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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 achalasia and how would this correlate on the esophageal mannometry?
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
Bronchial dilation (bronchiectasis)
Skin flushing and warmth; prostaglandins; give with aspirin
Vagus (auricular branch); vasovagal syncope!

2. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
differentiate
Regular insulin (Not fast acting - regular better)
Extrinsic def; instrinsic def; platelet def
No; MRI

3. where are Beta 1 receptors found?
Strength of cell mediated immune response
SSRI; erectile dysfunction
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
On cardiac tissue and renal juxtaglomerular cells

4. What is the mc location of brain germinomas?What are the classic symptoms?
...
Ketone body production by preventing fatty acids into the mitochondria
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

5. what murmur is enhanced by decreased blood flow to the heart?
Fibronectin - laminin - collagen
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Cluster
Reiter syndrome; B27

6. Which is slower AV node or ventricular muscle?
TCAs and prazosin
Nonsense; mRNA processing
Southern - western
AV node slowest - to allow time for diastole

7. What is it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
Vertical diplopia
Increase; decreased
Circular - outside nucleus; transport proteins - rRNA - tRNA
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

8. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
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
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

9. What antibiotic is best to treat alcoholic pulm infections? why?
I is more benign and can present later in adulthood
RER; RER
Squatting - sitting - lying supine - passive leg raising
Clindamycin; covers anaerobic oral flora and aerobic bacteria

10. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
E. coli; staphylococcus saprophyticus
glycerol kinase
Bile salt accumulation in urine

11. What are the potassium sparing diuretics?
Radial nerve damage
Measles and M3 AML`
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Amiloride - spironolactone - triamterene

12. which two virus families have hemagluttinin on their surface?
Paramyxo and influenza
Insulin like growth factor 1 (just another name)
Atrial
Squatting - sitting - lying supine - passive leg raising

13. What is the mcc of extrinsic allergic asthma?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Inhaled animal dander allergens
SSRI; erectile dysfunction
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

14. What is the best indicator for the severity of mitral stenosis?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
The term used to describe decreased drug responsiveness with repeated administration
The time interval between S2 and OS- the shorter the interval - the more intense
Ceftriaxone; azithromycin

15. other than in pyelonephritis - where else are WBC casts seen?
Nocardia
Acute interstitial nephritis
Pulmonary hypertension
Adductor

16. What is the cause of fixed splitting of S2? why?
Diabetic microangiopathy
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Because gamma chains replace beta chains and then gamma chain formation wanes
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

17. What is pickwickian syndrome? What are the lab findings?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
gram positive organisms
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

18. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
Thymic tumor
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
HSV ( also in utero: chlymadia - neisseria - group B strep)
Relfex tachycardia; giving beta blockers

19. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Superior larygeal; cricothyroid; recurrent laryngeal
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Pulmonary hypertension
Reticulocytes

20. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Normally close to systolic
RER; RER
Pulmonary hypertension

21. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
Chorda tympani branch
Lateral; RV; RA; LV
P53 mutation; AD
Turbulence

22. What are the three causes of acute MI in context of normal coronary arteries ?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
OCPs - multiparity - breast feeding
...

23. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
Headaches and facial flushing; vasodilation in meninges and skin
Amiadarone
Mean greater than median greater than mode
Hypothyroidism

24. What is suggestive of complete central DI?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Increase by 50% in urine osmolality
Valproate
Downs; regurgitant AV valves - ASDs

25. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Become beta pleated and then form neurofibrillary tangle!
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
RER; RER

26. What are the common causes of metabolic alkalosis? How do you differentiate between them?
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)
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

27. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Integration of viral DNA into genome of host hepatocytes
Increase; decreased
LT (LTD4 - E4 - C4) - and Ach
Radial nerve damage

28. What are the three dopaminergic systems and What are they responsible for? disease?
Bile soluble which means they are bile sensitive
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
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

29. where are the vegetations on the valves of a libman sacks endocarditis?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
HSV and VZV
Both sides
Pulmonary hypertension

30. how much percent of sodium is excreted? urea? glucose?
<1% - 55% - concentration dependent
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
GI tract; mood!
Recurrent larygneal

31. What is the neurologic manifestation of ADPKD?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Radial nerve damage
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

32. What does sustained hand grip do to the C/V system?
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
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

33. what immune deficiency causes recurrent neisseria infections?
Because gamma chains replace beta chains and then gamma chain formation wanes
MAC complex (C5b - C9 complement deficiency)
Medial circumflex artery; avascular necrosis
Tissue redistribution (out of plasma) rather than metabolism

34. 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
chronic urticaria and allergic symptoms
Mean greater than median greater than mode
Coagulation factors are made in the liver

35. What is a common complication of acute pancreatitis? What is it?
hyponatremia (aldosterone activation equilibrates body volume)
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
RBF= PAH clearance/(1- hematocrit)
The time interval between S2 and OS- the shorter the interval - the more intense

36. where exactly is ACE expressed in the lungs? What type of enzyme is it?
Right heart failure
Measure of depth invasion (vertical!)
Vascular endothelium; protease
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

37. What does the tuberoinfundibular pathway connect? What is it responsible for?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
hyponatremia (aldosterone activation equilibrates body volume)
Squatting - sitting - lying supine - passive leg raising
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin

38. How do bradykinin - C3a and C5a cause edema?
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
SVT; increases vagal tone; rectus abdominis
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)
By vascular permeability and vasodilation

39. What are diastolic (lowest) pressures in aorta? LV?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
I is more benign and can present later in adulthood
Around 70 (normal measured diastolic pressures); 9--
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

40. which antiarrythmic is associated with blue gray discoloration ?
Brief psychotic disorder; schizophreniform; schizophrenia
Amiadarone
Nocardia
Skin flushing and warmth; prostaglandins; give with aspirin

41. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
Demargination of neutrophils from the vessel walls
RBC mass; epo levels (secondary has high)
Aromatase deficiency in child
Raphe

42. What is a clara cell?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
HSV and VZV
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

43. what locations of UC increase the risk of Colon cancer?
Pan colitis and right sided colitis (more than left sided and proctitis)
ATP binding (resets the myosin head to contract again for next binding)
RER; copper
differentiate

44. What does L/S stand for in fetal lung maturity? When does maturity occur?
Increase lymphatic drainage!
Medial circumflex artery; avascular necrosis
200-500
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

45. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
Decreases both
Sickle cell; G6PD
Extrinsic def; instrinsic def; platelet def
chronic urticaria and allergic symptoms

46. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
Bronchial dilation (bronchiectasis)
Elevated GGT and macrocytosis
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Well

47. what nerve and artery course along the posterior aspect of the humerus?
facultative intracellular
Radial nerve and deep brachial artery
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Both sides

48. which are the only glycosylated proteins in HIV virus?
Env genes (for getting into target cells)
Underestimation of gestational age
IgE
When it invades the bm; carcinoma in situ

49. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
women
NF- KB; responsible for cytokine production

50. How do left sided colon adenocarcinomas present? right sided?
ANCA because of lack of Ig and C3 deposits on IF
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
PDA open
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone