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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. 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?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
INTRApartum Abs (ampicillin/penicillin)
RR-1/RR
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

2. What is contraindicated in toxic mega colon?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Tibial
Faulty positioning of the genital tubercle

3. What is pickwickian syndrome? What are the lab findings?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Measles and M3 AML`

4. within the right atrium - What is the maximum pressure? left atrium?
Hyperkalemia; potassium sparing diuretics - potassium supplements
Permissive - sensitizes vasoconstrictive response from catecholamines - doesnt actually act on them but increases transcription of some genes that creates permissive effect (not additive or synergistic becuase cortisol alone doesnt have any effect on
8; 12
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

5. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Vancomycin
P53 mutation; AD
Susceptible; soluble (unable to be cultured in bile)
<1% - 55% - concentration dependent

6. What is the mc manifestation of CMV in HIV patient? immunocompetent?
Acute gastric mucosal defects (superficial or full thickness)
Retinitis; mononucleosis
Right heart failure
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

7. What are the two growth factors associated with angiogenesis?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
FGF and VEGF
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

8. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
Syringomelia
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Skin flushing and warmth; prostaglandins; give with aspirin
Trochlear nerve (IV); abducens nerve (VI)

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

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10. biotin is used By what in tissues responsible for gluconeogenesis
transcription activation/suppression
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
As a CO2 carrier with the carboxylase enzyme
Phencyclidine (PCP)

11. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
only up to bronchi
transcription activation/suppression
Superior larygeal; cricothyroid; recurrent laryngeal
Cluster

12. What can cause virilization of a mother during pregnancy?
Spongiosis
Faulty positioning of the genital tubercle
Aromatase deficiency in child
IgE

13. What is a keloid?
Anti cholinergic effects of pupil dilation and lack of accomodation
Excessive collagen formation during tissue repair in susceptible individuals
Drink plenty of fluids
Spongiosis

14. What are the two mcc of focal brain lesions in HIV positive patients?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Adeno
Thymic tumor
Sickle cell; G6PD

15. What is Tzanck smear used to detect?
The time interval between S2 and OS- the shorter the interval - the more intense
Sarcoid
No
HSV and VZV

16. who bleed more DIC or TTP- HUS patients?
DIC; TTP- HUS dont bleed that much
Underestimation of gestational age
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Increased reticulocytes

17. What is mcc of death pre hospital phase of MI? in hospital phase?
Fibrosis; macrophages
V fib; v. failure
Hyperkalemia; potassium sparing diuretics - potassium supplements
Headaches and facial flushing; vasodilation in meninges and skin

18. What is a cord factor and Which bugs have it? How do they appear on culture?
Serum FFA and serum triglyceride levels
Because gamma chains replace beta chains and then gamma chain formation wanes
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

19. If a patient has higher levels of HbF - What does this mean?
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)
Think Hb deformation diseases
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
SSRI

20. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
Increase; decreased
Paramyxo and influenza
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Sudden loss of muscle tone without loss of consciousness; narcolepsy

21. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Valproate
Acute interstitial nephritis
Around 70 (normal measured diastolic pressures); 9--
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

22. What is the most common neurologic complication of VZV reactivation?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
LT (LTD4 - E4 - C4) - and Ach
Skin flushing and warmth; prostaglandins; give with aspirin
Localized dermatologic pain that persists for more than one month after zoster eruption

23. why does neutrophila occur with corticosteroids?
Amiadarone
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Demargination of neutrophils from the vessel walls
Turbulence

24. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
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
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Increase by 50% in urine osmolality
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

25. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Chorda tympani branch
Reticulocytes
Extrinsic def; instrinsic def; platelet def
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

26. What does sustained hand grip do to the C/V system?
DIC; TTP- HUS dont bleed that much
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Radial nerve and deep brachial artery
Headaches and facial flushing; vasodilation in meninges and skin

27. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
liver specific
SaO2 <92%
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Brief psychotic disorder; schizophreniform; schizophrenia

28. What is medullary sponge kidney disease and how does it present? What does it lead to?
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)
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Initiation - pointing; pincer grasp; walking; mama/dada
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

29. what happens to sperm count and semineferous tubules in patient with cryptoorchidism? hormonal function? why do they need to be surgically descended?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Folic acid treatment!
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
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. What is a primary HSV 1 infection like?
I is more benign and can present later in adulthood
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Superior larygeal; cricothyroid; recurrent laryngeal

31. what immune deficiency causes recurrent neisseria infections?
T test; chi squared
Ig A deficiency
Pulmonary hypertension
MAC complex (C5b - C9 complement deficiency)

32. What type of disease has selective proteinuria? What is found in urine? What is not?
LT (LTD4 - E4 - C4) - and Ach
46 - 4N; 23 2N
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

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?
Prostate tumor and increased osteoclast activity
Chorda tympani branch
Duration and extent of disease
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

34. Which is faster purkinje system or atrial muscle?
...
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Chlorpheniramine and diphenhydramine
Close but purkinje system to ensure contraction in a bottom up fashion

35. what commonly happens in GI in response to acute physiologic stress?
INTRApartum Abs (ampicillin/penicillin)
Acute gastric mucosal defects (superficial or full thickness)
Susceptible; soluble (unable to be cultured in bile)
Hydrogen bonds dictate alpha or beta structure

36. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
Chlorpheniramine and diphenhydramine
HSV ( also in utero: chlymadia - neisseria - group B strep)
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)
RBC mass; epo levels (secondary has high)

37. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
High potassium conductance and some sodium conductance
Bronchial dilation (bronchiectasis)
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)
In ER of bile canaliculi

38. When is acid phosphatase elevated (Name two times)?
Little effect on cell and no change
Prostate tumor and increased osteoclast activity
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
...

39. How do you treat gonococcal infection? chlymadia?
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Ceftriaxone; azithromycin
Acute gastric mucosal defects (superficial or full thickness)
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

40. What is the sole neurologic manifestation of acute rheumatic fever?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Sydenham chorea
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

41. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
indomethacin
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

42. PDAs are often asymptomatic. How do you treat?
indomethacin
MAC complex (C5b - C9 complement deficiency)
On cardiac tissue and renal juxtaglomerular cells
liver specific

43. at 2 years of age - What are the social - fine motor - gross motor and language developments?
Drug induced interstitial nephritis
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
ANCA because of lack of Ig and C3 deposits on IF
Apocrine; eccrine

44. What is the presentation of angioedema? Where is most commonly affected?
46 - 4N; 23 2N
Increases cytokine production
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
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

45. What three factors effect total oxygen content of blood?
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
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Hypo or hyper pigmentations; after tanning

46. What three pathogens cause infectious esophagitis in HIV positive patients?
Tissue redistribution (out of plasma) rather than metabolism
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Bile soluble which means they are bile sensitive
CMV - HSV 1 - Candida

47. erythema nodosum - elevated ACE - scattered granulomas - arthralgias - hilar lymphadenoapthy are indicative of what?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Drug induced interstitial nephritis
Sarcoid
gram positive organisms

48. how much percent of sodium is excreted? urea? glucose?
Myasthenia gravis
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
<1% - 55% - concentration dependent
11

49. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
Strength of cell mediated immune response
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
women
Brief psychotic disorder; schizophreniform; schizophrenia

50. What are the potassium sparing diuretics?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Normally close to systolic
Amiloride - spironolactone - triamterene
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration