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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. when do ghon complexes form - primary or secondary TB?
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
Downs; regurgitant AV valves - ASDs
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Primary

2. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Pain reliever - reduces pain by locking substance P in the PNS
Large stroke volumes with ventricular contraction; aortic regurg
Increase in permeability of two ions with equal and opposite equilibrium potentials
Because of vasodiation to skeletal muscles

3. which RPGN is also called pauci immune GN? why?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
ANCA because of lack of Ig and C3 deposits on IF

4. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Appetite suppressants
low in serum
Gluteus maximus; difficulty getting up from seated position and climbing chair
Bronchial dilation (bronchiectasis)

5. What is 5- HETE and What does it do?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Leukotriene precursor and does neutrophil chemotaxis

6. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Diabetic microangiopathy
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
RR-1/RR
Covalent (between two cysteines)- allows protein to withstand denaturation

7. What are fenfluramine - phentermine?
Headaches and facial flushing; vasodilation in meninges and skin
Inactivates kallikrein which activates kininogen into bradykinin
Appetite suppressants
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

8. What is diagnostic (and possible therapeutic for intussusception)?
indomethacin
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
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
Barium enema

9. How is dobutamine better than dopamine?
NF- KB; responsible for cytokine production
Prevents hepatic VLDL production
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Localized dermatologic pain that persists for more than one month after zoster eruption

10. What does nitroprusside do to afterload? preload?
P53 mutation; AD
Increase lymphatic drainage!
Decreases both
Increase by 50% in urine osmolality

11. where exactly is ACE expressed in the lungs? What type of enzyme is it?
Prepatellar
Vascular endothelium; protease
women
Vagus nerve stimulation

12. What is acanthosis nigricans associated with?
Trauma to stereociliated hair cells of the organ of corti
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Chorda tympani branch
GI malignancies and Insulin resistance (acromegal for ex)

13. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
transcription activation/suppression
Nonsense; mRNA processing
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Localized dermatologic pain that persists for more than one month after zoster eruption

14. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
11
C3 decreased after 5-10 days; sulfonamides
Tibial

15. What is the presentation of sever aortic stenosis?
In the extracellular space
Ig A deficiency
Syncope - angina - dyspnea (SAD)
RR-1/RR

16. What does extended consumption of appetite suppressants lead to?
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Inhibits it
Smoking
Pulmonary hypertension

17. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Intussusception
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

18. Which is faster atrial muscle or ventricular muscle?
Atrial
Underestimation of gestational age
S3 gallop; S2 to opening snap interval
gram positive organisms

19. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
V fib; v. failure
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Standing suddenly from supine position; valsalva maneuver
IgE

20. Which is slower AV node or ventricular muscle?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
AV node slowest - to allow time for diastole
Ceftriaxone; azithromycin

21. why does hypothyroidism cause increased CPK levels?
Common peroneal; bony fractures and compression; sciatic
SSRI; erectile dysfunction
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Medial circumflex artery; avascular necrosis

22. What does prolonged PT indicated? aPTT? bleeding time?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Extrinsic def; instrinsic def; platelet def
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Serum FFA and serum triglyceride levels

23. why does neutrophila occur with corticosteroids?
Prevents hepatic VLDL production
Adductor
Demargination of neutrophils from the vessel walls
Dihydropyridine sensitive Ca channels (L type)

24. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Covalent (between two cysteines)- allows protein to withstand denaturation
Increase lymphatic drainage!
Radial nerve damage
glycerol kinase

25. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Recurrent larygneal
Purkinje system; AV node
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

26. other than in pyelonephritis - where else are WBC casts seen?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
The term used to describe decreased drug responsiveness with repeated administration
Acute gastric mucosal defects (superficial or full thickness)
Acute interstitial nephritis

27. What is a cord factor and Which bugs have it? How do they appear on culture?
Cluster
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Syringomelia
DIC; TTP- HUS dont bleed that much

28. What is difference between Arnold Chiari type I and II?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
I is more benign and can present later in adulthood
Little effect on cell and no change
Tzanck smear

29. In what view of CXR is anterior part of heart best seen? anterior part of heart is formed by?right border of heart is formed by? left border?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Phencyclidine (PCP)
Become beta pleated and then form neurofibrillary tangle!
Lateral; RV; RA; LV

30. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
women
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Another type of aldosterone antagonist (like spironolactone)

31. What is Bortezomib and What is it used for?
11 aa polypeptide; pain NT in CNS and PNS
Proteasome inhibitor; treatment for MM and waldenstroms
No; yes
RR-1/RR

32. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Elevated GGT and macrocytosis
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
HSV ( also in utero: chlymadia - neisseria - group B strep)

33. what indicates the severity of a mitral regurg ? mitral stenosis?
S. saprophyticus - and s. epidermidis; novobiocin
indomethacin
Sydenham chorea
S3 gallop; S2 to opening snap interval

34. What pulmonary structural change can kartageners syndrome cause?
Pan colitis and right sided colitis (more than left sided and proctitis)
...
Drink plenty of fluids
Bronchial dilation (bronchiectasis)

35. which antiarrythmic is associated with blue gray discoloration ?
Amiadarone
Standing suddenly from supine position; valsalva maneuver
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Regular insulin (Not fast acting - regular better)

36. are there signs of inflammation in avascular necrosis? then How do you diagnose?
Extrinsic def; instrinsic def; platelet def
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
No; MRI

37. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Increase; decreased
Excessive collagen formation during tissue repair in susceptible individuals
8 (myc protein) with 2 - 14 - 22 (iG chains)
transcription activation/suppression

38. 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?
Cluster
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Ceftriaxone; azithromycin
Regular insulin (Not fast acting - regular better)

39. What is medullary sponge kidney disease and how does it present? What does it lead to?
Sydenham chorea
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)
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
II; I (I more abundant)

40. Where is conduction in heart fastest? slowest?
Purkinje system; AV node
CMV - HSV 1 - Candida
Brief psychotic disorder; schizophreniform; schizophrenia
4 - 4 - 9

41. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
Syringomelia
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)
Barium enema
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

42. which two drug types can cause orthostatic hypotension (think depression and BPH)?
Folic acid treatment!
Hereditary angioedema; ACE inhibitors
TCAs and prazosin
Lateral; RV; RA; LV

43. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Anti centromere; anti DNA topoisomerase
Echinococcus granulosus; anaphylaxis
Octreotide

44. What are the acute effects of corticosteroids on the CBC?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
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
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

45. what diseases can vit A be used to treat?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Measles and M3 AML`
APP on chrom 21 (this is why downs more susceptible)
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

46. What is the primary histologic finding in patients with eczematous dermatitis?
Covalent (between two cysteines)- allows protein to withstand denaturation
C3 decreased after 5-10 days; sulfonamides
Spongiosis
CMV - HSV 1 - Candida

47. What causes release of myosin head from the actin filament?
Coagulation factors are made in the liver
Headaches and facial flushing; vasodilation in meninges and skin
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
ATP binding (resets the myosin head to contract again for next binding)

48. What is used to treat heparin toxicity?
Minimal change disease
Fibronectin - laminin - collagen
Protamine sulfate
Boiling - bleach - formalin - UV irradiation

49. what locations of UC increase the risk of Colon cancer?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Pan colitis and right sided colitis (more than left sided and proctitis)
Joints d/t increased purine production and thus uric acid production
Closer to head; closer to diaphragm

50. at four years of age - What are the social - fine motor - gross motor - and language developments?
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
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)
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use