors can cause hyperthyroidism)
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
(urine PAH x urine flow rate)/plasma PAH
FGF and VEGF

35. in B12 deficiency - what levels in blood rise very quickly and then drop?
25; 25
In ER of bile canaliculi
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Reticulocytes

36. What is the mc location for avascular necrosis? What is it associated with?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
women
Purkinje system; AV node
Appetite suppressants

37. what murmur is enhanced by decreased blood flow to the heart?
Recurrent larygneal
Inactivates kallikrein which activates kininogen into bradykinin
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Syringomelia

38. What are the long term consequences of hydrocephalus?
IgE
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Barium enema

39. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Sydenham chorea
Gluteus maximus; difficulty getting up from seated position and climbing chair
Folic acid treatment!
RER; RER

40. What is used to prevent vertical transmission of HIV?
Pulmonic and systemic!
Paramyxo and influenza
Protamine sulfate
ZDV or AZT

41. What agonists reduce the gradient across the LV outflow tract?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Selective alpha 1 (increases SVR)
Lateral; RV; RA; LV

42. what would be a sign of absence of cardiogenic pulm edem?
ATP binding (resets the myosin head to contract again for next binding)
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Inhibits it
C3 decreased after 5-10 days; sulfonamides

43. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
Superior larygeal; cricothyroid; recurrent laryngeal
Hypothyroidism
No and yes
Downs; regurgitant AV valves - ASDs

44. the rate of blood flow of which two circulations must equal each other at all times?
Superior larygeal; cricothyroid; recurrent laryngeal
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Pulmonic and systemic!
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

45. What is epleronone?
P53 mutation; DCC is also required for adenoma to carcinoma
P450 mitochondrial monooxygenase
Another type of aldosterone antagonist (like spironolactone)
Varying; erythema nodosum is common

46. In What type of nephritis would you see high serum eos count?
Lateral; RV; RA; LV
Ether and other organic solvents
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Drug induced interstitial nephritis

47. h1 receptor anatagonists are not effective in treatment of asthma only for...
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)
chronic urticaria and allergic symptoms
Spongiosis
In the extracellular space for collagen cross linking; zinc

48. within the right atrium - What is the maximum pressure? left atrium?
Increase in permeability of two ions with equal and opposite equilibrium potentials
Valproate
SaO2 <92%
8; 12

49. What is the diagnosis in delayed puberty plus anosmia?
Joints d/t increased purine production and thus uric acid production
To pump calcium out in cardiac myocytes so that relaxation occurs
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Kallmans

50. at three years of age What are social - fine motor - gross motor and language developments?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Anti - apoptotic (prevents going into apoptosis)- 18; 14
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Excessive collagen formation during tissue repair in susceptible individuals