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. How can renal blood flow be calculated from RPF?
Right heart failure
Mean greater than median greater than mode
glycerol kinase
RBF= PAH clearance/(1- hematocrit)

2. what commonly happens in GI in response to acute physiologic stress?
Large stroke volumes with ventricular contraction; aortic regurg
Acute gastric mucosal defects (superficial or full thickness)
Proteasome inhibitor; treatment for MM and waldenstroms
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

3. What does sustained hand grip do to the C/V system?
Gluteus medius and minimus; positive trendelenberg
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

4. What is the cause of fixed splitting of S2? why?
IgE
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Trochlear nerve (IV); abducens nerve (VI)

5. What type of vision is myopia? In What type of patients does it improve?
Because ACE blocks breakdown of bradykinin and hereditary angioedema patients have high levels of bradykinin; high levels of bradykinin - C3a - and C5a mediate edema by increasing vascular permeability and vasodilation
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
In the extracellular space
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

6. What type of calcium channels dictate the plateau in cardiac myocyte?
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
Dihydropyridine sensitive Ca channels (L type)
Decreases both
Fibronectin - laminin - collagen

7. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Right before diastole (filling begins)
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Localized dermatologic pain that persists for more than one month after zoster eruption

8. What is acanthosis nigricans associated with?
only up to bronchi
Turners`
GI malignancies and Insulin resistance (acromegal for ex)
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

9. In What type of nephritis would you see high serum eos count?
Bile salt accumulation in urine
Drug induced interstitial nephritis
RR-1/RR
Paramyxo and influenza

10. What is contraindicated in toxic mega colon?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Chlorpheniramine and diphenhydramine
Primary
transcription activation/suppression

11. What is the most important prognostic indicator in patients with malignant melanoma?
Increase; decreased
Spongiosis
46 - 4N; 23 2N
Measure of depth invasion (vertical!)

12. how can HAV be inactivated?
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
Integration of viral DNA into genome of host hepatocytes
RBF= PAH clearance/(1- hematocrit)
Boiling - bleach - formalin - UV irradiation

13. What does 'oxygen' content in blood refer to?
Mean greater than median greater than mode
hyponatremia (aldosterone activation equilibrates body volume)
Dissolved in plasma and attached to Hgb
Bile salt accumulation in urine

14. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Retinitis; mononucleosis
Relfex tachycardia; giving beta blockers
transcription activation/suppression

15. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
The time interval between S2 and OS- the shorter the interval - the more intense
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Hereditary angioedema; ACE inhibitors

16. how much percent of sodium is excreted? urea? glucose?
E. coli; staphylococcus saprophyticus
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
<1% - 55% - concentration dependent
No (unlike adenomyosis); yes

17. What are the two growth factors associated with angiogenesis?
ZDV or AZT
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
FGF and VEGF
Decreases both

18. What does the severity of leprosy depend on?
11 aa polypeptide; pain NT in CNS and PNS
Strength of cell mediated immune response
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

19. other than mycobacterim wha other bacteria is acid fast?
S3 gallop; S2 to opening snap interval
Nocardia
Acute interstitial nephritis
Appetite suppressants

20. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
women
HSV ( also in utero: chlymadia - neisseria - group B strep)
Single adenomatous ones
Vascular endothelium; protease

21. what murmur is enhanced by decreased blood flow to the heart?
Pan colitis and right sided colitis (more than left sided and proctitis)
Kallmans
Underestimation of gestational age
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

22. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
Barium enema
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)
P53 mutation; AD
Ether and other organic solvents

23. after a thrombus extraction - what serum enzyme shoots up and why?
Another type of aldosterone antagonist (like spironolactone)
No; yes
RR-1/RR
Serum creatine kinase; reperfusion injury causes necrosis

24. What is a keloid?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Elevated GGT and macrocytosis
Excessive collagen formation during tissue repair in susceptible individuals
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

25. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
Boiling - bleach - formalin - UV irradiation
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
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

26. at four years of age - What are the social - fine motor - gross motor - and language developments?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
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)
By vascular permeability and vasodilation
Fibrosis; macrophages

27. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
RER; copper
25; 25
Serum FFA and serum triglyceride levels
P53 mutation; DCC is also required for adenoma to carcinoma

28. What is achalasia and how would this correlate on the esophageal mannometry?
No (unlike adenomyosis); yes
NF- KB; responsible for cytokine production
Prostate tumor and increased osteoclast activity
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

29. in essential fructosuria - what enzyme do patients use to metabolize fructose?
On cardiac tissue and renal juxtaglomerular cells
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Standing suddenly from supine position; valsalva maneuver
Hexokinase

30. What is a clara cell?
SaO2 <92%
G to T in p53; HCC
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Raphe

31. What are the two coagulase negative staphylococci? How do you distinguish them?
In the extracellular space
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
CMV - HSV 1 - Candida
S. saprophyticus - and s. epidermidis; novobiocin

32. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Anti cholinergic effects of pupil dilation and lack of accomodation
Gluteus maximus; difficulty getting up from seated position and climbing chair
Become beta pleated and then form neurofibrillary tangle!
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences

33. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
Tissue redistribution (out of plasma) rather than metabolism
No; yes
LT (LTD4 - E4 - C4) - and Ach
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

34. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
Dihydropyridine sensitive Ca channels (L type)
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
RBC mass; epo levels (secondary has high)
MAC complex (C5b - C9 complement deficiency)

35. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Vagus (auricular branch); vasovagal syncope!
Anti - apoptotic (prevents going into apoptosis)- 18; 14
SSRI; erectile dysfunction
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

36. what chromosome is c - myc found on?
Well trained athletes and children
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)
Chrom 8

37. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
Brief psychotic disorder; schizophreniform; schizophrenia
HSV and VZV
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Transported to liver - glycerol kinase converts it to glycerol 3 phosphate Which is then converted to DHAP which can either join glycolysis for ATP or be used to make glucose

38. which antiarrythmic is associated with blue gray discoloration ?
Bile salt accumulation in urine
Amiadarone
liver specific
Prostate tumor and increased osteoclast activity

39. What is used to treat heparin toxicity?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Protamine sulfate
Octreotide
Faulty positioning of the genital tubercle

40. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Reiter syndrome; B27
Downs; regurgitant AV valves - ASDs
Strength of cell mediated immune response
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

41. what protein is increased in Crohns disease? What does it do?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Mean greater than median greater than mode
P53 mutation; AD
NF- KB; responsible for cytokine production

42. What is medullary sponge kidney disease and how does it present? What does it lead to?
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)
Insulin like growth factor 1 (just another name)
Fat - fertile - forty - female
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

43. Which nerve lies in close proximity to the inferior thyroid artery?
Recurrent larygneal
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
In the extracellular space
G to T in p53; HCC

44. What is capacitance inversely proportional to?
Elastance
By vascular permeability and vasodilation
Measure of depth invasion (vertical!)
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

45. What is the mcc of extrinsic allergic asthma?
Decreases both
Classical conditioning
Inhaled animal dander allergens
By vascular permeability and vasodilation

46. 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?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Superior larygeal; cricothyroid; recurrent laryngeal
Because of vasodiation to skeletal muscles
Prepatellar

47. What are the three dopaminergic systems and What are they responsible for? disease?
Little effect on cell and no change
Think Hb deformation diseases
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
E6 and E7 of HPV knock off p53 and Rb suppressor genes

48. what locations of UC increase the risk of Colon cancer?
Pan colitis and right sided colitis (more than left sided and proctitis)
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
differentiate
Turbulence

49. What three factors effect total oxygen content of blood?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Because ACE blocks breakdown of bradykinin and hereditary angioedema patients have high levels of bradykinin; high levels of bradykinin - C3a - and C5a mediate edema by increasing vascular permeability and vasodilation
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

50. Is there edema in primary Conns? secondary hyperaldosteronism? why?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Superior larygeal; cricothyroid; recurrent laryngeal
No and yes