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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 is used to prevent vertical transmission of HIV?
Well
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
ZDV or AZT
Ketone body production by preventing fatty acids into the mitochondria

2. What are some of the permissive effects of cortisol?
OCPs - multiparity - breast feeding
Vagus (auricular branch); vasovagal syncope!
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Increases bronchial and vascular smooth muscle reactivity to catecholamines

3. What test would be best to determine if a gene is being transcribed? translated?
Southern - western
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Brief psychotic disorder; schizophreniform; schizophrenia

4. What is it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
No (unlike adenomyosis); yes
Regular insulin (Not fast acting - regular better)
Vertical diplopia

5. 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
Trauma to stereociliated hair cells of the organ of corti
glycerol kinase
GI malignancies and Insulin resistance (acromegal for ex)

6. What does nitroprusside do to afterload? preload?
Decreases both
OCPs - multiparity - breast feeding
Phencyclidine (PCP)
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

7. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Folic acid treatment!
P53 mutation; DCC is also required for adenoma to carcinoma
Proteasome inhibitor; treatment for MM and waldenstroms

8. What is used to compare means? categorical outcomes?
Sickle cell; G6PD
No
T test; chi squared
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

9. What does protein M do in Group A strep<
25; 25
Not lined by epithelium
Prevent phagocytosis
Spongiosis

10. What are three symptoms in s.typhi?
IgE
Bronchogenic carcinoma
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Anti cholinergic effects of pupil dilation and lack of accomodation

11. What causes the blurry vision side effects in first generation anti histamines?
Turners`
AV node slowest - to allow time for diastole
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Anti cholinergic effects of pupil dilation and lack of accomodation

12. What is diphenoxylate and What is it used for? what drug is it structurally similar to? What allows for potent anti diarrheal effect without signigicant opiate effects?
Serum creatine kinase; reperfusion injury causes necrosis
SSRI
S. aureus
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)

13. Where does terminal peptide cleavage of collagen fibrils take place?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
In the extracellular space
Vagus (auricular branch); vasovagal syncope!
Hyperkalemia; potassium sparing diuretics - potassium supplements

14. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
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
low in serum
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

15. What is difference between Arnold Chiari type I and II?
TCAs and prazosin
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
In ER of bile canaliculi
I is more benign and can present later in adulthood

16. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
Amiadarone
Initiation - pointing; pincer grasp; walking; mama/dada
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Inhaled animal dander allergens

17. other than mycobacterim wha other bacteria is acid fast?
Gluteus medius and minimus; positive trendelenberg
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
Nocardia
Another type of aldosterone antagonist (like spironolactone)

18. What can chronic vit A toxicity cause?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Phencyclidine (PCP)
Echinococcus granulosus; anaphylaxis
Single adenomatous ones

19. prostaglandin synthesis keeps...
Increase by 50% in urine osmolality
PDA open
Increase in permeability of two ions with equal and opposite equilibrium potentials
Curlings ulcers

20. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
No (unlike adenomyosis); yes
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
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
GI tract; mood!

21. What does prolonged PT indicated? aPTT? bleeding time?
Extrinsic def; instrinsic def; platelet def
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
By vascular permeability and vasodilation
SSRI; erectile dysfunction

22. What triggers the neoplastic changes that are associated with HBV infecton?
AV node slowest - to allow time for diastole
Because of the low output from heart failure - they will have increased aldosterone levels
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

23. the rate of blood flow of which two circulations must equal each other at all times?
Pulmonic and systemic!
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Superior larygeal; cricothyroid; recurrent laryngeal
AV node slowest - to allow time for diastole

24. Metronidizaole does not cover...
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
gram positive organisms
DIC; TTP- HUS dont bleed that much
SSRI

25. What is normal fibrinogen levels?
200-500
Biphosphonate
Joints d/t increased purine production and thus uric acid production
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

26. What type of bond is a disulfide bond?
Hypothyroidism
Elevated GGT and macrocytosis
Covalent (between two cysteines)- allows protein to withstand denaturation
No (unlike adenomyosis); yes

27. Where does conjugation of bilirubin take place?
In ER of bile canaliculi
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
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
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

28. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Hexokinase
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
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
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

29. What is the mcc of elevated AFP leves in pregnancy>
LT (LTD4 - E4 - C4) - and Ach
Underestimation of gestational age
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Highly negative resting potential

30. What does glycosylase do to DNA? endonuclease? lyase? What does the order here of enzymes represent? what other enzymes are needed?

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31. what makes bruits?
RER; RER
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
Inhibits it
Turbulence

32. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
IgE
When it invades the bm; carcinoma in situ
Syringomelia
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

33. What is the stabilizing force for the secondary structure of proteins?
T test; chi squared
Regular insulin (Not fast acting - regular better)
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Hydrogen bonds dictate alpha or beta structure

34. on which chromosome is wilms tumor found?
11
Retinitis; mononucleosis
INTRApartum Abs (ampicillin/penicillin)
Fibronectin - laminin - collagen

35. Which nerve lies in close proximity to the inferior thyroid artery?
8 (myc protein) with 2 - 14 - 22 (iG chains)
Tzanck smear
Recurrent larygneal
Turners`

36. What is the most important prognostic indicator in patients with malignant melanoma?
RER; RER
Measure of depth invasion (vertical!)
Neisseria induced small cell vasculitis (including hands and soles)
Regular insulin (Not fast acting - regular better)

37. what dissolves the lipid bilayer of a viral envelope?
Kallmans
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Ether and other organic solvents
frameshift mutations (missense is substitution)

38. why does variocele occur more in left side?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
S. saprophyticus - and s. epidermidis; novobiocin

39. What is extraocular muscle weakness a common symptom of?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Ig A deficiency
Myasthenia gravis
Standing suddenly from supine position; valsalva maneuver

40. do Class IC agents prolong the QT interval?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Amiadarone
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
No

41. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
Aromatase deficiency in child
Vagus (auricular branch); vasovagal syncope!
High potassium conductance and some sodium conductance
G to T in p53; HCC

42. What is the mainstay treatment for acute mania?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Selective alpha 1 (increases SVR)

43. What type of vision is myopia? In What type of patients does it improve?
200-500
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Increase by 50% in urine osmolality
Hydrogen bonds dictate alpha or beta structure

44. what phase do adenosine and acetylcholine act on? doing what?
SaO2 <92%
Nonsense; mRNA processing
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

45. What would a deflection of the membrane potential to near zero indicate?
Measure of depth invasion (vertical!)
Increase in permeability of two ions with equal and opposite equilibrium potentials
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Cluster

46. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Inhibits it
P53 mutation; DCC is also required for adenoma to carcinoma

47. What are the skin presentation in sarcoid?
Varying; erythema nodosum is common
Headaches and facial flushing; vasodilation in meninges and skin
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
S3 gallop; S2 to opening snap interval

48. What are the primary determinants of colon cancer risk in UC patients
chronic urticaria and allergic symptoms
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
facultative intracellular
Duration and extent of disease

49. What is the cause of fixed splitting of S2? why?
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
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

50. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Hypo or hyper pigmentations; after tanning
Phencyclidine (PCP)
Mean greater than median greater than mode
S. aureus