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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. If a patient has higher levels of HbF - What does this mean?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Think Hb deformation diseases
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
only up to bronchi

2. which nerve is at risk when ligating the superior thyroid artery? Which is the only muscle this nerve innervates? what nerve innervates all the other laryngeal muscles?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Ether and other organic solvents
Superior larygeal; cricothyroid; recurrent laryngeal
In ER of bile canaliculi

3. why are beta thal major patients asymptomatic at birth?
Relfex tachycardia; giving beta blockers
Class I
Because gamma chains replace beta chains and then gamma chain formation wanes
Varying; erythema nodosum is common

4. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Purkinje system; AV node
Become beta pleated and then form neurofibrillary tangle!
Hypo or hyper pigmentations; after tanning
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

5. what chromosome is c - myc found on?
Chrom 8
Inhaled animal dander allergens
No
Classical conditioning

6. What is difference between Arnold Chiari type I and II?
Boiling - bleach - formalin - UV irradiation
Think Hb deformation diseases
Abnormal closing of the urethral folds
I is more benign and can present later in adulthood

7. what indicates the severity of a mitral regurg ? mitral stenosis?
Prepatellar
Nocardia
Gluteus maximus; difficulty getting up from seated position and climbing chair
S3 gallop; S2 to opening snap interval

8. how long is substance P? What does it do?
Ceftriaxone; azithromycin
11 aa polypeptide; pain NT in CNS and PNS
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
RBF= PAH clearance/(1- hematocrit)

9. What does TGF beta do? What produces it?
When it invades the bm; carcinoma in situ
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
Excessive collagen formation during tissue repair in susceptible individuals
Fibrosis; macrophages

10. When does neovascularization granulation tissue begin to form after severe ischemia and MI? what happens in 12-24 hours? 2 weeks to 2 months? 1-5 days? 0-4 hours? when do you see edema - hemorrhage - wavy fibers?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Nonsense; mRNA processing
Hyperkalemia; potassium sparing diuretics - potassium supplements

11. Where does lysyl oxidase act? What is the cofactor for that?
DIC; TTP- HUS dont bleed that much
Increase; decreased
To pump calcium out in cardiac myocytes so that relaxation occurs
In the extracellular space for collagen cross linking; zinc

12. what protects the resting heart from arrhythmias?
Coagulation factors are made in the liver
Highly negative resting potential
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

13. 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)
In ER of bile canaliculi
Initiation - pointing; pincer grasp; walking; mama/dada
Terminal bronchioles; small bronchi

14. What type of bond is a disulfide bond?
RBF= PAH clearance/(1- hematocrit)
MAO inhibitors; wine and cheese
Covalent (between two cysteines)- allows protein to withstand denaturation
liver specific

15. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
chronic urticaria and allergic symptoms
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Serum FFA and serum triglyceride levels
HSV ( also in utero: chlymadia - neisseria - group B strep)

16. carnitine deficiency impairs production of What and how?
Ketone body production by preventing fatty acids into the mitochondria
Decreases both
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Ceftriaxone; azithromycin

17. at 2 years of age - What are the social - fine motor - gross motor and language developments?
low in serum
Well trained athletes and children
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

18. How can renal blood flow be calculated from RPF?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
hyponatremia (aldosterone activation equilibrates body volume)
Pain reliever - reduces pain by locking substance P in the PNS
RBF= PAH clearance/(1- hematocrit)

19. What can worse neurologic dysfunction in cobalamic def?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Folic acid treatment!
Because of vasodiation to skeletal muscles
Class I

20. What is somatomedin C?
Recurrent larygneal
Bronchogenic carcinoma
Relfex tachycardia; giving beta blockers
Insulin like growth factor 1 (just another name)

21. which type of glands produce an initially odorless secretion but can become malodorous secondary to bacterial decompisition on the skin surface? which glands are present throughout the skin except on lips and glans penis?
Both sides
Fibronectin - laminin - collagen
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Apocrine; eccrine

22. why does hypothyroidism cause increased CPK levels?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Terminal bronchioles; small bronchi
RBC mass; epo levels (secondary has high)

23. Which is slower AV node or ventricular muscle?
Coagulation factors are made in the liver
SSRI
P53 mutation; AD
AV node slowest - to allow time for diastole

24. What is acanthosis nigricans associated with?
On cardiac tissue and renal juxtaglomerular cells
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
GI malignancies and Insulin resistance (acromegal for ex)
Acute interstitial nephritis

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?
Closer to head; closer to diaphragm
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Close but purkinje system to ensure contraction in a bottom up fashion
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

26. What is the cause of fixed splitting of S2? why?
TCAs and prazosin
Spongiosis
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Trauma to stereociliated hair cells of the organ of corti

27. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
T test; chi squared
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

28. IL4 is used for isotypye switching to what?
Ether and other organic solvents
II; I (I more abundant)
Primary
IgE

29. neisseria are...
Increase by 50% in urine osmolality
facultative intracellular
Vagus nerve stimulation
I is more benign and can present later in adulthood

30. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Fibronectin - laminin - collagen
Ether and other organic solvents
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)

31. What is the most important prognostic indicator in patients with malignant melanoma?
Minimal change disease
Medullary
Vancomycin; histamine mediated
Measure of depth invasion (vertical!)

32. 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
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Around 70 (normal measured diastolic pressures); 9--
P450 mitochondrial monooxygenase

33. How do you treat gonococcal infection? chlymadia?
Ceftriaxone; azithromycin
11 aa polypeptide; pain NT in CNS and PNS
Reiter syndrome; B27
Anti cholinergic effects of pupil dilation and lack of accomodation

34. what marker should be followed in a patient with cirrhosis?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

35. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Raphe
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Vagus (auricular branch); vasovagal syncope!

36. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
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
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Not lined by epithelium
transcription activation/suppression

37. why is crohns disease associated with oxaloacetate kidney stones?
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
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
No
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)

38. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Chorda tympani branch
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Gluteus maximus; difficulty getting up from seated position and climbing chair

39. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
11
E. coli
Increased reticulocytes

40. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
frameshift mutations (missense is substitution)
When it invades the bm; carcinoma in situ
Superior larygeal; cricothyroid; recurrent laryngeal
On cardiac tissue and renal juxtaglomerular cells

41. What is a cell surface marker seen in liver angiosarcoma?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
11
Tzanck smear
Right heart failure

42. when do ghon complexes form - primary or secondary TB?
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Sickle cell; G6PD
Primary
Leukotriene precursor and does neutrophil chemotaxis

43. What is congestive hepatomegaly specific for?
only up to bronchi
II; I (I more abundant)
Right heart failure
Lateral; RV; RA; LV

44. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
...
Hereditary angioedema; ACE inhibitors
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Valproate

45. What type of calcium channels dictate the plateau in cardiac myocyte?
Tissue redistribution (out of plasma) rather than metabolism
Dihydropyridine sensitive Ca channels (L type)
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

46. What does Rb protein do? what chrom is it on?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
differentiate
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
MAO inhibitors; wine and cheese

47. How do you calculate atributable risk percent?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
RR-1/RR
Valproate
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

48. how does eos release MBP to kill protozoa etc?
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
Pulmonic and systemic!
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
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

49. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
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
Bile soluble which means they are bile sensitive
CGD; t cell dysfxn (diGeorge)
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

50. which staphylococci can do mannitol fermaentation?
Cluster
MAO inhibitors; wine and cheese
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
S. aureus