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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. which has better side effect profile - SSRI or TCA?
Hexokinase
SSRI
Regular insulin (Not fast acting - regular better)
In ER of bile canaliculi

2. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
RBC mass; epo levels (secondary has high)
Adeno
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
No; yes

3. what bursa is affected when on knees like a maid/gardner?
Prepatellar
ATP binding (resets the myosin head to contract again for next binding)
Purkinje system; AV node
V fib; v. failure

4. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Measles and M3 AML`
Secretin stimulates the exocrine pancrease; S enteroendocrine cells in duodenal mucosa in response to acid secrete secretin (HCL is most potent stimulus for secretin release)
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

5. which two drug types can cause orthostatic hypotension (think depression and BPH)?
Vagus nerve stimulation
only up to bronchi
TCAs and prazosin
To pump calcium out in cardiac myocytes so that relaxation occurs

6. What is suggestive of complete central DI?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Joints d/t increased purine production and thus uric acid production
Little effect on cell and no change
Increase by 50% in urine osmolality

7. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
P53 mutation; AD
Myasthenia gravis
Dissolved in plasma and attached to Hgb
Prevents hepatic VLDL production

8. In What type of nephritis would you see high serum eos count?
Increase by 50% in urine osmolality
Hypertension - edema - and proteinuria
Drug induced interstitial nephritis
Covalent (between two cysteines)- allows protein to withstand denaturation

9. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Duration and extent of disease
liver specific

10. What is easiest way to treat nephrolithiasis?
Drink plenty of fluids
Hydrogen bonds dictate alpha or beta structure
Headaches and facial flushing; vasodilation in meninges and skin
Sydenham chorea

11. Would alpha 1 agonists cause flushing? muscarinic antagonist?
GI tract; mood!
Squatting - sitting - lying supine - passive leg raising
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
No; yes

12. who bleed more DIC or TTP- HUS patients?
Extrinsic def; instrinsic def; platelet def
Faulty positioning of the genital tubercle
When it invades the bm; carcinoma in situ
DIC; TTP- HUS dont bleed that much

13. which type of glands produce an initially odorless secretion but can become malodorous secondary to bacterial decompisition on the skin surface? which glands are present throughout the skin except on lips and glans penis?
Initiation - pointing; pincer grasp; walking; mama/dada
Gluteus maximus; difficulty getting up from seated position and climbing chair
...
Apocrine; eccrine

14. What are the skin presentation in sarcoid?
Bile soluble which means they are bile sensitive
CMV - HSV 1 - Candida
Varying; erythema nodosum is common
Appetite suppressants

15. other than in pyelonephritis - where else are WBC casts seen?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Acute interstitial nephritis
No; MRI
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

16. How do left sided colon adenocarcinomas present? right sided?
Obstruction because they infiltrate the intestinal wall and encircle causing decrease in size of lumen - constipation - abdominal distension - abdominal pain - changes in stool caliber; right sided are often exophytic masses iron def anemia and syste
Not lined by epithelium
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Joints d/t increased purine production and thus uric acid production

17. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Diabetic microangiopathy
Enterococci (e. faecalis)- found on genitalia area
Increase lymphatic drainage!
Vagus nerve stimulation

18. What is best to prevent GBS infection in a baby?
Right heart failure
Because of vasodiation to skeletal muscles
INTRApartum Abs (ampicillin/penicillin)
Bile soluble which means they are bile sensitive

19. what clinical findings help distinguish small cell carcinoma?
Intussusception
Underestimation of gestational age
Curlings ulcers
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

20. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
RER; RER
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Medial part
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

21. Where does 90% of serotonin lie? What is this NT responsible?
The time interval between S2 and OS- the shorter the interval - the more intense
facultative intracellular
GI tract; mood!
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

22. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
SSRI; erectile dysfunction
Gluteus maximus; difficulty getting up from seated position and climbing chair
Bile soluble which means they are bile sensitive
Medial circumflex artery; avascular necrosis

23. What can long term leg cast wearing cause?
ANCA because of lack of Ig and C3 deposits on IF
I is more benign and can present later in adulthood
Radial nerve damage
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

24. Where is conduction in heart fastest? slowest?
Purkinje system; AV node
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
Joints d/t increased purine production and thus uric acid production
Acute interstitial nephritis

25. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
Sarcoid
Serum FFA and serum triglyceride levels
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
When it invades the bm; carcinoma in situ

26. What type of disease has selective proteinuria? What is found in urine? What is not?
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)
CGD; t cell dysfxn (diGeorge)
Prepatellar
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

27. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Lateral; RV; RA; LV
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

28. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
SVT; increases vagal tone; rectus abdominis
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Leukotriene precursor and does neutrophil chemotaxis
As a CO2 carrier with the carboxylase enzyme

29. What does the severity of leprosy depend on?
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
Increase lymphatic drainage!
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Strength of cell mediated immune response

30. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
High potassium conductance and some sodium conductance
Gluteus medius and minimus; positive trendelenberg
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
Terminal bronchioles; small bronchi

31. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Appetite suppressants
Pain reliever - reduces pain by locking substance P in the PNS
The term used to describe decreased drug responsiveness with repeated administration

32. where are the vegetations on the valves of a libman sacks endocarditis?
High potassium conductance and some sodium conductance
Chrom 8
Both sides
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

33. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
Normal; low
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Drink plenty of fluids
differentiate

34. What is hypospadias caused by?
(urine PAH x urine flow rate)/plasma PAH
Lateral; RV; RA; LV
4 - 4 - 9
Abnormal closing of the urethral folds

35. 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?
Superior larygeal; cricothyroid; recurrent laryngeal
Little effect on cell and no change
Nocardia
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

36. What does 'oxygen' content in blood refer to?
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)
Dissolved in plasma and attached to Hgb
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
To pump calcium out in cardiac myocytes so that relaxation occurs

37. What is the best indicator for the severity of mitral stenosis?
TCAs and prazosin
Paramyxo and influenza
The time interval between S2 and OS- the shorter the interval - the more intense
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

38. what virus causes pharyngoconjuctival fever?
Nonsense; mRNA processing
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Adeno
gram positive organisms

39. how does increased ICP result in curlings ulcers?
Gluteus medius and minimus; positive trendelenberg
Vagus nerve stimulation
Tissue redistribution (out of plasma) rather than metabolism
frameshift mutations (missense is substitution)

40. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
P53 mutation; DCC is also required for adenoma to carcinoma
Aromatase deficiency in child
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
Inhaled animal dander allergens

41. What is the cause of fixed splitting of S2? why?
Gluteus maximus; difficulty getting up from seated position and climbing chair
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Gluteus medius and minimus; positive trendelenberg

42. What is the mcc of elevated AFP leves in pregnancy>
On cardiac tissue and renal juxtaglomerular cells
Dissolved in plasma and attached to Hgb
Barium enema
Underestimation of gestational age

43. how does achalasia present? What does barium swallow show on dilated esophagus?
(urine PAH x urine flow rate)/plasma PAH
Prepatellar
Chlorpheniramine and diphenhydramine
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

44. Where is aromatase used?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
GI malignancies and Insulin resistance (acromegal for ex)
Vagus nerve stimulation

45. What is tachyphylaxis?
The term used to describe decreased drug responsiveness with repeated administration
In the extracellular space
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

46. what locations of UC increase the risk of Colon cancer?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
TCAs and prazosin
Pan colitis and right sided colitis (more than left sided and proctitis)
T test; chi squared

47. What is extraocular muscle weakness a common symptom of?
Selective alpha 1 (increases SVR)
Myasthenia gravis
Pain reliever - reduces pain by locking substance P in the PNS
Normally close to systolic

48. What is acanthosis nigricans associated with?
Prevents hepatic VLDL production
GI malignancies and Insulin resistance (acromegal for ex)
SSRI; erectile dysfunction
On cardiac tissue and renal juxtaglomerular cells

49. What is it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
Vertical diplopia
Little effect on cell and no change
Become beta pleated and then form neurofibrillary tangle!
No and yes

50. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Measure of depth invasion (vertical!)
Lack of calcium to bind oxaloacetate; crohns prevents fat absorption from lack of bile reabsorption in the terminal illeum which leads to fats pulling calcium and lack of calcium reabsorption
Increase; decreased
Because of vasodiation to skeletal muscles