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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. Where is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
Close but purkinje system to ensure contraction in a bottom up fashion
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
PDA open

2. who bleed more DIC or TTP- HUS patients?
DIC; TTP- HUS dont bleed that much
Paramyxo and influenza
Acute interstitial nephritis
25; 25

3. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
Syringomelia
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
High potassium conductance and some sodium conductance
APP on chrom 21 (this is why downs more susceptible)

4. What effects does cortisol have on catecholamines?
Trochlear nerve (IV); abducens nerve (VI)
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
Integration of viral DNA into genome of host hepatocytes
I is more benign and can present later in adulthood

5. 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
Common peroneal; bony fractures and compression; sciatic
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Normal; low

6. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
When it invades the bm; carcinoma in situ
Large stroke volumes with ventricular contraction; aortic regurg
Myasthenia gravis
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)

7. What can chronic vit A toxicity cause?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Squatting - sitting - lying supine - passive leg raising
GI tract; mood!

8. What does protein M do in Group A strep<
Prevent phagocytosis
V fib; v. failure
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

9. What is contraindicated in toxic mega colon?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Increases cytokine production

10. what diseases can vit A be used to treat?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Become beta pleated and then form neurofibrillary tangle!
Around 70 (normal measured diastolic pressures); 9--
Measles and M3 AML`

11. when do ghon complexes form - primary or secondary TB?
Circular - outside nucleus; transport proteins - rRNA - tRNA
Primary
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Demargination of neutrophils from the vessel walls

12. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
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
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

13. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
Rabies encephalitis from cave bats; rabies killed vaccines
OCPs - multiparity - breast feeding
Leukotriene precursor and does neutrophil chemotaxis
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

14. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
Covalent (between two cysteines)- allows protein to withstand denaturation
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Criggler Najjar (UGT enzyme in bilirubin glucoronidation) ; Dubin Johnson (transport protein lacking - Black liver) and Rotor syndrome - defects in hepatic uptake and excretion of bile (numerous defect)
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

15. What does 'oxygen' content in blood refer to?
Retinitis; mononucleosis
Insulin like growth factor 1 (just another name)
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Dissolved in plasma and attached to Hgb

16. SIADH patients have normal blood volume but...
Amiloride - spironolactone - triamterene
hyponatremia (aldosterone activation equilibrates body volume)
Integration of viral DNA into genome of host hepatocytes
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

17. What type of calcium channels dictate the plateau in cardiac myocyte?
Covalent (between two cysteines)- allows protein to withstand denaturation
Measles and M3 AML`
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Dihydropyridine sensitive Ca channels (L type)

18. What antibodies are present in CREST? What is the most specific?
Hydrogen bonds dictate alpha or beta structure
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
V fib; v. failure
Anti centromere; anti DNA topoisomerase

19. biotin is used By what in tissues responsible for gluconeogenesis
I is more benign and can present later in adulthood
As a CO2 carrier with the carboxylase enzyme
Vancomycin; histamine mediated
Coagulation factors are made in the liver

20. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
LT (LTD4 - E4 - C4) - and Ach
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Medullary

21. What is the presentation of angioedema? Where is most commonly affected?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Inhaled animal dander allergens
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
Elevated GGT and macrocytosis

22. on What part of the clavicle does the SCM attach?
DIC; TTP- HUS dont bleed that much
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Elastance
Medial part

23. on which chromosome is wilms tumor found?
Vancomycin; histamine mediated
11
Increase in permeability of two ions with equal and opposite equilibrium potentials
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

24. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Skin flushing and warmth; prostaglandins; give with aspirin
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Elevated GGT and macrocytosis
Integration of viral DNA into genome of host hepatocytes

25. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Hypertension - edema - and proteinuria
RR-1/RR
Hereditary angioedema; ACE inhibitors

26. do patients with cor pulmonale have increased or decreased levels of aldosterone?
Increases cytokine production
Because of the low output from heart failure - they will have increased aldosterone levels
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Faulty positioning of the genital tubercle

27. What is easiest way to treat nephrolithiasis?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
25; 25
Drink plenty of fluids

28. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
women
Proteasome inhibitor; treatment for MM and waldenstroms
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Reticulocytes

29. Where does terminal peptide cleavage of collagen fibrils take place?
Think Hb deformation diseases
Excessive collagen formation during tissue repair in susceptible individuals
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
In the extracellular space

30. Acyl coA synthetase is not...
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
liver specific
Ether and other organic solvents

31. which nucleus releases serotonin?
Raphe
Apocrine; eccrine
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Skin flushing and warmth; prostaglandins; give with aspirin

32. a patient fearing all white coats is a phenomenon of what?
Classical conditioning
The term used to describe decreased drug responsiveness with repeated administration
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
CGD; t cell dysfxn (diGeorge)

33. there are mucus secreting cells in the bronchioles...
Valproate
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
only up to bronchi

34. Which is faster atrial muscle or ventricular muscle?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Trauma to stereociliated hair cells of the organ of corti
Increase; decreased
Atrial

35. What is the stabilizing force for the secondary structure of proteins?
chronic urticaria and allergic symptoms
Hydrogen bonds dictate alpha or beta structure
Adductor
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

36. what would be a sign of absence of cardiogenic pulm edem?
Chlorpheniramine and diphenhydramine
glycerol kinase
Insulin like growth factor 1 (just another name)
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

37. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Medial circumflex artery; avascular necrosis
Dihydropyridine sensitive Ca channels (L type)
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Barium enema

38. h1 receptor anatagonists are not effective in treatment of asthma only for...
No; MRI
chronic urticaria and allergic symptoms
Increase; decreased
Standing suddenly from supine position; valsalva maneuver

39. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Protamine sulfate
ANCA because of lack of Ig and C3 deposits on IF
Reiter syndrome; B27
Anti centromere; anti DNA topoisomerase

40. What are examples of action that decrease venous return to the heart?
Prepatellar
HSV ( also in utero: chlymadia - neisseria - group B strep)
Amiadarone
Standing suddenly from supine position; valsalva maneuver

41. What does C1 esterase do other than inhibiting complement pathway?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
AV node slowest - to allow time for diastole
Inactivates kallikrein which activates kininogen into bradykinin
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

42. What are some of the permissive effects of cortisol?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
gram positive organisms
Syncope - angina - dyspnea (SAD)
low in serum

43. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Aromatase deficiency in child
AV node slowest - to allow time for diastole

44. How do you calculate excretion rate of a substance? How do you calculate the filtration rate of a substance? clearance of what substance estimates the GFR?
Amiadarone
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
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

45. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Elevated GGT and macrocytosis
Excessive collagen formation during tissue repair in susceptible individuals
Retinitis; mononucleosis
Turners`

46. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
E. coli; staphylococcus saprophyticus
Inactivates kallikrein which activates kininogen into bradykinin
Sickle cell; G6PD
Faulty positioning of the genital tubercle

47. Which nerve lies in close proximity to the inferior thyroid artery?
Joints d/t increased purine production and thus uric acid production
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)
Recurrent larygneal
Smoking

48. What actions increase venous return?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Medial circumflex artery; avascular necrosis
Sarcoid
Squatting - sitting - lying supine - passive leg raising

49. How do you calculate RPF from urine PAH?
Become beta pleated and then form neurofibrillary tangle!
(urine PAH x urine flow rate)/plasma PAH
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Smoking

50. what bursa is affected when on knees like a maid/gardner?
No; MRI
Prepatellar
facultative intracellular
Fibronectin - laminin - collagen