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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 is the presentation of angioedema? Where is most commonly affected?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
women
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

2. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Drug induced interstitial nephritis
AV node slowest - to allow time for diastole
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

3. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Bronchogenic carcinoma
only up to bronchi
Medullary
Atrial

4. What is the most common neurologic complication of VZV reactivation?
Pain reliever - reduces pain by locking substance P in the PNS
Nocardia
Little effect on cell and no change
Localized dermatologic pain that persists for more than one month after zoster eruption

5. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
E. coli; staphylococcus saprophyticus
Fibronectin - laminin - collagen
Both sides
Increase in permeability of two ions with equal and opposite equilibrium potentials

6. What is subacute sclerosisng encephalitis caused by?
Barium enema
Echinococcus granulosus; anaphylaxis
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
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

7. what marker should be followed in a patient with cirrhosis?
Integration of viral DNA into genome of host hepatocytes
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

8. What is the most important prognostic indicator in patients with malignant melanoma?
Medial circumflex artery; avascular necrosis
Measure of depth invasion (vertical!)
Large stroke volumes with ventricular contraction; aortic regurg
Terminal bronchioles; small bronchi

9. Metronidizaole does not cover...
Curlings ulcers
gram positive organisms
Because of vasodiation to skeletal muscles
Reticulocytes

10. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
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
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Sickle cell; G6PD
APP on chrom 21 (this is why downs more susceptible)

11. What is used to compare means? categorical outcomes?
T test; chi squared
The term used to describe decreased drug responsiveness with repeated administration
No only for prophylaxis (even for treating staphylococcal endocarditis its as multi drug); this is to prevent drug resistance from spontaneous mutations by DNA dependent RNA polymerase
frameshift mutations (missense is substitution)

12. Where does conjugation of bilirubin take place?
Vascular endothelium; protease
Tissue redistribution (out of plasma) rather than metabolism
ANCA because of lack of Ig and C3 deposits on IF
In ER of bile canaliculi

13. which nerve in the lower leg is easily injured and causes foot drop ? What are common causes? From what nerve does it branch off or?
Integration of viral DNA into genome of host hepatocytes
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Common peroneal; bony fractures and compression; sciatic

14. What is the sole neurologic manifestation of acute rheumatic fever?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Sydenham chorea
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Well

15. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Hereditary angioedema; ACE inhibitors
Covalent (between two cysteines)- allows protein to withstand denaturation

16. How is dobutamine better than dopamine?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Demargination of neutrophils from the vessel walls
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
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

17. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
RER; copper
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Valproate
Cluster

18. what protects the resting heart from arrhythmias?
Highly negative resting potential
Large stroke volumes with ventricular contraction; aortic regurg
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Well trained athletes and children

19. What is an abortive viral infection?
Well
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Little effect on cell and no change
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

20. a patient fearing all white coats is a phenomenon of what?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Drink plenty of fluids
Classical conditioning
Vertical diplopia

21. Acyl coA synthetase is not...
Duration and extent of disease
NF- KB; responsible for cytokine production
liver specific
Radial nerve and deep brachial artery

22. neisseria are...
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
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
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
facultative intracellular

23. What is the most common cause of pyelonephritis in both adults and childre?
E. coli
Downs; regurgitant AV valves - ASDs
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Ceftriaxone; azithromycin

24. What antibodies are present in CREST? What is the most specific?
Anti centromere; anti DNA topoisomerase
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

25. What is intussusception? how does ischemia and necrosis occur?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
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
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

26. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
GI malignancies and Insulin resistance (acromegal for ex)
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Vancomycin
Susceptible; soluble (unable to be cultured in bile)

27. how can HAV be inactivated?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Boiling - bleach - formalin - UV irradiation
GI tract; mood!
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

28. What is the diagnosis in delayed puberty plus anosmia?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
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
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Kallmans

29. What are the long term consequences of hydrocephalus?
E. coli
Raphe
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Anti cholinergic effects of pupil dilation and lack of accomodation

30. How can renal blood flow be calculated from RPF?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Prepatellar
Radial nerve damage
RBF= PAH clearance/(1- hematocrit)

31. 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?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
hyponatremia (aldosterone activation equilibrates body volume)

32. at three years of age What are social - fine motor - gross motor and language developments?
Acute interstitial nephritis
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
hyponatremia (aldosterone activation equilibrates body volume)

33. What is a keloid?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Excessive collagen formation during tissue repair in susceptible individuals
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Tzanck smear

34. where are the vegetations on the valves of a libman sacks endocarditis?
Both sides
MAC complex (C5b - C9 complement deficiency)
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Recurrent larygneal

35. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Insulin like growth factor 1 (just another name)
Because of vasodiation to skeletal muscles

36. in the LV and aorta - What are the pressures?
Sarcoid
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Normally close to systolic
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

37. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
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
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Dissolved in plasma and attached to Hgb

38. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
MAO inhibitors; wine and cheese
On cardiac tissue and renal juxtaglomerular cells
Hyperkalemia; potassium sparing diuretics - potassium supplements
Both sides

39. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Susceptible; soluble (unable to be cultured in bile)
frameshift mutations (missense is substitution)
Varying; erythema nodosum is common

40. What does Rb protein do? what chrom is it on?
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)
Intussusception
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

41. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
No; yes
GI tract; mood!
Gluteus maximus; difficulty getting up from seated position and climbing chair
Bile soluble which means they are bile sensitive

42. how does neisseria cause a petechial rash?
Neisseria induced small cell vasculitis (including hands and soles)
HSV ( also in utero: chlymadia - neisseria - group B strep)
T test; chi squared
Increased reticulocytes

43. What does NF- KB do?
Hexokinase
Neisseria induced small cell vasculitis (including hands and soles)
Inhaled animal dander allergens
Increases cytokine production

44. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
High potassium conductance and some sodium conductance

45. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
Think Hb deformation diseases
Large stroke volumes with ventricular contraction; aortic regurg
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

46. there are mucus secreting cells in the bronchioles...
Downs; regurgitant AV valves - ASDs
Class I
only up to bronchi
Anterior nares

47. What is mcc of death pre hospital phase of MI? in hospital phase?
Relfex tachycardia; giving beta blockers
V fib; v. failure
Anti centromere; anti DNA topoisomerase
Spongiosis

48. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
Ig A deficiency
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Measure of depth invasion (vertical!)
TSh (in testicular tumors can cause hyperthyroidism)

49. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
46 - 4N; 23 2N
Large stroke volumes with ventricular contraction; aortic regurg
transcription activation/suppression

50. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Bile soluble which means they are bile sensitive
HSV ( also in utero: chlymadia - neisseria - group B strep)
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Curlings ulcers