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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 are fenfluramine - phentermine?
Appetite suppressants
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Apocrine; eccrine

2. What is diphenoxylate and What is it used for? what drug is it structurally similar to? What allows for potent anti diarrheal effect without signigicant opiate effects?
Chorda tympani branch
E. coli
Varying; erythema nodosum is common
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)

3. what should you think of in 'smear of an oral ulcer base'?
Right heart failure
SVC and IVC; right below the aortic knob
Tzanck smear
Trauma to stereociliated hair cells of the organ of corti

4. What does the tuberoinfundibular pathway connect? What is it responsible for?
differentiate
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
NF- KB; responsible for cytokine production
Recurrent larygneal

5. What is hypospadias caused by?
Abnormal closing of the urethral folds
Southern - western
RBC mass; epo levels (secondary has high)
Medial circumflex artery; avascular necrosis

6. why is crohns disease associated with oxaloacetate kidney stones?
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
Boiling - bleach - formalin - UV irradiation
IgE
Because gamma chains replace beta chains and then gamma chain formation wanes

7. which two virus families have hemagluttinin on their surface?
Tibial
Valproate
Prostate tumor and increased osteoclast activity
Paramyxo and influenza

8. In what form are mitochondrial DNA? What do they transcribe?
GI tract; mood!
transcription activation/suppression
Circular - outside nucleus; transport proteins - rRNA - tRNA
NF- KB; responsible for cytokine production

9. what immune deficiency causes recurrent neisseria infections?
Gluteus maximus; difficulty getting up from seated position and climbing chair
Normally close to systolic
MAC complex (C5b - C9 complement deficiency)
Bile salt accumulation in urine

10. What is the presentation of angioedema? Where is most commonly affected?
As a CO2 carrier with the carboxylase enzyme
Southern - western
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

11. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
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
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Trochlear nerve (IV); abducens nerve (VI)
Neisseria induced small cell vasculitis (including hands and soles)

12. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
Tzanck smear
Localized dermatologic pain that persists for more than one month after zoster eruption
frameshift mutations (missense is substitution)
Curlings ulcers

13. what nerve and artery course along the posterior aspect of the humerus?
Vertical diplopia
Radial nerve and deep brachial artery
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Vascular endothelium; protease

14. how does achalasia present? What does barium swallow show on dilated esophagus?
Leukotriene precursor and does neutrophil chemotaxis
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
SaO2 <92%

15. Would alpha 1 agonists cause flushing? muscarinic antagonist?
No; yes
Elastance
Prevent phagocytosis
Relfex tachycardia; giving beta blockers

16. how does increased ICP result in curlings ulcers?
Vagus nerve stimulation
Myasthenia gravis
Fibronectin - laminin - collagen
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

17. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Serum creatine kinase; reperfusion injury causes necrosis
Downs; regurgitant AV valves - ASDs
Sarcoid
RR-1/RR

18. which two drug types can cause orthostatic hypotension (think depression and BPH)?
Turners`
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
TCAs and prazosin
glycerol kinase

19. what drugs causes the red man syndrome? how does it occur?
Acute gastric mucosal defects (superficial or full thickness)
Anterior nares
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Vancomycin; histamine mediated

20. What is the immune deficinecy seen in ataxia telangactasia?
Ig A deficiency
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Bronchial dilation (bronchiectasis)
11

21. which headaches are seen mostly in men - are severe - unilateral - periorbital - episodic (around same time every day) - temporal pain - with lacrimation - nasal congestion and ptosis?
Think Hb deformation diseases
When it invades the bm; carcinoma in situ
Cluster
INTRApartum Abs (ampicillin/penicillin)

22. If a patient has higher levels of HbF - What does this mean?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
11
Appetite suppressants
Think Hb deformation diseases

23. What is achalasia and how would this correlate on the esophageal mannometry?
Pain reliever - reduces pain by locking substance P in the PNS
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
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
Decreases both

24. what diseases can vit A be used to treat?
Folic acid treatment!
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
Measles and M3 AML`
Hereditary angioedema; ACE inhibitors

25. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
APP on chrom 21 (this is why downs more susceptible)
Prevent phagocytosis
MAC complex (C5b - C9 complement deficiency)
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

26. Which is slower AV node or ventricular muscle?
Increases cytokine production
Joints d/t increased purine production and thus uric acid production
Elevated GGT and macrocytosis
AV node slowest - to allow time for diastole

27. What type of calcium channels dictate the plateau in cardiac myocyte?
Dihydropyridine sensitive Ca channels (L type)
Anterior circumflex (and axillary nerve)
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

28. What are the two growth factors associated with angiogenesis?
The term used to describe decreased drug responsiveness with repeated administration
FGF and VEGF
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

29. What are pancreatic pseudocysts called pseudo rather than true cysts?
Turbulence
Not lined by epithelium
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Terminal bronchioles; small bronchi

30. What is a cord factor and Which bugs have it? How do they appear on culture?
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
CGD; t cell dysfxn (diGeorge)
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)
Large stroke volumes with ventricular contraction; aortic regurg

31. What is the cause of fixed splitting of S2? why?
LT (LTD4 - E4 - C4) - and Ach
Drug induced interstitial nephritis
Well
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

32. What does prolonged PT indicated? aPTT? bleeding time?
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
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Echinococcus granulosus; anaphylaxis
Extrinsic def; instrinsic def; platelet def

33. non ceruloplasmin deposition - ceruloplasmin is...
Diabetic microangiopathy
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
low in serum
S. saprophyticus - and s. epidermidis; novobiocin

34. which opponens muscle does ulnar innervate?
Superior larygeal; cricothyroid; recurrent laryngeal
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Adductor
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

35. What are two indicators of chronic alcohol consumption?
Elevated GGT and macrocytosis
Underestimation of gestational age
Single adenomatous ones
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

36. where are Beta 1 receptors found?
On cardiac tissue and renal juxtaglomerular cells
Acute gastric mucosal defects (superficial or full thickness)
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin

37. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
T test; chi squared
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Increase; decreased
Large stroke volumes with ventricular contraction; aortic regurg

38. Which is faster atrial muscle or ventricular muscle?
Radial nerve damage
Atrial
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)
Chlorpheniramine and diphenhydramine

39. How do you calculate excretion rate of a substance? How do you calculate the filtration rate of a substance? clearance of what substance estimates the GFR?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Reticulocytes
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
GI malignancies and Insulin resistance (acromegal for ex)

40. What is diagnostic (and possible therapeutic for intussusception)?
DIC; TTP- HUS dont bleed that much
No
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
Barium enema

41. what virus causes pharyngoconjuctival fever?
200-500
Adeno
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
MAC complex (C5b - C9 complement deficiency)

42. which antiarrythmic is associated with blue gray discoloration ?
Sickle cell; G6PD
Amiadarone
Prevents hepatic VLDL production
HSV ( also in utero: chlymadia - neisseria - group B strep)

43. Is there edema in primary Conns? secondary hyperaldosteronism? why?
Pulmonic and systemic!
Obstruction because they infiltrate the intestinal wall and encircle causing decrease in size of lumen - constipation - abdominal distension - abdominal pain - changes in stool caliber; right sided are often exophytic masses iron def anemia and syste
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
NF- KB; responsible for cytokine production

44. metabolism of 1 gram of protein produces How many calories? carb? fat?
4 - 4 - 9
Extrinsic def; instrinsic def; platelet def
Adductor
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

45. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Adeno
No
Intussusception

46. at one year of age - What are the social - fine motor - gross motor and language developments?
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Initiation - pointing; pincer grasp; walking; mama/dada
SSRI
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

47. What causes wrist drop?
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)
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Radial nerve damage
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

48. What does the severity of leprosy depend on?
Retinitis; mononucleosis
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Strength of cell mediated immune response

49. a patient fearing all white coats is a phenomenon of what?
Classical conditioning
Tibial
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
PDA open

50. What does sustained hand grip do to the C/V system?
Anti cholinergic effects of pupil dilation and lack of accomodation
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Susceptible; soluble (unable to be cultured in bile)