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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 can cause aortic regurg? What is the heart sound you hear?
Skin flushing and warmth; prostaglandins; give with aspirin
transcription activation/suppression
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Right before diastole (filling begins)

2. What is the most common neurologic complication of VZV reactivation?
Localized dermatologic pain that persists for more than one month after zoster eruption
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
glycerol kinase
Proteasome inhibitor; treatment for MM and waldenstroms

3. What is epispadias caused by?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
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
Faulty positioning of the genital tubercle
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

4. which cells produce surfactant? which ones mediate gas exchange?
II; I (I more abundant)
Hexokinase
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

5. What are the acute effects of corticosteroids on the CBC?
Pulmonic and systemic!
Recurrent larygneal
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Faulty positioning of the genital tubercle

6. 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?
Relfex tachycardia; giving beta blockers
Common peroneal; bony fractures and compression; sciatic
Boiling - bleach - formalin - UV irradiation
Excessive collagen formation during tissue repair in susceptible individuals

7. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
Mean greater than median greater than mode
Demargination of neutrophils from the vessel walls
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Syncope - angina - dyspnea (SAD)

8. How do you treat gonococcal infection? chlymadia?
only up to bronchi
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Ceftriaxone; azithromycin
Mean greater than median greater than mode

9. What is the presentation of sever aortic stenosis?
hyponatremia (aldosterone activation equilibrates body volume)
Neisseria induced small cell vasculitis (including hands and soles)
Syncope - angina - dyspnea (SAD)
Integration of viral DNA into genome of host hepatocytes

10. What is 5- HETE and What does it do?
Leukotriene precursor and does neutrophil chemotaxis
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
No (unlike adenomyosis); yes
Sarcoid

11. What is a keloid?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Excessive collagen formation during tissue repair in susceptible individuals
Echinococcus granulosus; anaphylaxis
Medial part

12. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
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)
RBF= PAH clearance/(1- hematocrit)
RR-1/RR

13. In what form are mitochondrial DNA? What do they transcribe?
Valproate
Neisseria induced small cell vasculitis (including hands and soles)
Circular - outside nucleus; transport proteins - rRNA - tRNA
Curlings ulcers

14. Where does 90% of serotonin lie? What is this NT responsible?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
GI tract; mood!
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

15. Where does terminal peptide cleavage of collagen fibrils take place?
Gluteus medius and minimus; positive trendelenberg
Because gamma chains replace beta chains and then gamma chain formation wanes
In the extracellular space
Ceftriaxone; azithromycin

16. what clinical findings help distinguish small cell carcinoma?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Fibronectin - laminin - collagen

17. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Increased reticulocytes
Skin flushing and warmth; prostaglandins; give with aspirin
V fib; v. failure
Medullary

18. 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
HSV ( also in utero: chlymadia - neisseria - group B strep)
P53 mutation; AD
Measure of depth invasion (vertical!)

19. What is the preferred treatment for DKA?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Regular insulin (Not fast acting - regular better)
hyponatremia (aldosterone activation equilibrates body volume)
Chorda tympani branch

20. What type of mutation does aflatoxin cause? what cancer does this increase for?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
G to T in p53; HCC
To pump calcium out in cardiac myocytes so that relaxation occurs
Relfex tachycardia; giving beta blockers

21. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
only up to bronchi
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Purkinje system; AV node
Apocrine; eccrine

22. What does the tuberoinfundibular pathway connect? What is it responsible for?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Localized dermatologic pain that persists for more than one month after zoster eruption

23. why are beta thal major patients asymptomatic at birth?
Inactivates kallikrein which activates kininogen into bradykinin
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Because gamma chains replace beta chains and then gamma chain formation wanes
Localized dermatologic pain that persists for more than one month after zoster eruption

24. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
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)
Gluteus medius and minimus; positive trendelenberg
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

25. how does eos release MBP to kill protozoa etc?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Trochlear nerve (IV); abducens nerve (VI)
Increases
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

26. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
Raphe
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Rabies encephalitis from cave bats; rabies killed vaccines
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)

27. what dictates the resting membrane potential of most cells?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
High potassium conductance and some sodium conductance
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Headaches and facial flushing; vasodilation in meninges and skin

28. What is the sole neurologic manifestation of acute rheumatic fever?
S. aureus
Sydenham chorea
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Acute interstitial nephritis

29. What is used to compare means? categorical outcomes?
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
Because of vasodiation to skeletal muscles
T test; chi squared
Decreases both

30. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Recurrent larygneal
On cardiac tissue and renal juxtaglomerular cells
RER; copper

31. other than proteinuria - What can cause foamy froathy urine?
Trauma to stereociliated hair cells of the organ of corti
Bile salt accumulation in urine
Radial nerve damage
Because of the low output from heart failure - they will have increased aldosterone levels

32. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
SS +rNA
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Myasthenia gravis

33. which staphylococci can do mannitol fermaentation?
S. aureus
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
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
PDA open

34. why is glucagon used in beta blocker toxicitiy?
Ig A deficiency
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Octreotide
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

35. what hormone is structurally similar to hCG?
Amiadarone
TSh (in testicular tumors can cause hyperthyroidism)
11
Prevent phagocytosis

36. What is the neurologic manifestation of ADPKD?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Because of vasodiation to skeletal muscles
TCAs and prazosin
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

37. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
Primary
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Intussusception

38. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
HSV and VZV
...
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

39. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Gluteus maximus; difficulty getting up from seated position and climbing chair
Highly negative resting potential
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Valproate

40. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Right before diastole (filling begins)
MAO inhibitors; wine and cheese
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

41. other than parvo B19 - what else is associated with red cell aplasia?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Thymic tumor
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
S3 gallop; S2 to opening snap interval

42. ___________ is liver specific
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
glycerol kinase
Varying; erythema nodosum is common
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

43. What causes curlings ulcers?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Diabetic microangiopathy
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

44. SIADH patients have normal blood volume but...
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
hyponatremia (aldosterone activation equilibrates body volume)
SVT; increases vagal tone; rectus abdominis

45. What three pathogens cause infectious esophagitis in HIV positive patients?
CMV - HSV 1 - Candida
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

46. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Curlings ulcers
<1% - 55% - concentration dependent
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

47. what drugs causes the red man syndrome? how does it occur?
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)
46 - 4N; 23 2N
Ig A deficiency
Vancomycin; histamine mediated

48. Where does lysyl oxidase act? What is the cofactor for that?
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
In the extracellular space for collagen cross linking; zinc
T test; chi squared
Abnormal closing of the urethral folds

49. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Adeno
Coagulation factors are made in the liver
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

50. What is diagnostic (and possible therapeutic for intussusception)?
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Barium enema
Tissue redistribution (out of plasma) rather than metabolism
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)