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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. Where does terminal peptide cleavage of collagen fibrils take place?
In the extracellular space
OCPs - multiparity - breast feeding
Increases cytokine production
Right heart failure

2. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Fibronectin - laminin - collagen
Intussusception
Curlings ulcers
Superior larygeal; cricothyroid; recurrent laryngeal

3. which trisomy is associated with endocardial cushion defects? What does thsi mean>
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
glycerol kinase
Downs; regurgitant AV valves - ASDs
Hypothyroidism

4. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Increase lymphatic drainage!
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Elevated GGT and macrocytosis
APP on chrom 21 (this is why downs more susceptible)

5. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Because of vasodiation to skeletal muscles
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

6. when do ghon complexes form - primary or secondary TB?
Acute interstitial nephritis
Hereditary angioedema; ACE inhibitors
Another type of aldosterone antagonist (like spironolactone)
Primary

7. at 2 years of age - What are the social - fine motor - gross motor and language developments?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
I is more benign and can present later in adulthood
Myasthenia gravis
Chlorpheniramine and diphenhydramine

8. What does VIP do to gastric acid secretion?
Lateral; RV; RA; LV
Inhibits it
Joints d/t increased purine production and thus uric acid production
Fibrosis; macrophages

9. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Sarcoid
Excessive collagen formation during tissue repair in susceptible individuals
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

10. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Leukotriene precursor and does neutrophil chemotaxis
Tzanck smear
No; yes

11. what protein is increased in Crohns disease? What does it do?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
NF- KB; responsible for cytokine production
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Medial circumflex artery; avascular necrosis

12. how does eos release MBP to kill protozoa etc?
Fibrosis; macrophages
Brief psychotic disorder; schizophreniform; schizophrenia
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

13. What is Tzanck smear used to detect?
HSV and VZV
Common peroneal; bony fractures and compression; sciatic
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

14. Where does conjugation of bilirubin take place?
In ER of bile canaliculi
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Serum creatine kinase; reperfusion injury causes necrosis
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

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

16. What is the best indicator for the severity of mitral stenosis?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
The time interval between S2 and OS- the shorter the interval - the more intense
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

17. What does protein M do in Group A strep<
Bronchogenic carcinoma
Hypothyroidism
Boiling - bleach - formalin - UV irradiation
Prevent phagocytosis

18. How do you calculate atributable risk percent?
Anti centromere; anti DNA topoisomerase
Extrinsic def; instrinsic def; platelet def
GI tract; mood!
RR-1/RR

19. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
Class I
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
In ER of bile canaliculi
LT (LTD4 - E4 - C4) - and Ach

20. how does achalasia present? What does barium swallow show on dilated esophagus?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
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)

21. What are two indicators of chronic alcohol consumption?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Elevated GGT and macrocytosis
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

22. What is the stabilizing force for the secondary structure of proteins?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Sickle cell; G6PD
Hydrogen bonds dictate alpha or beta structure
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

23. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
Radial nerve and deep brachial artery
gram positive organisms
Sickle cell; G6PD
No; yes

24. ___________ is liver specific
glycerol kinase
Increase lymphatic drainage!
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Increase by 50% in urine osmolality

25. non ceruloplasmin deposition - ceruloplasmin is...
Excessive collagen formation during tissue repair in susceptible individuals
Pulmonic and systemic!
Serum creatine kinase; reperfusion injury causes necrosis
low in serum

26. why are beta thal major patients asymptomatic at birth?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Because gamma chains replace beta chains and then gamma chain formation wanes
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Increases

27. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
To pump calcium out in cardiac myocytes so that relaxation occurs
Curlings ulcers
Fibronectin - laminin - collagen
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

28. in the LV and aorta - What are the pressures?
FGF and VEGF
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Dihydropyridine sensitive Ca channels (L type)
Normally close to systolic

29. which staphylococci can do mannitol fermaentation?
S. aureus
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Duration and extent of disease
Increases

30. What does extended consumption of appetite suppressants lead to?
Diabetic microangiopathy
Chorda tympani branch
Squatting - sitting - lying supine - passive leg raising
Pulmonary hypertension

31. what drugs causes the red man syndrome? how does it occur?
Vancomycin; histamine mediated
By vascular permeability and vasodilation
Headaches and facial flushing; vasodilation in meninges and skin
Selective alpha 1 (increases SVR)

32. what immune deficiency causes recurrent neisseria infections?
IgE
Dissolved in plasma and attached to Hgb
Protamine sulfate
MAC complex (C5b - C9 complement deficiency)

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

34. How do you treat gonococcal infection? chlymadia?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
E. coli
Ceftriaxone; azithromycin

35. What is congestive hepatomegaly specific for?
In the extracellular space for collagen cross linking; zinc
Chrom 8
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Right heart failure

36. how does noise induced hearing loss occur?
Trauma to stereociliated hair cells of the organ of corti
Minimal change disease
Prostate tumor and increased osteoclast activity
E6 and E7 of HPV knock off p53 and Rb suppressor genes

37. what chromosome is c - myc found on?
Chrom 8
Multiple miscarriages d/t hypercoaguability
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
chronic urticaria and allergic symptoms

38. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Downs; regurgitant AV valves - ASDs
transcription activation/suppression
Abnormal closing of the urethral folds

39. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Susceptible; soluble (unable to be cultured in bile)
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
46 - 4N; 23 2N
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

40. What is a keloid?
Relfex tachycardia; giving beta blockers
Excessive collagen formation during tissue repair in susceptible individuals
Because of the low output from heart failure - they will have increased aldosterone levels
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

41. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Because gamma chains replace beta chains and then gamma chain formation wanes
Hereditary angioedema; ACE inhibitors

42. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
facultative intracellular
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
P53 mutation; DCC is also required for adenoma to carcinoma
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

43. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Increases cytokine production
AV node slowest - to allow time for diastole
Permissive - sensitizes vasoconstrictive response from catecholamines - doesnt actually act on them but increases transcription of some genes that creates permissive effect (not additive or synergistic becuase cortisol alone doesnt have any effect on
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

44. What is the cause of fixed splitting of S2? why?
ANCA because of lack of Ig and C3 deposits on IF
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
...

45. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Drink plenty of fluids
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

46. name three pathological states that present with large tongues.
Congenital hypothyroidism - downs - amyloidosis - acromegaly
11 aa polypeptide; pain NT in CNS and PNS
Fat - fertile - forty - female
No only for prophylaxis (even for treating staphylococcal endocarditis its as multi drug); this is to prevent drug resistance from spontaneous mutations by DNA dependent RNA polymerase

47. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Hypothyroidism
Not lined by epithelium
Closer to head; closer to diaphragm

48. What triggers the neoplastic changes that are associated with HBV infecton?
Hereditary angioedema; ACE inhibitors
Integration of viral DNA into genome of host hepatocytes
Appetite suppressants
Southern - western

49. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
chronic urticaria and allergic symptoms
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
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
In the extracellular space

50. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
only up to bronchi
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
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
Around 70 (normal measured diastolic pressures); 9--