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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. Where is aromatase used?
Headaches and facial flushing; vasodilation in meninges and skin
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Coagulation factors are made in the liver
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

2. Which is faster atrial muscle or ventricular muscle?
Atrial
transcription activation/suppression
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Vertical diplopia

3. What does the severity of leprosy depend on?
CMV - HSV 1 - Candida
Sudden loss of muscle tone without loss of consciousness; narcolepsy
In ER of bile canaliculi
Strength of cell mediated immune response

4. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Nonsense; mRNA processing
Relfex tachycardia; giving beta blockers
Protamine sulfate

5. What does the tuberoinfundibular pathway connect? What is it responsible for?
Vancomycin
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Increase by 50% in urine osmolality

6. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Little effect on cell and no change
Mean greater than median greater than mode
In ER of bile canaliculi

7. What actions increase venous return?
Squatting - sitting - lying supine - passive leg raising
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
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

8. within the right ventricle - What are maximum pressures? the pulm arter?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
glycerol kinase
When it invades the bm; carcinoma in situ
25; 25

9. What is a keloid?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Excessive collagen formation during tissue repair in susceptible individuals
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

10. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
Hereditary angioedema; ACE inhibitors
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Curlings ulcers
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

11. What is capsaicin? Where does it work?
Another type of aldosterone antagonist (like spironolactone)
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)
Pain reliever - reduces pain by locking substance P in the PNS
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

12. What is hypospadias caused by?
Large stroke volumes with ventricular contraction; aortic regurg
Initiation - pointing; pincer grasp; walking; mama/dada
Abnormal closing of the urethral folds
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

13. What is omalizumab and What is it used for?
Medial circumflex artery; avascular necrosis
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)
Closer to head; closer to diaphragm
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

14. what vessel would a fracture to the neck of the of the humerus damage?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Anterior circumflex (and axillary nerve)
Hypertension - edema - and proteinuria
Lateral; RV; RA; LV

15. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Echinococcus granulosus; anaphylaxis
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
Curlings ulcers

16. What is mcc of death pre hospital phase of MI? in hospital phase?
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
V fib; v. failure
Syncope - angina - dyspnea (SAD)
RBC mass; epo levels (secondary has high)

17. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
INTRApartum Abs (ampicillin/penicillin)
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Close but purkinje system to ensure contraction in a bottom up fashion

18. What is used to treat heparin toxicity?
Protamine sulfate
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Brief psychotic disorder; schizophreniform; schizophrenia
Radial nerve damage

19. which cells produce surfactant? which ones mediate gas exchange?
Gluteus medius and minimus; positive trendelenberg
Anterior circumflex (and axillary nerve)
II; I (I more abundant)
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

20. metabolism of 1 gram of protein produces How many calories? carb? fat?
Covalent (between two cysteines)- allows protein to withstand denaturation
4 - 4 - 9
11
SVC and IVC; right below the aortic knob

21. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
Excessive collagen formation during tissue repair in susceptible individuals
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Vancomycin; histamine mediated

22. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
TCAs and prazosin
P450 mitochondrial monooxygenase
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
S. aureus

23. What does NF- KB do?
Adductor
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Increases cytokine production
facultative intracellular

24. What causes the blurry vision side effects in first generation anti histamines?
DIC; TTP- HUS dont bleed that much
...
Anti cholinergic effects of pupil dilation and lack of accomodation
Serum creatine kinase; reperfusion injury causes necrosis

25. What is suggestive of complete central DI?
Headaches and facial flushing; vasodilation in meninges and skin
Increase by 50% in urine osmolality
Atrial
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

26. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
Hyperkalemia; potassium sparing diuretics - potassium supplements
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Reiter syndrome; B27
C3 decreased after 5-10 days; sulfonamides

27. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
V fib; v. failure
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
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
transcription activation/suppression

28. what bursa is affected when on knees like a maid/gardner?
Medullary
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Prepatellar
Trochlear nerve (IV); abducens nerve (VI)

29. In what view of CXR is anterior part of heart best seen? anterior part of heart is formed by?right border of heart is formed by? left border?
SVT; increases vagal tone; rectus abdominis
Lateral; RV; RA; LV
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Octreotide

30. How do left sided colon adenocarcinomas present? right sided?
11 aa polypeptide; pain NT in CNS and PNS
Obstruction because they infiltrate the intestinal wall and encircle causing decrease in size of lumen - constipation - abdominal distension - abdominal pain - changes in stool caliber; right sided are often exophytic masses iron def anemia and syste
Bronchial dilation (bronchiectasis)
Bile salt accumulation in urine

31. what marker should be followed in a patient with cirrhosis?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Underestimation of gestational age

32. What is medullary sponge kidney disease and how does it present? What does it lead to?
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
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)
Think Hb deformation diseases
Common peroneal; bony fractures and compression; sciatic

33. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Chorda tympani branch
Acute interstitial nephritis
SVC and IVC; right below the aortic knob

34. within the right atrium - What is the maximum pressure? left atrium?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Ceftriaxone; azithromycin
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
8; 12

35. why are pregnant predisposed to cholelithiasis?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Pan colitis and right sided colitis (more than left sided and proctitis)
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
glycerol kinase

36. What are the first generation anti histamines?
SVT; increases vagal tone; rectus abdominis
Chlorpheniramine and diphenhydramine
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Vagus nerve stimulation

37. what drugs causes the red man syndrome? how does it occur?
Prevents hepatic VLDL production
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Decreases both
Vancomycin; histamine mediated

38. IL4 is used for isotypye switching to what?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Susceptible; soluble (unable to be cultured in bile)
IgE
Intussusception

39. What can long term leg cast wearing cause?
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
Medial part
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
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

40. What can cause aortic regurg? What is the heart sound you hear?
In the extracellular space for collagen cross linking; zinc
Thymic tumor
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Boiling - bleach - formalin - UV irradiation

41. after a thrombus extraction - what serum enzyme shoots up and why?
GI tract; mood!
Increases
Serum creatine kinase; reperfusion injury causes necrosis
Prepatellar

42. what immune deficiency causes recurrent neisseria infections?
Increase by 50% in urine osmolality
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Well
MAC complex (C5b - C9 complement deficiency)

43. what makes bruits?
Turbulence
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Insulin like growth factor 1 (just another name)
I is more benign and can present later in adulthood

44. What are the three dopaminergic systems and What are they responsible for? disease?
Myasthenia gravis
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Serum creatine kinase; reperfusion injury causes necrosis

45. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
Turners`
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Valproate

46. What are the acute effects of corticosteroids on the CBC?
Proteasome inhibitor; treatment for MM and waldenstroms
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

47. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
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)
Relfex tachycardia; giving beta blockers
Appetite suppressants
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

48. what locations of UC increase the risk of Colon cancer?
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)
Protamine sulfate
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Pan colitis and right sided colitis (more than left sided and proctitis)

49. What is the preferred treatment for DKA?
Headaches and facial flushing; vasodilation in meninges and skin
Dihydropyridine sensitive Ca channels (L type)
women
Regular insulin (Not fast acting - regular better)

50. why does neutrophila occur with corticosteroids?
Demargination of neutrophils from the vessel walls
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
differentiate
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased