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. What is a clara cell?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
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
Squatting - sitting - lying supine - passive leg raising
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system


2. where exactly is ACE expressed in the lungs? What type of enzyme is it?
Ig A deficiency
Vascular endothelium; protease
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
GI malignancies and Insulin resistance (acromegal for ex)


3. are there signs of inflammation in avascular necrosis? then How do you diagnose?
No; MRI
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Adductor


4. What does C1 esterase do other than inhibiting complement pathway?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
E6 and E7 of HPV knock off p53 and Rb suppressor genes
<1% - 55% - concentration dependent
Inactivates kallikrein which activates kininogen into bradykinin


5. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Myasthenia gravis
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Tibial


6. What causes vertical diplopia? horizontal?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Trochlear nerve (IV); abducens nerve (VI)
Anti cholinergic effects of pupil dilation and lack of accomodation
SaO2 <92%


7. What are some side effects seen in TCAs?
Strength of cell mediated immune response
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
No; yes
FGF and VEGF


8. How do you treat gonococcal infection? chlymadia?
Ceftriaxone; azithromycin
Susceptible; soluble (unable to be cultured in bile)
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
On cardiac tissue and renal juxtaglomerular cells


9. why does neutrophila occur with corticosteroids?
Dihydropyridine sensitive Ca channels (L type)
APP on chrom 21 (this is why downs more susceptible)
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Demargination of neutrophils from the vessel walls


10. What can worse neurologic dysfunction in cobalamic def?
Folic acid treatment!
Permissive - sensitizes vasoconstrictive response from catecholamines - doesnt actually act on them but increases transcription of some genes that creates permissive effect (not additive or synergistic becuase cortisol alone doesnt have any effect on
(urine PAH x urine flow rate)/plasma PAH
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased


11. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Aromatase deficiency in child
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Single adenomatous ones
Sickle cell; G6PD


12. what dissolves the lipid bilayer of a viral envelope?
Hereditary angioedema; ACE inhibitors
Ether and other organic solvents
FGF and VEGF
Faulty positioning of the genital tubercle


13. what diseases can vit A be used to treat?
Inhibits it
NF- KB; responsible for cytokine production
Measles and M3 AML`
Bronchogenic carcinoma


14. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Apocrine; eccrine
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac


15. What is the mcc of elevated AFP leves in pregnancy>
Underestimation of gestational age
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
P53 mutation; DCC is also required for adenoma to carcinoma


16. What is the mc malignancy in asbestosis?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
G to T in p53; HCC
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Bronchogenic carcinoma


17. what bursa is affected when on knees like a maid/gardner?
Prepatellar
Vagus (auricular branch); vasovagal syncope!
Gluteus medius and minimus; positive trendelenberg
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13


18. What is achalasia and how would this correlate on the esophageal mannometry?
Vancomycin; histamine mediated
Turbulence
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)
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


19. What is a cell surface marker seen in liver angiosarcoma?
Primary
Integration of viral DNA into genome of host hepatocytes
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
<1% - 55% - concentration dependent


20. What does NF- KB do?
Single adenomatous ones
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Increases cytokine production


21. at 2 years of age - What are the social - fine motor - gross motor and language developments?
AV node slowest - to allow time for diastole
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Strength of cell mediated immune response
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases


22. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
RR-1/RR
V fib; v. failure
RBC mass; epo levels (secondary has high)
11 aa polypeptide; pain NT in CNS and PNS


23. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
To pump calcium out in cardiac myocytes so that relaxation occurs
IgE
Smoking
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


24. How is dobutamine better than dopamine?
Standing suddenly from supine position; valsalva maneuver
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)
Recurrent larygneal
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)


25. When is an S4 sound normal?
...
Intussusception
Well trained athletes and children
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)


26. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
E. coli; staphylococcus saprophyticus
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
ANCA because of lack of Ig and C3 deposits on IF
ATP binding (resets the myosin head to contract again for next binding)


27. which viruses require a protease?
gram positive organisms
Prevent phagocytosis
Intussusception
SS +rNA


28. which nucleus releases serotonin?
High potassium conductance and some sodium conductance
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Trauma to stereociliated hair cells of the organ of corti
Raphe


29. SIADH patients have normal blood volume but...
Echinococcus granulosus; anaphylaxis
Increase lymphatic drainage!
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
hyponatremia (aldosterone activation equilibrates body volume)


30. What does 'oxygen' content in blood refer to?
E. coli; staphylococcus saprophyticus
Duration and extent of disease
G to T in p53; HCC
Dissolved in plasma and attached to Hgb


31. What type of calcium channels dictate the plateau in cardiac myocyte?
AV node slowest - to allow time for diastole
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
ANCA because of lack of Ig and C3 deposits on IF
Dihydropyridine sensitive Ca channels (L type)


32. in the LV and aorta - What are the pressures?
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
Demargination of neutrophils from the vessel walls
Ketone body production by preventing fatty acids into the mitochondria
Normally close to systolic


33. What is the presentation of sever aortic stenosis?
Syncope - angina - dyspnea (SAD)
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
RER; RER
Protamine sulfate


34. What is the mc location for avascular necrosis? What is it associated with?
Not lined by epithelium
Turbulence
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic


35. What translocations can cause c - myc overexpression?
Closer to head; closer to diaphragm
8 (myc protein) with 2 - 14 - 22 (iG chains)
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Vascular endothelium; protease


36. When does opening snap begin?
No; yes
Excessive collagen formation during tissue repair in susceptible individuals
Increase; decreased
Right before diastole (filling begins)


37. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Around 70 (normal measured diastolic pressures); 9--
Minimal change disease
Integration of viral DNA into genome of host hepatocytes
Medullary


38. what defines hypoxemia?
SaO2 <92%
Bronchial dilation (bronchiectasis)
Acute gastric mucosal defects (superficial or full thickness)
P450 mitochondrial monooxygenase


39. What is contraindicated in toxic mega colon?
Varying; erythema nodosum is common
25; 25
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Octreotide


40. What is used to treat heparin toxicity?
Protamine sulfate
46 - 4N; 23 2N
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
IgE


41. what organ would an activating mutation in PRPP synthetase effect?
Common peroneal; bony fractures and compression; sciatic
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Joints d/t increased purine production and thus uric acid production
Drug induced interstitial nephritis


42. what receptors do first generation anti histamines block?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
8; 12


43. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Lateral; RV; RA; LV
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Because of vasodiation to skeletal muscles


44. name three pathological states that present with large tongues.
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
Covalent (between two cysteines)- allows protein to withstand denaturation
I is more benign and can present later in adulthood
Congenital hypothyroidism - downs - amyloidosis - acromegaly


45. What is medullary sponge kidney disease and how does it present? What does it lead to?
Medial part
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)
low in serum
chronic urticaria and allergic symptoms


46. What does prolonged PT indicated? aPTT? bleeding time?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
APP on chrom 21 (this is why downs more susceptible)
Extrinsic def; instrinsic def; platelet def
Headaches and facial flushing; vasodilation in meninges and skin


47. What are the acute effects of corticosteroids on the CBC?
Increase by 50% in urine osmolality
Closer to head; closer to diaphragm
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
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)


48. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Echinococcus granulosus; anaphylaxis
LT (LTD4 - E4 - C4) - and Ach
Around 70 (normal measured diastolic pressures); 9--
SSRI; erectile dysfunction


49. at one year of age - What are the social - fine motor - gross motor and language developments?
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
Initiation - pointing; pincer grasp; walking; mama/dada
manifestations - congenital (stretching of periventricular pyrimadal fibers)
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)


50. Metronidizaole does not cover...
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
gram positive organisms
women
Adeno