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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 is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
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
Aromatase deficiency in child
E. coli; staphylococcus saprophyticus
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

2. do patients with cor pulmonale have increased or decreased levels of aldosterone?
MAC complex (C5b - C9 complement deficiency)
Syringomelia
Because of the low output from heart failure - they will have increased aldosterone levels
Intussusception

3. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Barium enema
Normal; low
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Large stroke volumes with ventricular contraction; aortic regurg

4. where are the two classical places that the ulnar nerve can be injured?

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5. What causes release of myosin head from the actin filament?
Initiation - pointing; pincer grasp; walking; mama/dada
Reticulocytes
ATP binding (resets the myosin head to contract again for next binding)
Bile salt accumulation in urine

6. What is contraindicated in toxic mega colon?
Hereditary angioedema; ACE inhibitors
Regular insulin (Not fast acting - regular better)
Brief psychotic disorder; schizophreniform; schizophrenia
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

7. 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?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
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)
Sydenham chorea

8. what virus causes pharyngoconjuctival fever?
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
Adeno
indomethacin
NF- KB; responsible for cytokine production

9. What does glycosylase do to DNA? endonuclease? lyase? What does the order here of enzymes represent? what other enzymes are needed?

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10. What is used to prevent vertical transmission of HIV?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
ZDV or AZT
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
Prevents hepatic VLDL production

11. What is the stabilizing force for the secondary structure of proteins?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Vertical diplopia
In the extracellular space for collagen cross linking; zinc
Hydrogen bonds dictate alpha or beta structure

12. where are Beta 1 receptors found?
P53 mutation; DCC is also required for adenoma to carcinoma
Both sides
On cardiac tissue and renal juxtaglomerular cells
Raphe

13. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
HSV ( also in utero: chlymadia - neisseria - group B strep)

14. What is omalizumab and What is it used for?
manifestations - congenital (stretching of periventricular pyrimadal fibers)
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Joints d/t increased purine production and thus uric acid production
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

15. What is mcc of death pre hospital phase of MI? in hospital phase?
Superior larygeal; cricothyroid; recurrent laryngeal
Enterococci (e. faecalis)- found on genitalia area
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
V fib; v. failure

16. 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)
INTRApartum Abs (ampicillin/penicillin)
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Amiloride - spironolactone - triamterene

17. which opponens muscle does ulnar innervate?
Adductor
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Single adenomatous ones
Normally close to systolic

18. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Increase; decreased
By vascular permeability and vasodilation
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Class I

19. 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
Classical conditioning
Localized dermatologic pain that persists for more than one month after zoster eruption
Multiple miscarriages d/t hypercoaguability

20. in overweight individuals What is thought to contribute to insulin resistance?
Little effect on cell and no change
Vertical diplopia
Serum FFA and serum triglyceride levels
Radial nerve and deep brachial artery

21. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Fibronectin - laminin - collagen
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Paramyxo and influenza

22. What are examples of action that decrease venous return to the heart?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Standing suddenly from supine position; valsalva maneuver
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

23. What is an abortive viral infection?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Little effect on cell and no change
Increase in permeability of two ions with equal and opposite equilibrium potentials
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

24. what drug is useful for secretory diarrhea?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Elastance
Octreotide
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

25. what kind of drug is sertraline? What is a common side effect?
SSRI; erectile dysfunction
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Integration of viral DNA into genome of host hepatocytes
low in serum

26. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Serum creatine kinase; reperfusion injury causes necrosis
chronic urticaria and allergic symptoms
Retinitis; mononucleosis
Increase lymphatic drainage!

27. what commonly happens in GI in response to acute physiologic stress?
Trochlear nerve (IV); abducens nerve (VI)
Superior larygeal; cricothyroid; recurrent laryngeal
Abnormal closing of the urethral folds
Acute gastric mucosal defects (superficial or full thickness)

28. How do you treat gonococcal infection? chlymadia?
Hypo or hyper pigmentations; after tanning
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
Ceftriaxone; azithromycin
OCPs - multiparity - breast feeding

29. which has better side effect profile - SSRI or TCA?
RBC mass; epo levels (secondary has high)
SSRI
G to T in p53; HCC
Because gamma chains replace beta chains and then gamma chain formation wanes

30. What is the difference between paranoid personality disorder and delusional disorder?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Boiling - bleach - formalin - UV irradiation
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

31. When does neovascularization granulation tissue begin to form after severe ischemia and MI? what happens in 12-24 hours? 2 weeks to 2 months? 1-5 days? 0-4 hours? when do you see edema - hemorrhage - wavy fibers?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Anti centromere; anti DNA topoisomerase
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
Inactivates kallikrein which activates kininogen into bradykinin

32. What are the skin presentation in sarcoid?
Boiling - bleach - formalin - UV irradiation
Varying; erythema nodosum is common
Octreotide
ANCA because of lack of Ig and C3 deposits on IF

33. What is extraocular muscle weakness a common symptom of?
Right heart failure
Common peroneal; bony fractures and compression; sciatic
Hydrogen bonds dictate alpha or beta structure
Myasthenia gravis

34. within the right ventricle - What are maximum pressures? the pulm arter?
25; 25
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Skin flushing and warmth; prostaglandins; give with aspirin

35. What are the three causes of acute MI in context of normal coronary arteries ?
Bronchogenic carcinoma
Think Hb deformation diseases
Env genes (for getting into target cells)
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

36. What is used to compare means? categorical outcomes?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Hydrogen bonds dictate alpha or beta structure
INTRApartum Abs (ampicillin/penicillin)
T test; chi squared

37. how does noise induced hearing loss occur?
Chorda tympani branch
glycerol kinase
Trauma to stereociliated hair cells of the organ of corti
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

38. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Increase lymphatic drainage!
Purkinje system; AV node
Prepatellar
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

39. What is a clara cell?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Sydenham chorea
Turbulence
Proteasome inhibitor; treatment for MM and waldenstroms

40. which nerve in the lower leg is easily injured and causes foot drop ? What are common causes? From what nerve does it branch off or?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Common peroneal; bony fractures and compression; sciatic
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Pulmonic and systemic!

41. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

42. What is a keloid?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Excessive collagen formation during tissue repair in susceptible individuals
Another type of aldosterone antagonist (like spironolactone)
No and yes

43. How do you explain the selective proteinuria of loss to albumin only in MCD?
Prostate tumor and increased osteoclast activity
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

44. What are the two coagulase negative staphylococci? How do you distinguish them?
glycerol kinase
Tzanck smear
S. saprophyticus - and s. epidermidis; novobiocin
Because gamma chains replace beta chains and then gamma chain formation wanes

45. What is normal fibrinogen levels?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
200-500
RER; copper
Medullary

46. What test would be best to determine if a gene is being transcribed? translated?
Tissue redistribution (out of plasma) rather than metabolism
Southern - western
Faulty positioning of the genital tubercle
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

47. which RPGN is also called pauci immune GN? why?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Selective alpha 1 (increases SVR)
ANCA because of lack of Ig and C3 deposits on IF
Ether and other organic solvents

48. What is the sole neurologic manifestation of acute rheumatic fever?
Hereditary angioedema; ACE inhibitors
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Underestimation of gestational age
Sydenham chorea

49. which two virus families have hemagluttinin on their surface?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Headaches and facial flushing; vasodilation in meninges and skin
Right before diastole (filling begins)
Paramyxo and influenza

50. What type of disease has selective proteinuria? What is found in urine? What is not?
Prepatellar
Vagus nerve stimulation
Lateral; RV; RA; LV
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin