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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 is epispadias caused by?
Gluteus maximus; difficulty getting up from seated position and climbing chair
Coagulation factors are made in the liver
Faulty positioning of the genital tubercle
differentiate

2. how does eos release MBP to kill protozoa etc?
Acute interstitial nephritis
Phencyclidine (PCP)
Circular - outside nucleus; transport proteins - rRNA - tRNA
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

3. hypertonicity and hyperreflexity are ________________ of hydrocephalus
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Selective alpha 1 (increases SVR)
SVC and IVC; right below the aortic knob
ATP binding (resets the myosin head to contract again for next binding)

4. on which chromosome is wilms tumor found?
11
No; yes
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Drink plenty of fluids

5. why does hypothyroidism cause increased CPK levels?
Decreases both
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
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

6. 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?
HSV and VZV
Smoking
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

7. which cells produce surfactant? which ones mediate gas exchange?
II; I (I more abundant)
Regular insulin (Not fast acting - regular better)
Little effect on cell and no change
Diabetic microangiopathy

8. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Hereditary angioedema; ACE inhibitors
Large stroke volumes with ventricular contraction; aortic regurg
Pulmonary hypertension
Medial circumflex artery; avascular necrosis

9. 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?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Intussusception
Bronchial dilation (bronchiectasis)
46 - 4N; 23 2N

10. What type of disease has selective proteinuria? What is found in urine? What is not?
Smoking
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Dissolved in plasma and attached to Hgb
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

11. What can chronic vit A toxicity cause?
Serum creatine kinase; reperfusion injury causes necrosis
Enterococci (e. faecalis)- found on genitalia area
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
High potassium conductance and some sodium conductance

12. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
Retinitis; mononucleosis
Rabies encephalitis from cave bats; rabies killed vaccines
Anti cholinergic effects of pupil dilation and lack of accomodation
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)

13. What does TGF beta do? What produces it?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Fibrosis; macrophages
Prepatellar
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

14. What does nitroprusside do to afterload? preload?
Decreases both
Anti - apoptotic (prevents going into apoptosis)- 18; 14
No; yes
Coagulation factors are made in the liver

15. why does neutrophila occur with corticosteroids?
II; I (I more abundant)
Sydenham chorea
Demargination of neutrophils from the vessel walls
11 aa polypeptide; pain NT in CNS and PNS

16. What is a cell surface marker seen in liver angiosarcoma?
Sarcoid
transcription activation/suppression
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Anti centromere; anti DNA topoisomerase

17. what dictates the resting membrane potential of most cells?
High potassium conductance and some sodium conductance
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Normally close to systolic
Pain reliever - reduces pain by locking substance P in the PNS

18. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
46 - 4N; 23 2N
Anti - apoptotic (prevents going into apoptosis)- 18; 14

19. IL4 is used for isotypye switching to what?
Syncope - angina - dyspnea (SAD)
Right heart failure
IgE
Paramyxo and influenza

20. What is subacute sclerosisng encephalitis caused by?
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
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Medial circumflex artery; avascular necrosis
RBF= PAH clearance/(1- hematocrit)

21. What is hyaline arteriosclerosis usually a sign of ?
Diabetic microangiopathy
Boiling - bleach - formalin - UV irradiation
ZDV or AZT
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

22. How do bradykinin - C3a and C5a cause edema?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
By vascular permeability and vasodilation
Intussusception
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

23. How do you calculate atributable risk percent?
Lateral; RV; RA; LV
RR-1/RR
Raphe
Decreases both

24. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
Thymic tumor
Ig A deficiency
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
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

25. 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?
Common peroneal; bony fractures and compression; sciatic
Superior larygeal; cricothyroid; recurrent laryngeal
Single adenomatous ones
Circular - outside nucleus; transport proteins - rRNA - tRNA

26. on What part of the clavicle does the SCM attach?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Medial part
Joints d/t increased purine production and thus uric acid production

27. Which is faster purkinje system or atrial muscle?
Varying; erythema nodosum is common
glycerol kinase
Close but purkinje system to ensure contraction in a bottom up fashion
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

28. when do ghon complexes form - primary or secondary TB?
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
Primary
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
low in serum

29. What are some side effects seen in TCAs?
Vancomycin
Tibial
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Folic acid treatment!

30. What is extraocular muscle weakness a common symptom of?
Superior larygeal; cricothyroid; recurrent laryngeal
Myasthenia gravis
low in serum
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

31. what indicates the severity of a mitral regurg ? mitral stenosis?
Enterococci (e. faecalis)- found on genitalia area
transcription activation/suppression
Amiadarone
S3 gallop; S2 to opening snap interval

32. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
transcription activation/suppression

33. at three years of age What are social - fine motor - gross motor and language developments?
Anterior circumflex (and axillary nerve)
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences

34. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
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
Because gamma chains replace beta chains and then gamma chain formation wanes
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
S. aureus

35. What is gardeners mydriasis? How is it treated?
ATP binding (resets the myosin head to contract again for next binding)
Headaches and facial flushing; vasodilation in meninges and skin
Tzanck smear
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

36. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
HSV ( also in utero: chlymadia - neisseria - group B strep)
Because of vasodiation to skeletal muscles
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Faulty positioning of the genital tubercle

37. What antibodies are present in CREST? What is the most specific?
Large stroke volumes with ventricular contraction; aortic regurg
Vertical diplopia
Anti centromere; anti DNA topoisomerase
Chorda tympani branch

38. Where is aromatase used?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
frameshift mutations (missense is substitution)
Appetite suppressants
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

39. What does anti phospholipid syndrome in SLE patients predispose them to?
Multiple miscarriages d/t hypercoaguability
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
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
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)

40. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Proteasome inhibitor; treatment for MM and waldenstroms
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
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Medullary

41. other than proteinuria - What can cause foamy froathy urine?
V fib; v. failure
Standing suddenly from supine position; valsalva maneuver
Bile salt accumulation in urine
Elevated GGT and macrocytosis

42. what enzyme converts procarcinogens into carcinogens?
In ER of bile canaliculi
P450 mitochondrial monooxygenase
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
CMV - HSV 1 - Candida

43. What can worse neurologic dysfunction in cobalamic def?
Hexokinase
Raphe
Folic acid treatment!
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

44. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
Excessive collagen formation during tissue repair in susceptible individuals
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Turners`
Octreotide

45. What are two indicators of chronic alcohol consumption?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Elevated GGT and macrocytosis

46. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
Increases cytokine production
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
OCPs - multiparity - breast feeding
Bronchial dilation (bronchiectasis)

47. a patient fearing all white coats is a phenomenon of what?
Appetite suppressants
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
gram positive organisms
Classical conditioning

48. What is the Na/Ca exchange used for?
S3 gallop; S2 to opening snap interval
To pump calcium out in cardiac myocytes so that relaxation occurs
Coagulation factors are made in the liver
Nocardia

49. why are pregnant predisposed to cholelithiasis?
Nocardia
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
Because of the low output from heart failure - they will have increased aldosterone levels
25; 25

50. What actions increase venous return?
Syncope - angina - dyspnea (SAD)
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Squatting - sitting - lying supine - passive leg raising