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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 dobutamine? What is it used for?how it is it most helpful? What is bad about it?
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
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
11
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

2. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
Amiloride - spironolactone - triamterene
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Pan colitis and right sided colitis (more than left sided and proctitis)

3. 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
Terminal bronchioles; small bronchi
P53 mutation; AD
Brief psychotic disorder; schizophreniform; schizophrenia

4. What is damaged in early syringomelia? later?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
RER; copper
G to T in p53; HCC
Hydrogen bonds dictate alpha or beta structure

5. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Insulin like growth factor 1 (just another name)
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Underestimation of gestational age
8; 12

6. Where does complement bind on the Fc region of Ig chains?
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
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
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
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

7. What is the most common neurologic complication of VZV reactivation?
Localized dermatologic pain that persists for more than one month after zoster eruption
Well
Hypo or hyper pigmentations; after tanning
No (unlike adenomyosis); yes

8. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
ANCA because of lack of Ig and C3 deposits on IF
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
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

9. which viruses require a protease?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
SVC and IVC; right below the aortic knob
SS +rNA

10. What is achalasia and how would this correlate on the esophageal mannometry?
Phencyclidine (PCP)
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
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
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

11. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
differentiate
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

12. Where is conduction in heart fastest? slowest?
Purkinje system; AV node
Brief psychotic disorder; schizophreniform; schizophrenia
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
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)

13. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Well
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

14. other than mycobacterim wha other bacteria is acid fast?
Neisseria induced small cell vasculitis (including hands and soles)
High potassium conductance and some sodium conductance
Nocardia
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

15. How do you explain the selective proteinuria of loss to albumin only in MCD?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Nonsense; mRNA processing
In ER of bile canaliculi

16. which nerve provides innervation for plantar flexion and inversion?
Tibial
MAC complex (C5b - C9 complement deficiency)
S. saprophyticus - and s. epidermidis; novobiocin
Large stroke volumes with ventricular contraction; aortic regurg

17. what happens to capacitance with age?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
APP on chrom 21 (this is why downs more susceptible)
...
glycerol kinase

18. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Hyperkalemia; potassium sparing diuretics - potassium supplements
Large stroke volumes with ventricular contraction; aortic regurg
Increases
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

19. how does neisseria cause a petechial rash?
LT (LTD4 - E4 - C4) - and Ach
Leukotriene precursor and does neutrophil chemotaxis
Neisseria induced small cell vasculitis (including hands and soles)
NF- KB; responsible for cytokine production

20. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Underestimation of gestational age
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Syncope - angina - dyspnea (SAD)

21. other than parvo B19 - what else is associated with red cell aplasia?
Turbulence
Thymic tumor
Ketone body production by preventing fatty acids into the mitochondria
indomethacin

22. What is epispadias caused by?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
RBF= PAH clearance/(1- hematocrit)
T test; chi squared
Faulty positioning of the genital tubercle

23. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
SSRI
When it invades the bm; carcinoma in situ
Protamine sulfate

24. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Anterior circumflex (and axillary nerve)
Boiling - bleach - formalin - UV irradiation
Decreases both
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

25. prostaglandin synthesis keeps...
Anterior nares
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
PDA open
S. saprophyticus - and s. epidermidis; novobiocin

26. What is normal fibrinogen levels?
Lateral; RV; RA; LV
200-500
CMV - HSV 1 - Candida
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

27. What is the preferred treatment for DKA?
Reticulocytes
Regular insulin (Not fast acting - regular better)
RBC mass; epo levels (secondary has high)
Increase in permeability of two ions with equal and opposite equilibrium potentials

28. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
Syringomelia
Bile soluble which means they are bile sensitive
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Trochlear nerve (IV); abducens nerve (VI)

29. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Chlorpheniramine and diphenhydramine
Abnormal closing of the urethral folds
Medullary
Joints d/t increased purine production and thus uric acid production

30. a patient fearing all white coats is a phenomenon of what?
Demargination of neutrophils from the vessel walls
Vagus nerve stimulation
Classical conditioning
Inhibits it

31. at four years of age - What are the social - fine motor - gross motor - and language developments?
Protamine sulfate
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
ZDV or AZT
Circular - outside nucleus; transport proteins - rRNA - tRNA

32. Which is faster atrial muscle or ventricular muscle?
Ig A deficiency
Increase by 50% in urine osmolality
Curlings ulcers
Atrial

33. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Valproate
Drink plenty of fluids
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

34. What actions increase venous return?
T test; chi squared
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Squatting - sitting - lying supine - passive leg raising
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

35. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Nonsense; mRNA processing
E. coli; staphylococcus saprophyticus
Reiter syndrome; B27
facultative intracellular

36. What is hypospadias caused by?
Trauma to stereociliated hair cells of the organ of corti
Multiple miscarriages d/t hypercoaguability
Abnormal closing of the urethral folds
Proteasome inhibitor; treatment for MM and waldenstroms

37. What is pickwickian syndrome? What are the lab findings?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Vancomycin; histamine mediated
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Bronchogenic carcinoma

38. Where does the aorta lie in relation to the pulmonary artery in transposition of the great arteries (is this right to left or left to right shunt?)?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Well
Tibial
Intussusception

39. what clinical findings help distinguish small cell carcinoma?
SSRI; erectile dysfunction
Leukotriene precursor and does neutrophil chemotaxis
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Classical conditioning

40. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
8; 12

41. What is a cord factor and Which bugs have it? How do they appear on culture?
Octreotide
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Vagus nerve stimulation
No; MRI

42. What does the tuberoinfundibular pathway connect? What is it responsible for?
8 (myc protein) with 2 - 14 - 22 (iG chains)
Pan colitis and right sided colitis (more than left sided and proctitis)
Bile salt accumulation in urine
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin

43. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Susceptible; soluble (unable to be cultured in bile)
P450 mitochondrial monooxygenase
ANCA because of lack of Ig and C3 deposits on IF
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

44. what immune deficiency causes recurrent neisseria infections?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
MAC complex (C5b - C9 complement deficiency)
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

45. Which is slower AV node or ventricular muscle?
AV node slowest - to allow time for diastole
Chlorpheniramine and diphenhydramine
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
High potassium conductance and some sodium conductance

46. What are some side effects seen in TCAs?
Underestimation of gestational age
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
In ER of bile canaliculi

47. which cells produce surfactant? which ones mediate gas exchange?
Vagus nerve stimulation
II; I (I more abundant)
11 aa polypeptide; pain NT in CNS and PNS
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

48. metabolism of 1 gram of protein produces How many calories? carb? fat?
Normal; low
Headaches and facial flushing; vasodilation in meninges and skin
liver specific
4 - 4 - 9

49. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
In the extracellular space for collagen cross linking; zinc
Rabies encephalitis from cave bats; rabies killed vaccines
SVC and IVC; right below the aortic knob

50. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Neisseria induced small cell vasculitis (including hands and soles)
Minimal change disease