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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 can cause aortic regurg? What is the heart sound you hear?
Apocrine; eccrine
S. saprophyticus - and s. epidermidis; novobiocin
Well
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

2. What is gardeners mydriasis? How is it treated?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
ANCA because of lack of Ig and C3 deposits on IF
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

3. What is the most common cause of pyelonephritis in both adults and childre?
E. coli
Purkinje system; AV node
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
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

4. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

5. What are the long term consequences of hydrocephalus?
When it invades the bm; carcinoma in situ
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Because of vasodiation to skeletal muscles
GI malignancies and Insulin resistance (acromegal for ex)

6. where exactly is ACE expressed in the lungs? What type of enzyme is it?
Medullary
RR-1/RR
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Vascular endothelium; protease

7. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
Well trained athletes and children
Primary
S. aureus
No (unlike adenomyosis); yes

8. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Increase; decreased
Bronchial dilation (bronchiectasis)
transcription activation/suppression
Intussusception

9. How can renal blood flow be calculated from RPF?
RBF= PAH clearance/(1- hematocrit)
Terminal bronchioles; small bronchi
Dissolved in plasma and attached to Hgb
Proteasome inhibitor; treatment for MM and waldenstroms

10. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Hyperkalemia; potassium sparing diuretics - potassium supplements
Paramyxo and influenza
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

11. What is extraocular muscle weakness a common symptom of?
Tzanck smear
Myasthenia gravis
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
Chlorpheniramine and diphenhydramine

12. what organ would an activating mutation in PRPP synthetase effect?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Joints d/t increased purine production and thus uric acid production

13. What is the precursor protein to beta amyloid and On what chromosome is it found?
LT (LTD4 - E4 - C4) - and Ach
In the extracellular space
APP on chrom 21 (this is why downs more susceptible)
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

14. which antiarrythmic is associated with blue gray discoloration ?
Amiadarone
Increase in permeability of two ions with equal and opposite equilibrium potentials
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Elastance

15. What type of mutation does aflatoxin cause? what cancer does this increase for?
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
Fibrosis; macrophages
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
G to T in p53; HCC

16. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

17. what protects the resting heart from arrhythmias?
CMV - HSV 1 - Candida
Underestimation of gestational age
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Highly negative resting potential

18. What is used to compare means? categorical outcomes?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
T test; chi squared
Barium enema
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

19. neisseria are...
facultative intracellular
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
differentiate
Dissolved in plasma and attached to Hgb

20. what makes bruits?
APP on chrom 21 (this is why downs more susceptible)
Turbulence
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
...

21. What is hyaline arteriosclerosis usually a sign of ?
Sydenham chorea
Diabetic microangiopathy
indomethacin
Serum FFA and serum triglyceride levels

22. What test would be best to determine if a gene is being transcribed? translated?
Become beta pleated and then form neurofibrillary tangle!
Selective alpha 1 (increases SVR)
Single adenomatous ones
Southern - western

23. What is damaged in early syringomelia? later?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

24. why does liver dysfunction cause coagulation disorders?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
CGD; t cell dysfxn (diGeorge)
Coagulation factors are made in the liver
Inhibits it

25. Would alpha 1 agonists cause flushing? muscarinic antagonist?
differentiate
No; yes
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
SVT; increases vagal tone; rectus abdominis

26. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
Leukotriene precursor and does neutrophil chemotaxis
Bile soluble which means they are bile sensitive
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Vertical diplopia

27. other than mycobacterim wha other bacteria is acid fast?
Thymic tumor
Nocardia
S. aureus
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

28. metabolism of 1 gram of protein produces How many calories? carb? fat?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
...
4 - 4 - 9

29. which two drug types can cause orthostatic hypotension (think depression and BPH)?
Normal; low
TCAs and prazosin
Class I
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

30. PDAs are often asymptomatic. How do you treat?
Chrom 8
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
indomethacin
No

31. why is glucagon used in beta blocker toxicitiy?
Adeno
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Become beta pleated and then form neurofibrillary tangle!

32. what clinical findings help distinguish small cell carcinoma?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Boiling - bleach - formalin - UV irradiation
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

33. other than proteinuria - What can cause foamy froathy urine?
Increased reticulocytes
Bile salt accumulation in urine
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

34. how long is substance P? What does it do?
Turners`
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
APP on chrom 21 (this is why downs more susceptible)
11 aa polypeptide; pain NT in CNS and PNS

35. What is pickwickian syndrome? What are the lab findings?
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Excessive collagen formation during tissue repair in susceptible individuals
Leukotriene precursor and does neutrophil chemotaxis
Ether and other organic solvents

36. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
SVC and IVC; right below the aortic knob
LT (LTD4 - E4 - C4) - and Ach
Tibial
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

37. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
V fib; v. failure
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
In the extracellular space for collagen cross linking; zinc

38. What is the most common location of colonization of all s. aureus types?
In the extracellular space for collagen cross linking; zinc
hyponatremia (aldosterone activation equilibrates body volume)
Anterior nares
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

39. which staphylococci can do mannitol fermaentation?
PDA open
Strength of cell mediated immune response
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
S. aureus

40. What is cataplexy and When is it seen?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Headaches and facial flushing; vasodilation in meninges and skin
...

41. at one year of age - What are the social - fine motor - gross motor and language developments?
Vascular endothelium; protease
Initiation - pointing; pincer grasp; walking; mama/dada
In the extracellular space for collagen cross linking; zinc
Lateral; RV; RA; LV

42. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Pain reliever - reduces pain by locking substance P in the PNS
Varying; erythema nodosum is common
Curlings ulcers

43. What is the mainstay treatment for acute mania?
Insulin like growth factor 1 (just another name)
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

44. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
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)
Increases bronchial and vascular smooth muscle reactivity to catecholamines
P53 mutation; DCC is also required for adenoma to carcinoma

45. what enzyme converts procarcinogens into carcinogens?
Primary
Turners`
P450 mitochondrial monooxygenase
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

46. what dictates the resting membrane potential of most cells?
High potassium conductance and some sodium conductance
Not lined by epithelium
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
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

47. what color pigmentations are caused by malassezia furfur? when do they become more visible?
ATP binding (resets the myosin head to contract again for next binding)
Multiple miscarriages d/t hypercoaguability
Hypo or hyper pigmentations; after tanning
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

48. What is a keloid?
Excessive collagen formation during tissue repair in susceptible individuals
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
No (unlike adenomyosis); yes
Both sides

49. what would be a sign of absence of cardiogenic pulm edem?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Drink plenty of fluids
Sickle cell; G6PD

50. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
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
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities