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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 cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
ZDV or AZT
Aromatase deficiency in child
Elastance
Large stroke volumes with ventricular contraction; aortic regurg

2. What is best to prevent GBS infection in a baby?
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
INTRApartum Abs (ampicillin/penicillin)
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
Vagus nerve stimulation

3. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
As a CO2 carrier with the carboxylase enzyme
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
RBC mass; epo levels (secondary has high)
TSh (in testicular tumors can cause hyperthyroidism)

4. h1 receptor anatagonists are not effective in treatment of asthma only for...
chronic urticaria and allergic symptoms
Increases
Medial part
liver specific

5. 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)
liver specific
frameshift mutations (missense is substitution)
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

6. which staphylococci can do mannitol fermaentation?
S. aureus
SVT; increases vagal tone; rectus abdominis
Neisseria induced small cell vasculitis (including hands and soles)
MAC complex (C5b - C9 complement deficiency)

7. What is the difference between additive and synergistic?
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
Retinitis; mononucleosis
DIC; TTP- HUS dont bleed that much
gram positive organisms

8. What causes release of myosin head from the actin filament?
ATP binding (resets the myosin head to contract again for next binding)
Hypothyroidism
Relfex tachycardia; giving beta blockers
T test; chi squared

9. What is a cell surface marker seen in liver angiosarcoma?
Because gamma chains replace beta chains and then gamma chain formation wanes
<1% - 55% - concentration dependent
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Radial nerve damage

10. What can cause virilization of a mother during pregnancy?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Aromatase deficiency in child
SVT; increases vagal tone; rectus abdominis

11. What does protein M do in Group A strep<
Prevents hepatic VLDL production
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Prevent phagocytosis
Ceftriaxone; azithromycin

12. metabolism of 1 gram of protein produces How many calories? carb? fat?
NF- KB; responsible for cytokine production
4 - 4 - 9
P53 mutation; DCC is also required for adenoma to carcinoma
Bile salt accumulation in urine

13. what drugs causes the red man syndrome? how does it occur?
Relfex tachycardia; giving beta blockers
Reticulocytes
RR-1/RR
Vancomycin; histamine mediated

14. What are pancreatic pseudocysts called pseudo rather than true cysts?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Phencyclidine (PCP)
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Not lined by epithelium

15. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
MAO inhibitors; wine and cheese
Measles and M3 AML`
The term used to describe decreased drug responsiveness with repeated administration
When it invades the bm; carcinoma in situ

16. What is the most common initital symptom of ADPKD? what else?
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
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Hypertension - edema - and proteinuria
Skin flushing and warmth; prostaglandins; give with aspirin

17. non ceruloplasmin deposition - ceruloplasmin is...
Syringomelia
low in serum
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Retinitis; mononucleosis

18. What is hyaline arteriosclerosis usually a sign of ?
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Sydenham chorea
Diabetic microangiopathy

19. nucleotide deletions do not cause missense mutations - they cause...
frameshift mutations (missense is substitution)
Covalent (between two cysteines)- allows protein to withstand denaturation
Tzanck smear
Coagulation factors are made in the liver

20. What is the mcc of elevated AFP leves in pregnancy>
Underestimation of gestational age
Medial circumflex artery; avascular necrosis
SSRI
Anti - apoptotic (prevents going into apoptosis)- 18; 14

21. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Gluteus medius and minimus; positive trendelenberg
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Folic acid treatment!
Env genes (for getting into target cells)

22. other than increasing HDL levels - what else does niacin do?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Prevents hepatic VLDL production
P53 mutation; DCC is also required for adenoma to carcinoma
Around 70 (normal measured diastolic pressures); 9--

23. SIADH patients have normal blood volume but...
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
hyponatremia (aldosterone activation equilibrates body volume)
RR-1/RR

24. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
Downs; regurgitant AV valves - ASDs
Strength of cell mediated immune response
Tibial
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

25. what should you think of in 'smear of an oral ulcer base'?
C3 decreased after 5-10 days; sulfonamides
women
G to T in p53; HCC
Tzanck smear

26. what receptors do first generation anti histamines block?
No (unlike adenomyosis); yes
Normal; low
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

27. What is hypospadias caused by?
Because of the low output from heart failure - they will have increased aldosterone levels
Sarcoid
Abnormal closing of the urethral folds
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

28. When is an S4 sound normal?
Turbulence
Inhibits it
Acute gastric mucosal defects (superficial or full thickness)
Well trained athletes and children

29. What is the most important prognostic indicator in patients with malignant melanoma?
E. coli
Measure of depth invasion (vertical!)
Brief psychotic disorder; schizophreniform; schizophrenia
Phencyclidine (PCP)

30. where are Beta 1 receptors found?
On cardiac tissue and renal juxtaglomerular cells
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Sickle cell; G6PD

31. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
Bile soluble which means they are bile sensitive
Hyperkalemia; potassium sparing diuretics - potassium supplements
Single adenomatous ones
Enterococci (e. faecalis)- found on genitalia area

32. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Terminal bronchioles; small bronchi
Radial nerve and deep brachial artery
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
S3 gallop; S2 to opening snap interval

33. where are the two classical places that the ulnar nerve can be injured?

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34. What can cause aortic regurg? What is the heart sound you hear?
Pain reliever - reduces pain by locking substance P in the PNS
Standing suddenly from supine position; valsalva maneuver
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Chlorpheniramine and diphenhydramine

35. What are the primary determinants of colon cancer risk in UC patients
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
DIC; TTP- HUS dont bleed that much
No (unlike adenomyosis); yes
Duration and extent of disease

36. What can too much IgA in serum produces?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
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
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

37. other than proteinuria - What can cause foamy froathy urine?
No
Boiling - bleach - formalin - UV irradiation
Bile salt accumulation in urine
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)

38. What does L/S stand for in fetal lung maturity? When does maturity occur?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Superior larygeal; cricothyroid; recurrent laryngeal
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Boiling - bleach - formalin - UV irradiation

39. where exactly is ACE expressed in the lungs? What type of enzyme is it?
Syringomelia
Vascular endothelium; protease
Relatively selective B1 adrenergic agonist; acute heart failure with decreased myocardial contractility (cardiogenic shock); increases myocardial contractility; can induce arrhythmias because increases cardiac conduction velocity
AV node slowest - to allow time for diastole

40. which RPGN is also called pauci immune GN? why?
Smoking
Paramyxo and influenza
ANCA because of lack of Ig and C3 deposits on IF
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics

41. What are examples of action that decrease venous return to the heart?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
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
Standing suddenly from supine position; valsalva maneuver

42. What is the most common neurologic complication of VZV reactivation?
Hypo or hyper pigmentations; after tanning
SSRI; erectile dysfunction
facultative intracellular
Localized dermatologic pain that persists for more than one month after zoster eruption

43. why does variocele occur more in left side?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
INTRApartum Abs (ampicillin/penicillin)
Protamine sulfate
MAC complex (C5b - C9 complement deficiency)

44. Where does lysyl oxidase act? What is the cofactor for that?
In the extracellular space for collagen cross linking; zinc
Tibial
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Env genes (for getting into target cells)

45. How do you calculate excretion rate of a substance? How do you calculate the filtration rate of a substance? clearance of what substance estimates the GFR?
Bronchogenic carcinoma
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
gram positive organisms

46. which nucleus releases serotonin?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Raphe
OCPs - multiparity - breast feeding
Acute interstitial nephritis

47. What are the two mcc of focal brain lesions in HIV positive patients?
V fib; v. failure
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
MAO inhibitors; wine and cheese

48. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Apocrine; eccrine
NF- KB; responsible for cytokine production
Elastance
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

49. What is used to treat heparin toxicity?
11 aa polypeptide; pain NT in CNS and PNS
Myasthenia gravis
Right heart failure
Protamine sulfate

50. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
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
Right before diastole (filling begins)
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
To pump calcium out in cardiac myocytes so that relaxation occurs