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. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Increase; decreased
As a CO2 carrier with the carboxylase enzyme
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Integration of viral DNA into genome of host hepatocytes

2. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
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
women
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

3. What are the three dopaminergic systems and What are they responsible for? disease?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Fibrosis; macrophages
Bile salt accumulation in urine
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

4. What does extended consumption of appetite suppressants lead to?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Integration of viral DNA into genome of host hepatocytes
11
Pulmonary hypertension

5. why should you not use ACE inhibitors with someone who had hereditary angioedema?
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)
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
Bronchogenic carcinoma
Leukotriene precursor and does neutrophil chemotaxis

6. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
GI tract; mood!
Well
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
Localized dermatologic pain that persists for more than one month after zoster eruption

7. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
In the extracellular space
Class I
Chorda tympani branch
Close but purkinje system to ensure contraction in a bottom up fashion

8. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
Myasthenia gravis
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
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
MAO inhibitors; wine and cheese

9. other than in pyelonephritis - where else are WBC casts seen?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Initiation - pointing; pincer grasp; walking; mama/dada
Acute interstitial nephritis
Anti cholinergic effects of pupil dilation and lack of accomodation

10. What is cataplexy and When is it seen?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Well
G to T in p53; HCC
Sudden loss of muscle tone without loss of consciousness; narcolepsy

11. where are Beta 1 receptors found?
ANCA because of lack of Ig and C3 deposits on IF
Classical conditioning
On cardiac tissue and renal juxtaglomerular cells
Hypertension - edema - and proteinuria

12. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Fibrosis; macrophages
HSV ( also in utero: chlymadia - neisseria - group B strep)
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
low in serum

13. How do you calculate atributable risk percent?
Prevents hepatic VLDL production
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
RR-1/RR
Prepatellar

14. which two virus families have hemagluttinin on their surface?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
G to T in p53; HCC
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
Paramyxo and influenza

15. What do you treat s. epidermidis with?
Elevated GGT and macrocytosis
Vancomycin
Downs; regurgitant AV valves - ASDs
S3 gallop; S2 to opening snap interval

16. What is the cause of rapid plasma decay of thiopental?
S3 gallop; S2 to opening snap interval
Tissue redistribution (out of plasma) rather than metabolism
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Pan colitis and right sided colitis (more than left sided and proctitis)

17. How do you treat gonococcal infection? chlymadia?
PDA open
Think Hb deformation diseases
Ceftriaxone; azithromycin
Pulmonic and systemic!

18. What is the mc location for avascular necrosis? What is it associated with?
low in serum
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

19. What are two indicators of chronic alcohol consumption?
Acute gastric mucosal defects (superficial or full thickness)
Retinitis; mononucleosis
G to T in p53; HCC
Elevated GGT and macrocytosis

20. What is the neurologic manifestation of ADPKD?
ATP binding (resets the myosin head to contract again for next binding)
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Sickle cell; G6PD
SSRI

21. what commonly happens in GI in response to acute physiologic stress?
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)
Underestimation of gestational age
Acute gastric mucosal defects (superficial or full thickness)
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

22. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Turners`
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

23. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
GI malignancies and Insulin resistance (acromegal for ex)
Increased reticulocytes
LT (LTD4 - E4 - C4) - and Ach
Smoking

24. What is gardeners mydriasis? How is it treated?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Ceftriaxone; azithromycin
Pan colitis and right sided colitis (more than left sided and proctitis)
Increase; decreased

25. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Downs; regurgitant AV valves - ASDs
Env genes (for getting into target cells)
To pump calcium out in cardiac myocytes so that relaxation occurs

26. what hernia has a similar mechanism to hydrocele?
Chlorpheniramine and diphenhydramine
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
indomethacin

27. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Medial circumflex artery; avascular necrosis
Class I
Amiloride - spironolactone - triamterene
Terminal bronchioles; small bronchi

28. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Increase lymphatic drainage!
Nocardia
Intussusception
Hexokinase

29. What are some of the permissive effects of cortisol?
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Increases bronchial and vascular smooth muscle reactivity to catecholamines
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
MAC complex (C5b - C9 complement deficiency)

30. what vessel would a fracture to the neck of the of the humerus damage?
Skin flushing and warmth; prostaglandins; give with aspirin
Tissue redistribution (out of plasma) rather than metabolism
Anterior circumflex (and axillary nerve)
Bronchogenic carcinoma

31. What does protein M do in Group A strep<
The term used to describe decreased drug responsiveness with repeated administration
Mean greater than median greater than mode
NF- KB; responsible for cytokine production
Prevent phagocytosis

32. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
Amiadarone
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
Chorda tympani branch
Hyperkalemia; potassium sparing diuretics - potassium supplements

33. What agonists reduce the gradient across the LV outflow tract?
Selective alpha 1 (increases SVR)
Trauma to stereociliated hair cells of the organ of corti
Elastance
Bile soluble which means they are bile sensitive

34. How do you explain the selective proteinuria of loss to albumin only in MCD?
differentiate
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Circular - outside nucleus; transport proteins - rRNA - tRNA
Decreases both

35. What are the first generation anti histamines?
ZDV or AZT
Enterococci (e. faecalis)- found on genitalia area
Chlorpheniramine and diphenhydramine
Congenital hypothyroidism - downs - amyloidosis - acromegaly

36. how does achalasia present? What does barium swallow show on dilated esophagus?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Circular - outside nucleus; transport proteins - rRNA - tRNA
Vancomycin; histamine mediated
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

37. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
Well trained athletes and children
P450 mitochondrial monooxygenase
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
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

38. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
<1% - 55% - concentration dependent
Vagus nerve stimulation
Intussusception
Tibial

39. What type of drug is alendronate?
Because gamma chains replace beta chains and then gamma chain formation wanes
Biphosphonate
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Serum creatine kinase; reperfusion injury causes necrosis

40. What does the severity of leprosy depend on?
Strength of cell mediated immune response
I is more benign and can present later in adulthood
8; 12
The time interval between S2 and OS- the shorter the interval - the more intense

41. what indicates the severity of a mitral regurg ? mitral stenosis?
Valproate
S3 gallop; S2 to opening snap interval
Inhaled animal dander allergens
Nocardia

42. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
hyponatremia (aldosterone activation equilibrates body volume)
Valproate
chronic urticaria and allergic symptoms
Curlings ulcers

43. What is used to prevent vertical transmission of HIV?
ZDV or AZT
Inhaled animal dander allergens
Measles and M3 AML`
Chrom 8

44. 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
MAC complex (C5b - C9 complement deficiency)
SaO2 <92%
Elevated GGT and macrocytosis

45. What is a cord factor and Which bugs have it? How do they appear on culture?
DIC; TTP- HUS dont bleed that much
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
FGF and VEGF
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

46. What causes the blurry vision side effects in first generation anti histamines?
Anti cholinergic effects of pupil dilation and lack of accomodation
Class I
RER; copper
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

47. Which nerve lies in close proximity to the inferior thyroid artery?
Recurrent larygneal
Ether and other organic solvents
Biphosphonate
Chorda tympani branch

48. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
CMV - HSV 1 - Candida
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Tissue redistribution (out of plasma) rather than metabolism
Vancomycin

49. what receptors do first generation anti histamines block?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
IgE
Trauma to stereociliated hair cells of the organ of corti

50. What are the two coagulase negative staphylococci? How do you distinguish them?
S. saprophyticus - and s. epidermidis; novobiocin
Gluteus medius and minimus; positive trendelenberg
Increases
Anterior circumflex (and axillary nerve)