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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 does L/S stand for in fetal lung maturity? When does maturity occur?
Spongiosis
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Enterococci (e. faecalis)- found on genitalia area
Anti - apoptotic (prevents going into apoptosis)- 18; 14

2. what happens with LDL receptor density in statin therapy?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Increases
Spongiosis

3. are there signs of inflammation in avascular necrosis? then How do you diagnose?
No; MRI
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
Primary
Boiling - bleach - formalin - UV irradiation

4. What antibodies are present in CREST? What is the most specific?
Anti centromere; anti DNA topoisomerase
E. coli
PDA open
46 - 4N; 23 2N

5. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
Pulmonic and systemic!
CGD; t cell dysfxn (diGeorge)
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Vertical diplopia

6. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
GI tract; mood!
Normally close to systolic
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Raphe

7. What does nitroprusside do to afterload? preload?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Around 70 (normal measured diastolic pressures); 9--
Decreases both
Increase lymphatic drainage!

8. What is the precursor protein to beta amyloid and On what chromosome is it found?
APP on chrom 21 (this is why downs more susceptible)
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
In the extracellular space for collagen cross linking; zinc
RBF= PAH clearance/(1- hematocrit)

9. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Appetite suppressants
11
Hydrogen bonds dictate alpha or beta structure
Chorda tympani branch

10. What are the first generation anti histamines?
SaO2 <92%
Chlorpheniramine and diphenhydramine
Ceftriaxone; azithromycin
No and yes

11. where are the vegetations on the valves of a libman sacks endocarditis?
Both sides
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
Adductor
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

12. What type of endocarditis is cytoscopy induced?
To pump calcium out in cardiac myocytes so that relaxation occurs
Paramyxo and influenza
Enterococci (e. faecalis)- found on genitalia area
Pulmonic and systemic!

13. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Increased reticulocytes
E6 and E7 of HPV knock off p53 and Rb suppressor genes
P53 mutation; DCC is also required for adenoma to carcinoma
Apocrine; eccrine

14. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
Fibronectin - laminin - collagen
Syringomelia
Vagus nerve stimulation
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics

15. What is the mc malignancy in asbestosis?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Bronchogenic carcinoma
Trauma to stereociliated hair cells of the organ of corti

16. When does opening snap begin?
Vagus (auricular branch); vasovagal syncope!
Right before diastole (filling begins)
Radial nerve damage
Pain reliever - reduces pain by locking substance P in the PNS

17. what virus causes pharyngoconjuctival fever?
Ceftriaxone; azithromycin
Adeno
Phencyclidine (PCP)
indomethacin

18. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
Aromatase deficiency in child
Acute interstitial nephritis
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Anterior nares

19. Where does complement bind on the Fc region of Ig chains?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
RBF= PAH clearance/(1- hematocrit)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

20. What type of bond is a disulfide bond?
Covalent (between two cysteines)- allows protein to withstand denaturation
Become beta pleated and then form neurofibrillary tangle!
Thymic tumor
Myasthenia gravis

21. What is the mc manifestation of CMV in HIV patient? immunocompetent?
Retinitis; mononucleosis
Ceftriaxone; azithromycin
Common peroneal; bony fractures and compression; sciatic
LT (LTD4 - E4 - C4) - and Ach

22. Where does 90% of serotonin lie? What is this NT responsible?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
GI tract; mood!

23. What is congestive hepatomegaly specific for?
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
S. saprophyticus - and s. epidermidis; novobiocin
Right heart failure
Localized dermatologic pain that persists for more than one month after zoster eruption

24. what nerve and artery course along the posterior aspect of the humerus?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Radial nerve and deep brachial artery
I is more benign and can present later in adulthood
Decreases both

25. where exactly is ACE expressed in the lungs? What type of enzyme is it?
200-500
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
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Vascular endothelium; protease

26. What is used to compare means? categorical outcomes?
II; I (I more abundant)
T test; chi squared
Large stroke volumes with ventricular contraction; aortic regurg
Ig A deficiency

27. What is the sole neurologic manifestation of acute rheumatic fever?
...
Pulmonary hypertension
Large stroke volumes with ventricular contraction; aortic regurg
Sydenham chorea

28. Where is conduction in heart fastest? slowest?
Purkinje system; AV node
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)
Terminal bronchioles; small bronchi
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

29. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Increase in permeability of two ions with equal and opposite equilibrium potentials
Brief psychotic disorder; schizophreniform; schizophrenia
HSV ( also in utero: chlymadia - neisseria - group B strep)
Medial circumflex artery; avascular necrosis

30. How do you treat gonococcal infection? chlymadia?
As a CO2 carrier with the carboxylase enzyme
Ceftriaxone; azithromycin
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Myasthenia gravis

31. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Gluteus maximus; difficulty getting up from seated position and climbing chair
women
HSV ( also in utero: chlymadia - neisseria - group B strep)
Pain reliever - reduces pain by locking substance P in the PNS

32. What is the mc location for avascular necrosis? What is it associated with?
OCPs - multiparity - breast feeding
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Myasthenia gravis

33. What does extended consumption of appetite suppressants lead to?
In the extracellular space
V fib; v. failure
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Pulmonary hypertension

34. What is achalasia and how would this correlate on the esophageal mannometry?
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
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Turners`
Around 70 (normal measured diastolic pressures); 9--

35. h1 receptor anatagonists are not effective in treatment of asthma only for...
chronic urticaria and allergic symptoms
Acute gastric mucosal defects (superficial or full thickness)
Relfex tachycardia; giving beta blockers
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

36. What is the neurologic manifestation of ADPKD?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Varying; erythema nodosum is common
Aromatase deficiency in child
Serum creatine kinase; reperfusion injury causes necrosis

37. In what population does cholelithiasis occur?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Fat - fertile - forty - female
Because gamma chains replace beta chains and then gamma chain formation wanes
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

38. What causes curlings ulcers?
Prostate tumor and increased osteoclast activity
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Right before diastole (filling begins)

39. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
Valproate
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
T test; chi squared
Minimal change disease

40. which antiarrythmic is associated with blue gray discoloration ?
To pump calcium out in cardiac myocytes so that relaxation occurs
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Amiadarone
Bile soluble which means they are bile sensitive

41. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Large stroke volumes with ventricular contraction; aortic regurg
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
TCAs and prazosin
In ER of bile canaliculi

42. who bleed more DIC or TTP- HUS patients?
DIC; TTP- HUS dont bleed that much
ST become atrophic and hyalinized (temp induced damage) and depressed sperm count becuase of that; hormonal function not impaired (test and LH levels normal) because Leydig cells not as temp sensitive so secondary sexual characteristics and sexual pe
Cluster
Increases

43. How do you calculate RPF from urine PAH?
(urine PAH x urine flow rate)/plasma PAH
only up to bronchi
CMV - HSV 1 - Candida
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)

44. In what form are mitochondrial DNA? What do they transcribe?
Circular - outside nucleus; transport proteins - rRNA - tRNA
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Syringomelia
Ether and other organic solvents

45. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
SSRI
Nocardia
Prevent phagocytosis

46. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
Sickle cell; G6PD
Acute gastric mucosal defects (superficial or full thickness)
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Biphosphonate

47. why is glucagon used in beta blocker toxicitiy?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Pan colitis and right sided colitis (more than left sided and proctitis)
Rabies encephalitis from cave bats; rabies killed vaccines
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

48. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Enterococci (e. faecalis)- found on genitalia area
OCPs - multiparity - breast feeding

49. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Fibronectin - laminin - collagen
Prostate tumor and increased osteoclast activity

50. What is Bortezomib and What is it used for?
Fat - fertile - forty - female
Because of vasodiation to skeletal muscles
Proteasome inhibitor; treatment for MM and waldenstroms
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)