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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. What are the skin presentation in sarcoid?
Varying; erythema nodosum is common
MAO inhibitors; wine and cheese
25; 25
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

2. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Minimal change disease
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Acute interstitial nephritis

3. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
SaO2 <92%
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Diabetic microangiopathy
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

4. What causes wrist drop?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Covalent (between two cysteines)- allows protein to withstand denaturation
Radial nerve damage

5. at three years of age What are social - fine motor - gross motor and language developments?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences

6. nucleotide deletions do not cause missense mutations - they cause...
Reticulocytes
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
frameshift mutations (missense is substitution)
MAC complex (C5b - C9 complement deficiency)

7. What is capsaicin? Where does it work?
Close but purkinje system to ensure contraction in a bottom up fashion
Reticulocytes
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Pain reliever - reduces pain by locking substance P in the PNS

8. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
Serum creatine kinase; reperfusion injury causes necrosis
The term used to describe decreased drug responsiveness with repeated administration
HSV ( also in utero: chlymadia - neisseria - group B strep)
C3 decreased after 5-10 days; sulfonamides

9. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Intussusception
Atrial
V fib; v. failure

10. why are pregnant predisposed to cholelithiasis?
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
Drug induced interstitial nephritis
Prevents hepatic VLDL production
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

11. which staphylococci can do mannitol fermaentation?
S. aureus
Vagus nerve stimulation
Reiter syndrome; B27
Decreases both

12. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
transcription activation/suppression
frameshift mutations (missense is substitution)
Minimal change disease
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

13. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
...
Diabetic microangiopathy
Medullary
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

14. what drugs causes the red man syndrome? how does it occur?
Paramyxo and influenza
Vertical diplopia
RBF= PAH clearance/(1- hematocrit)
Vancomycin; histamine mediated

15. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
No
Skin flushing and warmth; prostaglandins; give with aspirin
25; 25
Prevent phagocytosis

16. How can renal blood flow be calculated from RPF?
RBF= PAH clearance/(1- hematocrit)
Hereditary angioedema; ACE inhibitors
Chrom 8
P53 mutation; AD

17. What are three symptoms in s.typhi?
46 - 4N; 23 2N
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Gluteus maximus; difficulty getting up from seated position and climbing chair
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

18. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Echinococcus granulosus; anaphylaxis

19. on which chromosome is wilms tumor found?
11
Sarcoid
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Joints d/t increased purine production and thus uric acid production

20. What can worse neurologic dysfunction in cobalamic def?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Because of vasodiation to skeletal muscles
Folic acid treatment!
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)

21. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
SaO2 <92%
Dihydropyridine sensitive Ca channels (L type)
Vagus (auricular branch); vasovagal syncope!
Trauma to stereociliated hair cells of the organ of corti

22. What does Rb protein do? what chrom is it on?
MAC complex (C5b - C9 complement deficiency)
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
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
25; 25

23. how does neisseria cause a petechial rash?
Anti cholinergic effects of pupil dilation and lack of accomodation
Neisseria induced small cell vasculitis (including hands and soles)
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

24. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
Appetite suppressants
Increased reticulocytes
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
P53 mutation; DCC is also required for adenoma to carcinoma

25. which RPGN is also called pauci immune GN? why?
facultative intracellular
11
ANCA because of lack of Ig and C3 deposits on IF
APP on chrom 21 (this is why downs more susceptible)

26. What is a common complication of acute pancreatitis? What is it?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
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
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Thymic tumor

27. What are the acute effects of corticosteroids on the CBC?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Intussusception
Strength of cell mediated immune response

28. What causes vertical diplopia? horizontal?
RBF= PAH clearance/(1- hematocrit)
Trochlear nerve (IV); abducens nerve (VI)
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
Insulin like growth factor 1 (just another name)

29. What can too much IgA in serum produces?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Become beta pleated and then form neurofibrillary tangle!
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
RER; RER

30. Where does 90% of serotonin lie? What is this NT responsible?
Vagus nerve stimulation
GI tract; mood!
Skin flushing and warmth; prostaglandins; give with aspirin
Class I

31. Where does the aorta lie in relation to the pulmonary artery in transposition of the great arteries (is this right to left or left to right shunt?)?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
C3 decreased after 5-10 days; sulfonamides
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

32. name three pathological states that present with large tongues.
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Anti cholinergic effects of pupil dilation and lack of accomodation
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

33. what immune deficiency causes recurrent neisseria infections?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
MAC complex (C5b - C9 complement deficiency)
Circular - outside nucleus; transport proteins - rRNA - tRNA

34. What is the most common location of colonization of all s. aureus types?
Anterior circumflex (and axillary nerve)
By vascular permeability and vasodilation
Anterior nares
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

35. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
facultative intracellular
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Covalent (between two cysteines)- allows protein to withstand denaturation
No (unlike adenomyosis); yes

36. What is the diagnosis in delayed puberty plus anosmia?
Kallmans
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Well trained athletes and children
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

37. what chromosome is c - myc found on?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Chrom 8
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

38. What is the mcc of elevated AFP leves in pregnancy>
SVC and IVC; right below the aortic knob
Superior larygeal; cricothyroid; recurrent laryngeal
Underestimation of gestational age
Ether and other organic solvents

39. prostaglandin synthesis keeps...
Sydenham chorea
Vagus (auricular branch); vasovagal syncope!
SVC and IVC; right below the aortic knob
PDA open

40. What does C1 esterase do other than inhibiting complement pathway?
Inactivates kallikrein which activates kininogen into bradykinin
Ceftriaxone; azithromycin
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Think Hb deformation diseases

41. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
low in serum
differentiate
Pain reliever - reduces pain by locking substance P in the PNS

42. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Hypo or hyper pigmentations; after tanning
Increase lymphatic drainage!
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

43. what receptors do first generation anti histamines block?
Anti cholinergic effects of pupil dilation and lack of accomodation
No (unlike adenomyosis); yes
Right before diastole (filling begins)
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

44. What are the three causes of acute MI in context of normal coronary arteries ?
Retinitis; mononucleosis
Diabetic microangiopathy
Pan colitis and right sided colitis (more than left sided and proctitis)
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

45. h1 receptor anatagonists are not effective in treatment of asthma only for...
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
chronic urticaria and allergic symptoms
CMV - HSV 1 - Candida
Anti - apoptotic (prevents going into apoptosis)- 18; 14

46. there are mucus secreting cells in the bronchioles...
Vancomycin
only up to bronchi
Coagulation factors are made in the liver
E6 and E7 of HPV knock off p53 and Rb suppressor genes

47. which viruses require a protease?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
SS +rNA
Both sides

48. What three factors effect total oxygen content of blood?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Vagus (auricular branch); vasovagal syncope!

49. Where is the base of the heart? apex?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
E. coli
Closer to head; closer to diaphragm

50. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
High potassium conductance and some sodium conductance
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Medullary
SSRI