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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 locations of UC increase the risk of Colon cancer?
RBF= PAH clearance/(1- hematocrit)
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
Coagulation factors are made in the liver

2. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
Secretin stimulates the exocrine pancrease; S enteroendocrine cells in duodenal mucosa in response to acid secrete secretin (HCL is most potent stimulus for secretin release)
Tissue redistribution (out of plasma) rather than metabolism
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Gluteus maximus; difficulty getting up from seated position and climbing chair

3. What are two indicators of chronic alcohol consumption?
Well
Insulin like growth factor 1 (just another name)
Syncope - angina - dyspnea (SAD)
Elevated GGT and macrocytosis

4. What does VIP do to gastric acid secretion?
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
SaO2 <92%
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Inhibits it

5. where exactly is ACE expressed in the lungs? What type of enzyme is it?
Insulin like growth factor 1 (just another name)
Vascular endothelium; protease
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Amiadarone

6. What is intussusception? how does ischemia and necrosis occur?
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
When it invades the bm; carcinoma in situ
Anti centromere; anti DNA topoisomerase
S. saprophyticus - and s. epidermidis; novobiocin

7. What do you treat s. epidermidis with?
Sickle cell; G6PD
Vancomycin
ZDV or AZT
Turbulence

8. What are examples of action that decrease venous return to the heart?
Proteasome inhibitor; treatment for MM and waldenstroms
PDA open
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Standing suddenly from supine position; valsalva maneuver

9. What is the mcc of extrinsic allergic asthma?
Inhaled animal dander allergens
Skin flushing and warmth; prostaglandins; give with aspirin
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Congenital hypothyroidism - downs - amyloidosis - acromegaly

10. 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?
APP on chrom 21 (this is why downs more susceptible)
Because of vasodiation to skeletal muscles
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

11. 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?
Not lined by epithelium
Pulmonic and systemic!
Common peroneal; bony fractures and compression; sciatic
Fat - fertile - forty - female

12. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
MAC complex (C5b - C9 complement deficiency)
facultative intracellular
Elevated GGT and macrocytosis
Brief psychotic disorder; schizophreniform; schizophrenia

13. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
Bronchogenic carcinoma
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Minimal change disease
MAO inhibitors; wine and cheese

14. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
Anterior nares
Kallmans
Sickle cell; G6PD
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

15. What does p53 do? what chrom is it on?
CMV - HSV 1 - Candida
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
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
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

16. What are some side effects seen in TCAs?
...
Increase in permeability of two ions with equal and opposite equilibrium potentials
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
SS +rNA

17. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Relfex tachycardia; giving beta blockers
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

18. what enzyme converts procarcinogens into carcinogens?
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
Dissolved in plasma and attached to Hgb
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
P450 mitochondrial monooxygenase

19. which has better side effect profile - SSRI or TCA?
SSRI
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
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

20. How do bradykinin - C3a and C5a cause edema?
By vascular permeability and vasodilation
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Lateral; RV; RA; LV
Echinococcus granulosus; anaphylaxis

21. ___________ is liver specific
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Single adenomatous ones
glycerol kinase

22. What test would be best to determine if a gene is being transcribed? translated?
Raphe
Adductor
Southern - western
Because of the low output from heart failure - they will have increased aldosterone levels

23. What does prolonged PT indicated? aPTT? bleeding time?
Tibial
Extrinsic def; instrinsic def; platelet def
Syncope - angina - dyspnea (SAD)
Dihydropyridine sensitive Ca channels (L type)

24. What is diagnostic (and possible therapeutic for intussusception)?
Barium enema
INTRApartum Abs (ampicillin/penicillin)
8; 12
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

25. What can cause aortic regurg? What is the heart sound you hear?
200-500
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Become beta pleated and then form neurofibrillary tangle!
Think Hb deformation diseases

26. which two drug types can cause orthostatic hypotension (think depression and BPH)?
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
TCAs and prazosin
Because of the low output from heart failure - they will have increased aldosterone levels
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

27. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Ketone body production by preventing fatty acids into the mitochondria
Bile salt accumulation in urine

28. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Hyperkalemia; potassium sparing diuretics - potassium supplements
Vascular endothelium; protease
Fibrosis; macrophages
Gluteus medius and minimus; positive trendelenberg

29. what makes bruits?
Turbulence
Covalent (between two cysteines)- allows protein to withstand denaturation
Turners`
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

30. are there signs of inflammation in avascular necrosis? then How do you diagnose?
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
SVT; increases vagal tone; rectus abdominis
No; MRI
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

31. Where is the base of the heart? apex?
Vascular endothelium; protease
NF- KB; responsible for cytokine production
Closer to head; closer to diaphragm
ANCA because of lack of Ig and C3 deposits on IF

32. what kind of drug is sertraline? What is a common side effect?
Increase; decreased
SSRI; erectile dysfunction
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Pan colitis and right sided colitis (more than left sided and proctitis)

33. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
transcription activation/suppression
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
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
Chlorpheniramine and diphenhydramine

34. What is acanthosis nigricans associated with?
RER; RER
GI malignancies and Insulin resistance (acromegal for ex)
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Acute gastric mucosal defects (superficial or full thickness)

35. how does noise induced hearing loss occur?
Trauma to stereociliated hair cells of the organ of corti
Appetite suppressants
Drug induced interstitial nephritis
Selective alpha 1 (increases SVR)

36. What is used to compare means? categorical outcomes?
Serum FFA and serum triglyceride levels
Mean greater than median greater than mode
T test; chi squared
Underestimation of gestational age

37. why does neutrophila occur with corticosteroids?
GI tract; mood!
Adeno
Demargination of neutrophils from the vessel walls
AV node slowest - to allow time for diastole

38. who bleed more DIC or TTP- HUS patients?
Syncope - angina - dyspnea (SAD)
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
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
DIC; TTP- HUS dont bleed that much

39. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Because of vasodiation to skeletal muscles
TSh (in testicular tumors can cause hyperthyroidism)
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
MAC complex (C5b - C9 complement deficiency)

40. What is the triad seen in pre eclampsia?
Diabetic microangiopathy
Adeno
Hypertension - edema - and proteinuria
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

41. What is the preferred treatment for DKA?
Trauma to stereociliated hair cells of the organ of corti
Regular insulin (Not fast acting - regular better)
No; MRI
Boiling - bleach - formalin - UV irradiation

42. carnitine deficiency impairs production of What and how?
Increases cytokine production
Normally close to systolic
Hypo or hyper pigmentations; after tanning
Ketone body production by preventing fatty acids into the mitochondria

43. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Reiter syndrome; B27
No; yes
Regular insulin (Not fast acting - regular better)
Skin flushing and warmth; prostaglandins; give with aspirin

44. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
MAO inhibitors; wine and cheese
Anti cholinergic effects of pupil dilation and lack of accomodation
Increase lymphatic drainage!
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

45. what happens to sperm count and semineferous tubules in patient with cryptoorchidism? hormonal function? why do they need to be surgically descended?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
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
11 aa polypeptide; pain NT in CNS and PNS

46. how much percent of sodium is excreted? urea? glucose?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
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
only up to bronchi
<1% - 55% - concentration dependent

47. what vessel would a fracture to the neck of the of the humerus damage?
transcription activation/suppression
Anterior circumflex (and axillary nerve)
Increase by 50% in urine osmolality
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

48. 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)
Highly negative resting potential
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
As a CO2 carrier with the carboxylase enzyme

49. what bursa is affected when on knees like a maid/gardner?
Prepatellar
Pan colitis and right sided colitis (more than left sided and proctitis)
CMV - HSV 1 - Candida
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

50. what virus causes pharyngoconjuctival fever?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Adeno
IgE
SVC and IVC; right below the aortic knob