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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 the mc malignancy in asbestosis?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Bronchogenic carcinoma
Abnormal closing of the urethral folds
Underestimation of gestational age

2. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Hereditary angioedema; ACE inhibitors
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Multiple miscarriages d/t hypercoaguability

3. where exactly is ACE expressed in the lungs? What type of enzyme is it?
Vascular endothelium; protease
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Class I
Dissolved in plasma and attached to Hgb

4. What is a common complication of acute pancreatitis? What is it?
P53 mutation; AD
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Insulin like growth factor 1 (just another name)

5. why does neutrophila occur with corticosteroids?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Demargination of neutrophils from the vessel walls
Medial part
Drink plenty of fluids

6. What is acanthosis nigricans associated with?
only up to bronchi
GI malignancies and Insulin resistance (acromegal for ex)
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)
frameshift mutations (missense is substitution)

7. What causes curlings ulcers?
Transported to liver - glycerol kinase converts it to glycerol 3 phosphate Which is then converted to DHAP which can either join glycolysis for ATP or be used to make glucose
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Both sides
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

8. what organ would an activating mutation in PRPP synthetase effect?
Joints d/t increased purine production and thus uric acid production
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Because of the low output from heart failure - they will have increased aldosterone levels
Prepatellar

9. What is a keloid?
Excessive collagen formation during tissue repair in susceptible individuals
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
SVT; increases vagal tone; rectus abdominis
MAO inhibitors; wine and cheese

10. What is used to prevent vertical transmission of HIV?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
NF- KB; responsible for cytokine production
ZDV or AZT
Become beta pleated and then form neurofibrillary tangle!

11. what dissolves the lipid bilayer of a viral envelope?
Ether and other organic solvents
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Elevated GGT and macrocytosis
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

12. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
HSV and VZV
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

13. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Turbulence
Intussusception
Hexokinase
Medullary

14. How is dobutamine better than dopamine?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Downs; regurgitant AV valves - ASDs

15. What is intussusception? how does ischemia and necrosis occur?
Drink plenty of fluids
<1% - 55% - concentration dependent
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
Ether and other organic solvents

16. What can long term leg cast wearing cause?
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
SVC and IVC; right below the aortic knob
Biphosphonate
Fat - fertile - forty - female

17. What is easiest way to treat nephrolithiasis?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Drink plenty of fluids
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Increases

18. which opponens muscle does ulnar innervate?
E. coli; staphylococcus saprophyticus
Another type of aldosterone antagonist (like spironolactone)
Adductor
AV node slowest - to allow time for diastole

19. What is extraocular muscle weakness a common symptom of?
Another type of aldosterone antagonist (like spironolactone)
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Myasthenia gravis
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

20. What are some side effects seen in TCAs?
Selective alpha 1 (increases SVR)
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
No and yes
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

21. What does C1 esterase do other than inhibiting complement pathway?
Turners`
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Inactivates kallikrein which activates kininogen into bradykinin
Protamine sulfate

22. What is the mcc of elevated AFP leves in pregnancy>
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Rabies encephalitis from cave bats; rabies killed vaccines
Underestimation of gestational age
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics

23. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Prevent phagocytosis
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

24. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
SVC and IVC; right below the aortic knob
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

25. When is an S4 sound normal?
Anterior nares
Well trained athletes and children
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
E. coli

26. 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
HSV and VZV
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Hyperkalemia; potassium sparing diuretics - potassium supplements

27. What are the primary determinants of colon cancer risk in UC patients
Duration and extent of disease
Underestimation of gestational age
Highly negative resting potential
liver specific

28. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Increased reticulocytes
S. saprophyticus - and s. epidermidis; novobiocin
Circular - outside nucleus; transport proteins - rRNA - tRNA
only up to bronchi

29. How do you treat gonococcal infection? chlymadia?
Ceftriaxone; azithromycin
liver specific
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
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

30. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Adductor
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Relfex tachycardia; giving beta blockers

31. carnitine deficiency impairs production of What and how?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Ketone body production by preventing fatty acids into the mitochondria
High potassium conductance and some sodium conductance
Nocardia

32. other than in pyelonephritis - where else are WBC casts seen?
Anterior nares
Acute interstitial nephritis
GI malignancies and Insulin resistance (acromegal for ex)
Because gamma chains replace beta chains and then gamma chain formation wanes

33. why are pregnant predisposed to cholelithiasis?
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
Inhibits it
Another type of aldosterone antagonist (like spironolactone)
Elastance

34. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Vascular endothelium; protease
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Phencyclidine (PCP)

35. which are the only glycosylated proteins in HIV virus?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Env genes (for getting into target cells)
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Bile salt accumulation in urine

36. What is the fibrinogen level in patient with TTP- HUS? DIC?
glycerol kinase
GI malignancies and Insulin resistance (acromegal for ex)
Normal; low
25; 25

37. Which is slower AV node or ventricular muscle?
11
Diabetic microangiopathy
SSRI; erectile dysfunction
AV node slowest - to allow time for diastole

38. 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
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
APP on chrom 21 (this is why downs more susceptible)
8; 12

39. IL4 is used for isotypye switching to what?
Right heart failure
IgE
Turbulence
Susceptible; soluble (unable to be cultured in bile)

40. What type of bond is a disulfide bond?
Covalent (between two cysteines)- allows protein to withstand denaturation
Insulin like growth factor 1 (just another name)
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
No (unlike adenomyosis); yes

41. What are pancreatic pseudocysts called pseudo rather than true cysts?
Southern - western
Not lined by epithelium
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Insulin like growth factor 1 (just another name)

42. What does TGF beta do? What produces it?
RBC mass; epo levels (secondary has high)
Hexokinase
Fibrosis; macrophages
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

43. how can HAV be inactivated?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Tibial
Trochlear nerve (IV); abducens nerve (VI)
Boiling - bleach - formalin - UV irradiation

44. what happens with LDL receptor density in statin therapy?
Increases
Inactivates kallikrein which activates kininogen into bradykinin
Another type of aldosterone antagonist (like spironolactone)
Well

45. What is the preferred treatment for DKA?
Regular insulin (Not fast acting - regular better)
ANCA because of lack of Ig and C3 deposits on IF
LT (LTD4 - E4 - C4) - and Ach
In ER of bile canaliculi

46. which RPGN is also called pauci immune GN? why?
Hypo or hyper pigmentations; after tanning
ANCA because of lack of Ig and C3 deposits on IF
Valproate
Dissolved in plasma and attached to Hgb

47. What antibodies are present in CREST? What is the most specific?
Normally close to systolic
Protamine sulfate
Anti centromere; anti DNA topoisomerase
Inhibits it

48. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Protamine sulfate

49. how does eos release MBP to kill protozoa etc?
TSh (in testicular tumors can cause hyperthyroidism)
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Chlorpheniramine and diphenhydramine
Prepatellar

50. What test would be best to determine if a gene is being transcribed? translated?
No
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Southern - western
Nonsense; mRNA processing