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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. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Increased reticulocytes
E. coli; staphylococcus saprophyticus
Turners`
Regular insulin (Not fast acting - regular better)

2. What is used to compare means? categorical outcomes?
T test; chi squared
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
As a CO2 carrier with the carboxylase enzyme
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

3. What is capsaicin? Where does it work?
GI tract; mood!
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
ZDV or AZT
Pain reliever - reduces pain by locking substance P in the PNS

4. What is the neurologic manifestation of ADPKD?
Measure of depth invasion (vertical!)
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
High potassium conductance and some sodium conductance
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

5. What do you treat s. epidermidis with?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Well
Vancomycin
Diabetic microangiopathy

6. why does neutrophila occur with corticosteroids?
Diabetic microangiopathy
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Hypo or hyper pigmentations; after tanning
Demargination of neutrophils from the vessel walls

7. sporadic colon cancer tend to arise From what type of polyps?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Single adenomatous ones
V fib; v. failure
Congenital hypothyroidism - downs - amyloidosis - acromegaly

8. what makes bruits?
Turbulence
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
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)

9. What is the difference between additive and synergistic?
P450 mitochondrial monooxygenase
To pump calcium out in cardiac myocytes so that relaxation occurs
Anti cholinergic effects of pupil dilation and lack of accomodation
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

10. What type of calcium channels dictate the plateau in cardiac myocyte?
Superior larygeal; cricothyroid; recurrent laryngeal
Dihydropyridine sensitive Ca channels (L type)
In the extracellular space
Fat - fertile - forty - female

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

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12. What causes release of myosin head from the actin filament?
Echinococcus granulosus; anaphylaxis
DIC; TTP- HUS dont bleed that much
ATP binding (resets the myosin head to contract again for next binding)
ZDV or AZT

13. What is damaged in early syringomelia? later?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Standing suddenly from supine position; valsalva maneuver
8 (myc protein) with 2 - 14 - 22 (iG chains)

14. when do ghon complexes form - primary or secondary TB?
Boiling - bleach - formalin - UV irradiation
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Primary
Cluster

15. What does extended consumption of appetite suppressants lead to?
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Because of the low output from heart failure - they will have increased aldosterone levels
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Pulmonary hypertension

16. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Hexokinase
Increase lymphatic drainage!
Drug induced interstitial nephritis
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

17. What is the preferred treatment for DKA?
Regular insulin (Not fast acting - regular better)
The term used to describe decreased drug responsiveness with repeated administration
Hypertension - edema - and proteinuria
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

18. What is normal fibrinogen levels?
Syncope - angina - dyspnea (SAD)
Increases
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
200-500

19. Metronidizaole does not cover...
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
gram positive organisms
Decreases both

20. where exactly is ACE expressed in the lungs? What type of enzyme is it?
Anterior nares
Class I
Vagus (auricular branch); vasovagal syncope!
Vascular endothelium; protease

21. What are two indicators of chronic alcohol consumption?
Fibronectin - laminin - collagen
Elevated GGT and macrocytosis
Prostate tumor and increased osteoclast activity
High potassium conductance and some sodium conductance

22. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
Sydenham chorea
Drug induced interstitial nephritis
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
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)

23. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Southern - western
Ceftriaxone; azithromycin
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

24. is Rifampin ever used as monotherapY? why either way?
No only for prophylaxis (even for treating staphylococcal endocarditis its as multi drug); this is to prevent drug resistance from spontaneous mutations by DNA dependent RNA polymerase
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
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

25. in the LV and aorta - What are the pressures?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Amiadarone
S. aureus
Normally close to systolic

26. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
AV node slowest - to allow time for diastole
Acute gastric mucosal defects (superficial or full thickness)
Intussusception
S3 gallop; S2 to opening snap interval

27. What is the primary histologic finding in patients with eczematous dermatitis?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Spongiosis
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

28. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Valproate
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Increase by 50% in urine osmolality
Increases

29. What causes curlings ulcers?
GI malignancies and Insulin resistance (acromegal for ex)
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
P53 mutation; DCC is also required for adenoma to carcinoma
Fibrosis; macrophages

30. What is medullary sponge kidney disease and how does it present? What does it lead to?
Biphosphonate
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
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 happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
4 - 4 - 9
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Prevent phagocytosis
Syncope - angina - dyspnea (SAD)

32. What is the precursor protein to beta amyloid and On what chromosome is it found?
APP on chrom 21 (this is why downs more susceptible)
RER; RER
IgE
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

33. What are diastolic (lowest) pressures in aorta? LV?
S. aureus
Hereditary angioedema; ACE inhibitors
Fibrosis; macrophages
Around 70 (normal measured diastolic pressures); 9--

34. which nerve provides innervation for plantar flexion and inversion?
Prostate tumor and increased osteoclast activity
Rabies encephalitis from cave bats; rabies killed vaccines
Tibial
Aromatase deficiency in child

35. What is suggestive of complete central DI?
Increase by 50% in urine osmolality
Sickle cell; G6PD
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Chorda tympani branch

36. What is a cell surface marker seen in liver angiosarcoma?
Tissue redistribution (out of plasma) rather than metabolism
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Diabetic microangiopathy

37. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
Chrom 8
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

38. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
Single adenomatous ones
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
C3 decreased after 5-10 days; sulfonamides

39. at one year of age - What are the social - fine motor - gross motor and language developments?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Initiation - pointing; pincer grasp; walking; mama/dada
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Tibial

40. How can renal blood flow be calculated from RPF?
Increase in permeability of two ions with equal and opposite equilibrium potentials
Minimal change disease
Curlings ulcers
RBF= PAH clearance/(1- hematocrit)

41. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
Medial circumflex artery; avascular necrosis
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Pain reliever - reduces pain by locking substance P in the PNS
Atrial

42. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Medial circumflex artery; avascular necrosis
Prevent phagocytosis
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Ether and other organic solvents

43. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
Reiter syndrome; B27
Chrom 8
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

44. What type of vision is myopia? In What type of patients does it improve?
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
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
TSh (in testicular tumors can cause hyperthyroidism)
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

45. what organ would an activating mutation in PRPP synthetase effect?
Joints d/t increased purine production and thus uric acid production
Vertical diplopia
MAC complex (C5b - C9 complement deficiency)
Extrinsic def; instrinsic def; platelet def

46. What effects does cortisol have on catecholamines?
RER; RER
Apocrine; eccrine
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
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

47. how long is substance P? What does it do?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
11 aa polypeptide; pain NT in CNS and PNS
Relfex tachycardia; giving beta blockers
Paramyxo and influenza

48. 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?
Medial circumflex artery; avascular necrosis
Tissue redistribution (out of plasma) rather than metabolism
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
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

49. In What type of nephritis would you see high serum eos count?
Ether and other organic solvents
Drug induced interstitial nephritis
<1% - 55% - concentration dependent
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

50. Where is conduction in heart fastest? slowest?
frameshift mutations (missense is substitution)
S. saprophyticus - and s. epidermidis; novobiocin
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Purkinje system; AV node