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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 eos release MBP to kill protozoa etc?
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
II; I (I more abundant)
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

2. How do you calculate excretion rate of a substance? How do you calculate the filtration rate of a substance? clearance of what substance estimates the GFR?
Recurrent larygneal
Bronchial dilation (bronchiectasis)
Hyperkalemia; potassium sparing diuretics - potassium supplements
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

3. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Retinitis; mononucleosis
Trauma to stereociliated hair cells of the organ of corti
Become beta pleated and then form neurofibrillary tangle!

4. Where is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Retinitis; mononucleosis
The term used to describe decreased drug responsiveness with repeated administration
Env genes (for getting into target cells)

5. What causes vertical diplopia? horizontal?
Trochlear nerve (IV); abducens nerve (VI)
Integration of viral DNA into genome of host hepatocytes
P53 mutation; AD
Little effect on cell and no change

6. why does hypothyroidism cause increased CPK levels?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Leukotriene precursor and does neutrophil chemotaxis
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Strength of cell mediated immune response

7. ___________ is liver specific
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Protamine sulfate
glycerol kinase

8. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
No and yes
OCPs - multiparity - breast feeding
only up to bronchi
11

9. What is Tzanck smear used to detect?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Acute gastric mucosal defects (superficial or full thickness)
HSV and VZV
SSRI

10. What is best to prevent GBS infection in a baby?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Hyperkalemia; potassium sparing diuretics - potassium supplements
200-500
INTRApartum Abs (ampicillin/penicillin)

11. which antiarrythmic is associated with blue gray discoloration ?
Myasthenia gravis
Amiadarone
Well trained athletes and children
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

12. What antibiotic is best to treat alcoholic pulm infections? why?
Hereditary angioedema; ACE inhibitors
Clindamycin; covers anaerobic oral flora and aerobic bacteria
S3 gallop; S2 to opening snap interval
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

13. In What type of nephritis would you see high serum eos count?
When it invades the bm; carcinoma in situ
IgE
Drug induced interstitial nephritis
APP on chrom 21 (this is why downs more susceptible)

14. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
I is more benign and can present later in adulthood
Terminal bronchioles; small bronchi
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)
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

15. What does hypocapnia cause in teh brain? What is hypocapnia?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
SVC and IVC; right below the aortic knob

16. 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
Standing suddenly from supine position; valsalva maneuver
No and yes
Elevated GGT and macrocytosis

17. What are the common causes of metabolic alkalosis? How do you differentiate between them?
P450 mitochondrial monooxygenase
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
facultative intracellular
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

18. What are two indicators of chronic alcohol consumption?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
C3 decreased after 5-10 days; sulfonamides
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

19. What causes wrist drop?
Atrial
Chorda tympani branch
Radial nerve and deep brachial artery
Radial nerve damage

20. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Increases
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
HSV ( also in utero: chlymadia - neisseria - group B strep)
Chrom 8

21. within the right atrium - What is the maximum pressure? left atrium?
8; 12
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
SSRI
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)

22. What is damaged in early syringomelia? later?
Joints d/t increased purine production and thus uric acid production
Anterior circumflex (and axillary nerve)
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Increase lymphatic drainage!

23. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
Increases
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

24. why are beta thal major patients asymptomatic at birth?
Tissue redistribution (out of plasma) rather than metabolism
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Because gamma chains replace beta chains and then gamma chain formation wanes
Ether and other organic solvents

25. What is a keloid?
Excessive collagen formation during tissue repair in susceptible individuals
P53 mutation; DCC is also required for adenoma to carcinoma
...
Leukotriene precursor and does neutrophil chemotaxis

26. In what population does cholelithiasis occur?
Right before diastole (filling begins)
Cluster
To pump calcium out in cardiac myocytes so that relaxation occurs
Fat - fertile - forty - female

27. there are mucus secreting cells in the bronchioles...
Ceftriaxone; azithromycin
Southern - western
Hexokinase
only up to bronchi

28. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
Sydenham chorea
Hyperkalemia; potassium sparing diuretics - potassium supplements
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Normally close to systolic

29. how does increased ICP result in curlings ulcers?
Hyperkalemia; potassium sparing diuretics - potassium supplements
Demargination of neutrophils from the vessel walls
Vagus nerve stimulation
Congenital hypothyroidism - downs - amyloidosis - acromegaly

30. metabolism of 1 gram of protein produces How many calories? carb? fat?
<1% - 55% - concentration dependent
8 (myc protein) with 2 - 14 - 22 (iG chains)
4 - 4 - 9
Superior larygeal; cricothyroid; recurrent laryngeal

31. if there are keratin swirls does that mean well or poorly differentiated?
Well
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
Anti cholinergic effects of pupil dilation and lack of accomodation
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

32. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Prepatellar
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Amiloride - spironolactone - triamterene

33. what vessel would a fracture to the neck of the of the humerus damage?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Anterior circumflex (and axillary nerve)
Elevated GGT and macrocytosis
transcription activation/suppression

34. what marker should be followed in a patient with cirrhosis?
Phencyclidine (PCP)
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
Octreotide
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

35. What type of mutation does aflatoxin cause? what cancer does this increase for?
G to T in p53; HCC
Hereditary angioedema; ACE inhibitors
Decreases both
Hyperkalemia; potassium sparing diuretics - potassium supplements

36. What pulmonary structural change can kartageners syndrome cause?
Dissolved in plasma and attached to Hgb
manifestations - congenital (stretching of periventricular pyrimadal fibers)
facultative intracellular
Bronchial dilation (bronchiectasis)

37. on which chromosome is wilms tumor found?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
11
Integration of viral DNA into genome of host hepatocytes
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

38. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
Prevents hepatic VLDL production
Hypothyroidism
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
Increase lymphatic drainage!

39. What type of endocarditis is cytoscopy induced?
Coagulation factors are made in the liver
Purkinje system; AV node
Enterococci (e. faecalis)- found on genitalia area
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

40. What are fenfluramine - phentermine?
ATP binding (resets the myosin head to contract again for next binding)
4 - 4 - 9
Appetite suppressants
TCAs and prazosin

41. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Proteasome inhibitor; treatment for MM and waldenstroms
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
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

42. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Elastance
Curlings ulcers
Medullary

43. IL4 is used for isotypye switching to what?
Become beta pleated and then form neurofibrillary tangle!
MAO inhibitors; wine and cheese
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
IgE

44. What is capacitance inversely proportional to?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
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
Elastance
Reiter syndrome; B27

45. a patient fearing all white coats is a phenomenon of what?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
MAO inhibitors; wine and cheese
Sarcoid
Classical conditioning

46. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Susceptible; soluble (unable to be cultured in bile)
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Phencyclidine (PCP)

47. What is a cord factor and Which bugs have it? How do they appear on culture?
Relfex tachycardia; giving beta blockers
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
transcription activation/suppression

48. What can chronic vit A toxicity cause?
Minimal change disease
Octreotide
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

49. What can long term leg cast wearing cause?
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
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
Bronchial dilation (bronchiectasis)
FGF and VEGF

50. which nerve provides innervation for plantar flexion and inversion?
Downs; regurgitant AV valves - ASDs
Tibial
When it invades the bm; carcinoma in situ
Dissolved in plasma and attached to Hgb