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. within the right atrium - What is the maximum pressure? left atrium?
Barium enema
8; 12
Pan colitis and right sided colitis (more than left sided and proctitis)
Boiling - bleach - formalin - UV irradiation

2. What are the three predominant symptoms of VHL? What is its mode of inheritance?
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)
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

3. What is Bortezomib and What is it used for?
Purkinje system; AV node
Proteasome inhibitor; treatment for MM and waldenstroms
Barium enema
Lateral; RV; RA; LV

4. SIADH patients have normal blood volume but...
Sydenham chorea
8 (myc protein) with 2 - 14 - 22 (iG chains)
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
hyponatremia (aldosterone activation equilibrates body volume)

5. PDAs are often asymptomatic. How do you treat?
Squatting - sitting - lying supine - passive leg raising
Think Hb deformation diseases
4 - 4 - 9
indomethacin

6. Acyl coA synthetase is not...
Acute gastric mucosal defects (superficial or full thickness)
Reticulocytes
Measure of depth invasion (vertical!)
liver specific

7. What can chronic vit A toxicity cause?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
DIC; TTP- HUS dont bleed that much
Acute interstitial nephritis
Ceftriaxone; azithromycin

8. which opponens muscle does ulnar innervate?
Extrinsic def; instrinsic def; platelet def
G to T in p53; HCC
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Adductor

9. What is the difference between additive and synergistic?
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)
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
Atrial
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

10. What is damaged in early syringomelia? later?
Pulmonary hypertension
Bronchogenic carcinoma
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

11. which antiarrythmic is associated with blue gray discoloration ?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
indomethacin
Amiadarone
Selective alpha 1 (increases SVR)

12. name three pathological states that present with large tongues.
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Congenital hypothyroidism - downs - amyloidosis - acromegaly
SaO2 <92%
Biphosphonate

13. What are pancreatic pseudocysts called pseudo rather than true cysts?
Bronchogenic carcinoma
TCAs and prazosin
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Not lined by epithelium

14. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
ZDV or AZT
E. coli
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
No and yes

15. What is the preferred treatment for DKA?
Regular insulin (Not fast acting - regular better)
Bronchogenic carcinoma
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

16. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Anti cholinergic effects of pupil dilation and lack of accomodation
11 aa polypeptide; pain NT in CNS and PNS
Hereditary angioedema; ACE inhibitors
Amiloride - spironolactone - triamterene

17. What are fenfluramine - phentermine?
Mean greater than median greater than mode
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Appetite suppressants
Dihydropyridine sensitive Ca channels (L type)

18. When is an S4 sound normal?
Initiation - pointing; pincer grasp; walking; mama/dada
Well trained athletes and children
Hypothyroidism
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

19. What translocations can cause c - myc overexpression?
GI malignancies and Insulin resistance (acromegal for ex)
Integration of viral DNA into genome of host hepatocytes
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
8 (myc protein) with 2 - 14 - 22 (iG chains)

20. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
CGD; t cell dysfxn (diGeorge)
Drink plenty of fluids
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Chrom 8

21. are there signs of inflammation in avascular necrosis? then How do you diagnose?
Valproate
Serum FFA and serum triglyceride levels
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
No; MRI

22. What is the mutation type in thalassemias? what process is defective because of this?
Nonsense; mRNA processing
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
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
8; 12

23. What can cause virilization of a mother during pregnancy?
Aromatase deficiency in child
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

24. which headaches are seen mostly in men - are severe - unilateral - periorbital - episodic (around same time every day) - temporal pain - with lacrimation - nasal congestion and ptosis?
Trochlear nerve (IV); abducens nerve (VI)
Serum FFA and serum triglyceride levels
Cluster
Duration and extent of disease

25. What is diagnostic (and possible therapeutic for intussusception)?
No (unlike adenomyosis); yes
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Barium enema

26. 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?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Vagus (auricular branch); vasovagal syncope!
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

27. What is best to prevent GBS infection in a baby?
INTRApartum Abs (ampicillin/penicillin)
MAO inhibitors; wine and cheese
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Minimal change disease

28. why does neutrophila occur with corticosteroids?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Increased reticulocytes
Because of vasodiation to skeletal muscles
Demargination of neutrophils from the vessel walls

29. What is a primary HSV 1 infection like?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
No (unlike adenomyosis); yes
Susceptible; soluble (unable to be cultured in bile)
200-500

30. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
P450 mitochondrial monooxygenase
Superior larygeal; cricothyroid; recurrent laryngeal
Brief psychotic disorder; schizophreniform; schizophrenia
Injury to common peroneal nerve (d/t trauma or sustained pressure to neck of fibula) causing pain and numbness on dorsum of foot and inability to dorsiflex

31. what immune deficiency causes recurrent neisseria infections?
Protamine sulfate
Cluster
MAC complex (C5b - C9 complement deficiency)
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

32. ___________ is liver specific
glycerol kinase
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Southern - western
Neisseria induced small cell vasculitis (including hands and soles)

33. What is the mcc of extrinsic allergic asthma?
Hypertension - edema - and proteinuria
Inhaled animal dander allergens
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Sydenham chorea

34. metabolism of 1 gram of protein produces How many calories? carb? fat?
Common peroneal; bony fractures and compression; sciatic
4 - 4 - 9
TCAs and prazosin
Downs; regurgitant AV valves - ASDs

35. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
chronic urticaria and allergic symptoms
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

36. how does neisseria cause a petechial rash?
Well trained athletes and children
Underestimation of gestational age
Neisseria induced small cell vasculitis (including hands and soles)
Vagus nerve stimulation

37. What is the mcc of elevated AFP leves in pregnancy>
G to T in p53; HCC
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Underestimation of gestational age
Amiloride - spironolactone - triamterene

38. What are the three causes of acute MI in context of normal coronary arteries ?
Apocrine; eccrine
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

39. which trisomy is associated with endocardial cushion defects? What does thsi mean>
SSRI; erectile dysfunction
46 - 4N; 23 2N
Skin flushing and warmth; prostaglandins; give with aspirin
Downs; regurgitant AV valves - ASDs

40. what diseases can vit A be used to treat?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Pulmonic and systemic!
Measles and M3 AML`
Common peroneal; bony fractures and compression; sciatic

41. what drug is useful for secretory diarrhea?
Varying; erythema nodosum is common
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Hypertension - edema - and proteinuria
Octreotide

42. What type of mutation does aflatoxin cause? what cancer does this increase for?
G to T in p53; HCC
Lateral; RV; RA; LV
Strength of cell mediated immune response
25; 25

43. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Recurrent larygneal

44. what defines hypoxemia?
Chlorpheniramine and diphenhydramine
TCAs and prazosin
Syringomelia
SaO2 <92%

45. What is gardeners mydriasis? How is it treated?
Paramyxo and influenza
No (unlike adenomyosis); yes
Prepatellar
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

46. what commonly happens in GI in response to acute physiologic stress?
Ceftriaxone; azithromycin
Acute gastric mucosal defects (superficial or full thickness)
Cluster
SS +rNA

47. after a thrombus extraction - what serum enzyme shoots up and why?
Leukotriene precursor and does neutrophil chemotaxis
Prevent phagocytosis
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Serum creatine kinase; reperfusion injury causes necrosis

48. 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
The term used to describe decreased drug responsiveness with repeated administration
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
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)

49. at three years of age What are social - fine motor - gross motor and language developments?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Tissue redistribution (out of plasma) rather than metabolism
Fat - fertile - forty - female

50. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
Prevents hepatic VLDL production
Prepatellar
Ketone body production by preventing fatty acids into the mitochondria
E. coli; staphylococcus saprophyticus