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 the most common neurologic complication of VZV reactivation?
Localized dermatologic pain that persists for more than one month after zoster eruption
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Southern - western
Pain reliever - reduces pain by locking substance P in the PNS

2. What is pickwickian syndrome? What are the lab findings?
Ether and other organic solvents
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
An invagination of portion of intestine into the lumen of the adjacent intestinal segment; can lead to impaired venous return from the invaginated segment of the bowel which can cause ischemia and subsequent necrosis
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

3. What does extended consumption of appetite suppressants lead to?
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Pulmonary hypertension
Echinococcus granulosus; anaphylaxis

4. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Become beta pleated and then form neurofibrillary tangle!
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

5. What type of bond is a disulfide bond?
Covalent (between two cysteines)- allows protein to withstand denaturation
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
INTRApartum Abs (ampicillin/penicillin)
RBF= PAH clearance/(1- hematocrit)

6. How can renal blood flow be calculated from RPF?
Become beta pleated and then form neurofibrillary tangle!
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
RBF= PAH clearance/(1- hematocrit)
GI malignancies and Insulin resistance (acromegal for ex)

7. Which nerve lies in close proximity to the inferior thyroid artery?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Fibrosis; macrophages
RER; RER
Recurrent larygneal

8. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Vertical diplopia
Hypo or hyper pigmentations; after tanning

9. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Raphe
4 - 4 - 9
Dihydropyridine sensitive Ca channels (L type)

10. What is the difference between additive and synergistic?
only up to bronchi
No (unlike adenomyosis); yes
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
Excessive collagen formation during tissue repair in susceptible individuals

11. Where is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
Kallmans
ATP binding (resets the myosin head to contract again for next binding)
Syringomelia
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

12. PDAs are often asymptomatic. How do you treat?
indomethacin
RER; RER
The time interval between S2 and OS- the shorter the interval - the more intense
Trochlear nerve (IV); abducens nerve (VI)

13. What is extraocular muscle weakness a common symptom of?
Myasthenia gravis
S. saprophyticus - and s. epidermidis; novobiocin
The term used to describe decreased drug responsiveness with repeated administration
Common peroneal; bony fractures and compression; sciatic

14. within the right ventricle - What are maximum pressures? the pulm arter?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
25; 25
Prevents hepatic VLDL production
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

15. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
No (unlike adenomyosis); yes
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

16. What is the mc location of brain germinomas?What are the classic symptoms?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Nonsense; mRNA processing
Gluteus medius and minimus; positive trendelenberg

17. in the LV and aorta - What are the pressures?
Dihydropyridine sensitive Ca channels (L type)
Hypothyroidism
Well
Normally close to systolic

18. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
By vascular permeability and vasodilation
Anti centromere; anti DNA topoisomerase
transcription activation/suppression
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

19. What triggers the neoplastic changes that are associated with HBV infecton?
P53 mutation; AD
Ketone body production by preventing fatty acids into the mitochondria
Integration of viral DNA into genome of host hepatocytes
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

20. is Rifampin ever used as monotherapY? why either way?
Drug induced interstitial nephritis
Syncope - angina - dyspnea (SAD)
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
Nocardia

21. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
Trauma to stereociliated hair cells of the organ of corti
Sudden loss of muscle tone without loss of consciousness; narcolepsy
LT (LTD4 - E4 - C4) - and Ach
MAC complex (C5b - C9 complement deficiency)

22. What is cataplexy and When is it seen?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Rabies encephalitis from cave bats; rabies killed vaccines
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

23. What are the primary determinants of colon cancer risk in UC patients
Duration and extent of disease
Selective alpha 1 (increases SVR)
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
11 aa polypeptide; pain NT in CNS and PNS

24. What is epispadias caused by?
When it invades the bm; carcinoma in situ
Coagulation factors are made in the liver
Bile salt accumulation in urine
Faulty positioning of the genital tubercle

25. what clinical findings help distinguish small cell carcinoma?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
11 aa polypeptide; pain NT in CNS and PNS
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

26. How is dobutamine better than dopamine?
Both sides
Bronchogenic carcinoma
Increased reticulocytes
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

27. which virus inactivates both Rb and p53?
INTRApartum Abs (ampicillin/penicillin)
Medial circumflex artery; avascular necrosis
E6 and E7 of HPV knock off p53 and Rb suppressor genes
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)

28. What is easiest way to treat nephrolithiasis?
Drink plenty of fluids
Squatting - sitting - lying supine - passive leg raising
(urine PAH x urine flow rate)/plasma PAH
Serum FFA and serum triglyceride levels

29. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
HSV and VZV
Syringomelia
P53 mutation; DCC is also required for adenoma to carcinoma
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

30. What does prolonged PT indicated? aPTT? bleeding time?
Think Hb deformation diseases
Insulin like growth factor 1 (just another name)
Relfex tachycardia; giving beta blockers
Extrinsic def; instrinsic def; platelet def

31. What does C1 esterase do other than inhibiting complement pathway?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Inactivates kallikrein which activates kininogen into bradykinin
I is more benign and can present later in adulthood
Tissue redistribution (out of plasma) rather than metabolism

32. What is used to prevent vertical transmission of HIV?
Fibronectin - laminin - collagen
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
ZDV or AZT
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)

33. How do you explain the selective proteinuria of loss to albumin only in MCD?
Nonsense; mRNA processing
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
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
Sudden loss of muscle tone without loss of consciousness; narcolepsy

34. What is subacute sclerosisng encephalitis caused by?
No; yes
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
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
OCPs - multiparity - breast feeding

35. What type of drug is alendronate?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Regular insulin (Not fast acting - regular better)
Biphosphonate
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

36. In what view of CXR is anterior part of heart best seen? anterior part of heart is formed by?right border of heart is formed by? left border?
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)
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
Terminal bronchioles; small bronchi
Lateral; RV; RA; LV

37. What is used to treat heparin toxicity?
Myasthenia gravis
Protamine sulfate
Elastance
Intussusception

38. how does noise induced hearing loss occur?
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
Trauma to stereociliated hair cells of the organ of corti
facultative intracellular
Neisseria induced small cell vasculitis (including hands and soles)

39. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Vagus nerve stimulation
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

40. which nerve provides innervation for plantar flexion and inversion?
Tibial
(urine PAH x urine flow rate)/plasma PAH
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Acute gastric mucosal defects (superficial or full thickness)

41. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
Ether and other organic solvents
Purkinje system; AV node
Fibrosis; macrophages
P53 mutation; AD

42. what defines hypoxemia?
Atrial
SaO2 <92%
CGD; t cell dysfxn (diGeorge)
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

43. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Tzanck smear
Inhibits it
Vancomycin
Increase lymphatic drainage!

44. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
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)
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Echinococcus granulosus; anaphylaxis
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

45. why are beta thal major patients asymptomatic at birth?
Myasthenia gravis
Pulmonary hypertension
SVC and IVC; right below the aortic knob
Because gamma chains replace beta chains and then gamma chain formation wanes

46. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Nocardia
Increases cytokine production
TSh (in testicular tumors can cause hyperthyroidism)
Medial circumflex artery; avascular necrosis

47. how long is substance P? What does it do?
I is more benign and can present later in adulthood
11 aa polypeptide; pain NT in CNS and PNS
Recurrent larygneal
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

48. 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
25; 25
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Coagulation factors are made in the liver

49. What would a deflection of the membrane potential to near zero indicate?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Increase in permeability of two ions with equal and opposite equilibrium potentials
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Single adenomatous ones

50. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
hyponatremia (aldosterone activation equilibrates body volume)
Increased reticulocytes
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Radial nerve damage