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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. Where does terminal peptide cleavage of collagen fibrils take place?
Anterior circumflex (and axillary nerve)
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)
Increases
In the extracellular space

2. if there are keratin swirls does that mean well or poorly differentiated?
Integration of viral DNA into genome of host hepatocytes
Well
In the extracellular space
Octreotide

3. what should you think of in 'smear of an oral ulcer base'?
Tzanck smear
Fat - fertile - forty - female
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)
liver specific

4. What is the primary histologic finding in patients with eczematous dermatitis?
C3 decreased after 5-10 days; sulfonamides
Enterococci (e. faecalis)- found on genitalia area
Spongiosis
DIC; TTP- HUS dont bleed that much

5. Which is faster purkinje system or atrial muscle?
Close but purkinje system to ensure contraction in a bottom up fashion
Hypothyroidism
Elevated GGT and macrocytosis
Enterococci (e. faecalis)- found on genitalia area

6. What is damaged in early syringomelia? later?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Close but purkinje system to ensure contraction in a bottom up fashion
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

7. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Syringomelia
E. coli
SS +rNA

8. other than increasing HDL levels - what else does niacin do?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Varying; erythema nodosum is common
Tissue redistribution (out of plasma) rather than metabolism
Prevents hepatic VLDL production

9. what dictates the resting membrane potential of most cells?
CGD; t cell dysfxn (diGeorge)
chronic urticaria and allergic symptoms
High potassium conductance and some sodium conductance
Ig A deficiency

10. Which is slower AV node or ventricular muscle?
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
AV node slowest - to allow time for diastole
8 (myc protein) with 2 - 14 - 22 (iG chains)
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

11. What does protein M do in Group A strep<
Right before diastole (filling begins)
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Prevent phagocytosis
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

12. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
G to T in p53; HCC
Vagus (auricular branch); vasovagal syncope!
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Syncope - angina - dyspnea (SAD)

13. how much percent of sodium is excreted? urea? glucose?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Retinitis; mononucleosis
Gluteus maximus; difficulty getting up from seated position and climbing chair
<1% - 55% - concentration dependent

14. what hernia has a similar mechanism to hydrocele?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Tzanck smear
Drug induced interstitial nephritis
Increase in permeability of two ions with equal and opposite equilibrium potentials

15. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Pain reliever - reduces pain by locking substance P in the PNS
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

16. name three pathological states that present with large tongues.
Lateral; RV; RA; LV
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
8 (myc protein) with 2 - 14 - 22 (iG chains)
Congenital hypothyroidism - downs - amyloidosis - acromegaly

17. in overweight individuals What is thought to contribute to insulin resistance?
Serum FFA and serum triglyceride levels
Appetite suppressants
Sickle cell; G6PD
To pump calcium out in cardiac myocytes so that relaxation occurs

18. Which is faster atrial muscle or ventricular muscle?
Atrial
Amiadarone
Bile soluble which means they are bile sensitive
Right before diastole (filling begins)

19. What does hypocapnia cause in teh brain? What is hypocapnia?
<1% - 55% - concentration dependent
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Tibial

20. What are the skin presentation in sarcoid?
Covalent (between two cysteines)- allows protein to withstand denaturation
Varying; erythema nodosum is common
Syringomelia
Standing suddenly from supine position; valsalva maneuver

21. which nerve provides innervation for plantar flexion and inversion?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Tibial

22. which two virus families have hemagluttinin on their surface?
Ether and other organic solvents
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Paramyxo and influenza
E. coli

23. What is the mc location for avascular necrosis? What is it associated with?
Circular - outside nucleus; transport proteins - rRNA - tRNA
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Syncope - angina - dyspnea (SAD)

24. What is the most common location of colonization of all s. aureus types?
Recurrent larygneal
Raphe
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Anterior nares

25. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Apocrine; eccrine
Reiter syndrome; B27
Protamine sulfate
No (unlike adenomyosis); yes

26. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Relfex tachycardia; giving beta blockers
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

27. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
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
S. aureus
As a CO2 carrier with the carboxylase enzyme
Think Hb deformation diseases

28. What is the mcc of elevated AFP leves in pregnancy>
Underestimation of gestational age
Reticulocytes
Right heart failure
Normal; low

29. what organ would an activating mutation in PRPP synthetase effect?
gram positive organisms
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Joints d/t increased purine production and thus uric acid production
Anti cholinergic effects of pupil dilation and lack of accomodation

30. What are the three dopaminergic systems and What are they responsible for? disease?
Apocrine; eccrine
Bronchial dilation (bronchiectasis)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

31. What are the two growth factors associated with angiogenesis?
FGF and VEGF
Classical conditioning
Hyperkalemia; potassium sparing diuretics - potassium supplements
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

32. What is the preferred treatment for DKA?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Regular insulin (Not fast acting - regular better)
Adeno
Recurrent larygneal

33. What can cause virilization of a mother during pregnancy?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Apocrine; eccrine
Terminal bronchioles; small bronchi
Aromatase deficiency in child

34. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Hereditary angioedema; ACE inhibitors
Susceptible; soluble (unable to be cultured in bile)
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
SaO2 <92%

35. why does liver dysfunction cause coagulation disorders?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Coagulation factors are made in the liver
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
Selective alpha 1 (increases SVR)

36. which cells produce surfactant? which ones mediate gas exchange?
S. aureus
II; I (I more abundant)
PDA open
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

37. What type of drug is alendronate?
Biphosphonate
women
II; I (I more abundant)
11 aa polypeptide; pain NT in CNS and PNS

38. How can renal blood flow be calculated from RPF?
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
Trauma to stereociliated hair cells of the organ of corti
RBF= PAH clearance/(1- hematocrit)
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

39. Acyl coA synthetase is not...
No and yes
In the extracellular space
liver specific
Hyperkalemia; potassium sparing diuretics - potassium supplements

40. what diseases can vit A be used to treat?
Measles and M3 AML`
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
S3 gallop; S2 to opening snap interval

41. What does 'oxygen' content in blood refer to?
Measure of depth invasion (vertical!)
ATP binding (resets the myosin head to contract again for next binding)
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Dissolved in plasma and attached to Hgb

42. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Mean greater than median greater than mode
Appetite suppressants
Terminal bronchioles; small bronchi
GI tract; mood!

43. What is the fibrinogen level in patient with TTP- HUS? DIC?
CMV - HSV 1 - Candida
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Normal; low
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

44. What causes wrist drop?
Trochlear nerve (IV); abducens nerve (VI)
Radial nerve damage
Decreases both
INTRApartum Abs (ampicillin/penicillin)

45. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Intussusception
Phencyclidine (PCP)
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
facultative intracellular

46. Where is the base of the heart? apex?
Thymic tumor
Closer to head; closer to diaphragm
Increases
Vancomycin; histamine mediated

47. at one year of age - What are the social - fine motor - gross motor and language developments?
Initiation - pointing; pincer grasp; walking; mama/dada
Gluteus medius and minimus; positive trendelenberg
Relfex tachycardia; giving beta blockers
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

48. Metronidizaole does not cover...
Kallmans
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
gram positive organisms
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

49. what vessel would a fracture to the neck of the of the humerus damage?
Well trained athletes and children
P53 mutation; DCC is also required for adenoma to carcinoma
Anterior circumflex (and axillary nerve)
Hydrogen bonds dictate alpha or beta structure

50. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Vagus nerve stimulation
Medullary
Relfex tachycardia; giving beta blockers