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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 locations of UC increase the risk of Colon cancer?
Leukotriene precursor and does neutrophil chemotaxis
Faulty positioning of the genital tubercle
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Pan colitis and right sided colitis (more than left sided and proctitis)

2. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
11 aa polypeptide; pain NT in CNS and PNS
Sudden loss of muscle tone without loss of consciousness; narcolepsy
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)
8; 12

3. What causes vertical diplopia? horizontal?
Trochlear nerve (IV); abducens nerve (VI)
In the extracellular space
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

4. what commonly happens in GI in response to acute physiologic stress?
transcription activation/suppression
Acute gastric mucosal defects (superficial or full thickness)
In ER of bile canaliculi
Demargination of neutrophils from the vessel walls

5. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
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)
Nocardia
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
HSV ( also in utero: chlymadia - neisseria - group B strep)

6. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
RR-1/RR
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
When it invades the bm; carcinoma in situ
Chlorpheniramine and diphenhydramine

7. If a patient has higher levels of HbF - What does this mean?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
E. coli
Think Hb deformation diseases
11 aa polypeptide; pain NT in CNS and PNS

8. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
CMV - HSV 1 - Candida
Integration of viral DNA into genome of host hepatocytes
Joints d/t increased purine production and thus uric acid production
Hypothyroidism

9. What triggers the neoplastic changes that are associated with HBV infecton?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Chlorpheniramine and diphenhydramine
ZDV or AZT
Integration of viral DNA into genome of host hepatocytes

10. why does neutrophila occur with corticosteroids?
Chlorpheniramine and diphenhydramine
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Well
Demargination of neutrophils from the vessel walls

11. What is the neurologic manifestation of ADPKD?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Tissue redistribution (out of plasma) rather than metabolism
Vagus nerve stimulation
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

12. How do you calculate RPF from urine PAH?
RER; copper
(urine PAH x urine flow rate)/plasma PAH
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
...

13. What almost exclusively causes Epliglottitis?What type of capsule does it have? What are the symptoms?

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14. What does TGF beta do? What produces it?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Fibrosis; macrophages
E. coli
(urine PAH x urine flow rate)/plasma PAH

15. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
Ig A deficiency
8; 12
CMV - HSV 1 - Candida
No (unlike adenomyosis); yes

16. other than in pyelonephritis - where else are WBC casts seen?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Acute interstitial nephritis
manifestations - congenital (stretching of periventricular pyrimadal fibers)
INTRApartum Abs (ampicillin/penicillin)

17. What is the fibrinogen level in patient with TTP- HUS? DIC?
PDA open
Normal; low
On cardiac tissue and renal juxtaglomerular cells
SS +rNA

18. do patients with cor pulmonale have increased or decreased levels of aldosterone?
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
PDA open
Increased reticulocytes
Because of the low output from heart failure - they will have increased aldosterone levels

19. What pulmonary structural change can kartageners syndrome cause?
RR-1/RR
Bronchial dilation (bronchiectasis)
Integration of viral DNA into genome of host hepatocytes
Reticulocytes

20. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Curlings ulcers
Downs; regurgitant AV valves - ASDs
Increases bronchial and vascular smooth muscle reactivity to catecholamines
only up to bronchi

21. What type of vision is myopia? In What type of patients does it improve?
S. aureus
Lateral; RV; RA; LV
S3 gallop; S2 to opening snap interval
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

22. after a thrombus extraction - what serum enzyme shoots up and why?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
facultative intracellular
Serum creatine kinase; reperfusion injury causes necrosis
Hereditary angioedema; ACE inhibitors

23. other than parvo B19 - what else is associated with red cell aplasia?
differentiate
Thymic tumor
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
GI tract; mood!

24. What is epispadias caused by?
Radial nerve and deep brachial artery
No; yes
Faulty positioning of the genital tubercle
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

25. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
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
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Syringomelia

26. what drug is useful for secretory diarrhea?
chronic urticaria and allergic symptoms
Octreotide
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Tzanck smear

27. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Diabetic microangiopathy
Biphosphonate
Prostate tumor and increased osteoclast activity
Increase; decreased

28. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Phencyclidine (PCP)
Smoking
...
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

29. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
Anterior circumflex (and axillary nerve)
Measles and M3 AML`
P53 mutation; DCC is also required for adenoma to carcinoma
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

30. What is acanthosis nigricans associated with?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
SS +rNA
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
GI malignancies and Insulin resistance (acromegal for ex)

31. do Class IC agents prolong the QT interval?
Phencyclidine (PCP)
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
No
Sickle cell; G6PD

32. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Inactivates kallikrein which activates kininogen into bradykinin
Adeno

33. What is the mcc of extrinsic allergic asthma?
Valproate
Multiple miscarriages d/t hypercoaguability
Inhaled animal dander allergens
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

34. What is it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Vertical diplopia
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
APP on chrom 21 (this is why downs more susceptible)

35. Which nerve lies in close proximity to the inferior thyroid artery?
Radial nerve damage
Neisseria induced small cell vasculitis (including hands and soles)
Recurrent larygneal
Ketone body production by preventing fatty acids into the mitochondria

36. what induces bronchial squamous metaplasia?
INTRApartum Abs (ampicillin/penicillin)
HSV and VZV
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Smoking

37. metabolism of 1 gram of protein produces How many calories? carb? fat?
transcription activation/suppression
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
In the extracellular space
4 - 4 - 9

38. What is easiest way to treat nephrolithiasis?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Boiling - bleach - formalin - UV irradiation
Drink plenty of fluids
Regular insulin (Not fast acting - regular better)

39. What can nitrates lead to that is bad for angina therapy? How do you counter this?
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
Relfex tachycardia; giving beta blockers
RER; RER
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

40. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Hexokinase
Vagus (auricular branch); vasovagal syncope!
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Large stroke volumes with ventricular contraction; aortic regurg

41. why should you not use ACE inhibitors with someone who had hereditary angioedema?
Chrom 8
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
indomethacin
Measure of depth invasion (vertical!)

42. What is pickwickian syndrome? What are the lab findings?
No and yes
HSV and VZV
Pan colitis and right sided colitis (more than left sided and proctitis)
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

43. Where is the base of the heart? apex?
Closer to head; closer to diaphragm
Ig A deficiency
Ether and other organic solvents
Circular - outside nucleus; transport proteins - rRNA - tRNA

44. How do you explain the selective proteinuria of loss to albumin only in MCD?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
frameshift mutations (missense is substitution)
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

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

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46. which are the only glycosylated proteins in HIV virus?
Anti cholinergic effects of pupil dilation and lack of accomodation
Env genes (for getting into target cells)
Spongiosis
Pain reliever - reduces pain by locking substance P in the PNS

47. What are the potassium sparing diuretics?
Amiloride - spironolactone - triamterene
Normal; low
Ig A deficiency
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

48. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
SSRI
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Prostate tumor and increased osteoclast activity
Normal; low

49. what marker should be followed in a patient with cirrhosis?
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

50. What translocations can cause c - myc overexpression?
Trochlear nerve (IV); abducens nerve (VI)
Acute gastric mucosal defects (superficial or full thickness)
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
8 (myc protein) with 2 - 14 - 22 (iG chains)