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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 is pickwickian syndrome? What are the lab findings?
Turbulence
Gluteus medius and minimus; positive trendelenberg
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
High potassium conductance and some sodium conductance

2. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Initiation - pointing; pincer grasp; walking; mama/dada
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Fibronectin - laminin - collagen

3. what vessel would a fracture to the neck of the of the humerus damage?
Susceptible; soluble (unable to be cultured in bile)
CMV - HSV 1 - Candida
Anterior circumflex (and axillary nerve)
Around 70 (normal measured diastolic pressures); 9--

4. what should you think of in 'smear of an oral ulcer base'?
Tzanck smear
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Prevent phagocytosis
DIC; TTP- HUS dont bleed that much

5. other than proteinuria - What can cause foamy froathy urine?
SSRI
Bile salt accumulation in urine
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Hexokinase

6. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
Myasthenia gravis
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
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

7. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
No
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Pulmonary hypertension
Elevated GGT and macrocytosis

8. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Echinococcus granulosus; anaphylaxis
Atrial
Medial part
Sudden loss of muscle tone without loss of consciousness; narcolepsy

9. which viruses require a protease?
SS +rNA
Bile soluble which means they are bile sensitive
11 aa polypeptide; pain NT in CNS and PNS
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

10. What is the most common initital symptom of ADPKD? what else?
Little effect on cell and no change
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
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
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

11. where are Beta 1 receptors found?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Vascular endothelium; protease
On cardiac tissue and renal juxtaglomerular cells
Class I

12. What causes the blurry vision side effects in first generation anti histamines?
Serum creatine kinase; reperfusion injury causes necrosis
200-500
Anti cholinergic effects of pupil dilation and lack of accomodation
HSV and VZV

13. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Chorda tympani branch
Susceptible; soluble (unable to be cultured in bile)
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Class I

14. What does 'oxygen' content in blood refer to?
Dissolved in plasma and attached to Hgb
Inhibits it
liver specific
MAO inhibitors; wine and cheese

15. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
P53 mutation; AD
Vertical diplopia
Because gamma chains replace beta chains and then gamma chain formation wanes
Syringomelia

16. if there are keratin swirls does that mean well or poorly differentiated?
Large stroke volumes with ventricular contraction; aortic regurg
Well
differentiate
Biphosphonate

17. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
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
The time interval between S2 and OS- the shorter the interval - the more intense
C3 decreased after 5-10 days; sulfonamides
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

18. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
46 - 4N; 23 2N
Rabies encephalitis from cave bats; rabies killed vaccines
Kallmans
Bronchial dilation (bronchiectasis)

19. when do ghon complexes form - primary or secondary TB?
Prepatellar
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Primary
GI malignancies and Insulin resistance (acromegal for ex)

20. In what form are mitochondrial DNA? What do they transcribe?
Become beta pleated and then form neurofibrillary tangle!
Circular - outside nucleus; transport proteins - rRNA - tRNA
Well
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

21. what commonly happens in GI in response to acute physiologic stress?
Acute gastric mucosal defects (superficial or full thickness)
Vagus (auricular branch); vasovagal syncope!
Anterior nares
Coagulation factors are made in the liver

22. When is acid phosphatase elevated (Name two times)?
Prostate tumor and increased osteoclast activity
Gluteus maximus; difficulty getting up from seated position and climbing chair
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Pan colitis and right sided colitis (more than left sided and proctitis)

23. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
LT (LTD4 - E4 - C4) - and Ach
...
Increase lymphatic drainage!

24. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
No (unlike adenomyosis); yes
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Multiple miscarriages d/t hypercoaguability
Well

25. What are the acute effects of corticosteroids on the CBC?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Serum FFA and serum triglyceride levels
Spongiosis

26. how does eos release MBP to kill protozoa etc?
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
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
RBC mass; epo levels (secondary has high)
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

27. What is capsaicin? Where does it work?
Pain reliever - reduces pain by locking substance P in the PNS
G to T in p53; HCC
Demargination of neutrophils from the vessel walls
SVT; increases vagal tone; rectus abdominis

28. what murmur is enhanced by decreased blood flow to the heart?
Common peroneal; bony fractures and compression; sciatic
Prepatellar
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Measure of depth invasion (vertical!)

29. Where is the base of the heart? apex?
Closer to head; closer to diaphragm
Pain reliever - reduces pain by locking substance P in the PNS
Class I
Vagus nerve stimulation

30. What are the three causes of acute MI in context of normal coronary arteries ?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
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
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Anti - apoptotic (prevents going into apoptosis)- 18; 14

31. is Rifampin ever used as monotherapY? why either way?
CMV - HSV 1 - Candida
HSV and VZV
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
Underestimation of gestational age

32. What is the sole neurologic manifestation of acute rheumatic fever?
Brief psychotic disorder; schizophreniform; schizophrenia
Sydenham chorea
Hexokinase
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

33. What does NF- KB do?
Ketone body production by preventing fatty acids into the mitochondria
Increases cytokine production
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Neisseria induced small cell vasculitis (including hands and soles)

34. in B12 deficiency - what levels in blood rise very quickly and then drop?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Reticulocytes
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Not lined by epithelium

35. prostaglandin synthesis keeps...
II; I (I more abundant)
Raphe
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)
PDA open

36. what locations of UC increase the risk of Colon cancer?
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)
Recurrent larygneal
Duration and extent of disease
Pan colitis and right sided colitis (more than left sided and proctitis)

37. What is the diagnosis in delayed puberty plus anosmia?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Terminal bronchioles; small bronchi
Kallmans

38. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
Measure of depth invasion (vertical!)
RER; copper
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

39. how does neisseria cause a petechial rash?
Apocrine; eccrine
Neisseria induced small cell vasculitis (including hands and soles)
SSRI; erectile dysfunction
P53 mutation; DCC is also required for adenoma to carcinoma

40. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
Appetite suppressants
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
ANCA because of lack of Ig and C3 deposits on IF

41. Which is faster purkinje system or atrial muscle?
Close but purkinje system to ensure contraction in a bottom up fashion
Acute interstitial nephritis
Susceptible; soluble (unable to be cultured in bile)
No and yes

42. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Normally close to systolic
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Large stroke volumes with ventricular contraction; aortic regurg
Susceptible; soluble (unable to be cultured in bile)

43. What type of vision is myopia? In What type of patients does it improve?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Class I
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

44. How do bradykinin - C3a and C5a cause edema?
Increase in permeability of two ions with equal and opposite equilibrium potentials
Right before diastole (filling begins)
Recurrent larygneal
By vascular permeability and vasodilation

45. What is used to compare means? categorical outcomes?
4 - 4 - 9
Additive is equal to the sum of the two actions (lets say agonists at a receptor) and synergistic is when the sum is greater than just their two effects together
T test; chi squared
Pulmonary hypertension

46. What type of calcium channels dictate the plateau in cardiac myocyte?
manifestations - congenital (stretching of periventricular pyrimadal fibers)
FGF and VEGF
Increase by 50% in urine osmolality
Dihydropyridine sensitive Ca channels (L type)

47. What are the skin presentation in sarcoid?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Env genes (for getting into target cells)
Dihydropyridine sensitive Ca channels (L type)
Varying; erythema nodosum is common

48. What is an abortive viral infection?
Insulin like growth factor 1 (just another name)
Classical conditioning
Little effect on cell and no change
Hypo or hyper pigmentations; after tanning

49. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
TCAs and prazosin
Hypertension - edema - and proteinuria
Gluteus medius and minimus; positive trendelenberg
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

50. What are the three dopaminergic systems and What are they responsible for? disease?
Biphosphonate
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Elastance
Trauma to stereociliated hair cells of the organ of corti