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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. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
Hypo or hyper pigmentations; after tanning
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Tissue redistribution (out of plasma) rather than metabolism
Regular insulin (Not fast acting - regular better)

2. how does noise induced hearing loss occur?
Trauma to stereociliated hair cells of the organ of corti
Close but purkinje system to ensure contraction in a bottom up fashion
IgE
SVT; increases vagal tone; rectus abdominis

3. IL4 is used for isotypye switching to what?
Inhaled animal dander allergens
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
IgE
ANCA because of lack of Ig and C3 deposits on IF

4. SIADH patients have normal blood volume but...
Superior larygeal; cricothyroid; recurrent laryngeal
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
hyponatremia (aldosterone activation equilibrates body volume)
Recurrent larygneal

5. What is the primary histologic finding in patients with eczematous dermatitis?
CMV - HSV 1 - Candida
Spongiosis
Southern - western
Well trained athletes and children

6. How do you calculate RPF from urine PAH?
Abnormal closing of the urethral folds
When it invades the bm; carcinoma in situ
(urine PAH x urine flow rate)/plasma PAH
Varying; erythema nodosum is common

7. metabolism of 1 gram of protein produces How many calories? carb? fat?
4 - 4 - 9
S3 gallop; S2 to opening snap interval
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Abnormal closing of the urethral folds

8. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Initiation - pointing; pincer grasp; walking; mama/dada
gram positive organisms
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
E6 and E7 of HPV knock off p53 and Rb suppressor genes

9. Which nerve lies in close proximity to the inferior thyroid artery?
Southern - western
Recurrent larygneal
Atrial
Standing suddenly from supine position; valsalva maneuver

10. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Curlings ulcers
Integration of viral DNA into genome of host hepatocytes
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

11. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
CGD; t cell dysfxn (diGeorge)
Elastance
Leukotriene precursor and does neutrophil chemotaxis
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

12. What is omalizumab and What is it used for?
In the extracellular space
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Curlings ulcers
Increase lymphatic drainage!

13. Where does lysyl oxidase act? What is the cofactor for that?
Bile salt accumulation in urine
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
In the extracellular space for collagen cross linking; zinc
Measure of depth invasion (vertical!)

14. Where does the aorta lie in relation to the pulmonary artery in transposition of the great arteries (is this right to left or left to right shunt?)?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Rabies encephalitis from cave bats; rabies killed vaccines
Diabetic microangiopathy
Increase; decreased

15. What can long term leg cast wearing cause?
Syncope - angina - dyspnea (SAD)
Well trained athletes and children
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
Inhibits it

16. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Because of the low output from heart failure - they will have increased aldosterone levels
Ceftriaxone; azithromycin
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

17. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
Drink plenty of fluids
Mean greater than median greater than mode
11 aa polypeptide; pain NT in CNS and PNS
FGF and VEGF

18. What three pathogens cause infectious esophagitis in HIV positive patients?
Tibial
CMV - HSV 1 - Candida
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Proteasome inhibitor; treatment for MM and waldenstroms

19. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
Gluteus medius and minimus; positive trendelenberg
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
11 aa polypeptide; pain NT in CNS and PNS
RER; copper

20. non ceruloplasmin deposition - ceruloplasmin is...
In ER of bile canaliculi
Demargination of neutrophils from the vessel walls
low in serum
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

21. What is damaged in early syringomelia? later?
Circular - outside nucleus; transport proteins - rRNA - tRNA
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Chlorpheniramine and diphenhydramine

22. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Chorda tympani branch
Pulmonary hypertension

23. What is the preferred treatment for DKA?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Regular insulin (Not fast acting - regular better)
Recurrent larygneal

24. What is the sole neurologic manifestation of acute rheumatic fever?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Underestimation of gestational age
Sydenham chorea
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

25. What does the severity of leprosy depend on?
Aromatase deficiency in child
I is more benign and can present later in adulthood
Proteasome inhibitor; treatment for MM and waldenstroms
Strength of cell mediated immune response

26. What agonists reduce the gradient across the LV outflow tract?
Neisseria induced small cell vasculitis (including hands and soles)
Drink plenty of fluids
Selective alpha 1 (increases SVR)
Hyperkalemia; potassium sparing diuretics - potassium supplements

27. What does NF- KB do?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Around 70 (normal measured diastolic pressures); 9--
Increases cytokine production
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

28. What is suggestive of complete central DI?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Cluster
Increase by 50% in urine osmolality
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

29. sporadic colon cancer tend to arise From what type of polyps?
glycerol kinase
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
E. coli; staphylococcus saprophyticus
Single adenomatous ones

30. where are the two classical places that the ulnar nerve can be injured?

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31. Where does 90% of serotonin lie? What is this NT responsible?
GI tract; mood!
Increase by 50% in urine osmolality
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

32. which nucleus releases serotonin?
Raphe
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
E. coli
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

33. What are the three dopaminergic systems and What are they responsible for? disease?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Rabies encephalitis from cave bats; rabies killed vaccines
Regular insulin (Not fast acting - regular better)
hyponatremia (aldosterone activation equilibrates body volume)

34. What actions increase venous return?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Squatting - sitting - lying supine - passive leg raising
Retinitis; mononucleosis
women

35. What are the potassium sparing diuretics?
Minimal change disease
Normal; low
Amiloride - spironolactone - triamterene
ATP binding (resets the myosin head to contract again for next binding)

36. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
PDA open
P53 mutation; AD
Common peroneal; bony fractures and compression; sciatic
Chorda tympani branch

37. at one year of age - What are the social - fine motor - gross motor and language developments?
Initiation - pointing; pincer grasp; walking; mama/dada
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)
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Prevent phagocytosis

38. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Medial circumflex artery; avascular necrosis
PDA open
<1% - 55% - concentration dependent
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

39. What does p53 do? what chrom is it on?
Env genes (for getting into target cells)
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

40. What is epispadias caused by?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Faulty positioning of the genital tubercle
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

41. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
Drink plenty of fluids
Prepatellar
Fibrosis; macrophages
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

42. What are the lab findings in poststreptococcal GN?
Boiling - bleach - formalin - UV irradiation
Downs; regurgitant AV valves - ASDs
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
TCAs and prazosin

43. What is the mcc of elevated AFP leves in pregnancy>
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Underestimation of gestational age
Reiter syndrome; B27
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

44. What does extended consumption of appetite suppressants lead to?
Prepatellar
Faulty positioning of the genital tubercle
Pulmonary hypertension
Circular - outside nucleus; transport proteins - rRNA - tRNA

45. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
The term used to describe decreased drug responsiveness with repeated administration
Class I
MAC complex (C5b - C9 complement deficiency)
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

46. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
Bile soluble which means they are bile sensitive
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
4 - 4 - 9
Serum FFA and serum triglyceride levels

47. which cells produce surfactant? which ones mediate gas exchange?
Become beta pleated and then form neurofibrillary tangle!
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Ketone body production by preventing fatty acids into the mitochondria
II; I (I more abundant)

48. What does L/S stand for in fetal lung maturity? When does maturity occur?
MAC complex (C5b - C9 complement deficiency)
Integration of viral DNA into genome of host hepatocytes
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

49. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Closer to head; closer to diaphragm
Prepatellar
Sydenham chorea
Increase lymphatic drainage!

50. where are the vegetations on the valves of a libman sacks endocarditis?
Well
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Both sides
MAO inhibitors; wine and cheese