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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 does NF- KB do?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
ATP binding (resets the myosin head to contract again for next binding)
Increases cytokine production

2. What are three symptoms in s.typhi?
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Paramyxo and influenza
Folic acid treatment!
GI malignancies and Insulin resistance (acromegal for ex)

3. h1 receptor anatagonists are not effective in treatment of asthma only for...
chronic urticaria and allergic symptoms
S. saprophyticus - and s. epidermidis; novobiocin
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

4. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Susceptible; soluble (unable to be cultured in bile)
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
MAO inhibitors; wine and cheese
Increase lymphatic drainage!

5. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
LT (LTD4 - E4 - C4) - and Ach
Vancomycin
P53 mutation; AD
gram positive organisms

6. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
Joints d/t increased purine production and thus uric acid production
RBC mass; epo levels (secondary has high)
Not lined by epithelium
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

7. What are two common side effects of both acute and long acting nitrates? What causes them?
Paramyxo and influenza
Turners`
RER; copper
Headaches and facial flushing; vasodilation in meninges and skin

8. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
Prepatellar
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Brief psychotic disorder; schizophreniform; schizophrenia
SVT; increases vagal tone; rectus abdominis

9. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Vancomycin; histamine mediated
Because gamma chains replace beta chains and then gamma chain formation wanes
25; 25

10. What is hyaline arteriosclerosis usually a sign of ?
No (unlike adenomyosis); yes
Hypertension - edema - and proteinuria
Diabetic microangiopathy
P450 mitochondrial monooxygenase

11. what organ would an activating mutation in PRPP synthetase effect?
Joints d/t increased purine production and thus uric acid production
TCAs and prazosin
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Adeno

12. What are the two mcc of focal brain lesions in HIV positive patients?
Sarcoid
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
No; MRI
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

13. what kind of drug is sertraline? What is a common side effect?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Permissive - sensitizes vasoconstrictive response from catecholamines - doesnt actually act on them but increases transcription of some genes that creates permissive effect (not additive or synergistic becuase cortisol alone doesnt have any effect on
SSRI; erectile dysfunction
Sarcoid

14. nucleotide deletions do not cause missense mutations - they cause...
Increase; decreased
Amiadarone
frameshift mutations (missense is substitution)
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

15. which has better side effect profile - SSRI or TCA?
Drug induced interstitial nephritis
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
Decreases both
SSRI

16. What is extraocular muscle weakness a common symptom of?
E. coli; staphylococcus saprophyticus
Aromatase deficiency in child
Myasthenia gravis
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

17. What are the three causes of acute MI in context of normal coronary arteries ?
Trochlear nerve (IV); abducens nerve (VI)
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Superior larygeal; cricothyroid; recurrent laryngeal

18. What test would be best to determine if a gene is being transcribed? translated?
Southern - western
S3 gallop; S2 to opening snap interval
Echinococcus granulosus; anaphylaxis
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

19. What is capacitance inversely proportional to?
Elastance
Anti - apoptotic (prevents going into apoptosis)- 18; 14
The term used to describe decreased drug responsiveness with repeated administration
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

20. What is the cause of fixed splitting of S2? why?
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
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Covalent (between two cysteines)- allows protein to withstand denaturation
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

21. What is easiest way to treat nephrolithiasis?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Drink plenty of fluids
High potassium conductance and some sodium conductance
Turners`

22. why does variocele occur more in left side?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Hyperkalemia; potassium sparing diuretics - potassium supplements
Acute gastric mucosal defects (superficial or full thickness)
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

23. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
S3 gallop; S2 to opening snap interval
Circular - outside nucleus; transport proteins - rRNA - tRNA
Reiter syndrome; B27
Skin flushing and warmth; prostaglandins; give with aspirin

24. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Hyperkalemia; potassium sparing diuretics - potassium supplements
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Nonsense; mRNA processing

25. What does protein M do in Group A strep<
Prevent phagocytosis
Circular - outside nucleus; transport proteins - rRNA - tRNA
Acute interstitial nephritis
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

26. what phase do adenosine and acetylcholine act on? doing what?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Phencyclidine (PCP)
RBC mass; epo levels (secondary has high)
Amiloride - spironolactone - triamterene

27. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Medial part

28. what vessel would a fracture to the neck of the of the humerus damage?
Anterior circumflex (and axillary nerve)
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
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

29. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Hypo or hyper pigmentations; after tanning
Fibronectin - laminin - collagen
APP on chrom 21 (this is why downs more susceptible)
Acute interstitial nephritis

30. What is the most important prognostic indicator in patients with malignant melanoma?
Close but purkinje system to ensure contraction in a bottom up fashion
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Measure of depth invasion (vertical!)

31. What antibiotic is best to treat alcoholic pulm infections? why?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
8; 12

32. which opponens muscle does ulnar innervate?
ZDV or AZT
Well trained athletes and children
Adductor
Primary

33. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
glycerol kinase
RER; copper
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Sydenham chorea

34. What is the most common initital symptom of ADPKD? what else?
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)
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

35. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
Not lined by epithelium
glycerol kinase
Strength of cell mediated immune response
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

36. What translocations can cause c - myc overexpression?
Well
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
8 (myc protein) with 2 - 14 - 22 (iG chains)
GI tract; mood!

37. In what form are mitochondrial DNA? What do they transcribe?
Fat - fertile - forty - female
Recurrent larygneal
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Circular - outside nucleus; transport proteins - rRNA - tRNA

38. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Right heart failure
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
ATP binding (resets the myosin head to contract again for next binding)
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

39. 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
Anterior nares
8 (myc protein) with 2 - 14 - 22 (iG chains)
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

40. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Phencyclidine (PCP)
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Gluteus medius and minimus; positive trendelenberg

41. which antiarrythmic is associated with blue gray discoloration ?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Amiadarone
Little effect on cell and no change
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

42. Where is conduction in heart fastest? slowest?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Radial nerve damage
E. coli
Purkinje system; AV node

43. In what view of CXR is anterior part of heart best seen? anterior part of heart is formed by?right border of heart is formed by? left border?
...
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
No; MRI
Lateral; RV; RA; LV

44. who bleed more DIC or TTP- HUS patients?
indomethacin
When it invades the bm; carcinoma in situ
DIC; TTP- HUS dont bleed that much
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

45. What are the long term consequences of hydrocephalus?
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)
25; 25
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Abnormal closing of the urethral folds

46. where are Beta 1 receptors found?
On cardiac tissue and renal juxtaglomerular cells
Phencyclidine (PCP)
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
gram positive organisms

47. What are the acute effects of corticosteroids on the CBC?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
T test; chi squared
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Apocrine; eccrine

48. What does C1 esterase do other than inhibiting complement pathway?
Inactivates kallikrein which activates kininogen into bradykinin
Apocrine; eccrine
Chlorpheniramine and diphenhydramine
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

49. What antibodies are present in CREST? What is the most specific?
Anti centromere; anti DNA topoisomerase
Bile salt accumulation in urine
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Right heart failure

50. What is difference between Arnold Chiari type I and II?
I is more benign and can present later in adulthood
Around 70 (normal measured diastolic pressures); 9--
Neisseria induced small cell vasculitis (including hands and soles)
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased