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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. non ceruloplasmin deposition - ceruloplasmin is...
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
low in serum
Recurrent larygneal
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

2. What is the presentation of sever aortic stenosis?
Syncope - angina - dyspnea (SAD)
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
11 aa polypeptide; pain NT in CNS and PNS
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

3. How do you treat gonococcal infection? chlymadia?
Adductor
Standing suddenly from supine position; valsalva maneuver
Ceftriaxone; azithromycin
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)

4. What does C1 esterase do other than inhibiting complement pathway?
Nonsense; mRNA processing
Inactivates kallikrein which activates kininogen into bradykinin
Appetite suppressants
S. saprophyticus - and s. epidermidis; novobiocin

5. What is the mainstay treatment for acute mania?
Strength of cell mediated immune response
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Insulin like growth factor 1 (just another name)
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

6. What can cause virilization of a mother during pregnancy?
Fibronectin - laminin - collagen
Aromatase deficiency in child
On cardiac tissue and renal juxtaglomerular cells
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

7. What is the stabilizing force for the secondary structure of proteins?
NF- KB; responsible for cytokine production
Hydrogen bonds dictate alpha or beta structure
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)
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

8. how does neisseria cause a petechial rash?
Neisseria induced small cell vasculitis (including hands and soles)
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
The term used to describe decreased drug responsiveness with repeated administration

9. which type of glands produce an initially odorless secretion but can become malodorous secondary to bacterial decompisition on the skin surface? which glands are present throughout the skin except on lips and glans penis?
Syringomelia
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
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Apocrine; eccrine

10. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Biphosphonate
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

11. What is used to treat heparin toxicity?
Increased reticulocytes
ZDV or AZT
Protamine sulfate
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

12. Where does 90% of serotonin lie? What is this NT responsible?
GI tract; mood!
Atrial
Single adenomatous ones
Barium enema

13. in B12 deficiency - what levels in blood rise very quickly and then drop?
High potassium conductance and some sodium conductance
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Become beta pleated and then form neurofibrillary tangle!
Reticulocytes

14. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Phencyclidine (PCP)
Normal; low
...

15. What is the triad seen in pre eclampsia?
Valproate
Appetite suppressants
Syncope - angina - dyspnea (SAD)
Hypertension - edema - and proteinuria

16. What is the mcc of extrinsic allergic asthma?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Selective alpha 1 (increases SVR)
Inhaled animal dander allergens
Syncope - angina - dyspnea (SAD)

17. What are pancreatic pseudocysts called pseudo rather than true cysts?
Not lined by epithelium
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)
(urine PAH x urine flow rate)/plasma PAH
MAC complex (C5b - C9 complement deficiency)

18. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
Mean greater than median greater than mode
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
Integration of viral DNA into genome of host hepatocytes
Dihydropyridine sensitive Ca channels (L type)

19. Where does lysyl oxidase act? What is the cofactor for that?
Bile soluble which means they are bile sensitive
In the extracellular space for collagen cross linking; zinc
Underestimation of gestational age
hyponatremia (aldosterone activation equilibrates body volume)

20. What is congestive hepatomegaly specific for?
Turbulence
Measles and M3 AML`
Increase by 50% in urine osmolality
Right heart failure

21. why is crohns disease associated with oxaloacetate kidney stones?
Amiloride - spironolactone - triamterene
Lack of calcium to bind oxaloacetate; crohns prevents fat absorption from lack of bile reabsorption in the terminal illeum which leads to fats pulling calcium and lack of calcium reabsorption
8; 12
Phencyclidine (PCP)

22. What would a deflection of the membrane potential to near zero indicate?
Hereditary angioedema; ACE inhibitors
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Increase in permeability of two ions with equal and opposite equilibrium potentials
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

23. what virus causes pharyngoconjuctival fever?
Because gamma chains replace beta chains and then gamma chain formation wanes
Adeno
Chlorpheniramine and diphenhydramine
Because of the low output from heart failure - they will have increased aldosterone levels

24. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
Faulty positioning of the genital tubercle
Chorda tympani branch
Enterococci (e. faecalis)- found on genitalia area
Transported to liver - glycerol kinase converts it to glycerol 3 phosphate Which is then converted to DHAP which can either join glycolysis for ATP or be used to make glucose

25. What does p53 do? what chrom is it on?
Drug induced interstitial nephritis
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)
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Pulmonic and systemic!

26. metabolism of 1 gram of protein produces How many calories? carb? fat?
Retinitis; mononucleosis
4 - 4 - 9
High potassium conductance and some sodium conductance
Proteasome inhibitor; treatment for MM and waldenstroms

27. how does noise induced hearing loss occur?
Sickle cell; G6PD
Trauma to stereociliated hair cells of the organ of corti
Curlings ulcers
MAC complex (C5b - C9 complement deficiency)

28. What is the mc location for avascular necrosis? What is it associated with?
Another type of aldosterone antagonist (like spironolactone)
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Standing suddenly from supine position; valsalva maneuver
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

29. What does NF- KB do?
transcription activation/suppression
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Increases cytokine production
Because of vasodiation to skeletal muscles

30. what murmur is enhanced by decreased blood flow to the heart?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Varying; erythema nodosum is common
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Turbulence

31. on which chromosome is wilms tumor found?
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
11
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

32. What does L/S stand for in fetal lung maturity? When does maturity occur?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Acute gastric mucosal defects (superficial or full thickness)
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

33. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
In ER of bile canaliculi
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Turners`
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

34. What is damaged in early syringomelia? later?
Echinococcus granulosus; anaphylaxis
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Protamine sulfate
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

35. What does nitroprusside do to afterload? preload?
Cluster
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Anterior nares
Decreases both

36. What is Bortezomib and What is it used for?
<1% - 55% - concentration dependent
Increases cytokine production
46 - 4N; 23 2N
Proteasome inhibitor; treatment for MM and waldenstroms

37. h1 receptor anatagonists are not effective in treatment of asthma only for...
Little effect on cell and no change
chronic urticaria and allergic symptoms
Anti centromere; anti DNA topoisomerase
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. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
Ceftriaxone; azithromycin
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
Serum FFA and serum triglyceride levels
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac

39. What is tachyphylaxis?
The term used to describe decreased drug responsiveness with repeated administration
Nocardia
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Right heart failure

40. What is the primary histologic finding in patients with eczematous dermatitis?
Hydrogen bonds dictate alpha or beta structure
Duration and extent of disease
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Spongiosis

41. When does opening snap begin?
Class I
Right before diastole (filling begins)
Anti cholinergic effects of pupil dilation and lack of accomodation
No; MRI

42. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Syringomelia
SVT; increases vagal tone; rectus abdominis
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

43. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
Trochlear nerve (IV); abducens nerve (VI)
RR-1/RR
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Because of vasodiation to skeletal muscles

44. What can worse neurologic dysfunction in cobalamic def?
Folic acid treatment!
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)
IgE
Fibrosis; macrophages

45. What is contraindicated in toxic mega colon?
Elevated GGT and macrocytosis
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Trauma to stereociliated hair cells of the organ of corti

46. what vessel would a fracture to the neck of the of the humerus damage?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Kallmans
Cluster
Anterior circumflex (and axillary nerve)

47. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
To pump calcium out in cardiac myocytes so that relaxation occurs
SVC and IVC; right below the aortic knob
No
Normal; low

48. at four years of age - What are the social - fine motor - gross motor - and language developments?
<1% - 55% - concentration dependent
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
ANCA because of lack of Ig and C3 deposits on IF

49. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Retinitis; mononucleosis
V fib; v. failure
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
DIC; TTP- HUS dont bleed that much

50. do Class IC agents prolong the QT interval?
Coagulation factors are made in the liver
ANCA because of lack of Ig and C3 deposits on IF
No
Intussusception