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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. In what population does cholelithiasis occur?
Bile salt accumulation in urine
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Drink plenty of fluids
Fat - fertile - forty - female

2. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Because of vasodiation to skeletal muscles
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)
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
RR-1/RR

3. why does variocele occur more in left side?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Anti cholinergic effects of pupil dilation and lack of accomodation
Rabies encephalitis from cave bats; rabies killed vaccines
Ketone body production by preventing fatty acids into the mitochondria

4. other than in pyelonephritis - where else are WBC casts seen?
Acute interstitial nephritis
Increase by 50% in urine osmolality
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
Retinitis; mononucleosis

5. What is a common complication of acute pancreatitis? What is it?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Myasthenia gravis
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
chronic urticaria and allergic symptoms

6. What is capacitance inversely proportional to?
To pump calcium out in cardiac myocytes so that relaxation occurs
Elastance
Large stroke volumes with ventricular contraction; aortic regurg
Increased reticulocytes

7. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
only up to bronchi
ZDV or AZT
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Chorda tympani branch

8. When is acid phosphatase elevated (Name two times)?
Not lined by epithelium
Coagulation factors are made in the liver
Reiter syndrome; B27
Prostate tumor and increased osteoclast activity

9. What are pancreatic pseudocysts called pseudo rather than true cysts?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Raphe
PDA open
Not lined by epithelium

10. what chromosome is c - myc found on?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Turbulence
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Chrom 8

11. What is the most common initital symptom of ADPKD? what else?
Classical conditioning
Initiation - pointing; pincer grasp; walking; mama/dada
Increase; decreased
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

12. What is the cause of rapid plasma decay of thiopental?
Acute interstitial nephritis
In the extracellular space for collagen cross linking; zinc
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
Tissue redistribution (out of plasma) rather than metabolism

13. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Downs; regurgitant AV valves - ASDs
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
AV node slowest - to allow time for diastole

14. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
INTRApartum Abs (ampicillin/penicillin)
SaO2 <92%
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

15. What type of endocarditis is cytoscopy induced?
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
In ER of bile canaliculi
Enterococci (e. faecalis)- found on genitalia area
...

16. What are the two growth factors associated with angiogenesis?
FGF and VEGF
By vascular permeability and vasodilation
glycerol kinase
Tibial

17. How do you calculate atributable risk percent?
TCAs and prazosin
Smoking
RR-1/RR
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

18. What antibiotic is best to treat alcoholic pulm infections? why?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Congenital hypothyroidism - downs - amyloidosis - acromegaly
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
chronic urticaria and allergic symptoms

19. What is epleronone?
RR-1/RR
11 aa polypeptide; pain NT in CNS and PNS
S. aureus
Another type of aldosterone antagonist (like spironolactone)

20. what should you think of in 'smear of an oral ulcer base'?
Sydenham chorea
Tzanck smear
Sickle cell; G6PD
Another type of aldosterone antagonist (like spironolactone)

21. What are two indicators of chronic alcohol consumption?
Closer to head; closer to diaphragm
Elevated GGT and macrocytosis
Raphe
Hypothyroidism

22. neisseria are...
facultative intracellular
CMV - HSV 1 - Candida
Prevents hepatic VLDL production
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

23. How do you treat gonococcal infection? chlymadia?
Around 70 (normal measured diastolic pressures); 9--
Downs; regurgitant AV valves - ASDs
Fat - fertile - forty - female
Ceftriaxone; azithromycin

24. What is the stabilizing force for the secondary structure of proteins?
Hydrogen bonds dictate alpha or beta structure
Become beta pleated and then form neurofibrillary tangle!
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Squatting - sitting - lying supine - passive leg raising

25. What causes wrist drop?
Right before diastole (filling begins)
Radial nerve damage
Well trained athletes and children
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

26. What is the most common cause of pyelonephritis in both adults and childre?
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
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
E. coli
Sarcoid

27. which nerve provides innervation for plantar flexion and inversion?
Localized dermatologic pain that persists for more than one month after zoster eruption
Tibial
4 - 4 - 9
In the extracellular space for collagen cross linking; zinc

28. What is gardeners mydriasis? How is it treated?
Barium enema
Adductor
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

29. which nucleus releases serotonin?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
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
Little effect on cell and no change
Raphe

30. What can cause virilization of a mother during pregnancy?
Kallmans
Acute gastric mucosal defects (superficial or full thickness)
Circular - outside nucleus; transport proteins - rRNA - tRNA
Aromatase deficiency in child

31. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Increase lymphatic drainage!
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

32. What is epispadias caused by?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Faulty positioning of the genital tubercle
MAO inhibitors; wine and cheese

33. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Fibronectin - laminin - collagen
Valproate
Varying; erythema nodosum is common
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

34. What is the most important prognostic indicator in patients with malignant melanoma?
IgE
Hypo or hyper pigmentations; after tanning
Initiation - pointing; pincer grasp; walking; mama/dada
Measure of depth invasion (vertical!)

35. on which chromosome is wilms tumor found?
11
Anti cholinergic effects of pupil dilation and lack of accomodation
Fibronectin - laminin - collagen
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

36. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
RBF= PAH clearance/(1- hematocrit)
Little effect on cell and no change
Increase lymphatic drainage!
Dihydropyridine sensitive Ca channels (L type)

37. what murmur is enhanced by decreased blood flow to the heart?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
frameshift mutations (missense is substitution)
Well
4 - 4 - 9

38. PDAs are often asymptomatic. How do you treat?
Superior larygeal; cricothyroid; recurrent laryngeal
Bile salt accumulation in urine
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
indomethacin

39. What is difference between Arnold Chiari type I and II?
I is more benign and can present later in adulthood
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Drink plenty of fluids
To pump calcium out in cardiac myocytes so that relaxation occurs

40. What causes curlings ulcers?
LT (LTD4 - E4 - C4) - and Ach
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
FGF and VEGF
Biphosphonate

41. What do you treat s. epidermidis with?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Vancomycin
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Octreotide

42. What is achalasia and how would this correlate on the esophageal mannometry?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
DIC; TTP- HUS dont bleed that much
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
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

43. what hernia has a similar mechanism to hydrocele?
Myasthenia gravis
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Hydrogen bonds dictate alpha or beta structure

44. what clinical findings help distinguish small cell carcinoma?
Covalent (between two cysteines)- allows protein to withstand denaturation
No; MRI
Pulmonary hypertension
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

45. What does NF- KB do?
Increases cytokine production
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Enterococci (e. faecalis)- found on genitalia area

46. what bursa is affected when on knees like a maid/gardner?
Prepatellar
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
C3 decreased after 5-10 days; sulfonamides
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase

47. What type of drug is alendronate?
Elastance
Biphosphonate
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Radial nerve and deep brachial artery

48. 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?
Aromatase deficiency in child
Common peroneal; bony fractures and compression; sciatic
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Bronchial dilation (bronchiectasis)

49. What is hypospadias caused by?
Class I
Extrinsic def; instrinsic def; platelet def
Abnormal closing of the urethral folds
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

50. What is the most common neurologic complication of VZV reactivation?
Normal; low
Localized dermatologic pain that persists for more than one month after zoster eruption
RR-1/RR
Hereditary angioedema; ACE inhibitors