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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 does prolonged PT indicated? aPTT? bleeding time?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Extrinsic def; instrinsic def; platelet def
chronic urticaria and allergic symptoms
Duration and extent of disease

2. why should you not use ACE inhibitors with someone who had hereditary angioedema?
glycerol kinase
Abnormal closing of the urethral folds
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
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

3. within the right ventricle - What are maximum pressures? the pulm arter?
Anterior nares
transcription activation/suppression
25; 25
Coagulation factors are made in the liver

4. how does eos release MBP to kill protozoa etc?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Echinococcus granulosus; anaphylaxis
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Boiling - bleach - formalin - UV irradiation

5. at one year of age - What are the social - fine motor - gross motor and language developments?
Initiation - pointing; pincer grasp; walking; mama/dada
Increases
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Gluteus medius and minimus; positive trendelenberg

6. Where is aromatase used?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Become beta pleated and then form neurofibrillary tangle!

7. 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?)?
Adeno
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Radial nerve and deep brachial artery
Hypothyroidism

8. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
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
AV node slowest - to allow time for diastole
<1% - 55% - concentration dependent
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

9. IL4 is used for isotypye switching to what?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Bile salt accumulation in urine
Appetite suppressants
IgE

10. how much percent of sodium is excreted? urea? glucose?
Medullary
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
<1% - 55% - concentration dependent
Vagus nerve stimulation

11. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Because of the low output from heart failure - they will have increased aldosterone levels
Regular insulin (Not fast acting - regular better)
Skin flushing and warmth; prostaglandins; give with aspirin
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

12. What type of vision is myopia? In What type of patients does it improve?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Vagus (auricular branch); vasovagal syncope!
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

13. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Echinococcus granulosus; anaphylaxis
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
Curlings ulcers
Selective alpha 1 (increases SVR)

14. 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
Because of vasodiation to skeletal muscles
11
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

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

16. Where does terminal peptide cleavage of collagen fibrils take place?
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
In the extracellular space
Vancomycin; histamine mediated
transcription activation/suppression

17. What is the immune deficinecy seen in ataxia telangactasia?
II; I (I more abundant)
Ig A deficiency
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

18. what dictates the resting membrane potential of most cells?
Appetite suppressants
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Single adenomatous ones
High potassium conductance and some sodium conductance

19. What is diagnostic (and possible therapeutic for intussusception)?
Spongiosis
Barium enema
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

20. When is an S4 sound normal?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
I is more benign and can present later in adulthood
Well trained athletes and children
Measles and M3 AML`

21. What is used to prevent vertical transmission of HIV?
Adeno
ZDV or AZT
Hypertension - edema - and proteinuria
When it invades the bm; carcinoma in situ

22. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
Hexokinase
Thymic tumor
Dihydropyridine sensitive Ca channels (L type)
LT (LTD4 - E4 - C4) - and Ach

23. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Barium enema
Hypo or hyper pigmentations; after tanning
Inhibits it
Regular insulin (Not fast acting - regular better)

24. sporadic colon cancer tend to arise From what type of polyps?
P53 mutation; AD
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Single adenomatous ones
ATP binding (resets the myosin head to contract again for next binding)

25. What is the mc location of brain germinomas?What are the classic symptoms?
Another type of aldosterone antagonist (like spironolactone)
4 - 4 - 9
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Rabies encephalitis from cave bats; rabies killed vaccines

26. What does protein M do in Group A strep<
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Prevent phagocytosis
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)

27. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
hyponatremia (aldosterone activation equilibrates body volume)
On cardiac tissue and renal juxtaglomerular cells
Little effect on cell and no change

28. What is pickwickian syndrome? What are the lab findings?
RER; RER
Dihydropyridine sensitive Ca channels (L type)
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

29. What is a primary HSV 1 infection like?
...
Brief psychotic disorder; schizophreniform; schizophrenia
Env genes (for getting into target cells)
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

30. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
ATP binding (resets the myosin head to contract again for next binding)
Myasthenia gravis
SVC and IVC; right below the aortic knob
Become beta pleated and then form neurofibrillary tangle!

31. erythema nodosum - elevated ACE - scattered granulomas - arthralgias - hilar lymphadenoapthy are indicative of what?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Anterior nares
Sarcoid

32. what locations of UC increase the risk of Colon cancer?
Vertical diplopia
Pan colitis and right sided colitis (more than left sided and proctitis)
46 - 4N; 23 2N
Superior larygeal; cricothyroid; recurrent laryngeal

33. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
Trauma to stereociliated hair cells of the organ of corti
Bile soluble which means they are bile sensitive
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

34. which RPGN is also called pauci immune GN? why?
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
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
ANCA because of lack of Ig and C3 deposits on IF
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

35. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Downs; regurgitant AV valves - ASDs
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
low in serum

36. which two drug types can cause orthostatic hypotension (think depression and BPH)?
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
Reticulocytes
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
TCAs and prazosin

37. What three pathogens cause infectious esophagitis in HIV positive patients?
ANCA because of lack of Ig and C3 deposits on IF
Nocardia
T test; chi squared
CMV - HSV 1 - Candida

38. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
Underestimation of gestational age
Acute interstitial nephritis
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

39. What effects does cortisol have on catecholamines?
200-500
Well trained athletes and children
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
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

40. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
MAO inhibitors; wine and cheese
Acute interstitial nephritis
Enterococci (e. faecalis)- found on genitalia area
Because of vasodiation to skeletal muscles

41. 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?
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)
Pan colitis and right sided colitis (more than left sided and proctitis)
Purkinje system; AV node
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

42. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Sarcoid
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
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

43. what protects the resting heart from arrhythmias?
Both sides
Highly negative resting potential
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Serum creatine kinase; reperfusion injury causes necrosis

44. What does Rb protein do? what chrom is it on?
Sarcoid
Bronchogenic carcinoma
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Increase in permeability of two ions with equal and opposite equilibrium potentials

45. what drugs causes the red man syndrome? how does it occur?
(urine PAH x urine flow rate)/plasma PAH
Vancomycin; histamine mediated
Normal; low
Integration of viral DNA into genome of host hepatocytes

46. in the LV and aorta - What are the pressures?
Normally close to systolic
Spongiosis
Anti centromere; anti DNA topoisomerase
Sarcoid

47. In what population does cholelithiasis occur?
Fat - fertile - forty - female
hyponatremia (aldosterone activation equilibrates body volume)
Barium enema
Regular insulin (Not fast acting - regular better)

48. What does NF- KB do?
Drug induced interstitial nephritis
Raphe
Dihydropyridine sensitive Ca channels (L type)
Increases cytokine production

49. if there are keratin swirls does that mean well or poorly differentiated?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Amiloride - spironolactone - triamterene
TSh (in testicular tumors can cause hyperthyroidism)
Well

50. Where does conjugation of bilirubin take place?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
In ER of bile canaliculi
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration