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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. how does neisseria cause a petechial rash?
transcription activation/suppression
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Neisseria induced small cell vasculitis (including hands and soles)

2. which cells produce surfactant? which ones mediate gas exchange?
Closer to head; closer to diaphragm
Bile soluble which means they are bile sensitive
Underestimation of gestational age
II; I (I more abundant)

3. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Turners`
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
AV node slowest - to allow time for diastole
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

4. other than increasing HDL levels - what else does niacin do?
Well
Extrinsic def; instrinsic def; platelet def
By vascular permeability and vasodilation
Prevents hepatic VLDL production

5. what would be a sign of absence of cardiogenic pulm edem?
Vancomycin
As a CO2 carrier with the carboxylase enzyme
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

6. why is crohns disease associated with oxaloacetate kidney stones?
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
Enterococci (e. faecalis)- found on genitalia area
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
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

7. how does increased ICP result in curlings ulcers?
Ketone body production by preventing fatty acids into the mitochondria
Vagus nerve stimulation
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

8. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
Demargination of neutrophils from the vessel walls
No; yes
facultative intracellular
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

9. which nerve in the lower leg is easily injured and causes foot drop ? What are common causes? From what nerve does it branch off or?
Common peroneal; bony fractures and compression; sciatic
Large stroke volumes with ventricular contraction; aortic regurg
Demargination of neutrophils from the vessel walls
ATP binding (resets the myosin head to contract again for next binding)

10. which nerve is at risk when ligating the superior thyroid artery? Which is the only muscle this nerve innervates? what nerve innervates all the other laryngeal muscles?
Tibial
Another type of aldosterone antagonist (like spironolactone)
Superior larygeal; cricothyroid; recurrent laryngeal
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

11. When does neovascularization granulation tissue begin to form after severe ischemia and MI? what happens in 12-24 hours? 2 weeks to 2 months? 1-5 days? 0-4 hours? when do you see edema - hemorrhage - wavy fibers?
In ER of bile canaliculi
Inhibits it
Lateral; RV; RA; LV
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

12. What is the diagnosis in delayed puberty plus anosmia?
Kallmans
In ER of bile canaliculi
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
Vancomycin; histamine mediated

13. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Headaches and facial flushing; vasodilation in meninges and skin
Because of vasodiation to skeletal muscles
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
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

14. Where does lysyl oxidase act? What is the cofactor for that?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Little effect on cell and no change
In the extracellular space for collagen cross linking; zinc
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

15. what protein is increased in Crohns disease? What does it do?
NF- KB; responsible for cytokine production
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Vancomycin
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)

16. What is used to compare means? categorical outcomes?
200-500
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
T test; chi squared
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

17. What is the cause of rapid plasma decay of thiopental?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Tissue redistribution (out of plasma) rather than metabolism

18. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Extrinsic def; instrinsic def; platelet def
Hypo or hyper pigmentations; after tanning
TCAs and prazosin
Excessive collagen formation during tissue repair in susceptible individuals

19. What causes wrist drop?
Well
Radial nerve damage
Coagulation factors are made in the liver
FGF and VEGF

20. IL4 is used for isotypye switching to what?
IgE
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

21. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Myasthenia gravis
Increase; decreased
Chorda tympani branch
No; MRI

22. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Chorda tympani branch
To pump calcium out in cardiac myocytes so that relaxation occurs
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

23. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
RR-1/RR
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Fibronectin - laminin - collagen
Radial nerve and deep brachial artery

24. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
Enterococci (e. faecalis)- found on genitalia area
PDA open
Measles and M3 AML`
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

25. What is a cell surface marker seen in liver angiosarcoma?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Syncope - angina - dyspnea (SAD)
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Sudden loss of muscle tone without loss of consciousness; narcolepsy

26. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
facultative intracellular
E. coli
Because gamma chains replace beta chains and then gamma chain formation wanes
Hyperkalemia; potassium sparing diuretics - potassium supplements

27. How do you treat gonococcal infection? chlymadia?
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
Tibial
Cluster
Ceftriaxone; azithromycin

28. what defines hypoxemia?
Localized dermatologic pain that persists for more than one month after zoster eruption
SaO2 <92%
Measure of depth invasion (vertical!)
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

29. Where does complement bind on the Fc region of Ig chains?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Drink plenty of fluids
Terminal bronchioles; small bronchi
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

30. What does 'oxygen' content in blood refer to?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Localized dermatologic pain that persists for more than one month after zoster eruption
Dissolved in plasma and attached to Hgb
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

31. name three pathological states that present with large tongues.
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Elastance
transcription activation/suppression

32. what drugs causes the red man syndrome? how does it occur?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Varying; erythema nodosum is common
Vancomycin; histamine mediated

33. What is best to prevent GBS infection in a baby?
SSRI; erectile dysfunction
Spongiosis
INTRApartum Abs (ampicillin/penicillin)
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

34. what vessel would a fracture to the neck of the of the humerus damage?
Vertical diplopia
Bronchogenic carcinoma
Acute interstitial nephritis
Anterior circumflex (and axillary nerve)

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

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36. which antiarrythmic is associated with blue gray discoloration ?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Amiadarone
Env genes (for getting into target cells)
SaO2 <92%

37. What is normal fibrinogen levels?
200-500
Southern - western
Biphosphonate
Ig A deficiency

38. Where is the base of the heart? apex?
Bronchial dilation (bronchiectasis)
indomethacin
Closer to head; closer to diaphragm
chronic urticaria and allergic symptoms

39. What can chronic vit A toxicity cause?
Smoking
SS +rNA
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Adeno

40. What is mcc of death pre hospital phase of MI? in hospital phase?
PDA open
Varying; erythema nodosum is common
Minimal change disease
V fib; v. failure

41. What is cataplexy and When is it seen?
<1% - 55% - concentration dependent
Prostate tumor and increased osteoclast activity
Right heart failure
Sudden loss of muscle tone without loss of consciousness; narcolepsy

42. biotin is used By what in tissues responsible for gluconeogenesis
Kallmans
SS +rNA
As a CO2 carrier with the carboxylase enzyme
Measure of depth invasion (vertical!)

43. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
I is more benign and can present later in adulthood
OCPs - multiparity - breast feeding
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

44. What agonists reduce the gradient across the LV outflow tract?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Aromatase deficiency in child
Selective alpha 1 (increases SVR)

45. how does noise induced hearing loss occur?
Demargination of neutrophils from the vessel walls
S. saprophyticus - and s. epidermidis; novobiocin
Trauma to stereociliated hair cells of the organ of corti
Recurrent larygneal

46. What is it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
8; 12
In the extracellular space for collagen cross linking; zinc
Prevent phagocytosis
Vertical diplopia

47. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
S. aureus
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Myasthenia gravis

48. What is contraindicated in toxic mega colon?
SVT; increases vagal tone; rectus abdominis
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
G to T in p53; HCC
MAO inhibitors; wine and cheese

49. What are two indicators of chronic alcohol consumption?
Vagus nerve stimulation
Pulmonary hypertension
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Elevated GGT and macrocytosis

50. what has the greatest effect on prognosis when treating c. diptheriae?
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
LT (LTD4 - E4 - C4) - and Ach
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
SVC and IVC; right below the aortic knob