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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. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Squatting - sitting - lying supine - passive leg raising
Lateral; RV; RA; LV
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
Skin flushing and warmth; prostaglandins; give with aspirin

2. In What type of nephritis would you see high serum eos count?
Purkinje system; AV node
Drug induced interstitial nephritis
Elastance
Increase lymphatic drainage!

3. why are pregnant predisposed to cholelithiasis?
Ketone body production by preventing fatty acids into the mitochondria
TCAs and prazosin
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
Hydrogen bonds dictate alpha or beta structure

4. What are diastolic (lowest) pressures in aorta? LV?
Enterococci (e. faecalis)- found on genitalia area
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Skin flushing and warmth; prostaglandins; give with aspirin
Around 70 (normal measured diastolic pressures); 9--

5. 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
Southern - western
Duration and extent of disease
Pain reliever - reduces pain by locking substance P in the PNS

6. where are Beta 1 receptors found?
On cardiac tissue and renal juxtaglomerular cells
hyponatremia (aldosterone activation equilibrates body volume)
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

7. What would a deflection of the membrane potential to near zero indicate?
SaO2 <92%
Vagus (auricular branch); vasovagal syncope!
Purkinje system; AV node
Increase in permeability of two ions with equal and opposite equilibrium potentials

8. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
Localized dermatologic pain that persists for more than one month after zoster eruption
Reticulocytes
Intussusception
Around 70 (normal measured diastolic pressures); 9--

9. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
HSV ( also in utero: chlymadia - neisseria - group B strep)
Around 70 (normal measured diastolic pressures); 9--
Sydenham chorea

10. Which is faster atrial muscle or ventricular muscle?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Atrial
Reticulocytes

11. why should you not use ACE inhibitors with someone who had hereditary angioedema?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
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
Purkinje system; AV node

12. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Superior larygeal; cricothyroid; recurrent laryngeal
25; 25
Regular insulin (Not fast acting - regular better)
Hypo or hyper pigmentations; after tanning

13. How do you treat gonococcal infection? chlymadia?
Right heart failure
Vancomycin; histamine mediated
Ceftriaxone; azithromycin
200-500

14. In what form are mitochondrial DNA? What do they transcribe?
Localized dermatologic pain that persists for more than one month after zoster eruption
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
On cardiac tissue and renal juxtaglomerular cells
Circular - outside nucleus; transport proteins - rRNA - tRNA

15. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
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
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Kallmans
Hypertension - edema - and proteinuria

16. What type of disease has selective proteinuria? What is found in urine? What is not?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Covalent (between two cysteines)- allows protein to withstand denaturation
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
glycerol kinase

17. why is crohns disease associated with oxaloacetate kidney stones?
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
Covalent (between two cysteines)- allows protein to withstand denaturation
ATP binding (resets the myosin head to contract again for next binding)
Initiation - pointing; pincer grasp; walking; mama/dada

18. at 2 years of age - What are the social - fine motor - gross motor and language developments?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
P53 mutation; AD
SVT; increases vagal tone; rectus abdominis

19. What is the immune deficinecy seen in ataxia telangactasia?
Ig A deficiency
Folic acid treatment!
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Intussusception

20. h1 receptor anatagonists are not effective in treatment of asthma only for...
Nocardia
chronic urticaria and allergic symptoms
Anti centromere; anti DNA topoisomerase
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

21. within the right ventricle - What are maximum pressures? the pulm arter?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Pulmonic and systemic!
25; 25
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

22. What is congestive hepatomegaly specific for?
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Right heart failure

23. What are the potassium sparing diuretics?
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)
Amiloride - spironolactone - triamterene
Increase by 50% in urine osmolality
differentiate

24. What is capsaicin? Where does it work?
Pain reliever - reduces pain by locking substance P in the PNS
Paramyxo and influenza
HSV and VZV
TCAs and prazosin

25. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Ig A deficiency
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Susceptible; soluble (unable to be cultured in bile)

26. how does increased ICP result in curlings ulcers?
Vagus nerve stimulation
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
Normally close to systolic
Nocardia

27. What is damaged in early syringomelia? later?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

28. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Dihydropyridine sensitive Ca channels (L type)
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
No and yes

29. what kind of drug is sertraline? What is a common side effect?
SSRI; erectile dysfunction
ZDV or AZT
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
women

30. Where does 90% of serotonin lie? What is this NT responsible?
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
Measure of depth invasion (vertical!)
GI tract; mood!
Sudden loss of muscle tone without loss of consciousness; narcolepsy

31. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
Curlings ulcers
Duration and extent of disease
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Inhaled animal dander allergens

32. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
Boiling - bleach - formalin - UV irradiation
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)
Radial nerve and deep brachial artery
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

33. Which is slower AV node or ventricular muscle?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Around 70 (normal measured diastolic pressures); 9--
Classical conditioning
AV node slowest - to allow time for diastole

34. after a thrombus extraction - what serum enzyme shoots up and why?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Serum creatine kinase; reperfusion injury causes necrosis
LT (LTD4 - E4 - C4) - and Ach

35. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
Ketone body production by preventing fatty acids into the mitochondria
Reticulocytes
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Single adenomatous ones

36. how can HAV be inactivated?
To pump calcium out in cardiac myocytes so that relaxation occurs
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Boiling - bleach - formalin - UV irradiation

37. what protects the resting heart from arrhythmias?
Highly negative resting potential
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
E. coli
P53 mutation; AD

38. which antiarrythmic is associated with blue gray discoloration ?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Amiadarone
4 - 4 - 9
Hexokinase

39. What is used to compare means? categorical outcomes?
transcription activation/suppression
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
T test; chi squared
Kallmans

40. what would be a sign of absence of cardiogenic pulm edem?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Pulmonary hypertension
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Appetite suppressants

41. When does neovascularization granulation tissue begin to form after severe ischemia and MI? what happens in 12-24 hours? 2 weeks to 2 months? 1-5 days? 0-4 hours? when do you see edema - hemorrhage - wavy fibers?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Because of the low output from heart failure - they will have increased aldosterone levels
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

42. What is the triad seen in pre eclampsia?
INTRApartum Abs (ampicillin/penicillin)
Hypertension - edema - and proteinuria
Regular insulin (Not fast acting - regular better)
Radial nerve and deep brachial artery

43. what hormone is structurally similar to hCG?
Hypothyroidism
Anterior circumflex (and axillary nerve)
TSh (in testicular tumors can cause hyperthyroidism)
Medullary

44. What test would be best to determine if a gene is being transcribed? translated?
Abnormal closing of the urethral folds
Southern - western
Diabetic microangiopathy
Selective alpha 1 (increases SVR)

45. 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
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Fat - fertile - forty - female

46. What is achalasia and how would this correlate on the esophageal mannometry?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
MAC complex (C5b - C9 complement deficiency)
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

47. sporadic colon cancer tend to arise From what type of polyps?
Single adenomatous ones
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Vancomycin
Aromatase deficiency in child

48. Where does complement bind on the Fc region of Ig chains?
II; I (I more abundant)
Anterior circumflex (and axillary nerve)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

49. 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?
46 - 4N; 23 2N
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Biphosphonate
In the extracellular space for collagen cross linking; zinc

50. What can cause aortic regurg? What is the heart sound you hear?
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
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Faulty positioning of the genital tubercle
Fibrosis; macrophages