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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 exactly is ACE expressed in the lungs? What type of enzyme is it?
Vascular endothelium; protease
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Well trained athletes and children

2. What is mcc of death pre hospital phase of MI? in hospital phase?
Serum creatine kinase; reperfusion injury causes necrosis
V fib; v. failure
IgE
Thymic tumor

3. do Class IC agents prolong the QT interval?
Bile soluble which means they are bile sensitive
Dihydropyridine sensitive Ca channels (L type)
No
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

4. Acyl coA synthetase is not...
liver specific
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Fibrosis; macrophages
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

5. on which chromosome is wilms tumor found?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
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)
11

6. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
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)
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Intussusception
Appetite suppressants

7. what vessel would a fracture to the neck of the of the humerus damage?
Anterior circumflex (and axillary nerve)
II; I (I more abundant)
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
G to T in p53; HCC

8. which are the only glycosylated proteins in HIV virus?
No; MRI
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
INTRApartum Abs (ampicillin/penicillin)
Env genes (for getting into target cells)

9. which virus inactivates both Rb and p53?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Strength of cell mediated immune response
Tibial
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

10. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Tzanck smear
46 - 4N; 23 2N
women

11. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Echinococcus granulosus; anaphylaxis
Little effect on cell and no change
Diabetic microangiopathy

12. What can chronic vit A toxicity cause?
Acute interstitial nephritis
Terminal bronchioles; small bronchi
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
(urine PAH x urine flow rate)/plasma PAH

13. What is normal fibrinogen levels?
200-500
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)
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

14. why are beta thal major patients asymptomatic at birth?
Because gamma chains replace beta chains and then gamma chain formation wanes
On cardiac tissue and renal juxtaglomerular cells
Folic acid treatment!
Amiloride - spironolactone - triamterene

15. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
Curlings ulcers
LT (LTD4 - E4 - C4) - and Ach
RER; RER
Multiple miscarriages d/t hypercoaguability

16. What three factors effect total oxygen content of blood?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Superior larygeal; cricothyroid; recurrent laryngeal
Pulmonic and systemic!

17. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Ig A deficiency
Gluteus maximus; difficulty getting up from seated position and climbing chair
CMV - HSV 1 - Candida
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

18. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
RBC mass; epo levels (secondary has high)
Acute gastric mucosal defects (superficial or full thickness)
Kallmans
Increased reticulocytes

19. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
46 - 4N; 23 2N
Gluteus maximus; difficulty getting up from seated position and climbing chair
Because of vasodiation to skeletal muscles
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

20. what kind of drug is sertraline? What is a common side effect?
Trauma to stereociliated hair cells of the organ of corti
S. saprophyticus - and s. epidermidis; novobiocin
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
SSRI; erectile dysfunction

21. why is glucagon used in beta blocker toxicitiy?
glycerol kinase
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Prepatellar
Prostate tumor and increased osteoclast activity

22. What causes wrist drop?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Skin flushing and warmth; prostaglandins; give with aspirin
Mean greater than median greater than mode
Radial nerve damage

23. What does prolonged PT indicated? aPTT? bleeding time?
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Extrinsic def; instrinsic def; platelet def
Phencyclidine (PCP)
Well

24. What are the skin presentation in sarcoid?
Varying; erythema nodosum is common
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

25. What are the potassium sparing diuretics?
Brief psychotic disorder; schizophreniform; schizophrenia
Amiloride - spironolactone - triamterene
Adductor
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)

26. What is the diagnosis in delayed puberty plus anosmia?
low in serum
Intussusception
Biphosphonate
Kallmans

27. What type of calcium channels dictate the plateau in cardiac myocyte?
Radial nerve damage
Dihydropyridine sensitive Ca channels (L type)
SVC and IVC; right below the aortic knob
Pulmonic and systemic!

28. how can HAV be inactivated?
Boiling - bleach - formalin - UV irradiation
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
On cardiac tissue and renal juxtaglomerular cells
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

29. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Fibronectin - laminin - collagen
MAC complex (C5b - C9 complement deficiency)

30. how does noise induced hearing loss occur?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Single adenomatous ones
Trauma to stereociliated hair cells of the organ of corti
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

31. biotin is used By what in tissues responsible for gluconeogenesis
Increase in permeability of two ions with equal and opposite equilibrium potentials
Initiation - pointing; pincer grasp; walking; mama/dada
As a CO2 carrier with the carboxylase enzyme
Measure of depth invasion (vertical!)

32. there are mucus secreting cells in the bronchioles...
only up to bronchi
Biphosphonate
glycerol kinase
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

33. What actions increase venous return?
Squatting - sitting - lying supine - passive leg raising
Measles and M3 AML`
Duration and extent of disease
Hexokinase

34. What is omalizumab and What is it used for?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Squatting - sitting - lying supine - passive leg raising
Another type of aldosterone antagonist (like spironolactone)
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

35. what commonly happens in GI in response to acute physiologic stress?
II; I (I more abundant)
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Acute gastric mucosal defects (superficial or full thickness)
Increased reticulocytes

36. What are the long term consequences of hydrocephalus?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
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)
TCAs and prazosin

37. h1 receptor anatagonists are not effective in treatment of asthma only for...
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
chronic urticaria and allergic symptoms

38. 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?
Bronchogenic carcinoma
Superior larygeal; cricothyroid; recurrent laryngeal
The term used to describe decreased drug responsiveness with repeated administration
Increases

39. What is 5- HETE and What does it do?
Headaches and facial flushing; vasodilation in meninges and skin
Leukotriene precursor and does neutrophil chemotaxis
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
C3 decreased after 5-10 days; sulfonamides

40. at four years of age - What are the social - fine motor - gross motor - and language developments?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Increase lymphatic drainage!

41. What is the mutation type in thalassemias? what process is defective because of this?
Because of the low output from heart failure - they will have increased aldosterone levels
Nonsense; mRNA processing
Serum creatine kinase; reperfusion injury causes necrosis
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)

42. What is the cause of fixed splitting of S2? why?
Proteasome inhibitor; treatment for MM and waldenstroms
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Vancomycin; histamine mediated
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

43. other than parvo B19 - what else is associated with red cell aplasia?
Syncope - angina - dyspnea (SAD)
Highly negative resting potential
Thymic tumor
Increase in permeability of two ions with equal and opposite equilibrium potentials

44. What is pickwickian syndrome? What are the lab findings?
Increased reticulocytes
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Paramyxo and influenza
liver specific

45. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Not lined by epithelium
Retinitis; mononucleosis
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Octreotide

46. What type of disease has selective proteinuria? What is found in urine? What is not?
No; MRI
On cardiac tissue and renal juxtaglomerular cells
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

47. What is hypospadias caused by?
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
Myasthenia gravis
Abnormal closing of the urethral folds

48. What antibiotic is best to treat alcoholic pulm infections? why?
Sydenham chorea
Clindamycin; covers anaerobic oral flora and aerobic bacteria
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
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

49. What would a deflection of the membrane potential to near zero indicate?
200-500
Increase in permeability of two ions with equal and opposite equilibrium potentials
Chrom 8
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

50. PDAs are often asymptomatic. How do you treat?
Selective alpha 1 (increases SVR)
indomethacin
Mean greater than median greater than mode
Apocrine; eccrine