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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. how long is substance P? What does it do?
SSRI; erectile dysfunction
Anti - apoptotic (prevents going into apoptosis)- 18; 14
11 aa polypeptide; pain NT in CNS and PNS
Rabies encephalitis from cave bats; rabies killed vaccines

2. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Dihydropyridine sensitive Ca channels (L type)
IgE
HSV ( also in utero: chlymadia - neisseria - group B strep)
Well

3. What would a deflection of the membrane potential to near zero indicate?
Because of the low output from heart failure - they will have increased aldosterone levels
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
OCPs - multiparity - breast feeding
Increase in permeability of two ions with equal and opposite equilibrium potentials

4. why are beta thal major patients asymptomatic at birth?
PDA open
Pulmonary hypertension
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Because gamma chains replace beta chains and then gamma chain formation wanes

5. What type of bond is a disulfide bond?
Covalent (between two cysteines)- allows protein to withstand denaturation
Sydenham chorea
Atrial
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

6. What is diphenoxylate and What is it used for? what drug is it structurally similar to? What allows for potent anti diarrheal effect without signigicant opiate effects?
Varying; erythema nodosum is common
Opiate anti diarrheal that binds to mu opiate receptors in GI tract and slows motility; meperidine; low doses - but therapeutic doses combined with atropine (under marked brand name lomotil)
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

7. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Kallmans
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Highly negative resting potential

8. which type of glands produce an initially odorless secretion but can become malodorous secondary to bacterial decompisition on the skin surface? which glands are present throughout the skin except on lips and glans penis?
Sarcoid
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Bronchogenic carcinoma
Apocrine; eccrine

9. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
differentiate
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
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)
Underestimation of gestational age

10. What three factors effect total oxygen content of blood?
Common peroneal; bony fractures and compression; sciatic
No and yes
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Increase in permeability of two ions with equal and opposite equilibrium potentials

11. how can HAV be inactivated?
Boiling - bleach - formalin - UV irradiation
Curlings ulcers
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

12. are there signs of inflammation in avascular necrosis? then How do you diagnose?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Brief psychotic disorder; schizophreniform; schizophrenia
No; MRI

13. What is easiest way to treat nephrolithiasis?
No
Drink plenty of fluids
Covalent (between two cysteines)- allows protein to withstand denaturation
Selective alpha 1 (increases SVR)

14. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Neisseria induced small cell vasculitis (including hands and soles)
Reticulocytes
Downs; regurgitant AV valves - ASDs

15. what chromosome is c - myc found on?
Biphosphonate
25; 25
Chrom 8
Turbulence

16. What does nitroprusside do to afterload? preload?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Inhibits it
Reiter syndrome; B27
Decreases both

17. What is damaged in early syringomelia? later?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

18. which nucleus releases serotonin?
Raphe
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Primary
INTRApartum Abs (ampicillin/penicillin)

19. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Standing suddenly from supine position; valsalva maneuver

20. at four years of age - What are the social - fine motor - gross motor - and language developments?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
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
Demargination of neutrophils from the vessel walls
Faulty positioning of the genital tubercle

21. which staphylococci can do mannitol fermaentation?
Diabetic microangiopathy
Gluteus maximus; difficulty getting up from seated position and climbing chair
S. aureus
I is more benign and can present later in adulthood

22. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
indomethacin
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Minimal change disease

23. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
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
25; 25
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
Gluteus medius and minimus; positive trendelenberg

24. which virus inactivates both Rb and p53?
Class I
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
On cardiac tissue and renal juxtaglomerular cells

25. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
ANCA because of lack of Ig and C3 deposits on IF
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

26. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Medullary
Appetite suppressants
The time interval between S2 and OS- the shorter the interval - the more intense
Around 70 (normal measured diastolic pressures); 9--

27. name three pathological states that present with large tongues.
GI tract; mood!
Atrial
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

28. which two drug types can cause orthostatic hypotension (think depression and BPH)?
APP on chrom 21 (this is why downs more susceptible)
TCAs and prazosin
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Radial nerve and deep brachial artery

29. What type of drug is alendronate?
Biphosphonate
Standing suddenly from supine position; valsalva maneuver
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Ceftriaxone; azithromycin

30. how does neisseria cause a petechial rash?
When it invades the bm; carcinoma in situ
Proteasome inhibitor; treatment for MM and waldenstroms
GI malignancies and Insulin resistance (acromegal for ex)
Neisseria induced small cell vasculitis (including hands and soles)

31. What causes the blurry vision side effects in first generation anti histamines?
MAO inhibitors; wine and cheese
Because gamma chains replace beta chains and then gamma chain formation wanes
Anti cholinergic effects of pupil dilation and lack of accomodation
Relfex tachycardia; giving beta blockers

32. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Medial circumflex artery; avascular necrosis
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Increase lymphatic drainage!
Class I

33. why does liver dysfunction cause coagulation disorders?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Coagulation factors are made in the liver
Fibronectin - laminin - collagen

34. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Anterior nares
Proteasome inhibitor; treatment for MM and waldenstroms
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
By vascular permeability and vasodilation

35. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
CGD; t cell dysfxn (diGeorge)
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
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

36. What does hypocapnia cause in teh brain? What is hypocapnia?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Retinitis; mononucleosis
Ether and other organic solvents

37. what locations of UC increase the risk of Colon cancer?
Phencyclidine (PCP)
T test; chi squared
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Pan colitis and right sided colitis (more than left sided and proctitis)

38. biotin is used By what in tissues responsible for gluconeogenesis
C3 decreased after 5-10 days; sulfonamides
As a CO2 carrier with the carboxylase enzyme
INTRApartum Abs (ampicillin/penicillin)
SSRI; erectile dysfunction

39. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Southern - western
RER; RER
Class I
Medullary

40. How is dobutamine better than dopamine?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Diabetic microangiopathy
Susceptible; soluble (unable to be cultured in bile)
Cluster

41. how does increased ICP result in curlings ulcers?
Vagus nerve stimulation
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Thymic tumor
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

42. In what population does cholelithiasis occur?
Leukotriene precursor and does neutrophil chemotaxis
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
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Fat - fertile - forty - female

43. What is Tzanck smear used to detect?
HSV and VZV
Single adenomatous ones
Not lined by epithelium
Cluster

44. When does opening snap begin?
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Turners`
Right before diastole (filling begins)
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

45. What is the most important prognostic indicator in patients with malignant melanoma?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Measure of depth invasion (vertical!)
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
4 - 4 - 9

46. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Increased reticulocytes
HSV ( also in utero: chlymadia - neisseria - group B strep)
Neisseria induced small cell vasculitis (including hands and soles)
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac

47. which nerve is at risk when ligating the superior thyroid artery? Which is the only muscle this nerve innervates? what nerve innervates all the other laryngeal muscles?
Superior larygeal; cricothyroid; recurrent laryngeal
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Chrom 8
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

48. What is achalasia and how would this correlate on the esophageal mannometry?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Circular - outside nucleus; transport proteins - rRNA - tRNA
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
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

49. how does achalasia present? What does barium swallow show on dilated esophagus?
P450 mitochondrial monooxygenase
HSV ( also in utero: chlymadia - neisseria - group B strep)
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
OCPs - multiparity - breast feeding

50. What is diagnostic (and possible therapeutic for intussusception)?
Around 70 (normal measured diastolic pressures); 9--
HSV and VZV
Inhaled animal dander allergens
Barium enema