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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 are the potassium sparing diuretics?
Tissue redistribution (out of plasma) rather than metabolism
Medial part
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Amiloride - spironolactone - triamterene

2. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Turners`
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

3. who bleed more DIC or TTP- HUS patients?
low in serum
Increase; decreased
DIC; TTP- HUS dont bleed that much
S. aureus

4. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Chorda tympani branch
Right before diastole (filling begins)
Curlings ulcers

5. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
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
Classical conditioning
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
TCAs and prazosin

6. which two drug types can cause orthostatic hypotension (think depression and BPH)?
High potassium conductance and some sodium conductance
Hypo or hyper pigmentations; after tanning
TCAs and prazosin
<1% - 55% - concentration dependent

7. What is used to compare means? categorical outcomes?
Chrom 8
Appetite suppressants
T test; chi squared
AV node slowest - to allow time for diastole

8. Where does terminal peptide cleavage of collagen fibrils take place?
In the extracellular space
<1% - 55% - concentration dependent
women
Syringomelia

9. What is the most important prognostic indicator in patients with malignant melanoma?
Selective alpha 1 (increases SVR)
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Measure of depth invasion (vertical!)
I is more benign and can present later in adulthood

10. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
(urine PAH x urine flow rate)/plasma PAH
Think Hb deformation diseases
women

11. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
S. saprophyticus - and s. epidermidis; novobiocin
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Relfex tachycardia; giving beta blockers

12. What is the difference between additive and synergistic?
Barium enema
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
Gluteus maximus; difficulty getting up from seated position and climbing chair
Duration and extent of disease

13. In what view of CXR is anterior part of heart best seen? anterior part of heart is formed by?right border of heart is formed by? left border?
Lateral; RV; RA; LV
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
Aromatase deficiency in child
II; I (I more abundant)

14. what nerve and artery course along the posterior aspect of the humerus?
Rabies encephalitis from cave bats; rabies killed vaccines
Radial nerve and deep brachial artery
transcription activation/suppression
Adductor

15. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
HSV ( also in utero: chlymadia - neisseria - group B strep)
Increase lymphatic drainage!
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
The term used to describe decreased drug responsiveness with repeated administration

16. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
Amiloride - spironolactone - triamterene
Myasthenia gravis
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
P53 mutation; AD

17. Acyl coA synthetase is not...
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Curlings ulcers
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
liver specific

18. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
Diabetic microangiopathy
Skin flushing and warmth; prostaglandins; give with aspirin
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

19. What is the mcc of elevated AFP leves in pregnancy>
differentiate
Underestimation of gestational age
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Single adenomatous ones

20. 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
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Adeno
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

21. What is tachyphylaxis?
SSRI; erectile dysfunction
II; I (I more abundant)
Radial nerve and deep brachial artery
The term used to describe decreased drug responsiveness with repeated administration

22. what dictates the resting membrane potential of most cells?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Anti centromere; anti DNA topoisomerase
High potassium conductance and some sodium conductance

23. Which is slower AV node or ventricular muscle?
Localized dermatologic pain that persists for more than one month after zoster eruption
Multiple miscarriages d/t hypercoaguability
Reticulocytes
AV node slowest - to allow time for diastole

24. which staphylococci can do mannitol fermaentation?
S. aureus
RER; RER
Abnormal closing of the urethral folds
Primary

25. What does hypocapnia cause in teh brain? What is hypocapnia?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Vertical diplopia
T test; chi squared
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics

26. carnitine deficiency impairs production of What and how?
Ketone body production by preventing fatty acids into the mitochondria
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)
To pump calcium out in cardiac myocytes so that relaxation occurs
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

27. what has the greatest effect on prognosis when treating c. diptheriae?
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
T test; chi squared
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

28. What effects does cortisol have on catecholamines?
Become beta pleated and then form neurofibrillary tangle!
I is more benign and can present later in adulthood
Permissive - sensitizes vasoconstrictive response from catecholamines - doesnt actually act on them but increases transcription of some genes that creates permissive effect (not additive or synergistic becuase cortisol alone doesnt have any effect on
Primary

29. what would be a sign of absence of cardiogenic pulm edem?
Drug induced interstitial nephritis
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Increase lymphatic drainage!
Susceptible; soluble (unable to be cultured in bile)

30. which has better side effect profile - SSRI or TCA?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
G to T in p53; HCC
Well trained athletes and children
SSRI

31. What is the mc manifestation of CMV in HIV patient? immunocompetent?
Paramyxo and influenza
TCAs and prazosin
Prepatellar
Retinitis; mononucleosis

32. How do you treat gonococcal infection? chlymadia?
hyponatremia (aldosterone activation equilibrates body volume)
Prevents hepatic VLDL production
Ceftriaxone; azithromycin
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

33. erythema nodosum - elevated ACE - scattered granulomas - arthralgias - hilar lymphadenoapthy are indicative of what?
Sarcoid
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
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Highly negative resting potential

34. Would alpha 1 agonists cause flushing? muscarinic antagonist?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Syringomelia
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
No; yes

35. What test would be best to determine if a gene is being transcribed? translated?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Excessive collagen formation during tissue repair in susceptible individuals
The term used to describe decreased drug responsiveness with repeated administration
Southern - western

36. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
Brief psychotic disorder; schizophreniform; schizophrenia
Headaches and facial flushing; vasodilation in meninges and skin
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
RBF= PAH clearance/(1- hematocrit)

37. What is capsaicin? Where does it work?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
differentiate
SS +rNA
Pain reliever - reduces pain by locking substance P in the PNS

38. What is the diagnosis in delayed puberty plus anosmia?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
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
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Kallmans

39. What is epispadias caused by?
Faulty positioning of the genital tubercle
...
Hypertension - edema - and proteinuria
Hexokinase

40. What is the most common cause of pyelonephritis in both adults and childre?
By vascular permeability and vasodilation
E. coli
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Vagus nerve stimulation

41. at four years of age - What are the social - fine motor - gross motor - and language developments?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Vancomycin; histamine mediated
Turners`
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

42. what vessel would a fracture to the neck of the of the humerus damage?
Fibronectin - laminin - collagen
Think Hb deformation diseases
Anterior circumflex (and axillary nerve)
manifestations - congenital (stretching of periventricular pyrimadal fibers)

43. what defines hypoxemia?
SaO2 <92%
Serum creatine kinase; reperfusion injury causes necrosis
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
chronic urticaria and allergic symptoms

44. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
SS +rNA
Intussusception
25; 25
indomethacin

45. What is hyaline arteriosclerosis usually a sign of ?
Ether and other organic solvents
8; 12
Diabetic microangiopathy
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

46. What is capacitance inversely proportional to?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Headaches and facial flushing; vasodilation in meninges and skin
Elastance
Fibronectin - laminin - collagen

47. IL4 is used for isotypye switching to what?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
IgE
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
No and yes

48. are there signs of inflammation in avascular necrosis? then How do you diagnose?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
No; MRI
Fibrosis; macrophages
Turners`

49. on What part of the clavicle does the SCM attach?
Covalent (between two cysteines)- allows protein to withstand denaturation
Medial part
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

50. What is mcc of death pre hospital phase of MI? in hospital phase?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Paramyxo and influenza
V fib; v. failure
RBC mass; epo levels (secondary has high)