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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 are diastolic (lowest) pressures in aorta? LV?
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
Turners`
Vagus (auricular branch); vasovagal syncope!
Around 70 (normal measured diastolic pressures); 9--

2. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
Bile soluble which means they are bile sensitive
Apocrine; eccrine
Minimal change disease
Superior larygeal; cricothyroid; recurrent laryngeal

3. What are the two coagulase negative staphylococci? How do you distinguish them?
S. saprophyticus - and s. epidermidis; novobiocin
FGF and VEGF
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
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

4. 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?
Apocrine; eccrine
Downs; regurgitant AV valves - ASDs
Appetite suppressants
Right heart failure

5. How do you calculate excretion rate of a substance? How do you calculate the filtration rate of a substance? clearance of what substance estimates the GFR?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
RBF= PAH clearance/(1- hematocrit)
Squatting - sitting - lying supine - passive leg raising
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

6. What is mcc of death pre hospital phase of MI? in hospital phase?
Curlings ulcers
frameshift mutations (missense is substitution)
Coagulation factors are made in the liver
V fib; v. failure

7. What are the two growth factors associated with angiogenesis?
FGF and VEGF
Tzanck smear
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
frameshift mutations (missense is substitution)

8. What does C1 esterase do other than inhibiting complement pathway?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Lateral; RV; RA; LV
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Inactivates kallikrein which activates kininogen into bradykinin

9. 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
Hereditary angioedema; ACE inhibitors
Normal; low
Inhibits it

10. which cells produce surfactant? which ones mediate gas exchange?
II; I (I more abundant)
SVT; increases vagal tone; rectus abdominis
differentiate
Serum FFA and serum triglyceride levels

11. What does Rb protein do? what chrom is it on?
Both sides
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Radial nerve damage
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

12. What is used to prevent vertical transmission of HIV?
PDA open
Large stroke volumes with ventricular contraction; aortic regurg
Gluteus medius and minimus; positive trendelenberg
ZDV or AZT

13. What is contraindicated in toxic mega colon?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Sickle cell; G6PD
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Purkinje system; AV node

14. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Elevated GGT and macrocytosis
Susceptible; soluble (unable to be cultured in bile)
Turners`
S3 gallop; S2 to opening snap interval

15. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
8 (myc protein) with 2 - 14 - 22 (iG chains)
Skin flushing and warmth; prostaglandins; give with aspirin
Hexokinase
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

16. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
Rabies encephalitis from cave bats; rabies killed vaccines
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Demargination of neutrophils from the vessel walls
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

17. Metronidizaole does not cover...
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
gram positive organisms
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
II; I (I more abundant)

18. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Susceptible; soluble (unable to be cultured in bile)
Nocardia
women

19. What does L/S stand for in fetal lung maturity? When does maturity occur?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
<1% - 55% - concentration dependent
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Pulmonic and systemic!

20. which nerve provides innervation for plantar flexion and inversion?
Smoking
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
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Tibial

21. Where does complement bind on the Fc region of Ig chains?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
No

22. what would be a sign of absence of cardiogenic pulm edem?
Adeno
Southern - western
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Hereditary angioedema; ACE inhibitors

23. In what population does cholelithiasis occur?
Fat - fertile - forty - female
Dissolved in plasma and attached to Hgb
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Ig A deficiency

24. What type of drug is alendronate?
Recurrent larygneal
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Biphosphonate
INTRApartum Abs (ampicillin/penicillin)

25. hypertonicity and hyperreflexity are ________________ of hydrocephalus
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
manifestations - congenital (stretching of periventricular pyrimadal fibers)
PDA open
Measure of depth invasion (vertical!)

26. What is the mc manifestation of CMV in HIV patient? immunocompetent?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
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
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
Retinitis; mononucleosis

27. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Normally close to systolic
Class I
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

28. What is the most common location of colonization of all s. aureus types?
HSV and VZV
SS +rNA
Anterior nares
Covalent (between two cysteines)- allows protein to withstand denaturation

29. in overweight individuals What is thought to contribute to insulin resistance?
Vancomycin; histamine mediated
Appetite suppressants
Serum FFA and serum triglyceride levels
Vertical diplopia

30. which are the only glycosylated proteins in HIV virus?
Env genes (for getting into target cells)
Curlings ulcers
Relfex tachycardia; giving beta blockers
Protamine sulfate

31. what makes bruits?
Turbulence
Integration of viral DNA into genome of host hepatocytes
Superior larygeal; cricothyroid; recurrent laryngeal
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

32. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Relfex tachycardia; giving beta blockers
Well
No and yes

33. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Echinococcus granulosus; anaphylaxis
Paramyxo and influenza
200-500
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

34. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Nocardia
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
Downs; regurgitant AV valves - ASDs
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

35. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Chorda tympani branch
Demargination of neutrophils from the vessel walls
Acute gastric mucosal defects (superficial or full thickness)
hyponatremia (aldosterone activation equilibrates body volume)

36. on which chromosome is wilms tumor found?
indomethacin
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
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
11

37. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Hypo or hyper pigmentations; after tanning
Reiter syndrome; B27
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Turners`

38. what hormone is structurally similar to hCG?
TSh (in testicular tumors can cause hyperthyroidism)
hyponatremia (aldosterone activation equilibrates body volume)
Vertical diplopia
Myasthenia gravis

39. What is the best indicator for the severity of mitral stenosis?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Single adenomatous ones
The time interval between S2 and OS- the shorter the interval - the more intense

40. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
TSh (in testicular tumors can cause hyperthyroidism)
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Rabies encephalitis from cave bats; rabies killed vaccines

41. What is used to treat heparin toxicity?
Protamine sulfate
Serum FFA and serum triglyceride levels
Because of vasodiation to skeletal muscles
Rabies encephalitis from cave bats; rabies killed vaccines

42. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Cluster
ANCA because of lack of Ig and C3 deposits on IF
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

43. which nerve is at risk when ligating the superior thyroid artery? Which is the only muscle this nerve innervates? what nerve innervates all the other laryngeal muscles?
Superior larygeal; cricothyroid; recurrent laryngeal
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
Measure of depth invasion (vertical!)
11

44. IL4 is used for isotypye switching to what?
IgE
Increases bronchial and vascular smooth muscle reactivity to catecholamines
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Inhibits it

45. What are some of the permissive effects of cortisol?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Coagulation factors are made in the liver
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
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

46. What is epispadias caused by?
Faulty positioning of the genital tubercle
Reticulocytes
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Coagulation factors are made in the liver

47. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Closer to head; closer to diaphragm
APP on chrom 21 (this is why downs more susceptible)
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
HSV ( also in utero: chlymadia - neisseria - group B strep)

48. How do you treat gonococcal infection? chlymadia?
Ceftriaxone; azithromycin
Think Hb deformation diseases
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Aromatase deficiency in child

49. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Folic acid treatment!
Hereditary angioedema; ACE inhibitors
Because of the low output from heart failure - they will have increased aldosterone levels
Nocardia

50. What is the presentation of sever aortic stenosis?
11
Syncope - angina - dyspnea (SAD)
Classical conditioning
Increase by 50% in urine osmolality