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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 the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
Chlorpheniramine and diphenhydramine
C3 decreased after 5-10 days; sulfonamides
Dihydropyridine sensitive Ca channels (L type)
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

2. What is the diagnosis in delayed puberty plus anosmia?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
ZDV or AZT
11 aa polypeptide; pain NT in CNS and PNS
Kallmans

3. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Fibronectin - laminin - collagen
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Drink plenty of fluids
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

4. which opponens muscle does ulnar innervate?
ANCA because of lack of Ig and C3 deposits on IF
Adductor
To pump calcium out in cardiac myocytes so that relaxation occurs
High potassium conductance and some sodium conductance

5. What are the first generation anti histamines?
Chlorpheniramine and diphenhydramine
MAC complex (C5b - C9 complement deficiency)
Single adenomatous ones
Vancomycin; histamine mediated

6. where are the vegetations on the valves of a libman sacks endocarditis?
Both sides
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Sickle cell; G6PD
Turners`

7. what protects the resting heart from arrhythmias?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
transcription activation/suppression
Highly negative resting potential
Radial nerve damage

8. What type of disease has selective proteinuria? What is found in urine? What is not?
Measure of depth invasion (vertical!)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Smoking
I is more benign and can present later in adulthood

9. What type of bond is a disulfide bond?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Covalent (between two cysteines)- allows protein to withstand denaturation
Hyperkalemia; potassium sparing diuretics - potassium supplements
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

10. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
Excessive collagen formation during tissue repair in susceptible individuals
Class I
Adductor
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

11. Where does the aorta lie in relation to the pulmonary artery in transposition of the great arteries (is this right to left or left to right shunt?)?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
CGD; t cell dysfxn (diGeorge)
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
Elevated GGT and macrocytosis

12. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
Enterococci (e. faecalis)- found on genitalia area
Pan colitis and right sided colitis (more than left sided and proctitis)
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Env genes (for getting into target cells)

13. Acyl coA synthetase is not...
RBC mass; epo levels (secondary has high)
RBF= PAH clearance/(1- hematocrit)
liver specific
glycerol kinase

14. What causes curlings ulcers?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Localized dermatologic pain that persists for more than one month after zoster eruption
Elastance
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

15. What is a keloid?
Excessive collagen formation during tissue repair in susceptible individuals
Kallmans
Bile salt accumulation in urine
Normal; low

16. How do you explain the selective proteinuria of loss to albumin only in MCD?
Class I
Anterior circumflex (and axillary nerve)
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Anti - apoptotic (prevents going into apoptosis)- 18; 14

17. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
Hypothyroidism
As a CO2 carrier with the carboxylase enzyme
RBC mass; epo levels (secondary has high)
Tzanck smear

18. What is cataplexy and When is it seen?
Prevents hepatic VLDL production
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

19. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Vancomycin; histamine mediated
Turners`
Right heart failure

20. How do you treat gonococcal infection? chlymadia?
Ceftriaxone; azithromycin
Single adenomatous ones
indomethacin
Brief psychotic disorder; schizophreniform; schizophrenia

21. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
facultative intracellular
Turners`
Prostate tumor and increased osteoclast activity
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

22. which antiarrythmic is associated with blue gray discoloration ?
Amiadarone
The time interval between S2 and OS- the shorter the interval - the more intense
Echinococcus granulosus; anaphylaxis
Serum FFA and serum triglyceride levels

23. what dictates the resting membrane potential of most cells?
Prostate tumor and increased osteoclast activity
8 (myc protein) with 2 - 14 - 22 (iG chains)
Increase in permeability of two ions with equal and opposite equilibrium potentials
High potassium conductance and some sodium conductance

24. Where does conjugation of bilirubin take place?
Smoking
Echinococcus granulosus; anaphylaxis
In ER of bile canaliculi
Proteasome inhibitor; treatment for MM and waldenstroms

25. What agonists reduce the gradient across the LV outflow tract?
Selective alpha 1 (increases SVR)
S. aureus
Normally close to systolic
No and yes

26. what organ would an activating mutation in PRPP synthetase effect?
SSRI; erectile dysfunction
Multiple miscarriages d/t hypercoaguability
Joints d/t increased purine production and thus uric acid production
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

27. What three pathogens cause infectious esophagitis in HIV positive patients?
I is more benign and can present later in adulthood
CMV - HSV 1 - Candida
Amiadarone
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

28. what nerve and artery course along the posterior aspect of the humerus?
Radial nerve and deep brachial artery
Drink plenty of fluids
Hyperkalemia; potassium sparing diuretics - potassium supplements
SSRI; erectile dysfunction

29. what virus causes pharyngoconjuctival fever?
chronic urticaria and allergic symptoms
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Adeno
Relfex tachycardia; giving beta blockers

30. what phase do adenosine and acetylcholine act on? doing what?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Syncope - angina - dyspnea (SAD)

31. hypertonicity and hyperreflexity are ________________ of hydrocephalus
V fib; v. failure
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Radial nerve damage
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

32. What are the three causes of acute MI in context of normal coronary arteries ?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Adductor
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
25; 25

33. What is a cell surface marker seen in liver angiosarcoma?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Retinitis; mononucleosis
E. coli; staphylococcus saprophyticus
Sarcoid

34. What is epleronone?
Another type of aldosterone antagonist (like spironolactone)
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
In ER of bile canaliculi
ZDV or AZT

35. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
MAO inhibitors; wine and cheese
chronic urticaria and allergic symptoms
Localized dermatologic pain that persists for more than one month after zoster eruption
High potassium conductance and some sodium conductance

36. how does neisseria cause a petechial rash?
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
Neisseria induced small cell vasculitis (including hands and soles)
GI tract; mood!
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

37. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
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
Retinitis; mononucleosis
Kallmans

38. within the right atrium - What is the maximum pressure? left atrium?
Because gamma chains replace beta chains and then gamma chain formation wanes
8; 12
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
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

39. which RPGN is also called pauci immune GN? why?
Demargination of neutrophils from the vessel walls
Serum creatine kinase; reperfusion injury causes necrosis
Well trained athletes and children
ANCA because of lack of Ig and C3 deposits on IF

40. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Large stroke volumes with ventricular contraction; aortic regurg
Reiter syndrome; B27
Proteasome inhibitor; treatment for MM and waldenstroms

41. what happens to sperm count and semineferous tubules in patient with cryptoorchidism? hormonal function? why do they need to be surgically descended?
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
Decreases both
Serum FFA and serum triglyceride levels
Covalent (between two cysteines)- allows protein to withstand denaturation

42. which two virus families have hemagluttinin on their surface?
Paramyxo and influenza
In ER of bile canaliculi
Little effect on cell and no change
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

43. what has the greatest effect on prognosis when treating c. diptheriae?
Purkinje system; AV node
Common and benign congenital disorder characterized by cystic dilation of the medullary collecting ducts (cortex is spared); painless hematuria or asymptomatic; mc is development of kidney stones (benign disease)
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

44. What does hypocapnia cause in teh brain? What is hypocapnia?
Insulin like growth factor 1 (just another name)
Skin flushing and warmth; prostaglandins; give with aspirin
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

45. What is medullary sponge kidney disease and how does it present? What does it lead to?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Common and benign congenital disorder characterized by cystic dilation of the medullary collecting ducts (cortex is spared); painless hematuria or asymptomatic; mc is development of kidney stones (benign disease)
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
S. saprophyticus - and s. epidermidis; novobiocin

46. erythema nodosum - elevated ACE - scattered granulomas - arthralgias - hilar lymphadenoapthy are indicative of what?
Sarcoid
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Bronchogenic carcinoma
transcription activation/suppression

47. how does noise induced hearing loss occur?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Trauma to stereociliated hair cells of the organ of corti
Varying; erythema nodosum is common
Bile salt accumulation in urine

48. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Vancomycin
GI tract; mood!
Increased reticulocytes
I is more benign and can present later in adulthood

49. What is damaged in early syringomelia? later?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Faulty positioning of the genital tubercle
Drink plenty of fluids
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

50. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Decreases both
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
Valproate
Highly negative resting potential