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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 clinical findings help distinguish small cell carcinoma?
Fibronectin - laminin - collagen
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

2. How do you calculate atributable risk percent?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
RR-1/RR
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

3. What do you treat s. epidermidis with?
Turners`
When it invades the bm; carcinoma in situ
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Vancomycin

4. What actions increase venous return?
Squatting - sitting - lying supine - passive leg raising
differentiate
Regular insulin (Not fast acting - regular better)
Highly negative resting potential

5. What are the two mcc of focal brain lesions in HIV positive patients?
Anterior nares
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
TCAs and prazosin

6. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Injury to common peroneal nerve (d/t trauma or sustained pressure to neck of fibula) causing pain and numbness on dorsum of foot and inability to dorsiflex
Echinococcus granulosus; anaphylaxis
The term used to describe decreased drug responsiveness with repeated administration

7. What is medullary sponge kidney disease and how does it present? What does it lead to?
Normal; low
Excessive collagen formation during tissue repair in susceptible individuals
E. coli; staphylococcus saprophyticus
Common and benign congenital disorder characterized by cystic dilation of the medullary collecting ducts (cortex is spared); painless hematuria or asymptomatic; mc is development of kidney stones (benign disease)

8. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Skin flushing and warmth; prostaglandins; give with aspirin
P53 mutation; DCC is also required for adenoma to carcinoma
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Radial nerve and deep brachial artery

9. what drug is useful for secretory diarrhea?
Retinitis; mononucleosis
Adductor
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Octreotide

10. What is the preferred treatment for DKA?
Regular insulin (Not fast acting - regular better)
CMV - HSV 1 - Candida
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
low in serum

11. Where does 90% of serotonin lie? What is this NT responsible?
Fibronectin - laminin - collagen
GI tract; mood!
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
APP on chrom 21 (this is why downs more susceptible)

12. at 2 years of age - What are the social - fine motor - gross motor and language developments?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
differentiate
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
11

13. Where does terminal peptide cleavage of collagen fibrils take place?
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
Insulin like growth factor 1 (just another name)
In the extracellular space
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

14. in B12 deficiency - what levels in blood rise very quickly and then drop?
Reticulocytes
Retinitis; mononucleosis
Inactivates kallikrein which activates kininogen into bradykinin
Medullary

15. What are the first generation anti histamines?
Bile salt accumulation in urine
Chlorpheniramine and diphenhydramine
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Curlings ulcers

16. what indicates the severity of a mitral regurg ? mitral stenosis?
manifestations - congenital (stretching of periventricular pyrimadal fibers)
CMV - HSV 1 - Candida
S3 gallop; S2 to opening snap interval
GI tract; mood!

17. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
C3 decreased after 5-10 days; sulfonamides
differentiate
Radial nerve damage
Hydrogen bonds dictate alpha or beta structure

18. What is used to prevent vertical transmission of HIV?
ZDV or AZT
Paramyxo and influenza
No
Prepatellar

19. What are two common side effects of both acute and long acting nitrates? What causes them?
Protamine sulfate
Headaches and facial flushing; vasodilation in meninges and skin
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
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

20. what marker should be followed in a patient with cirrhosis?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Extrinsic def; instrinsic def; platelet def
ANCA because of lack of Ig and C3 deposits on IF
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

21. what immune deficiency causes recurrent neisseria infections?
MAC complex (C5b - C9 complement deficiency)
Southern - western
S. saprophyticus - and s. epidermidis; novobiocin
MAO inhibitors; wine and cheese

22. What is the most common neurologic complication of VZV reactivation?
Hypothyroidism
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Ether and other organic solvents
Localized dermatologic pain that persists for more than one month after zoster eruption

23. Which is faster atrial muscle or ventricular muscle?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Atrial
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Standing suddenly from supine position; valsalva maneuver

24. What is the cause of fixed splitting of S2? why?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Dissolved in plasma and attached to Hgb
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Reiter syndrome; B27

25. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Another type of aldosterone antagonist (like spironolactone)
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
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
Large stroke volumes with ventricular contraction; aortic regurg

26. What are the skin presentation in sarcoid?
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
gram positive organisms
Varying; erythema nodosum is common
Terminal bronchioles; small bronchi

27. why should you not use ACE inhibitors with someone who had hereditary angioedema?
Vagus (auricular branch); vasovagal syncope!
Classical conditioning
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
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

28. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
<1% - 55% - concentration dependent
Become beta pleated and then form neurofibrillary tangle!
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
differentiate

29. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
No and yes
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Appetite suppressants
Joints d/t increased purine production and thus uric acid production

30. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
Minimal change disease
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Strength of cell mediated immune response
Anti - apoptotic (prevents going into apoptosis)- 18; 14

31. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Diabetic microangiopathy
Terminal bronchioles; small bronchi
Because gamma chains replace beta chains and then gamma chain formation wanes

32. In what view of CXR is anterior part of heart best seen? anterior part of heart is formed by?right border of heart is formed by? left border?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
In ER of bile canaliculi
Lateral; RV; RA; LV
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

33. What is diagnostic (and possible therapeutic for intussusception)?
Well
Cluster
ZDV or AZT
Barium enema

34. What does Rb protein do? what chrom is it on?
Drink plenty of fluids
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
Enterococci (e. faecalis)- found on genitalia area
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

35. What is hyaline arteriosclerosis usually a sign of ?
RER; RER
Diabetic microangiopathy
Ig A deficiency
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase

36. what locations of UC increase the risk of Colon cancer?
Fibronectin - laminin - collagen
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
Hexokinase
Pan colitis and right sided colitis (more than left sided and proctitis)

37. why are beta thal major patients asymptomatic at birth?
Because gamma chains replace beta chains and then gamma chain formation wanes
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Well
Injury to common peroneal nerve (d/t trauma or sustained pressure to neck of fibula) causing pain and numbness on dorsum of foot and inability to dorsiflex

38. Where is the base of the heart? apex?
Closer to head; closer to diaphragm
Spongiosis
Insulin like growth factor 1 (just another name)
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)

39. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
GI malignancies and Insulin resistance (acromegal for ex)
P53 mutation; AD
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

40. which nucleus releases serotonin?
GI tract; mood!
The term used to describe decreased drug responsiveness with repeated administration
Raphe
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

41. other than parvo B19 - what else is associated with red cell aplasia?
Thymic tumor
Adeno
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
25; 25

42. What is it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
Vertical diplopia
Aromatase deficiency in child
Vagus (auricular branch); vasovagal syncope!
Rabies encephalitis from cave bats; rabies killed vaccines

43. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Relfex tachycardia; giving beta blockers
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Minimal change disease
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

44. In what form are mitochondrial DNA? What do they transcribe?
Increases cytokine production
Increase by 50% in urine osmolality
Circular - outside nucleus; transport proteins - rRNA - tRNA
Bile soluble which means they are bile sensitive

45. 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)
Elastance
Well
Injury to common peroneal nerve (d/t trauma or sustained pressure to neck of fibula) causing pain and numbness on dorsum of foot and inability to dorsiflex

46. What is the difference between paranoid personality disorder and delusional disorder?
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)
S3 gallop; S2 to opening snap interval
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Syncope - angina - dyspnea (SAD)

47. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
P53 mutation; AD
Barium enema
Amiloride - spironolactone - triamterene
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

48. What are fenfluramine - phentermine?
Aromatase deficiency in child
Boiling - bleach - formalin - UV irradiation
RER; copper
Appetite suppressants

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?
TCAs and prazosin
Hypertension - edema - and proteinuria
Hypothyroidism
46 - 4N; 23 2N

50. which viruses require a protease?
In the extracellular space
SS +rNA
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Trauma to stereociliated hair cells of the organ of corti