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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 difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
HSV and VZV
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
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

2. What is diagnostic (and possible therapeutic for intussusception)?
Purkinje system; AV node
Barium enema
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
8 (myc protein) with 2 - 14 - 22 (iG chains)

3. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Increase; decreased
Prevents hepatic VLDL production
Ig A deficiency
Around 70 (normal measured diastolic pressures); 9--

4. What type of bond is a disulfide bond?
Covalent (between two cysteines)- allows protein to withstand denaturation
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
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Turbulence

5. What is Bortezomib and What is it used for?
Fibrosis; macrophages
Because of the low output from heart failure - they will have increased aldosterone levels
Proteasome inhibitor; treatment for MM and waldenstroms
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

6. there are mucus secreting cells in the bronchioles...
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
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
only up to bronchi
Lateral; RV; RA; LV

7. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
Integration of viral DNA into genome of host hepatocytes
Elastance
E. coli; staphylococcus saprophyticus
Right heart failure

8. what protein is increased in Crohns disease? What does it do?
Purkinje system; AV node
Primary
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
NF- KB; responsible for cytokine production

9. What is mcc of death pre hospital phase of MI? in hospital phase?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
V fib; v. failure
ATP binding (resets the myosin head to contract again for next binding)
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

10. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
Faulty positioning of the genital tubercle
SVC and IVC; right below the aortic knob
Bile soluble which means they are bile sensitive
MAC complex (C5b - C9 complement deficiency)

11. do patients with cor pulmonale have increased or decreased levels of aldosterone?
Single adenomatous ones
Common peroneal; bony fractures and compression; sciatic
Because of the low output from heart failure - they will have increased aldosterone levels
Hereditary angioedema; ACE inhibitors

12. What is the mcc of extrinsic allergic asthma?
Medial part
Adductor
APP on chrom 21 (this is why downs more susceptible)
Inhaled animal dander allergens

13. What is 5- HETE and What does it do?
No
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Leukotriene precursor and does neutrophil chemotaxis
Medial part

14. What is the preferred treatment for DKA?
Regular insulin (Not fast acting - regular better)
CMV - HSV 1 - Candida
Syncope - angina - dyspnea (SAD)
Sydenham chorea

15. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Drink plenty of fluids
transcription activation/suppression
Turners`

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

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17. What does sustained hand grip do to the C/V system?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Rabies encephalitis from cave bats; rabies killed vaccines
differentiate
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

18. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
Increase lymphatic drainage!
RER; RER
SSRI; erectile dysfunction
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)

19. What type of disease has selective proteinuria? What is found in urine? What is not?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
indomethacin
women

20. why should you not use ACE inhibitors with someone who had hereditary angioedema?
E. coli; staphylococcus saprophyticus
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Joints d/t increased purine production and thus uric acid production
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

21. within the right ventricle - What are maximum pressures? the pulm arter?
Adductor
25; 25
No and yes
Bile salt accumulation in urine

22. What is the most common neurologic complication of VZV reactivation?
Localized dermatologic pain that persists for more than one month after zoster eruption
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
Intussusception
Curlings ulcers

23. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
TSh (in testicular tumors can cause hyperthyroidism)
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Secretin stimulates the exocrine pancrease; S enteroendocrine cells in duodenal mucosa in response to acid secrete secretin (HCL is most potent stimulus for secretin release)
Hypothyroidism

24. What can worse neurologic dysfunction in cobalamic def?
I is more benign and can present later in adulthood
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
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!

25. when arrested in prophase of meiosis I - What are primary oocytes chrom number? What about the secondary oocytes that are stuck in metaphase of Meiosis II?
46 - 4N; 23 2N
Echinococcus granulosus; anaphylaxis
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)
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

26. Where does 90% of serotonin lie? What is this NT responsible?
Demargination of neutrophils from the vessel walls
Barium enema
low in serum
GI tract; mood!

27. What is a cell surface marker seen in liver angiosarcoma?
No and yes
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
CGD; t cell dysfxn (diGeorge)
Env genes (for getting into target cells)

28. what has the greatest effect on prognosis when treating c. diptheriae?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
differentiate
When it invades the bm; carcinoma in situ

29. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
S. saprophyticus - and s. epidermidis; novobiocin
Prostate tumor and increased osteoclast activity
Anti centromere; anti DNA topoisomerase
Class I

30. in B12 deficiency - what levels in blood rise very quickly and then drop?
Purkinje system; AV node
Coagulation factors are made in the liver
Reticulocytes
Sudden loss of muscle tone without loss of consciousness; narcolepsy

31. 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
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Atrial
P450 mitochondrial monooxygenase

32. What are the primary determinants of colon cancer risk in UC patients
Closer to head; closer to diaphragm
Localized dermatologic pain that persists for more than one month after zoster eruption
No; yes
Duration and extent of disease

33. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Large stroke volumes with ventricular contraction; aortic regurg
Standing suddenly from supine position; valsalva maneuver
Superior larygeal; cricothyroid; recurrent laryngeal
Spongiosis

34. What is an abortive viral infection?
glycerol kinase
Little effect on cell and no change
25; 25
Increase by 50% in urine osmolality

35. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
Minimal change disease
The term used to describe decreased drug responsiveness with repeated administration
Insulin like growth factor 1 (just another name)
Bile soluble which means they are bile sensitive

36. what dictates the resting membrane potential of most cells?
High potassium conductance and some sodium conductance
Valproate
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
HSV ( also in utero: chlymadia - neisseria - group B strep)

37. How do you calculate excretion rate of a substance? How do you calculate the filtration rate of a substance? clearance of what substance estimates the GFR?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Chrom 8
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Fibronectin - laminin - collagen

38. What are the potassium sparing diuretics?
Gluteus medius and minimus; positive trendelenberg
Amiloride - spironolactone - triamterene
HSV and VZV
DIC; TTP- HUS dont bleed that much

39. What causes the blurry vision side effects in first generation anti histamines?
Well trained athletes and children
hyponatremia (aldosterone activation equilibrates body volume)
Biphosphonate
Anti cholinergic effects of pupil dilation and lack of accomodation

40. What is the mc location for avascular necrosis? What is it associated with?
RBF= PAH clearance/(1- hematocrit)
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Nocardia
Ether and other organic solvents

41. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Protamine sulfate
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Hereditary angioedema; ACE inhibitors
Strength of cell mediated immune response

42. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
RBC mass; epo levels (secondary has high)
Hydrogen bonds dictate alpha or beta structure
Bile salt accumulation in urine
8; 12

43. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

44. What is gardeners mydriasis? How is it treated?
Turners`
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
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
The term used to describe decreased drug responsiveness with repeated administration

45. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
Medullary
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
200-500
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

46. What does protein M do in Group A strep<
Atrial
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Purkinje system; AV node
Prevent phagocytosis

47. what should you think of in 'smear of an oral ulcer base'?
Tzanck smear
CGD; t cell dysfxn (diGeorge)
Sarcoid
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

48. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
200-500
RBC mass; epo levels (secondary has high)
Phencyclidine (PCP)

49. other than increasing HDL levels - what else does niacin do?
frameshift mutations (missense is substitution)
Sarcoid
Relfex tachycardia; giving beta blockers
Prevents hepatic VLDL production

50. What is a cord factor and Which bugs have it? How do they appear on culture?
When it invades the bm; carcinoma in situ
Smoking
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
In the extracellular space