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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 almost exclusively causes Epliglottitis?What type of capsule does it have? What are the symptoms?

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2. Would alpha 1 agonists cause flushing? muscarinic antagonist?
No; yes
E. coli
In the extracellular space
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

3. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
In the extracellular space for collagen cross linking; zinc
Medial part
Brief psychotic disorder; schizophreniform; schizophrenia
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac

4. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
FGF and VEGF
Class I
Curlings ulcers

5. What would a deflection of the membrane potential to near zero indicate?
Initiation - pointing; pincer grasp; walking; mama/dada
Increase in permeability of two ions with equal and opposite equilibrium potentials
Prostate tumor and increased osteoclast activity
HSV and VZV

6. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Chorda tympani branch
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

7. why is crohns disease associated with oxaloacetate kidney stones?
Vancomycin
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Varying; erythema nodosum is common
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. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Vancomycin; histamine mediated
Pulmonic and systemic!
Mean greater than median greater than mode

9. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
TSh (in testicular tumors can cause hyperthyroidism)
Intussusception
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
SVT; increases vagal tone; rectus abdominis

10. What are the two coagulase negative staphylococci? How do you distinguish them?
S. saprophyticus - and s. epidermidis; novobiocin
No; MRI
Tzanck smear
Congenital hypothyroidism - downs - amyloidosis - acromegaly

11. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Joints d/t increased purine production and thus uric acid production
To pump calcium out in cardiac myocytes so that relaxation occurs
Skin flushing and warmth; prostaglandins; give with aspirin

12. Where is aromatase used?
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
S. aureus
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
OCPs - multiparity - breast feeding

13. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
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
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Squatting - sitting - lying supine - passive leg raising
E. coli; staphylococcus saprophyticus

14. at 2 years of age - What are the social - fine motor - gross motor and language developments?
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
Thymic tumor
(urine PAH x urine flow rate)/plasma PAH
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

15. there are mucus secreting cells in the bronchioles...
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Circular - outside nucleus; transport proteins - rRNA - tRNA
only up to bronchi

16. in essential fructosuria - what enzyme do patients use to metabolize fructose?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Curlings ulcers
Hexokinase
P53 mutation; AD

17. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Rabies encephalitis from cave bats; rabies killed vaccines
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Measles and M3 AML`

18. What is the most common neurologic complication of VZV reactivation?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Localized dermatologic pain that persists for more than one month after zoster eruption
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

19. What are the lab findings in poststreptococcal GN?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Inactivates kallikrein which activates kininogen into bradykinin

20. h1 receptor anatagonists are not effective in treatment of asthma only for...
chronic urticaria and allergic symptoms
Circular - outside nucleus; transport proteins - rRNA - tRNA
Bile salt accumulation in urine
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

21. SIADH patients have normal blood volume but...
hyponatremia (aldosterone activation equilibrates body volume)
Varying; erythema nodosum is common
Vagus (auricular branch); vasovagal syncope!
S3 gallop; S2 to opening snap interval

22. What three pathogens cause infectious esophagitis in HIV positive patients?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
CMV - HSV 1 - Candida
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

23. what should you think of in 'smear of an oral ulcer base'?
Protamine sulfate
Tzanck smear
Curlings ulcers
Serum creatine kinase; reperfusion injury causes necrosis

24. What does hypocapnia cause in teh brain? What is hypocapnia?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
HSV ( also in utero: chlymadia - neisseria - group B strep)
Chlorpheniramine and diphenhydramine
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

25. What is the Na/Ca exchange used for?
Aromatase deficiency in child
46 - 4N; 23 2N
Increase in permeability of two ions with equal and opposite equilibrium potentials
To pump calcium out in cardiac myocytes so that relaxation occurs

26. What is an abortive viral infection?
Adeno
Little effect on cell and no change
Sydenham chorea
Paramyxo and influenza

27. What type of vision is myopia? In What type of patients does it improve?
Headaches and facial flushing; vasodilation in meninges and skin
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Medial part
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

28. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
Anti cholinergic effects of pupil dilation and lack of accomodation
transcription activation/suppression
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)
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

29. Where is conduction in heart fastest? slowest?
Purkinje system; AV node
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
TCAs and prazosin
The time interval between S2 and OS- the shorter the interval - the more intense

30. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
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)
Serum FFA and serum triglyceride levels
SVC and IVC; right below the aortic knob
No; yes

31. 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
GI tract; mood!
MAC complex (C5b - C9 complement deficiency)
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

32. What does nitroprusside do to afterload? preload?
Decreases both
Insulin like growth factor 1 (just another name)
Drink plenty of fluids
No; yes

33. What is a common complication of acute pancreatitis? What is it?
In the extracellular space for collagen cross linking; zinc
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
HSV ( also in utero: chlymadia - neisseria - group B strep)
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

34. How do you treat gonococcal infection? chlymadia?
Abnormal closing of the urethral folds
Increase in permeability of two ions with equal and opposite equilibrium potentials
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Ceftriaxone; azithromycin

35. what vessel would a fracture to the neck of the of the humerus damage?
Anterior circumflex (and axillary nerve)
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Duration and extent of disease
DIC; TTP- HUS dont bleed that much

36. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
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
Skin flushing and warmth; prostaglandins; give with aspirin
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

37. What is achalasia and how would this correlate on the esophageal mannometry?
Amiloride - spironolactone - triamterene
NF- KB; responsible for cytokine production
Neisseria induced small cell vasculitis (including hands and soles)
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

38. what indicates the severity of a mitral regurg ? mitral stenosis?
Covalent (between two cysteines)- allows protein to withstand denaturation
only up to bronchi
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
S3 gallop; S2 to opening snap interval

39. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
V fib; v. failure
RR-1/RR
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Hyperkalemia; potassium sparing diuretics - potassium supplements

40. What are two common side effects of both acute and long acting nitrates? What causes them?
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Headaches and facial flushing; vasodilation in meninges and skin
No; MRI
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

41. why does neutrophila occur with corticosteroids?
200-500
Bronchial dilation (bronchiectasis)
Demargination of neutrophils from the vessel walls
Squatting - sitting - lying supine - passive leg raising

42. What type of bond is a disulfide bond?
Measure of depth invasion (vertical!)
Normally close to systolic
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Covalent (between two cysteines)- allows protein to withstand denaturation

43. why should you not use ACE inhibitors with someone who had hereditary angioedema?
Skin flushing and warmth; prostaglandins; give with aspirin
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
Hypo or hyper pigmentations; after tanning
Acute gastric mucosal defects (superficial or full thickness)

44. on What part of the clavicle does the SCM attach?
No; MRI
Medial part
Extrinsic def; instrinsic def; platelet def
Sydenham chorea

45. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
Increased reticulocytes
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
OCPs - multiparity - breast feeding
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

46. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
S3 gallop; S2 to opening snap interval
Chorda tympani branch
P53 mutation; DCC is also required for adenoma to carcinoma
11 aa polypeptide; pain NT in CNS and PNS

47. What test would be best to determine if a gene is being transcribed? translated?
SS +rNA
Southern - western
Regular insulin (Not fast acting - regular better)
II; I (I more abundant)

48. Acyl coA synthetase is not...
Cluster
The time interval between S2 and OS- the shorter the interval - the more intense
liver specific
Minimal change disease

49. What is the mc location of brain germinomas?What are the classic symptoms?
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
TSh (in testicular tumors can cause hyperthyroidism)
glycerol kinase

50. What type of calcium channels dictate the plateau in cardiac myocyte?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Underestimation of gestational age
Dihydropyridine sensitive Ca channels (L type)
DIC; TTP- HUS dont bleed that much