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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 a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
S. saprophyticus - and s. epidermidis; novobiocin
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Recurrent larygneal
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

2. What is the most common location of colonization of all s. aureus types?
Anterior nares
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
women
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

3. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Ketone body production by preventing fatty acids into the mitochondria
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

4. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
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
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Hypothyroidism
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

5. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Reticulocytes
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Class I
Not lined by epithelium

6. What is epispadias caused by?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
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
Faulty positioning of the genital tubercle
No; yes

7. why is glucagon used in beta blocker toxicitiy?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
MAC complex (C5b - C9 complement deficiency)
46 - 4N; 23 2N
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

8. what receptors do first generation anti histamines block?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Multiple miscarriages d/t hypercoaguability
T test; chi squared
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

9. What is a cell surface marker seen in liver angiosarcoma?
chronic urticaria and allergic symptoms
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Integration of viral DNA into genome of host hepatocytes
DIC; TTP- HUS dont bleed that much

10. What are two common side effects of both acute and long acting nitrates? What causes them?
Headaches and facial flushing; vasodilation in meninges and skin
manifestations - congenital (stretching of periventricular pyrimadal fibers)
RR-1/RR
Elastance

11. what drugs causes the red man syndrome? how does it occur?
liver specific
Vancomycin; histamine mediated
Tzanck smear
Underestimation of gestational age

12. What is medullary sponge kidney disease and how does it present? What does it lead to?
Decreases both
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)
MAC complex (C5b - C9 complement deficiency)
46 - 4N; 23 2N

13. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
Inhaled animal dander allergens
transcription activation/suppression
Nonsense; mRNA processing
Reticulocytes

14. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Phencyclidine (PCP)
P450 mitochondrial monooxygenase
Dissolved in plasma and attached to Hgb
Ether and other organic solvents

15. biotin is used By what in tissues responsible for gluconeogenesis
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
As a CO2 carrier with the carboxylase enzyme
Fibronectin - laminin - collagen

16. there are mucus secreting cells in the bronchioles...
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Bronchial dilation (bronchiectasis)
Retinitis; mononucleosis
only up to bronchi

17. How do you explain the selective proteinuria of loss to albumin only in MCD?
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
Reiter syndrome; B27
Elevated GGT and macrocytosis
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

18. What can long term leg cast wearing cause?
Aromatase deficiency in child
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)
Fibronectin - laminin - collagen
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

19. 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?
No and yes
Common peroneal; bony fractures and compression; sciatic
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Ketone body production by preventing fatty acids into the mitochondria

20. how long is substance P? What does it do?
11 aa polypeptide; pain NT in CNS and PNS
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Reticulocytes
Tibial

21. What is tachyphylaxis?
Increased reticulocytes
The term used to describe decreased drug responsiveness with repeated administration
Increase in permeability of two ions with equal and opposite equilibrium potentials
Anti - apoptotic (prevents going into apoptosis)- 18; 14

22. What agonists reduce the gradient across the LV outflow tract?
Selective alpha 1 (increases SVR)
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
The LES is supposed to relax when food comes its way (from above) and in achalasia - a motor dysfunction - LES doesnt relax and seen as elevated pressure on the esophageal mannometry
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

23. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
Joints d/t increased purine production and thus uric acid production
Intussusception
Hyperkalemia; potassium sparing diuretics - potassium supplements
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

24. hypertonicity and hyperreflexity are ________________ of hydrocephalus
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Nonsense; mRNA processing
Increases cytokine production
manifestations - congenital (stretching of periventricular pyrimadal fibers)

25. what has the greatest effect on prognosis when treating c. diptheriae?
Vancomycin; histamine mediated
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Terminal bronchioles; small bronchi

26. what hormone is structurally similar to hCG?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
TSh (in testicular tumors can cause hyperthyroidism)

27. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Medial part
Kallmans
HSV ( also in utero: chlymadia - neisseria - group B strep)

28. which has better side effect profile - SSRI or TCA?
RBC mass; epo levels (secondary has high)
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Congenital hypothyroidism - downs - amyloidosis - acromegaly
SSRI

29. What is the immune deficinecy seen in ataxia telangactasia?
Chrom 8
MAO inhibitors; wine and cheese
Ig A deficiency
Clindamycin; covers anaerobic oral flora and aerobic bacteria

30. What pulmonary structural change can kartageners syndrome cause?
Bronchial dilation (bronchiectasis)
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
HSV ( also in utero: chlymadia - neisseria - group B strep)
Anti - apoptotic (prevents going into apoptosis)- 18; 14

31. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
In the extracellular space
Because of vasodiation to skeletal muscles
Gluteus maximus; difficulty getting up from seated position and climbing chair
Close but purkinje system to ensure contraction in a bottom up fashion

32. how does achalasia present? What does barium swallow show on dilated esophagus?
Normally close to systolic
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)
Increased reticulocytes
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

33. at 2 years of age - What are the social - fine motor - gross motor and language developments?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Chlorpheniramine and diphenhydramine
Joints d/t increased purine production and thus uric acid production
GI malignancies and Insulin resistance (acromegal for ex)

34. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
APP on chrom 21 (this is why downs more susceptible)
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Increase by 50% in urine osmolality
Susceptible; soluble (unable to be cultured in bile)

35. How can renal blood flow be calculated from RPF?
RBF= PAH clearance/(1- hematocrit)
SVC and IVC; right below the aortic knob
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

36. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
ZDV or AZT
SVC and IVC; right below the aortic knob
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

37. What three pathogens cause infectious esophagitis in HIV positive patients?
Vancomycin
Radial nerve and deep brachial artery
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
CMV - HSV 1 - Candida

38. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
No; yes
RER; copper
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
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)

39. carnitine deficiency impairs production of What and how?
Tissue redistribution (out of plasma) rather than metabolism
Circular - outside nucleus; transport proteins - rRNA - tRNA
only up to bronchi
Ketone body production by preventing fatty acids into the mitochondria

40. What is congestive hepatomegaly specific for?
Echinococcus granulosus; anaphylaxis
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Right heart failure
Spongiosis

41. What translocations can cause c - myc overexpression?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Anti centromere; anti DNA topoisomerase
8 (myc protein) with 2 - 14 - 22 (iG chains)
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

42. non ceruloplasmin deposition - ceruloplasmin is...
ATP binding (resets the myosin head to contract again for next binding)
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
low in serum

43. How do bradykinin - C3a and C5a cause edema?
By vascular permeability and vasodilation
Bile soluble which means they are bile sensitive
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Proteasome inhibitor; treatment for MM and waldenstroms

44. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
4 - 4 - 9
Myasthenia gravis
Skin flushing and warmth; prostaglandins; give with aspirin
P450 mitochondrial monooxygenase

45. What does prolonged PT indicated? aPTT? bleeding time?
Multiple miscarriages d/t hypercoaguability
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Extrinsic def; instrinsic def; platelet def
Barium enema

46. what phase do adenosine and acetylcholine act on? doing what?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Hexokinase
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

47. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
OCPs - multiparity - breast feeding
Classical conditioning
Normally close to systolic
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

48. when arrested in prophase of meiosis I - What are primary oocytes chrom number? What about the secondary oocytes that are stuck in metaphase of Meiosis II?
Downs; regurgitant AV valves - ASDs
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
46 - 4N; 23 2N
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics

49. 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
Nocardia
Bronchial dilation (bronchiectasis)
Close but purkinje system to ensure contraction in a bottom up fashion

50. do Class IC agents prolong the QT interval?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
indomethacin
No
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD