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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. there are mucus secreting cells in the bronchioles...
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Neisseria induced small cell vasculitis (including hands and soles)
Coagulation factors are made in the liver
only up to bronchi

2. What are the long term consequences of hydrocephalus?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
...
Barium enema
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

3. When is acid phosphatase elevated (Name two times)?
Prostate tumor and increased osteoclast activity
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Another type of aldosterone antagonist (like spironolactone)

4. name three pathological states that present with large tongues.
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Downs; regurgitant AV valves - ASDs
SSRI; erectile dysfunction

5. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Adductor
GI malignancies and Insulin resistance (acromegal for ex)
Valproate
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

6. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
Tibial
Gluteus maximus; difficulty getting up from seated position and climbing chair
Dihydropyridine sensitive Ca channels (L type)
No and yes

7. What causes release of myosin head from the actin filament?
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
200-500
ATP binding (resets the myosin head to contract again for next binding)
HSV and VZV

8. what nerve and artery course along the posterior aspect of the humerus?
Chrom 8
Radial nerve and deep brachial artery
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase

9. what virus causes pharyngoconjuctival fever?
Cluster
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Adeno
Turners`

10. what dictates the resting membrane potential of most cells?
SS +rNA
Insulin like growth factor 1 (just another name)
Tzanck smear
High potassium conductance and some sodium conductance

11. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Increases
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

12. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
HSV ( also in utero: chlymadia - neisseria - group B strep)
CGD; t cell dysfxn (diGeorge)
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
No

13. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
200-500
Prepatellar
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
frameshift mutations (missense is substitution)

14. What is intussusception? how does ischemia and necrosis occur?
Insulin like growth factor 1 (just another name)
Regular insulin (Not fast acting - regular better)
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
glycerol kinase

15. how can HAV be inactivated?
Inhaled animal dander allergens
Nonsense; mRNA processing
Thymic tumor
Boiling - bleach - formalin - UV irradiation

16. What is Tzanck smear used to detect?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
ZDV or AZT
HSV and VZV
Vagus (auricular branch); vasovagal syncope!

17. What causes wrist drop?
In the extracellular space for collagen cross linking; zinc
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Smoking
Radial nerve damage

18. What is the mutation type in thalassemias? what process is defective because of this?
Nonsense; mRNA processing
Brief psychotic disorder; schizophreniform; schizophrenia
Localized dermatologic pain that persists for more than one month after zoster eruption
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

19. What are pancreatic pseudocysts called pseudo rather than true cysts?
MAC complex (C5b - C9 complement deficiency)
Circular - outside nucleus; transport proteins - rRNA - tRNA
Vascular endothelium; protease
Not lined by epithelium

20. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Downs; regurgitant AV valves - ASDs
Close but purkinje system to ensure contraction in a bottom up fashion
Lateral; RV; RA; LV
I is more benign and can present later in adulthood

21. What antibodies are present in CREST? What is the most specific?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Circular - outside nucleus; transport proteins - rRNA - tRNA
APP on chrom 21 (this is why downs more susceptible)
Anti centromere; anti DNA topoisomerase

22. What is pickwickian syndrome? What are the lab findings?
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Drink plenty of fluids
Bronchial dilation (bronchiectasis)
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

23. is Rifampin ever used as monotherapY? why either way?
No only for prophylaxis (even for treating staphylococcal endocarditis its as multi drug); this is to prevent drug resistance from spontaneous mutations by DNA dependent RNA polymerase
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
frameshift mutations (missense is substitution)

24. What are two indicators of chronic alcohol consumption?
CGD; t cell dysfxn (diGeorge)
Aromatase deficiency in child
Not lined by epithelium
Elevated GGT and macrocytosis

25. What are the two growth factors associated with angiogenesis?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
FGF and VEGF
Ether and other organic solvents
Increase by 50% in urine osmolality

26. What is normal fibrinogen levels?
Spongiosis
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Skin flushing and warmth; prostaglandins; give with aspirin
200-500

27. why does neutrophila occur with corticosteroids?
glycerol kinase
Demargination of neutrophils from the vessel walls
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

28. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
Curlings ulcers
V fib; v. failure
Drink plenty of fluids
Circular - outside nucleus; transport proteins - rRNA - tRNA

29. How can renal blood flow be calculated from RPF?
Biphosphonate
Because gamma chains replace beta chains and then gamma chain formation wanes
RBF= PAH clearance/(1- hematocrit)
E. coli

30. metabolism of 1 gram of protein produces How many calories? carb? fat?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Syncope - angina - dyspnea (SAD)
Sickle cell; G6PD
4 - 4 - 9

31. What is used to treat heparin toxicity?
Classical conditioning
Mean greater than median greater than mode
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Protamine sulfate

32. What does anti phospholipid syndrome in SLE patients predispose them to?
Excessive collagen formation during tissue repair in susceptible individuals
Multiple miscarriages d/t hypercoaguability
Gluteus medius and minimus; positive trendelenberg
Abnormal closing of the urethral folds

33. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Chorda tympani branch
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)
Sydenham chorea

34. 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?
Cluster
To pump calcium out in cardiac myocytes so that relaxation occurs
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

35. which has better side effect profile - SSRI or TCA?
Primary
low in serum
SSRI
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

36. Acyl coA synthetase is not...
Prevent phagocytosis
Paramyxo and influenza
Acute interstitial nephritis
liver specific

37. why is glucagon used in beta blocker toxicitiy?
IgE
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Turners`

38. if there are keratin swirls does that mean well or poorly differentiated?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Well
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Prepatellar

39. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Classical conditioning
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Recurrent larygneal
liver specific

40. What translocations can cause c - myc overexpression?
Class I
8 (myc protein) with 2 - 14 - 22 (iG chains)
Because of vasodiation to skeletal muscles
ZDV or AZT

41. What is 5- HETE and What does it do?
CMV - HSV 1 - Candida
Leukotriene precursor and does neutrophil chemotaxis
Appetite suppressants
Sickle cell; G6PD

42. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
OCPs - multiparity - breast feeding
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
...
S. saprophyticus - and s. epidermidis; novobiocin

43. Which nerve lies in close proximity to the inferior thyroid artery?
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Regular insulin (Not fast acting - regular better)
Recurrent larygneal
Ig A deficiency

44. which nerve provides innervation for plantar flexion and inversion?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Diabetic microangiopathy
Radial nerve and deep brachial artery
Tibial

45. which antiarrythmic is associated with blue gray discoloration ?
Multiple miscarriages d/t hypercoaguability
Amiadarone
FGF and VEGF
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

46. PDAs are often asymptomatic. How do you treat?
indomethacin
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
MAO inhibitors; wine and cheese
Both sides

47. what marker should be followed in a patient with cirrhosis?
Insulin like growth factor 1 (just another name)
Ig A deficiency
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Increases

48. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
Octreotide
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
The time interval between S2 and OS- the shorter the interval - the more intense
Prevents hepatic VLDL production

49. What are examples of action that decrease venous return to the heart?
Standing suddenly from supine position; valsalva maneuver
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Trauma to stereociliated hair cells of the organ of corti
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

50. What is the best indicator for the severity of mitral stenosis?
The time interval between S2 and OS- the shorter the interval - the more intense
Skin flushing and warmth; prostaglandins; give with aspirin
Anti centromere; anti DNA topoisomerase
Insulin like growth factor 1 (just another name)