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 presentation of angioedema? Where is most commonly affected?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Sickle cell; G6PD

2. within the right atrium - What is the maximum pressure? left atrium?
8; 12
Vagus (auricular branch); vasovagal syncope!
P53 mutation; DCC is also required for adenoma to carcinoma
Phencyclidine (PCP)

3. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
No and yes
Lack of calcium to bind oxaloacetate; crohns prevents fat absorption from lack of bile reabsorption in the terminal illeum which leads to fats pulling calcium and lack of calcium reabsorption
Brief psychotic disorder; schizophreniform; schizophrenia

4. metabolism of 1 gram of protein produces How many calories? carb? fat?
4 - 4 - 9
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Right heart failure
Insulin like growth factor 1 (just another name)

5. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Susceptible; soluble (unable to be cultured in bile)
Prevent phagocytosis
Covalent (between two cysteines)- allows protein to withstand denaturation
To pump calcium out in cardiac myocytes so that relaxation occurs

6. Where is aromatase used?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
HSV and VZV
Become beta pleated and then form neurofibrillary tangle!
Gluteus maximus; difficulty getting up from seated position and climbing chair

7. what locations of UC increase the risk of Colon cancer?
Increases
Pan colitis and right sided colitis (more than left sided and proctitis)
Lack of calcium to bind oxaloacetate; crohns prevents fat absorption from lack of bile reabsorption in the terminal illeum which leads to fats pulling calcium and lack of calcium reabsorption
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

8. why are beta thal major patients asymptomatic at birth?
Little effect on cell and no change
Nonsense; mRNA processing
Because gamma chains replace beta chains and then gamma chain formation wanes
No (unlike adenomyosis); yes

9. in essential fructosuria - what enzyme do patients use to metabolize fructose?
11
Cluster
Hexokinase
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

10. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
Hyperkalemia; potassium sparing diuretics - potassium supplements
RER; copper
Normal; low
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

11. What type of disease has selective proteinuria? What is found in urine? What is not?
TSh (in testicular tumors can cause hyperthyroidism)
Bronchogenic carcinoma
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

12. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
No
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Appetite suppressants
In the extracellular space

13. 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)
Duration and extent of disease
Demargination of neutrophils from the vessel walls
Smoking

14. which viruses require a protease?
(urine PAH x urine flow rate)/plasma PAH
hyponatremia (aldosterone activation equilibrates body volume)
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
SS +rNA

15. What are the potassium sparing diuretics?
Aromatase deficiency in child
Amiloride - spironolactone - triamterene
Tissue redistribution (out of plasma) rather than metabolism
Vagus nerve stimulation

16. What does extended consumption of appetite suppressants lead to?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Pulmonary hypertension
Bronchial dilation (bronchiectasis)
Syringomelia

17. What does NF- KB do?
Brief psychotic disorder; schizophreniform; schizophrenia
Increases cytokine production
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

18. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Rabies encephalitis from cave bats; rabies killed vaccines
Initiation - pointing; pincer grasp; walking; mama/dada
Boiling - bleach - formalin - UV irradiation
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

19. What is used to treat heparin toxicity?
By vascular permeability and vasodilation
G to T in p53; HCC
Protamine sulfate
Minimal change disease

20. other than mycobacterim wha other bacteria is acid fast?
Adductor
Nocardia
Measure of depth invasion (vertical!)
25; 25

21. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
Syringomelia
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Coagulation factors are made in the liver
11 aa polypeptide; pain NT in CNS and PNS

22. why is glucagon used in beta blocker toxicitiy?
Atrial
Vagus nerve stimulation
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Anti cholinergic effects of pupil dilation and lack of accomodation

23. 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?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Extrinsic def; instrinsic def; platelet def
Common peroneal; bony fractures and compression; sciatic
Env genes (for getting into target cells)

24. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Minimal change disease
P53 mutation; DCC is also required for adenoma to carcinoma
Hypothyroidism

25. what nerve and artery course along the posterior aspect of the humerus?
Radial nerve and deep brachial artery
Minimal change disease
11 aa polypeptide; pain NT in CNS and PNS
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

26. What is the difference between paranoid personality disorder and delusional disorder?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Biphosphonate
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
In ER of bile canaliculi

27. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Varying; erythema nodosum is common
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Anti centromere; anti DNA topoisomerase

28. What are two common side effects of both acute and long acting nitrates? What causes them?
(urine PAH x urine flow rate)/plasma PAH
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Headaches and facial flushing; vasodilation in meninges and skin
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

29. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
Close but purkinje system to ensure contraction in a bottom up fashion
Hypothyroidism
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

30. What is the difference between additive and synergistic?
Coagulation factors are made in the liver
Phencyclidine (PCP)
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
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

31. Is there edema in primary Conns? secondary hyperaldosteronism? why?
By vascular permeability and vasodilation
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Initiation - pointing; pincer grasp; walking; mama/dada
25; 25

32. What can chronic vit A toxicity cause?
Ceftriaxone; azithromycin
DIC; TTP- HUS dont bleed that much
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
In the extracellular space for collagen cross linking; zinc

33. What does the tuberoinfundibular pathway connect? What is it responsible for?
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
hyponatremia (aldosterone activation equilibrates body volume)
Excessive collagen formation during tissue repair in susceptible individuals

34. What is diphenoxylate and What is it used for? what drug is it structurally similar to? What allows for potent anti diarrheal effect without signigicant opiate effects?
Not lined by epithelium
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Chorda tympani branch
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)

35. which RPGN is also called pauci immune GN? why?
Nocardia
ANCA because of lack of Ig and C3 deposits on IF
NF- KB; responsible for cytokine production
differentiate

36. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Covalent (between two cysteines)- allows protein to withstand denaturation
Syringomelia
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

37. What is the mainstay treatment for acute mania?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Ketone body production by preventing fatty acids into the mitochondria
The term used to describe decreased drug responsiveness with repeated administration
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

38. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Covalent (between two cysteines)- allows protein to withstand denaturation
Echinococcus granulosus; anaphylaxis
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)

39. Which nerve lies in close proximity to the inferior thyroid artery?
Recurrent larygneal
Hypo or hyper pigmentations; after tanning
IgE
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

40. What is the mc location of brain germinomas?What are the classic symptoms?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
MAO inhibitors; wine and cheese
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Anterior circumflex (and axillary nerve)

41. how can HAV be inactivated?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Adductor
Hypothyroidism
Boiling - bleach - formalin - UV irradiation

42. How do you calculate atributable risk percent?
Both sides
OCPs - multiparity - breast feeding
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
RR-1/RR

43. What are three symptoms in s.typhi?
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Inhibits it
Sydenham chorea

44. What can too much IgA in serum produces?
Enterococci (e. faecalis)- found on genitalia area
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Pain reliever - reduces pain by locking substance P in the PNS
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

45. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
CMV - HSV 1 - Candida
Inactivates kallikrein which activates kininogen into bradykinin
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

46. how does noise induced hearing loss occur?
Highly negative resting potential
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Trauma to stereociliated hair cells of the organ of corti

47. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
<1% - 55% - concentration dependent
200-500

48. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
RBC mass; epo levels (secondary has high)
Right heart failure
Highly negative resting potential
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

49. What is damaged in early syringomelia? later?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Increase; decreased
Demargination of neutrophils from the vessel walls
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

50. why does variocele occur more in left side?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Large stroke volumes with ventricular contraction; aortic regurg
SaO2 <92%
Appetite suppressants