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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 is a clara cell?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Increases
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Selective alpha 1 (increases SVR)

2. What is capsaicin? Where does it work?
Pain reliever - reduces pain by locking substance P in the PNS
Inhaled animal dander allergens
Hereditary angioedema; ACE inhibitors
Octreotide

3. What causes wrist drop?
SaO2 <92%
Radial nerve damage
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

4. Where does terminal peptide cleavage of collagen fibrils take place?
Hypertension - edema - and proteinuria
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
Sydenham chorea
In the extracellular space

5. what protects the resting heart from arrhythmias?
Because of the low output from heart failure - they will have increased aldosterone levels
In ER of bile canaliculi
Increased reticulocytes
Highly negative resting potential

6. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Classical conditioning
Valproate
Syringomelia
Hypothyroidism

7. hypertonicity and hyperreflexity are ________________ of hydrocephalus
Elevated GGT and macrocytosis
Radial nerve and deep brachial artery
LT (LTD4 - E4 - C4) - and Ach
manifestations - congenital (stretching of periventricular pyrimadal fibers)

8. what enzyme converts procarcinogens into carcinogens?
In ER of bile canaliculi
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
P450 mitochondrial monooxygenase
transcription activation/suppression

9. What is intussusception? how does ischemia and necrosis occur?
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
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
OCPs - multiparity - breast feeding
Vancomycin; histamine mediated

10. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Myasthenia gravis
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Hypo or hyper pigmentations; after tanning
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

11. why does liver dysfunction cause coagulation disorders?
Coagulation factors are made in the liver
Smoking
Minimal change disease
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

12. why are pregnant predisposed to cholelithiasis?
Smoking
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
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

13. how long is substance P? What does it do?
11 aa polypeptide; pain NT in CNS and PNS
Acute interstitial nephritis
gram positive organisms
Demargination of neutrophils from the vessel walls

14. which headaches are seen mostly in men - are severe - unilateral - periorbital - episodic (around same time every day) - temporal pain - with lacrimation - nasal congestion and ptosis?
Cluster
Hyperkalemia; potassium sparing diuretics - potassium supplements
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
TSh (in testicular tumors can cause hyperthyroidism)

15. What are the three dopaminergic systems and What are they responsible for? disease?
Reticulocytes
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Anti cholinergic effects of pupil dilation and lack of accomodation

16. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
T test; chi squared
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Acute gastric mucosal defects (superficial or full thickness)

17. Where is aromatase used?
Close but purkinje system to ensure contraction in a bottom up fashion
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Single adenomatous ones
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

18. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
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
gram positive organisms
E6 and E7 of HPV knock off p53 and Rb suppressor genes
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

19. What is the stabilizing force for the secondary structure of proteins?
On cardiac tissue and renal juxtaglomerular cells
gram positive organisms
Hydrogen bonds dictate alpha or beta structure
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

20. Where does 90% of serotonin lie? What is this NT responsible?
Regular insulin (Not fast acting - regular better)
GI tract; mood!
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Prepatellar

21. What type of vision is myopia? In What type of patients does it improve?
By vascular permeability and vasodilation
Recurrent larygneal
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
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

22. In what form are mitochondrial DNA? What do they transcribe?
Normal; low
Circular - outside nucleus; transport proteins - rRNA - tRNA
MAC complex (C5b - C9 complement deficiency)
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

23. What is the presentation of sever aortic stenosis?
Ketone body production by preventing fatty acids into the mitochondria
Syncope - angina - dyspnea (SAD)
Proteasome inhibitor; treatment for MM and waldenstroms
Excessive collagen formation during tissue repair in susceptible individuals

24. Where is conduction in heart fastest? slowest?
Purkinje system; AV node
Primary
Nonsense; mRNA processing
Measure of depth invasion (vertical!)

25. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
8 (myc protein) with 2 - 14 - 22 (iG chains)
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

26. which staphylococci can do mannitol fermaentation?
Increases cytokine production
Fat - fertile - forty - female
Faulty positioning of the genital tubercle
S. aureus

27. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
Fibrosis; macrophages
Reticulocytes
8; 12
OCPs - multiparity - breast feeding

28. What is cataplexy and When is it seen?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Susceptible; soluble (unable to be cultured in bile)
Sarcoid

29. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
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
High potassium conductance and some sodium conductance
Radial nerve damage
Inhibits it

30. What are two common side effects of both acute and long acting nitrates? What causes them?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Hypo or hyper pigmentations; after tanning
Headaches and facial flushing; vasodilation in meninges and skin
GI malignancies and Insulin resistance (acromegal for ex)

31. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Curlings ulcers
Bile salt accumulation in urine
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics

32. What is the triad seen in pre eclampsia?
Extrinsic def; instrinsic def; platelet def
Excessive collagen formation during tissue repair in susceptible individuals
S. saprophyticus - and s. epidermidis; novobiocin
Hypertension - edema - and proteinuria

33. which viruses require a protease?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
SS +rNA
4 - 4 - 9

34. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Gluteus maximus; difficulty getting up from seated position and climbing chair
GI malignancies and Insulin resistance (acromegal for ex)
Enterococci (e. faecalis)- found on genitalia area
Increase lymphatic drainage!

35. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
hyponatremia (aldosterone activation equilibrates body volume)
Aromatase deficiency in child
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Paramyxo and influenza

36. What is the most common cause of hydatid cysts in humans? What does spilling of cysts 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
Echinococcus granulosus; anaphylaxis
Chlorpheniramine and diphenhydramine
Vertical diplopia

37. How do bradykinin - C3a and C5a cause edema?
Primary
GI malignancies and Insulin resistance (acromegal for ex)
Vagus nerve stimulation
By vascular permeability and vasodilation

38. biotin is used By what in tissues responsible for gluconeogenesis
Appetite suppressants
As a CO2 carrier with the carboxylase enzyme
Ceftriaxone; azithromycin
Gluteus maximus; difficulty getting up from seated position and climbing chair

39. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
To pump calcium out in cardiac myocytes so that relaxation occurs
Sickle cell; G6PD
Octreotide
Phencyclidine (PCP)

40. How do you calculate RPF from urine PAH?
I is more benign and can present later in adulthood
Not lined by epithelium
Single adenomatous ones
(urine PAH x urine flow rate)/plasma PAH

41. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Kallmans
Aromatase deficiency in child
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Fibronectin - laminin - collagen

42. What effects does cortisol have on catecholamines?
Both sides
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
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)
Cluster

43. why is crohns disease associated with oxaloacetate kidney stones?
High potassium conductance and some sodium conductance
E. coli; staphylococcus saprophyticus
Acute gastric mucosal defects (superficial or full thickness)
Lack of calcium to bind oxaloacetate; crohns prevents fat absorption from lack of bile reabsorption in the terminal illeum which leads to fats pulling calcium and lack of calcium reabsorption

44. What does VIP do to gastric acid secretion?
Chrom 8
Inhibits it
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

45. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
Mean greater than median greater than mode
Hypertension - edema - and proteinuria
4 - 4 - 9
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

46. When is an S4 sound normal?
Well trained athletes and children
LT (LTD4 - E4 - C4) - and Ach
CMV - HSV 1 - Candida
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

47. what hormone is structurally similar to hCG?
Bile soluble which means they are bile sensitive
Reiter syndrome; B27
TSh (in testicular tumors can cause hyperthyroidism)
In the extracellular space for collagen cross linking; zinc

48. what virus causes pharyngoconjuctival fever?
Octreotide
Adeno
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Fibronectin - laminin - collagen

49. What is 5- HETE and What does it do?
Leukotriene precursor and does neutrophil chemotaxis
Pulmonary hypertension
Circular - outside nucleus; transport proteins - rRNA - tRNA
Medial circumflex artery; avascular necrosis

50. How do you explain the selective proteinuria of loss to albumin only in MCD?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
P450 mitochondrial monooxygenase
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin