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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. how does eos release MBP to kill protozoa etc?
Joints d/t increased purine production and thus uric acid production
200-500
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
ATP binding (resets the myosin head to contract again for next binding)

2. What type of mutation does aflatoxin cause? what cancer does this increase for?
HSV ( also in utero: chlymadia - neisseria - group B strep)
Radial nerve damage
Paramyxo and influenza
G to T in p53; HCC

3. 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?
Common peroneal; bony fractures and compression; sciatic
Anti cholinergic effects of pupil dilation and lack of accomodation
Nocardia
GI malignancies and Insulin resistance (acromegal for ex)

4. What does nitroprusside do to afterload? preload?
Decreases both
25; 25
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

5. What is a keloid?
Relfex tachycardia; giving beta blockers
Reticulocytes
Excessive collagen formation during tissue repair in susceptible individuals
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

6. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
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
Hypo or hyper pigmentations; after tanning
Rabies encephalitis from cave bats; rabies killed vaccines

7. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
II; I (I more abundant)
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
S. saprophyticus - and s. epidermidis; novobiocin
Terminal bronchioles; small bronchi

8. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
Strength of cell mediated immune response
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)
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)
LT (LTD4 - E4 - C4) - and Ach

9. do Class IC agents prolong the QT interval?
No
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
RBC mass; epo levels (secondary has high)

10. Where does terminal peptide cleavage of collagen fibrils take place?
In the extracellular space
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
RBC mass; epo levels (secondary has high)

11. after a thrombus extraction - what serum enzyme shoots up and why?
Anterior circumflex (and axillary nerve)
Serum creatine kinase; reperfusion injury causes necrosis
liver specific
GI malignancies and Insulin resistance (acromegal for ex)

12. Metronidizaole does not cover...
Superior larygeal; cricothyroid; recurrent laryngeal
gram positive organisms
Tissue redistribution (out of plasma) rather than metabolism
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

13. what commonly happens in GI in response to acute physiologic stress?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
C3 decreased after 5-10 days; sulfonamides
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Acute gastric mucosal defects (superficial or full thickness)

14. where exactly is ACE expressed in the lungs? What type of enzyme is it?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
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
Vascular endothelium; protease
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

15. What does protein M do in Group A strep<
No
4 - 4 - 9
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Prevent phagocytosis

16. What type of endocarditis is cytoscopy induced?
Pulmonic and systemic!
Hypo or hyper pigmentations; after tanning
Downs; regurgitant AV valves - ASDs
Enterococci (e. faecalis)- found on genitalia area

17. What is pickwickian syndrome? What are the lab findings?
chronic urticaria and allergic symptoms
HSV and VZV
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
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

18. what happens to capacitance with age?
46 - 4N; 23 2N
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)
...
MAC complex (C5b - C9 complement deficiency)

19. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Rabies encephalitis from cave bats; rabies killed vaccines
Because of vasodiation to skeletal muscles
CMV - HSV 1 - Candida

20. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
Trochlear nerve (IV); abducens nerve (VI)
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Mean greater than median greater than mode
Proteasome inhibitor; treatment for MM and waldenstroms

21. what protein is increased in Crohns disease? What does it do?
Because of the low output from heart failure - they will have increased aldosterone levels
NF- KB; responsible for cytokine production
Pulmonary hypertension
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

22. which two virus families have hemagluttinin on their surface?
SVC and IVC; right below the aortic knob
Paramyxo and influenza
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
On cardiac tissue and renal juxtaglomerular cells

23. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
HSV ( also in utero: chlymadia - neisseria - group B strep)
Anti cholinergic effects of pupil dilation and lack of accomodation
Regular insulin (Not fast acting - regular better)
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac

24. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
MAO inhibitors; wine and cheese
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Syncope - angina - dyspnea (SAD)
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

25. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Paramyxo and influenza
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
T test; chi squared
Medial circumflex artery; avascular necrosis

26. What is difference between Arnold Chiari type I and II?
Chlorpheniramine and diphenhydramine
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
No
I is more benign and can present later in adulthood

27. What does anti phospholipid syndrome in SLE patients predispose them to?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
low in serum
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Multiple miscarriages d/t hypercoaguability

28. What is the most common initital symptom of ADPKD? what else?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
ANCA because of lack of Ig and C3 deposits on IF
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Anterior nares

29. which opponens muscle does ulnar innervate?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Adductor
P53 mutation; AD

30. What is the most common neurologic complication of VZV reactivation?
P450 mitochondrial monooxygenase
Minimal change disease
8 (myc protein) with 2 - 14 - 22 (iG chains)
Localized dermatologic pain that persists for more than one month after zoster eruption

31. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Well trained athletes and children

32. Where is aromatase used?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Syncope - angina - dyspnea (SAD)
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
No; MRI

33. 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
Because of vasodiation to skeletal muscles
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Southern - western

34. in the LV and aorta - What are the pressures?
Elastance
Medial part
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
Normally close to systolic

35. What is the stabilizing force for the secondary structure of proteins?
Hydrogen bonds dictate alpha or beta structure
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Regular insulin (Not fast acting - regular better)
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

36. What are examples of action that decrease venous return to the heart?
Standing suddenly from supine position; valsalva maneuver
25; 25
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

37. other than increasing HDL levels - what else does niacin do?
Increase lymphatic drainage!
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Prevents hepatic VLDL production

38. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
Fibrosis; macrophages
8 (myc protein) with 2 - 14 - 22 (iG chains)
CMV - HSV 1 - Candida
Bile soluble which means they are bile sensitive

39. which type of glands produce an initially odorless secretion but can become malodorous secondary to bacterial decompisition on the skin surface? which glands are present throughout the skin except on lips and glans penis?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Common peroneal; bony fractures and compression; sciatic
Apocrine; eccrine

40. What is the mcc of elevated AFP leves in pregnancy>
Underestimation of gestational age
TCAs and prazosin
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Well trained athletes and children

41. at 2 years of age - What are the social - fine motor - gross motor and language developments?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

42. What causes vertical diplopia? horizontal?
Turbulence
Increase by 50% in urine osmolality
Trochlear nerve (IV); abducens nerve (VI)
Vagus nerve stimulation

43. what hormone is structurally similar to hCG?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Normal; low
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
TSh (in testicular tumors can cause hyperthyroidism)

44. which viruses require a protease?
Hypertension - edema - and proteinuria
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Myasthenia gravis
SS +rNA

45. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
Common peroneal; bony fractures and compression; sciatic
Chrom 8
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

46. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Anti centromere; anti DNA topoisomerase
Vagus nerve stimulation
Single adenomatous ones
Large stroke volumes with ventricular contraction; aortic regurg

47. what phase do adenosine and acetylcholine act on? doing what?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

48. What is the cause of rapid plasma decay of thiopental?
Tissue redistribution (out of plasma) rather than metabolism
GI malignancies and Insulin resistance (acromegal for ex)
Normal; low
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

49. other than proteinuria - What can cause foamy froathy urine?
Bile salt accumulation in urine
Radial nerve and deep brachial artery
Susceptible; soluble (unable to be cultured in bile)
Tzanck smear

50. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
Purkinje system; AV node
manifestations - congenital (stretching of periventricular pyrimadal fibers)
RBF= PAH clearance/(1- hematocrit)
OCPs - multiparity - breast feeding