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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?
Anterior nares
Prevents hepatic VLDL production
Sudden loss of muscle tone without loss of consciousness; narcolepsy
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

2. which two virus families have hemagluttinin on their surface?
Barium enema
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Chorda tympani branch
Paramyxo and influenza

3. What is the cause of rapid plasma decay of thiopental?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Tissue redistribution (out of plasma) rather than metabolism
Fibronectin - laminin - collagen
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

4. What is the most common location of colonization of all s. aureus types?
Normal; low
Anterior nares
Trauma to stereociliated hair cells of the organ of corti
By vascular permeability and vasodilation

5. after a thrombus extraction - what serum enzyme shoots up and why?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Serum creatine kinase; reperfusion injury causes necrosis
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
Neisseria induced small cell vasculitis (including hands and soles)

6. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Bronchial dilation (bronchiectasis)
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Tibial

7. What causes release of myosin head from the actin filament?
ATP binding (resets the myosin head to contract again for next binding)
Ether and other organic solvents
Prevents hepatic VLDL production
SSRI

8. What is the mainstay treatment for acute mania?
Protamine sulfate
ANCA because of lack of Ig and C3 deposits on IF
C3 decreased after 5-10 days; sulfonamides
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

9. What can cause aortic regurg? What is the heart sound you hear?
Southern - western
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
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

10. What is the most common initital symptom of ADPKD? what else?
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
I is more benign and can present later in adulthood
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Leukotriene precursor and does neutrophil chemotaxis

11. which type of glands produce an initially odorless secretion but can become malodorous secondary to bacterial decompisition on the skin surface? which glands are present throughout the skin except on lips and glans penis?
Raphe
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Apocrine; eccrine
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

12. What agonists reduce the gradient across the LV outflow tract?
Increases
Trochlear nerve (IV); abducens nerve (VI)
Selective alpha 1 (increases SVR)
No and yes

13. What does NF- KB do?
T test; chi squared
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Thymic tumor
Increases cytokine production

14. Where is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
Hydrogen bonds dictate alpha or beta structure
Ether and other organic solvents
Highly negative resting potential
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

15. there are mucus secreting cells in the bronchioles...
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)
Increases cytokine production
only up to bronchi
11 aa polypeptide; pain NT in CNS and PNS

16. Metronidizaole does not cover...
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Pulmonic and systemic!
gram positive organisms
Right before diastole (filling begins)

17. 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?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

18. what happens to capacitance with age?
...
Single adenomatous ones
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Medial circumflex artery; avascular necrosis

19. What does hypocapnia cause in teh brain? What is hypocapnia?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Anti centromere; anti DNA topoisomerase
II; I (I more abundant)
Appetite suppressants

20. how does eos release MBP to kill protozoa etc?
Highly negative resting potential
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Think Hb deformation diseases
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

21. What is intussusception? how does ischemia and necrosis occur?
glycerol kinase
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
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Superior larygeal; cricothyroid; recurrent laryngeal

22. What are the skin presentation in sarcoid?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Varying; erythema nodosum is common
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
indomethacin

23. non ceruloplasmin deposition - ceruloplasmin is...
Sudden loss of muscle tone without loss of consciousness; narcolepsy
low in serum
Prevent phagocytosis
Sarcoid

24. What causes wrist drop?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Hydrogen bonds dictate alpha or beta structure
Radial nerve damage
E6 and E7 of HPV knock off p53 and Rb suppressor genes

25. in overweight individuals What is thought to contribute to insulin resistance?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Barium enema
Radial nerve damage
Serum FFA and serum triglyceride levels

26. What is the mutation type in thalassemias? what process is defective because of this?
Neisseria induced small cell vasculitis (including hands and soles)
Dihydropyridine sensitive Ca channels (L type)
4 - 4 - 9
Nonsense; mRNA processing

27. What is the fibrinogen level in patient with TTP- HUS? DIC?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Drink plenty of fluids
Normal; low
Serum creatine kinase; reperfusion injury causes necrosis

28. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
SVT; increases vagal tone; rectus abdominis
No

29. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Inhibits it
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
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

30. what nerve and artery course along the posterior aspect of the humerus?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Radial nerve and deep brachial artery
S3 gallop; S2 to opening snap interval

31. what hernia has a similar mechanism to hydrocele?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Reticulocytes
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

32. Which is slower AV node or ventricular muscle?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
To pump calcium out in cardiac myocytes so that relaxation occurs
AV node slowest - to allow time for diastole
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

33. what happens with LDL receptor density in statin therapy?
CGD; t cell dysfxn (diGeorge)
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Increases

34. What is an abortive viral infection?
Classical conditioning
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Retinitis; mononucleosis
Little effect on cell and no change

35. What are the two coagulase negative staphylococci? How do you distinguish them?
S. saprophyticus - and s. epidermidis; novobiocin
NF- KB; responsible for cytokine production
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Turners`

36. What is the mcc of extrinsic allergic asthma?
Inhaled animal dander allergens
Coagulation factors are made in the liver
T test; chi squared
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

37. What is the Na/Ca exchange used for?
To pump calcium out in cardiac myocytes so that relaxation occurs
HSV and VZV
In the extracellular space for collagen cross linking; zinc
P450 mitochondrial monooxygenase

38. What is the presentation of sever aortic stenosis?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Syncope - angina - dyspnea (SAD)
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Squatting - sitting - lying supine - passive leg raising

39. how does increased ICP result in curlings ulcers?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Vagus nerve stimulation
Neisseria induced small cell vasculitis (including hands and soles)
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

40. what protects the resting heart from arrhythmias?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Think Hb deformation diseases
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Highly negative resting potential

41. at one year of age - What are the social - fine motor - gross motor and language developments?
(urine PAH x urine flow rate)/plasma PAH
Initiation - pointing; pincer grasp; walking; mama/dada
Fibronectin - laminin - collagen
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

42. What are some of the permissive effects of cortisol?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Increases bronchial and vascular smooth muscle reactivity to catecholamines
LT (LTD4 - E4 - C4) - and Ach
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

43. h1 receptor anatagonists are not effective in treatment of asthma only for...
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
chronic urticaria and allergic symptoms
Downs; regurgitant AV valves - ASDs
Hypertension - edema - and proteinuria

44. 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?
chronic urticaria and allergic symptoms
Primary
Paramyxo and influenza
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)

45. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
Hyperkalemia; potassium sparing diuretics - potassium supplements
ZDV or AZT
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
RER; copper

46. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
Radial nerve and deep brachial artery
Echinococcus granulosus; anaphylaxis
Hypothyroidism
V fib; v. failure

47. What is the sole neurologic manifestation of acute rheumatic fever?
Little effect on cell and no change
Sydenham chorea
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Raphe

48. What does prolonged PT indicated? aPTT? bleeding time?
Extrinsic def; instrinsic def; platelet def
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Anti cholinergic effects of pupil dilation and lack of accomodation
LT (LTD4 - E4 - C4) - and Ach

49. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
8 (myc protein) with 2 - 14 - 22 (iG chains)
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Purkinje system; AV node
Curlings ulcers

50. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
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
Hydrogen bonds dictate alpha or beta structure
Sickle cell; G6PD