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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 the most common cause of pyelonephritis in both adults and childre?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
P53 mutation; AD
Pain reliever - reduces pain by locking substance P in the PNS
E. coli

2. What type of endocarditis is cytoscopy induced?
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Enterococci (e. faecalis)- found on genitalia area
Prevents hepatic VLDL production
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

3. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Increase lymphatic drainage!
Minimal change disease
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Diabetic microangiopathy

4. What is the mcc of extrinsic allergic asthma?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
An invagination of portion of intestine into the lumen of the adjacent intestinal segment; can lead to impaired venous return from the invaginated segment of the bowel which can cause ischemia and subsequent necrosis
Bronchial dilation (bronchiectasis)
Inhaled animal dander allergens

5. how does noise induced hearing loss occur?
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
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Measure of depth invasion (vertical!)
Trauma to stereociliated hair cells of the organ of corti

6. What can cause aortic regurg? What is the heart sound you hear?
SSRI
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Env genes (for getting into target cells)

7. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
V fib; v. failure
OCPs - multiparity - breast feeding
SVC and IVC; right below the aortic knob
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

8. what dissolves the lipid bilayer of a viral envelope?
Ether and other organic solvents
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Think Hb deformation diseases
Increase lymphatic drainage!

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?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Common peroneal; bony fractures and compression; sciatic
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)
Acute gastric mucosal defects (superficial or full thickness)

10. how can HAV be inactivated?
Trochlear nerve (IV); abducens nerve (VI)
MAC complex (C5b - C9 complement deficiency)
Boiling - bleach - formalin - UV irradiation
Not lined by epithelium

11. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Increase; decreased
TCAs and prazosin
Tibial

12. what drug is useful for secretory diarrhea?
Turners`
Octreotide
Medial part
Hypothyroidism

13. what happens to capacitance with age?
Nocardia
...
SS +rNA
Little effect on cell and no change

14. at four years of age - What are the social - fine motor - gross motor - and language developments?
Paramyxo and influenza
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
High potassium conductance and some sodium conductance
Hexokinase

15. What does NF- KB do?
Increases cytokine production
Drink plenty of fluids
Hydrogen bonds dictate alpha or beta structure
Kallmans

16. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Well
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Relfex tachycardia; giving beta blockers
Cluster

17. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
Bronchogenic carcinoma
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
...
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

18. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Minimal change disease
Hypo or hyper pigmentations; after tanning

19. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
TCAs and prazosin
Sickle cell; G6PD
Measles and M3 AML`
In ER of bile canaliculi

20. When does opening snap begin?
In the extracellular space
Right before diastole (filling begins)
Smoking
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

21. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
11
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Because of vasodiation to skeletal muscles
S3 gallop; S2 to opening snap interval

22. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
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
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
V fib; v. failure

23. what kind of drug is sertraline? What is a common side effect?
Retinitis; mononucleosis
Leukotriene precursor and does neutrophil chemotaxis
Downs; regurgitant AV valves - ASDs
SSRI; erectile dysfunction

24. What is hypospadias caused by?
Paramyxo and influenza
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Abnormal closing of the urethral folds

25. What does hypocapnia cause in teh brain? What is hypocapnia?
Duration and extent of disease
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Closer to head; closer to diaphragm
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

26. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

27. What do you treat s. epidermidis with?
Increase in permeability of two ions with equal and opposite equilibrium potentials
Decreases both
Vancomycin
Normal; low

28. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Primary
Rabies encephalitis from cave bats; rabies killed vaccines
INTRApartum Abs (ampicillin/penicillin)
Adeno

29. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
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)
Single adenomatous ones
Right before diastole (filling begins)

30. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Close but purkinje system to ensure contraction in a bottom up fashion
I is more benign and can present later in adulthood
Large stroke volumes with ventricular contraction; aortic regurg
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

31. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
ANCA because of lack of Ig and C3 deposits on IF
Medullary
Joints d/t increased purine production and thus uric acid production
Mean greater than median greater than mode

32. What is gardeners mydriasis? How is it treated?
Diabetic microangiopathy
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
DIC; TTP- HUS dont bleed that much
Increase by 50% in urine osmolality

33. Metronidizaole does not cover...
gram positive organisms
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Demargination of neutrophils from the vessel walls

34. what immune deficiency causes recurrent neisseria infections?
On cardiac tissue and renal juxtaglomerular cells
Decreases both
MAC complex (C5b - C9 complement deficiency)
II; I (I more abundant)

35. What is the cause of fixed splitting of S2? why?
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Vagus (auricular branch); vasovagal syncope!
SVC and IVC; right below the aortic knob
11 aa polypeptide; pain NT in CNS and PNS

36. What are the two coagulase negative staphylococci? How do you distinguish them?
S. saprophyticus - and s. epidermidis; novobiocin
Hyperkalemia; potassium sparing diuretics - potassium supplements
chronic urticaria and allergic symptoms
IgE

37. What is acanthosis nigricans associated with?
GI malignancies and Insulin resistance (acromegal for ex)
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
200-500

38. why does hypothyroidism cause increased CPK levels?
RBF= PAH clearance/(1- hematocrit)
RR-1/RR
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
ANCA because of lack of Ig and C3 deposits on IF

39. what marker should be followed in a patient with cirrhosis?
Increases
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Trochlear nerve (IV); abducens nerve (VI)
Selective alpha 1 (increases SVR)

40. what hernia has a similar mechanism to hydrocele?
S3 gallop; S2 to opening snap interval
Cluster
Classical conditioning
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

41. How do you treat gonococcal infection? chlymadia?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Ceftriaxone; azithromycin
glycerol kinase
Enterococci (e. faecalis)- found on genitalia area

42. In what view of CXR is anterior part of heart best seen? anterior part of heart is formed by?right border of heart is formed by? left border?
Ig A deficiency
Lateral; RV; RA; LV
Vertical diplopia
Initiation - pointing; pincer grasp; walking; mama/dada

43. What type of calcium channels dictate the plateau in cardiac myocyte?
Radial nerve damage
Dihydropyridine sensitive Ca channels (L type)
Syringomelia
Proteasome inhibitor; treatment for MM and waldenstroms

44. What does the severity of leprosy depend on?
Syncope - angina - dyspnea (SAD)
Strength of cell mediated immune response
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Increases cytokine production

45. erythema nodosum - elevated ACE - scattered granulomas - arthralgias - hilar lymphadenoapthy are indicative of what?
E. coli
Sarcoid
Elastance
Drink plenty of fluids

46. 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?
Barium enema
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Increased reticulocytes
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)

47. What are two common side effects of both acute and long acting nitrates? What causes them?
Vancomycin; histamine mediated
Headaches and facial flushing; vasodilation in meninges and skin
MAC complex (C5b - C9 complement deficiency)
Anti centromere; anti DNA topoisomerase

48. which nerve provides innervation for plantar flexion and inversion?
Elevated GGT and macrocytosis
P53 mutation; AD
SVC and IVC; right below the aortic knob
Tibial

49. What is the fibrinogen level in patient with TTP- HUS? DIC?
Normal; low
Southern - western
As a CO2 carrier with the carboxylase enzyme
P53 mutation; DCC is also required for adenoma to carcinoma

50. Where does terminal peptide cleavage of collagen fibrils take place?
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)
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
In the extracellular space
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)