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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. the rate of blood flow of which two circulations must equal each other at all times?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Pulmonic and systemic!

2. What can worse neurologic dysfunction in cobalamic def?
Vagus (auricular branch); vasovagal syncope!
Folic acid treatment!
Well trained athletes and children
Prevent phagocytosis

3. what happens to capacitance with age?
Acute gastric mucosal defects (superficial or full thickness)
...
No and yes
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

4. there are mucus secreting cells in the bronchioles...
Nonsense; mRNA processing
Trauma to stereociliated hair cells of the organ of corti
only up to bronchi
Sydenham chorea

5. within the right ventricle - What are maximum pressures? the pulm arter?
Gluteus maximus; difficulty getting up from seated position and climbing chair
ZDV or AZT
25; 25
SSRI; erectile dysfunction

6. how does neisseria cause a petechial rash?
RBF= PAH clearance/(1- hematocrit)
Neisseria induced small cell vasculitis (including hands and soles)
E. coli; staphylococcus saprophyticus
Curlings ulcers

7. What are fenfluramine - phentermine?
frameshift mutations (missense is substitution)
Anti cholinergic effects of pupil dilation and lack of accomodation
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Appetite suppressants

8. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
RBC mass; epo levels (secondary has high)
transcription activation/suppression
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

9. what happens to sperm count and semineferous tubules in patient with cryptoorchidism? hormonal function? why do they need to be surgically descended?
Ether and other organic solvents
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
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
The term used to describe decreased drug responsiveness with repeated administration

10. Acyl coA synthetase is not...
200-500
liver specific
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
No (unlike adenomyosis); yes

11. which two virus families have hemagluttinin on their surface?
Paramyxo and influenza
Fat - fertile - forty - female
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Boiling - bleach - formalin - UV irradiation

12. What is the mcc of extrinsic allergic asthma?
S3 gallop; S2 to opening snap interval
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Inhaled animal dander allergens
Vancomycin; histamine mediated

13. which virus inactivates both Rb and p53?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
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
E6 and E7 of HPV knock off p53 and Rb suppressor genes
frameshift mutations (missense is substitution)

14. Where does 90% of serotonin lie? What is this NT responsible?
Amiadarone
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Trauma to stereociliated hair cells of the organ of corti
GI tract; mood!

15. which cells produce surfactant? which ones mediate gas exchange?
Measles and M3 AML`
Hypothyroidism
II; I (I more abundant)
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

16. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
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
gram positive organisms
As a CO2 carrier with the carboxylase enzyme
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)

17. 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?
Curlings ulcers
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

18. What is the mutation type in thalassemias? what process is defective because of this?
Retinitis; mononucleosis
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Nonsense; mRNA processing
46 - 4N; 23 2N

19. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Measles and M3 AML`
Medial circumflex artery; avascular necrosis
11 aa polypeptide; pain NT in CNS and PNS

20. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
gram positive organisms
INTRApartum Abs (ampicillin/penicillin)
Hypertension - edema - and proteinuria
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

21. What is a primary HSV 1 infection like?
Primary
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
RR-1/RR
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

22. What are two indicators of chronic alcohol consumption?
HSV ( also in utero: chlymadia - neisseria - group B strep)
Elevated GGT and macrocytosis
Amiadarone
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

23. How do you explain the selective proteinuria of loss to albumin only in MCD?
Hypothyroidism
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Radial nerve damage
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

24. What is a common complication of acute pancreatitis? What is it?
11
Drink plenty of fluids
Acute interstitial nephritis
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

25. What does anti phospholipid syndrome in SLE patients predispose them to?
MAC complex (C5b - C9 complement deficiency)
Aromatase deficiency in child
Terminal bronchioles; small bronchi
Multiple miscarriages d/t hypercoaguability

26. which nerve in the lower leg is easily injured and causes foot drop ? What are common causes? From what nerve does it branch off or?
Common peroneal; bony fractures and compression; sciatic
INTRApartum Abs (ampicillin/penicillin)
Think Hb deformation diseases
RBF= PAH clearance/(1- hematocrit)

27. why does variocele occur more in left side?
Well trained athletes and children
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Prevents hepatic VLDL production
Standing suddenly from supine position; valsalva maneuver

28. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Gluteus maximus; difficulty getting up from seated position and climbing chair
Duration and extent of disease
Primary
Congenital hypothyroidism - downs - amyloidosis - acromegaly

29. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
Vagus (auricular branch); vasovagal syncope!
RBF= PAH clearance/(1- hematocrit)
women
S. aureus

30. 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?
Localized dermatologic pain that persists for more than one month after zoster eruption
Superior larygeal; cricothyroid; recurrent laryngeal
women
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

31. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
ZDV or AZT
Vancomycin; histamine mediated
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

32. Where is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
Trauma to stereociliated hair cells of the organ of corti
Anti cholinergic effects of pupil dilation and lack of accomodation
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
GI malignancies and Insulin resistance (acromegal for ex)

33. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Circular - outside nucleus; transport proteins - rRNA - tRNA
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)
Become beta pleated and then form neurofibrillary tangle!

34. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Fibronectin - laminin - collagen
Vagus nerve stimulation
Decreases both
(urine PAH x urine flow rate)/plasma PAH

35. why should you not use ACE inhibitors with someone who had hereditary angioedema?
I is more benign and can present later in adulthood
To pump calcium out in cardiac myocytes so that relaxation occurs
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
As a CO2 carrier with the carboxylase enzyme

36. What translocations can cause c - myc overexpression?
Because gamma chains replace beta chains and then gamma chain formation wanes
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
8 (myc protein) with 2 - 14 - 22 (iG chains)
25; 25

37. What is normal fibrinogen levels?
frameshift mutations (missense is substitution)
200-500
The time interval between S2 and OS- the shorter the interval - the more intense
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase

38. What type of bond is a disulfide bond?
E. coli
Thymic tumor
Terminal bronchioles; small bronchi
Covalent (between two cysteines)- allows protein to withstand denaturation

39. on which chromosome is wilms tumor found?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Biphosphonate
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
11

40. What is cataplexy and When is it seen?
MAC complex (C5b - C9 complement deficiency)
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Echinococcus granulosus; anaphylaxis
Nonsense; mRNA processing

41. what would be a sign of absence of cardiogenic pulm edem?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Fibrosis; macrophages
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

42. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
S. aureus
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
RER; RER

43. how does eos release MBP to kill protozoa etc?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Raphe
46 - 4N; 23 2N

44. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Reticulocytes
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
DIC; TTP- HUS dont bleed that much

45. What is acanthosis nigricans associated with?
In ER of bile canaliculi
GI malignancies and Insulin resistance (acromegal for ex)
Tzanck smear
women

46. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
Trauma to stereociliated hair cells of the organ of corti
TCAs and prazosin
No and yes
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

47. What is the cause of rapid plasma decay of thiopental?
Tissue redistribution (out of plasma) rather than metabolism
On cardiac tissue and renal juxtaglomerular cells
46 - 4N; 23 2N
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

48. What are the acute effects of corticosteroids on the CBC?
Measles and M3 AML`
Anti cholinergic effects of pupil dilation and lack of accomodation
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

49. What is diphenoxylate and What is it used for? what drug is it structurally similar to? What allows for potent anti diarrheal effect without signigicant opiate effects?
Joints d/t increased purine production and thus uric acid production
Opiate anti diarrheal that binds to mu opiate receptors in GI tract and slows motility; meperidine; low doses - but therapeutic doses combined with atropine (under marked brand name lomotil)
Both sides
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

50. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Sickle cell; G6PD
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Prevents hepatic VLDL production