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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 can nitrates lead to that is bad for angina therapy? How do you counter this?
Chorda tympani branch
Vertical diplopia
Vancomycin
Relfex tachycardia; giving beta blockers

2. What is congestive hepatomegaly specific for?
Right heart failure
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
MAC complex (C5b - C9 complement deficiency)
Faulty positioning of the genital tubercle

3. what bursa is affected when on knees like a maid/gardner?
Prepatellar
Elevated GGT and macrocytosis
GI tract; mood!
Diabetic microangiopathy

4. What are two indicators of chronic alcohol consumption?
Myasthenia gravis
E. coli
Elevated GGT and macrocytosis
IgE

5. What are the two growth factors associated with angiogenesis?
Extrinsic def; instrinsic def; platelet def
Amiloride - spironolactone - triamterene
FGF and VEGF
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

6. what locations of UC increase the risk of Colon cancer?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Pan colitis and right sided colitis (more than left sided and proctitis)
Gluteus maximus; difficulty getting up from seated position and climbing chair
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

7. What are the potassium sparing diuretics?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
E. coli
Amiloride - spironolactone - triamterene
frameshift mutations (missense is substitution)

8. What can chronic vit A toxicity cause?
Skin flushing and warmth; prostaglandins; give with aspirin
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Regular insulin (Not fast acting - regular better)

9. What is the most important prognostic indicator in patients with malignant melanoma?
Measure of depth invasion (vertical!)
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
46 - 4N; 23 2N
P450 mitochondrial monooxygenase

10. 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?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Superior larygeal; cricothyroid; recurrent laryngeal
Selective alpha 1 (increases SVR)
Clindamycin; covers anaerobic oral flora and aerobic bacteria

11. What type of drug is alendronate?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Biphosphonate
Terminal bronchioles; small bronchi
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

12. What is the presentation of sever aortic stenosis?
Reticulocytes
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Duration and extent of disease
Syncope - angina - dyspnea (SAD)

13. How do you calculate excretion rate of a substance? How do you calculate the filtration rate of a substance? clearance of what substance estimates the GFR?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
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
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

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

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15. What three factors effect total oxygen content of blood?
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
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

16. What is the preferred treatment for DKA?
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
Regular insulin (Not fast acting - regular better)
Hypo or hyper pigmentations; after tanning
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

17. Where does 90% of serotonin lie? What is this NT responsible?
Faulty positioning of the genital tubercle
GI tract; mood!
To pump calcium out in cardiac myocytes so that relaxation occurs
Varying; erythema nodosum is common

18. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
No and yes
When it invades the bm; carcinoma in situ
Selective alpha 1 (increases SVR)
T test; chi squared

19. Where is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Classical conditioning
Ketone body production by preventing fatty acids into the mitochondria
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

20. how much percent of sodium is excreted? urea? glucose?
Prostate tumor and increased osteoclast activity
...
P53 mutation; DCC is also required for adenoma to carcinoma
<1% - 55% - concentration dependent

21. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
RBF= PAH clearance/(1- hematocrit)
Atrial
Increase; decreased
Hyperkalemia; potassium sparing diuretics - potassium supplements

22. What are three symptoms in s.typhi?
Echinococcus granulosus; anaphylaxis
G to T in p53; HCC
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
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

23. What does prolonged PT indicated? aPTT? bleeding time?
Extrinsic def; instrinsic def; platelet def
Bile salt accumulation in urine
4 - 4 - 9
Dihydropyridine sensitive Ca channels (L type)

24. which antiarrythmic is associated with blue gray discoloration ?
Drink plenty of fluids
Amiadarone
hyponatremia (aldosterone activation equilibrates body volume)
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

25. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
Coagulation factors are made in the liver
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
C3 decreased after 5-10 days; sulfonamides
No (unlike adenomyosis); yes

26. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
FGF and VEGF
Hypertension - edema - and proteinuria
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
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

27. Where does lysyl oxidase act? What is the cofactor for that?
8; 12
In the extracellular space for collagen cross linking; zinc
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
low in serum

28. name three pathological states that present with large tongues.
Relfex tachycardia; giving beta blockers
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Hypothyroidism
Congenital hypothyroidism - downs - amyloidosis - acromegaly

29. What type of calcium channels dictate the plateau in cardiac myocyte?
Myasthenia gravis
Dihydropyridine sensitive Ca channels (L type)
HSV and VZV
SVT; increases vagal tone; rectus abdominis

30. erythema nodosum - elevated ACE - scattered granulomas - arthralgias - hilar lymphadenoapthy are indicative of what?
Sarcoid
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Headaches and facial flushing; vasodilation in meninges and skin

31. where are the vegetations on the valves of a libman sacks endocarditis?
Increase; decreased
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Both sides
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences

32. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
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
SVT; increases vagal tone; rectus abdominis
women

33. What is the mcc of elevated AFP leves in pregnancy>
Prevents hepatic VLDL production
Underestimation of gestational age
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
Not lined by epithelium

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

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35. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Class I
Folic acid treatment!
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Reiter syndrome; B27

36. what nerve and artery course along the posterior aspect of the humerus?
Radial nerve and deep brachial artery
S. saprophyticus - and s. epidermidis; novobiocin
Boiling - bleach - formalin - UV irradiation
glycerol kinase

37. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Rabies encephalitis from cave bats; rabies killed vaccines
Reticulocytes
Terminal bronchioles; small bronchi

38. What is medullary sponge kidney disease and how does it present? What does it lead to?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
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)
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

39. What is mcc of death pre hospital phase of MI? in hospital phase?
Enterococci (e. faecalis)- found on genitalia area
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Measles and M3 AML`
V fib; v. failure

40. What is the primary histologic finding in patients with eczematous dermatitis?
High potassium conductance and some sodium conductance
Spongiosis
SVT; increases vagal tone; rectus abdominis
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

41. What does glycosylase do to DNA? endonuclease? lyase? What does the order here of enzymes represent? what other enzymes are needed?

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42. What is the fibrinogen level in patient with TTP- HUS? DIC?
Normal; low
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Regular insulin (Not fast acting - regular better)
Around 70 (normal measured diastolic pressures); 9--

43. which has better side effect profile - SSRI or TCA?
Ether and other organic solvents
SSRI
Anti centromere; anti DNA topoisomerase
Neisseria induced small cell vasculitis (including hands and soles)

44. What does anti phospholipid syndrome in SLE patients predispose them to?
Primary
Multiple miscarriages d/t hypercoaguability
Sickle cell; G6PD
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

45. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
Strength of cell mediated immune response
By vascular permeability and vasodilation
Vagus nerve stimulation
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

46. which nerve provides innervation for plantar flexion and inversion?
4 - 4 - 9
Tibial
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
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

47. what defines hypoxemia?
Minimal change disease
E. coli; staphylococcus saprophyticus
SaO2 <92%
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

48. at one year of age - What are the social - fine motor - gross motor and language developments?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Initiation - pointing; pincer grasp; walking; mama/dada
Close but purkinje system to ensure contraction in a bottom up fashion
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

49. what organ would an activating mutation in PRPP synthetase effect?
Joints d/t increased purine production and thus uric acid production
frameshift mutations (missense is substitution)
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
4 - 4 - 9

50. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
APP on chrom 21 (this is why downs more susceptible)
In the extracellular space
The term used to describe decreased drug responsiveness with repeated administration
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi