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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 mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
Octreotide
RBC mass; epo levels (secondary has high)
S3 gallop; S2 to opening snap interval
E. coli; staphylococcus saprophyticus

2. other than parvo B19 - what else is associated with red cell aplasia?
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Covalent (between two cysteines)- allows protein to withstand denaturation
Medial circumflex artery; avascular necrosis
Thymic tumor

3. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
S. aureus
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Amiadarone
S3 gallop; S2 to opening snap interval

4. what diseases can vit A be used to treat?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
8; 12
Measles and M3 AML`

5. what nerve and artery course along the posterior aspect of the humerus?
Radial nerve and deep brachial artery
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Minimal change disease
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

6. what hormone is structurally similar to hCG?
TSh (in testicular tumors can cause hyperthyroidism)
Purkinje system; AV node
Increased reticulocytes
High potassium conductance and some sodium conductance

7. What can worse neurologic dysfunction in cobalamic def?
Pan colitis and right sided colitis (more than left sided and proctitis)
differentiate
Folic acid treatment!
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

8. What causes the blurry vision side effects in first generation anti histamines?
Trochlear nerve (IV); abducens nerve (VI)
Chrom 8
Anti cholinergic effects of pupil dilation and lack of accomodation
S. aureus

9. What is the presentation of angioedema? Where is most commonly affected?
Prevent phagocytosis
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Hydrogen bonds dictate alpha or beta structure
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

10. What are diastolic (lowest) pressures in aorta? LV?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Around 70 (normal measured diastolic pressures); 9--
11

11. What are the potassium sparing diuretics?
Syncope - angina - dyspnea (SAD)
Amiloride - spironolactone - triamterene
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

12. after a thrombus extraction - what serum enzyme shoots up and why?
Serum creatine kinase; reperfusion injury causes necrosis
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
Class I
Hereditary angioedema; ACE inhibitors

13. when do ghon complexes form - primary or secondary TB?
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
Amiloride - spironolactone - triamterene
Fibrosis; macrophages
Primary

14. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
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
Sydenham chorea
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Prevents hepatic VLDL production

15. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Sarcoid
Medullary
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

16. other than proteinuria - What can cause foamy froathy urine?
Bile salt accumulation in urine
Medial part
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
As a CO2 carrier with the carboxylase enzyme

17. prostaglandin synthesis keeps...
RBF= PAH clearance/(1- hematocrit)
PDA open
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Southern - western

18. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
INTRApartum Abs (ampicillin/penicillin)
Hereditary angioedema; ACE inhibitors
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac

19. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
S. saprophyticus - and s. epidermidis; novobiocin
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Appetite suppressants
Duration and extent of disease

20. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
Intussusception
To pump calcium out in cardiac myocytes so that relaxation occurs
Selective alpha 1 (increases SVR)
Well

21. Metronidizaole does not cover...
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
gram positive organisms
Octreotide
SVT; increases vagal tone; rectus abdominis

22. What is the difference between paranoid personality disorder and delusional disorder?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
200-500
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Lateral; RV; RA; LV

23. how long is substance P? What does it do?
11 aa polypeptide; pain NT in CNS and PNS
Excessive collagen formation during tissue repair in susceptible individuals
Vertical diplopia
Close but purkinje system to ensure contraction in a bottom up fashion

24. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Kallmans
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

25. What is epispadias caused by?
Enterococci (e. faecalis)- found on genitalia area
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Vascular endothelium; protease
Faulty positioning of the genital tubercle

26. at one year of age - What are the social - fine motor - gross motor and language developments?
Myasthenia gravis
Initiation - pointing; pincer grasp; walking; mama/dada
Insulin like growth factor 1 (just another name)
The time interval between S2 and OS- the shorter the interval - the more intense

27. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Thymic tumor
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

28. What causes release of myosin head from the actin filament?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
ATP binding (resets the myosin head to contract again for next binding)
Myasthenia gravis
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

29. What is difference between Arnold Chiari type I and II?
Lateral; RV; RA; LV
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
I is more benign and can present later in adulthood

30. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
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)
Anti centromere; anti DNA topoisomerase
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
No and yes

31. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
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
Bronchogenic carcinoma
Radial nerve damage
Hereditary angioedema; ACE inhibitors

32. Which nerve lies in close proximity to the inferior thyroid artery?
liver specific
Abnormal closing of the urethral folds
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Recurrent larygneal

33. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Large stroke volumes with ventricular contraction; aortic regurg
Adeno
Drink plenty of fluids
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

34. Which is slower AV node or ventricular muscle?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Increase in permeability of two ions with equal and opposite equilibrium potentials
AV node slowest - to allow time for diastole

35. What is the mc malignancy in asbestosis?
TCAs and prazosin
Bronchogenic carcinoma
Hereditary angioedema; ACE inhibitors
Nocardia

36. What is a keloid?
Brief psychotic disorder; schizophreniform; schizophrenia
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Normal; low
Excessive collagen formation during tissue repair in susceptible individuals

37. How is dobutamine better than dopamine?
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
Vertical diplopia
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
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

38. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
SSRI; erectile dysfunction
<1% - 55% - concentration dependent
Vagus nerve stimulation
Mean greater than median greater than mode

39. What are the long term consequences of hydrocephalus?
Fibronectin - laminin - collagen
Medial circumflex artery; avascular necrosis
Turbulence
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

40. What almost exclusively causes Epliglottitis?What type of capsule does it have? What are the symptoms?

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41. What are the two coagulase negative staphylococci? How do you distinguish them?
S. saprophyticus - and s. epidermidis; novobiocin
Paramyxo and influenza
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
RER; RER

42. at four years of age - What are the social - fine motor - gross motor - and language developments?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
NF- KB; responsible for cytokine production
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

43. Where is aromatase used?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Proteasome inhibitor; treatment for MM and waldenstroms
Sudden loss of muscle tone without loss of consciousness; narcolepsy

44. What can long term leg cast wearing cause?
Primary
Increased reticulocytes
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
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

45. which RPGN is also called pauci immune GN? why?
Common peroneal; bony fractures and compression; sciatic
Drink plenty of fluids
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
ANCA because of lack of Ig and C3 deposits on IF

46. What is extraocular muscle weakness a common symptom of?
Inhaled animal dander allergens
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Myasthenia gravis
Rabies encephalitis from cave bats; rabies killed vaccines

47. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Reticulocytes
Adeno
25; 25

48. How do you calculate RPF from urine PAH?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Insulin like growth factor 1 (just another name)
(urine PAH x urine flow rate)/plasma PAH

49. Where is conduction in heart fastest? slowest?
Downs; regurgitant AV valves - ASDs
Prevents hepatic VLDL production
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Purkinje system; AV node

50. What is the mainstay treatment for acute mania?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Normally close to systolic
RBC mass; epo levels (secondary has high)
manifestations - congenital (stretching of periventricular pyrimadal fibers)