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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. When does neovascularization granulation tissue begin to form after severe ischemia and MI? what happens in 12-24 hours? 2 weeks to 2 months? 1-5 days? 0-4 hours? when do you see edema - hemorrhage - wavy fibers?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
To pump calcium out in cardiac myocytes so that relaxation occurs
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

2. What is the immune deficinecy seen in ataxia telangactasia?
S. aureus
Ig A deficiency
No; yes
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

3. What is damaged in early syringomelia? later?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
S. aureus

4. What type of mutation does aflatoxin cause? what cancer does this increase for?
G to T in p53; HCC
Little effect on cell and no change
Pulmonary hypertension
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

5. who bleed more DIC or TTP- HUS patients?
DIC; TTP- HUS dont bleed that much
Skin flushing and warmth; prostaglandins; give with aspirin
Inhibits it
Normal; low

6. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
No; yes
To pump calcium out in cardiac myocytes so that relaxation occurs
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

7. which opponens muscle does ulnar innervate?
Adductor
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Lateral; RV; RA; LV
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

8. What is the mcc of elevated AFP leves in pregnancy>
200-500
(urine PAH x urine flow rate)/plasma PAH
Proteasome inhibitor; treatment for MM and waldenstroms
Underestimation of gestational age

9. hypertonicity and hyperreflexity are ________________ of hydrocephalus
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Hypothyroidism

10. what drug is useful for secretory diarrhea?
Octreotide
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Skin flushing and warmth; prostaglandins; give with aspirin
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

11. What is medullary sponge kidney disease and how does it present? What does it lead to?
Standing suddenly from supine position; valsalva maneuver
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)
Raphe
Closer to head; closer to diaphragm

12. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Downs; regurgitant AV valves - ASDs
P450 mitochondrial monooxygenase

13. what makes bruits?
Turbulence
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Thymic tumor

14. What causes vertical diplopia? horizontal?
200-500
Trochlear nerve (IV); abducens nerve (VI)
Increases bronchial and vascular smooth muscle reactivity to catecholamines
GI malignancies and Insulin resistance (acromegal for ex)

15. What is intussusception? how does ischemia and necrosis occur?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
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
Susceptible; soluble (unable to be cultured in bile)
Closer to head; closer to diaphragm

16. What is the sole neurologic manifestation of acute rheumatic fever?
Sydenham chorea
RER; RER
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

17. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
Paramyxo and influenza
Not lined by epithelium
E. coli; staphylococcus saprophyticus
Spongiosis

18. what dictates the resting membrane potential of most cells?
Folic acid treatment!
High potassium conductance and some sodium conductance
Proteasome inhibitor; treatment for MM and waldenstroms
Amiloride - spironolactone - triamterene

19. What is the most important prognostic indicator in patients with malignant melanoma?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Anterior circumflex (and axillary nerve)
Dissolved in plasma and attached to Hgb
Measure of depth invasion (vertical!)

20. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
gram positive organisms
Not lined by epithelium
No (unlike adenomyosis); yes
Ig A deficiency

21. What are the acute effects of corticosteroids on the CBC?
Think Hb deformation diseases
8 (myc protein) with 2 - 14 - 22 (iG chains)
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Elevated GGT and macrocytosis

22. how does increased ICP result in curlings ulcers?
Pain reliever - reduces pain by locking substance P in the PNS
Vagus nerve stimulation
Appetite suppressants
Ig A deficiency

23. 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
Abnormal closing of the urethral folds
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Diabetic microangiopathy

24. How do you explain the selective proteinuria of loss to albumin only in MCD?
Phencyclidine (PCP)
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
SaO2 <92%
P450 mitochondrial monooxygenase

25. within the right atrium - What is the maximum pressure? left atrium?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
8; 12
ATP binding (resets the myosin head to contract again for next binding)

26. What do you treat s. epidermidis with?
Right heart failure
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
Hypertension - edema - and proteinuria
Vancomycin

27. What is Tzanck smear used to detect?
HSV and VZV
Acute interstitial nephritis
SSRI
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

28. What are diastolic (lowest) pressures in aorta? LV?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Around 70 (normal measured diastolic pressures); 9--
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
RER; RER

29. What actions increase venous return?
Squatting - sitting - lying supine - passive leg raising
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
In the extracellular space for collagen cross linking; zinc
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

30. What are the skin presentation in sarcoid?
II; I (I more abundant)
Coagulation factors are made in the liver
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
Varying; erythema nodosum is common

31. What is a cell surface marker seen in liver angiosarcoma?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Large stroke volumes with ventricular contraction; aortic regurg
Neisseria induced small cell vasculitis (including hands and soles)
Curlings ulcers

32. When is acid phosphatase elevated (Name two times)?
The term used to describe decreased drug responsiveness with repeated administration
Prostate tumor and increased osteoclast activity
Atrial
Increase in permeability of two ions with equal and opposite equilibrium potentials

33. What is suggestive of complete central DI?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Another type of aldosterone antagonist (like spironolactone)
Tzanck smear
Increase by 50% in urine osmolality

34. at one year of age - What are the social - fine motor - gross motor and language developments?
Standing suddenly from supine position; valsalva maneuver
Large stroke volumes with ventricular contraction; aortic regurg
Chorda tympani branch
Initiation - pointing; pincer grasp; walking; mama/dada

35. metabolism of 1 gram of protein produces How many calories? carb? fat?
Pulmonary hypertension
Turners`
Increase by 50% in urine osmolality
4 - 4 - 9

36. What is the most common initital symptom of ADPKD? what else?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
DIC; TTP- HUS dont bleed that much
Hyperkalemia; potassium sparing diuretics - potassium supplements
8; 12

37. Where does complement bind on the Fc region of Ig chains?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Aromatase deficiency in child
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Right before diastole (filling begins)

38. 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
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
SVT; increases vagal tone; rectus abdominis
SSRI; erectile dysfunction

39. What is epispadias caused by?
Faulty positioning of the genital tubercle
High potassium conductance and some sodium conductance
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Apocrine; eccrine

40. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Bile soluble which means they are bile sensitive
200-500
Barium enema
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

41. ___________ is liver specific
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Thymic tumor
Bronchial dilation (bronchiectasis)
glycerol kinase

42. What is congestive hepatomegaly specific for?
Well
Southern - western
women
Right heart failure

43. What are three symptoms in s.typhi?
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
Adeno
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

44. sporadic colon cancer tend to arise From what type of polyps?
Increase by 50% in urine osmolality
The time interval between S2 and OS- the shorter the interval - the more intense
Single adenomatous ones
Chlorpheniramine and diphenhydramine

45. What does extended consumption of appetite suppressants lead to?
Ceftriaxone; azithromycin
Both sides
Pulmonary hypertension
Medullary

46. which cells produce surfactant? which ones mediate gas exchange?
Insulin like growth factor 1 (just another name)
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
II; I (I more abundant)
No; MRI

47. Where is conduction in heart fastest? slowest?
Anterior nares
Bile soluble which means they are bile sensitive
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Purkinje system; AV node

48. Acyl coA synthetase is not...
Chlorpheniramine and diphenhydramine
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
liver specific

49. Where is aromatase used?
Syringomelia
Increases cytokine production
Think Hb deformation diseases
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

50. What three factors effect total oxygen content of blood?
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Tissue redistribution (out of plasma) rather than metabolism
Vagus (auricular branch); vasovagal syncope!
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures