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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 are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
P53 mutation; AD
Sudden loss of muscle tone without loss of consciousness; narcolepsy
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Superior larygeal; cricothyroid; recurrent laryngeal

2. 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?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Become beta pleated and then form neurofibrillary tangle!
Inactivates kallikrein which activates kininogen into bradykinin
S. saprophyticus - and s. epidermidis; novobiocin

3. Is there edema in primary Conns? secondary hyperaldosteronism? why?
Susceptible; soluble (unable to be cultured in bile)
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Medial circumflex artery; avascular necrosis

4. at four years of age - What are the social - fine motor - gross motor - and language developments?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Both sides
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
High potassium conductance and some sodium conductance

5. What is the mc location for avascular necrosis? What is it associated with?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Appetite suppressants
Inactivates kallikrein which activates kininogen into bradykinin
...

6. How do bradykinin - C3a and C5a cause edema?
Tissue redistribution (out of plasma) rather than metabolism
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Prevent phagocytosis
By vascular permeability and vasodilation

7. What actions increase venous return?
Leukotriene precursor and does neutrophil chemotaxis
Squatting - sitting - lying supine - passive leg raising
Vancomycin; histamine mediated
Vertical diplopia

8. in overweight individuals What is thought to contribute to insulin resistance?
Sarcoid
Serum FFA and serum triglyceride levels
Demargination of neutrophils from the vessel walls
SSRI; erectile dysfunction

9. What are some of the permissive effects of cortisol?
Bronchial dilation (bronchiectasis)
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

10. What can too much IgA in serum produces?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Underestimation of gestational age
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Hypertension - edema - and proteinuria

11. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
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
Gluteus medius and minimus; positive trendelenberg

12. What are the potassium sparing diuretics?
Hexokinase
Diabetic microangiopathy
Right heart failure
Amiloride - spironolactone - triamterene

13. what commonly happens in GI in response to acute physiologic stress?
Reiter syndrome; B27
chronic urticaria and allergic symptoms
No; MRI
Acute gastric mucosal defects (superficial or full thickness)

14. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
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)
Terminal bronchioles; small bronchi
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

15. what drugs causes the red man syndrome? how does it occur?
Vancomycin; histamine mediated
Around 70 (normal measured diastolic pressures); 9--
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)

16. What effects does cortisol have on catecholamines?
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
Prepatellar
E. coli; staphylococcus saprophyticus
frameshift mutations (missense is substitution)

17. What antibiotic is best to treat alcoholic pulm infections? why?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Increase lymphatic drainage!

18. 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?
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)
Decreases both
Common peroneal; bony fractures and compression; sciatic
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

19. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
V fib; v. failure
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
E6 and E7 of HPV knock off p53 and Rb suppressor genes

20. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Radial nerve damage
Become beta pleated and then form neurofibrillary tangle!
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)
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

21. When is an S4 sound normal?
Well trained athletes and children
Hypertension - edema - and proteinuria
differentiate
In the extracellular space for collagen cross linking; zinc

22. why are beta thal major patients asymptomatic at birth?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Because gamma chains replace beta chains and then gamma chain formation wanes
To pump calcium out in cardiac myocytes so that relaxation occurs
When it invades the bm; carcinoma in situ

23. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Closer to head; closer to diaphragm
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Congenital hypothyroidism - downs - amyloidosis - acromegaly
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

24. What is pickwickian syndrome? What are the lab findings?
Excessive collagen formation during tissue repair in susceptible individuals
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Adeno
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

25. Where is the base of the heart? apex?
Anterior circumflex (and axillary nerve)
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Closer to head; closer to diaphragm
Squatting - sitting - lying supine - passive leg raising

26. where are the vegetations on the valves of a libman sacks endocarditis?
Adductor
Acute gastric mucosal defects (superficial or full thickness)
Regular insulin (Not fast acting - regular better)
Both sides

27. What do you treat s. epidermidis with?
Vagus nerve stimulation
P53 mutation; AD
Thymic tumor
Vancomycin

28. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Think Hb deformation diseases
DIC; TTP- HUS dont bleed that much
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Thymic tumor

29. In what form are mitochondrial DNA? What do they transcribe?
AV node slowest - to allow time for diastole
Circular - outside nucleus; transport proteins - rRNA - tRNA
Little effect on cell and no change
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

30. which headaches are seen mostly in men - are severe - unilateral - periorbital - episodic (around same time every day) - temporal pain - with lacrimation - nasal congestion and ptosis?
25; 25
...
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Cluster

31. What is contraindicated in toxic mega colon?
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Normally close to systolic
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
46 - 4N; 23 2N

32. who bleed more DIC or TTP- HUS patients?
Chlorpheniramine and diphenhydramine
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
DIC; TTP- HUS dont bleed that much
SVT; increases vagal tone; rectus abdominis

33. What is congestive hepatomegaly specific for?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
HSV and VZV
Right heart failure
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

34. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Terminal bronchioles; small bronchi
Vagus (auricular branch); vasovagal syncope!
TSh (in testicular tumors can cause hyperthyroidism)

35. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Hexokinase
8 (myc protein) with 2 - 14 - 22 (iG chains)
Serum FFA and serum triglyceride levels
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

36. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Chorda tympani branch
Abnormal closing of the urethral folds
Medullary

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

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38. What is used to compare means? categorical outcomes?
Become beta pleated and then form neurofibrillary tangle!
hyponatremia (aldosterone activation equilibrates body volume)
T test; chi squared
Because gamma chains replace beta chains and then gamma chain formation wanes

39. which virus inactivates both Rb and p53?
Little effect on cell and no change
V fib; v. failure
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Leukotriene precursor and does neutrophil chemotaxis

40. IL4 is used for isotypye switching to what?
IgE
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Faulty positioning of the genital tubercle
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

41. What is the mutation type in thalassemias? what process is defective because of this?
hyponatremia (aldosterone activation equilibrates body volume)
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Nonsense; mRNA processing
IgE

42. What is Bortezomib and What is it used for?
FGF and VEGF
Vertical diplopia
Proteasome inhibitor; treatment for MM and waldenstroms
Turbulence

43. what phase do adenosine and acetylcholine act on? doing what?
liver specific
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
As a CO2 carrier with the carboxylase enzyme

44. which trisomy is associated with endocardial cushion defects? What does thsi mean>
11 aa polypeptide; pain NT in CNS and PNS
Downs; regurgitant AV valves - ASDs
Bronchial dilation (bronchiectasis)
manifestations - congenital (stretching of periventricular pyrimadal fibers)

45. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
II; I (I more abundant)
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
S3 gallop; S2 to opening snap interval
Increase lymphatic drainage!

46. what bursa is affected when on knees like a maid/gardner?
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Prepatellar
No
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

47. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Measure of depth invasion (vertical!)
Gluteus maximus; difficulty getting up from seated position and climbing chair
Covalent (between two cysteines)- allows protein to withstand denaturation
gram positive organisms

48. Where does conjugation of bilirubin take place?
Vancomycin
Become beta pleated and then form neurofibrillary tangle!
In ER of bile canaliculi
To pump calcium out in cardiac myocytes so that relaxation occurs

49. What is best to prevent GBS infection in a baby?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
INTRApartum Abs (ampicillin/penicillin)
II; I (I more abundant)
ATP binding (resets the myosin head to contract again for next binding)

50. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
RER; RER
Terminal bronchioles; small bronchi
Extrinsic def; instrinsic def; platelet def
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