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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 the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Increase; decreased
TCAs and prazosin
IgE
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

2. Acyl coA synthetase is not...
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
liver specific
Nocardia

3. what makes bruits?
Turbulence
differentiate
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

4. what vessel would a fracture to the neck of the of the humerus damage?
Squatting - sitting - lying supine - passive leg raising
Because of vasodiation to skeletal muscles
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Anterior circumflex (and axillary nerve)

5. What agonists reduce the gradient across the LV outflow tract?
V fib; v. failure
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Radial nerve and deep brachial artery
Selective alpha 1 (increases SVR)

6. what bursa is affected when on knees like a maid/gardner?
Prepatellar
Hydrogen bonds dictate alpha or beta structure
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Underestimation of gestational age

7. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
LT (LTD4 - E4 - C4) - and Ach
Large stroke volumes with ventricular contraction; aortic regurg
Southern - western

8. What is the neurologic manifestation of ADPKD?
CGD; t cell dysfxn (diGeorge)
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase

9. if there are keratin swirls does that mean well or poorly differentiated?
Syringomelia
Estrogen induced cholesterol hypersecretion (increase HMG CoA reductase activity) and progesterone induced gallbladder hypomotility (decreases bile acid secretion)-- both these conditions predispose cholesterole to insolubilize out
Well
Acute gastric mucosal defects (superficial or full thickness)

10. what hernia has a similar mechanism to hydrocele?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Curlings ulcers
Sudden loss of muscle tone without loss of consciousness; narcolepsy

11. in B12 deficiency - what levels in blood rise very quickly and then drop?
Acute gastric mucosal defects (superficial or full thickness)
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Reticulocytes
Tissue redistribution (out of plasma) rather than metabolism

12. What can cause virilization of a mother during pregnancy?
Aromatase deficiency in child
The term used to describe decreased drug responsiveness with repeated administration
Smoking
Bile soluble which means they are bile sensitive

13. 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)
Joints d/t increased purine production and thus uric acid production
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
8 (myc protein) with 2 - 14 - 22 (iG chains)

14. which are the only glycosylated proteins in HIV virus?
Sydenham chorea
Chlorpheniramine and diphenhydramine
Env genes (for getting into target cells)
25; 25

15. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
Increase in permeability of two ions with equal and opposite equilibrium potentials
hyponatremia (aldosterone activation equilibrates body volume)
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
Close but purkinje system to ensure contraction in a bottom up fashion

16. What are the two growth factors associated with angiogenesis?
FGF and VEGF
Trochlear nerve (IV); abducens nerve (VI)
Phencyclidine (PCP)
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

17. What does sustained hand grip do to the C/V system?
Because of vasodiation to skeletal muscles
Chrom 8
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Headaches and facial flushing; vasodilation in meninges and skin

18. What type of disease has selective proteinuria? What is found in urine? What is not?
Large stroke volumes with ventricular contraction; aortic regurg
P53 mutation; DCC is also required for adenoma to carcinoma
ATP binding (resets the myosin head to contract again for next binding)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

19. what protects the resting heart from arrhythmias?
Highly negative resting potential
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
No (unlike adenomyosis); yes
CGD; t cell dysfxn (diGeorge)

20. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
indomethacin
Ig A deficiency
8 (myc protein) with 2 - 14 - 22 (iG chains)

21. How do bradykinin - C3a and C5a cause edema?
SSRI; erectile dysfunction
Medullary
Anti cholinergic effects of pupil dilation and lack of accomodation
By vascular permeability and vasodilation

22. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
P53 mutation; AD
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Brief psychotic disorder; schizophreniform; schizophrenia
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

23. biotin is used By what in tissues responsible for gluconeogenesis
As a CO2 carrier with the carboxylase enzyme
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

24. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
only up to bronchi
Inhaled animal dander allergens

25. which opponens muscle does ulnar innervate?
LT (LTD4 - E4 - C4) - and Ach
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Adductor
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

26. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Hypothyroidism
Increases cytokine production
APP on chrom 21 (this is why downs more susceptible)

27. What actions increase venous return?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Squatting - sitting - lying supine - passive leg raising
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
T test; chi squared

28. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Tibial
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
As a CO2 carrier with the carboxylase enzyme

29. at one year of age - What are the social - fine motor - gross motor and language developments?
Env genes (for getting into target cells)
Measure of depth invasion (vertical!)
Boiling - bleach - formalin - UV irradiation
Initiation - pointing; pincer grasp; walking; mama/dada

30. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Fibrosis; macrophages
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
Hypo or hyper pigmentations; after tanning
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

31. What are the two mcc of focal brain lesions in HIV positive patients?
Smoking
Because of vasodiation to skeletal muscles
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Myasthenia gravis

32. why is crohns disease associated with oxaloacetate kidney stones?
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
Lack of calcium to bind oxaloacetate; crohns prevents fat absorption from lack of bile reabsorption in the terminal illeum which leads to fats pulling calcium and lack of calcium reabsorption
ZDV or AZT
Anterior circumflex (and axillary nerve)

33. at four years of age - What are the social - fine motor - gross motor - and language developments?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
No (unlike adenomyosis); yes
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

34. What can too much IgA in serum produces?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Congenital hypothyroidism - downs - amyloidosis - acromegaly

35. What is somatomedin C?
Insulin like growth factor 1 (just another name)
Mean greater than median greater than mode
Turners`
Increase by 50% in urine osmolality

36. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
ATP binding (resets the myosin head to contract again for next binding)
GI malignancies and Insulin resistance (acromegal for ex)
No (unlike adenomyosis); yes
gram positive organisms

37. What does glycosylase do to DNA? endonuclease? lyase? What does the order here of enzymes represent? what other enzymes are needed?

38. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Vancomycin

39. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
MAO inhibitors; wine and cheese
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Tibial
Integration of viral DNA into genome of host hepatocytes

40. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
Anti cholinergic effects of pupil dilation and lack of accomodation
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Initiation - pointing; pincer grasp; walking; mama/dada
P53 mutation; AD

41. What is the triad seen in pre eclampsia?
Hypertension - edema - and proteinuria
Sydenham chorea
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Intussusception

42. What is contraindicated in toxic mega colon?
Because of the low output from heart failure - they will have increased aldosterone levels
Susceptible; soluble (unable to be cultured in bile)
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

43. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
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
Turbulence
Intussusception

44. What are the primary determinants of colon cancer risk in UC patients
Medial part
No and yes
Duration and extent of disease
Vascular endothelium; protease

45. What is epispadias caused by?
Mean greater than median greater than mode
Large stroke volumes with ventricular contraction; aortic regurg
Faulty positioning of the genital tubercle
RER; copper

46. who bleed more DIC or TTP- HUS patients?
Close but purkinje system to ensure contraction in a bottom up fashion
DIC; TTP- HUS dont bleed that much
liver specific
Circular - outside nucleus; transport proteins - rRNA - tRNA

47. What is a keloid?
High potassium conductance and some sodium conductance
Excessive collagen formation during tissue repair in susceptible individuals
Decreases both
Medial circumflex artery; avascular necrosis

48. What does TGF beta do? What produces it?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Because of the low output from heart failure - they will have increased aldosterone levels
Fibrosis; macrophages
Little effect on cell and no change

49. What three factors effect total oxygen content of blood?
indomethacin
Downs; regurgitant AV valves - ASDs
S. saprophyticus - and s. epidermidis; novobiocin
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

50. what drugs causes the red man syndrome? how does it occur?
Apocrine; eccrine
S. aureus
Normal; low
Vancomycin; histamine mediated