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 kind of drug is sertraline? What is a common side effect?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Trochlear nerve (IV); abducens nerve (VI)
Minimal change disease
SSRI; erectile dysfunction

2. What is the fibrinogen level in patient with TTP- HUS? DIC?
hyponatremia (aldosterone activation equilibrates body volume)
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Normal; low

3. What is the best indicator for the severity of mitral stenosis?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Prepatellar
Boiling - bleach - formalin - UV irradiation
The time interval between S2 and OS- the shorter the interval - the more intense

4. What is the neurologic manifestation of ADPKD?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Integration of viral DNA into genome of host hepatocytes
S. aureus
Southern - western

5. What is a common complication of acute pancreatitis? What is it?
Relfex tachycardia; giving beta blockers
Inhibits it
women
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

6. where are Beta 1 receptors found?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
G to T in p53; HCC
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
On cardiac tissue and renal juxtaglomerular cells

7. What is the preferred treatment for DKA?
Aromatase deficiency in child
No; MRI
Tibial
Regular insulin (Not fast acting - regular better)

8. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Become beta pleated and then form neurofibrillary tangle!
Inactivates kallikrein which activates kininogen into bradykinin
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Adeno

9. what clinical findings help distinguish small cell carcinoma?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
The term used to describe decreased drug responsiveness with repeated administration
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

10. What is the most important prognostic indicator in patients with malignant melanoma?
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
TCAs and prazosin
Anti cholinergic effects of pupil dilation and lack of accomodation
Measure of depth invasion (vertical!)

11. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Fibronectin - laminin - collagen
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

12. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Lateral; RV; RA; LV
Echinococcus granulosus; anaphylaxis
Prevent phagocytosis
OCPs - multiparity - breast feeding

13. Where is conduction in heart fastest? slowest?
Standing suddenly from supine position; valsalva maneuver
Excessive collagen formation during tissue repair in susceptible individuals
Purkinje system; AV node
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

14. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
RBC mass; epo levels (secondary has high)
Terminal bronchioles; small bronchi
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

15. are there signs of inflammation in avascular necrosis? then How do you diagnose?
Hyperkalemia; potassium sparing diuretics - potassium supplements
No; MRI
Reiter syndrome; B27
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

16. other than increasing HDL levels - what else does niacin do?
Prevents hepatic VLDL production
RBF= PAH clearance/(1- hematocrit)
Dissolved in plasma and attached to Hgb
Intussusception

17. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Prepatellar
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Because gamma chains replace beta chains and then gamma chain formation wanes

18. 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?
GI malignancies and Insulin resistance (acromegal for ex)
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
Serum creatine kinase; reperfusion injury causes necrosis
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

19. when do ghon complexes form - primary or secondary TB?
Hyperkalemia; potassium sparing diuretics - potassium supplements
MAC complex (C5b - C9 complement deficiency)
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Primary

20. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Think Hb deformation diseases
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
FGF and VEGF

21. How do bradykinin - C3a and C5a cause edema?
By vascular permeability and vasodilation
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
Nonsense; mRNA processing
Retinitis; mononucleosis

22. why are beta thal major patients asymptomatic at birth?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
GI malignancies and Insulin resistance (acromegal for ex)
Thymic tumor
Because gamma chains replace beta chains and then gamma chain formation wanes

23. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Fat - fertile - forty - female
Minimal change disease
differentiate

24. other than parvo B19 - what else is associated with red cell aplasia?
Primary
Joints d/t increased purine production and thus uric acid production
Thymic tumor
Barium enema

25. where exactly is ACE expressed in the lungs? What type of enzyme is it?
Vascular endothelium; protease
Because of the low output from heart failure - they will have increased aldosterone levels
V fib; v. failure
Nocardia

26. What can long term leg cast wearing cause?
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
No and yes
Around 70 (normal measured diastolic pressures); 9--
Varying; erythema nodosum is common

27. 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?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Superior larygeal; cricothyroid; recurrent laryngeal
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
When it invades the bm; carcinoma in situ

28. What is congestive hepatomegaly specific for?
Right heart failure
Pulmonary hypertension
Fibronectin - laminin - collagen
Increases bronchial and vascular smooth muscle reactivity to catecholamines

29. which nerve provides innervation for plantar flexion and inversion?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Tibial
RBF= PAH clearance/(1- hematocrit)
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

30. What is Bortezomib and What is it used for?
PDA open
Medial part
Curlings ulcers
Proteasome inhibitor; treatment for MM and waldenstroms

31. in the LV and aorta - What are the pressures?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Amiloride - spironolactone - triamterene
Demargination of neutrophils from the vessel walls
Normally close to systolic

32. what protein is increased in Crohns disease? What does it do?
HSV ( also in utero: chlymadia - neisseria - group B strep)
Radial nerve damage
NF- KB; responsible for cytokine production
Intussusception

33. do Class IC agents prolong the QT interval?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Brief psychotic disorder; schizophreniform; schizophrenia
Pain reliever - reduces pain by locking substance P in the PNS
No

34. What type of mutation does aflatoxin cause? what cancer does this increase for?
RER; copper
G to T in p53; HCC
FGF and VEGF
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

35. within the right atrium - What is the maximum pressure? left atrium?
8; 12
Nonsense; mRNA processing
Susceptible; soluble (unable to be cultured in bile)
Little effect on cell and no change

36. what receptors do first generation anti histamines block?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Minimal change disease
E. coli
PDA open

37. after a thrombus extraction - what serum enzyme shoots up and why?
frameshift mutations (missense is substitution)
liver specific
Serum creatine kinase; reperfusion injury causes necrosis
P53 mutation; AD

38. What are the first generation anti histamines?
S. aureus
Chlorpheniramine and diphenhydramine
Chrom 8
Large stroke volumes with ventricular contraction; aortic regurg

39. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Rabies encephalitis from cave bats; rabies killed vaccines
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

40. What is capacitance inversely proportional to?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
No and yes
Elastance
(urine PAH x urine flow rate)/plasma PAH

41. sporadic colon cancer tend to arise From what type of polyps?
Tzanck smear
Single adenomatous ones
CMV - HSV 1 - Candida
Anterior circumflex (and axillary nerve)

42. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Excessive collagen formation during tissue repair in susceptible individuals
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
chronic urticaria and allergic symptoms

43. what dissolves the lipid bilayer of a viral envelope?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Ether and other organic solvents
Hypothyroidism

44. metabolism of 1 gram of protein produces How many calories? carb? fat?
Medial circumflex artery; avascular necrosis
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
indomethacin
4 - 4 - 9

45. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Biphosphonate
E. coli; staphylococcus saprophyticus
Curlings ulcers

46. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
Medial part
Vancomycin
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

47. on What part of the clavicle does the SCM attach?
Amiadarone
indomethacin
Paramyxo and influenza
Medial part

48. what marker should be followed in a patient with cirrhosis?
No; yes
Anti cholinergic effects of pupil dilation and lack of accomodation
Paramyxo and influenza
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

49. What is a cord factor and Which bugs have it? How do they appear on culture?
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Valproate
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Varying; erythema nodosum is common

50. What is acanthosis nigricans associated with?
Medullary
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
women
GI malignancies and Insulin resistance (acromegal for ex)