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 are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
INTRApartum Abs (ampicillin/penicillin)
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

2. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Phencyclidine (PCP)

3. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Adductor
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
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)

4. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
P53 mutation; DCC is also required for adenoma to 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
CGD; t cell dysfxn (diGeorge)
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

5. What causes wrist drop?
Radial nerve damage
Ether and other organic solvents
11 aa polypeptide; pain NT in CNS and PNS
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

6. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
When it invades the bm; carcinoma in situ
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Classical conditioning
Medial part

7. What three factors effect total oxygen content of blood?
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Pulmonary hypertension
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
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

8. which type of glands produce an initially odorless secretion but can become malodorous secondary to bacterial decompisition on the skin surface? which glands are present throughout the skin except on lips and glans penis?
IgE
Apocrine; eccrine
Inhaled animal dander allergens
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

9. What is capsaicin? Where does it work?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Because of vasodiation to skeletal muscles
Pain reliever - reduces pain by locking substance P in the PNS

10. prostaglandin synthesis keeps...
PDA open
Faulty positioning of the genital tubercle
To pump calcium out in cardiac myocytes so that relaxation occurs
...

11. How do you calculate RPF from urine PAH?
P53 mutation; AD
(urine PAH x urine flow rate)/plasma PAH
Medullary
As a CO2 carrier with the carboxylase enzyme

12. other than in pyelonephritis - where else are WBC casts seen?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Relfex tachycardia; giving beta blockers
Prevents hepatic VLDL production
Acute interstitial nephritis

13. What are the three causes of acute MI in context of normal coronary arteries ?
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
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
11

14. What are examples of action that decrease venous return to the heart?
Standing suddenly from supine position; valsalva maneuver
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)
Sudden loss of muscle tone without loss of consciousness; narcolepsy
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

15. in essential fructosuria - what enzyme do patients use to metabolize fructose?
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
Echinococcus granulosus; anaphylaxis
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Hexokinase

16. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
Proteasome inhibitor; treatment for MM and waldenstroms
Env genes (for getting into target cells)
facultative intracellular
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

17. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Increase in permeability of two ions with equal and opposite equilibrium potentials
Hereditary angioedema; ACE inhibitors
Gluteus maximus; difficulty getting up from seated position and climbing chair

18. What is the most important prognostic indicator in patients with malignant melanoma?
transcription activation/suppression
Measure of depth invasion (vertical!)
Barium enema
V fib; v. failure

19. What is a keloid?
ANCA because of lack of Ig and C3 deposits on IF
Atrial
Increase lymphatic drainage!
Excessive collagen formation during tissue repair in susceptible individuals

20. which viruses require a protease?
V fib; v. failure
GI tract; mood!
Ceftriaxone; azithromycin
SS +rNA

21. hypertonicity and hyperreflexity are ________________ of hydrocephalus
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Extrinsic def; instrinsic def; platelet def
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
In the extracellular space

22. where exactly is ACE expressed in the lungs? What type of enzyme is it?
Vascular endothelium; protease
Downs; regurgitant AV valves - ASDs
Think Hb deformation diseases
Trochlear nerve (IV); abducens nerve (VI)

23. how does neisseria cause a petechial rash?
Reiter syndrome; B27
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Measure of depth invasion (vertical!)
Neisseria induced small cell vasculitis (including hands and soles)

24. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
RBC mass; epo levels (secondary has high)
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Headaches and facial flushing; vasodilation in meninges and skin

25. What is the presentation of angioedema? Where is most commonly affected?
transcription activation/suppression
Insulin like growth factor 1 (just another name)
Radial nerve and deep brachial artery
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

26. What does prolonged PT indicated? aPTT? bleeding time?
Extrinsic def; instrinsic def; platelet def
Dissolved in plasma and attached to Hgb
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

27. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
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
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Pain reliever - reduces pain by locking substance P in the PNS
transcription activation/suppression

28. What does L/S stand for in fetal lung maturity? When does maturity occur?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Increase; decreased
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

29. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Extrinsic def; instrinsic def; platelet def
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Increased reticulocytes

30. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Coagulation factors are made in the liver
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
HSV ( also in utero: chlymadia - neisseria - group B strep)

31. What effects does cortisol have on catecholamines?
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
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
ZDV or AZT

32. Where does lysyl oxidase act? What is the cofactor for that?
In the extracellular space for collagen cross linking; zinc
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Protamine sulfate

33. What is tachyphylaxis?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
The term used to describe decreased drug responsiveness with repeated administration
Because of the low output from heart failure - they will have increased aldosterone levels
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

34. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
No
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)
APP on chrom 21 (this is why downs more susceptible)
RER; RER

35. What are the lab findings in poststreptococcal GN?
Curlings ulcers
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
Vancomycin
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

36. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Superior larygeal; cricothyroid; recurrent laryngeal
Fibronectin - laminin - collagen
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
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

37. What is the mcc of extrinsic allergic asthma?
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 time interval between S2 and OS- the shorter the interval - the more intense
Inhaled animal dander allergens
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

38. What are pancreatic pseudocysts called pseudo rather than true cysts?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Not lined by epithelium
Drink plenty of fluids
E6 and E7 of HPV knock off p53 and Rb suppressor genes

39. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
C3 decreased after 5-10 days; sulfonamides
Echinococcus granulosus; anaphylaxis
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

40. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Pulmonary hypertension
Chorda tympani branch
Increase in permeability of two ions with equal and opposite equilibrium potentials

41. which nucleus releases serotonin?
Tibial
Raphe
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Bronchogenic carcinoma

42. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
S. aureus
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
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)
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

43. what defines hypoxemia?
SaO2 <92%
Anti cholinergic effects of pupil dilation and lack of accomodation
Because of vasodiation to skeletal muscles
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

44. What does extended consumption of appetite suppressants lead to?
RR-1/RR
Skin flushing and warmth; prostaglandins; give with aspirin
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Pulmonary hypertension

45. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
No and yes
Brief psychotic disorder; schizophreniform; schizophrenia
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
gram positive organisms

46. What is a primary HSV 1 infection like?
Ig A deficiency
frameshift mutations (missense is substitution)
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
SS +rNA

47. name three pathological states that present with large tongues.
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Joints d/t increased purine production and thus uric acid production

48. What is it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
TCAs and prazosin
Vertical diplopia
Chorda tympani branch
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

49. what diseases can vit A be used to treat?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Duration and extent of disease
Right heart failure
Measles and M3 AML`

50. how does eos release MBP to kill protozoa etc?
Become beta pleated and then form neurofibrillary tangle!
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC