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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. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
E. coli; staphylococcus saprophyticus
Valproate
Vagus nerve stimulation

2. What are the long term consequences of hydrocephalus?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Apocrine; eccrine
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

3. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
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)
Chrom 8

4. Where does terminal peptide cleavage of collagen fibrils take place?
In the extracellular space
Inactivates kallikrein which activates kininogen into bradykinin
Varying; erythema nodosum is common
Clindamycin; covers anaerobic oral flora and aerobic bacteria

5. neisseria are...
Headaches and facial flushing; vasodilation in meninges and skin
SVC and IVC; right below the aortic knob
facultative intracellular
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

6. Metronidizaole does not cover...
gram positive organisms
To pump calcium out in cardiac myocytes so that relaxation occurs
Anterior nares
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences

7. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
Measles and M3 AML`
V fib; v. failure
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)
Turbulence

8. What is diagnostic (and possible therapeutic for intussusception)?
Vancomycin; histamine mediated
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
Coagulation factors are made in the liver
Barium enema

9. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
SSRI
RBF= PAH clearance/(1- hematocrit)
Vascular endothelium; protease
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

10. What is the difference between additive and synergistic?
Well trained athletes and children
Atrial
Ether and other organic solvents
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

11. what enzyme converts procarcinogens into carcinogens?
P450 mitochondrial monooxygenase
facultative intracellular
Ig A deficiency
Prevents hepatic VLDL production

12. what virus causes pharyngoconjuctival fever?
Bronchogenic carcinoma
Sydenham chorea
Adeno
RBF= PAH clearance/(1- hematocrit)

13. What are two common side effects of both acute and long acting nitrates? What causes them?
RR-1/RR
Hydrogen bonds dictate alpha or beta structure
RBC mass; epo levels (secondary has high)
Headaches and facial flushing; vasodilation in meninges and skin

14. 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)
Pulmonary hypertension
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Brief psychotic disorder; schizophreniform; schizophrenia

15. What translocations can cause c - myc overexpression?
8 (myc protein) with 2 - 14 - 22 (iG chains)
Increase lymphatic drainage!
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

16. What are fenfluramine - phentermine?
Appetite suppressants
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Hyperkalemia; potassium sparing diuretics - potassium supplements

17. What can long term leg cast wearing cause?
Purkinje system; AV node
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
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
ST become atrophic and hyalinized (temp induced damage) and depressed sperm count becuase of that; hormonal function not impaired (test and LH levels normal) because Leydig cells not as temp sensitive so secondary sexual characteristics and sexual pe

18. What is epispadias caused by?
Little effect on cell and no change
E. coli; staphylococcus saprophyticus
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Faulty positioning of the genital tubercle

19. In What type of nephritis would you see high serum eos count?
E. coli
Rabies encephalitis from cave bats; rabies killed vaccines
Drug induced interstitial nephritis
In the extracellular space

20. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
only up to bronchi
Amiloride - spironolactone - triamterene
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Measure of depth invasion (vertical!)

21. how long is substance P? What does it do?
SaO2 <92%
Pulmonary hypertension
Elevated GGT and macrocytosis
11 aa polypeptide; pain NT in CNS and PNS

22. what clinical findings help distinguish small cell carcinoma?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Medial part
No; MRI
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

23. What is the immune deficinecy seen in ataxia telangactasia?
Close but purkinje system to ensure contraction in a bottom up fashion
Ig A deficiency
RBC mass; epo levels (secondary has high)
46 - 4N; 23 2N

24. which nucleus releases serotonin?
...
Raphe
Fat - fertile - forty - female
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

25. How can renal blood flow be calculated from RPF?
RBF= PAH clearance/(1- hematocrit)
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Chrom 8
Apocrine; eccrine

26. what makes bruits?
Turbulence
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Vascular endothelium; protease

27. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Turners`
Pan colitis and right sided colitis (more than left sided and proctitis)
Closer to head; closer to diaphragm
<1% - 55% - concentration dependent

28. why are pregnant predisposed to cholelithiasis?
Serum creatine kinase; reperfusion injury causes necrosis
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
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
Atrial

29. what marker should be followed in a patient with cirrhosis?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
hyponatremia (aldosterone activation equilibrates body volume)
No; MRI
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

30. What is used to prevent vertical transmission of HIV?
ZDV or AZT
Gluteus maximus; difficulty getting up from seated position and climbing chair
Amiadarone
Anti centromere; anti DNA topoisomerase

31. What is the most common cause of pyelonephritis in both adults and childre?
Faulty positioning of the genital tubercle
E. coli
Normally close to systolic
MAC complex (C5b - C9 complement deficiency)

32. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Highly negative resting potential
Rabies encephalitis from cave bats; rabies killed vaccines
No and yes
Tissue redistribution (out of plasma) rather than metabolism

33. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
Demargination of neutrophils from the vessel walls
transcription activation/suppression
Trochlear nerve (IV); abducens nerve (VI)
Headaches and facial flushing; vasodilation in meninges and skin

34. What would a deflection of the membrane potential to near zero indicate?
Bronchial dilation (bronchiectasis)
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Increases cytokine production
Increase in permeability of two ions with equal and opposite equilibrium potentials

35. What is the preferred treatment for DKA?
8 (myc protein) with 2 - 14 - 22 (iG chains)
To pump calcium out in cardiac myocytes so that relaxation occurs
Prevents hepatic VLDL production
Regular insulin (Not fast acting - regular better)

36. What is epleronone?
The term used to describe decreased drug responsiveness with repeated administration
Another type of aldosterone antagonist (like spironolactone)
Vancomycin; histamine mediated
Vagus (auricular branch); vasovagal syncope!

37. do patients with cor pulmonale have increased or decreased levels of aldosterone?
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Common peroneal; bony fractures and compression; sciatic
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Because of the low output from heart failure - they will have increased aldosterone levels

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

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39. 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)
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
...
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

40. why does neutrophila occur with corticosteroids?
Demargination of neutrophils from the vessel walls
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Atrial
Turbulence

41. What are the acute effects of corticosteroids on the CBC?
Valproate
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
LT (LTD4 - E4 - C4) - and Ach
Elevated GGT and macrocytosis

42. What are the skin presentation in sarcoid?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
chronic urticaria and allergic symptoms
SVT; increases vagal tone; rectus abdominis
Varying; erythema nodosum is common

43. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
ANCA because of lack of Ig and C3 deposits on IF
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Rabies encephalitis from cave bats; rabies killed vaccines
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

44. What is the mc location of brain germinomas?What are the classic symptoms?
Right before diastole (filling begins)
RR-1/RR
Adductor
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

45. why does hypothyroidism cause increased CPK levels?
Folic acid treatment!
Myasthenia gravis
SS +rNA
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

46. What is the Na/Ca exchange used for?
To pump calcium out in cardiac myocytes so that relaxation occurs
glycerol kinase
No and yes
Radial nerve damage

47. where exactly is ACE expressed in the lungs? What type of enzyme is it?
RBC mass; epo levels (secondary has high)
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
Bile salt accumulation in urine
Vascular endothelium; protease

48. What is the mainstay treatment for acute mania?
Intussusception
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Nocardia

49. What is congestive hepatomegaly specific for?
Right heart failure
Classical conditioning
Increase by 50% in urine osmolality
11

50. in the LV and aorta - What are the pressures?
Normally close to systolic
Because of the low output from heart failure - they will have increased aldosterone levels
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Sydenham chorea