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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. is Rifampin ever used as monotherapY? why either way?
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
Proteasome inhibitor; treatment for MM and waldenstroms
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
Because gamma chains replace beta chains and then gamma chain formation wanes

2. which antiarrythmic is associated with blue gray discoloration ?
Amiadarone
11
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Nonsense; mRNA processing

3. other than proteinuria - What can cause foamy froathy urine?
Bile salt accumulation in urine
GI malignancies and Insulin resistance (acromegal for ex)
P53 mutation; DCC is also required for adenoma to carcinoma
Joints d/t increased purine production and thus uric acid production

4. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
S3 gallop; S2 to opening snap interval
High potassium conductance and some sodium conductance
Class I
Increased reticulocytes

5. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Think Hb deformation diseases
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
Hereditary angioedema; ACE inhibitors

6. Which nerve lies in close proximity to the inferior thyroid artery?
PDA open
Atrial
Recurrent larygneal
Vagus nerve stimulation

7. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
Prostate tumor and increased osteoclast activity
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
RER; RER

8. how can HAV be inactivated?
Boiling - bleach - formalin - UV irradiation
Barium enema
<1% - 55% - concentration dependent
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

9. What pulmonary structural change can kartageners syndrome cause?
Atrial
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
differentiate
Bronchial dilation (bronchiectasis)

10. how does achalasia present? What does barium swallow show on dilated esophagus?
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
Tibial
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Not lined by epithelium

11. What are the acute effects of corticosteroids on the CBC?
No
liver specific
Another type of aldosterone antagonist (like spironolactone)
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

12. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
In ER of bile canaliculi
Sarcoid
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

13. What does 'oxygen' content in blood refer to?
Minimal change disease
Serum FFA and serum triglyceride levels
Dissolved in plasma and attached to Hgb
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

14. what diseases can vit A be used to treat?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Measles and M3 AML`
Medial part

15. What are the first generation anti histamines?
Neisseria induced small cell vasculitis (including hands and soles)
INTRApartum Abs (ampicillin/penicillin)
Chlorpheniramine and diphenhydramine
MAO inhibitors; wine and cheese

16. What is the cause of rapid plasma decay of thiopental?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Tissue redistribution (out of plasma) rather than metabolism
Barium enema
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

17. What is the most common location of colonization of all s. aureus types?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Anterior nares
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Normally close to systolic

18. What is tachyphylaxis?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
S. aureus
The term used to describe decreased drug responsiveness with repeated administration

19. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
MAC complex (C5b - C9 complement deficiency)
Rabies encephalitis from cave bats; rabies killed vaccines
Terminal bronchioles; small bronchi
Phencyclidine (PCP)

20. Where does complement bind on the Fc region of Ig chains?
Phencyclidine (PCP)
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Because of vasodiation to skeletal muscles

21. What does hypocapnia cause in teh brain? What is hypocapnia?
Appetite suppressants
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

22. what induces bronchial squamous metaplasia?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Smoking
ZDV or AZT
Inhaled animal dander allergens

23. what enzyme converts procarcinogens into carcinogens?
Transported to liver - glycerol kinase converts it to glycerol 3 phosphate Which is then converted to DHAP which can either join glycolysis for ATP or be used to make glucose
liver specific
Trochlear nerve (IV); abducens nerve (VI)
P450 mitochondrial monooxygenase

24. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Squatting - sitting - lying supine - passive leg raising
manifestations - congenital (stretching of periventricular pyrimadal fibers)
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

25. What is capacitance inversely proportional to?
SVT; increases vagal tone; rectus abdominis
Elastance
I is more benign and can present later in adulthood
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

26. nucleotide deletions do not cause missense mutations - they cause...
frameshift mutations (missense is substitution)
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Spongiosis
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

27. What is a common complication of acute pancreatitis? What is it?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
APP on chrom 21 (this is why downs more susceptible)
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Chlorpheniramine and diphenhydramine

28. What is diphenoxylate and What is it used for? what drug is it structurally similar to? What allows for potent anti diarrheal effect without signigicant opiate effects?
11
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)
Both sides
HSV ( also in utero: chlymadia - neisseria - group B strep)

29. What is cataplexy and When is it seen?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Estrogen induced cholesterol hypersecretion (increase HMG CoA reductase activity) and progesterone induced gallbladder hypomotility (decreases bile acid secretion)-- both these conditions predispose cholesterole to insolubilize out
Echinococcus granulosus; anaphylaxis

30. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Closer to head; closer to diaphragm
In the extracellular space for collagen cross linking; zinc
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
HSV ( also in utero: chlymadia - neisseria - group B strep)

31. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
ANCA because of lack of Ig and C3 deposits on IF
V fib; v. failure
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
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

32. Where does 90% of serotonin lie? What is this NT responsible?
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Faulty positioning of the genital tubercle
GI tract; mood!
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

33. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Highly negative resting potential
Anterior nares
Serum creatine kinase; reperfusion injury causes necrosis

34. How do you calculate atributable risk percent?
Primary
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Joints d/t increased purine production and thus uric acid production
RR-1/RR

35. What is 5- HETE and What does it do?
Leukotriene precursor and does neutrophil chemotaxis
Increase by 50% in urine osmolality
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Proteasome inhibitor; treatment for MM and waldenstroms

36. What are some of the permissive effects of cortisol?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

37. How do you treat gonococcal infection? chlymadia?
Prevents hepatic VLDL production
Ceftriaxone; azithromycin
When it invades the bm; carcinoma in situ
Anterior circumflex (and axillary nerve)

38. what bursa is affected when on knees like a maid/gardner?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
women
Prepatellar
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

39. which two drug types can cause orthostatic hypotension (think depression and BPH)?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
TCAs and prazosin
Pan colitis and right sided colitis (more than left sided and proctitis)
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

40. in the LV and aorta - What are the pressures?
RER; RER
Elastance
No and yes
Normally close to systolic

41. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
Syringomelia
4 - 4 - 9
glycerol kinase
Diabetic microangiopathy

42. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Chorda tympani branch
Sarcoid
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Appetite suppressants

43. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Fibrosis; macrophages
Raphe
Ether and other organic solvents
Because of vasodiation to skeletal muscles

44. 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?)?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
G to T in p53; HCC
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
NF- KB; responsible for cytokine production

45. What does sustained hand grip do to the C/V system?
25; 25
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Primary
Ether and other organic solvents

46. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Inhaled animal dander allergens
INTRApartum Abs (ampicillin/penicillin)
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
RBF= PAH clearance/(1- hematocrit)

47. metabolism of 1 gram of protein produces How many calories? carb? fat?
No (unlike adenomyosis); yes
chronic urticaria and allergic symptoms
11
4 - 4 - 9

48. What is omalizumab and What is it used for?
frameshift mutations (missense is substitution)
Lateral; RV; RA; LV
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

49. within the right ventricle - What are maximum pressures? the pulm arter?
25; 25
ZDV or AZT
No and yes
Acute interstitial nephritis

50. What is a primary HSV 1 infection like?
Amiadarone
manifestations - congenital (stretching of periventricular pyrimadal fibers)
only up to bronchi
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)