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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. within the right atrium - What is the maximum pressure? left atrium?
V fib; v. failure
Reticulocytes
8; 12
By vascular permeability and vasodilation

2. What is the triad seen in pre eclampsia?
V fib; v. failure
Hypertension - edema - and proteinuria
Vagus (auricular branch); vasovagal syncope!
In the extracellular space for collagen cross linking; zinc

3. what should you think of in 'smear of an oral ulcer base'?
Joints d/t increased purine production and thus uric acid production
Tzanck smear
NF- KB; responsible for cytokine production
Env genes (for getting into target cells)

4. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Leukotriene precursor and does neutrophil chemotaxis
Prevent phagocytosis
11 aa polypeptide; pain NT in CNS and PNS

5. how does neisseria cause a petechial rash?
Folic acid treatment!
FGF and VEGF
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
Neisseria induced small cell vasculitis (including hands and soles)

6. what chromosome is c - myc found on?
Syncope - angina - dyspnea (SAD)
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Closer to head; closer to diaphragm
Chrom 8

7. What can cause aortic regurg? What is the heart sound you hear?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Bile salt accumulation in urine
Vagus nerve stimulation
Standing suddenly from supine position; valsalva maneuver

8. why should you not use ACE inhibitors with someone who had hereditary angioedema?
Well
Lateral; RV; RA; LV
Around 70 (normal measured diastolic pressures); 9--
Because ACE blocks breakdown of bradykinin and hereditary angioedema patients have high levels of bradykinin; high levels of bradykinin - C3a - and C5a mediate edema by increasing vascular permeability and vasodilation

9. What is cataplexy and When is it seen?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Ketone body production by preventing fatty acids into the mitochondria
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

10. What do you treat s. epidermidis with?
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
Vancomycin
Minimal change disease
25; 25

11. What is the diagnosis in delayed puberty plus anosmia?
Kallmans
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)
Demargination of neutrophils from the vessel walls
In ER of bile canaliculi

12. What is gardeners mydriasis? How is it treated?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
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)

13. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Increase; decreased
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Spongiosis
Amiadarone

14. what indicates the severity of a mitral regurg ? mitral stenosis?
Phencyclidine (PCP)
S3 gallop; S2 to opening snap interval
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Because ACE blocks breakdown of bradykinin and hereditary angioedema patients have high levels of bradykinin; high levels of bradykinin - C3a - and C5a mediate edema by increasing vascular permeability and vasodilation

15. What pulmonary structural change can kartageners syndrome cause?
Right heart failure
Adductor
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Bronchial dilation (bronchiectasis)

16. What is capacitance inversely proportional to?
Vancomycin
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Serum FFA and serum triglyceride levels
Elastance

17. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Joints d/t increased purine production and thus uric acid production
Increase; decreased
P53 mutation; AD
Susceptible; soluble (unable to be cultured in bile)

18. What is damaged in early syringomelia? later?
SSRI; erectile dysfunction
No and yes
Faulty positioning of the genital tubercle
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

19. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
Retinitis; mononucleosis
Acute gastric mucosal defects (superficial or full thickness)
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

20. What are the potassium sparing diuretics?
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Amiloride - spironolactone - triamterene
Because of vasodiation to skeletal muscles
SVC and IVC; right below the aortic knob

21. What are the first generation anti histamines?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
C3 decreased after 5-10 days; sulfonamides
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
Chlorpheniramine and diphenhydramine

22. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Class I
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Protamine sulfate

23. other than proteinuria - What can cause foamy froathy urine?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Initiation - pointing; pincer grasp; walking; mama/dada
Medial part
Bile salt accumulation in urine

24. which type of glands produce an initially odorless secretion but can become malodorous secondary to bacterial decompisition on the skin surface? which glands are present throughout the skin except on lips and glans penis?
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Apocrine; eccrine
NF- KB; responsible for cytokine production
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

25. What is normal fibrinogen levels?
Radial nerve and deep brachial artery
200-500
SS +rNA
Close but purkinje system to ensure contraction in a bottom up fashion

26. What is diphenoxylate and What is it used for? what drug is it structurally similar to? What allows for potent anti diarrheal effect without signigicant opiate effects?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
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)
Turbulence
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

27. What is a common complication of acute pancreatitis? What is it?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Appetite suppressants
Fat - fertile - forty - female
8 (myc protein) with 2 - 14 - 22 (iG chains)

28. which nerve in the lower leg is easily injured and causes foot drop ? What are common causes? From what nerve does it branch off or?
Common peroneal; bony fractures and compression; sciatic
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Valproate

29. do Class IC agents prolong the QT interval?
No
Pulmonic and systemic!
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Because of the low output from heart failure - they will have increased aldosterone levels

30. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
hyponatremia (aldosterone activation equilibrates body volume)
Minimal change disease
Initiation - pointing; pincer grasp; walking; mama/dada

31. What is the precursor protein to beta amyloid and On what chromosome is it found?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
ATP binding (resets the myosin head to contract again for next binding)
APP on chrom 21 (this is why downs more susceptible)
Ig A deficiency

32. what dictates the resting membrane potential of most cells?
Syringomelia
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
High potassium conductance and some sodium conductance
Regular insulin (Not fast acting - regular better)

33. who bleed more DIC or TTP- HUS patients?
Superior larygeal; cricothyroid; recurrent laryngeal
Prepatellar
DIC; TTP- HUS dont bleed that much
Hypothyroidism

34. which staphylococci can do mannitol fermaentation?
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Purkinje system; AV node
Biphosphonate
S. aureus

35. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Faulty positioning of the genital tubercle
Aromatase deficiency in child
Atrial
Reiter syndrome; B27

36. What is Tzanck smear used to detect?
Adeno
Primary
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
HSV and VZV

37. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
P53 mutation; DCC is also required for adenoma to carcinoma
E. coli; staphylococcus saprophyticus

38. What is used to treat heparin toxicity?
Think Hb deformation diseases
Protamine sulfate
As a CO2 carrier with the carboxylase enzyme
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

39. What is used to prevent vertical transmission of HIV?
ZDV or AZT
Medial part
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Hydrogen bonds dictate alpha or beta structure

40. what makes bruits?
Turbulence
Fat - fertile - forty - female
On cardiac tissue and renal juxtaglomerular cells
Kallmans

41. What is epispadias caused by?
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
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Faulty positioning of the genital tubercle

42. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Prevents hepatic VLDL production
Apocrine; eccrine

43. which RPGN is also called pauci immune GN? why?
ANCA because of lack of Ig and C3 deposits on IF
Protamine sulfate
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
No; yes

44. What effects does cortisol have on catecholamines?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
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
Squatting - sitting - lying supine - passive leg raising
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase

45. What is suggestive of complete central DI?
Increase by 50% in urine osmolality
low in serum
Susceptible; soluble (unable to be cultured in bile)
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

46. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
Bile soluble which means they are bile sensitive
Closer to head; closer to diaphragm
SVC and IVC; right below the aortic knob
Both sides

47. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
Underestimation of gestational age
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

48. neisseria are...
Southern - western
facultative intracellular
Mean greater than median greater than mode
Covalent (between two cysteines)- allows protein to withstand denaturation

49. When is an S4 sound normal?
Right heart failure
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Turbulence
Well trained athletes and children

50. when do ghon complexes form - primary or secondary TB?
By vascular permeability and vasodilation
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Pain reliever - reduces pain by locking substance P in the PNS
Primary