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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 composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
Acute gastric mucosal defects (superficial or full thickness)
SVC and IVC; right below the aortic knob
Turners`
Appetite suppressants

2. What antibodies are present in CREST? What is the most specific?
Anti centromere; anti DNA topoisomerase
Reiter syndrome; B27
C3 decreased after 5-10 days; sulfonamides
SaO2 <92%

3. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
Elastance
Intussusception
Sydenham chorea
Kallmans

4. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
High potassium conductance and some sodium conductance
Squatting - sitting - lying supine - passive leg raising
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
P53 mutation; DCC is also required for adenoma to carcinoma

5. In What type of nephritis would you see high serum eos count?
Folic acid treatment!
Smoking
SS +rNA
Drug induced interstitial nephritis

6. h1 receptor anatagonists are not effective in treatment of asthma only for...
Inhaled animal dander allergens
chronic urticaria and allergic symptoms
AV node slowest - to allow time for diastole
Ether and other organic solvents

7. What are two common side effects of both acute and long acting nitrates? What causes them?
Superior larygeal; cricothyroid; recurrent laryngeal
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Curlings ulcers
Headaches and facial flushing; vasodilation in meninges and skin

8. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
only up to bronchi
Because of vasodiation to skeletal muscles
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

9. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
SVT; increases vagal tone; rectus abdominis
chronic urticaria and allergic symptoms
Faulty positioning of the genital tubercle
Measure of depth invasion (vertical!)

10. What can cause aortic regurg? What is the heart sound you hear?
Chorda tympani branch
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Localized dermatologic pain that persists for more than one month after zoster eruption
Smoking

11. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
facultative intracellular
Gluteus medius and minimus; positive trendelenberg
Reiter syndrome; B27

12. where are Beta 1 receptors found?
Think Hb deformation diseases
OCPs - multiparity - breast feeding
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
On cardiac tissue and renal juxtaglomerular cells

13. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Sydenham chorea
Terminal bronchioles; small bronchi
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
Because of vasodiation to skeletal muscles

14. What triggers the neoplastic changes that are associated with HBV infecton?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Integration of viral DNA into genome of host hepatocytes
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
OCPs - multiparity - breast feeding

15. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
Chlorpheniramine and diphenhydramine
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
P450 mitochondrial monooxygenase
Minimal change disease

16. Where does terminal peptide cleavage of collagen fibrils take place?
Brief psychotic disorder; schizophreniform; schizophrenia
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
PDA open
In the extracellular space

17. What does the severity of leprosy depend on?
Anti centromere; anti DNA topoisomerase
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Fibrosis; macrophages
Strength of cell mediated immune response

18. What are some of the permissive effects of cortisol?
Acute interstitial nephritis
Increases bronchial and vascular smooth muscle reactivity to catecholamines
No (unlike adenomyosis); yes
Inhibits it

19. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Medullary
GI tract; mood!
Gluteus medius and minimus; positive trendelenberg
The time interval between S2 and OS- the shorter the interval - the more intense

20. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
Syringomelia
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
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)
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

21. What causes vertical diplopia? horizontal?
Trochlear nerve (IV); abducens nerve (VI)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Prevent phagocytosis
TCAs and prazosin

22. PDAs are often asymptomatic. How do you treat?
Well trained athletes and children
indomethacin
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
ZDV or AZT

23. What type of mutation does aflatoxin cause? what cancer does this increase for?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
G to T in p53; HCC
Pulmonic and systemic!
Biphosphonate

24. Acyl coA synthetase is not...
Leukotriene precursor and does neutrophil chemotaxis
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Bronchogenic carcinoma
liver specific

25. within the right ventricle - What are maximum pressures? the pulm arter?
Drink plenty of fluids
25; 25
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
liver specific

26. which cells produce surfactant? which ones mediate gas exchange?
Closer to head; closer to diaphragm
II; I (I more abundant)
Headaches and facial flushing; vasodilation in meninges and skin
Bronchial dilation (bronchiectasis)

27. What does the tuberoinfundibular pathway connect? What is it responsible for?
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
NF- KB; responsible for cytokine production
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

28. sporadic colon cancer tend to arise From what type of polyps?
TCAs and prazosin
Single adenomatous ones
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Primary

29. What is medullary sponge kidney disease and how does it present? What does it lead to?
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)
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
frameshift mutations (missense is substitution)
Bile salt accumulation in urine

30. why does neutrophila occur with corticosteroids?
Increased reticulocytes
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
Demargination of neutrophils from the vessel walls
Fibronectin - laminin - collagen

31. Which nerve lies in close proximity to the inferior thyroid artery?
...
(urine PAH x urine flow rate)/plasma PAH
CMV - HSV 1 - Candida
Recurrent larygneal

32. Where does 90% of serotonin lie? What is this NT responsible?
Intussusception
GI tract; mood!
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Inhibits it

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

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34. what protects the resting heart from arrhythmias?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Proteasome inhibitor; treatment for MM and waldenstroms
Highly negative resting potential
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

35. What is congestive hepatomegaly specific for?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Pulmonic and systemic!
frameshift mutations (missense is substitution)
Right heart failure

36. why are beta thal major patients asymptomatic at birth?
Because gamma chains replace beta chains and then gamma chain formation wanes
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Bile salt accumulation in urine
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

37. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Susceptible; soluble (unable to be cultured in bile)
Increase by 50% in urine osmolality
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
H. influenzae type B; polyribosyl phosphate (PRP); cherry red uvula - dysphagia - stridor (sometimes) - difficulty breathing - fever - drooling - positive 'thumbs up sign' on lateral xray of cervical region d/t swollen epiglottis

38. at three years of age What are social - fine motor - gross motor and language developments?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Rabies encephalitis from cave bats; rabies killed vaccines
Another type of aldosterone antagonist (like spironolactone)
Hereditary angioedema; ACE inhibitors

39. What is contraindicated in toxic mega colon?
...
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Vancomycin; histamine mediated

40. What type of disease has selective proteinuria? What is found in urine? What is not?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Diabetic microangiopathy
CMV - HSV 1 - Candida
Purkinje system; AV node

41. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
Chrom 8
Excessive collagen formation during tissue repair in susceptible individuals
Nonsense; mRNA processing
Bile soluble which means they are bile sensitive

42. when arrested in prophase of meiosis I - What are primary oocytes chrom number? What about the secondary oocytes that are stuck in metaphase of Meiosis II?
Coagulation factors are made in the liver
Highly negative resting potential
46 - 4N; 23 2N
SaO2 <92%

43. What is epleronone?
Another type of aldosterone antagonist (like spironolactone)
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Gluteus maximus; difficulty getting up from seated position and climbing chair
Hexokinase

44. What does p53 do? what chrom is it on?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Dihydropyridine sensitive Ca channels (L type)
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Tibial

45. What are three symptoms in s.typhi?
SVC and IVC; right below the aortic knob
Hexokinase
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
SSRI; erectile dysfunction

46. what chromosome is c - myc found on?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Chrom 8
Vertical diplopia
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

47. What is damaged in early syringomelia? later?
Ether and other organic solvents
Hyperkalemia; potassium sparing diuretics - potassium supplements
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

48. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
In ER of bile canaliculi
indomethacin
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

49. what happens with LDL receptor density in statin therapy?
Vertical diplopia
Increases
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

50. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Boiling - bleach - formalin - UV irradiation
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
glycerol kinase