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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. why does hypothyroidism cause increased CPK levels?
low in serum
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Myasthenia gravis
G to T in p53; HCC

2. What causes curlings ulcers?
S. aureus
Circular - outside nucleus; transport proteins - rRNA - tRNA
...
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

3. which two drug types can cause orthostatic hypotension (think depression and BPH)?
By vascular permeability and vasodilation
TCAs and prazosin
Fibronectin - laminin - collagen
Pan colitis and right sided colitis (more than left sided and proctitis)

4. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Initiation - pointing; pincer grasp; walking; mama/dada

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

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6. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Medullary
RER; RER
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Hyperkalemia; potassium sparing diuretics - potassium supplements

7. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
only up to bronchi
transcription activation/suppression
Relfex tachycardia; giving beta blockers

8. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Terminal bronchioles; small bronchi
Coagulation factors are made in the liver
Inhaled animal dander allergens

9. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
indomethacin
Joints d/t increased purine production and thus uric acid production
Coagulation factors are made in the liver
Mean greater than median greater than mode

10. Which is faster purkinje system or atrial muscle?
Close but purkinje system to ensure contraction in a bottom up fashion
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Drug induced interstitial nephritis
manifestations - congenital (stretching of periventricular pyrimadal fibers)

11. What is easiest way to treat nephrolithiasis?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Bronchial dilation (bronchiectasis)
Drink plenty of fluids
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

12. on What part of the clavicle does the SCM attach?
Hypo or hyper pigmentations; after tanning
Terminal bronchioles; small bronchi
Medial part
only up to bronchi

13. What does protein M do in Group A strep<
Prevent phagocytosis
DIC; TTP- HUS dont bleed that much
GI malignancies and Insulin resistance (acromegal for ex)
Retinitis; mononucleosis

14. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
Increase lymphatic drainage!
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Ether and other organic solvents
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

15. What three pathogens cause infectious esophagitis in HIV positive patients?
CMV - HSV 1 - Candida
Minimal change disease
Hypertension - edema - and proteinuria
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

16. What is congestive hepatomegaly specific for?
RER; copper
APP on chrom 21 (this is why downs more susceptible)
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Right heart failure

17. if there are keratin swirls does that mean well or poorly differentiated?
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)
Decreases both
RER; copper
Well

18. what dissolves the lipid bilayer of a viral envelope?
II; I (I more abundant)
Ether and other organic solvents
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)
P53 mutation; DCC is also required for adenoma to carcinoma

19. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Highly negative resting potential
Fibronectin - laminin - collagen
Serum creatine kinase; reperfusion injury causes necrosis

20. how can HAV be inactivated?
Radial nerve and deep brachial artery
Right heart failure
Chorda tympani branch
Boiling - bleach - formalin - UV irradiation

21. When is acid phosphatase elevated (Name two times)?
SS +rNA
Paramyxo and influenza
Prostate tumor and increased osteoclast activity
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

22. a patient fearing all white coats is a phenomenon of what?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Because gamma chains replace beta chains and then gamma chain formation wanes
Sarcoid
Classical conditioning

23. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Coagulation factors are made in the liver
RBC mass; epo levels (secondary has high)
AV node slowest - to allow time for diastole

24. which RPGN is also called pauci immune GN? why?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Tzanck smear
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
ANCA because of lack of Ig and C3 deposits on IF

25. how much percent of sodium is excreted? urea? glucose?
Classical conditioning
Adductor
<1% - 55% - concentration dependent
Increases bronchial and vascular smooth muscle reactivity to catecholamines

26. What is difference between Arnold Chiari type I and II?
T test; chi squared
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Decreases both
I is more benign and can present later in adulthood

27. What can chronic vit A toxicity cause?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Serum FFA and serum triglyceride levels
Increase by 50% in urine osmolality
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

28. What is the most common location of colonization of all s. aureus types?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Anterior nares
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Coagulation factors are made in the liver

29. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Gluteus maximus; difficulty getting up from seated position and climbing chair
RBC mass; epo levels (secondary has high)
Vertical diplopia

30. What are two common side effects of both acute and long acting nitrates? What causes them?
frameshift mutations (missense is substitution)
Headaches and facial flushing; vasodilation in meninges and skin
Syncope - angina - dyspnea (SAD)
Common peroneal; bony fractures and compression; sciatic

31. What are examples of action that decrease venous return to the heart?
NF- KB; responsible for cytokine production
Hereditary angioedema; ACE inhibitors
Standing suddenly from supine position; valsalva maneuver
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)

32. What pulmonary structural change can kartageners syndrome cause?
Abnormal closing of the urethral folds
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Ketone body production by preventing fatty acids into the mitochondria
Bronchial dilation (bronchiectasis)

33. What is omalizumab and What is it used for?
liver specific
ANCA because of lack of Ig and C3 deposits on IF
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

34. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
HSV ( also in utero: chlymadia - neisseria - group B strep)
Hypothyroidism
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Tibial

35. there are mucus secreting cells in the bronchioles...
Octreotide
Enterococci (e. faecalis)- found on genitalia area
only up to bronchi
Intussusception

36. why does variocele occur more in left side?
Localized dermatologic pain that persists for more than one month after zoster eruption
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Vagus (auricular branch); vasovagal syncope!
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

37. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Large stroke volumes with ventricular contraction; aortic regurg
frameshift mutations (missense is substitution)
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

38. What is the Na/Ca exchange used for?
Because of vasodiation to skeletal muscles
indomethacin
Tibial
To pump calcium out in cardiac myocytes so that relaxation occurs

39. What are some side effects seen in TCAs?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Serum FFA and serum triglyceride levels
On cardiac tissue and renal juxtaglomerular cells
S3 gallop; S2 to opening snap interval

40. How do you calculate RPF from urine PAH?
(urine PAH x urine flow rate)/plasma PAH
SSRI
Both sides
Pulmonic and systemic!

41. What is the mutation type in thalassemias? what process is defective because of this?
Because gamma chains replace beta chains and then gamma chain formation wanes
ANCA because of lack of Ig and C3 deposits on IF
Nonsense; mRNA processing
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

42. who bleed more DIC or TTP- HUS patients?
ANCA because of lack of Ig and C3 deposits on IF
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
manifestations - congenital (stretching of periventricular pyrimadal fibers)
DIC; TTP- HUS dont bleed that much

43. What is the precursor protein to beta amyloid and On what chromosome is it found?
High potassium conductance and some sodium conductance
Measles and M3 AML`
APP on chrom 21 (this is why downs more susceptible)
women

44. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
Pulmonic and systemic!
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

45. Acyl coA synthetase is not...
liver specific
Octreotide
S. aureus
Elevated GGT and macrocytosis

46. what protein is increased in Crohns disease? What does it do?
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
Brief psychotic disorder; schizophreniform; schizophrenia
Apocrine; eccrine
NF- KB; responsible for cytokine production

47. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Standing suddenly from supine position; valsalva maneuver
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

48. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Anterior circumflex (and axillary nerve)
Medial circumflex artery; avascular necrosis
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

49. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Elevated GGT and macrocytosis
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
Increase lymphatic drainage!
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

50. Where does terminal peptide cleavage of collagen fibrils take place?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
No; MRI
In the extracellular space
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression