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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. Where does 90% of serotonin lie? What is this NT responsible?
Regular insulin (Not fast acting - regular better)
GI tract; mood!
SaO2 <92%
CMV - HSV 1 - Candida

2. What causes vertical diplopia? horizontal?
Trochlear nerve (IV); abducens nerve (VI)
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Chorda tympani branch
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

3. which has better side effect profile - SSRI or TCA?
SSRI
Trauma to stereociliated hair cells of the organ of corti
Increases cytokine production
No; yes

4. what enzyme converts procarcinogens into carcinogens?
Hereditary angioedema; ACE inhibitors
Bile soluble which means they are bile sensitive
P450 mitochondrial monooxygenase
Medullary

5. What is hypospadias caused by?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Strength of cell mediated immune response
Rabies encephalitis from cave bats; rabies killed vaccines
Abnormal closing of the urethral folds

6. What can cause aortic regurg? What is the heart sound you hear?
Increases cytokine production
Regular insulin (Not fast acting - regular better)
No (unlike adenomyosis); yes
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

7. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Sarcoid
Large stroke volumes with ventricular contraction; aortic regurg
Close but purkinje system to ensure contraction in a bottom up fashion
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

8. How is dobutamine better than dopamine?
In ER of bile canaliculi
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Well trained athletes and children
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

9. What are the three causes of acute MI in context of normal coronary arteries ?
Minimal change disease
GI malignancies and Insulin resistance (acromegal for ex)
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

10. why are pregnant predisposed to cholelithiasis?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
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
Chorda tympani branch

11. What does hypocapnia cause in teh brain? What is hypocapnia?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
HSV ( also in utero: chlymadia - neisseria - group B strep)
RBF= PAH clearance/(1- hematocrit)
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

12. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
46 - 4N; 23 2N
Brief psychotic disorder; schizophreniform; schizophrenia

13. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
No; MRI
By vascular permeability and vasodilation
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

14. what commonly happens in GI in response to acute physiologic stress?
Acute gastric mucosal defects (superficial or full thickness)
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
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
No (unlike adenomyosis); yes

15. What translocations can cause c - myc overexpression?
8 (myc protein) with 2 - 14 - 22 (iG chains)
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Protamine sulfate
Duration and extent of disease

16. What is diagnostic (and possible therapeutic for intussusception)?
Barium enema
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
MAC complex (C5b - C9 complement deficiency)
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

17. what organ would an activating mutation in PRPP synthetase effect?
Minimal change disease
chronic urticaria and allergic symptoms
Joints d/t increased purine production and thus uric acid production
Pain reliever - reduces pain by locking substance P in the PNS

18. What does protein M do in Group A strep<
Acute gastric mucosal defects (superficial or full thickness)
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)
Aromatase deficiency in child
Prevent phagocytosis

19. sporadic colon cancer tend to arise From what type of polyps?
Acute gastric mucosal defects (superficial or full thickness)
P53 mutation; AD
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Single adenomatous ones

20. What does VIP do to gastric acid secretion?
Inhibits it
Hydrogen bonds dictate alpha or beta structure
Lateral; RV; RA; LV
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

21. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Trochlear nerve (IV); abducens nerve (VI)
Relfex tachycardia; giving beta blockers
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

22. What is contraindicated in toxic mega colon?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Superior larygeal; cricothyroid; recurrent laryngeal
S. saprophyticus - and s. epidermidis; novobiocin
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

23. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
Vagus (auricular branch); vasovagal syncope!
Selective alpha 1 (increases SVR)
Sydenham chorea
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

24. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Paramyxo and influenza
8; 12
Octreotide
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

25. other than proteinuria - What can cause foamy froathy urine?
Bile salt accumulation in urine
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Well
Leukotriene precursor and does neutrophil chemotaxis

26. what clinical findings help distinguish small cell carcinoma?
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
S3 gallop; S2 to opening snap interval
Hypo or hyper pigmentations; after tanning
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

27. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
indomethacin
OCPs - multiparity - breast feeding
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

28. What does prolonged PT indicated? aPTT? bleeding time?
Squatting - sitting - lying supine - passive leg raising
Extrinsic def; instrinsic def; platelet def
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Medullary

29. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Rabies encephalitis from cave bats; rabies killed vaccines
Medial part

30. why is glucagon used in beta blocker toxicitiy?
frameshift mutations (missense is substitution)
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Kallmans
Increase by 50% in urine osmolality

31. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Medullary
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Drink plenty of fluids
Downs; regurgitant AV valves - ASDs

32. What causes release of myosin head from the actin filament?
200-500
ATP binding (resets the myosin head to contract again for next binding)
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
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

33. SIADH patients have normal blood volume but...
Acute interstitial nephritis
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
hyponatremia (aldosterone activation equilibrates body volume)

34. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Increase by 50% in urine osmolality
frameshift mutations (missense is substitution)
SS +rNA

35. What type of vision is myopia? In What type of patients does it improve?
<1% - 55% - concentration dependent
Vertical diplopia
Folic acid treatment!
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

36. What is the most common location of colonization of all s. aureus types?
Anterior nares
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)
SVC and IVC; right below the aortic knob
Radial nerve and deep brachial artery

37. What type of endocarditis is cytoscopy induced?
Covalent (between two cysteines)- allows protein to withstand denaturation
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Medullary
Enterococci (e. faecalis)- found on genitalia area

38. What is the stabilizing force for the secondary structure of proteins?
liver specific
Bile soluble which means they are bile sensitive
(urine PAH x urine flow rate)/plasma PAH
Hydrogen bonds dictate alpha or beta structure

39. What does NF- KB do?
IgE
Increases cytokine production
Measles and M3 AML`
transcription activation/suppression

40. 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)
Vancomycin; histamine mediated
Increase in permeability of two ions with equal and opposite equilibrium potentials
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

41. What antibiotic is best to treat alcoholic pulm infections? why?
Tibial
Mean greater than median greater than mode
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Syringomelia

42. Where is aromatase used?
Turners`
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

43. What is used to prevent vertical transmission of HIV?
Echinococcus granulosus; anaphylaxis
ZDV or AZT
No (unlike adenomyosis); yes
SVT; increases vagal tone; rectus abdominis

44. which antiarrythmic is associated with blue gray discoloration ?
Amiadarone
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Prepatellar
Tibial

45. other than increasing HDL levels - what else does niacin do?
Prevents hepatic VLDL production
Downs; regurgitant AV valves - ASDs
C3 decreased after 5-10 days; sulfonamides
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

46. What is intussusception? how does ischemia and necrosis occur?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
transcription activation/suppression
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
RBF= PAH clearance/(1- hematocrit)

47. within the right ventricle - What are maximum pressures? the pulm arter?
25; 25
Folic acid treatment!
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Barium enema

48. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
RR-1/RR
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Localized dermatologic pain that persists for more than one month after zoster eruption
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

49. What is the most common neurologic complication of VZV reactivation?
Localized dermatologic pain that persists for more than one month after zoster eruption
Faulty positioning of the genital tubercle
Bronchogenic carcinoma
Neisseria induced small cell vasculitis (including hands and soles)

50. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Because of vasodiation to skeletal muscles
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Anterior circumflex (and axillary nerve)
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR