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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 drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
chronic urticaria and allergic symptoms
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Phencyclidine (PCP)
HSV ( also in utero: chlymadia - neisseria - group B strep)

2. why does neutrophila occur with corticosteroids?
Demargination of neutrophils from the vessel walls
Normally close to systolic
Downs; regurgitant AV valves - ASDs
HSV ( also in utero: chlymadia - neisseria - group B strep)

3. What is the best indicator for the severity of mitral stenosis?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
The time interval between S2 and OS- the shorter the interval - the more intense

4. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
Ig A deficiency
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
As a CO2 carrier with the carboxylase enzyme
Prevents hepatic VLDL production

5. 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?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Aromatase deficiency in child
Elastance
Superior larygeal; cricothyroid; recurrent laryngeal

6. there are mucus secreting cells in the bronchioles...
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Tissue redistribution (out of plasma) rather than metabolism
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
only up to bronchi

7. what commonly happens in GI in response to acute physiologic stress?
Reiter syndrome; B27
facultative intracellular
Acute gastric mucosal defects (superficial or full thickness)
ZDV or AZT

8. a patient fearing all white coats is a phenomenon of what?
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
S. saprophyticus - and s. epidermidis; novobiocin
Classical conditioning
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

9. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
facultative intracellular
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

10. What is the Na/Ca exchange used for?
Hereditary angioedema; ACE inhibitors
In the extracellular space for collagen cross linking; zinc
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
To pump calcium out in cardiac myocytes so that relaxation occurs

11. What is contraindicated in toxic mega colon?
Downs; regurgitant AV valves - ASDs
Chorda tympani branch
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Anti cholinergic effects of pupil dilation and lack of accomodation

12. What is the immune deficinecy seen in ataxia telangactasia?
Ig A deficiency
46 - 4N; 23 2N
Duration and extent of disease
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

13. what makes bruits?
Not lined by epithelium
Turbulence
Anterior nares
Trochlear nerve (IV); abducens nerve (VI)

14. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Octreotide
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
OCPs - multiparity - breast feeding

15. What is the triad seen in pre eclampsia?
Cluster
women
Hypertension - edema - and proteinuria
Drug induced interstitial nephritis

16. What does TGF beta do? What produces it?
Fibrosis; macrophages
...
Multiple miscarriages d/t hypercoaguability
Normal; low

17. other than proteinuria - What can cause foamy froathy urine?
AV node slowest - to allow time for diastole
Bile salt accumulation in urine
Normally close to systolic
Serum FFA and serum triglyceride levels

18. What is a common complication of acute pancreatitis? What is it?
Fat - fertile - forty - female
Inhaled animal dander allergens
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Syringomelia

19. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
AV node slowest - to allow time for diastole
Clindamycin; covers anaerobic oral flora and aerobic bacteria
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
CMV - HSV 1 - Candida

20. What translocations can cause c - myc overexpression?
Medial circumflex artery; avascular necrosis
Well trained athletes and children
46 - 4N; 23 2N
8 (myc protein) with 2 - 14 - 22 (iG chains)

21. what drug is useful for secretory diarrhea?
Octreotide
Closer to head; closer to diaphragm
Syncope - angina - dyspnea (SAD)
Normally close to systolic

22. What is Tzanck smear used to detect?
Closer to head; closer to diaphragm
No (unlike adenomyosis); yes
HSV and VZV
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

23. in the LV and aorta - What are the pressures?
P53 mutation; AD
Terminal bronchioles; small bronchi
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Normally close to systolic

24. What does NF- KB do?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Mean greater than median greater than mode
Increases cytokine production

25. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
CGD; t cell dysfxn (diGeorge)
Elevated GGT and macrocytosis
Intussusception
DIC; TTP- HUS dont bleed that much

26. biotin is used By what in tissues responsible for gluconeogenesis
Reticulocytes
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Ketone body production by preventing fatty acids into the mitochondria
As a CO2 carrier with the carboxylase enzyme

27. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Medial circumflex artery; avascular necrosis
Valproate
Adductor
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

28. which two drug types can cause orthostatic hypotension (think depression and BPH)?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
OCPs - multiparity - breast feeding
TCAs and prazosin
Hereditary angioedema; ACE inhibitors

29. What does the severity of leprosy depend on?
Turners`
Strength of cell mediated immune response
Leukotriene precursor and does neutrophil chemotaxis
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

30. What does 'oxygen' content in blood refer to?
MAC complex (C5b - C9 complement deficiency)
Well trained athletes and children
Little effect on cell and no change
Dissolved in plasma and attached to Hgb

31. what murmur is enhanced by decreased blood flow to the heart?
GI tract; mood!
Amiloride - spironolactone - triamterene
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
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

32. What is normal fibrinogen levels?
Closer to head; closer to diaphragm
Kallmans
200-500
Protamine sulfate

33. What are diastolic (lowest) pressures in aorta? LV?
Around 70 (normal measured diastolic pressures); 9--
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics

34. on which chromosome is wilms tumor found?
11
No; MRI
Echinococcus granulosus; anaphylaxis
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

35. What can long term leg cast wearing cause?
Regular insulin (Not fast acting - regular better)
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
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
T test; chi squared

36. What can cause virilization of a mother during pregnancy?
Aromatase deficiency in child
Thymic tumor
Gluteus maximus; difficulty getting up from seated position and climbing chair
G to T in p53; HCC

37. What agonists reduce the gradient across the LV outflow tract?
Syringomelia
OCPs - multiparity - breast feeding
Covalent (between two cysteines)- allows protein to withstand denaturation
Selective alpha 1 (increases SVR)

38. 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
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
INTRApartum Abs (ampicillin/penicillin)
Env genes (for getting into target cells)

39. at four years of age - What are the social - fine motor - gross motor - and language developments?
women
To pump calcium out in cardiac myocytes so that relaxation occurs
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

40. how does eos release MBP to kill protozoa etc?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Chrom 8
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Valproate

41. when do ghon complexes form - primary or secondary TB?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Vancomycin
No and yes
Primary

42. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
TCAs and prazosin
ANCA because of lack of Ig and C3 deposits on IF
In the extracellular space
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

43. What is diagnostic (and possible therapeutic for intussusception)?
Barium enema
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
NF- KB; responsible for cytokine production

44. 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?
Inhaled animal dander allergens
APP on chrom 21 (this is why downs more susceptible)
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac

45. which opponens muscle does ulnar innervate?
Adductor
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Tibial
Closer to head; closer to diaphragm

46. What is diphenoxylate and What is it used for? what drug is it structurally similar to? What allows for potent anti diarrheal effect without signigicant opiate effects?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Acute interstitial nephritis
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)

47. What can worse neurologic dysfunction in cobalamic def?
SS +rNA
Folic acid treatment!
Anterior nares
T test; chi squared

48. erythema nodosum - elevated ACE - scattered granulomas - arthralgias - hilar lymphadenoapthy are indicative of what?
Syncope - angina - dyspnea (SAD)
Sarcoid
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Raphe

49. name three pathological states that present with large tongues.
SSRI; erectile dysfunction
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Both sides
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

50. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Become beta pleated and then form neurofibrillary tangle!
Demargination of neutrophils from the vessel walls
Smoking
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)