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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 test would be best to determine if a gene is being transcribed? translated?
Standing suddenly from supine position; valsalva maneuver
Prostate tumor and increased osteoclast activity
Prevent phagocytosis
Southern - western

2. What is a cord factor and Which bugs have it? How do they appear on culture?
Normally close to systolic
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Become beta pleated and then form neurofibrillary tangle!
ANCA because of lack of Ig and C3 deposits on IF

3. In what view of CXR is anterior part of heart best seen? anterior part of heart is formed by?right border of heart is formed by? left border?
gram positive organisms
Lateral; RV; RA; LV
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Sarcoid

4. In What type of nephritis would you see high serum eos count?
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
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Drug induced interstitial nephritis
Medial circumflex artery; avascular necrosis

5. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
P53 mutation; AD
Normal; low
Hyperkalemia; potassium sparing diuretics - potassium supplements
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

6. What is the preferred treatment for DKA?
Regular insulin (Not fast acting - regular better)
Multiple miscarriages d/t hypercoaguability
differentiate
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

7. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
SS +rNA
25; 25
CGD; t cell dysfxn (diGeorge)
Echinococcus granulosus; anaphylaxis

8. What is used to prevent vertical transmission of HIV?
ZDV or AZT
TSh (in testicular tumors can cause hyperthyroidism)
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Susceptible; soluble (unable to be cultured in bile)

9. What is normal fibrinogen levels?
200-500
Class I
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

10. which antiarrythmic is associated with blue gray discoloration ?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
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)
Amiadarone
Ig A deficiency

11. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
Mean greater than median greater than mode
only up to bronchi
Hydrogen bonds dictate alpha or beta structure
Myasthenia gravis

12. why does liver dysfunction cause coagulation disorders?
Fibrosis; macrophages
MAC complex (C5b - C9 complement deficiency)
In the extracellular space for collagen cross linking; zinc
Coagulation factors are made in the liver

13. What causes release of myosin head from the actin filament?
ATP binding (resets the myosin head to contract again for next binding)
Dissolved in plasma and attached to Hgb
T test; chi squared
Increased reticulocytes

14. What would a deflection of the membrane potential to near zero indicate?
Increase in permeability of two ions with equal and opposite equilibrium potentials
Large stroke volumes with ventricular contraction; aortic regurg
Southern - western
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

15. other than proteinuria - What can cause foamy froathy urine?
chronic urticaria and allergic symptoms
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Bile salt accumulation in urine

16. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
women
Increases
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

17. which nerve provides innervation for plantar flexion and inversion?
Tibial
Ether and other organic solvents
Inhaled animal dander allergens
Excessive collagen formation during tissue repair in susceptible individuals

18. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
Hypertension - edema - and proteinuria
Increase in permeability of two ions with equal and opposite equilibrium potentials
CMV - HSV 1 - Candida
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics

19. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
SVC and IVC; right below the aortic knob
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
P53 mutation; DCC is also required for adenoma to carcinoma
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

20. What is easiest way to treat nephrolithiasis?
Regular insulin (Not fast acting - regular better)
Drink plenty of fluids
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

21. What do you treat s. epidermidis with?
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
Vancomycin
frameshift mutations (missense is substitution)
Prepatellar

22. What pulmonary structural change can kartageners syndrome cause?
In the extracellular space for collagen cross linking; zinc
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Bronchial dilation (bronchiectasis)
DIC; TTP- HUS dont bleed that much

23. What is tachyphylaxis?
4 - 4 - 9
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Mean greater than median greater than mode
The term used to describe decreased drug responsiveness with repeated administration

24. How can renal blood flow be calculated from RPF?
Well
Southern - western
RBF= PAH clearance/(1- hematocrit)
Trauma to stereociliated hair cells of the organ of corti

25. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
Fibrosis; macrophages
APP on chrom 21 (this is why downs more susceptible)
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

26. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Increased reticulocytes
Amiadarone
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

27. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Spongiosis
Reticulocytes
Hypo or hyper pigmentations; after tanning
Diabetic microangiopathy

28. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
MAC complex (C5b - C9 complement deficiency)
Decreases both
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

29. What is the sole neurologic manifestation of acute rheumatic fever?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
By vascular permeability and vasodilation
Sydenham chorea
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

30. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
Chlorpheniramine and diphenhydramine
gram positive organisms
MAO inhibitors; wine and cheese
Sickle cell; G6PD

31. Where does terminal peptide cleavage of collagen fibrils take place?
In the extracellular space
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Rabies encephalitis from cave bats; rabies killed vaccines
indomethacin

32. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
Susceptible; soluble (unable to be cultured in bile)
DIC; TTP- HUS dont bleed that much
differentiate
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

33. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
transcription activation/suppression
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
E. coli
Class I

34. What is a primary HSV 1 infection like?
Drink plenty of fluids
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Varying; erythema nodosum is common

35. What is the neurologic manifestation of ADPKD?
Pain reliever - reduces pain by locking substance P in the PNS
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Adductor

36. which nucleus releases serotonin?
Raphe
OCPs - multiparity - breast feeding
8 (myc protein) with 2 - 14 - 22 (iG chains)
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

37. what would be a sign of absence of cardiogenic pulm edem?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Measure of depth invasion (vertical!)
glycerol kinase

38. What is cataplexy and When is it seen?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Sudden loss of muscle tone without loss of consciousness; narcolepsy
GI malignancies and Insulin resistance (acromegal for ex)

39. ___________ is liver specific
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
T test; chi squared
glycerol kinase
Classical conditioning

40. what immune deficiency causes recurrent neisseria infections?
Adductor
Skin flushing and warmth; prostaglandins; give with aspirin
MAC complex (C5b - C9 complement deficiency)
Joints d/t increased purine production and thus uric acid production

41. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
APP on chrom 21 (this is why downs more susceptible)
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
Minimal change disease
GI tract; mood!

42. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
Vagus (auricular branch); vasovagal syncope!
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
INTRApartum Abs (ampicillin/penicillin)
The time interval between S2 and OS- the shorter the interval - the more intense

43. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
transcription activation/suppression
liver specific
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
indomethacin

44. which two virus families have hemagluttinin on their surface?
Vancomycin
SSRI
Paramyxo and influenza
Retinitis; mononucleosis

45. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Adductor
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
The time interval between S2 and OS- the shorter the interval - the more intense

46. is Rifampin ever used as monotherapY? why either way?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
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
ATP binding (resets the myosin head to contract again for next binding)
Neisseria induced small cell vasculitis (including hands and soles)

47. What are the two coagulase negative staphylococci? How do you distinguish them?
S. saprophyticus - and s. epidermidis; novobiocin
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Close but purkinje system to ensure contraction in a bottom up fashion

48. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Relfex tachycardia; giving beta blockers
Amiadarone
Because gamma chains replace beta chains and then gamma chain formation wanes

49. What does L/S stand for in fetal lung maturity? When does maturity occur?
Neisseria induced small cell vasculitis (including hands and soles)
Gluteus maximus; difficulty getting up from seated position and climbing chair
Pulmonary hypertension
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

50. What does glycosylase do to DNA? endonuclease? lyase? What does the order here of enzymes represent? what other enzymes are needed?

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