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 are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
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)
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
Biphosphonate

2. What does TGF beta do? What produces it?
Spongiosis
Turbulence
Hereditary angioedema; ACE inhibitors
Fibrosis; macrophages

3. non ceruloplasmin deposition - ceruloplasmin is...
differentiate
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Demargination of neutrophils from the vessel walls
low in serum

4. prostaglandin synthesis keeps...
Amiloride - spironolactone - triamterene
PDA open
Intussusception
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)

5. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Hyperkalemia; potassium sparing diuretics - potassium supplements
Medial circumflex artery; avascular necrosis
Drink plenty of fluids

6. what organ would an activating mutation in PRPP synthetase effect?
Joints d/t increased purine production and thus uric acid production
Circular - outside nucleus; transport proteins - rRNA - tRNA
Protamine sulfate
Recurrent larygneal

7. What are the three causes of acute MI in context of normal coronary arteries ?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Fibrosis; macrophages

8. What does prolonged PT indicated? aPTT? bleeding time?
25; 25
Extrinsic def; instrinsic def; platelet def
Because of the low output from heart failure - they will have increased aldosterone levels
Vascular endothelium; protease

9. What are some of the permissive effects of cortisol?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
AV node slowest - to allow time for diastole
Pain reliever - reduces pain by locking substance P in the PNS
Secretin stimulates the exocrine pancrease; S enteroendocrine cells in duodenal mucosa in response to acid secrete secretin (HCL is most potent stimulus for secretin release)

10. what nerve and artery course along the posterior aspect of the humerus?
Anti cholinergic effects of pupil dilation and lack of accomodation
No; MRI
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Radial nerve and deep brachial artery

11. What does hypocapnia cause in teh brain? What is hypocapnia?
By vascular permeability and vasodilation
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Anterior circumflex (and axillary nerve)
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

12. what locations of UC increase the risk of Colon cancer?
Pan colitis and right sided colitis (more than left sided and proctitis)
TSh (in testicular tumors can cause hyperthyroidism)
Another type of aldosterone antagonist (like spironolactone)
Inhaled animal dander allergens

13. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Large stroke volumes with ventricular contraction; aortic regurg
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

14. how can HAV be inactivated?
PDA open
Boiling - bleach - formalin - UV irradiation
Standing suddenly from supine position; valsalva maneuver
Measles and M3 AML`

15. sporadic colon cancer tend to arise From what type of polyps?
In ER of bile canaliculi
Single adenomatous ones
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
Spongiosis

16. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
When it invades the bm; carcinoma in situ
Vancomycin
Radial nerve and deep brachial artery

17. who bleed more DIC or TTP- HUS patients?
Pulmonary hypertension
DIC; TTP- HUS dont bleed that much
T test; chi squared
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

18. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
T test; chi squared
Sydenham chorea
Medial circumflex artery; avascular necrosis

19. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
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
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Mean greater than median greater than mode
Increase by 50% in urine osmolality

20. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Common peroneal; bony fractures and compression; sciatic
Syringomelia
25; 25

21. What actions increase venous return?
No (unlike adenomyosis); yes
Nonsense; mRNA processing
An invagination of portion of intestine into the lumen of the adjacent intestinal segment; can lead to impaired venous return from the invaginated segment of the bowel which can cause ischemia and subsequent necrosis
Squatting - sitting - lying supine - passive leg raising

22. h1 receptor anatagonists are not effective in treatment of asthma only for...
chronic urticaria and allergic symptoms
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
ZDV or AZT

23. What does glycosylase do to DNA? endonuclease? lyase? What does the order here of enzymes represent? what other enzymes are needed?

24. What is the precursor protein to beta amyloid and On what chromosome is it found?
Nonsense; mRNA processing
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
APP on chrom 21 (this is why downs more susceptible)
To pump calcium out in cardiac myocytes so that relaxation occurs

25. what induces bronchial squamous metaplasia?
Smoking
Become beta pleated and then form neurofibrillary tangle!
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Sickle cell; G6PD

26. What are the lab findings in poststreptococcal GN?
INTRApartum Abs (ampicillin/penicillin)
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Hypothyroidism
T test; chi squared

27. 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?
Lateral; RV; RA; LV
TSh (in testicular tumors can cause hyperthyroidism)
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
SVT; increases vagal tone; rectus abdominis

28. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
Ether and other organic solvents
Bile soluble which means they are bile sensitive
RR-1/RR
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

29. What does VIP do to gastric acid secretion?
The time interval between S2 and OS- the shorter the interval - the more intense
Anti centromere; anti DNA topoisomerase
Inhibits it
...

30. How do bradykinin - C3a and C5a cause edema?
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
By vascular permeability and vasodilation
...
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

31. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
DIC; TTP- HUS dont bleed that much
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
In the extracellular space for collagen cross linking; zinc
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

32. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
Secretin stimulates the exocrine pancrease; S enteroendocrine cells in duodenal mucosa in response to acid secrete secretin (HCL is most potent stimulus for secretin release)
To pump calcium out in cardiac myocytes so that relaxation occurs
Apocrine; eccrine
Standing suddenly from supine position; valsalva maneuver

33. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
II; I (I more abundant)
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Raphe
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

34. erythema nodosum - elevated ACE - scattered granulomas - arthralgias - hilar lymphadenoapthy are indicative of what?
IgE
glycerol kinase
Sarcoid
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

35. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
women
Common peroneal; bony fractures and compression; sciatic
Hereditary angioedema; ACE inhibitors
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

36. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Susceptible; soluble (unable to be cultured in bile)
Right heart failure
Enterococci (e. faecalis)- found on genitalia area
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

37. How do you explain the selective proteinuria of loss to albumin only in MCD?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Increases
Prostate tumor and increased osteoclast activity
Vancomycin

38. which RPGN is also called pauci immune GN? why?
Paramyxo and influenza
8 (myc protein) with 2 - 14 - 22 (iG chains)
ANCA because of lack of Ig and C3 deposits on IF
Large stroke volumes with ventricular contraction; aortic regurg

39. what has the greatest effect on prognosis when treating c. diptheriae?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Integration of viral DNA into genome of host hepatocytes
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

40. what protein is increased in Crohns disease? What does it do?
No and yes
NF- KB; responsible for cytokine production
Increased reticulocytes
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

41. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
Ether and other organic solvents
ATP binding (resets the myosin head to contract again for next binding)
CGD; t cell dysfxn (diGeorge)
Terminal bronchioles; small bronchi

42. What are the two growth factors associated with angiogenesis?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Selective alpha 1 (increases SVR)
FGF and VEGF
Strength of cell mediated immune response

43. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
Vancomycin
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
gram positive organisms
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

44. 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?
PDA open
Syringomelia
Common peroneal; bony fractures and compression; sciatic
In ER of bile canaliculi

45. What is cataplexy and When is it seen?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
low in serum
11

46. other than increasing HDL levels - what else does niacin do?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Prevents hepatic VLDL production
Circular - outside nucleus; transport proteins - rRNA - tRNA
Radial nerve damage

47. What effects does cortisol have on catecholamines?
Protamine sulfate
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
Adductor
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

48. why is crohns disease associated with oxaloacetate kidney stones?
Biphosphonate
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
No (unlike adenomyosis); yes
Echinococcus granulosus; anaphylaxis

49. how much percent of sodium is excreted? urea? glucose?
Increase by 50% in urine osmolality
Strength of cell mediated immune response
<1% - 55% - concentration dependent
Appetite suppressants

50. what murmur is enhanced by decreased blood flow to the heart?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Trochlear nerve (IV); abducens nerve (VI)
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)