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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. 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?
Fibrosis; macrophages
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Hyperkalemia; potassium sparing diuretics - potassium supplements
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

2. What type of bond is a disulfide bond?
Normally close to systolic
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
Covalent (between two cysteines)- allows protein to withstand denaturation
Increase lymphatic drainage!

3. 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?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
MAC complex (C5b - C9 complement deficiency)
Common peroneal; bony fractures and compression; sciatic

4. 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
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Enterococci (e. faecalis)- found on genitalia area
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

5. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Skin flushing and warmth; prostaglandins; give with aspirin
CMV - HSV 1 - Candida
ZDV or AZT

6. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
Normally close to systolic
P53 mutation; AD
The time interval between S2 and OS- the shorter the interval - the more intense
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

7. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Hypo or hyper pigmentations; after tanning
Increased reticulocytes
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

8. What is contraindicated in toxic mega colon?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
200-500
Inhibits it
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

9. there are mucus secreting cells in the bronchioles...
Pan colitis and right sided colitis (more than left sided and proctitis)
Not lined by epithelium
only up to bronchi
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

10. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Reticulocytes
HSV and VZV
Fibronectin - laminin - collagen
Normally close to systolic

11. What is a keloid?
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
Excessive collagen formation during tissue repair in susceptible individuals
Paramyxo and influenza
When it invades the bm; carcinoma in situ

12. why does hypothyroidism cause increased CPK levels?
<1% - 55% - concentration dependent
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Anterior circumflex (and axillary nerve)
In ER of bile canaliculi

13. What can cause aortic regurg? What is the heart sound you hear?
Appetite suppressants
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
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
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

14. 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?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Paramyxo and influenza
Chorda tympani branch
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)

15. What is used to treat heparin toxicity?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Protamine sulfate
Abnormal closing of the urethral folds
E. coli

16. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
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
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

17. What translocations can cause c - myc overexpression?
8 (myc protein) with 2 - 14 - 22 (iG chains)
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Ether and other organic solvents

18. SIADH patients have normal blood volume but...
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Closer to head; closer to diaphragm
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
hyponatremia (aldosterone activation equilibrates body volume)

19. how much percent of sodium is excreted? urea? glucose?
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
<1% - 55% - concentration dependent
SVT; increases vagal tone; rectus abdominis

20. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
women

21. Which is faster atrial muscle or ventricular muscle?
Become beta pleated and then form neurofibrillary tangle!
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
AV node slowest - to allow time for diastole
Atrial

22. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Vagus nerve stimulation
differentiate
Reiter syndrome; B27
gram positive organisms

23. Would alpha 1 agonists cause flushing? muscarinic antagonist?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Recurrent larygneal
No; yes
Myasthenia gravis

24. What is the precursor protein to beta amyloid and On what chromosome is it found?
Tibial
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
APP on chrom 21 (this is why downs more susceptible)
(urine PAH x urine flow rate)/plasma PAH

25. What are the potassium sparing diuretics?
Intussusception
Amiloride - spironolactone - triamterene
By vascular permeability and vasodilation
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

26. other than mycobacterim wha other bacteria is acid fast?
No; yes
Nocardia
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Amiadarone

27. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
Bronchogenic carcinoma
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
OCPs - multiparity - breast feeding
RER; copper

28. within the right ventricle - What are maximum pressures? the pulm arter?
Vagus (auricular branch); vasovagal syncope!
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
25; 25
Vancomycin; histamine mediated

29. What is capsaicin? Where does it work?
Syringomelia
Enterococci (e. faecalis)- found on genitalia area
RBC mass; epo levels (secondary has high)
Pain reliever - reduces pain by locking substance P in the PNS

30. What is normal fibrinogen levels?
200-500
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
OCPs - multiparity - breast feeding
GI malignancies and Insulin resistance (acromegal for ex)

31. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
Large stroke volumes with ventricular contraction; aortic regurg
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
No; yes
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

32. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Neisseria induced small cell vasculitis (including hands and soles)
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
As a CO2 carrier with the carboxylase enzyme

33. What antibiotic is best to treat alcoholic pulm infections? why?
Highly negative resting potential
Minimal change disease
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Increase by 50% in urine osmolality

34. What is the most important prognostic indicator in patients with malignant melanoma?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Measure of depth invasion (vertical!)
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Atrial

35. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Reiter syndrome; B27
Vancomycin

36. how does eos release MBP to kill protozoa etc?
INTRApartum Abs (ampicillin/penicillin)
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
transcription activation/suppression
Fibronectin - laminin - collagen

37. what color pigmentations are caused by malassezia furfur? when do they become more visible?
46 - 4N; 23 2N
Hypo or hyper pigmentations; after tanning
Sickle cell; G6PD
Phencyclidine (PCP)

38. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Well
P53 mutation; DCC is also required for adenoma to carcinoma
transcription activation/suppression

39. which nerve provides innervation for plantar flexion and inversion?
Tibial
Relfex tachycardia; giving beta blockers
RER; RER
Fat - fertile - forty - female

40. What is suggestive of complete central DI?
HSV and VZV
Valproate
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Increase by 50% in urine osmolality

41. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
only up to bronchi
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
To pump calcium out in cardiac myocytes so that relaxation occurs
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)

42. What does TGF beta do? What produces it?
Fibrosis; macrophages
Common peroneal; bony fractures and compression; sciatic
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

43. other than proteinuria - What can cause foamy froathy urine?
Turbulence
Bile salt accumulation in urine
Common peroneal; bony fractures and compression; sciatic
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

44. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
T test; chi squared
Myasthenia gravis

45. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Gluteus maximus; difficulty getting up from seated position and climbing chair
Because ACE blocks breakdown of bradykinin and hereditary angioedema patients have high levels of bradykinin; high levels of bradykinin - C3a - and C5a mediate edema by increasing vascular permeability and vasodilation
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Anti - apoptotic (prevents going into apoptosis)- 18; 14

46. IL4 is used for isotypye switching to what?
HSV ( also in utero: chlymadia - neisseria - group B strep)
IgE
Folic acid treatment!
Strength of cell mediated immune response

47. other than increasing HDL levels - what else does niacin do?
Prevents hepatic VLDL production
High potassium conductance and some sodium conductance
Vagus (auricular branch); vasovagal syncope!
Syncope - angina - dyspnea (SAD)

48. What can long term leg cast wearing cause?
Biphosphonate
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
Think Hb deformation diseases
manifestations - congenital (stretching of periventricular pyrimadal fibers)

49. What does anti phospholipid syndrome in SLE patients predispose them to?
Biphosphonate
gram positive organisms
Multiple miscarriages d/t hypercoaguability
Protamine sulfate

50. What three pathogens cause infectious esophagitis in HIV positive patients?
ZDV or AZT
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
CMV - HSV 1 - Candida
Vagus nerve stimulation