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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 does 'oxygen' content in blood refer to?
Dissolved in plasma and attached to Hgb
Serum creatine kinase; reperfusion injury causes necrosis
Chrom 8
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

2. where are Beta 1 receptors found?
Hypertension - edema - and proteinuria
Increase lymphatic drainage!
On cardiac tissue and renal juxtaglomerular cells
Downs; regurgitant AV valves - ASDs

3. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Medullary
Chorda tympani branch
H. influenzae type B; polyribosyl phosphate (PRP); cherry red uvula - dysphagia - stridor (sometimes) - difficulty breathing - fever - drooling - positive 'thumbs up sign' on lateral xray of cervical region d/t swollen epiglottis
Standing suddenly from supine position; valsalva maneuver

4. what commonly happens in GI in response to acute physiologic stress?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
To pump calcium out in cardiac myocytes so that relaxation occurs
Acute gastric mucosal defects (superficial or full thickness)

5. How do you calculate excretion rate of a substance? How do you calculate the filtration rate of a substance? clearance of what substance estimates the GFR?
C3 decreased after 5-10 days; sulfonamides
glycerol kinase
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

6. Which is faster purkinje system or atrial muscle?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Turners`
Close but purkinje system to ensure contraction in a bottom up fashion
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

7. on What part of the clavicle does the SCM attach?
Normally close to systolic
Increase by 50% in urine osmolality
Prepatellar
Medial part

8. where are the vegetations on the valves of a libman sacks endocarditis?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Faulty positioning of the genital tubercle
Pulmonary hypertension
Both sides

9. What is gardeners mydriasis? How is it treated?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Hydrogen bonds dictate alpha or beta structure
HSV and VZV

10. at four years of age - What are the social - fine motor - gross motor - and language developments?
Chrom 8
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Thymic tumor
Prevents hepatic VLDL production

11. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
OCPs - multiparity - breast feeding
Increases cytokine production
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Anterior circumflex (and axillary nerve)

12. What is easiest way to treat nephrolithiasis?
Trochlear nerve (IV); abducens nerve (VI)
MAO inhibitors; wine and cheese
Brief psychotic disorder; schizophreniform; schizophrenia
Drink plenty of fluids

13. What is the Na/Ca exchange used for?
To pump calcium out in cardiac myocytes so that relaxation occurs
Measles and M3 AML`
Serum creatine kinase; reperfusion injury causes necrosis
Varying; erythema nodosum is common

14. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
HSV ( also in utero: chlymadia - neisseria - group B strep)
indomethacin
INTRApartum Abs (ampicillin/penicillin)

15. which virus inactivates both Rb and p53?
Reiter syndrome; B27
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Ketone body production by preventing fatty acids into the mitochondria
E6 and E7 of HPV knock off p53 and Rb suppressor genes

16. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Medial circumflex artery; avascular necrosis
P53 mutation; AD
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Turners`

17. What are two indicators of chronic alcohol consumption?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Elevated GGT and macrocytosis
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

18. What is the primary histologic finding in patients with eczematous dermatitis?
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
S. saprophyticus - and s. epidermidis; novobiocin
gram positive organisms
Spongiosis

19. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Hyperkalemia; potassium sparing diuretics - potassium supplements
Prevent phagocytosis
Acute interstitial nephritis
46 - 4N; 23 2N

20. where are the two classical places that the ulnar nerve can be injured?

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21. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
TCAs and prazosin
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Large stroke volumes with ventricular contraction; aortic regurg
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

22. in essential fructosuria - what enzyme do patients use to metabolize fructose?
<1% - 55% - concentration dependent
Pain reliever - reduces pain by locking substance P in the PNS
Hexokinase
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

23. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
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)
Tzanck smear
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

24. What would a deflection of the membrane potential to near zero indicate?
Medial circumflex artery; avascular necrosis
11
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Increase in permeability of two ions with equal and opposite equilibrium potentials

25. when arrested in prophase of meiosis I - What are primary oocytes chrom number? What about the secondary oocytes that are stuck in metaphase of Meiosis II?
PDA open
...
In the extracellular space for collagen cross linking; zinc
46 - 4N; 23 2N

26. What is the most common neurologic complication of VZV reactivation?
Apocrine; eccrine
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
HSV ( also in utero: chlymadia - neisseria - group B strep)
Localized dermatologic pain that persists for more than one month after zoster eruption

27. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Increases cytokine production
Fibronectin - laminin - collagen
TSh (in testicular tumors can cause hyperthyroidism)

28. Metronidizaole does not cover...
RBC mass; epo levels (secondary has high)
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
gram positive organisms
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

29. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Valproate
Recurrent larygneal
Drug induced interstitial nephritis
Normal; low

30. what should you think of in 'smear of an oral ulcer base'?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Intussusception
Tzanck smear

31. What is subacute sclerosisng encephalitis caused by?
PDA open
Varying; erythema nodosum is common
HSV and VZV
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

32. what receptors do first generation anti histamines block?
Vancomycin; histamine mediated
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

33. What is the mcc of elevated AFP leves in pregnancy>
Vascular endothelium; protease
Chrom 8
Ceftriaxone; azithromycin
Underestimation of gestational age

34. Where is aromatase used?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
manifestations - congenital (stretching of periventricular pyrimadal fibers)

35. When does opening snap begin?
Little effect on cell and no change
Right before diastole (filling begins)
GI malignancies and Insulin resistance (acromegal for ex)
liver specific

36. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
Coagulation factors are made in the liver
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Purkinje system; AV node
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)

37. What is medullary sponge kidney disease and how does it present? What does it lead to?
Env genes (for getting into target cells)
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)
AV node slowest - to allow time for diastole
RBC mass; epo levels (secondary has high)

38. what induces bronchial squamous metaplasia?
Smoking
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Large stroke volumes with ventricular contraction; aortic regurg

39. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Fibronectin - laminin - collagen
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Neisseria induced small cell vasculitis (including hands and soles)
Regular insulin (Not fast acting - regular better)

40. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
DIC; TTP- HUS dont bleed that much
Octreotide

41. What type of drug is alendronate?
C3 decreased after 5-10 days; sulfonamides
Biphosphonate
Localized dermatologic pain that persists for more than one month after zoster eruption
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

42. Where does 90% of serotonin lie? What is this NT responsible?
GI tract; mood!
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Smoking
Brief psychotic disorder; schizophreniform; schizophrenia

43. What is the mc manifestation of CMV in HIV patient? immunocompetent?
Additive is equal to the sum of the two actions (lets say agonists at a receptor) and synergistic is when the sum is greater than just their two effects together
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Retinitis; mononucleosis
LT (LTD4 - E4 - C4) - and Ach

44. why should you not use ACE inhibitors with someone who had hereditary angioedema?
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
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
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Acute gastric mucosal defects (superficial or full thickness)

45. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Cluster
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
E6 and E7 of HPV knock off p53 and Rb suppressor genes

46. what makes bruits?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Turbulence
Bile soluble which means they are bile sensitive
Criggler Najjar (UGT enzyme in bilirubin glucoronidation) ; Dubin Johnson (transport protein lacking - Black liver) and Rotor syndrome - defects in hepatic uptake and excretion of bile (numerous defect)

47. which nerve provides innervation for plantar flexion and inversion?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Tibial

48. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Susceptible; soluble (unable to be cultured in bile)
Phencyclidine (PCP)
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
No and yes

49. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
Think Hb deformation diseases
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Sickle cell; G6PD
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac

50. What is the mutation type in thalassemias? what process is defective because of this?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Normal; low
Around 70 (normal measured diastolic pressures); 9--
Nonsense; mRNA processing