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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. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
No and yes
Inhaled animal dander allergens
Cluster
Because of the low output from heart failure - they will have increased aldosterone levels

2. What can cause virilization of a mother during pregnancy?
Aromatase deficiency in child
Hypo or hyper pigmentations; after tanning
Trochlear nerve (IV); abducens nerve (VI)
E. coli

3. What are diastolic (lowest) pressures in aorta? LV?
Around 70 (normal measured diastolic pressures); 9--
Drug induced interstitial nephritis
...
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

4. What is the best indicator for the severity of mitral stenosis?
The time interval between S2 and OS- the shorter the interval - the more intense
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Prostate tumor and increased osteoclast activity
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

5. what dissolves the lipid bilayer of a viral envelope?
RBF= PAH clearance/(1- hematocrit)
Ether and other organic solvents
Think Hb deformation diseases
RER; copper

6. When is acid phosphatase elevated (Name two times)?
Inactivates kallikrein which activates kininogen into bradykinin
Prostate tumor and increased osteoclast activity
Measles and M3 AML`
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

7. what locations of UC increase the risk of Colon cancer?
RR-1/RR
Pan colitis and right sided colitis (more than left sided and proctitis)
MAO inhibitors; wine and cheese
S. saprophyticus - and s. epidermidis; novobiocin

8. What are two common side effects of both acute and long acting nitrates? What causes them?
women
Headaches and facial flushing; vasodilation in meninges and skin
Enterococci (e. faecalis)- found on genitalia area
Kallmans

9. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Acute interstitial nephritis
Downs; regurgitant AV valves - ASDs
Radial nerve damage

10. What are the skin presentation in sarcoid?
In the extracellular space for collagen cross linking; zinc
Varying; erythema nodosum is common
Pan colitis and right sided colitis (more than left sided and proctitis)
4 - 4 - 9

11. Which nerve lies in close proximity to the inferior thyroid artery?
No (unlike adenomyosis); yes
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Recurrent larygneal

12. at three years of age What are social - fine motor - gross motor and language developments?
Radial nerve damage
Medullary
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
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

13. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Anti centromere; anti DNA topoisomerase
Recurrent larygneal
TCAs and prazosin

14. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
P53 mutation; DCC is also required for adenoma to carcinoma
hyponatremia (aldosterone activation equilibrates body volume)
Valproate

15. what induces bronchial squamous metaplasia?
AV node slowest - to allow time for diastole
S3 gallop; S2 to opening snap interval
T test; chi squared
Smoking

16. what receptors do first generation anti histamines block?
Initiation - pointing; pincer grasp; walking; mama/dada
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Varying; erythema nodosum is common
Prevent phagocytosis

17. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
Classical conditioning
Extrinsic def; instrinsic def; platelet def
No and yes
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

18. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
11 aa polypeptide; pain NT in CNS and PNS
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Squatting - sitting - lying supine - passive leg raising

19. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Pulmonic and systemic!
Serum creatine kinase; reperfusion injury causes necrosis
Hereditary angioedema; ACE inhibitors
Decreases both

20. name three pathological states that present with large tongues.
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Close but purkinje system to ensure contraction in a bottom up fashion
Radial nerve damage
Congenital hypothyroidism - downs - amyloidosis - acromegaly

21. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Because of vasodiation to skeletal muscles
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Large stroke volumes with ventricular contraction; aortic regurg

22. why are beta thal major patients asymptomatic at birth?
Ether and other organic solvents
Because gamma chains replace beta chains and then gamma chain formation wanes
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

23. which has better side effect profile - SSRI or TCA?
Protamine sulfate
SSRI
Anti - apoptotic (prevents going into apoptosis)- 18; 14
HSV and VZV

24. What do you treat s. epidermidis with?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
4 - 4 - 9
Vancomycin

25. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Anterior circumflex (and axillary nerve)
Phencyclidine (PCP)

26. prostaglandin synthesis keeps...
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Reiter syndrome; B27
Appetite suppressants
PDA open

27. What are the first generation anti histamines?
Chlorpheniramine and diphenhydramine
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
RBF= PAH clearance/(1- hematocrit)
Barium enema

28. What are examples of action that decrease venous return to the heart?
Standing suddenly from supine position; valsalva maneuver
Rabies encephalitis from cave bats; rabies killed vaccines
Leukotriene precursor and does neutrophil chemotaxis
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

29. Where does 90% of serotonin lie? What is this NT responsible?
Syringomelia
GI tract; mood!
Duration and extent of disease
Increase lymphatic drainage!

30. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
RR-1/RR
Apocrine; eccrine

31. What is the mainstay treatment for acute mania?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
INTRApartum Abs (ampicillin/penicillin)
Squatting - sitting - lying supine - passive leg raising
Dihydropyridine sensitive Ca channels (L type)

32. 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?)?
Elastance
SVC and IVC; right below the aortic knob
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Not lined by epithelium

33. What is congestive hepatomegaly specific for?
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
Aromatase deficiency in child
No; yes
Right heart failure

34. What are the lab findings in poststreptococcal GN?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Curlings ulcers
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Adductor

35. What actions increase venous return?
Squatting - sitting - lying supine - passive leg raising
Rare complication of measles (years later)- thought to be d/t certain type that doesnt have surface M protein antigen so goes unseen into CNS
SVC and IVC; right below the aortic knob
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

36. what indicates the severity of a mitral regurg ? mitral stenosis?
S3 gallop; S2 to opening snap interval
P53 mutation; DCC is also required for adenoma to carcinoma
Become beta pleated and then form neurofibrillary tangle!
Vertical diplopia

37. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
E. coli
Intussusception
S. saprophyticus - and s. epidermidis; novobiocin
Increased reticulocytes

38. what diseases can vit A be used to treat?
Paramyxo and influenza
Measles and M3 AML`
Cluster
No

39. what hernia has a similar mechanism to hydrocele?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Initiation - pointing; pincer grasp; walking; mama/dada

40. What is capacitance inversely proportional to?
TCAs and prazosin
Localized dermatologic pain that persists for more than one month after zoster eruption
...
Elastance

41. nucleotide deletions do not cause missense mutations - they cause...
liver specific
E. coli
frameshift mutations (missense is substitution)
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

42. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
When it invades the bm; carcinoma in situ
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
II; I (I more abundant)

43. How do you calculate RPF from urine PAH?
Acute gastric mucosal defects (superficial or full thickness)
(urine PAH x urine flow rate)/plasma PAH
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Hereditary angioedema; ACE inhibitors

44. What is the mc location for avascular necrosis? What is it associated with?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Right heart failure
P450 mitochondrial monooxygenase
Env genes (for getting into target cells)

45. What is epispadias caused by?
Faulty positioning of the genital tubercle
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
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

46. Where is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
RER; copper
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
To pump calcium out in cardiac myocytes so that relaxation occurs
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

47. What type of calcium channels dictate the plateau in cardiac myocyte?
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
Little effect on cell and no change
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Dihydropyridine sensitive Ca channels (L type)

48. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Close but purkinje system to ensure contraction in a bottom up fashion
Myasthenia gravis

49. what clinical findings help distinguish small cell carcinoma?
Another type of aldosterone antagonist (like spironolactone)
Normal; low
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Aromatase deficiency in child

50. what has the greatest effect on prognosis when treating c. diptheriae?
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
Little effect on cell and no change
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)