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Test your basic knowledge |
USMLE Prep 2
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Subjects
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health-sciences
,
usmle
Instructions:
Answer 50 questions in 15 minutes.
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study here
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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. Which nerve lies in close proximity to the inferior thyroid artery?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Recurrent larygneal
No; MRI
E. coli; staphylococcus saprophyticus
2. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Vagus (auricular branch); vasovagal syncope!
Chorda tympani branch
Strength of cell mediated immune response
<1% - 55% - concentration dependent
3. What is the mc location of brain germinomas?What are the classic symptoms?
Env genes (for getting into target cells)
Covalent (between two cysteines)- allows protein to withstand denaturation
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Inactivates kallikrein which activates kininogen into bradykinin
4. what murmur is enhanced by decreased blood flow to the heart?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Increased reticulocytes
Myasthenia gravis
Syringomelia
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?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Superior larygeal; cricothyroid; recurrent laryngeal
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Bile soluble which means they are bile sensitive
6. What is the cause of fixed splitting of S2? why?
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
OCPs - multiparity - breast feeding
Anterior nares
7. what chromosome is c - myc found on?
Chrom 8
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
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Close but purkinje system to ensure contraction in a bottom up fashion
8. What is achalasia and how would this correlate on the esophageal mannometry?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
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
Phencyclidine (PCP)
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
9. Where is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
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
P53 mutation; DCC is also required for adenoma to carcinoma
II; I (I more abundant)
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
10. Would alpha 1 agonists cause flushing? muscarinic antagonist?
Extrinsic def; instrinsic def; platelet def
No; yes
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Mean greater than median greater than mode
11. which cells produce surfactant? which ones mediate gas exchange?
II; I (I more abundant)
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
No; MRI
Think Hb deformation diseases
12. What translocations can cause c - myc overexpression?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
8 (myc protein) with 2 - 14 - 22 (iG chains)
Prevents hepatic VLDL production
Coagulation factors are made in the liver
13. What are examples of action that decrease venous return to the heart?
Turners`
Standing suddenly from supine position; valsalva maneuver
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Well trained athletes and children
14. What is hypospadias caused by?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Initiation - pointing; pincer grasp; walking; mama/dada
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Abnormal closing of the urethral folds
15. What is contraindicated in toxic mega colon?
Increase by 50% in urine osmolality
Demargination of neutrophils from the vessel walls
Fat - fertile - forty - female
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
16. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Atrial
SVC and IVC; right below the aortic knob
Downs; regurgitant AV valves - ASDs
17. What does TGF beta do? What produces it?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Fibrosis; macrophages
Elastance
Anti cholinergic effects of pupil dilation and lack of accomodation
18. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
Increase lymphatic drainage!
Brief psychotic disorder; schizophreniform; schizophrenia
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
19. carnitine deficiency impairs production of What and how?
Ketone body production by preventing fatty acids into the mitochondria
Not lined by epithelium
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
C3 decreased after 5-10 days; sulfonamides
20. what happens with LDL receptor density in statin therapy?
Increases
RR-1/RR
Hypo or hyper pigmentations; after tanning
Inhaled animal dander allergens
21. biotin is used By what in tissues responsible for gluconeogenesis
As a CO2 carrier with the carboxylase enzyme
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Nonsense; mRNA processing
Headaches and facial flushing; vasodilation in meninges and skin
22. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
No (unlike adenomyosis); yes
Become beta pleated and then form neurofibrillary tangle!
Common peroneal; bony fractures and compression; sciatic
23. hypertonicity and hyperreflexity are ________________ of hydrocephalus
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Vascular endothelium; protease
Chrom 8
manifestations - congenital (stretching of periventricular pyrimadal fibers)
24. which two drug types can cause orthostatic hypotension (think depression and BPH)?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
TCAs and prazosin
In the extracellular space
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
25. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Pulmonary hypertension
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Sarcoid
Increased reticulocytes
26. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
Increases cytokine production
By vascular permeability and vasodilation
Radial nerve and deep brachial artery
women
27. which two virus families have hemagluttinin on their surface?
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)
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Paramyxo and influenza
28. 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
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
IgE
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
29. in the LV and aorta - What are the pressures?
Echinococcus granulosus; anaphylaxis
Syncope - angina - dyspnea (SAD)
Normally close to systolic
Tissue redistribution (out of plasma) rather than metabolism
30. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Gluteus maximus; difficulty getting up from seated position and climbing chair
frameshift mutations (missense is substitution)
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
S3 gallop; S2 to opening snap interval
31. which RPGN is also called pauci immune GN? why?
Standing suddenly from supine position; valsalva maneuver
ANCA because of lack of Ig and C3 deposits on IF
Inhaled animal dander allergens
No; MRI
32. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
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
Integration of viral DNA into genome of host hepatocytes
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
33. where are the two classical places that the ulnar nerve can be injured?
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34. What actions increase venous return?
Fibrosis; macrophages
Squatting - sitting - lying supine - passive leg raising
No
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
35. what makes bruits?
SSRI; erectile dysfunction
Demargination of neutrophils from the vessel walls
Turbulence
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
36. other than in pyelonephritis - where else are WBC casts seen?
Acute interstitial nephritis
To pump calcium out in cardiac myocytes so that relaxation occurs
Ceftriaxone; azithromycin
Chorda tympani branch
37. What can cause virilization of a mother during pregnancy?
Aromatase deficiency in child
S. saprophyticus - and s. epidermidis; novobiocin
Biphosphonate
Appetite suppressants
38. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
Drug induced interstitial nephritis
When it invades the bm; carcinoma in situ
G to T in p53; HCC
Measles and M3 AML`
39. 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
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Initiation - pointing; pincer grasp; walking; mama/dada
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
40. What is Tzanck smear used to detect?
HSV and VZV
Inhaled animal dander allergens
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
41. name three pathological states that present with large tongues.
Congenital hypothyroidism - downs - amyloidosis - acromegaly
E6 and E7 of HPV knock off p53 and Rb suppressor genes
SSRI
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
42. why is crohns disease associated with oxaloacetate kidney stones?
Gluteus medius and minimus; positive trendelenberg
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
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
facultative intracellular
43. IL4 is used for isotypye switching to what?
Minimal change disease
IgE
25; 25
Acute gastric mucosal defects (superficial or full thickness)
44. Is there edema in primary Conns? secondary hyperaldosteronism? why?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Underestimation of gestational age
45. there are mucus secreting cells in the bronchioles...
only up to bronchi
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Hereditary angioedema; ACE inhibitors
By vascular permeability and vasodilation
46. What is tachyphylaxis?
The term used to describe decreased drug responsiveness with repeated administration
Serum creatine kinase; reperfusion injury causes necrosis
46 - 4N; 23 2N
Gluteus maximus; difficulty getting up from seated position and climbing chair
47. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
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
Bile salt accumulation in urine
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
Reiter syndrome; B27
48. Acyl coA synthetase is not...
liver specific
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Anterior circumflex (and axillary nerve)
49. which viruses require a protease?
liver specific
SS +rNA
Increase in permeability of two ions with equal and opposite equilibrium potentials
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
50. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Demargination of neutrophils from the vessel walls
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
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