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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 do ghon complexes form - primary or secondary TB?
Primary
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
OCPs - multiparity - breast feeding
Superior larygeal; cricothyroid; recurrent laryngeal

2. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
No (unlike adenomyosis); yes
4 - 4 - 9
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase

3. What are two common side effects of both acute and long acting nitrates? What causes them?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Headaches and facial flushing; vasodilation in meninges and skin

4. Where does complement bind on the Fc region of Ig chains?
Around 70 (normal measured diastolic pressures); 9--
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
chronic urticaria and allergic symptoms
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

5. 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?
Acute gastric mucosal defects (superficial or full thickness)
Prepatellar
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Apocrine; eccrine

6. What is the mcc of extrinsic allergic asthma?
SS +rNA
Permissive - sensitizes vasoconstrictive response from catecholamines - doesnt actually act on them but increases transcription of some genes that creates permissive effect (not additive or synergistic becuase cortisol alone doesnt have any effect on
Inhaled animal dander allergens
Well

7. what protein is increased in Crohns disease? What does it do?
GI tract; mood!
NF- KB; responsible for cytokine production
T test; chi squared
Enterococci (e. faecalis)- found on genitalia area

8. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Prevents hepatic VLDL production
Hereditary angioedema; ACE inhibitors
Prepatellar
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

9. What is an abortive viral infection?
Little effect on cell and no change
S. saprophyticus - and s. epidermidis; novobiocin
Medial circumflex artery; avascular necrosis
Ketone body production by preventing fatty acids into the mitochondria

10. PDAs are often asymptomatic. How do you treat?
indomethacin
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Prevent phagocytosis
No

11. What does hypocapnia cause in teh brain? What is hypocapnia?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Recurrent larygneal

12. carnitine deficiency impairs production of What and how?
Elevated GGT and macrocytosis
P53 mutation; AD
Ketone body production by preventing fatty acids into the mitochondria
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

13. What causes curlings ulcers?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

14. How do bradykinin - C3a and C5a cause edema?
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)
By vascular permeability and vasodilation
transcription activation/suppression
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

15. at 2 years of age - What are the social - fine motor - gross motor and language developments?
By vascular permeability and vasodilation
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Extrinsic def; instrinsic def; platelet def
Reiter syndrome; B27

16. What is the best indicator for the severity of mitral stenosis?
The time interval between S2 and OS- the shorter the interval - the more intense
No; yes
Rabies encephalitis from cave bats; rabies killed vaccines
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

17. What is achalasia and how would this correlate on the esophageal mannometry?
manifestations - congenital (stretching of periventricular pyrimadal fibers)
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
ST become atrophic and hyalinized (temp induced damage) and depressed sperm count becuase of that; hormonal function not impaired (test and LH levels normal) because Leydig cells not as temp sensitive so secondary sexual characteristics and sexual pe
RBF= PAH clearance/(1- hematocrit)

18. In What type of nephritis would you see high serum eos count?
Serum FFA and serum triglyceride levels
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Right heart failure
Drug induced interstitial nephritis

19. What can cause aortic regurg? What is the heart sound you hear?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Adductor
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

20. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Highly negative resting potential
Downs; regurgitant AV valves - ASDs
P53 mutation; AD

21. Which is slower AV node or ventricular muscle?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
AV node slowest - to allow time for diastole
<1% - 55% - concentration dependent

22. ___________ is liver specific
glycerol kinase
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
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 (unlike adenomyosis); yes

23. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
RBC mass; epo levels (secondary has high)
Radial nerve and deep brachial artery
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Chrom 8

24. What is epispadias caused by?
Adductor
Ketone body production by preventing fatty acids into the mitochondria
G to T in p53; HCC
Faulty positioning of the genital tubercle

25. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
High potassium conductance and some sodium conductance
Clindamycin; covers anaerobic oral flora and aerobic bacteria
SVC and IVC; right below the aortic knob
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

26. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
Reticulocytes
Thymic tumor
Vagus (auricular branch); vasovagal syncope!
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

27. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
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)
Ceftriaxone; azithromycin
CMV - HSV 1 - Candida
Sarcoid

28. What is suggestive of complete central DI?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Increase by 50% in urine osmolality
Prevents hepatic VLDL production
Squatting - sitting - lying supine - passive leg raising

29. What does protein M do in Group A strep<
Duration and extent of disease
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Prevent phagocytosis
transcription activation/suppression

30. which antiarrythmic is associated with blue gray discoloration ?
Amiadarone
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
On cardiac tissue and renal juxtaglomerular cells
Because gamma chains replace beta chains and then gamma chain formation wanes

31. why is glucagon used in beta blocker toxicitiy?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Medullary
Syncope - angina - dyspnea (SAD)
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 is the immune deficinecy seen in ataxia telangactasia?
200-500
APP on chrom 21 (this is why downs more susceptible)
Ig A deficiency
To pump calcium out in cardiac myocytes so that relaxation occurs

33. who bleed more DIC or TTP- HUS patients?
Increased reticulocytes
By vascular permeability and vasodilation
Not lined by epithelium
DIC; TTP- HUS dont bleed that much

34. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
ZDV or AZT
Class I
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

35. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
Raphe
Hypothyroidism
Mean greater than median greater than mode
NF- KB; responsible for cytokine production

36. What is capsaicin? Where does it work?
Pain reliever - reduces pain by locking substance P in the PNS
OCPs - multiparity - breast feeding
Bronchogenic carcinoma
Little effect on cell and no change

37. How can renal blood flow be calculated from RPF?
gram positive organisms
RBF= PAH clearance/(1- hematocrit)
ST become atrophic and hyalinized (temp induced damage) and depressed sperm count becuase of that; hormonal function not impaired (test and LH levels normal) because Leydig cells not as temp sensitive so secondary sexual characteristics and sexual pe
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

38. what drug is useful for secretory diarrhea?
Octreotide
Sydenham chorea
G to T in p53; HCC
Closer to head; closer to diaphragm

39. why does neutrophila occur with corticosteroids?
Anterior nares
Demargination of neutrophils from the vessel walls
SS +rNA
ATP binding (resets the myosin head to contract again for next binding)

40. metabolism of 1 gram of protein produces How many calories? carb? fat?
4 - 4 - 9
GI malignancies and Insulin resistance (acromegal for ex)
Prepatellar
Hypo or hyper pigmentations; after tanning

41. How do you calculate atributable risk percent?
CGD; t cell dysfxn (diGeorge)
Curlings ulcers
Well trained athletes and children
RR-1/RR

42. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
Turbulence
As a CO2 carrier with the carboxylase enzyme
C3 decreased after 5-10 days; sulfonamides
Octreotide

43. what bursa is affected when on knees like a maid/gardner?
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
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Prepatellar
Radial nerve and deep brachial artery

44. what enzyme converts procarcinogens into carcinogens?
P450 mitochondrial monooxygenase
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
Increased reticulocytes
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

45. What can worse neurologic dysfunction in cobalamic def?
Folic acid treatment!
gram positive organisms
No; yes
Susceptible; soluble (unable to be cultured in bile)

46. what vessel would a fracture to the neck of the of the humerus damage?
Anterior circumflex (and axillary nerve)
Large stroke volumes with ventricular contraction; aortic regurg
Hypo or hyper pigmentations; after tanning
SVT; increases vagal tone; rectus abdominis

47. What is congestive hepatomegaly specific for?
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Fibronectin - laminin - collagen
Right heart failure
The term used to describe decreased drug responsiveness with repeated administration

48. What is the mc manifestation of CMV in HIV patient? immunocompetent?
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Elevated GGT and macrocytosis
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Retinitis; mononucleosis

49. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Fibronectin - laminin - collagen
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

50. What is used to prevent vertical transmission of HIV?
ZDV or AZT
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Hyperkalemia; potassium sparing diuretics - potassium supplements
Hypertension - edema - and proteinuria