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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. there are mucus secreting cells in the bronchioles...
P53 mutation; AD
Pulmonic and systemic!
only up to bronchi
Biphosphonate

2. What is extraocular muscle weakness a common symptom of?
Headaches and facial flushing; vasodilation in meninges and skin
Myasthenia gravis
Because gamma chains replace beta chains and then gamma chain formation wanes
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

3. neisseria are...
Selective alpha 1 (increases SVR)
TCAs and prazosin
facultative intracellular
SVC and IVC; right below the aortic knob

4. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Rabies encephalitis from cave bats; rabies killed vaccines
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Hypo or hyper pigmentations; after tanning
Gluteus medius and minimus; positive trendelenberg

5. what hernia has a similar mechanism to hydrocele?
Hypertension - edema - and proteinuria
OCPs - multiparity - breast feeding
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Medial circumflex artery; avascular necrosis

6. 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?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Common peroneal; bony fractures and compression; sciatic
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Radial nerve and deep brachial artery

7. How do bradykinin - C3a and C5a cause edema?
differentiate
By vascular permeability and vasodilation
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Right heart failure

8. IL4 is used for isotypye switching to what?
Vertical diplopia
Paramyxo and influenza
Drug induced interstitial nephritis
IgE

9. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
Bile soluble which means they are bile sensitive
Kallmans
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Purkinje system; AV node

10. sporadic colon cancer tend to arise From what type of polyps?
Localized dermatologic pain that persists for more than one month after zoster eruption
MAC complex (C5b - C9 complement deficiency)
Single adenomatous ones
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

11. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Purkinje system; AV node
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

12. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Extrinsic def; instrinsic def; platelet def
Increases cytokine production
Measure of depth invasion (vertical!)
Rabies encephalitis from cave bats; rabies killed vaccines

13. What actions increase venous return?
Because gamma chains replace beta chains and then gamma chain formation wanes
Squatting - sitting - lying supine - passive leg raising
Turners`
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

14. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Large stroke volumes with ventricular contraction; aortic regurg
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
CGD; t cell dysfxn (diGeorge)

15. What are the lab findings in poststreptococcal GN?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Hyperkalemia; potassium sparing diuretics - potassium supplements
Brief psychotic disorder; schizophreniform; schizophrenia
Common peroneal; bony fractures and compression; sciatic

16. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
Radial nerve damage
differentiate
Increase lymphatic drainage!
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

17. How do you treat gonococcal infection? chlymadia?
Raphe
Elevated GGT and macrocytosis
Myasthenia gravis
Ceftriaxone; azithromycin

18. What do you treat s. epidermidis with?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Vancomycin
Syncope - angina - dyspnea (SAD)
Elastance

19. What is the primary histologic finding in patients with eczematous dermatitis?
Spongiosis
Appetite suppressants
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Retinitis; mononucleosis

20. What is suggestive of complete central DI?
Trauma to stereociliated hair cells of the organ of corti
Increase by 50% in urine osmolality
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
II; I (I more abundant)

21. Which nerve lies in close proximity to the inferior thyroid artery?
Recurrent larygneal
APP on chrom 21 (this is why downs more susceptible)
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
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

22. if there are keratin swirls does that mean well or poorly differentiated?
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
Well
Become beta pleated and then form neurofibrillary tangle!
Because gamma chains replace beta chains and then gamma chain formation wanes

23. What is somatomedin C?
Normal; low
Insulin like growth factor 1 (just another name)
E. coli
Vancomycin; histamine mediated

24. What is diagnostic (and possible therapeutic for intussusception)?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
On cardiac tissue and renal juxtaglomerular cells
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Barium enema

25. What are two indicators of chronic alcohol consumption?
Elevated GGT and macrocytosis
Skin flushing and warmth; prostaglandins; give with aspirin
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

26. What are the skin presentation in sarcoid?
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Varying; erythema nodosum is common
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Reticulocytes

27. Acyl coA synthetase is not...
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
liver specific
Increases bronchial and vascular smooth muscle reactivity to catecholamines
DIC; TTP- HUS dont bleed that much

28. why are pregnant predisposed to cholelithiasis?
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
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
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
SSRI

29. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Medial circumflex artery; avascular necrosis
Protamine sulfate
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

30. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
By vascular permeability and vasodilation
Vancomycin
Closer to head; closer to diaphragm

31. what marker should be followed in a patient with cirrhosis?
Bronchial dilation (bronchiectasis)
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Relfex tachycardia; giving beta blockers
Sudden loss of muscle tone without loss of consciousness; narcolepsy

32. What is the immune deficinecy seen in ataxia telangactasia?
S. aureus
PDA open
Ig A deficiency
Relfex tachycardia; giving beta blockers

33. which two virus families have hemagluttinin on their surface?
Syncope - angina - dyspnea (SAD)
In ER of bile canaliculi
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Paramyxo and influenza

34. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Valproate
Tzanck smear
11 aa polypeptide; pain NT in CNS and PNS

35. What is subacute sclerosisng encephalitis caused by?
Sickle cell; G6PD
Folic acid treatment!
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
When it invades the bm; carcinoma in situ

36. what has the greatest effect on prognosis when treating c. diptheriae?
V fib; v. failure
Serum creatine kinase; reperfusion injury causes necrosis
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

37. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
No; yes
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

38. what organ would an activating mutation in PRPP synthetase effect?
Joints d/t increased purine production and thus uric acid production
Trauma to stereociliated hair cells of the organ of corti
Anti - apoptotic (prevents going into apoptosis)- 18; 14
FGF and VEGF

39. Where is the base of the heart? apex?
Integration of viral DNA into genome of host hepatocytes
Closer to head; closer to diaphragm
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Drug induced interstitial nephritis

40. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
RER; RER
Chorda tympani branch
ANCA because of lack of Ig and C3 deposits on IF
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

41. What effects does cortisol have on catecholamines?
SaO2 <92%
Medial circumflex artery; avascular necrosis
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
SSRI

42. What is 5- HETE and What does it do?
Terminal bronchioles; small bronchi
Highly negative resting potential
Leukotriene precursor and does neutrophil chemotaxis
ANCA because of lack of Ig and C3 deposits on IF

43. which nerve provides innervation for plantar flexion and inversion?
Tibial
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Anterior nares
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

44. other than proteinuria - What can cause foamy froathy urine?
Bile salt accumulation in urine
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
Sydenham chorea
Recurrent larygneal

45. at 2 years of age - What are the social - fine motor - gross motor and language developments?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
25; 25
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Sarcoid

46. what indicates the severity of a mitral regurg ? mitral stenosis?
S3 gallop; S2 to opening snap interval
Drink plenty of fluids
Cluster
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

47. What does the tuberoinfundibular pathway connect? What is it responsible for?
Strength of cell mediated immune response
Serum FFA and serum triglyceride levels
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

48. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Relfex tachycardia; giving beta blockers
Superior larygeal; cricothyroid; recurrent laryngeal
Underestimation of gestational age

49. What pulmonary structural change can kartageners syndrome cause?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Hypertension - edema - and proteinuria
Bronchial dilation (bronchiectasis)
Adductor

50. What is the neurologic manifestation of ADPKD?
Terminal bronchioles; small bronchi
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
SVT; increases vagal tone; rectus abdominis
Headaches and facial flushing; vasodilation in meninges and skin