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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 has the greatest effect on prognosis when treating c. diptheriae?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Susceptible; soluble (unable to be cultured in bile)
Folic acid treatment!
Around 70 (normal measured diastolic pressures); 9--

2. What are the two growth factors associated with angiogenesis?
facultative intracellular
Hypothyroidism
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
FGF and VEGF

3. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Boiling - bleach - formalin - UV irradiation
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
Hypothyroidism

4. in overweight individuals What is thought to contribute to insulin resistance?
Anterior nares
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Serum FFA and serum triglyceride levels

5. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

6. 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
Increase by 50% in urine osmolality
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

7. What is omalizumab and What is it used for?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Increase by 50% in urine osmolality
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Valproate

8. other than proteinuria - What can cause foamy froathy urine?
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
Vagus nerve stimulation
Folic acid treatment!
Bile salt accumulation in urine

9. 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?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Closer to head; closer to diaphragm
Relfex tachycardia; giving beta blockers
46 - 4N; 23 2N

10. nucleotide deletions do not cause missense mutations - they cause...
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
frameshift mutations (missense is substitution)
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Increase; decreased

11. What is the neurologic manifestation of ADPKD?
Prevent phagocytosis
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Radial nerve and deep brachial artery
Syringomelia

12. What is the best indicator for the severity of mitral stenosis?
The time interval between S2 and OS- the shorter the interval - the more intense
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Enterococci (e. faecalis)- found on genitalia area
Purkinje system; AV node

13. what immune deficiency causes recurrent neisseria infections?
OCPs - multiparity - breast feeding
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
MAC complex (C5b - C9 complement deficiency)

14. What is the difference between additive and synergistic?
Bile soluble which means they are bile sensitive
Sickle cell; G6PD
Initiation - pointing; pincer grasp; walking; mama/dada
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

15. What is a cord factor and Which bugs have it? How do they appear on culture?
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)
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
only up to bronchi
MAC complex (C5b - C9 complement deficiency)

16. what murmur is enhanced by decreased blood flow to the heart?
Nocardia
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Env genes (for getting into target cells)
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

17. What is the stabilizing force for the secondary structure of proteins?
Hydrogen bonds dictate alpha or beta structure
Large stroke volumes with ventricular contraction; aortic regurg
OCPs - multiparity - breast feeding
S3 gallop; S2 to opening snap interval

18. What is tachyphylaxis?
The time interval between S2 and OS- the shorter the interval - the more intense
Smoking
The term used to describe decreased drug responsiveness with repeated administration
Prepatellar

19. sporadic colon cancer tend to arise From what type of polyps?
8 (myc protein) with 2 - 14 - 22 (iG chains)
Single adenomatous ones
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
AV node slowest - to allow time for diastole

20. what hormone is structurally similar to hCG?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
TSh (in testicular tumors can cause hyperthyroidism)
Valproate
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

21. is Rifampin ever used as monotherapY? why either way?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
No only for prophylaxis (even for treating staphylococcal endocarditis its as multi drug); this is to prevent drug resistance from spontaneous mutations by DNA dependent RNA polymerase
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Enterococci (e. faecalis)- found on genitalia area

22. How do you calculate RPF from urine PAH?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
(urine PAH x urine flow rate)/plasma PAH
Medullary
Serum creatine kinase; reperfusion injury causes necrosis

23. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
LT (LTD4 - E4 - C4) - and Ach
Turners`
Valproate
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

24. How do bradykinin - C3a and C5a cause edema?
Purkinje system; AV node
By vascular permeability and vasodilation
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
Diabetic microangiopathy

25. why is crohns disease associated with oxaloacetate kidney stones?
Curlings ulcers
Varying; erythema nodosum is common
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
C3 decreased after 5-10 days; sulfonamides

26. What are some of the permissive effects of cortisol?
Fat - fertile - forty - female
Increases bronchial and vascular smooth muscle reactivity to catecholamines
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Localized dermatologic pain that persists for more than one month after zoster eruption

27. What agonists reduce the gradient across the LV outflow tract?
Anti centromere; anti DNA topoisomerase
4 - 4 - 9
MAC complex (C5b - C9 complement deficiency)
Selective alpha 1 (increases SVR)

28. neisseria are...
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
No and yes
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
facultative intracellular

29. What is acanthosis nigricans associated with?
Single adenomatous ones
Apocrine; eccrine
P53 mutation; AD
GI malignancies and Insulin resistance (acromegal for ex)

30. What does the tuberoinfundibular pathway connect? What is it responsible for?
Because of the low output from heart failure - they will have increased aldosterone levels
NF- KB; responsible for cytokine production
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Protamine sulfate

31. metabolism of 1 gram of protein produces How many calories? carb? fat?
4 - 4 - 9
Hypertension - edema - and proteinuria
Intussusception
Clindamycin; covers anaerobic oral flora and aerobic bacteria

32. How do left sided colon adenocarcinomas present? right sided?
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
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Ceftriaxone; azithromycin
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

33. What does glycosylase do to DNA? endonuclease? lyase? What does the order here of enzymes represent? what other enzymes are needed?

34. What are three symptoms in s.typhi?
SSRI; erectile dysfunction
Vascular endothelium; protease
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
TCAs and prazosin

35. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
Abnormal closing of the urethral folds
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Terminal bronchioles; small bronchi

36. What is the mcc of elevated AFP leves in pregnancy>
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Another type of aldosterone antagonist (like spironolactone)
Underestimation of gestational age

37. What causes release of myosin head from the actin filament?
Selective alpha 1 (increases SVR)
ATP binding (resets the myosin head to contract again for next binding)
Retinitis; mononucleosis
Measles and M3 AML`

38. What are the three causes of acute MI in context of normal coronary arteries ?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
200-500
Gluteus maximus; difficulty getting up from seated position and climbing chair
Sarcoid

39. carnitine deficiency impairs production of What and how?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Ketone body production by preventing fatty acids into the mitochondria
ANCA because of lack of Ig and C3 deposits on IF
Pain reliever - reduces pain by locking substance P in the PNS

40. What is subacute sclerosisng encephalitis caused by?
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!
Smoking
RER; copper

41. What is a common complication of acute pancreatitis? What is it?
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)
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
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

42. 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?
ZDV or AZT
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Southern - western
Nocardia

43. which are the only glycosylated proteins in HIV virus?
Pain reliever - reduces pain by locking substance P in the PNS
(urine PAH x urine flow rate)/plasma PAH
Env genes (for getting into target cells)
Normally close to systolic

44. Where is aromatase used?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Demargination of neutrophils from the vessel walls
RBC mass; epo levels (secondary has high)

45. What test would be best to determine if a gene is being transcribed? translated?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Southern - western
Anterior circumflex (and axillary nerve)

46. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Phencyclidine (PCP)
Myasthenia gravis
Become beta pleated and then form neurofibrillary tangle!

47. What is best to prevent GBS infection in a baby?
indomethacin
INTRApartum Abs (ampicillin/penicillin)
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Recurrent larygneal

48. who bleed more DIC or TTP- HUS patients?
DIC; TTP- HUS dont bleed that much
Vagus nerve stimulation
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

49. why are beta thal major patients asymptomatic at birth?
Because gamma chains replace beta chains and then gamma chain formation wanes
Reticulocytes
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Env genes (for getting into target cells)

50. Where is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Atrial
Sarcoid
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound