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 Tzanck smear used to detect?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
HSV and VZV
Enterococci (e. faecalis)- found on genitalia area
Selective alpha 1 (increases SVR)

2. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
Fibrosis; macrophages
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
GI tract; mood!
Adeno

3. What is the most important prognostic indicator in patients with malignant melanoma?
Measure of depth invasion (vertical!)
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Acute interstitial nephritis
SSRI

4. What type of vision is myopia? In What type of patients does it improve?
Sarcoid
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Because gamma chains replace beta chains and then gamma chain formation wanes
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

5. What type of disease has selective proteinuria? What is found in urine? What is not?
P53 mutation; DCC is also required for adenoma to carcinoma
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Medial circumflex artery; avascular necrosis

6. why are beta thal major patients asymptomatic at birth?
No
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
Because gamma chains replace beta chains and then gamma chain formation wanes
Reiter syndrome; B27

7. how does noise induced hearing loss occur?
Trauma to stereociliated hair cells of the organ of corti
C3 decreased after 5-10 days; sulfonamides
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

8. do Class IC agents prolong the QT interval?
The time interval between S2 and OS- the shorter the interval - the more intense
Smoking
No
C3 decreased after 5-10 days; sulfonamides

9. do patients with cor pulmonale have increased or decreased levels of aldosterone?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
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
Biphosphonate
Because of the low output from heart failure - they will have increased aldosterone levels

10. SIADH patients have normal blood volume but...
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
hyponatremia (aldosterone activation equilibrates body volume)
TCAs and prazosin
RBF= PAH clearance/(1- hematocrit)

11. What is the difference between paranoid personality disorder and delusional disorder?
indomethacin
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
In the extracellular space
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

12. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
Syringomelia
Diabetic microangiopathy
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
Reiter syndrome; B27

13. what would be a sign of absence of cardiogenic pulm edem?
Radial nerve damage
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Vagus (auricular branch); vasovagal syncope!

14. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
When it invades the bm; carcinoma in situ
Serum creatine kinase; reperfusion injury causes necrosis
...

15. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Bronchial dilation (bronchiectasis)
Vagus nerve stimulation

16. why is crohns disease associated with oxaloacetate kidney stones?
CGD; t cell dysfxn (diGeorge)
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
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
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

17. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
The term used to describe decreased drug responsiveness with repeated administration
gram positive organisms
CGD; t cell dysfxn (diGeorge)
Nonsense; mRNA processing

18. What can chronic vit A toxicity cause?
facultative intracellular
To pump calcium out in cardiac myocytes so that relaxation occurs
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Biphosphonate

19. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
Brief psychotic disorder; schizophreniform; schizophrenia
Adductor
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

20. what clinical findings help distinguish small cell carcinoma?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
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)
Increases

21. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Medullary
Because of the low output from heart failure - they will have increased aldosterone levels
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Elastance

22. What are the first generation anti histamines?
Folic acid treatment!
Acute gastric mucosal defects (superficial or full thickness)
Thymic tumor
Chlorpheniramine and diphenhydramine

23. 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?
Downs; regurgitant AV valves - ASDs
Superior larygeal; cricothyroid; recurrent laryngeal
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)
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

24. which nucleus releases serotonin?
Mean greater than median greater than mode
Retinitis; mononucleosis
Raphe
8; 12

25. Is there edema in primary Conns? secondary hyperaldosteronism? why?
Dissolved in plasma and attached to Hgb
In the extracellular space
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Anti - apoptotic (prevents going into apoptosis)- 18; 14

26. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
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
Ceftriaxone; azithromycin
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Echinococcus granulosus; anaphylaxis

27. What is achalasia and how would this correlate on the esophageal mannometry?
Serum FFA and serum triglyceride levels
Ketone body production by preventing fatty acids into the mitochondria
LT (LTD4 - E4 - C4) - and Ach
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

28. Which nerve lies in close proximity to the inferior thyroid artery?
ANCA because of lack of Ig and C3 deposits on IF
Recurrent larygneal
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac

29. What is subacute sclerosisng encephalitis caused by?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Demargination of neutrophils from the vessel walls
Inhibits it
Rare complication of measles (years later)- thought to be d/t certain type that doesnt have surface M protein antigen so goes unseen into CNS

30. What is medullary sponge kidney disease and how does it present? What does it lead to?
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)
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
RBC mass; epo levels (secondary has high)

31. What is epleronone?
Ketone body production by preventing fatty acids into the mitochondria
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
Another type of aldosterone antagonist (like spironolactone)
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

32. What is a keloid?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Excessive collagen formation during tissue repair in susceptible individuals
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
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

33. What does anti phospholipid syndrome in SLE patients predispose them to?
Pulmonary hypertension
Turners`
Multiple miscarriages d/t hypercoaguability
Enterococci (e. faecalis)- found on genitalia area

34. Where is conduction in heart fastest? slowest?
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
E. coli
Purkinje system; AV node
Standing suddenly from supine position; valsalva maneuver

35. which are the only glycosylated proteins in HIV virus?
Env genes (for getting into target cells)
Well
Increases cytokine production
Ceftriaxone; azithromycin

36. What is easiest way to treat nephrolithiasis?
Drink plenty of fluids
Strength of cell mediated immune response
Because gamma chains replace beta chains and then gamma chain formation wanes
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

37. What is somatomedin C?
Insulin like growth factor 1 (just another name)
Integration of viral DNA into genome of host hepatocytes
NF- KB; responsible for cytokine production
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics

38. Metronidizaole does not cover...
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
FGF and VEGF
gram positive organisms
Not lined by epithelium

39. What is the mcc of extrinsic allergic asthma?
Inhaled animal dander allergens
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
only up to bronchi
Phencyclidine (PCP)

40. What is a primary HSV 1 infection like?
Gluteus medius and minimus; positive trendelenberg
low in serum
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Aromatase deficiency in child

41. 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?
Common peroneal; bony fractures and compression; sciatic
T test; chi squared
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
11 aa polypeptide; pain NT in CNS and PNS

42. What are fenfluramine - phentermine?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Serum creatine kinase; reperfusion injury causes necrosis
Appetite suppressants
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

43. What are the three causes of acute MI in context of normal coronary arteries ?
Drink plenty of fluids
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

44. What is diagnostic (and possible therapeutic for intussusception)?
Barium enema
Drug induced interstitial nephritis
Boiling - bleach - formalin - UV irradiation
Varying; erythema nodosum is common

45. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
Pulmonary hypertension
Anti cholinergic effects of pupil dilation and lack of accomodation
Vagus (auricular branch); vasovagal syncope!
Another type of aldosterone antagonist (like spironolactone)

46. What does L/S stand for in fetal lung maturity? When does maturity occur?
Myasthenia gravis
By vascular permeability and vasodilation
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Normal; low

47. which two virus families have hemagluttinin on their surface?
Common peroneal; bony fractures and compression; sciatic
Medial circumflex artery; avascular necrosis
Paramyxo and influenza
RBC mass; epo levels (secondary has high)

48. What is difference between Arnold Chiari type I and II?
Hexokinase
I is more benign and can present later in adulthood
Apocrine; eccrine
TCAs and prazosin

49. 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
In ER of bile canaliculi
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
HSV ( also in utero: chlymadia - neisseria - group B strep)

50. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
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)
Selective alpha 1 (increases SVR)
Gluteus medius and minimus; positive trendelenberg