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. metabolism of 1 gram of protein produces How many calories? carb? fat?
T test; chi squared
Elevated GGT and macrocytosis
4 - 4 - 9
Vascular endothelium; protease

2. What causes release of myosin head from the actin filament?
ATP binding (resets the myosin head to contract again for next binding)
Ketone body production by preventing fatty acids into the mitochondria
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
In the extracellular space for collagen cross linking; zinc

3. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Brief psychotic disorder; schizophreniform; schizophrenia
Biphosphonate
Close but purkinje system to ensure contraction in a bottom up fashion

4. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Minimal change disease
Varying; erythema nodosum is common
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac

5. 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?
Superior larygeal; cricothyroid; recurrent laryngeal
In the extracellular space
Protamine sulfate
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

6. which opponens muscle does ulnar innervate?
Adductor
HSV and VZV
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Elevated GGT and macrocytosis

7. What does the severity of leprosy depend on?
Strength of cell mediated immune response
Prevents hepatic VLDL production
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Dihydropyridine sensitive Ca channels (L type)

8. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
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)
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
Increase in permeability of two ions with equal and opposite equilibrium potentials

9. What effects does cortisol have on catecholamines?
Inhaled animal dander allergens
Aromatase deficiency in child
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Permissive - sensitizes vasoconstrictive response from catecholamines - doesnt actually act on them but increases transcription of some genes that creates permissive effect (not additive or synergistic becuase cortisol alone doesnt have any effect on

10. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
CGD; t cell dysfxn (diGeorge)
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Lateral; RV; RA; LV
Right before diastole (filling begins)

11. What is cataplexy and When is it seen?
Squatting - sitting - lying supine - passive leg raising
Terminal bronchioles; small bronchi
Anti cholinergic effects of pupil dilation and lack of accomodation
Sudden loss of muscle tone without loss of consciousness; narcolepsy

12. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
No (unlike adenomyosis); yes
HSV ( also in utero: chlymadia - neisseria - group B strep)
Echinococcus granulosus; anaphylaxis

13. What actions increase venous return?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Serum FFA and serum triglyceride levels
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Squatting - sitting - lying supine - passive leg raising

14. which two virus families have hemagluttinin on their surface?
To pump calcium out in cardiac myocytes so that relaxation occurs
Paramyxo and influenza
Downs; regurgitant AV valves - ASDs
transcription activation/suppression

15. in essential fructosuria - what enzyme do patients use to metabolize fructose?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Hexokinase
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

16. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Because gamma chains replace beta chains and then gamma chain formation wanes
ANCA because of lack of Ig and C3 deposits on IF
Vascular endothelium; protease

17. which type of glands produce an initially odorless secretion but can become malodorous secondary to bacterial decompisition on the skin surface? which glands are present throughout the skin except on lips and glans penis?
Purkinje system; AV node
Apocrine; eccrine
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Brief psychotic disorder; schizophreniform; schizophrenia

18. why should you not use ACE inhibitors with someone who had hereditary angioedema?
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
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Joints d/t increased purine production and thus uric acid production
Initiation - pointing; pincer grasp; walking; mama/dada

19. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
Nonsense; mRNA processing
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Bile soluble which means they are bile sensitive
Radial nerve damage

20. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
Chlorpheniramine and diphenhydramine
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

21. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
<1% - 55% - concentration dependent
Neisseria induced small cell vasculitis (including hands and soles)
Well trained athletes and children
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

22. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
25; 25
Brief psychotic disorder; schizophreniform; schizophrenia

23. Would alpha 1 agonists cause flushing? muscarinic antagonist?
No; yes
No; MRI
chronic urticaria and allergic symptoms
Think Hb deformation diseases

24. How can renal blood flow be calculated from RPF?
ST become atrophic and hyalinized (temp induced damage) and depressed sperm count becuase of that; hormonal function not impaired (test and LH levels normal) because Leydig cells not as temp sensitive so secondary sexual characteristics and sexual pe
RBF= PAH clearance/(1- hematocrit)
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Turners`

25. What does nitroprusside do to afterload? preload?
only up to bronchi
facultative intracellular
Decreases both
manifestations - congenital (stretching of periventricular pyrimadal fibers)

26. What are pancreatic pseudocysts called pseudo rather than true cysts?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
MAC complex (C5b - C9 complement deficiency)
Not lined by epithelium
G to T in p53; HCC

27. What is the best indicator for the severity of mitral stenosis?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Hyperkalemia; potassium sparing diuretics - potassium supplements
The time interval between S2 and OS- the shorter the interval - the more intense
Varying; erythema nodosum is common

28. What is the mcc of extrinsic allergic asthma?
Inhaled animal dander allergens
Inhibits it
Increase lymphatic drainage!
SaO2 <92%

29. what enzyme converts procarcinogens into carcinogens?
Phencyclidine (PCP)
P450 mitochondrial monooxygenase
Brief psychotic disorder; schizophreniform; schizophrenia
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

30. What can cause virilization of a mother during pregnancy?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Adductor
Aromatase deficiency in child
SaO2 <92%

31. what hormone is structurally similar to hCG?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Syringomelia
TSh (in testicular tumors can cause hyperthyroidism)
liver specific

32. a patient fearing all white coats is a phenomenon of what?
TCAs and prazosin
Classical conditioning
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Phencyclidine (PCP)

33. other than parvo B19 - what else is associated with red cell aplasia?
Vagus nerve stimulation
No
Gluteus medius and minimus; positive trendelenberg
Thymic tumor

34. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Radial nerve and deep brachial artery
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
RER; copper

35. What is mcc of death pre hospital phase of MI? in hospital phase?
V fib; v. failure
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
T test; chi squared
SVC and IVC; right below the aortic knob

36. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
ANCA because of lack of Ig and C3 deposits on IF
No; MRI
Sarcoid

37. do patients with cor pulmonale have increased or decreased levels of aldosterone?
Because of the low output from heart failure - they will have increased aldosterone levels
hyponatremia (aldosterone activation equilibrates body volume)
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

38. carnitine deficiency impairs production of What and how?
Vancomycin; histamine mediated
TCAs and prazosin
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Ketone body production by preventing fatty acids into the mitochondria

39. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
HSV and VZV
Localized dermatologic pain that persists for more than one month after zoster eruption
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
MAO inhibitors; wine and cheese

40. What does prolonged PT indicated? aPTT? bleeding time?
Ether and other organic solvents
Increase by 50% in urine osmolality
Extrinsic def; instrinsic def; platelet def
Primary

41. What is tachyphylaxis?
Pulmonic and systemic!
Pulmonary hypertension
The term used to describe decreased drug responsiveness with repeated administration
Selective alpha 1 (increases SVR)

42. What is capacitance inversely proportional to?
Decreases both
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Elastance
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

43. 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?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Medullary

44. What causes wrist drop?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Radial nerve damage
Another type of aldosterone antagonist (like spironolactone)
Tibial

45. what hernia has a similar mechanism to hydrocele?
Well
Vagus (auricular branch); vasovagal syncope!
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Sydenham chorea

46. What is the fibrinogen level in patient with TTP- HUS? DIC?
As a CO2 carrier with the carboxylase enzyme
Rabies encephalitis from cave bats; rabies killed vaccines
Normal; low
Become beta pleated and then form neurofibrillary tangle!

47. other than proteinuria - What can cause foamy froathy urine?
Increase; decreased
Bile salt accumulation in urine
Well trained athletes and children
Integration of viral DNA into genome of host hepatocytes

48. after a thrombus extraction - what serum enzyme shoots up and why?
Serum creatine kinase; reperfusion injury causes necrosis
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Regular insulin (Not fast acting - regular better)
T test; chi squared

49. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
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
In ER of bile canaliculi
Downs; regurgitant AV valves - ASDs
Headaches and facial flushing; vasodilation in meninges and skin

50. Where is the base of the heart? apex?
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
INTRApartum Abs (ampicillin/penicillin)
Closer to head; closer to diaphragm
Measure of depth invasion (vertical!)