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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. Where is the base of the heart? apex?
Bile salt accumulation in urine
Bronchogenic carcinoma
Chrom 8
Closer to head; closer to diaphragm

2. What type of drug is alendronate?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Biphosphonate
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

3. what bursa is affected when on knees like a maid/gardner?
P450 mitochondrial monooxygenase
Prepatellar
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Relfex tachycardia; giving beta blockers

4. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Acute interstitial nephritis
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

5. What is epleronone?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Another type of aldosterone antagonist (like spironolactone)
only up to bronchi
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

6. What is epispadias caused by?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Duration and extent of disease
Faulty positioning of the genital tubercle
HSV ( also in utero: chlymadia - neisseria - group B strep)

7. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Anterior nares
P450 mitochondrial monooxygenase
Susceptible; soluble (unable to be cultured in bile)
Class I

8. What are the primary determinants of colon cancer risk in UC patients
Valproate
Duration and extent of disease
Chrom 8
Fibrosis; macrophages

9. carnitine deficiency impairs production of What and how?
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
Ketone body production by preventing fatty acids into the mitochondria
Syncope - angina - dyspnea (SAD)
Squatting - sitting - lying supine - passive leg raising

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

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11. What can nitrates lead to that is bad for angina therapy? How do you counter this?
S. saprophyticus - and s. epidermidis; novobiocin
Spongiosis
Dihydropyridine sensitive Ca channels (L type)
Relfex tachycardia; giving beta blockers

12. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Another type of aldosterone antagonist (like spironolactone)
<1% - 55% - concentration dependent
Sickle cell; G6PD
Turners`

13. What does NF- KB do?
Trauma to stereociliated hair cells of the organ of corti
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Retinitis; mononucleosis
Increases cytokine production

14. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
SaO2 <92%
SS +rNA
Common and benign congenital disorder characterized by cystic dilation of the medullary collecting ducts (cortex is spared); painless hematuria or asymptomatic; mc is development of kidney stones (benign disease)
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

15. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Fibronectin - laminin - collagen
Skin flushing and warmth; prostaglandins; give with aspirin
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

16. What does L/S stand for in fetal lung maturity? When does maturity occur?
gram positive organisms
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Vascular endothelium; protease
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

17. 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?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Strength of cell mediated immune response
46 - 4N; 23 2N
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

18. what hormone is structurally similar to hCG?
Dihydropyridine sensitive Ca channels (L type)
E. coli; staphylococcus saprophyticus
S. aureus
TSh (in testicular tumors can cause hyperthyroidism)

19. there are mucus secreting cells in the bronchioles...
Lack of calcium to bind oxaloacetate; crohns prevents fat absorption from lack of bile reabsorption in the terminal illeum which leads to fats pulling calcium and lack of calcium reabsorption
Multiple miscarriages d/t hypercoaguability
only up to bronchi
Hydrogen bonds dictate alpha or beta structure

20. What antibodies are present in CREST? What is the most specific?
Gluteus maximus; difficulty getting up from seated position and climbing chair
Anti centromere; anti DNA topoisomerase
Adductor
MAO inhibitors; wine and cheese

21. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Because of vasodiation to skeletal muscles
Boiling - bleach - formalin - UV irradiation
Adeno
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

22. What three factors effect total oxygen content of blood?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Bronchial dilation (bronchiectasis)

23. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Insulin like growth factor 1 (just another name)
OCPs - multiparity - breast feeding
Hyperkalemia; potassium sparing diuretics - potassium supplements

24. What is pickwickian syndrome? What are the lab findings?
8; 12
No (unlike adenomyosis); yes
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)
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

25. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
only up to bronchi
LT (LTD4 - E4 - C4) - and Ach
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

26. What is the mc location for avascular necrosis? What is it associated with?
Leukotriene precursor and does neutrophil chemotaxis
Hyperkalemia; potassium sparing diuretics - potassium supplements
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

27. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
No and yes
Echinococcus granulosus; anaphylaxis
Valproate
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

28. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
Anti cholinergic effects of pupil dilation and lack of accomodation
TCAs and prazosin
Primary
transcription activation/suppression

29. other than proteinuria - What can cause foamy froathy urine?
Spongiosis
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Bile salt accumulation in urine
Paramyxo and influenza

30. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
women
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Highly negative resting potential
Insulin like growth factor 1 (just another name)

31. 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
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
Barium enema
Vascular endothelium; protease

32. What is the difference between additive and synergistic?
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
Anterior circumflex (and axillary nerve)
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

33. How do left sided colon adenocarcinomas present? right sided?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
GI malignancies and Insulin resistance (acromegal for ex)
Prevent phagocytosis
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

34. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
No and yes
C3 decreased after 5-10 days; sulfonamides
Fibronectin - laminin - collagen
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

35. 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
The term used to describe decreased drug responsiveness with repeated administration
Cluster
Vancomycin

36. sporadic colon cancer tend to arise From what type of polyps?
Anti centromere; anti DNA topoisomerase
Single adenomatous ones
T test; chi squared
When it invades the bm; carcinoma in situ

37. what dissolves the lipid bilayer of a viral envelope?
Ether and other organic solvents
...
Curlings ulcers
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

38. What is Tzanck smear used to detect?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
11 aa polypeptide; pain NT in CNS and PNS
Vertical diplopia
HSV and VZV

39. What does extended consumption of appetite suppressants lead to?
Ether and other organic solvents
Pulmonary hypertension
Thymic tumor
Measles and M3 AML`

40. what chromosome is c - myc found on?
Little effect on cell and no change
I is more benign and can present later in adulthood
Chrom 8
Increases

41. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Chlorpheniramine and diphenhydramine
Skin flushing and warmth; prostaglandins; give with aspirin
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
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

42. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
I is more benign and can present later in adulthood
Increases cytokine production
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

43. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
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
Demargination of neutrophils from the vessel walls
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Reticulocytes

44. are there signs of inflammation in avascular necrosis? then How do you diagnose?
No; MRI
The time interval between S2 and OS- the shorter the interval - the more intense
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
transcription activation/suppression

45. what protects the resting heart from arrhythmias?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Highly negative resting potential
Well trained athletes and children
Increase by 50% in urine osmolality

46. What does sustained hand grip do to the C/V system?
Circular - outside nucleus; transport proteins - rRNA - tRNA
Purkinje system; AV node
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

47. What is intussusception? how does ischemia and necrosis occur?
S. aureus
200-500
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
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

48. What is the triad seen in pre eclampsia?
Hypertension - edema - and proteinuria
Smoking
Chorda tympani branch
Lateral; RV; RA; LV

49. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
gram positive organisms

50. why are pregnant predisposed to cholelithiasis?
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)
Classical conditioning
T test; chi squared