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 dobutamine? What is it used for?how it is it most helpful? What is bad about it?
Fat - fertile - forty - female
Elastance
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
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

2. what chromosome is c - myc found on?
Chrom 8
Barium enema
HSV and VZV
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

3. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Medial circumflex artery; avascular necrosis
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
Underestimation of gestational age
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

4. in the LV and aorta - What are the pressures?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Normally close to systolic

5. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Drink plenty of fluids
MAC complex (C5b - C9 complement deficiency)
Because of vasodiation to skeletal muscles
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

6. what enzyme converts procarcinogens into carcinogens?
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
P450 mitochondrial monooxygenase
Right heart failure
Proteasome inhibitor; treatment for MM and waldenstroms

7. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
MAO inhibitors; wine and cheese
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Bronchogenic carcinoma
Abnormal closing of the urethral folds

8. which two drug types can cause orthostatic hypotension (think depression and BPH)?
Thymic tumor
Serum creatine kinase; reperfusion injury causes necrosis
Boiling - bleach - formalin - UV irradiation
TCAs and prazosin

9. What are pancreatic pseudocysts called pseudo rather than true cysts?
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Not lined by epithelium
Coagulation factors are made in the liver
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

10. how does eos release MBP to kill protozoa etc?
Medullary
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
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

11. how does increased ICP result in curlings ulcers?
Vagus nerve stimulation
Prostate tumor and increased osteoclast activity
In the extracellular space
As a CO2 carrier with the carboxylase enzyme

12. what would be a sign of absence of cardiogenic pulm edem?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Relfex tachycardia; giving beta blockers
By vascular permeability and vasodilation
Purkinje system; AV node

13. what virus causes pharyngoconjuctival fever?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Adeno
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Dissolved in plasma and attached to Hgb

14. What does anti phospholipid syndrome in SLE patients predispose them to?
Well trained athletes and children
transcription activation/suppression
Enterococci (e. faecalis)- found on genitalia area
Multiple miscarriages d/t hypercoaguability

15. What are the acute effects of corticosteroids on the CBC?
Common peroneal; bony fractures and compression; sciatic
frameshift mutations (missense is substitution)
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Ether and other organic solvents

16. IL4 is used for isotypye switching to what?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Spongiosis
AV node slowest - to allow time for diastole
IgE

17. Where is the base of the heart? apex?
Closer to head; closer to diaphragm
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Recurrent larygneal

18. are there signs of inflammation in avascular necrosis? then How do you diagnose?
No; MRI
Trochlear nerve (IV); abducens nerve (VI)
Prevents hepatic VLDL production
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

19. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Downs; regurgitant AV valves - ASDs
Normally close to systolic
Pain reliever - reduces pain by locking substance P in the PNS

20. What is the mc malignancy in asbestosis?
AV node slowest - to allow time for diastole
Bronchogenic carcinoma
No and yes
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

21. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
RER; RER
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Trochlear nerve (IV); abducens nerve (VI)
Regular insulin (Not fast acting - regular better)

22. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Skin flushing and warmth; prostaglandins; give with aspirin
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Prevents hepatic VLDL production
Turners`

23. what indicates the severity of a mitral regurg ? mitral stenosis?
S3 gallop; S2 to opening snap interval
Sickle cell; G6PD
(urine PAH x urine flow rate)/plasma PAH
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

24. what kind of drug is sertraline? What is a common side effect?
Echinococcus granulosus; anaphylaxis
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
SSRI; erectile dysfunction
Hydrogen bonds dictate alpha or beta structure

25. What is the triad seen in pre eclampsia?
Hypertension - edema - and proteinuria
S3 gallop; S2 to opening snap interval
LT (LTD4 - E4 - C4) - and Ach
P53 mutation; AD

26. why are beta thal major patients asymptomatic at birth?
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
Because gamma chains replace beta chains and then gamma chain formation wanes
Rabies encephalitis from cave bats; rabies killed vaccines
Hypertension - edema - and proteinuria

27. What does the tuberoinfundibular pathway connect? What is it responsible for?
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
Intussusception
CMV - HSV 1 - Candida
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin

28. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Highly negative resting potential
Barium enema
Increase lymphatic drainage!
Increase; decreased

29. What are the two growth factors associated with angiogenesis?
RER; copper
FGF and VEGF
Drink plenty of fluids
Enterococci (e. faecalis)- found on genitalia area

30. What effects does cortisol have on catecholamines?
liver specific
Pulmonic and systemic!
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
Increases cytokine production

31. What is epispadias caused by?
Faulty positioning of the genital tubercle
AV node slowest - to allow time for diastole
Intussusception
Dissolved in plasma and attached to Hgb

32. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Phencyclidine (PCP)
G to T in p53; HCC
Increase in permeability of two ions with equal and opposite equilibrium potentials

33. in B12 deficiency - what levels in blood rise very quickly and then drop?
Curlings ulcers
Radial nerve and deep brachial artery
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Reticulocytes

34. which virus inactivates both Rb and p53?
Biphosphonate
E6 and E7 of HPV knock off p53 and Rb suppressor genes
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
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

35. Which nerve lies in close proximity to the inferior thyroid artery?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
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
Recurrent larygneal
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

36. what dissolves the lipid bilayer of a viral envelope?
AV node slowest - to allow time for diastole
Increase in permeability of two ions with equal and opposite equilibrium potentials
Ether and other organic solvents
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

37. What is 5- HETE and What does it do?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Leukotriene precursor and does neutrophil chemotaxis
Hypo or hyper pigmentations; after tanning
Paramyxo and influenza

38. what phase do adenosine and acetylcholine act on? doing what?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Closer to head; closer to diaphragm
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Acute interstitial nephritis

39. What are diastolic (lowest) pressures in aorta? LV?
Around 70 (normal measured diastolic pressures); 9--
PDA open
Fibronectin - laminin - collagen
Insulin like growth factor 1 (just another name)

40. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Aromatase deficiency in child
Bile soluble which means they are bile sensitive
Normal; low

41. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
MAC complex (C5b - C9 complement deficiency)
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Become beta pleated and then form neurofibrillary tangle!

42. What is the best indicator for the severity of mitral stenosis?
Squatting - sitting - lying supine - passive leg raising
In the extracellular space for collagen cross linking; zinc
The time interval between S2 and OS- the shorter the interval - the more intense
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

43. if there are keratin swirls does that mean well or poorly differentiated?
Elevated GGT and macrocytosis
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
SaO2 <92%
Well

44. what happens with LDL receptor density in statin therapy?
Obstruction because they infiltrate the intestinal wall and encircle causing decrease in size of lumen - constipation - abdominal distension - abdominal pain - changes in stool caliber; right sided are often exophytic masses iron def anemia and syste
G to T in p53; HCC
Increases
(urine PAH x urine flow rate)/plasma PAH

45. h1 receptor anatagonists are not effective in treatment of asthma only for...
Tzanck smear
Closer to head; closer to diaphragm
Turbulence
chronic urticaria and allergic symptoms

46. What is easiest way to treat nephrolithiasis?
S3 gallop; S2 to opening snap interval
Thymic tumor
Drink plenty of fluids
Bronchial dilation (bronchiectasis)

47. What does L/S stand for in fetal lung maturity? When does maturity occur?
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
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 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

48. what hormone is structurally similar to hCG?
Well
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Increase by 50% in urine osmolality
TSh (in testicular tumors can cause hyperthyroidism)

49. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Radial nerve and deep brachial artery
Retinitis; mononucleosis
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
Class I

50. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
glycerol kinase
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
No; MRI
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)