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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. other than in pyelonephritis - where else are WBC casts seen?
Spongiosis
Acute interstitial nephritis
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
By vascular permeability and vasodilation

2. What is a keloid?
Valproate
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Diabetic microangiopathy
Excessive collagen formation during tissue repair in susceptible individuals

3. What is the mc location for avascular necrosis? What is it associated with?
Nocardia
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Curlings ulcers

4. what hormone is structurally similar to hCG?
Because of the low output from heart failure - they will have increased aldosterone levels
Pulmonary hypertension
TSh (in testicular tumors can cause hyperthyroidism)
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

5. What are the two growth factors associated with angiogenesis?
Kallmans
FGF and VEGF
Serum creatine kinase; reperfusion injury causes necrosis
Normal; low

6. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
Bile soluble which means they are bile sensitive
Prepatellar
Demargination of neutrophils from the vessel walls
Sickle cell; G6PD

7. If a patient has higher levels of HbF - What does this mean?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Kallmans
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Think Hb deformation diseases

8. What are the acute effects of corticosteroids on the CBC?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
RBC mass; epo levels (secondary has high)
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
No; yes

9. What can cause virilization of a mother during pregnancy?
P53 mutation; AD
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Aromatase deficiency in child

10. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Well trained athletes and children
Classical conditioning
Inactivates kallikrein which activates kininogen into bradykinin
Gluteus medius and minimus; positive trendelenberg

11. What is cataplexy and When is it seen?
Cluster
Tzanck smear
Radial nerve damage
Sudden loss of muscle tone without loss of consciousness; narcolepsy

12. what happens with LDL receptor density in statin therapy?
Raphe
T test; chi squared
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Increases

13. What is damaged in early syringomelia? later?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
RR-1/RR
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Closer to head; closer to diaphragm

14. when do ghon complexes form - primary or secondary TB?
Strength of cell mediated immune response
Primary
IgE
LT (LTD4 - E4 - C4) - and Ach

15. What is tachyphylaxis?
The term used to describe decreased drug responsiveness with repeated administration
11
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)
Southern - western

16. why are pregnant predisposed to cholelithiasis?
Barium enema
Congenital hypothyroidism - downs - amyloidosis - acromegaly
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
only up to bronchi

17. In what population does cholelithiasis occur?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Fat - fertile - forty - female
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

18. other than parvo B19 - what else is associated with red cell aplasia?
Thymic tumor
Increase by 50% in urine osmolality
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Valproate

19. What would a deflection of the membrane potential to near zero indicate?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Increase in permeability of two ions with equal and opposite equilibrium potentials

20. What type of vision is myopia? In What type of patients does it improve?
MAC complex (C5b - C9 complement deficiency)
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Anti - apoptotic (prevents going into apoptosis)- 18; 14

21. how does neisseria cause a petechial rash?
Neisseria induced small cell vasculitis (including hands and soles)
Multiple miscarriages d/t hypercoaguability
ATP binding (resets the myosin head to contract again for next binding)
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

22. What is the difference between paranoid personality disorder and delusional disorder?
Trochlear nerve (IV); abducens nerve (VI)
Reticulocytes
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Both sides

23. why is glucagon used in beta blocker toxicitiy?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Sarcoid

24. what vessel would a fracture to the neck of the of the humerus damage?
S. aureus
Varying; erythema nodosum is common
Selective alpha 1 (increases SVR)
Anterior circumflex (and axillary nerve)

25. What can too much IgA in serum produces?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Retinitis; mononucleosis
Vancomycin; histamine mediated
Chrom 8

26. which two virus families have hemagluttinin on their surface?
Right heart failure
Superior larygeal; cricothyroid; recurrent laryngeal
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Paramyxo and influenza

27. What is achalasia and how would this correlate on the esophageal mannometry?
Recurrent larygneal
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
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
G to T in p53; HCC

28. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
SSRI
Amiloride - spironolactone - triamterene
Paramyxo and influenza

29. how can HAV be inactivated?
Boiling - bleach - formalin - UV irradiation
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
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
MAO inhibitors; wine and cheese

30. which opponens muscle does ulnar innervate?
Well
Adductor
MAO inhibitors; wine and cheese
Atrial

31. What is it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
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)
Increase by 50% in urine osmolality
only up to bronchi
Vertical diplopia

32. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
Dissolved in plasma and attached to Hgb
When it invades the bm; carcinoma in situ
PDA open
Prepatellar

33. what diseases can vit A be used to treat?
HSV and VZV
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
Measles and M3 AML`
Increases bronchial and vascular smooth muscle reactivity to catecholamines

34. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Boiling - bleach - formalin - UV irradiation
Nonsense; mRNA processing
Regular insulin (Not fast acting - regular better)
Hereditary angioedema; ACE inhibitors

35. What is Bortezomib and What is it used for?
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)
Hypothyroidism
Proteasome inhibitor; treatment for MM and waldenstroms
Amiadarone

36. What is a primary HSV 1 infection like?
Increase in permeability of two ions with equal and opposite equilibrium potentials
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Rabies encephalitis from cave bats; rabies killed vaccines
PDA open

37. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
Vertical diplopia
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

38. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
To pump calcium out in cardiac myocytes so that relaxation occurs
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
Gluteus medius and minimus; positive trendelenberg
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

39. In what form are mitochondrial DNA? What do they transcribe?
Nonsense; mRNA processing
Myasthenia gravis
Drink plenty of fluids
Circular - outside nucleus; transport proteins - rRNA - tRNA

40. what enzyme converts procarcinogens into carcinogens?
Enterococci (e. faecalis)- found on genitalia area
Paramyxo and influenza
25; 25
P450 mitochondrial monooxygenase

41. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
Chrom 8
TCAs and prazosin
Medullary
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

42. on which chromosome is wilms tumor found?
Around 70 (normal measured diastolic pressures); 9--
Because of vasodiation to skeletal muscles
In ER of bile canaliculi
11

43. What is difference between Arnold Chiari type I and II?
I is more benign and can present later in adulthood
Chlorpheniramine and diphenhydramine
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

44. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
RER; RER
P53 mutation; AD
Classical conditioning

45. why does liver dysfunction cause coagulation disorders?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
No and yes
Coagulation factors are made in the liver
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

46. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
manifestations - congenital (stretching of periventricular pyrimadal fibers)

47. when arrested in prophase of meiosis I - What are primary oocytes chrom number? What about the secondary oocytes that are stuck in metaphase of Meiosis II?
46 - 4N; 23 2N
RER; copper
Turbulence
Headaches and facial flushing; vasodilation in meninges and skin

48. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Cluster
Anti - apoptotic (prevents going into apoptosis)- 18; 14
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

49. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
indomethacin
Increase lymphatic drainage!
low in serum
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

50. What does sustained hand grip do to the C/V system?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
I is more benign and can present later in adulthood
Covalent (between two cysteines)- allows protein to withstand denaturation
Medullary