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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 triggers the neoplastic changes that are associated with HBV infecton?
Hereditary angioedema; ACE inhibitors
The term used to describe decreased drug responsiveness with repeated administration
Integration of viral DNA into genome of host hepatocytes
Because of vasodiation to skeletal muscles

2. are there signs of inflammation in avascular necrosis? then How do you diagnose?
Terminal bronchioles; small bronchi
Skin flushing and warmth; prostaglandins; give with aspirin
No; MRI
Prevents hepatic VLDL production

3. What is cataplexy and When is it seen?
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
Chlorpheniramine and diphenhydramine
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Sudden loss of muscle tone without loss of consciousness; narcolepsy

4. What are the skin presentation in sarcoid?
Skin flushing and warmth; prostaglandins; give with aspirin
Varying; erythema nodosum is common
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Reticulocytes

5. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Hypo or hyper pigmentations; after tanning
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)
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

6. What is hypospadias caused by?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Lateral; RV; RA; LV
Abnormal closing of the urethral folds
<1% - 55% - concentration dependent

7. What is the cause of fixed splitting of S2? why?
Underestimation of gestational age
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

8. what organ would an activating mutation in PRPP synthetase effect?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Vagus nerve stimulation
Hypothyroidism
Joints d/t increased purine production and thus uric acid production

9. What is normal fibrinogen levels?
200-500
Appetite suppressants
Amiadarone
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

10. What do you treat s. epidermidis with?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Class I
Vancomycin
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

11. carnitine deficiency impairs production of What and how?
Kallmans
Ketone body production by preventing fatty acids into the mitochondria
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Around 70 (normal measured diastolic pressures); 9--

12. What does anti phospholipid syndrome in SLE patients predispose them to?
Multiple miscarriages d/t hypercoaguability
...
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Increase by 50% in urine osmolality

13. h1 receptor anatagonists are not effective in treatment of asthma only for...
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
chronic urticaria and allergic symptoms
Congenital hypothyroidism - downs - amyloidosis - acromegaly
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

14. at 2 years of age - What are the social - fine motor - gross motor and language developments?
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
Enterococci (e. faecalis)- found on genitalia area
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Measure of depth invasion (vertical!)

15. What is best to prevent GBS infection in a baby?
Large stroke volumes with ventricular contraction; aortic regurg
INTRApartum Abs (ampicillin/penicillin)
OCPs - multiparity - breast feeding
Because of vasodiation to skeletal muscles

16. nucleotide deletions do not cause missense mutations - they cause...
Fat - fertile - forty - female
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
frameshift mutations (missense is substitution)
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

17. What are the three causes of acute MI in context of normal coronary arteries ?
SVC and IVC; right below the aortic knob
Vertical diplopia
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
To pump calcium out in cardiac myocytes so that relaxation occurs

18. What antibiotic is best to treat alcoholic pulm infections? why?
Well
TCAs and prazosin
Smoking
Clindamycin; covers anaerobic oral flora and aerobic bacteria

19. why does variocele occur more in left side?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Because of the low output from heart failure - they will have increased aldosterone levels

20. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Vancomycin; histamine mediated
Protamine sulfate
Mean greater than median greater than mode

21. What does prolonged PT indicated? aPTT? bleeding time?
Radial nerve damage
Hexokinase
Extrinsic def; instrinsic def; platelet def
The term used to describe decreased drug responsiveness with repeated administration

22. What can cause virilization of a mother during pregnancy?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Southern - western
Varying; erythema nodosum is common
Aromatase deficiency in child

23. What is the mcc of extrinsic allergic asthma?
Radial nerve damage
Inhaled animal dander allergens
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Localized dermatologic pain that persists for more than one month after zoster eruption

24. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
only up to bronchi
RBC mass; epo levels (secondary has high)
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Appetite suppressants

25. Where does the aorta lie in relation to the pulmonary artery in transposition of the great arteries (is this right to left or left to right shunt?)?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
OCPs - multiparity - breast feeding
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)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

26. within the right atrium - What is the maximum pressure? left atrium?
Covalent (between two cysteines)- allows protein to withstand denaturation
8; 12
Varying; erythema nodosum is common
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

27. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Retinitis; mononucleosis
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
ZDV or AZT
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

28. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Reiter syndrome; B27
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
transcription activation/suppression
Southern - western

29. What are the potassium sparing diuretics?
Reiter syndrome; B27
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Amiloride - spironolactone - triamterene
Valproate

30. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Boiling - bleach - formalin - UV irradiation
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

31. What causes the blurry vision side effects in first generation anti histamines?
Classical conditioning
Anti cholinergic effects of pupil dilation and lack of accomodation
Octreotide
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

32. If a patient has higher levels of HbF - What does this mean?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Think Hb deformation diseases
Excessive collagen formation during tissue repair in susceptible individuals
Right heart failure

33. What is used to compare means? categorical outcomes?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
T test; chi squared
Radial nerve damage
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

34. What is omalizumab and What is it used for?
Normally close to systolic
Sydenham chorea
Boiling - bleach - formalin - UV irradiation
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

35. What is the immune deficinecy seen in ataxia telangactasia?
Reticulocytes
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
Ig A deficiency
Fat - fertile - forty - female

36. which two virus families have hemagluttinin on their surface?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Not lined by epithelium
Reticulocytes
Paramyxo and influenza

37. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Medullary
Another type of aldosterone antagonist (like spironolactone)
Raphe
Curlings ulcers

38. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
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)
Minimal change disease
Prevent phagocytosis
Right before diastole (filling begins)

39. In what population does cholelithiasis occur?
Excessive collagen formation during tissue repair in susceptible individuals
Fat - fertile - forty - female
Prevents hepatic VLDL production
Rabies encephalitis from cave bats; rabies killed vaccines

40. what dissolves the lipid bilayer of a viral envelope?
Bile salt accumulation in urine
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Anti cholinergic effects of pupil dilation and lack of accomodation
Ether and other organic solvents

41. how can HAV be inactivated?
Drink plenty of fluids
gram positive organisms
Boiling - bleach - formalin - UV irradiation
Prepatellar

42. what phase do adenosine and acetylcholine act on? doing what?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
11
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

43. what hernia has a similar mechanism to hydrocele?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Hereditary angioedema; ACE inhibitors
No; yes
Increase lymphatic drainage!

44. 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?
Regular insulin (Not fast acting - regular better)
Decreases both
Sickle cell; G6PD
Common peroneal; bony fractures and compression; sciatic

45. which cells produce surfactant? which ones mediate gas exchange?
II; I (I more abundant)
Chrom 8
Close but purkinje system to ensure contraction in a bottom up fashion
E. coli

46. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Inhaled animal dander allergens
Not lined by epithelium
Vagus (auricular branch); vasovagal syncope!

47. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
E. coli
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
transcription activation/suppression
Clindamycin; covers anaerobic oral flora and aerobic bacteria

48. What is used to prevent vertical transmission of HIV?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Hyperkalemia; potassium sparing diuretics - potassium supplements
ZDV or AZT
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)

49. What does sustained hand grip do to the C/V system?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Serum FFA and serum triglyceride levels

50. What are the primary determinants of colon cancer risk in UC patients
Diabetic microangiopathy
Duration and extent of disease
Myasthenia gravis
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone