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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. why is glucagon used in beta blocker toxicitiy?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
NF- KB; responsible for cytokine production
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
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

2. what would be a sign of absence of cardiogenic pulm edem?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
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 pulmonary capillary wedge pressure (used for LA pressure measurement)
Acute interstitial nephritis

3. What is the cause of fixed splitting of S2? why?
E. coli
Trochlear nerve (IV); abducens nerve (VI)
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Normally close to systolic

4. What is mcc of death pre hospital phase of MI? in hospital phase?
Relfex tachycardia; giving beta blockers
Hexokinase
In the extracellular space for collagen cross linking; zinc
V fib; v. failure

5. within the right atrium - What is the maximum pressure? left atrium?
facultative intracellular
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
8; 12

6. What are the three dopaminergic systems and What are they responsible for? disease?
Prostate tumor and increased osteoclast activity
Increase lymphatic drainage!
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

7. What is suggestive of complete central DI?
APP on chrom 21 (this is why downs more susceptible)
Increase by 50% in urine osmolality
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
low in serum

8. Would alpha 1 agonists cause flushing? muscarinic antagonist?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
No; yes
Initiation - pointing; pincer grasp; walking; mama/dada
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

9. 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?
Apocrine; eccrine
Primary
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Normal; low

10. What is used to prevent vertical transmission of HIV?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
ZDV or AZT
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

11. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Adeno
Curlings ulcers
Hereditary angioedema; ACE inhibitors

12. carnitine deficiency impairs production of What and how?
Fibrosis; macrophages
25; 25
Ketone body production by preventing fatty acids into the mitochondria
200-500

13. What does prolonged PT indicated? aPTT? bleeding time?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Extrinsic def; instrinsic def; platelet def
Clindamycin; covers anaerobic oral flora and aerobic bacteria

14. What is the difference between paranoid personality disorder and delusional disorder?
Ig A deficiency
Radial nerve damage
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
S. saprophyticus - and s. epidermidis; novobiocin

15. What is the cause of rapid plasma decay of thiopental?
Tissue redistribution (out of plasma) rather than metabolism
Vagus (auricular branch); vasovagal syncope!
Close but purkinje system to ensure contraction in a bottom up fashion
Single adenomatous ones

16. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
TSh (in testicular tumors can cause hyperthyroidism)
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
When it invades the bm; carcinoma in situ

17. how does neisseria cause a petechial rash?
Neisseria induced small cell vasculitis (including hands and soles)
Covalent (between two cysteines)- allows protein to withstand denaturation
Hexokinase
GI tract; mood!

18. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
Varying; erythema nodosum is common
Little effect on cell and no change
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
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

19. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
11
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
TSh (in testicular tumors can cause hyperthyroidism)
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

20. What does 'oxygen' content in blood refer to?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Dissolved in plasma and attached to Hgb
Right heart failure
Prostate tumor and increased osteoclast activity

21. what bursa is affected when on knees like a maid/gardner?
Amiadarone
46 - 4N; 23 2N
Adductor
Prepatellar

22. at four years of age - What are the social - fine motor - gross motor - and language developments?
Appetite suppressants
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
MAO inhibitors; wine and cheese
transcription activation/suppression

23. What is the preferred treatment for DKA?
Well trained athletes and children
SS +rNA
Regular insulin (Not fast acting - regular better)
Syncope - angina - dyspnea (SAD)

24. what nerve and artery course along the posterior aspect of the humerus?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Vertical diplopia
Radial nerve and deep brachial artery
Spongiosis

25. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Valproate
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Increase; decreased

26. there are mucus secreting cells in the bronchioles...
only up to bronchi
8; 12
Around 70 (normal measured diastolic pressures); 9--
Fat - fertile - forty - female

27. SIADH patients have normal blood volume but...
Acute interstitial nephritis
Dihydropyridine sensitive Ca channels (L type)
hyponatremia (aldosterone activation equilibrates body volume)
Vagus (auricular branch); vasovagal syncope!

28. Which is slower AV node or ventricular muscle?
Lateral; RV; RA; LV
AV node slowest - to allow time for diastole
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
Octreotide

29. what chromosome is c - myc found on?
Chrom 8
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
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Downs; regurgitant AV valves - ASDs

30. Where is conduction in heart fastest? slowest?
Chlorpheniramine and diphenhydramine
Underestimation of gestational age
By vascular permeability and vasodilation
Purkinje system; AV node

31. What does the severity of leprosy depend on?
On cardiac tissue and renal juxtaglomerular cells
Strength of cell mediated immune response
hyponatremia (aldosterone activation equilibrates body volume)
Little effect on cell and no change

32. What is Bortezomib and What is it used for?
Proteasome inhibitor; treatment for MM and waldenstroms
SVC and IVC; right below the aortic knob
Radial nerve damage
Barium enema

33. What is the mcc of elevated AFP leves in pregnancy>
Trochlear nerve (IV); abducens nerve (VI)
Amiadarone
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Underestimation of gestational age

34. do Class IC agents prolong the QT interval?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Decreases both
No
Faulty positioning of the genital tubercle

35. What is intussusception? how does ischemia and necrosis occur?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
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
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

36. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Gluteus maximus; difficulty getting up from seated position and climbing chair
Highly negative resting potential
Boiling - bleach - formalin - UV irradiation
11 aa polypeptide; pain NT in CNS and PNS

37. What type of endocarditis is cytoscopy induced?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Enterococci (e. faecalis)- found on genitalia area

38. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
Brief psychotic disorder; schizophreniform; schizophrenia
The time interval between S2 and OS- the shorter the interval - the more intense
Dihydropyridine sensitive Ca channels (L type)
Increase; decreased

39. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Prostate tumor and increased osteoclast activity
Folic acid treatment!
Susceptible; soluble (unable to be cultured in bile)
In ER of bile canaliculi

40. What causes the blurry vision side effects in first generation anti histamines?
In the extracellular space for collagen cross linking; zinc
Anti cholinergic effects of pupil dilation and lack of accomodation
Retinitis; mononucleosis
Ig A deficiency

41. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
As a CO2 carrier with the carboxylase enzyme
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Skin flushing and warmth; prostaglandins; give with aspirin

42. What is a keloid?
Phencyclidine (PCP)
Common peroneal; bony fractures and compression; sciatic
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Excessive collagen formation during tissue repair in susceptible individuals

43. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Bile soluble which means they are bile sensitive
P450 mitochondrial monooxygenase
Susceptible; soluble (unable to be cultured in bile)

44. PDAs are often asymptomatic. How do you treat?
Turners`
indomethacin
Close but purkinje system to ensure contraction in a bottom up fashion
Mean greater than median greater than mode

45. What three factors effect total oxygen content of blood?
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
11 aa polypeptide; pain NT in CNS and PNS
Hypo or hyper pigmentations; after tanning
low in serum

46. What does nitroprusside do to afterload? preload?
No (unlike adenomyosis); yes
Decreases both
hyponatremia (aldosterone activation equilibrates body volume)
Normally close to systolic

47. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Strength of cell mediated immune response
Medial circumflex artery; avascular necrosis
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
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

48. What do you treat s. epidermidis with?
Vancomycin
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Classical conditioning
Decreases both

49. name three pathological states that present with large tongues.
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
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Increase in permeability of two ions with equal and opposite equilibrium potentials

50. What does C1 esterase do other than inhibiting complement pathway?
No
Inactivates kallikrein which activates kininogen into bradykinin
Faulty positioning of the genital tubercle
Become beta pleated and then form neurofibrillary tangle!