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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. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Headaches and facial flushing; vasodilation in meninges and skin
Standing suddenly from supine position; valsalva maneuver
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
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

2. 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
Syringomelia
Rabies encephalitis from cave bats; rabies killed vaccines
Nonsense; mRNA processing

3. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
Headaches and facial flushing; vasodilation in meninges and skin
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Valproate
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

4. Where is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
Hypo or hyper pigmentations; after tanning
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
SVC and IVC; right below the aortic knob
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

5. What type of calcium channels dictate the plateau in cardiac myocyte?
Dihydropyridine sensitive Ca channels (L type)
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
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)
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)

6. What is the difference between paranoid personality disorder and delusional disorder?
Valproate
Vascular endothelium; protease
Both sides
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

7. What is the mainstay treatment for acute mania?
APP on chrom 21 (this is why downs more susceptible)
Increase; decreased
Chlorpheniramine and diphenhydramine
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

8. 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?
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)
Spongiosis
AV node slowest - to allow time for diastole
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

9. at one year of age - What are the social - fine motor - gross motor and language developments?
8 (myc protein) with 2 - 14 - 22 (iG chains)
No and yes
Initiation - pointing; pincer grasp; walking; mama/dada
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

10. other than increasing HDL levels - what else does niacin do?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Prevents hepatic VLDL production
Become beta pleated and then form neurofibrillary tangle!
Drink plenty of fluids

11. do Class IC agents prolong the QT interval?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
HSV ( also in utero: chlymadia - neisseria - group B strep)
Appetite suppressants
No

12. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
CGD; t cell dysfxn (diGeorge)
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
4 - 4 - 9

13. What can long term leg cast wearing cause?
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
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
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
Ether and other organic solvents

14. What is it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
SVT; increases vagal tone; rectus abdominis
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Primary
Vertical diplopia

15. What does 'oxygen' content in blood refer to?
LT (LTD4 - E4 - C4) - and Ach
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Dissolved in plasma and attached to Hgb
Anti cholinergic effects of pupil dilation and lack of accomodation

16. What type of bond is a disulfide bond?
Prevent phagocytosis
GI tract; mood!
Covalent (between two cysteines)- allows protein to withstand denaturation
HSV ( also in utero: chlymadia - neisseria - group B strep)

17. What are the acute effects of corticosteroids on the CBC?
Elastance
Inhaled animal dander allergens
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
S3 gallop; S2 to opening snap interval

18. 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)
Inhibits it
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Strength of cell mediated immune response

19. What is the mc location for avascular necrosis? What is it associated with?
In the extracellular space for collagen cross linking; zinc
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Serum creatine kinase; reperfusion injury causes necrosis
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

20. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
liver specific
Raphe
transcription activation/suppression
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

21. how can HAV be inactivated?
AV node slowest - to allow time for diastole
Ether and other organic solvents
Boiling - bleach - formalin - UV irradiation
ATP binding (resets the myosin head to contract again for next binding)

22. 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)
Prepatellar
HSV and VZV
Nocardia

23. What is intussusception? how does ischemia and necrosis occur?
To pump calcium out in cardiac myocytes so that relaxation occurs
FGF and VEGF
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
Rabies encephalitis from cave bats; rabies killed vaccines

24. What type of endocarditis is cytoscopy induced?
P53 mutation; AD
Enterococci (e. faecalis)- found on genitalia area
Hypothyroidism
RER; copper

25. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
LT (LTD4 - E4 - C4) - and Ach
Pulmonic and systemic!
Pan colitis and right sided colitis (more than left sided and proctitis)

26. which nucleus releases serotonin?
II; I (I more abundant)
Raphe
Faulty positioning of the genital tubercle
Recurrent larygneal

27. What is easiest way to treat nephrolithiasis?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Drink plenty of fluids
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
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

28. are there signs of inflammation in avascular necrosis? then How do you diagnose?
Covalent (between two cysteines)- allows protein to withstand denaturation
No; MRI
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Around 70 (normal measured diastolic pressures); 9--

29. What is the mc location of brain germinomas?What are the classic symptoms?
glycerol kinase
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
MAO inhibitors; wine and cheese

30. What is the most common initital symptom of ADPKD? what else?
Serum creatine kinase; reperfusion injury causes necrosis
Leukotriene precursor and does neutrophil chemotaxis
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

31. what receptors do first generation anti histamines block?
Decreases both
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

32. What test would be best to determine if a gene is being transcribed? translated?
Nocardia
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Southern - western
Medial part

33. What is the sole neurologic manifestation of acute rheumatic fever?
Highly negative resting potential
Sydenham chorea
Boiling - bleach - formalin - UV irradiation
APP on chrom 21 (this is why downs more susceptible)

34. SIADH patients have normal blood volume but...
Hyperkalemia; potassium sparing diuretics - potassium supplements
Increase in permeability of two ions with equal and opposite equilibrium potentials
Tibial
hyponatremia (aldosterone activation equilibrates body volume)

35. what vessel would a fracture to the neck of the of the humerus damage?
46 - 4N; 23 2N
Coagulation factors are made in the liver
CMV - HSV 1 - Candida
Anterior circumflex (and axillary nerve)

36. 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?
Thymic tumor
APP on chrom 21 (this is why downs more susceptible)
Common peroneal; bony fractures and compression; sciatic
Elastance

37. what murmur is enhanced by decreased blood flow to the heart?
FGF and VEGF
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
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)
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

38. What antibiotic is best to treat alcoholic pulm infections? why?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Apocrine; eccrine
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

39. What can chronic vit A toxicity cause?
Folic acid treatment!
Ether and other organic solvents
Dihydropyridine sensitive Ca channels (L type)
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

40. How can renal blood flow be calculated from RPF?
Well trained athletes and children
RBF= PAH clearance/(1- hematocrit)
Increases bronchial and vascular smooth muscle reactivity to catecholamines
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

41. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Tibial
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
Prostate tumor and increased osteoclast activity

42. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Increase in permeability of two ions with equal and opposite equilibrium potentials
Insulin like growth factor 1 (just another name)
Increase by 50% in urine osmolality

43. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
TCAs and prazosin
Proteasome inhibitor; treatment for MM and waldenstroms

44. what happens to capacitance with age?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
...
Dihydropyridine sensitive Ca channels (L type)
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

45. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Octreotide
In the extracellular space for collagen cross linking; zinc
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
Increase lymphatic drainage!

46. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
Cluster
DIC; TTP- HUS dont bleed that much
Hydrogen bonds dictate alpha or beta structure
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)

47. 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
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
Normally close to systolic
Elevated GGT and macrocytosis

48. what protein is increased in Crohns disease? What does it do?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
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
NF- KB; responsible for cytokine production

49. What are pancreatic pseudocysts called pseudo rather than true cysts?
Close but purkinje system to ensure contraction in a bottom up fashion
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
As a CO2 carrier with the carboxylase enzyme
Not lined by epithelium

50. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Spongiosis
Echinococcus granulosus; anaphylaxis
Another type of aldosterone antagonist (like spironolactone)
Turners`