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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 composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
SVC and IVC; right below the aortic knob
...
Vancomycin
Anterior circumflex (and axillary nerve)

2. What is the mcc of extrinsic allergic asthma?
Inhaled animal dander allergens
H. influenzae type B; polyribosyl phosphate (PRP); cherry red uvula - dysphagia - stridor (sometimes) - difficulty breathing - fever - drooling - positive 'thumbs up sign' on lateral xray of cervical region d/t swollen epiglottis
...
Chrom 8

3. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
II; I (I more abundant)
OCPs - multiparity - breast feeding

4. neisseria are...
Nocardia
facultative intracellular
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Trauma to stereociliated hair cells of the organ of corti

5. What is the mc manifestation of CMV in HIV patient? immunocompetent?
IgE
Aromatase deficiency in child
Paramyxo and influenza
Retinitis; mononucleosis

6. what dissolves the lipid bilayer of a viral envelope?
<1% - 55% - concentration dependent
Ether and other organic solvents
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Measles and M3 AML`

7. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Nonsense; mRNA processing
Hyperkalemia; potassium sparing diuretics - potassium supplements
IgE
High potassium conductance and some sodium conductance

8. What are the acute effects of corticosteroids on the CBC?
APP on chrom 21 (this is why downs more susceptible)
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Hydrogen bonds dictate alpha or beta structure

9. non ceruloplasmin deposition - ceruloplasmin is...
Regular insulin (Not fast acting - regular better)
LT (LTD4 - E4 - C4) - and Ach
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
low in serum

10. what defines hypoxemia?
SaO2 <92%
II; I (I more abundant)
Protamine sulfate
P53 mutation; AD

11. What effects does cortisol have on catecholamines?
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
Raphe
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
To pump calcium out in cardiac myocytes so that relaxation occurs

12. When does opening snap begin?
Right before diastole (filling begins)
Echinococcus granulosus; anaphylaxis
Prevents hepatic VLDL production
Serum FFA and serum triglyceride levels

13. how long is substance P? What does it do?
25; 25
11 aa polypeptide; pain NT in CNS and PNS
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
The term used to describe decreased drug responsiveness with repeated administration

14. which has better side effect profile - SSRI or TCA?
Hypothyroidism
Another type of aldosterone antagonist (like spironolactone)
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
SSRI

15. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
V fib; v. failure
When it invades the bm; carcinoma in situ
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

16. hypertonicity and hyperreflexity are ________________ of hydrocephalus
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Dissolved in plasma and attached to Hgb
MAO inhibitors; wine and cheese
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

17. what vessel would a fracture to the neck of the of the humerus damage?
Anterior circumflex (and axillary nerve)
Initiation - pointing; pincer grasp; walking; mama/dada
Normal; low
E6 and E7 of HPV knock off p53 and Rb suppressor genes

18. What does extended consumption of appetite suppressants lead to?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Pulmonary hypertension
Aromatase deficiency in child

19. What is tachyphylaxis?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Radial nerve and deep brachial artery
Skin flushing and warmth; prostaglandins; give with aspirin
The term used to describe decreased drug responsiveness with repeated administration

20. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Hereditary angioedema; ACE inhibitors
Ether and other organic solvents
MAO inhibitors; wine and cheese
...

21. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
Tzanck smear
Hypo or hyper pigmentations; after tanning
C3 decreased after 5-10 days; sulfonamides
Regular insulin (Not fast acting - regular better)

22. 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?
Abnormal closing of the urethral folds
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Lateral; RV; RA; LV
Increases bronchial and vascular smooth muscle reactivity to catecholamines

23. a patient fearing all white coats is a phenomenon of what?
gram positive organisms
Drug induced interstitial nephritis
Classical conditioning
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

24. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Large stroke volumes with ventricular contraction; aortic regurg
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Susceptible; soluble (unable to be cultured in bile)

25. What can cause virilization of a mother during pregnancy?
Measure of depth invasion (vertical!)
Aromatase deficiency in child
Fat - fertile - forty - female
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

26. What is difference between Arnold Chiari type I and II?
I is more benign and can present later in adulthood
Increase in permeability of two ions with equal and opposite equilibrium potentials
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
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

27. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
HSV ( also in utero: chlymadia - neisseria - group B strep)
Southern - western
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

28. What is an abortive viral infection?
Pain reliever - reduces pain by locking substance P in the PNS
Little effect on cell and no change
Congenital hypothyroidism - downs - amyloidosis - acromegaly
V fib; v. failure

29. What is easiest way to treat nephrolithiasis?
HSV and VZV
Serum creatine kinase; reperfusion injury causes necrosis
Lateral; RV; RA; LV
Drink plenty of fluids

30. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Env genes (for getting into target cells)
Turners`
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

31. What is diagnostic (and possible therapeutic for intussusception)?
Valproate
Barium enema
8; 12
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

32. What is a cell surface marker seen in liver angiosarcoma?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
No
Become beta pleated and then form neurofibrillary tangle!
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

33. where are Beta 1 receptors found?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
When it invades the bm; carcinoma in situ
On cardiac tissue and renal juxtaglomerular cells
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

34. which opponens muscle does ulnar innervate?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Adductor
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

35. What is the presentation of angioedema? Where is most commonly affected?
Demargination of neutrophils from the vessel walls
Leukotriene precursor and does neutrophil chemotaxis
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Elastance

36. What is the cause of fixed splitting of S2? why?
Increase in permeability of two ions with equal and opposite equilibrium potentials
Hydrogen bonds dictate alpha or beta structure
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Purkinje system; AV node

37. carnitine deficiency impairs production of What and how?
Ketone body production by preventing fatty acids into the mitochondria
The term used to describe decreased drug responsiveness with repeated administration
frameshift mutations (missense is substitution)
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

38. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
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
MAC complex (C5b - C9 complement deficiency)
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
transcription activation/suppression

39. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
Medial part
8; 12
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Increase; decreased

40. why should you not use ACE inhibitors with someone who had hereditary angioedema?
Tibial
11
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
Pulmonic and systemic!

41. What is the most common initital symptom of ADPKD? what else?
Right heart failure
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Underestimation of gestational age

42. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Biphosphonate
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
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

43. What are the two coagulase negative staphylococci? How do you distinguish them?
T test; chi squared
S. saprophyticus - and s. epidermidis; novobiocin
Nocardia
Turbulence

44. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Southern - western
CGD; t cell dysfxn (diGeorge)
CMV - HSV 1 - Candida

45. 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?
Leukotriene precursor and does neutrophil chemotaxis
Joints d/t increased purine production and thus uric acid production
Hexokinase
46 - 4N; 23 2N

46. which are the only glycosylated proteins in HIV virus?
PDA open
In ER of bile canaliculi
Env genes (for getting into target cells)
glycerol kinase

47. at 2 years of age - What are the social - fine motor - gross motor and language developments?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Env genes (for getting into target cells)
INTRApartum Abs (ampicillin/penicillin)

48. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
P53 mutation; AD
Normal; low
Large stroke volumes with ventricular contraction; aortic regurg
Congenital hypothyroidism - downs - amyloidosis - acromegaly

49. what chromosome is c - myc found on?
Proteasome inhibitor; treatment for MM and waldenstroms
Chrom 8
Elastance
Rare complication of measles (years later)- thought to be d/t certain type that doesnt have surface M protein antigen so goes unseen into CNS

50. What is gardeners mydriasis? How is it treated?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities