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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 effects does cortisol have on catecholamines?
Permissive - sensitizes vasoconstrictive response from catecholamines - doesnt actually act on them but increases transcription of some genes that creates permissive effect (not additive or synergistic becuase cortisol alone doesnt have any effect on
No
Vagus (auricular branch); vasovagal syncope!
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

2. which headaches are seen mostly in men - are severe - unilateral - periorbital - episodic (around same time every day) - temporal pain - with lacrimation - nasal congestion and ptosis?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Reiter syndrome; B27
Appetite suppressants
Cluster

3. What causes vertical diplopia? horizontal?
Highly negative resting potential
Trochlear nerve (IV); abducens nerve (VI)
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Brief psychotic disorder; schizophreniform; schizophrenia

4. What are three symptoms in s.typhi?
low in serum
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Prepatellar
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

5. how can HAV be inactivated?
Selective alpha 1 (increases SVR)
Boiling - bleach - formalin - UV irradiation
Leukotriene precursor and does neutrophil chemotaxis
Syncope - angina - dyspnea (SAD)

6. what drug is useful for secretory diarrhea?
Apocrine; eccrine
Octreotide
Ether and other organic solvents
SVC and IVC; right below the aortic knob

7. where are the two classical places that the ulnar nerve can be injured?

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8. Metronidizaole does not cover...
MAO inhibitors; wine and cheese
gram positive organisms
Downs; regurgitant AV valves - ASDs
Anti cholinergic effects of pupil dilation and lack of accomodation

9. What is hyaline arteriosclerosis usually a sign of ?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Diabetic microangiopathy
Reticulocytes
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

10. when do ghon complexes form - primary or secondary TB?
E. coli; staphylococcus saprophyticus
Fat - fertile - forty - female
Primary
LT (LTD4 - E4 - C4) - and Ach

11. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
Pain reliever - reduces pain by locking substance P in the PNS
Skin flushing and warmth; prostaglandins; give with aspirin
RR-1/RR
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

12. at three years of age What are social - fine motor - gross motor and language developments?
Env genes (for getting into target cells)
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Prevent phagocytosis

13. What is the sole neurologic manifestation of acute rheumatic fever?
Sydenham chorea
Southern - western
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Chorda tympani branch

14. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Apocrine; eccrine
women
RBC mass; epo levels (secondary has high)

15. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
Vagus nerve stimulation
Paramyxo and influenza
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
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

16. what defines hypoxemia?
SaO2 <92%
Terminal bronchioles; small bronchi
Recurrent larygneal
Phencyclidine (PCP)

17. What is the mc manifestation of CMV in HIV patient? immunocompetent?
No and yes
Retinitis; mononucleosis
Atrial
Underestimation of gestational age

18. where exactly is ACE expressed in the lungs? What type of enzyme is it?
Regular insulin (Not fast acting - regular better)
Medial part
Vascular endothelium; protease
Serum FFA and serum triglyceride levels

19. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
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
Syringomelia
Turners`
Vancomycin; histamine mediated

20. nucleotide deletions do not cause missense mutations - they cause...
frameshift mutations (missense is substitution)
To pump calcium out in cardiac myocytes so that relaxation occurs
Env genes (for getting into target cells)
Syncope - angina - dyspnea (SAD)

21. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
No
Hypertension - edema - and proteinuria
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Anti - apoptotic (prevents going into apoptosis)- 18; 14

22. What test would be best to determine if a gene is being transcribed? translated?
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Gluteus maximus; difficulty getting up from seated position and climbing chair
Southern - western

23. What is pickwickian syndrome? What are the lab findings?
Measles and M3 AML`
Boiling - bleach - formalin - UV irradiation
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

24. in overweight individuals What is thought to contribute to insulin resistance?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
No and yes
Serum FFA and serum triglyceride levels

25. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Selective alpha 1 (increases SVR)
Pulmonary hypertension
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
Increased reticulocytes

26. which nerve provides innervation for plantar flexion and inversion?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Tibial
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
facultative intracellular

27. Which is faster purkinje system or atrial muscle?
GI malignancies and Insulin resistance (acromegal for ex)
Smoking
On cardiac tissue and renal juxtaglomerular cells
Close but purkinje system to ensure contraction in a bottom up fashion

28. What does the tuberoinfundibular pathway connect? What is it responsible for?
Vagus (auricular branch); vasovagal syncope!
Tzanck smear
Ig A deficiency
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin

29. How do you calculate RPF from urine PAH?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Tissue redistribution (out of plasma) rather than metabolism
(urine PAH x urine flow rate)/plasma PAH

30. Which is faster atrial muscle or ventricular muscle?
High potassium conductance and some sodium conductance
Atrial
Circular - outside nucleus; transport proteins - rRNA - tRNA
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

31. what receptors do first generation anti histamines block?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Fat - fertile - forty - female
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
HSV and VZV

32. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
11 aa polypeptide; pain NT in CNS and PNS
Increase lymphatic drainage!
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

33. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
transcription activation/suppression
RER; copper
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Sydenham chorea

34. How can renal blood flow be calculated from RPF?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Ether and other organic solvents
RBF= PAH clearance/(1- hematocrit)
Retinitis; mononucleosis

35. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
Excessive collagen formation during tissue repair in susceptible individuals
Vagus (auricular branch); vasovagal syncope!
Amiadarone
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

36. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Initiation - pointing; pincer grasp; walking; mama/dada
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Reiter syndrome; B27
GI tract; mood!

37. What does sustained hand grip do to the C/V system?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Pulmonic and systemic!
Varying; erythema nodosum is common
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

38. What is the Na/Ca exchange used for?
Dissolved in plasma and attached to Hgb
To pump calcium out in cardiac myocytes so that relaxation occurs
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
only up to bronchi

39. what makes bruits?
Turbulence
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Southern - western
Increased reticulocytes

40. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
only up to bronchi
SaO2 <92%
Anti centromere; anti DNA topoisomerase
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)

41. What causes release of myosin head from the actin filament?
Elevated GGT and macrocytosis
Chorda tympani branch
Varying; erythema nodosum is common
ATP binding (resets the myosin head to contract again for next binding)

42. What causes curlings ulcers?
Bronchogenic carcinoma
INTRApartum Abs (ampicillin/penicillin)
low in serum
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

43. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
Minimal change disease
Fibronectin - laminin - collagen
Elastance
Common peroneal; bony fractures and compression; sciatic

44. How do you calculate atributable risk percent?
Think Hb deformation diseases
RR-1/RR
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Extrinsic def; instrinsic def; platelet def

45. What does extended consumption of appetite suppressants lead to?
Bronchial dilation (bronchiectasis)
Pulmonary hypertension
Demargination of neutrophils from the vessel walls
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

46. which nucleus releases serotonin?
INTRApartum Abs (ampicillin/penicillin)
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Raphe

47. What is difference between Arnold Chiari type I and II?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Leukotriene precursor and does neutrophil chemotaxis
Neisseria induced small cell vasculitis (including hands and soles)
I is more benign and can present later in adulthood

48. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Around 70 (normal measured diastolic pressures); 9--
Valproate
In the extracellular space for collagen cross linking; zinc
Demargination of neutrophils from the vessel walls

49. Is there edema in primary Conns? secondary hyperaldosteronism? why?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Tzanck smear
frameshift mutations (missense is substitution)

50. Where does lysyl oxidase act? What is the cofactor for that?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
In the extracellular space for collagen cross linking; zinc
8 (myc protein) with 2 - 14 - 22 (iG chains)
Increase lymphatic drainage!