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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 the most common initital symptom of ADPKD? what else?
Multiple miscarriages d/t hypercoaguability
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)
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Gluteus maximus; difficulty getting up from seated position and climbing chair

2. what indicates the severity of a mitral regurg ? mitral stenosis?
Large stroke volumes with ventricular contraction; aortic regurg
Inhaled animal dander allergens
S3 gallop; S2 to opening snap interval
Well trained athletes and children

3. 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
By vascular permeability and vasodilation
SSRI; erectile dysfunction
Multiple miscarriages d/t hypercoaguability

4. What are two common side effects of both acute and long acting nitrates? What causes them?
Hydrogen bonds dictate alpha or beta structure
Smoking
Headaches and facial flushing; vasodilation in meninges and skin
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

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?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Radial nerve damage
Anterior circumflex (and axillary nerve)
TSh (in testicular tumors can cause hyperthyroidism)

6. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Reiter syndrome; B27
Covalent (between two cysteines)- allows protein to withstand denaturation
transcription activation/suppression
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

7. What is the presentation of angioedema? Where is most commonly affected?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Well
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
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)

8. who bleed more DIC or TTP- HUS patients?
Faulty positioning of the genital tubercle
DIC; TTP- HUS dont bleed that much
AV node slowest - to allow time for diastole
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

9. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Boiling - bleach - formalin - UV irradiation
Hypothyroidism
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Spongiosis

10. What is the preferred treatment for DKA?
Little effect on cell and no change
Diabetic microangiopathy
INTRApartum Abs (ampicillin/penicillin)
Regular insulin (Not fast acting - regular better)

11. What is the neurologic manifestation of ADPKD?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
APP on chrom 21 (this is why downs more susceptible)
Extrinsic def; instrinsic def; platelet def
Kallmans

12. What translocations can cause c - myc overexpression?
Common peroneal; bony fractures and compression; sciatic
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
8 (myc protein) with 2 - 14 - 22 (iG chains)

13. why does hypothyroidism cause increased CPK levels?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
hyponatremia (aldosterone activation equilibrates body volume)
OCPs - multiparity - breast feeding

14. What does L/S stand for in fetal lung maturity? When does maturity occur?
...
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

15. in the LV and aorta - What are the pressures?
Relfex tachycardia; giving beta blockers
Normally close to systolic
Ketone body production by preventing fatty acids into the mitochondria
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

16. how does noise induced hearing loss occur?
Turbulence
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
Trauma to stereociliated hair cells of the organ of corti
II; I (I more abundant)

17. How do bradykinin - C3a and C5a cause edema?
By vascular permeability and vasodilation
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Dihydropyridine sensitive Ca channels (L type)
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

18. What three factors effect total oxygen content of blood?
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
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
P53 mutation; AD
S. saprophyticus - and s. epidermidis; novobiocin

19. What is the mcc of extrinsic allergic asthma?
AV node slowest - to allow time for diastole
Inhaled animal dander allergens
Boiling - bleach - formalin - UV irradiation
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

20. what drugs causes the red man syndrome? how does it occur?
Vancomycin; histamine mediated
Syringomelia
Recurrent larygneal
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

21. What is the cause of fixed splitting of S2? why?
Increases cytokine production
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
No and yes
Multiple miscarriages d/t hypercoaguability

22. name three pathological states that present with large tongues.
Congenital hypothyroidism - downs - amyloidosis - acromegaly
HSV and VZV
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
TCAs and prazosin

23. What does NF- KB do?
Proteasome inhibitor; treatment for MM and waldenstroms
Increases cytokine production
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

24. sporadic colon cancer tend to arise From what type of polyps?
Circular - outside nucleus; transport proteins - rRNA - tRNA
Single adenomatous ones
By vascular permeability and vasodilation
Bile salt accumulation in urine

25. why is glucagon used in beta blocker toxicitiy?
Become beta pleated and then form neurofibrillary tangle!
Terminal bronchioles; small bronchi
glycerol kinase
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

26. What are diastolic (lowest) pressures in aorta? LV?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Around 70 (normal measured diastolic pressures); 9--

27. Acyl coA synthetase is not...
liver specific
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

28. on What part of the clavicle does the SCM attach?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Well
Medial part

29. in overweight individuals What is thought to contribute to insulin resistance?
Serum FFA and serum triglyceride levels
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Serum creatine kinase; reperfusion injury causes necrosis
Susceptible; soluble (unable to be cultured in bile)

30. 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?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
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
Lateral; RV; RA; LV

31. which nerve provides innervation for plantar flexion and inversion?
Tibial
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Around 70 (normal measured diastolic pressures); 9--
Strength of cell mediated immune response

32. What are some side effects seen in TCAs?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Folic acid treatment!

33. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
Anterior circumflex (and axillary nerve)
Anti centromere; anti DNA topoisomerase
Curlings ulcers
Extrinsic def; instrinsic def; platelet def

34. What is used to treat heparin toxicity?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
glycerol kinase
Protamine sulfate
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

35. what should you think of in 'smear of an oral ulcer base'?
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
Tzanck smear
Fibrosis; macrophages
Protamine sulfate

36. why are pregnant predisposed to cholelithiasis?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
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
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
TSh (in testicular tumors can cause hyperthyroidism)

37. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
Sarcoid
Not lined by epithelium
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Standing suddenly from supine position; valsalva maneuver

38. What test would be best to determine if a gene is being transcribed? translated?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
frameshift mutations (missense is substitution)
Southern - western
women

39. What triggers the neoplastic changes that are associated with HBV infecton?
When it invades the bm; carcinoma in situ
Integration of viral DNA into genome of host hepatocytes
Superior larygeal; cricothyroid; recurrent laryngeal
Common peroneal; bony fractures and compression; sciatic

40. What can chronic vit A toxicity cause?
Serum FFA and serum triglyceride levels
Chrom 8
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

41. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
ATP binding (resets the myosin head to contract again for next binding)
Medullary
Medial circumflex artery; avascular necrosis

42. prostaglandin synthesis keeps...
PDA open
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
LT (LTD4 - E4 - C4) - and Ach
When it invades the bm; carcinoma in situ

43. IL4 is used for isotypye switching to what?
Cluster
frameshift mutations (missense is substitution)
Because gamma chains replace beta chains and then gamma chain formation wanes
IgE

44. what dissolves the lipid bilayer of a viral envelope?
Apocrine; eccrine
HSV and VZV
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Ether and other organic solvents

45. hypertonicity and hyperreflexity are ________________ of hydrocephalus
Circular - outside nucleus; transport proteins - rRNA - tRNA
S. saprophyticus - and s. epidermidis; novobiocin
Normally close to systolic
manifestations - congenital (stretching of periventricular pyrimadal fibers)

46. what protein is increased in Crohns disease? What does it do?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
NF- KB; responsible for cytokine production
Hypertension - edema - and proteinuria
Anti cholinergic effects of pupil dilation and lack of accomodation

47. What type of endocarditis is cytoscopy induced?
Enterococci (e. faecalis)- found on genitalia area
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
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
chronic urticaria and allergic symptoms

48. what chromosome is c - myc found on?
I is more benign and can present later in adulthood
RBF= PAH clearance/(1- hematocrit)
Chrom 8
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

49. What is the sole neurologic manifestation of acute rheumatic fever?
Sydenham chorea
Regular insulin (Not fast acting - regular better)
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

50. Which is faster atrial muscle or ventricular muscle?
Vertical diplopia
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Atrial