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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 can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
Large stroke volumes with ventricular contraction; aortic regurg
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Brief psychotic disorder; schizophreniform; schizophrenia
Retinitis; mononucleosis

2. which nerve in the lower leg is easily injured and causes foot drop ? What are common causes? From what nerve does it branch off or?
Common peroneal; bony fractures and compression; sciatic
Hypo or hyper pigmentations; after tanning
low in serum
NF- KB; responsible for cytokine production

3. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
gram positive organisms
Become beta pleated and then form neurofibrillary tangle!
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Vertical diplopia

4. What pulmonary structural change can kartageners syndrome cause?
IgE
Bronchial dilation (bronchiectasis)
I is more benign and can present later in adulthood
Cluster

5. on which chromosome is wilms tumor found?
Chlorpheniramine and diphenhydramine
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
Proteasome inhibitor; treatment for MM and waldenstroms
11

6. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Ketone body production by preventing fatty acids into the mitochondria
Hydrogen bonds dictate alpha or beta structure

7. What is the mutation type in thalassemias? what process is defective because of this?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Nonsense; mRNA processing
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

8. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
Ketone body production by preventing fatty acids into the mitochondria
Minimal change disease
200-500
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

9. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
Curlings ulcers
Prevents hepatic VLDL production
Fibronectin - laminin - collagen
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

10. What does protein M do in Group A strep<
Localized dermatologic pain that persists for more than one month after zoster eruption
SVC and IVC; right below the aortic knob
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Prevent phagocytosis

11. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
To pump calcium out in cardiac myocytes so that relaxation occurs
Ether and other organic solvents
8; 12
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

12. What is the difference between paranoid personality disorder and delusional disorder?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
hyponatremia (aldosterone activation equilibrates body volume)
Nocardia
Spongiosis

13. where are the two classical places that the ulnar nerve can be injured?

14. how long is substance P? What does it do?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
By vascular permeability and vasodilation
11 aa polypeptide; pain NT in CNS and PNS
CGD; t cell dysfxn (diGeorge)

15. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Joints d/t increased purine production and thus uric acid production
differentiate
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Closer to head; closer to diaphragm

16. What are three symptoms in s.typhi?
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Hereditary angioedema; ACE inhibitors

17. What is the stabilizing force for the secondary structure of proteins?
Hydrogen bonds dictate alpha or beta structure
Increase by 50% in urine osmolality
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac

18. the rate of blood flow of which two circulations must equal each other at all times?
Normal; low
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Proteasome inhibitor; treatment for MM and waldenstroms
Pulmonic and systemic!

19. What is the most important prognostic indicator in patients with malignant melanoma?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Measure of depth invasion (vertical!)
indomethacin
Ketone body production by preventing fatty acids into the mitochondria

20. 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?
No and yes
Sydenham chorea
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)
Curlings ulcers

21. which virus inactivates both Rb and p53?
Apocrine; eccrine
Think Hb deformation diseases
C3 decreased after 5-10 days; sulfonamides
E6 and E7 of HPV knock off p53 and Rb suppressor genes

22. What is Bortezomib and What is it used for?
Proteasome inhibitor; treatment for MM and waldenstroms
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Fibronectin - laminin - collagen
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

23. How is dobutamine better than dopamine?
As a CO2 carrier with the carboxylase enzyme
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
manifestations - congenital (stretching of periventricular pyrimadal fibers)

24. What actions increase venous return?
Squatting - sitting - lying supine - passive leg raising
differentiate
liver specific
Inhibits it

25. How do you explain the selective proteinuria of loss to albumin only in MCD?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Amiadarone
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
indomethacin

26. What type of vision is myopia? In What type of patients does it improve?
Increases
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
glycerol kinase

27. where are Beta 1 receptors found?
The term used to describe decreased drug responsiveness with repeated administration
On cardiac tissue and renal juxtaglomerular cells
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Sydenham chorea

28. What type of calcium channels dictate the plateau in cardiac myocyte?
only up to bronchi
NF- KB; responsible for cytokine production
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Dihydropyridine sensitive Ca channels (L type)

29. What type of disease has selective proteinuria? What is found in urine? What is not?
Ether and other organic solvents
Syringomelia
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
S. saprophyticus - and s. epidermidis; novobiocin

30. within the right ventricle - What are maximum pressures? the pulm arter?
25; 25
Fibrosis; macrophages
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Highly negative resting potential

31. if there are keratin swirls does that mean well or poorly differentiated?
Hexokinase
Vagus (auricular branch); vasovagal syncope!
GI malignancies and Insulin resistance (acromegal for ex)
Well

32. What is used to treat heparin toxicity?
Protamine sulfate
Chrom 8
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
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

33. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Raphe
Brief psychotic disorder; schizophreniform; schizophrenia
Ig A deficiency

34. What is achalasia and how would this correlate on the esophageal mannometry?
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
<1% - 55% - concentration dependent
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
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

35. within the right atrium - What is the maximum pressure? left atrium?
When it invades the bm; carcinoma in situ
Squatting - sitting - lying supine - passive leg raising
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
8; 12

36. name three pathological states that present with large tongues.
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Nocardia

37. What is used to compare means? categorical outcomes?
T test; chi squared
Right heart failure
Increase; decreased
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

38. What does nitroprusside do to afterload? preload?
In ER of bile canaliculi
Reiter syndrome; B27
Myasthenia gravis
Decreases both

39. Metronidizaole does not cover...
gram positive organisms
women
Kallmans
manifestations - congenital (stretching of periventricular pyrimadal fibers)

40. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
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)
200-500
Amiadarone
TCAs and prazosin

41. are there signs of inflammation in avascular necrosis? then How do you diagnose?
liver specific
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
No; MRI
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences

42. what happens to capacitance with age?
Kallmans
T test; chi squared
Vascular endothelium; protease
...

43. 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?
RER; copper
Localized dermatologic pain that persists for more than one month after zoster eruption
Lateral; RV; RA; LV
Apocrine; eccrine

44. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Gluteus medius and minimus; positive trendelenberg
Primary
8 (myc protein) with 2 - 14 - 22 (iG chains)
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

45. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
V fib; v. failure

46. What is suggestive of complete central DI?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
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
Increase by 50% in urine osmolality
Prevents hepatic VLDL production

47. what has the greatest effect on prognosis when treating c. diptheriae?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
CMV - HSV 1 - Candida
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)
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

48. what makes bruits?
Reticulocytes
Turbulence
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Curlings ulcers

49. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
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
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Prepatellar
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

50. What is capacitance inversely proportional to?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Elastance
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2