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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. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
Gluteus maximus; difficulty getting up from seated position and climbing chair
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
MAC complex (C5b - C9 complement deficiency)
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

2. What antibiotic is best to treat alcoholic pulm infections? why?
GI tract; mood!
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
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Vagus (auricular branch); vasovagal syncope!

3. What is the most important prognostic indicator in patients with malignant melanoma?
facultative intracellular
Measure of depth invasion (vertical!)
Insulin like growth factor 1 (just another name)
Abnormal closing of the urethral folds

4. What does TGF beta do? What produces it?
Fibrosis; macrophages
LT (LTD4 - E4 - C4) - and Ach
liver specific
The term used to describe decreased drug responsiveness with repeated administration

5. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
Adeno
OCPs - multiparity - breast feeding
Normally close to systolic
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

6. What does prolonged PT indicated? aPTT? bleeding time?
Classical conditioning
Extrinsic def; instrinsic def; platelet def
Prostate tumor and increased osteoclast activity
Close but purkinje system to ensure contraction in a bottom up fashion

7. which antiarrythmic is associated with blue gray discoloration ?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Amiadarone
Purkinje system; AV node
Decreases both

8. What pulmonary structural change can kartageners syndrome cause?
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Bronchial dilation (bronchiectasis)
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
Sarcoid

9. What is used to prevent vertical transmission of HIV?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Aromatase deficiency in child
indomethacin
ZDV or AZT

10. What is the most common location of colonization of all s. aureus types?
Folic acid treatment!
Fibronectin - laminin - collagen
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Anterior nares

11. In What type of nephritis would you see high serum eos count?
Hydrogen bonds dictate alpha or beta structure
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Drug induced interstitial nephritis
Intussusception

12. What does protein M do in Group A strep<
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Prevent phagocytosis
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Hereditary angioedema; ACE inhibitors

13. how does neisseria cause a petechial rash?
By vascular permeability and vasodilation
S. aureus
Neisseria induced small cell vasculitis (including hands and soles)
RER; RER

14. what induces bronchial squamous metaplasia?
Smoking
SaO2 <92%
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)
hyponatremia (aldosterone activation equilibrates body volume)

15. within the right atrium - What is the maximum pressure? left atrium?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Initiation - pointing; pincer grasp; walking; mama/dada
Sudden loss of muscle tone without loss of consciousness; narcolepsy
8; 12

16. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Hypertension - edema - and proteinuria
SVT; increases vagal tone; rectus abdominis
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

17. a patient fearing all white coats is a phenomenon of what?
Classical conditioning
Superior larygeal; cricothyroid; recurrent laryngeal
RR-1/RR
Terminal bronchioles; small bronchi

18. What is a keloid?
Excessive collagen formation during tissue repair in susceptible individuals
Terminal bronchioles; small bronchi
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
hyponatremia (aldosterone activation equilibrates body volume)

19. at four years of age - What are the social - fine motor - gross motor - and language developments?
Sickle cell; G6PD
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

20. What do you treat s. epidermidis with?
Vancomycin
SSRI; erectile dysfunction
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
SVC and IVC; right below the aortic knob

21. other than mycobacterim wha other bacteria is acid fast?
chronic urticaria and allergic symptoms
Leukotriene precursor and does neutrophil chemotaxis
Nocardia
S3 gallop; S2 to opening snap interval

22. What is the preferred treatment for DKA?
IgE
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
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
Regular insulin (Not fast acting - regular better)

23. What is Bortezomib and What is it used for?
Folic acid treatment!
Proteasome inhibitor; treatment for MM and waldenstroms
8; 12
Serum FFA and serum triglyceride levels

24. What are the two growth factors associated with angiogenesis?
Phencyclidine (PCP)
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
FGF and VEGF
Common peroneal; bony fractures and compression; sciatic

25. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
Underestimation of gestational age
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)
Headaches and facial flushing; vasodilation in meninges and skin
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

26. What is the most common cause of pyelonephritis in both adults and childre?
Anti cholinergic effects of pupil dilation and lack of accomodation
Localized dermatologic pain that persists for more than one month after zoster eruption
E. coli
only up to bronchi

27. what dissolves the lipid bilayer of a viral envelope?
S. saprophyticus - and s. epidermidis; novobiocin
Ether and other organic solvents
FGF and VEGF
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

28. What is the immune deficinecy seen in ataxia telangactasia?
RR-1/RR
Ig A deficiency
Serum FFA and serum triglyceride levels
Varying; erythema nodosum is common

29. what vessel would a fracture to the neck of the of the humerus damage?
Smoking
Anterior circumflex (and axillary nerve)
ATP binding (resets the myosin head to contract again for next binding)
The time interval between S2 and OS- the shorter the interval - the more intense

30. What are examples of action that decrease venous return to the heart?
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Reiter syndrome; B27
Standing suddenly from supine position; valsalva maneuver
Demargination of neutrophils from the vessel walls

31. What is pickwickian syndrome? What are the lab findings?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Ketone body production by preventing fatty acids into the mitochondria
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Dihydropyridine sensitive Ca channels (L type)

32. what protects the resting heart from arrhythmias?
Highly negative resting potential
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Adeno

33. What does hypocapnia cause in teh brain? What is hypocapnia?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Enterococci (e. faecalis)- found on genitalia area
In the extracellular space for collagen cross linking; zinc
Both sides

34. what protein is increased in Crohns disease? What does it do?
NF- KB; responsible for cytokine production
differentiate
Vertical diplopia
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

35. What would a deflection of the membrane potential to near zero indicate?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
SSRI
Increase in permeability of two ions with equal and opposite equilibrium potentials
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

36. which trisomy is associated with endocardial cushion defects? What does thsi mean>
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Downs; regurgitant AV valves - ASDs
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Hypo or hyper pigmentations; after tanning

37. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Selective alpha 1 (increases SVR)
As a CO2 carrier with the carboxylase enzyme
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Increased reticulocytes

38. 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
...
Ceftriaxone; azithromycin
Tissue redistribution (out of plasma) rather than metabolism

39. the rate of blood flow of which two circulations must equal each other at all times?
No; yes
Pulmonic and systemic!
Valproate
Coagulation factors are made in the liver

40. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Increase lymphatic drainage!
Leukotriene precursor and does neutrophil chemotaxis
Single adenomatous ones
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

41. 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
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Appetite suppressants
Increase in permeability of two ions with equal and opposite equilibrium potentials

42. Where does 90% of serotonin lie? What is this NT responsible?
Phencyclidine (PCP)
P450 mitochondrial monooxygenase
GI tract; mood!
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

43. What type of bond is a disulfide bond?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Purkinje system; AV node
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Covalent (between two cysteines)- allows protein to withstand denaturation

44. sporadic colon cancer tend to arise From what type of polyps?
Single adenomatous ones
Spongiosis
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
Underestimation of gestational age

45. Metronidizaole does not cover...
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Ceftriaxone; azithromycin
gram positive organisms
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

46. What is gardeners mydriasis? How is it treated?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Valproate
chronic urticaria and allergic symptoms

47. What is a cell surface marker seen in liver angiosarcoma?
S3 gallop; S2 to opening snap interval
Serum FFA and serum triglyceride levels
Increase by 50% in urine osmolality
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

48. h1 receptor anatagonists are not effective in treatment of asthma only for...
Fat - fertile - forty - female
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
chronic urticaria and allergic symptoms
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

49. other than proteinuria - What can cause foamy froathy urine?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Boiling - bleach - formalin - UV irradiation
Bile salt accumulation in urine
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

50. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Skin flushing and warmth; prostaglandins; give with aspirin
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