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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. non ceruloplasmin deposition - ceruloplasmin is...
low in serum
ST become atrophic and hyalinized (temp induced damage) and depressed sperm count becuase of that; hormonal function not impaired (test and LH levels normal) because Leydig cells not as temp sensitive so secondary sexual characteristics and sexual pe
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

2. Where does complement bind on the Fc region of Ig chains?
Apocrine; eccrine
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
Demargination of neutrophils from the vessel walls
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

3. what chromosome is c - myc found on?
Myasthenia gravis
Because of vasodiation to skeletal muscles
Chrom 8
Adeno

4. What are the long term consequences of hydrocephalus?
By vascular permeability and vasodilation
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
P53 mutation; DCC is also required for adenoma to carcinoma
Selective alpha 1 (increases SVR)

5. What is capsaicin? Where does it work?
Pain reliever - reduces pain by locking substance P in the PNS
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Echinococcus granulosus; anaphylaxis
Amiloride - spironolactone - triamterene

6. what bursa is affected when on knees like a maid/gardner?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
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)
Anterior nares
Prepatellar

7. What type of bond is a disulfide bond?
Covalent (between two cysteines)- allows protein to withstand denaturation
Elastance
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Neisseria induced small cell vasculitis (including hands and soles)

8. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
Ether and other organic solvents
Prepatellar
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Adeno

9. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Skin flushing and warmth; prostaglandins; give with aspirin
Smoking
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

10. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
P53 mutation; DCC is also required for adenoma to carcinoma
TCAs and prazosin
Southern - western

11. What would a deflection of the membrane potential to near zero indicate?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Inhibits it
Increase in permeability of two ions with equal and opposite equilibrium potentials
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

12. What almost exclusively causes Epliglottitis?What type of capsule does it have? What are the symptoms?

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13. SIADH patients have normal blood volume but...
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
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
hyponatremia (aldosterone activation equilibrates body volume)
S. aureus

14. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Insulin like growth factor 1 (just another name)
Adductor
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Echinococcus granulosus; anaphylaxis

15. What does C1 esterase do other than inhibiting complement pathway?
Adductor
Skin flushing and warmth; prostaglandins; give with aspirin
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Inactivates kallikrein which activates kininogen into bradykinin

16. What are three symptoms in s.typhi?
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Highly negative resting potential
Southern - western
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

17. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Folic acid treatment!
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
No and yes
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

18. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
transcription activation/suppression
GI tract; mood!

19. What does hypocapnia cause in teh brain? What is hypocapnia?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
46 - 4N; 23 2N
Ceftriaxone; azithromycin
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

20. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Tissue redistribution (out of plasma) rather than metabolism
Recurrent larygneal
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

21. What are the primary determinants of colon cancer risk in UC patients
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Duration and extent of disease
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Increases cytokine production

22. which two drug types can cause orthostatic hypotension (think depression and BPH)?
TCAs and prazosin
Anterior nares
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
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

23. what virus causes pharyngoconjuctival fever?
Adeno
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
Anterior circumflex (and axillary nerve)
Kallmans

24. where are the vegetations on the valves of a libman sacks endocarditis?
The time interval between S2 and OS- the shorter the interval - the more intense
Neisseria induced small cell vasculitis (including hands and soles)
Standing suddenly from supine position; valsalva maneuver
Both sides

25. What is normal fibrinogen levels?
Drug induced interstitial nephritis
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
SSRI
200-500

26. What is the most common cause of pyelonephritis in both adults and childre?
Sickle cell; G6PD
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
E. coli

27. other than increasing HDL levels - what else does niacin do?
Normally close to systolic
Medial part
Prevents hepatic VLDL production
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

28. What is easiest way to treat nephrolithiasis?
Drink plenty of fluids
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Acute gastric mucosal defects (superficial or full thickness)

29. What is Tzanck smear used to detect?
HSV and VZV
Not lined by epithelium
Hexokinase
Bronchial dilation (bronchiectasis)

30. What are the three dopaminergic systems and What are they responsible for? disease?
Trauma to stereociliated hair cells of the organ of corti
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
High potassium conductance and some sodium conductance

31. What type of calcium channels dictate the plateau in cardiac myocyte?
Excessive collagen formation during tissue repair in susceptible individuals
Increase in permeability of two ions with equal and opposite equilibrium potentials
Dihydropyridine sensitive Ca channels (L type)
Biphosphonate

32. which has better side effect profile - SSRI or TCA?
No
SSRI
Diabetic microangiopathy
Increase in permeability of two ions with equal and opposite equilibrium potentials

33. metabolism of 1 gram of protein produces How many calories? carb? fat?
In the extracellular space for collagen cross linking; zinc
Increase in permeability of two ions with equal and opposite equilibrium potentials
4 - 4 - 9
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

34. What is the fibrinogen level in patient with TTP- HUS? DIC?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Normal; low
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

35. what enzyme converts procarcinogens into carcinogens?
Circular - outside nucleus; transport proteins - rRNA - tRNA
Elastance
Trochlear nerve (IV); abducens nerve (VI)
P450 mitochondrial monooxygenase

36. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Hexokinase
Drug induced interstitial nephritis
Vascular endothelium; protease
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

37. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
E. coli; staphylococcus saprophyticus
TSh (in testicular tumors can cause hyperthyroidism)
Acute gastric mucosal defects (superficial or full thickness)

38. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
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)
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
No and yes
Underestimation of gestational age

39. When is acid phosphatase elevated (Name two times)?
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
Trochlear nerve (IV); abducens nerve (VI)
Prostate tumor and increased osteoclast activity
Around 70 (normal measured diastolic pressures); 9--

40. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
SSRI; erectile dysfunction
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Nonsense; mRNA processing
OCPs - multiparity - breast feeding

41. why does neutrophila occur with corticosteroids?
The term used to describe decreased drug responsiveness with repeated administration
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Demargination of neutrophils from the vessel walls
Bile soluble which means they are bile sensitive

42. who bleed more DIC or TTP- HUS patients?
DIC; TTP- HUS dont bleed that much
C3 decreased after 5-10 days; sulfonamides
SVC and IVC; right below the aortic knob
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase

43. name three pathological states that present with large tongues.
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Increased reticulocytes
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
11 aa polypeptide; pain NT in CNS and PNS

44. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
Sydenham chorea
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)
Ig A deficiency
SVT; increases vagal tone; rectus abdominis

45. What antibiotic is best to treat alcoholic pulm infections? why?
Intussusception
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Clindamycin; covers anaerobic oral flora and aerobic bacteria

46. which staphylococci can do mannitol fermaentation?
Bronchial dilation (bronchiectasis)
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
S. aureus
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

47. What is a cord factor and Which bugs have it? How do they appear on culture?
Hypertension - edema - and proteinuria
Fibrosis; macrophages
Underestimation of gestational age
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

48. which trisomy is associated with endocardial cushion defects? What does thsi mean>
...
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Downs; regurgitant AV valves - ASDs
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

49. What is epispadias caused by?
Cluster
Localized dermatologic pain that persists for more than one month after zoster eruption
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Faulty positioning of the genital tubercle

50. 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?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Reiter syndrome; B27
11
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately