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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. Which nerve lies in close proximity to the inferior thyroid artery?
IgE
Primary
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Recurrent larygneal

2. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
The time interval between S2 and OS- the shorter the interval - the more intense
SVT; increases vagal tone; rectus abdominis
Ceftriaxone; azithromycin
OCPs - multiparity - breast feeding

3. What is Tzanck smear used to detect?
Adductor
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Spongiosis
HSV and VZV

4. What does NF- KB do?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Circular - outside nucleus; transport proteins - rRNA - tRNA
Hereditary angioedema; ACE inhibitors
Increases cytokine production

5. What is the Na/Ca exchange used for?
No; MRI
Barium enema
To pump calcium out in cardiac myocytes so that relaxation occurs
Fat - fertile - forty - female

6. where are Beta 1 receptors found?
Chorda tympani branch
On cardiac tissue and renal juxtaglomerular cells
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

7. What is the preferred treatment for DKA?
Regular insulin (Not fast acting - regular better)
Increases cytokine production
Barium enema
Highly negative resting potential

8. What is the mcc of elevated AFP leves in pregnancy>
Echinococcus granulosus; anaphylaxis
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Underestimation of gestational age
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

9. Which is slower AV node or ventricular muscle?
Right before diastole (filling begins)
Demargination of neutrophils from the vessel walls
AV node slowest - to allow time for diastole
11

10. What translocations can cause c - myc overexpression?
GI tract; mood!
8 (myc protein) with 2 - 14 - 22 (iG chains)
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Normal; low

11. What does 'oxygen' content in blood refer to?
Dissolved in plasma and attached to Hgb
An invagination of portion of intestine into the lumen of the adjacent intestinal segment; can lead to impaired venous return from the invaginated segment of the bowel which can cause ischemia and subsequent necrosis
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
As a CO2 carrier with the carboxylase enzyme

12. what protects the resting heart from arrhythmias?
Biphosphonate
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Highly negative resting potential

13. What causes curlings ulcers?
frameshift mutations (missense is substitution)
In ER of bile canaliculi
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

14. Which is faster atrial muscle or ventricular muscle?
Raphe
Atrial
Multiple miscarriages d/t hypercoaguability
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

15. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Radial nerve damage
Vertical diplopia
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

16. why is glucagon used in beta blocker toxicitiy?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Increased reticulocytes
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
Barium enema

17. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Lateral; RV; RA; LV
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
RER; copper

18. in overweight individuals What is thought to contribute to insulin resistance?
Myasthenia gravis
Serum FFA and serum triglyceride levels
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Prepatellar

19. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
hyponatremia (aldosterone activation equilibrates body volume)
200-500
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)

20. What is hyaline arteriosclerosis usually a sign of ?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Radial nerve damage
Diabetic microangiopathy
Multiple miscarriages d/t hypercoaguability

21. What is a clara cell?
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)
ANCA because of lack of Ig and C3 deposits on IF
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

22. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Skin flushing and warmth; prostaglandins; give with aspirin
Chrom 8
RBF= PAH clearance/(1- hematocrit)
Clindamycin; covers anaerobic oral flora and aerobic bacteria

23. What is easiest way to treat nephrolithiasis?
By vascular permeability and vasodilation
Trochlear nerve (IV); abducens nerve (VI)
Drink plenty of fluids
Anti - apoptotic (prevents going into apoptosis)- 18; 14

24. What three factors effect total oxygen content of blood?
Susceptible; soluble (unable to be cultured in bile)
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Brief psychotic disorder; schizophreniform; schizophrenia
T test; chi squared

25. What three pathogens cause infectious esophagitis in HIV positive patients?
CMV - HSV 1 - Candida
No (unlike adenomyosis); yes
8; 12
On cardiac tissue and renal juxtaglomerular cells

26. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Prostate tumor and increased osteoclast activity
Neisseria induced small cell vasculitis (including hands and soles)
Hereditary angioedema; ACE inhibitors
Medial circumflex artery; avascular necrosis

27. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Atrial
Because of vasodiation to skeletal muscles
Hexokinase

28. What is the diagnosis in delayed puberty plus anosmia?
An invagination of portion of intestine into the lumen of the adjacent intestinal segment; can lead to impaired venous return from the invaginated segment of the bowel which can cause ischemia and subsequent necrosis
Kallmans
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Anti cholinergic effects of pupil dilation and lack of accomodation

29. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
Inactivates kallikrein which activates kininogen into bradykinin
Think Hb deformation diseases
Minimal change disease
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

30. What are the two growth factors associated with angiogenesis?
FGF and VEGF
Sickle cell; G6PD
Increase lymphatic drainage!
4 - 4 - 9

31. What are the two mcc of focal brain lesions in HIV positive patients?
Downs; regurgitant AV valves - ASDs
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Neisseria induced small cell vasculitis (including hands and soles)
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

32. What is the immune deficinecy seen in ataxia telangactasia?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
MAC complex (C5b - C9 complement deficiency)
Ig A deficiency
GI tract; mood!

33. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
Barium enema
transcription activation/suppression
P53 mutation; AD
Mean greater than median greater than mode

34. What does glycosylase do to DNA? endonuclease? lyase? What does the order here of enzymes represent? what other enzymes are needed?

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35. in essential fructosuria - what enzyme do patients use to metabolize fructose?
INTRApartum Abs (ampicillin/penicillin)
Hexokinase
Because of the low output from heart failure - they will have increased aldosterone levels
gram positive organisms

36. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
RBF= PAH clearance/(1- hematocrit)
Cluster
Become beta pleated and then form neurofibrillary tangle!
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

37. How do bradykinin - C3a and C5a cause edema?
NF- KB; responsible for cytokine production
Prostate tumor and increased osteoclast activity
By vascular permeability and vasodilation
Dissolved in plasma and attached to Hgb

38. what dictates the resting membrane potential of most cells?
High potassium conductance and some sodium conductance
Brief psychotic disorder; schizophreniform; schizophrenia
only up to bronchi
OCPs - multiparity - breast feeding

39. in B12 deficiency - what levels in blood rise very quickly and then drop?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Primary
Reticulocytes
V fib; v. failure

40. Would alpha 1 agonists cause flushing? muscarinic antagonist?
Class I
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
No; yes
Joints d/t increased purine production and thus uric acid production

41. What is difference between Arnold Chiari type I and II?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
...
I is more benign and can present later in adulthood
Medial circumflex artery; avascular necrosis

42. Where is conduction in heart fastest? slowest?
Purkinje system; AV node
Increase lymphatic drainage!
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
<1% - 55% - concentration dependent

43. ___________ is liver specific
No and yes
Hyperkalemia; potassium sparing diuretics - potassium supplements
P450 mitochondrial monooxygenase
glycerol kinase

44. What does protein M do in Group A strep<
CMV - HSV 1 - Candida
Vascular endothelium; protease
Initiation - pointing; pincer grasp; walking; mama/dada
Prevent phagocytosis

45. What is pickwickian syndrome? What are the lab findings?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

46. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Myasthenia gravis
46 - 4N; 23 2N
ATP binding (resets the myosin head to contract again for next binding)
Phencyclidine (PCP)

47. other than in pyelonephritis - where else are WBC casts seen?
NF- KB; responsible for cytokine production
Acute interstitial nephritis
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

48. Where does terminal peptide cleavage of collagen fibrils take place?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
In the extracellular space
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

49. What are the acute effects of corticosteroids on the CBC?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Env genes (for getting into target cells)

50. Is there edema in primary Conns? secondary hyperaldosteronism? why?
INTRApartum Abs (ampicillin/penicillin)
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Paramyxo and influenza
Turners`