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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 makes bruits?
Turbulence
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
ATP binding (resets the myosin head to contract again for next binding)
Radial nerve and deep brachial artery

2. other than in pyelonephritis - where else are WBC casts seen?
Acute interstitial nephritis
Aromatase deficiency in child
Radial nerve and deep brachial artery
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

3. What is achalasia and how would this correlate on the esophageal mannometry?
Superior larygeal; cricothyroid; recurrent laryngeal
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
IgE
Bile soluble which means they are bile sensitive

4. What does Rb protein do? what chrom is it on?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
High potassium conductance and some sodium conductance
Think Hb deformation diseases
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

5. What can long term leg cast wearing cause?
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)
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
Protamine sulfate
Sarcoid

6. on which chromosome is wilms tumor found?
manifestations - congenital (stretching of periventricular pyrimadal fibers)
11
PDA open
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

7. What are the primary determinants of colon cancer risk in UC patients
Because gamma chains replace beta chains and then gamma chain formation wanes
Paramyxo and influenza
Duration and extent of disease
Acute interstitial nephritis

8. how can HAV be inactivated?
Syncope - angina - dyspnea (SAD)
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Duration and extent of disease
Boiling - bleach - formalin - UV irradiation

9. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
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
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
CGD; t cell dysfxn (diGeorge)

10. What can chronic vit A toxicity cause?
Pulmonic and systemic!
Primary
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Standing suddenly from supine position; valsalva maneuver

11. do patients with cor pulmonale have increased or decreased levels of aldosterone?
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
Because of the low output from heart failure - they will have increased aldosterone levels
Recurrent larygneal
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

12. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
Tissue redistribution (out of plasma) rather than metabolism
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Primary
MAO inhibitors; wine and cheese

13. What is tachyphylaxis?
The term used to describe decreased drug responsiveness with repeated administration
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
8 (myc protein) with 2 - 14 - 22 (iG chains)

14. When is acid phosphatase elevated (Name two times)?
Prostate tumor and increased osteoclast activity
Think Hb deformation diseases
Transported to liver - glycerol kinase converts it to glycerol 3 phosphate Which is then converted to DHAP which can either join glycolysis for ATP or be used to make glucose
Ceftriaxone; azithromycin

15. What is congestive hepatomegaly specific for?
Increase in permeability of two ions with equal and opposite equilibrium potentials
Well trained athletes and children
frameshift mutations (missense is substitution)
Right heart failure

16. What does p53 do? what chrom is it on?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

17. what immune deficiency causes recurrent neisseria infections?
MAC complex (C5b - C9 complement deficiency)
Right before diastole (filling begins)
Right heart failure
Downs; regurgitant AV valves - ASDs

18. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
Not lined by epithelium
11
IgE
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

19. What does protein M do in Group A strep<
Vertical diplopia
TSh (in testicular tumors can cause hyperthyroidism)
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Prevent phagocytosis

20. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Inhibits it
Increases bronchial and vascular smooth muscle reactivity to catecholamines

21. what kind of drug is sertraline? What is a common side effect?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
SSRI; erectile dysfunction
V fib; v. failure
Prepatellar

22. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Increases
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Dissolved in plasma and attached to Hgb
NF- KB; responsible for cytokine production

23. What is contraindicated in toxic mega colon?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
No and yes
Increased reticulocytes
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

24. within the right ventricle - What are maximum pressures? the pulm arter?
The time interval between S2 and OS- the shorter the interval - the more intense
25; 25
Env genes (for getting into target cells)
Anterior nares

25. what phase do adenosine and acetylcholine act on? doing what?
Tibial
Vancomycin
Leukotriene precursor and does neutrophil chemotaxis
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

26. 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
Hypo or hyper pigmentations; after tanning
P53 mutation; AD
Brief psychotic disorder; schizophreniform; schizophrenia

27. What is normal fibrinogen levels?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
200-500
GI malignancies and Insulin resistance (acromegal for ex)

28. other than increasing HDL levels - what else does niacin do?
DIC; TTP- HUS dont bleed that much
indomethacin
Prevents hepatic VLDL production
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

29. Where is the base of the heart? apex?
Pain reliever - reduces pain by locking substance P in the PNS
NF- KB; responsible for cytokine production
SSRI; erectile dysfunction
Closer to head; closer to diaphragm

30. What test would be best to determine if a gene is being transcribed? translated?
Southern - western
manifestations - congenital (stretching of periventricular pyrimadal fibers)
On cardiac tissue and renal juxtaglomerular cells
Cluster

31. which has better side effect profile - SSRI or TCA?
Become beta pleated and then form neurofibrillary tangle!
4 - 4 - 9
SSRI
Selective alpha 1 (increases SVR)

32. do Class IC agents prolong the QT interval?
Not lined by epithelium
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
No
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

33. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
facultative intracellular
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Transported to liver - glycerol kinase converts it to glycerol 3 phosphate Which is then converted to DHAP which can either join glycolysis for ATP or be used to make glucose
glycerol kinase

34. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
When it invades the bm; carcinoma in situ
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
Coagulation factors are made in the liver
Medial circumflex artery; avascular necrosis

35. What is damaged in early syringomelia? later?
FGF and VEGF
Well
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Folic acid treatment!

36. What almost exclusively causes Epliglottitis?What type of capsule does it have? What are the symptoms?

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37. What are two common side effects of both acute and long acting nitrates? What causes them?
Headaches and facial flushing; vasodilation in meninges and skin
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Prevent phagocytosis
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

38. sporadic colon cancer tend to arise From what type of polyps?
Classical conditioning
Drink plenty of fluids
Reiter syndrome; B27
Single adenomatous ones

39. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Prostate tumor and increased osteoclast activity
Another type of aldosterone antagonist (like spironolactone)
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

40. when do ghon complexes form - primary or secondary TB?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Primary
Tibial
Vagus (auricular branch); vasovagal syncope!

41. why does liver dysfunction cause coagulation disorders?
GI malignancies and Insulin resistance (acromegal for ex)
Gluteus medius and minimus; positive trendelenberg
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Coagulation factors are made in the liver

42. What is diagnostic (and possible therapeutic for intussusception)?
Dissolved in plasma and attached to Hgb
Barium enema
Sydenham chorea
women

43. What is the difference between paranoid personality disorder and delusional disorder?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Close but purkinje system to ensure contraction in a bottom up fashion
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)
Right before diastole (filling begins)

44. 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
Relfex tachycardia; giving beta blockers
Vascular endothelium; protease
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

45. How do you treat gonococcal infection? chlymadia?
Ceftriaxone; azithromycin
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
P53 mutation; DCC is also required for adenoma to carcinoma
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

46. what protects the resting heart from arrhythmias?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
T test; chi squared
Transported to liver - glycerol kinase converts it to glycerol 3 phosphate Which is then converted to DHAP which can either join glycolysis for ATP or be used to make glucose
Highly negative resting potential

47. If a patient has higher levels of HbF - What does this mean?
Think Hb deformation diseases
Turners`
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Radial nerve and deep brachial artery

48. how does neisseria cause a petechial rash?
CGD; t cell dysfxn (diGeorge)
Highly negative resting potential
Neisseria induced small cell vasculitis (including hands and soles)
Octreotide

49. why does variocele occur more in left side?
Excessive collagen formation during tissue repair in susceptible individuals
Increase; decreased
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

50. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
Syringomelia
Brief psychotic disorder; schizophreniform; schizophrenia
FGF and VEGF
Intussusception