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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 is epleronone?
Measure of depth invasion (vertical!)
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
C3 decreased after 5-10 days; sulfonamides
Another type of aldosterone antagonist (like spironolactone)

2. where are Beta 1 receptors found?
Bile salt accumulation in urine
On cardiac tissue and renal juxtaglomerular cells
Chorda tympani branch
RER; RER

3. What does p53 do? what chrom is it on?
No (unlike adenomyosis); yes
Hypothyroidism
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
GI malignancies and Insulin resistance (acromegal for ex)

4. Which nerve lies in close proximity to the inferior thyroid artery?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Valproate
Around 70 (normal measured diastolic pressures); 9--
Recurrent larygneal

5. in B12 deficiency - what levels in blood rise very quickly and then drop?
Relfex tachycardia; giving beta blockers
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Reticulocytes
S. saprophyticus - and s. epidermidis; novobiocin

6. What is damaged in early syringomelia? later?
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
IgE
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

7. Which is faster purkinje system or atrial muscle?
ATP binding (resets the myosin head to contract again for next binding)
Close but purkinje system to ensure contraction in a bottom up fashion
SVT; increases vagal tone; rectus abdominis
Susceptible; soluble (unable to be cultured in bile)

8. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
Syringomelia
Tissue redistribution (out of plasma) rather than metabolism
ANCA because of lack of Ig and C3 deposits on IF
Turners`

9. How do you calculate RPF from urine PAH?
(urine PAH x urine flow rate)/plasma PAH
High potassium conductance and some sodium conductance
Dissolved in plasma and attached to Hgb
I is more benign and can present later in adulthood

10. what marker should be followed in a patient with cirrhosis?
Medullary
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
Echinococcus granulosus; anaphylaxis
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

11. which headaches are seen mostly in men - are severe - unilateral - periorbital - episodic (around same time every day) - temporal pain - with lacrimation - nasal congestion and ptosis?
Relfex tachycardia; giving beta blockers
Cluster
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Chrom 8

12. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Drink plenty of fluids
Octreotide
No; MRI
Susceptible; soluble (unable to be cultured in bile)

13. Which is slower AV node or ventricular muscle?
S. aureus
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
AV node slowest - to allow time for diastole

14. what hernia has a similar mechanism to hydrocele?
Ig A deficiency
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
S. saprophyticus - and s. epidermidis; novobiocin
Superior larygeal; cricothyroid; recurrent laryngeal

15. what induces bronchial squamous metaplasia?
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
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Smoking
Octreotide

16. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
glycerol kinase
women
Bronchial dilation (bronchiectasis)
Around 70 (normal measured diastolic pressures); 9--

17. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
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
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
No (unlike adenomyosis); yes
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

18. What type of drug is alendronate?
Common peroneal; bony fractures and compression; sciatic
APP on chrom 21 (this is why downs more susceptible)
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
Biphosphonate

19. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Pulmonary hypertension
Reiter syndrome; B27
Well

20. What is the presentation of sever aortic stenosis?
Hypothyroidism
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Syncope - angina - dyspnea (SAD)
Vertical diplopia

21. What is the difference between paranoid personality disorder and delusional disorder?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
gram positive organisms
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
...

22. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Strength of cell mediated immune response
11 aa polypeptide; pain NT in CNS and PNS
Bile salt accumulation in urine

23. What is the cause of rapid plasma decay of thiopental?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
200-500
Tissue redistribution (out of plasma) rather than metabolism
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

24. How can renal blood flow be calculated from RPF?
Drink plenty of fluids
RBF= PAH clearance/(1- hematocrit)
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Myasthenia gravis

25. What is the precursor protein to beta amyloid and On what chromosome is it found?
Extrinsic def; instrinsic def; platelet def
Proteasome inhibitor; treatment for MM and waldenstroms
APP on chrom 21 (this is why downs more susceptible)
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

26. what diseases can vit A be used to treat?
Southern - western
Bronchial dilation (bronchiectasis)
Measles and M3 AML`
V fib; v. failure

27. How do bradykinin - C3a and C5a cause edema?
Permissive - sensitizes vasoconstrictive response from catecholamines - doesnt actually act on them but increases transcription of some genes that creates permissive effect (not additive or synergistic becuase cortisol alone doesnt have any effect on
Myasthenia gravis
By vascular permeability and vasodilation
Prevent phagocytosis

28. what happens to capacitance with age?
...
Medial part
E. coli
Cluster

29. What is intussusception? how does ischemia and necrosis occur?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Classical conditioning
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

30. What is the fibrinogen level in patient with TTP- HUS? DIC?
Vertical diplopia
Around 70 (normal measured diastolic pressures); 9--
Decreases both
Normal; low

31. neisseria are...
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
facultative intracellular
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

32. What causes the blurry vision side effects in first generation anti histamines?
Sarcoid
glycerol kinase
FGF and VEGF
Anti cholinergic effects of pupil dilation and lack of accomodation

33. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Hexokinase
Regular insulin (Not fast acting - regular better)
Both sides
Integration of viral DNA into genome of host hepatocytes

34. What is difference between Arnold Chiari type I and II?
I is more benign and can present later in adulthood
Acute gastric mucosal defects (superficial or full thickness)
Increased reticulocytes
Skin flushing and warmth; prostaglandins; give with aspirin

35. What is the mc manifestation of CMV in HIV patient? immunocompetent?
Myasthenia gravis
Inhibits it
Bronchogenic carcinoma
Retinitis; mononucleosis

36. In what population does cholelithiasis occur?
Chlorpheniramine and diphenhydramine
Reticulocytes
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Fat - fertile - forty - female

37. non ceruloplasmin deposition - ceruloplasmin is...
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
frameshift mutations (missense is substitution)
low in serum
<1% - 55% - concentration dependent

38. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
OCPs - multiparity - breast feeding
Bile salt accumulation in urine
Valproate
Fibronectin - laminin - collagen

39. What three factors effect total oxygen content of blood?
Standing suddenly from supine position; valsalva maneuver
Medial circumflex artery; avascular necrosis
RBF= PAH clearance/(1- hematocrit)
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

40. how long is substance P? What does it do?
Increase by 50% in urine osmolality
Superior larygeal; cricothyroid; recurrent laryngeal
Adeno
11 aa polypeptide; pain NT in CNS and PNS

41. What is cataplexy and When is it seen?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
RER; copper
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

42. within the right atrium - What is the maximum pressure? left atrium?
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
8; 12
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

43. How do you explain the selective proteinuria of loss to albumin only in MCD?
Medial part
Recurrent larygneal
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Prostate tumor and increased osteoclast activity

44. When does opening snap begin?
Measles and M3 AML`
PDA open
Right before diastole (filling begins)
Trauma to stereociliated hair cells of the organ of corti

45. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
MAO inhibitors; wine and cheese
Both sides
Single adenomatous ones
H. influenzae type B; polyribosyl phosphate (PRP); cherry red uvula - dysphagia - stridor (sometimes) - difficulty breathing - fever - drooling - positive 'thumbs up sign' on lateral xray of cervical region d/t swollen epiglottis

46. What are diastolic (lowest) pressures in aorta? LV?
Medial part
RBC mass; epo levels (secondary has high)
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Around 70 (normal measured diastolic pressures); 9--

47. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
No and yes
indomethacin

48. What is the presentation of angioedema? Where is most commonly affected?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Joints d/t increased purine production and thus uric acid production
Kallmans

49. do Class IC agents prolong the QT interval?
Serum creatine kinase; reperfusion injury causes necrosis
Fibronectin - laminin - collagen
Radial nerve damage
No

50. what protects the resting heart from arrhythmias?
S. saprophyticus - and s. epidermidis; novobiocin
Highly negative resting potential
Inhibits it
Neisseria induced small cell vasculitis (including hands and soles)