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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 the most important prognostic indicator in patients with malignant melanoma?
HSV and VZV
Integration of viral DNA into genome of host hepatocytes
Measure of depth invasion (vertical!)
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

2. h1 receptor anatagonists are not effective in treatment of asthma only for...
Raphe
chronic urticaria and allergic symptoms
Multiple miscarriages d/t hypercoaguability
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin

3. What causes release of myosin head from the actin filament?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Medial part
ATP binding (resets the myosin head to contract again for next binding)

4. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
Chrom 8
chronic urticaria and allergic symptoms
Become beta pleated and then form neurofibrillary tangle!
No and yes

5. What can cause virilization of a mother during pregnancy?
Large stroke volumes with ventricular contraction; aortic regurg
Aromatase deficiency in child
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Increases

6. Which is faster atrial muscle or ventricular muscle?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
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)
Regular insulin (Not fast acting - regular better)
Atrial

7. carnitine deficiency impairs production of What and how?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Duration and extent of disease
Ketone body production by preventing fatty acids into the mitochondria
Normally close to systolic

8. after a thrombus extraction - what serum enzyme shoots up and why?
Serum creatine kinase; reperfusion injury causes necrosis
AV node slowest - to allow time for diastole
Increased reticulocytes
Prevents hepatic VLDL production

9. What three pathogens cause infectious esophagitis in HIV positive patients?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
RBC mass; epo levels (secondary has high)
CMV - HSV 1 - Candida

10. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Bronchial dilation (bronchiectasis)
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Smoking
Reticulocytes

11. 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?)?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Leukotriene precursor and does neutrophil chemotaxis
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

12. What is the stabilizing force for the secondary structure of proteins?
Hydrogen bonds dictate alpha or beta structure
4 - 4 - 9
chronic urticaria and allergic symptoms
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

13. What does p53 do? what chrom is it on?
S. aureus
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

14. IL4 is used for isotypye switching to what?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
46 - 4N; 23 2N
Vancomycin; histamine mediated
IgE

15. What is capsaicin? Where does it work?
S. saprophyticus - and s. epidermidis; novobiocin
Pain reliever - reduces pain by locking substance P in the PNS
No (unlike adenomyosis); yes
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

16. Where is the base of the heart? apex?
Closer to head; closer to diaphragm
hyponatremia (aldosterone activation equilibrates body volume)
Echinococcus granulosus; anaphylaxis
46 - 4N; 23 2N

17. What does nitroprusside do to afterload? preload?
Decreases both
Ig A deficiency
Demargination of neutrophils from the vessel walls
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

18. Where is aromatase used?
Class I
I is more benign and can present later in adulthood
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

19. What is an abortive viral infection?
Tzanck smear
S. saprophyticus - and s. epidermidis; novobiocin
CGD; t cell dysfxn (diGeorge)
Little effect on cell and no change

20. What is the most common cause of pyelonephritis in both adults and childre?
E. coli
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
To pump calcium out in cardiac myocytes so that relaxation occurs
Elevated GGT and macrocytosis

21. What is intussusception? how does ischemia and necrosis occur?
Thymic tumor
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
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
Drink plenty of fluids

22. SIADH patients have normal blood volume but...
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Increase in permeability of two ions with equal and opposite equilibrium potentials
Chorda tympani branch
hyponatremia (aldosterone activation equilibrates body volume)

23. what diseases can vit A be used to treat?
Measles and M3 AML`
Sarcoid
Syncope - angina - dyspnea (SAD)
RER; RER

24. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
Barium enema
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Bile soluble which means they are bile sensitive
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

25. what immune deficiency causes recurrent neisseria infections?
Vancomycin; histamine mediated
Another type of aldosterone antagonist (like spironolactone)
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
MAC complex (C5b - C9 complement deficiency)

26. What is the mutation type in thalassemias? what process is defective because of this?
Nonsense; mRNA processing
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Underestimation of gestational age
Cluster

27. What is achalasia and how would this correlate on the esophageal mannometry?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
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
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Class I

28. how does noise induced hearing loss occur?
Ceftriaxone; azithromycin
Trauma to stereociliated hair cells of the organ of corti
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Vagus nerve stimulation

29. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Relfex tachycardia; giving beta blockers
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Increases bronchial and vascular smooth muscle reactivity to catecholamines
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

30. which two virus families have hemagluttinin on their surface?
Radial nerve and deep brachial artery
Paramyxo and influenza
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
chronic urticaria and allergic symptoms

31. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
E. coli; staphylococcus saprophyticus
Inactivates kallikrein which activates kininogen into bradykinin
gram positive organisms

32. 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?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Bile soluble which means they are bile sensitive
Radial nerve and deep brachial artery
46 - 4N; 23 2N

33. What are examples of action that decrease venous return to the heart?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
S. aureus
Barium enema
Standing suddenly from supine position; valsalva maneuver

34. why does neutrophila occur with corticosteroids?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Demargination of neutrophils from the vessel walls
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
PDA open

35. What is the immune deficinecy seen in ataxia telangactasia?
Ig A deficiency
Another type of aldosterone antagonist (like spironolactone)
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
IgE

36. other than increasing HDL levels - what else does niacin do?
Prevents hepatic VLDL production
PDA open
Trochlear nerve (IV); abducens nerve (VI)
No

37. Acyl coA synthetase is not...
Inhibits it
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Dissolved in plasma and attached to Hgb
liver specific

38. other than parvo B19 - what else is associated with red cell aplasia?
Because of the low output from heart failure - they will have increased aldosterone levels
Thymic tumor
Hypothyroidism
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

39. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
TCAs and prazosin
LT (LTD4 - E4 - C4) - and Ach
S. saprophyticus - and s. epidermidis; novobiocin
Regular insulin (Not fast acting - regular better)

40. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Medial circumflex artery; avascular necrosis
Rabies encephalitis from cave bats; rabies killed vaccines
C3 decreased after 5-10 days; sulfonamides
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

41. are there signs of inflammation in avascular necrosis? then How do you diagnose?
Abnormal closing of the urethral folds
No; MRI
S. saprophyticus - and s. epidermidis; novobiocin
Because of vasodiation to skeletal muscles

42. What does TGF beta do? What produces it?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Fibrosis; macrophages
Drink plenty of fluids
gram positive organisms

43. what vessel would a fracture to the neck of the of the humerus damage?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Anterior circumflex (and axillary nerve)

44. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
No; MRI
Kallmans
Ig A deficiency
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

45. what color pigmentations are caused by malassezia furfur? when do they become more visible?
glycerol kinase
Hypo or hyper pigmentations; after tanning
Hypertension - edema - and proteinuria
Reticulocytes

46. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Reiter syndrome; B27
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Tzanck smear
Elastance

47. What does L/S stand for in fetal lung maturity? When does maturity occur?
Classical conditioning
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Octreotide
E. coli

48. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
Elastance
C3 decreased after 5-10 days; sulfonamides
Vagus nerve stimulation
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin

49. which staphylococci can do mannitol fermaentation?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
S. aureus
INTRApartum Abs (ampicillin/penicillin)
Downs; regurgitant AV valves - ASDs

50. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
OCPs - multiparity - breast feeding
P53 mutation; DCC is also required for adenoma to carcinoma
Trauma to stereociliated hair cells of the organ of corti
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration