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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 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
RER; copper
The time interval between S2 and OS- the shorter the interval - the more intense
Barium enema

2. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
Squatting - sitting - lying supine - passive leg raising
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
differentiate
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

3. why should you not use ACE inhibitors with someone who had hereditary angioedema?
transcription activation/suppression
Amiloride - spironolactone - triamterene
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
Increase; decreased

4. How do you treat gonococcal infection? chlymadia?
Standing suddenly from supine position; valsalva maneuver
Demargination of neutrophils from the vessel walls
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Ceftriaxone; azithromycin

5. What is the neurologic manifestation of ADPKD?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Prevent phagocytosis
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
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

6. What is the mc manifestation of CMV in HIV patient? immunocompetent?
Right before diastole (filling begins)
Become beta pleated and then form neurofibrillary tangle!
Retinitis; mononucleosis
Gluteus medius and minimus; positive trendelenberg

7. What is somatomedin C?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Gluteus maximus; difficulty getting up from seated position and climbing chair
Chrom 8
Insulin like growth factor 1 (just another name)

8. What is medullary sponge kidney disease and how does it present? What does it lead to?
Increase lymphatic drainage!
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)
Brief psychotic disorder; schizophreniform; schizophrenia
ST become atrophic and hyalinized (temp induced damage) and depressed sperm count becuase of that; hormonal function not impaired (test and LH levels normal) because Leydig cells not as temp sensitive so secondary sexual characteristics and sexual pe

9. What is the mcc of extrinsic allergic asthma?
Chorda tympani branch
Thymic tumor
Inhaled animal dander allergens
CGD; t cell dysfxn (diGeorge)

10. What triggers the neoplastic changes that are associated with HBV infecton?
Integration of viral DNA into genome of host hepatocytes
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
(urine PAH x urine flow rate)/plasma PAH
Kallmans

11. How do you explain the selective proteinuria of loss to albumin only in MCD?
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)
Appetite suppressants
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
ANCA because of lack of Ig and C3 deposits on IF

12. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
(urine PAH x urine flow rate)/plasma PAH
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Smoking

13. which antiarrythmic is associated with blue gray discoloration ?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Amiadarone
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Myasthenia gravis

14. How do bradykinin - C3a and C5a cause edema?
Folic acid treatment!
gram positive organisms
By vascular permeability and vasodilation
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

15. What are the primary determinants of colon cancer risk in UC patients
Duration and extent of disease
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Excessive collagen formation during tissue repair in susceptible individuals
Turbulence

16. What is a keloid?
Dihydropyridine sensitive Ca channels (L type)
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Vancomycin; histamine mediated
Excessive collagen formation during tissue repair in susceptible individuals

17. What type of vision is myopia? In What type of patients does it improve?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
V fib; v. failure
Both sides
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

18. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
Single adenomatous ones
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
RER; copper
Highly negative resting potential

19. What is the diagnosis in delayed puberty plus anosmia?
Kallmans
Curlings ulcers
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

20. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
8 (myc protein) with 2 - 14 - 22 (iG chains)
Rabies encephalitis from cave bats; rabies killed vaccines
Pain reliever - reduces pain by locking substance P in the PNS
Squatting - sitting - lying supine - passive leg raising

21. What agonists reduce the gradient across the LV outflow tract?
IgE
Selective alpha 1 (increases SVR)
OCPs - multiparity - breast feeding
Large stroke volumes with ventricular contraction; aortic regurg

22. What is the most common cause of pyelonephritis in both adults and childre?
Trochlear nerve (IV); abducens nerve (VI)
glycerol kinase
Pan colitis and right sided colitis (more than left sided and proctitis)
E. coli

23. why are pregnant predisposed to cholelithiasis?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
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
Boiling - bleach - formalin - UV irradiation
Radial nerve and deep brachial artery

24. what drugs causes the red man syndrome? how does it occur?
TCAs and prazosin
8 (myc protein) with 2 - 14 - 22 (iG chains)
Vancomycin; histamine mediated
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

25. What is Bortezomib and What is it used for?
HSV ( also in utero: chlymadia - neisseria - group B strep)
Tibial
low in serum
Proteasome inhibitor; treatment for MM and waldenstroms

26. What is normal fibrinogen levels?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Intussusception
200-500

27. What is the best indicator for the severity of mitral stenosis?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
The time interval between S2 and OS- the shorter the interval - the more intense
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Inactivates kallikrein which activates kininogen into bradykinin

28. why does liver dysfunction cause coagulation disorders?
NF- KB; responsible for cytokine production
Coagulation factors are made in the liver
Ceftriaxone; azithromycin
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

29. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
MAO inhibitors; wine and cheese
Normally close to systolic
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Highly negative resting potential

30. What can worse neurologic dysfunction in cobalamic def?
Ketone body production by preventing fatty acids into the mitochondria
The term used to describe decreased drug responsiveness with repeated administration
Anterior nares
Folic acid treatment!

31. What is omalizumab and What is it used for?
Proteasome inhibitor; treatment for MM and waldenstroms
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Both sides

32. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Gluteus medius and minimus; positive trendelenberg
Measles and M3 AML`
Medullary
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

33. 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?
Increase by 50% in urine osmolality
Relfex tachycardia; giving beta blockers
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Adeno

34. How is dobutamine better than dopamine?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
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
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Elevated GGT and macrocytosis

35. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
When it invades the bm; carcinoma in situ
Extrinsic def; instrinsic def; platelet def

36. Where is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
women
Well trained athletes and children
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

37. What is achalasia and how would this correlate on the esophageal mannometry?
High potassium conductance and some sodium conductance
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
Squatting - sitting - lying supine - passive leg raising
Because gamma chains replace beta chains and then gamma chain formation wanes

38. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
Hypertension - edema - and proteinuria
Chlorpheniramine and diphenhydramine
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

39. What is the triad seen in pre eclampsia?
Hypertension - edema - and proteinuria
P450 mitochondrial monooxygenase
Adeno
Anterior nares

40. What does TGF beta do? What produces it?
Minimal change disease
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
200-500
Fibrosis; macrophages

41. what induces bronchial squamous metaplasia?
Smoking
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
Underestimation of gestational age
Initiation - pointing; pincer grasp; walking; mama/dada

42. what vessel would a fracture to the neck of the of the humerus damage?
low in serum
11 aa polypeptide; pain NT in CNS and PNS
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Anterior circumflex (and axillary nerve)

43. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
IgE
Single adenomatous ones
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

44. What is suggestive of complete central DI?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Increase by 50% in urine osmolality
Syncope - angina - dyspnea (SAD)
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)

45. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
RER; copper
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

46. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
Highly negative resting potential
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Ether and other organic solvents
Not lined by epithelium

47. What are the first generation anti histamines?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Chlorpheniramine and diphenhydramine
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

48. What are the skin presentation in sarcoid?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
To pump calcium out in cardiac myocytes so that relaxation occurs
Smoking
Varying; erythema nodosum is common

49. What is the presentation of angioedema? Where is most commonly affected?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Strength of cell mediated immune response
Think Hb deformation diseases
Measles and M3 AML`

50. What test would be best to determine if a gene is being transcribed? translated?
Southern - western
Syringomelia
V fib; v. failure
(urine PAH x urine flow rate)/plasma PAH