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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. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
APP on chrom 21 (this is why downs more susceptible)
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
No and yes

2. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Common peroneal; bony fractures and compression; sciatic
11
Rabies encephalitis from cave bats; rabies killed vaccines
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

3. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
Mean greater than median greater than mode
S. saprophyticus - and s. epidermidis; novobiocin
OCPs - multiparity - breast feeding
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

4. What does glycosylase do to DNA? endonuclease? lyase? What does the order here of enzymes represent? what other enzymes are needed?

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5. IL4 is used for isotypye switching to what?
Underestimation of gestational age
Aromatase deficiency in child
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
IgE

6. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Not lined by epithelium
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Hexokinase

7. at one year of age - What are the social - fine motor - gross motor and language developments?
Initiation - pointing; pincer grasp; walking; mama/dada
Recurrent larygneal
SVT; increases vagal tone; rectus abdominis
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

8. What is the most common neurologic complication of VZV reactivation?
2 -3 BPG; glycolysis - instead of ATP; erythrocytes because want to right shift the oxygen dissociation curve so that oxygen is released from RBCs into tissue
Localized dermatologic pain that persists for more than one month after zoster eruption
facultative intracellular
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase

9. Where does the aorta lie in relation to the pulmonary artery in transposition of the great arteries (is this right to left or left to right shunt?)?
Tibial
Prevents hepatic VLDL production
Echinococcus granulosus; anaphylaxis
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

10. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
Lateral; RV; RA; LV
G to T in p53; HCC
P53 mutation; DCC is also required for adenoma to carcinoma
Atrial

11. What are some side effects seen in TCAs?
Sydenham chorea
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

12. What is 5- HETE and What does it do?
HSV ( also in utero: chlymadia - neisseria - group B strep)
Leukotriene precursor and does neutrophil chemotaxis
OCPs - multiparity - breast feeding
transcription activation/suppression

13. In what form are mitochondrial DNA? What do they transcribe?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Env genes (for getting into target cells)
Circular - outside nucleus; transport proteins - rRNA - tRNA
The term used to describe decreased drug responsiveness with repeated administration

14. which antiarrythmic is associated with blue gray discoloration ?
Thymic tumor
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Amiadarone
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

15. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Increase by 50% in urine osmolality
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
E. coli

16. What is the sole neurologic manifestation of acute rheumatic fever?
Sydenham chorea
Bronchogenic carcinoma
Selective alpha 1 (increases SVR)
Prostate tumor and increased osteoclast activity

17. In what view of CXR is anterior part of heart best seen? anterior part of heart is formed by?right border of heart is formed by? left border?
CGD; t cell dysfxn (diGeorge)
Lateral; RV; RA; LV
(urine PAH x urine flow rate)/plasma PAH
Inhaled animal dander allergens

18. why does liver dysfunction cause coagulation disorders?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Measure of depth invasion (vertical!)
Because gamma chains replace beta chains and then gamma chain formation wanes
Coagulation factors are made in the liver

19. What is the most important prognostic indicator in patients with malignant melanoma?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Myasthenia gravis
Measure of depth invasion (vertical!)
Hypertension - edema - and proteinuria

20. what happens to sperm count and semineferous tubules in patient with cryptoorchidism? hormonal function? why do they need to be surgically descended?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
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)
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
Clindamycin; covers anaerobic oral flora and aerobic bacteria

21. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
No; yes
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
2 -3 BPG; glycolysis - instead of ATP; erythrocytes because want to right shift the oxygen dissociation curve so that oxygen is released from RBCs into tissue
Vancomycin; histamine mediated

22. When does opening snap begin?
Right before diastole (filling begins)
Anterior nares
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

23. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Primary
Tissue redistribution (out of plasma) rather than metabolism
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Reiter syndrome; B27

24. what induces bronchial squamous metaplasia?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Inhibits it
Smoking
only up to bronchi

25. Acyl coA synthetase is not...
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
liver specific
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Vancomycin; histamine mediated

26. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Circular - outside nucleus; transport proteins - rRNA - tRNA
Increases
Gluteus medius and minimus; positive trendelenberg

27. how much percent of sodium is excreted? urea? glucose?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
<1% - 55% - concentration dependent
11 aa polypeptide; pain NT in CNS and PNS
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac

28. 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?
Gluteus medius and minimus; positive trendelenberg
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
differentiate
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

29. What are two common side effects of both acute and long acting nitrates? What causes them?
8; 12
Protamine sulfate
SS +rNA
Headaches and facial flushing; vasodilation in meninges and skin

30. In what population does cholelithiasis occur?
Pulmonic and systemic!
Myasthenia gravis
Fat - fertile - forty - female
Env genes (for getting into target cells)

31. how does neisseria cause a petechial rash?
Think Hb deformation diseases
CMV - HSV 1 - Candida
Lateral; RV; RA; LV
Neisseria induced small cell vasculitis (including hands and soles)

32. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
Octreotide
Skin flushing and warmth; prostaglandins; give with aspirin
2 -3 BPG; glycolysis - instead of ATP; erythrocytes because want to right shift the oxygen dissociation curve so that oxygen is released from RBCs into tissue
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

33. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Prevent phagocytosis
HSV ( also in utero: chlymadia - neisseria - group B strep)
Vascular endothelium; protease

34. which RPGN is also called pauci immune GN? why?
Extrinsic def; instrinsic def; platelet def
Dissolved in plasma and attached to Hgb
Nonsense; mRNA processing
ANCA because of lack of Ig and C3 deposits on IF

35. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
When it invades the bm; carcinoma in situ
No; MRI
Bronchial dilation (bronchiectasis)
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

36. where exactly is ACE expressed in the lungs? What type of enzyme is it?
Vascular endothelium; protease
Hereditary angioedema; ACE inhibitors
Sydenham chorea
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

37. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
Vertical diplopia
Pulmonary hypertension
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
INTRApartum Abs (ampicillin/penicillin)

38. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
Appetite suppressants
transcription activation/suppression
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Protamine sulfate

39. what bursa is affected when on knees like a maid/gardner?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Tibial
Increase in permeability of two ions with equal and opposite equilibrium potentials
Prepatellar

40. What can long term leg cast wearing cause?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
PDA open
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
Well

41. What is acanthosis nigricans associated with?
GI malignancies and Insulin resistance (acromegal for ex)
LT (LTD4 - E4 - C4) - and Ach
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Prostate tumor and increased osteoclast activity

42. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Selective alpha 1 (increases SVR)
Both sides

43. 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?
46 - 4N; 23 2N
Echinococcus granulosus; anaphylaxis
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Anterior nares

44. do Class IC agents prolong the QT interval?
SaO2 <92%
11 aa polypeptide; pain NT in CNS and PNS
No
Become beta pleated and then form neurofibrillary tangle!

45. What is the mainstay treatment for acute mania?
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
Chorda tympani branch
Downs; regurgitant AV valves - ASDs
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

46. other than increasing HDL levels - what else does niacin do?
Closer to head; closer to diaphragm
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
By vascular permeability and vasodilation
Prevents hepatic VLDL production

47. neisseria are...
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Large stroke volumes with ventricular contraction; aortic regurg
facultative intracellular
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

48. which nerve provides innervation for plantar flexion and inversion?
Bile salt accumulation in urine
Chlorpheniramine and diphenhydramine
When it invades the bm; carcinoma in situ
Tibial

49. What are the common causes of metabolic alkalosis? How do you differentiate between them?
In the extracellular space
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
ATP binding (resets the myosin head to contract again for next binding)

50. What are the acute effects of corticosteroids on the CBC?
Dihydropyridine sensitive Ca channels (L type)
Increase; decreased
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)