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USMLE Prep 2

Instructions:

Answer 50 questions in 15 minutes.
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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 an abortive viral infection?
Little effect on cell and no change
Tissue redistribution (out of plasma) rather than metabolism
Tibial
Drink plenty of fluids

2. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
Prevent phagocytosis
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
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Hyperkalemia; potassium sparing diuretics - potassium supplements

3. which has better side effect profile - SSRI or TCA?
Vagus nerve stimulation
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
SSRI
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

4. What does protein M do in Group A strep<
RBC mass; epo levels (secondary has high)
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Amiadarone
Prevent phagocytosis

5. 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?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
8 (myc protein) with 2 - 14 - 22 (iG chains)
SS +rNA
Common peroneal; bony fractures and compression; sciatic

6. In what population does cholelithiasis occur?
Syringomelia
Myasthenia gravis
Fat - fertile - forty - female
Prevent phagocytosis

7. What does the severity of leprosy depend on?
Strength of cell mediated immune response
Prevents hepatic VLDL production
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Lateral; RV; RA; LV

8. why are beta thal major patients asymptomatic at birth?
Curlings ulcers
P53 mutation; DCC is also required for adenoma to carcinoma
Because gamma chains replace beta chains and then gamma chain formation wanes
Serum creatine kinase; reperfusion injury causes necrosis

9. How do you calculate atributable risk percent?
RR-1/RR
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)
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
8 (myc protein) with 2 - 14 - 22 (iG chains)

10. What three factors effect total oxygen content of blood?
Prepatellar
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Terminal bronchioles; small bronchi

11. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Circular - outside nucleus; transport proteins - rRNA - tRNA
Phencyclidine (PCP)
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

12. What is a cord factor and Which bugs have it? How do they appear on culture?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
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

13. What is intussusception? how does ischemia and necrosis occur?
AV node slowest - to allow time for diastole
Varying; erythema nodosum is common
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
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

14. What can cause virilization of a mother during pregnancy?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Aromatase deficiency in child
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Inhibits it

15. how does noise induced hearing loss occur?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Trauma to stereociliated hair cells of the organ of corti
Serum FFA and serum triglyceride levels
Recurrent larygneal

16. How is dobutamine better than dopamine?
Ketone body production by preventing fatty acids into the mitochondria
HSV and VZV
11 aa polypeptide; pain NT in CNS and PNS
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

17. What is omalizumab and What is it used for?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

18. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
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
Mean greater than median greater than mode
P53 mutation; AD
Increase; decreased

19. Would alpha 1 agonists cause flushing? muscarinic antagonist?
Highly negative resting potential
Anti centromere; anti DNA topoisomerase
No; yes
Normally close to systolic

20. Where does complement bind on the Fc region of Ig chains?
Acute gastric mucosal defects (superficial or full thickness)
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
hyponatremia (aldosterone activation equilibrates body volume)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

21. When does opening snap begin?
Right before diastole (filling begins)
Chlorpheniramine and diphenhydramine
Protamine sulfate
V fib; v. failure

22. What does hypocapnia cause in teh brain? What is hypocapnia?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
APP on chrom 21 (this is why downs more susceptible)
NF- KB; responsible for cytokine production
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

23. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Minimal change disease
Rare complication of measles (years later)- thought to be d/t certain type that doesnt have surface M protein antigen so goes unseen into CNS
V fib; v. failure

24. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Echinococcus granulosus; anaphylaxis
HSV ( also in utero: chlymadia - neisseria - group B strep)
II; I (I more abundant)
OCPs - multiparity - breast feeding

25. How do you explain the selective proteinuria of loss to albumin only in MCD?
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Prevent phagocytosis

26. What do you treat s. epidermidis with?
Varying; erythema nodosum is common
Vancomycin
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Drink plenty of fluids

27. 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?
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)
Cluster
Increase in permeability of two ions with equal and opposite equilibrium potentials
Closer to head; closer to diaphragm

28. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Common peroneal; bony fractures and compression; sciatic
Underestimation of gestational age
No and yes
Gluteus medius and minimus; positive trendelenberg

29. What causes release of myosin head from the actin filament?
Barium enema
Chrom 8
ATP binding (resets the myosin head to contract again for next binding)
Initiation - pointing; pincer grasp; walking; mama/dada

30. What is best to prevent GBS infection in a baby?
INTRApartum Abs (ampicillin/penicillin)
NF- KB; responsible for cytokine production
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Demargination of neutrophils from the vessel walls

31. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Become beta pleated and then form neurofibrillary tangle!
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

32. what drug is useful for secretory diarrhea?
Octreotide
In ER of bile canaliculi
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Clindamycin; covers anaerobic oral flora and aerobic bacteria

33. How can renal blood flow be calculated from RPF?
RBF= PAH clearance/(1- hematocrit)
Kallmans
LT (LTD4 - E4 - C4) - and Ach
Sickle cell; G6PD

34. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Anti - apoptotic (prevents going into apoptosis)- 18; 14
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)
By vascular permeability and vasodilation

35. 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
Leukotriene precursor and does neutrophil chemotaxis
frameshift mutations (missense is substitution)
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

36. What pulmonary structural change can kartageners syndrome cause?
Tibial
Hypo or hyper pigmentations; after tanning
Bronchial dilation (bronchiectasis)
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

37. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Insulin like growth factor 1 (just another name)
Inactivates kallikrein which activates kininogen into bradykinin
DIC; TTP- HUS dont bleed that much

38. What is the cause of rapid plasma decay of thiopental?
Tissue redistribution (out of plasma) rather than metabolism
Elevated GGT and macrocytosis
Retinitis; mononucleosis
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

39. what commonly happens in GI in response to acute physiologic stress?
Acute gastric mucosal defects (superficial or full thickness)
Increased reticulocytes
Chorda tympani branch
Nocardia

40. What is the difference between additive and synergistic?
P53 mutation; DCC is also required for adenoma to carcinoma
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
Increase by 50% in urine osmolality
I is more benign and can present later in adulthood

41. What is a common complication of acute pancreatitis? What is it?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Protamine sulfate
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

42. what nerve and artery course along the posterior aspect of the humerus?
Closer to head; closer to diaphragm
Radial nerve and deep brachial artery
Dissolved in plasma and attached to Hgb
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin

43. What is tachyphylaxis?
The term used to describe decreased drug responsiveness with repeated administration
Obstruction because they infiltrate the intestinal wall and encircle causing decrease in size of lumen - constipation - abdominal distension - abdominal pain - changes in stool caliber; right sided are often exophytic masses iron def anemia and syste
As a CO2 carrier with the carboxylase enzyme
E. coli; staphylococcus saprophyticus

44. What type of calcium channels dictate the plateau in cardiac myocyte?
Biphosphonate
Dihydropyridine sensitive Ca channels (L type)
Not lined by epithelium
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

45. IL4 is used for isotypye switching to what?
Hereditary angioedema; ACE inhibitors
Acute gastric mucosal defects (superficial or full thickness)
IgE
Raphe

46. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Anterior nares
Highly negative resting potential
Skin flushing and warmth; prostaglandins; give with aspirin
Barium enema

47. how long is substance P? What does it do?
Bronchogenic carcinoma
frameshift mutations (missense is substitution)
Sarcoid
11 aa polypeptide; pain NT in CNS and PNS

48. What is the mc location for avascular necrosis? What is it associated with?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Trochlear nerve (IV); abducens nerve (VI)
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

49. 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
Proteasome inhibitor; treatment for MM and waldenstroms
Around 70 (normal measured diastolic pressures); 9--
The time interval between S2 and OS- the shorter the interval - the more intense

50. on What part of the clavicle does the SCM attach?
Excessive collagen formation during tissue repair in susceptible individuals
Medial part
<1% - 55% - concentration dependent
E6 and E7 of HPV knock off p53 and Rb suppressor genes