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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. Which nerve lies in close proximity to the inferior thyroid artery?
Recurrent larygneal
Single adenomatous ones
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
differentiate

2. in overweight individuals What is thought to contribute to insulin resistance?
Because of the low output from heart failure - they will have increased aldosterone levels
Amiloride - spironolactone - triamterene
Serum FFA and serum triglyceride levels
Chlorpheniramine and diphenhydramine

3. Where is aromatase used?
Relfex tachycardia; giving beta blockers
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Increase; decreased
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

4. non ceruloplasmin deposition - ceruloplasmin is...
low in serum
GI malignancies and Insulin resistance (acromegal for ex)
RER; copper
Fibrosis; macrophages

5. which antiarrythmic is associated with blue gray discoloration ?
Selective alpha 1 (increases SVR)
Mean greater than median greater than mode
Gluteus maximus; difficulty getting up from seated position and climbing chair
Amiadarone

6. there are mucus secreting cells in the bronchioles...
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Adductor
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
only up to bronchi

7. in B12 deficiency - what levels in blood rise very quickly and then drop?
Terminal bronchioles; small bronchi
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
IgE
Reticulocytes

8. which two drug types can cause orthostatic hypotension (think depression and BPH)?
Sarcoid
glycerol kinase
TCAs and prazosin
manifestations - congenital (stretching of periventricular pyrimadal fibers)

9. What does the severity of leprosy depend on?
Strength of cell mediated immune response
C3 decreased after 5-10 days; sulfonamides
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Increase; decreased

10. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
Headaches and facial flushing; vasodilation in meninges and skin
Chlorpheniramine and diphenhydramine
P53 mutation; DCC is also required for adenoma to carcinoma
Curlings ulcers

11. Where does lysyl oxidase act? What is the cofactor for that?
Increase lymphatic drainage!
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
In the extracellular space for collagen cross linking; zinc

12. what kind of drug is sertraline? What is a common side effect?
SSRI; erectile dysfunction
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)
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
MAC complex (C5b - C9 complement deficiency)

13. What is easiest way to treat nephrolithiasis?
CMV - HSV 1 - Candida
GI malignancies and Insulin resistance (acromegal for ex)
G to T in p53; HCC
Drink plenty of fluids

14. What does prolonged PT indicated? aPTT? bleeding time?
Extrinsic def; instrinsic def; platelet def
only up to bronchi
G to T in p53; HCC
Strength of cell mediated immune response

15. which two virus families have hemagluttinin on their surface?
Barium enema
Kallmans
Paramyxo and influenza
MAO inhibitors; wine and cheese

16. If a patient has higher levels of HbF - What does this mean?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Think Hb deformation diseases

17. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
chronic urticaria and allergic symptoms
Because of the low output from heart failure - they will have increased aldosterone levels
Phencyclidine (PCP)
Adeno

18. what murmur is enhanced by decreased blood flow to the heart?
GI malignancies and Insulin resistance (acromegal for ex)
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
8 (myc protein) with 2 - 14 - 22 (iG chains)
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

19. the rate of blood flow of which two circulations must equal each other at all times?
Lateral; RV; RA; LV
Pulmonic and systemic!
ATP binding (resets the myosin head to contract again for next binding)
Bronchogenic carcinoma

20. What is used to compare means? categorical outcomes?
T test; chi squared
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
indomethacin
I is more benign and can present later in adulthood

21. how does noise induced hearing loss occur?
Relfex tachycardia; giving beta blockers
Elastance
Trauma to stereociliated hair cells of the organ of corti
Elevated GGT and macrocytosis

22. what should you think of in 'smear of an oral ulcer base'?
Tzanck smear
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
25; 25

23. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Regular insulin (Not fast acting - regular better)
Excessive collagen formation during tissue repair in susceptible individuals
No (unlike adenomyosis); yes

24. What is the mcc of extrinsic allergic asthma?
Strength of cell mediated immune response
Because ACE blocks breakdown of bradykinin and hereditary angioedema patients have high levels of bradykinin; high levels of bradykinin - C3a - and C5a mediate edema by increasing vascular permeability and vasodilation
Inhaled animal dander allergens
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

25. What is contraindicated in toxic mega colon?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Relfex tachycardia; giving beta blockers
Chrom 8
indomethacin

26. What are the two coagulase negative staphylococci? How do you distinguish them?
Susceptible; soluble (unable to be cultured in bile)
Anterior circumflex (and axillary nerve)
OCPs - multiparity - breast feeding
S. saprophyticus - and s. epidermidis; novobiocin

27. why does liver dysfunction cause coagulation disorders?
Bronchial dilation (bronchiectasis)
Coagulation factors are made in the liver
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Intussusception

28. why should you not use ACE inhibitors with someone who had hereditary angioedema?
Because ACE blocks breakdown of bradykinin and hereditary angioedema patients have high levels of bradykinin; high levels of bradykinin - C3a - and C5a mediate edema by increasing vascular permeability and vasodilation
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Smoking
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

29. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
C3 decreased after 5-10 days; sulfonamides
Primary
On cardiac tissue and renal juxtaglomerular cells

30. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
Brief psychotic disorder; schizophreniform; schizophrenia
Decreases both
Bile salt accumulation in urine
Fat - fertile - forty - female

31. other than proteinuria - What can cause foamy froathy urine?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Bile salt accumulation in urine
Radial nerve damage
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

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

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33. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
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

34. when do ghon complexes form - primary or secondary TB?
Echinococcus granulosus; anaphylaxis
Primary
Well
MAO inhibitors; wine and cheese

35. What are some side effects seen in TCAs?
Pulmonic and systemic!
Susceptible; soluble (unable to be cultured in bile)
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

36. What is gardeners mydriasis? How is it treated?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

37. What is extraocular muscle weakness a common symptom of?
Myasthenia gravis
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Terminal bronchioles; small bronchi

38. What is hyaline arteriosclerosis usually a sign of ?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Diabetic microangiopathy
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
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

39. What does NF- KB do?
(urine PAH x urine flow rate)/plasma PAH
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Increases cytokine production
Serum FFA and serum triglyceride levels

40. What causes vertical diplopia? horizontal?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Trochlear nerve (IV); abducens nerve (VI)

41. Which is slower AV node or ventricular muscle?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
AV node slowest - to allow time for diastole
Prostate tumor and increased osteoclast activity

42. What can chronic vit A toxicity cause?
ATP binding (resets the myosin head to contract again for next binding)
Leukotriene precursor and does neutrophil chemotaxis
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Chorda tympani branch

43. which nerve is at risk when ligating the superior thyroid artery? Which is the only muscle this nerve innervates? what nerve innervates all the other laryngeal muscles?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Superior larygeal; cricothyroid; recurrent laryngeal
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
transcription activation/suppression

44. What is diagnostic (and possible therapeutic for intussusception)?
Terminal bronchioles; small bronchi
In ER of bile canaliculi
Barium enema
Minimal change disease

45. what immune deficiency causes recurrent neisseria infections?
MAC complex (C5b - C9 complement deficiency)
8 (myc protein) with 2 - 14 - 22 (iG chains)
The term used to describe decreased drug responsiveness with repeated administration
Pain reliever - reduces pain by locking substance P in the PNS

46. What is the precursor protein to beta amyloid and On what chromosome is it found?
No (unlike adenomyosis); yes
T test; chi squared
ATP binding (resets the myosin head to contract again for next binding)
APP on chrom 21 (this is why downs more susceptible)

47. other than mycobacterim wha other bacteria is acid fast?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Paramyxo and influenza
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Nocardia

48. What is the Na/Ca exchange used for?
Normal; low
Apocrine; eccrine
SVC and IVC; right below the aortic knob
To pump calcium out in cardiac myocytes so that relaxation occurs

49. which cells produce surfactant? which ones mediate gas exchange?
II; I (I more abundant)
Demargination of neutrophils from the vessel walls
In the extracellular space
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

50. What causes wrist drop?
Radial nerve damage
Ig A deficiency
E. coli
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)