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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 causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
In ER of bile canaliculi
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
P53 mutation; DCC is also required for adenoma to carcinoma
Standing suddenly from supine position; valsalva maneuver

2. What type of endocarditis is cytoscopy induced?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
...
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Enterococci (e. faecalis)- found on genitalia area

3. What is the fibrinogen level in patient with TTP- HUS? DIC?
G to T in p53; HCC
Amiloride - spironolactone - triamterene
Normal; low
manifestations - congenital (stretching of periventricular pyrimadal fibers)

4. What is contraindicated in toxic mega colon?
Recurrent larygneal
SVC and IVC; right below the aortic knob
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Susceptible; soluble (unable to be cultured in bile)

5. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Medial circumflex artery; avascular necrosis
S. aureus
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Curlings ulcers

6. how much percent of sodium is excreted? urea? glucose?
Well
Biphosphonate
Measles and M3 AML`
<1% - 55% - concentration dependent

7. what happens to capacitance with age?
TCAs and prazosin
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
...
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

8. What three pathogens cause infectious esophagitis in HIV positive patients?
CMV - HSV 1 - Candida
Strength of cell mediated immune response
Abnormal closing of the urethral folds
Large stroke volumes with ventricular contraction; aortic regurg

9. why should you not use ACE inhibitors with someone who had hereditary angioedema?
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
women
II; I (I more abundant)
Reiter syndrome; B27

10. What is the presentation of sever aortic stenosis?
Chlorpheniramine and diphenhydramine
Anterior circumflex (and axillary nerve)
Large stroke volumes with ventricular contraction; aortic regurg
Syncope - angina - dyspnea (SAD)

11. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
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
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Terminal bronchioles; small bronchi
G to T in p53; HCC

12. What are the three dopaminergic systems and What are they responsible for? disease?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Drink plenty of fluids
Demargination of neutrophils from the vessel walls

13. What are some side effects seen in TCAs?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
P53 mutation; AD
Additive is equal to the sum of the two actions (lets say agonists at a receptor) and synergistic is when the sum is greater than just their two effects together
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

14. Where does 90% of serotonin lie? What is this NT responsible?
Because of vasodiation to skeletal muscles
Increases cytokine production
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)
GI tract; mood!

15. When is acid phosphatase elevated (Name two times)?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Prostate tumor and increased osteoclast activity

16. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
Think Hb deformation diseases
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Sickle cell; G6PD

17. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Protamine sulfate
women
differentiate

18. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Minimal change disease
Anti centromere; anti DNA topoisomerase
Adeno
Gluteus medius and minimus; positive trendelenberg

19. What is medullary sponge kidney disease and how does it present? What does it lead to?
25; 25
Increase in permeability of two ions with equal and opposite equilibrium potentials
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)
hyponatremia (aldosterone activation equilibrates body volume)

20. what kind of drug is sertraline? What is a common side effect?
SSRI; erectile dysfunction
Well
8; 12
Chrom 8

21. What type of mutation does aflatoxin cause? what cancer does this increase for?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
G to T in p53; HCC
Pulmonic and systemic!

22. What is difference between Arnold Chiari type I and II?
I is more benign and can present later in adulthood
Boiling - bleach - formalin - UV irradiation
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
Folic acid treatment!

23. 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?
Pulmonary hypertension
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
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)

24. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
Rabies encephalitis from cave bats; rabies killed vaccines
frameshift mutations (missense is substitution)
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
RBF= PAH clearance/(1- hematocrit)

25. what nerve and artery course along the posterior aspect of the humerus?
No; yes
Radial nerve and deep brachial artery
Right before diastole (filling begins)
GI tract; mood!

26. What is the most common location of colonization of all s. aureus types?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Anterior nares
E. coli
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

27. What is the mutation type in thalassemias? what process is defective because of this?
Measles and M3 AML`
11 aa polypeptide; pain NT in CNS and PNS
Nonsense; mRNA processing
Retinitis; mononucleosis

28. What is epleronone?
P450 mitochondrial monooxygenase
Fibrosis; macrophages
Multiple miscarriages d/t hypercoaguability
Another type of aldosterone antagonist (like spironolactone)

29. What are fenfluramine - phentermine?
Increase in permeability of two ions with equal and opposite equilibrium potentials
Appetite suppressants
Anti centromere; anti DNA topoisomerase
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

30. Which is faster atrial muscle or ventricular muscle?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Retinitis; mononucleosis
Atrial
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

31. What triggers the neoplastic changes that are associated with HBV infecton?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Integration of viral DNA into genome of host hepatocytes
ANCA because of lack of Ig and C3 deposits on IF
GI tract; mood!

32. biotin is used By what in tissues responsible for gluconeogenesis
As a CO2 carrier with the carboxylase enzyme
Gluteus maximus; difficulty getting up from seated position and climbing chair
Proteasome inhibitor; treatment for MM and waldenstroms
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

33. Acyl coA synthetase is not...
Insulin like growth factor 1 (just another name)
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Vancomycin; histamine mediated
liver specific

34. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Fat - fertile - forty - female
FGF and VEGF

35. What type of bond is a disulfide bond?
T test; chi squared
Folic acid treatment!
Covalent (between two cysteines)- allows protein to withstand denaturation
Enterococci (e. faecalis)- found on genitalia area

36. What can cause aortic regurg? What is the heart sound you hear?
gram positive organisms
Medial circumflex artery; avascular necrosis
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Intussusception

37. What antibodies are present in CREST? What is the most specific?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Anti centromere; anti DNA topoisomerase
AV node slowest - to allow time for diastole
Leukotriene precursor and does neutrophil chemotaxis

38. What is somatomedin C?
Insulin like growth factor 1 (just another name)
Smoking
Gluteus maximus; difficulty getting up from seated position and climbing chair
Well

39. who bleed more DIC or TTP- HUS patients?
Headaches and facial flushing; vasodilation in meninges and skin
Thymic tumor
DIC; TTP- HUS dont bleed that much
Increases bronchial and vascular smooth muscle reactivity to catecholamines

40. What are diastolic (lowest) pressures in aorta? LV?
Around 70 (normal measured diastolic pressures); 9--
Normal; low
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
glycerol kinase

41. after a thrombus extraction - what serum enzyme shoots up and why?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
E. coli
Serum creatine kinase; reperfusion injury causes necrosis
Well trained athletes and children

42. how does increased ICP result in curlings ulcers?
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)
Vagus nerve stimulation
Paramyxo and influenza
25; 25

43. What does TGF beta do? What produces it?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Decreases both
Superior larygeal; cricothyroid; recurrent laryngeal
Fibrosis; macrophages

44. What is achalasia and how would this correlate on the esophageal mannometry?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
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
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

45. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Class I
Because of vasodiation to skeletal muscles
Susceptible; soluble (unable to be cultured in bile)
TSh (in testicular tumors can cause hyperthyroidism)

46. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Mean greater than median greater than mode
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

47. In what population does cholelithiasis occur?
Vancomycin; histamine mediated
Hypo or hyper pigmentations; after tanning
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Fat - fertile - forty - female

48. What causes release of myosin head from the actin filament?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Insulin like growth factor 1 (just another name)
Localized dermatologic pain that persists for more than one month after zoster eruption
ATP binding (resets the myosin head to contract again for next binding)

49. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Strength of cell mediated immune response
Fibronectin - laminin - collagen
C3 decreased after 5-10 days; sulfonamides

50. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
P53 mutation; DCC is also required for adenoma to carcinoma
Syringomelia
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Initiation - pointing; pincer grasp; walking; mama/dada