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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 is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
Become beta pleated and then form neurofibrillary tangle!
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

2. what kind of drug is sertraline? What is a common side effect?
Prepatellar
low in serum
SSRI; erectile dysfunction
Appetite suppressants

3. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Fibronectin - laminin - collagen
11
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
SVT; increases vagal tone; rectus abdominis

4. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Terminal bronchioles; small bronchi
Bile soluble which means they are bile sensitive
chronic urticaria and allergic symptoms
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

5. What is normal fibrinogen levels?
Reticulocytes
Localized dermatologic pain that persists for more than one month after zoster eruption
200-500
Turners`

6. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
AV node slowest - to allow time for diastole
Reiter syndrome; B27
Prostate tumor and increased osteoclast activity
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

7. what murmur is enhanced by decreased blood flow to the heart?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Chrom 8
Trauma to stereociliated hair cells of the organ of corti

8. in overweight individuals What is thought to contribute to insulin resistance?
Serum FFA and serum triglyceride levels
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Superior larygeal; cricothyroid; recurrent laryngeal
RER; copper

9. What are some side effects seen in TCAs?
200-500
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Prostate tumor and increased osteoclast activity
E. coli; staphylococcus saprophyticus

10. What type of vision is myopia? In What type of patients does it improve?
Enterococci (e. faecalis)- found on genitalia area
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
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Raphe

11. What causes curlings ulcers?
Squatting - sitting - lying supine - passive leg raising
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Hydrogen bonds dictate alpha or beta structure

12. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
Chorda tympani branch
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

13. What can cause aortic regurg? What is the heart sound you hear?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Brief psychotic disorder; schizophreniform; schizophrenia
Skin flushing and warmth; prostaglandins; give with aspirin
CGD; t cell dysfxn (diGeorge)

14. How do you calculate RPF from urine PAH?
women
When it invades the bm; carcinoma in situ
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
(urine PAH x urine flow rate)/plasma PAH

15. who bleed more DIC or TTP- HUS patients?
APP on chrom 21 (this is why downs more susceptible)
DIC; TTP- HUS dont bleed that much
Dissolved in plasma and attached to Hgb
Medial part

16. What does NF- KB do?
Increased reticulocytes
46 - 4N; 23 2N
Not lined by epithelium
Increases cytokine production

17. what hormone is structurally similar to hCG?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
TSh (in testicular tumors can cause hyperthyroidism)
Ether and other organic solvents
E. coli; staphylococcus saprophyticus

18. How do bradykinin - C3a and C5a cause edema?
Intussusception
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
By vascular permeability and vasodilation
T test; chi squared

19. If a patient has higher levels of HbF - What does this mean?
Reiter syndrome; B27
Think Hb deformation diseases
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
Hypo or hyper pigmentations; after tanning

20. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
indomethacin
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

21. What is hyaline arteriosclerosis usually a sign of ?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Diabetic microangiopathy
Turners`
11 aa polypeptide; pain NT in CNS and PNS

22. at four years of age - What are the social - fine motor - gross motor - and language developments?
women
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
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
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

23. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
E. coli; staphylococcus saprophyticus
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
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

24. What triggers the neoplastic changes that are associated with HBV infecton?
Integration of viral DNA into genome of host hepatocytes
Injury to common peroneal nerve (d/t trauma or sustained pressure to neck of fibula) causing pain and numbness on dorsum of foot and inability to dorsiflex
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Congenital hypothyroidism - downs - amyloidosis - acromegaly

25. What translocations can cause c - myc overexpression?
8 (myc protein) with 2 - 14 - 22 (iG chains)
DIC; TTP- HUS dont bleed that much
Anterior nares
E. coli

26. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
Medullary
Hereditary angioedema; ACE inhibitors
Localized dermatologic pain that persists for more than one month after zoster eruption
OCPs - multiparity - breast feeding

27. What does the severity of leprosy depend on?
Prevent phagocytosis
Syncope - angina - dyspnea (SAD)
Strength of cell mediated immune response
Vascular endothelium; protease

28. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Apocrine; eccrine
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Relfex tachycardia; giving beta blockers

29. What is a clara cell?
RR-1/RR
Acute interstitial nephritis
Measles and M3 AML`
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

30. why does hypothyroidism cause increased CPK levels?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Smoking
hyponatremia (aldosterone activation equilibrates body volume)
In the extracellular space

31. at 2 years of age - What are the social - fine motor - gross motor and language developments?
S. saprophyticus - and s. epidermidis; novobiocin
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
SSRI
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)

32. What does 'oxygen' content in blood refer to?
Dissolved in plasma and attached to Hgb
Increase in permeability of two ions with equal and opposite equilibrium potentials
glycerol kinase
SVC and IVC; right below the aortic knob

33. What is the triad seen in pre eclampsia?
Hypertension - edema - and proteinuria
E. coli
Acute interstitial nephritis
Normal; low

34. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
HSV ( also in utero: chlymadia - neisseria - group B strep)
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Purkinje system; AV node
8 (myc protein) with 2 - 14 - 22 (iG chains)

35. What antibiotic is best to treat alcoholic pulm infections? why?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Prevent phagocytosis
indomethacin
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

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

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37. What is a primary HSV 1 infection like?
HSV and VZV
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Chorda tympani branch
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

38. What type of drug is alendronate?
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
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Biphosphonate
No (unlike adenomyosis); yes

39. how much percent of sodium is excreted? urea? glucose?
Leukotriene precursor and does neutrophil chemotaxis
<1% - 55% - concentration dependent
Appetite suppressants
Joints d/t increased purine production and thus uric acid production

40. PDAs are often asymptomatic. How do you treat?
indomethacin
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Classical conditioning
frameshift mutations (missense is substitution)

41. what dissolves the lipid bilayer of a viral envelope?
Ether and other organic solvents
C3 decreased after 5-10 days; sulfonamides
Single adenomatous ones
women

42. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Primary
Rabies encephalitis from cave bats; rabies killed vaccines
CMV - HSV 1 - Candida
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

43. what makes bruits?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
ZDV or AZT
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)
Turbulence

44. What type of mutation does aflatoxin cause? what cancer does this increase for?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
G to T in p53; HCC
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

45. what dictates the resting membrane potential of most cells?
High potassium conductance and some sodium conductance
Barium enema
Multiple miscarriages d/t hypercoaguability
Fibronectin - laminin - collagen

46. what defines hypoxemia?
SaO2 <92%
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Close but purkinje system to ensure contraction in a bottom up fashion

47. How can renal blood flow be calculated from RPF?
Rabies encephalitis from cave bats; rabies killed vaccines
RER; RER
RBF= PAH clearance/(1- hematocrit)
Raphe

48. What does TGF beta do? What produces it?
Close but purkinje system to ensure contraction in a bottom up fashion
Fibrosis; macrophages
Become beta pleated and then form neurofibrillary tangle!
Ether and other organic solvents

49. What test would be best to determine if a gene is being transcribed? translated?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
8 (myc protein) with 2 - 14 - 22 (iG chains)
Pan colitis and right sided colitis (more than left sided and proctitis)
Southern - western

50. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Phencyclidine (PCP)
chronic urticaria and allergic symptoms
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Right heart failure