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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 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
Standing suddenly from supine position; valsalva maneuver
Hypo or hyper pigmentations; after tanning
Insulin like growth factor 1 (just another name)

2. Where is conduction in heart fastest? slowest?
Purkinje system; AV node
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Bile salt accumulation in urine
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

3. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Chorda tympani branch
HSV ( also in utero: chlymadia - neisseria - group B strep)
Intussusception
GI tract; mood!

4. is Rifampin ever used as monotherapY? why either way?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
No only for prophylaxis (even for treating staphylococcal endocarditis its as multi drug); this is to prevent drug resistance from spontaneous mutations by DNA dependent RNA polymerase
G to T in p53; HCC
CMV - HSV 1 - Candida

5. What is the mc manifestation of CMV in HIV patient? immunocompetent?
As a CO2 carrier with the carboxylase enzyme
Vancomycin
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Retinitis; mononucleosis

6. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Close but purkinje system to ensure contraction in a bottom up fashion
Medial part
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

7. how can HAV be inactivated?
Boiling - bleach - formalin - UV irradiation
Sydenham chorea
Rabies encephalitis from cave bats; rabies killed vaccines
Proteasome inhibitor; treatment for MM and waldenstroms

8. What is a keloid?
Excessive collagen formation during tissue repair in susceptible individuals
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Reiter syndrome; B27
Elastance

9. nucleotide deletions do not cause missense mutations - they cause...
Increases cytokine production
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
frameshift mutations (missense is substitution)

10. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
DIC; TTP- HUS dont bleed that much
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Pain reliever - reduces pain by locking substance P in the PNS
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences

11. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
Sickle cell; G6PD
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
Sarcoid
Insulin like growth factor 1 (just another name)

12. 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?
S. saprophyticus - and s. epidermidis; novobiocin
AV node slowest - to allow time for diastole
Cluster
P53 mutation; DCC is also required for adenoma to carcinoma

13. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Increased reticulocytes
Adductor
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
only up to bronchi

14. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
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)
gram positive organisms
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
Prostate tumor and increased osteoclast activity

15. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Circular - outside nucleus; transport proteins - rRNA - tRNA
Reiter syndrome; B27

16. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
OCPs - multiparity - breast feeding
Turners`
differentiate
Covalent (between two cysteines)- allows protein to withstand denaturation

17. what happens with LDL receptor density in statin therapy?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Increases
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
P450 mitochondrial monooxygenase

18. Would alpha 1 agonists cause flushing? muscarinic antagonist?
No; yes
Hypothyroidism
Fibronectin - laminin - collagen
Insulin like growth factor 1 (just another name)

19. What are diastolic (lowest) pressures in aorta? LV?
Become beta pleated and then form neurofibrillary tangle!
Highly negative resting potential
Around 70 (normal measured diastolic pressures); 9--
Env genes (for getting into target cells)

20. What are two common side effects of both acute and long acting nitrates? What causes them?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Acute interstitial nephritis
Headaches and facial flushing; vasodilation in meninges and skin
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

21. how does increased ICP result in curlings ulcers?
Vagus nerve stimulation
low in serum
Reticulocytes
Increases

22. What is the mc location for avascular necrosis? What is it associated with?
Vascular endothelium; protease
Dihydropyridine sensitive Ca channels (L type)
Tzanck smear
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

23. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
Echinococcus granulosus; anaphylaxis
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
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
DIC; TTP- HUS dont bleed that much

24. what immune deficiency causes recurrent neisseria infections?
MAC complex (C5b - C9 complement deficiency)
8 (myc protein) with 2 - 14 - 22 (iG chains)
Sickle cell; G6PD
Relfex tachycardia; giving beta blockers

25. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Rabies encephalitis from cave bats; rabies killed vaccines
Pan colitis and right sided colitis (more than left sided and proctitis)
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
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

26. What are the first generation anti histamines?
Well
Vagus nerve stimulation
Close but purkinje system to ensure contraction in a bottom up fashion
Chlorpheniramine and diphenhydramine

27. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
glycerol kinase
Neisseria induced small cell vasculitis (including hands and soles)
TSh (in testicular tumors can cause hyperthyroidism)

28. what commonly happens in GI in response to acute physiologic stress?
Hereditary angioedema; ACE inhibitors
Acute gastric mucosal defects (superficial or full thickness)
Because gamma chains replace beta chains and then gamma chain formation wanes
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

29. What does protein M do in Group A strep<
Anterior nares
Large stroke volumes with ventricular contraction; aortic regurg
facultative intracellular
Prevent phagocytosis

30. other than increasing HDL levels - what else does niacin do?
MAO inhibitors; wine and cheese
LT (LTD4 - E4 - C4) - and Ach
Large stroke volumes with ventricular contraction; aortic regurg
Prevents hepatic VLDL production

31. What causes curlings ulcers?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Protamine sulfate
Circular - outside nucleus; transport proteins - rRNA - tRNA
ZDV or AZT

32. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
E. coli
MAO inhibitors; wine and cheese
LT (LTD4 - E4 - C4) - and Ach
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

33. Where is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Circular - outside nucleus; transport proteins - rRNA - tRNA
Prepatellar
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

34. What triggers the neoplastic changes that are associated with HBV infecton?
Adductor
Integration of viral DNA into genome of host hepatocytes
Regular insulin (Not fast acting - regular better)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

35. What does nitroprusside do to afterload? preload?
200-500
Decreases both
frameshift mutations (missense is substitution)
Strength of cell mediated immune response

36. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Curlings ulcers
Coagulation factors are made in the liver
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

37. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
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)
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Because of the low output from heart failure - they will have increased aldosterone levels
No; MRI

38. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Relfex tachycardia; giving beta blockers
Not lined by epithelium
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Large stroke volumes with ventricular contraction; aortic regurg

39. What are the three causes of acute MI in context of normal coronary arteries ?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Ceftriaxone; azithromycin
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Selective alpha 1 (increases SVR)

40. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
200-500
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Chrom 8
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

41. what kind of drug is sertraline? What is a common side effect?
SSRI; erectile dysfunction
Elastance
Biphosphonate
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

42. Which is faster atrial muscle or ventricular muscle?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Atrial
Think Hb deformation diseases
Cluster

43. What is the stabilizing force for the secondary structure of proteins?
Hydrogen bonds dictate alpha or beta structure
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Initiation - pointing; pincer grasp; walking; mama/dada
Ether and other organic solvents

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

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45. Where is aromatase used?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Clindamycin; covers anaerobic oral flora and aerobic bacteria
No; MRI

46. What is the most common cause of pyelonephritis in both adults and childre?
E. coli
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Gluteus maximus; difficulty getting up from seated position and climbing chair
On cardiac tissue and renal juxtaglomerular cells

47. What is diagnostic (and possible therapeutic for intussusception)?
Appetite suppressants
Barium enema
Biphosphonate
8 (myc protein) with 2 - 14 - 22 (iG chains)

48. What is mcc of death pre hospital phase of MI? in hospital phase?
Increase; decreased
transcription activation/suppression
V fib; v. failure
SVT; increases vagal tone; rectus abdominis

49. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Prostate tumor and increased osteoclast activity
Vagus (auricular branch); vasovagal syncope!
Because of vasodiation to skeletal muscles
The time interval between S2 and OS- the shorter the interval - the more intense

50. If a patient has higher levels of HbF - What does this mean?
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Think Hb deformation diseases
ST become atrophic and hyalinized (temp induced damage) and depressed sperm count becuase of that; hormonal function not impaired (test and LH levels normal) because Leydig cells not as temp sensitive so secondary sexual characteristics and sexual pe
Myasthenia gravis