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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. h1 receptor anatagonists are not effective in treatment of asthma only for...
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Elastance
Faulty positioning of the genital tubercle
chronic urticaria and allergic symptoms

2. what protects the resting heart from arrhythmias?
Chorda tympani branch
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Highly negative resting potential
P53 mutation; AD

3. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
On cardiac tissue and renal juxtaglomerular cells
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

4. What is capacitance inversely proportional to?
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
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Elastance
Anti cholinergic effects of pupil dilation and lack of accomodation

5. how can HAV be inactivated?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Octreotide
glycerol kinase
Boiling - bleach - formalin - UV irradiation

6. what immune deficiency causes recurrent neisseria infections?
RER; RER
MAC complex (C5b - C9 complement deficiency)
Sarcoid
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

7. what indicates the severity of a mitral regurg ? mitral stenosis?
S3 gallop; S2 to opening snap interval
TSh (in testicular tumors can cause hyperthyroidism)
Boiling - bleach - formalin - UV irradiation
Decreases both

8. What is the sole neurologic manifestation of acute rheumatic fever?
Env genes (for getting into target cells)
Multiple miscarriages d/t hypercoaguability
Sydenham chorea
Primary

9. What is the most common neurologic complication of VZV reactivation?
Aromatase deficiency in child
RBF= PAH clearance/(1- hematocrit)
Mean greater than median greater than mode
Localized dermatologic pain that persists for more than one month after zoster eruption

10. other than increasing HDL levels - what else does niacin do?
Tzanck smear
Common peroneal; bony fractures and compression; sciatic
Myasthenia gravis
Prevents hepatic VLDL production

11. What is used to compare means? categorical outcomes?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Ceftriaxone; azithromycin
T test; chi squared
liver specific

12. how does eos release MBP to kill protozoa etc?
Raphe
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Ketone body production by preventing fatty acids into the mitochondria
Closer to head; closer to diaphragm

13. What can worse neurologic dysfunction in cobalamic def?
Folic acid treatment!
Bile salt accumulation in urine
Appetite suppressants
Reiter syndrome; B27

14. What is the most important prognostic indicator in patients with malignant melanoma?
Measure of depth invasion (vertical!)
By vascular permeability and vasodilation
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
...

15. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
<1% - 55% - concentration dependent
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
Cluster
Vagus (auricular branch); vasovagal syncope!

16. which cells produce surfactant? which ones mediate gas exchange?
II; I (I more abundant)
Diabetic microangiopathy
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
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

17. What are the lab findings in poststreptococcal GN?
SVC and IVC; right below the aortic knob
Enterococci (e. faecalis)- found on genitalia area
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Circular - outside nucleus; transport proteins - rRNA - tRNA

18. which staphylococci can do mannitol fermaentation?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
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
S. aureus
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

19. What is mcc of death pre hospital phase of MI? in hospital phase?
Thymic tumor
Hypothyroidism
V fib; v. failure
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

20. at three years of age What are social - fine motor - gross motor and language developments?
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
Well
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Relfex tachycardia; giving beta blockers

21. What are the two growth factors associated with angiogenesis?
FGF and VEGF
OCPs - multiparity - breast feeding
Susceptible; soluble (unable to be cultured in bile)
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

22. What is the cause of rapid plasma decay of thiopental?
Tissue redistribution (out of plasma) rather than metabolism
SS +rNA
LT (LTD4 - E4 - C4) - and Ach
Inhibits it

23. When is acid phosphatase elevated (Name two times)?
Prostate tumor and increased osteoclast activity
Sydenham chorea
Medial circumflex artery; avascular necrosis
200-500

24. which two virus families have hemagluttinin on their surface?
Paramyxo and influenza
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Common peroneal; bony fractures and compression; sciatic

25. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Adductor
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Varying; erythema nodosum is common
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

26. what enzyme converts procarcinogens into carcinogens?
Appetite suppressants
Cluster
RR-1/RR
P450 mitochondrial monooxygenase

27. at one year of age - What are the social - fine motor - gross motor and language developments?
Not lined by epithelium
Initiation - pointing; pincer grasp; walking; mama/dada
Aromatase deficiency in child
Hypothyroidism

28. do Class IC agents prolong the QT interval?
No
ZDV or AZT
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
In the extracellular space for collagen cross linking; zinc

29. What is used to treat heparin toxicity?
Protamine sulfate
Normal; low
Measure of depth invasion (vertical!)
HSV and VZV

30. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Increased reticulocytes
C3 decreased after 5-10 days; sulfonamides
Radial nerve damage

31. What type of calcium channels dictate the plateau in cardiac myocyte?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
I is more benign and can present later in adulthood
Become beta pleated and then form neurofibrillary tangle!
Dihydropyridine sensitive Ca channels (L type)

32. what vessel would a fracture to the neck of the of the humerus damage?
Anterior circumflex (and axillary nerve)
Single adenomatous ones
Diabetic microangiopathy
Radial nerve and deep brachial artery

33. What does sustained hand grip do to the C/V system?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Trochlear nerve (IV); abducens nerve (VI)
ATP binding (resets the myosin head to contract again for next binding)
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

34. What are the long term consequences of hydrocephalus?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Because of vasodiation to skeletal muscles
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

35. other than in pyelonephritis - where else are WBC casts seen?
Bronchial dilation (bronchiectasis)
Acute interstitial nephritis
SS +rNA
RBF= PAH clearance/(1- hematocrit)

36. What is a keloid?
low in serum
Excessive collagen formation during tissue repair in susceptible individuals
DIC; TTP- HUS dont bleed that much
...

37. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Sydenham chorea
Brief psychotic disorder; schizophreniform; schizophrenia
Medial circumflex artery; avascular necrosis
RBC mass; epo levels (secondary has high)

38. What are the three dopaminergic systems and What are they responsible for? disease?
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
Myasthenia gravis
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Barium enema

39. are there signs of inflammation in avascular necrosis? then How do you diagnose?
hyponatremia (aldosterone activation equilibrates body volume)
No; MRI
Measure of depth invasion (vertical!)
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

40. what dissolves the lipid bilayer of a viral envelope?
Ether and other organic solvents
The time interval between S2 and OS- the shorter the interval - the more intense
Sudden loss of muscle tone without loss of consciousness; narcolepsy
low in serum

41. How do bradykinin - C3a and C5a cause edema?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
By vascular permeability and vasodilation

42. in overweight individuals What is thought to contribute to insulin resistance?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Serum FFA and serum triglyceride levels
Radial nerve damage
Folic acid treatment!

43. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Acute interstitial nephritis
Gluteus maximus; difficulty getting up from seated position and climbing chair
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
When it invades the bm; carcinoma in situ

44. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Underestimation of gestational age
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
Sickle cell; G6PD

45. What are examples of action that decrease venous return to the heart?
Standing suddenly from supine position; valsalva maneuver
Fibronectin - laminin - collagen
Retinitis; mononucleosis
RER; copper

46. Where is aromatase used?
Integration of viral DNA into genome of host hepatocytes
MAO inhibitors; wine and cheese
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Smoking

47. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
IgE
Hyperkalemia; potassium sparing diuretics - potassium supplements
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

48. when do ghon complexes form - primary or secondary TB?
Increase in permeability of two ions with equal and opposite equilibrium potentials
Primary
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
TCAs and prazosin

49. What antibiotic is best to treat alcoholic pulm infections? why?
Trochlear nerve (IV); abducens nerve (VI)
Clindamycin; covers anaerobic oral flora and aerobic bacteria
frameshift mutations (missense is substitution)
II; I (I more abundant)

50. What type of drug is alendronate?
AV node slowest - to allow time for diastole
No (unlike adenomyosis); yes
Varying; erythema nodosum is common
Biphosphonate