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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 pickwickian syndrome? What are the lab findings?
Hydrogen bonds dictate alpha or beta structure
SVC and IVC; right below the aortic knob
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Thymic tumor

2. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
No and yes
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Varying; erythema nodosum is common

3. What antibiotic is best to treat alcoholic pulm infections? why?
women
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Clindamycin; covers anaerobic oral flora and aerobic bacteria

4. What is a keloid?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Excessive collagen formation during tissue repair in susceptible individuals

5. What test would be best to determine if a gene is being transcribed? translated?
Vascular endothelium; protease
Circular - outside nucleus; transport proteins - rRNA - tRNA
Southern - western
Selective alpha 1 (increases SVR)

6. What is the sole neurologic manifestation of acute rheumatic fever?
Sydenham chorea
CGD; t cell dysfxn (diGeorge)
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
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

7. What triggers the neoplastic changes that are associated with HBV infecton?
Prostate tumor and increased osteoclast activity
Integration of viral DNA into genome of host hepatocytes
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

8. at three years of age What are social - fine motor - gross motor and language developments?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
hyponatremia (aldosterone activation equilibrates body volume)

9. what happens to capacitance with age?
Vagus nerve stimulation
...
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

10. What is difference between Arnold Chiari type I and II?
Protamine sulfate
differentiate
I is more benign and can present later in adulthood
Measure of depth invasion (vertical!)

11. What are the lab findings in poststreptococcal GN?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
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
Varying; erythema nodosum is common
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

12. How do left sided colon adenocarcinomas present? right sided?
Underestimation of gestational age
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
MAO inhibitors; wine and cheese
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

13. What are diastolic (lowest) pressures in aorta? LV?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Around 70 (normal measured diastolic pressures); 9--
Neisseria induced small cell vasculitis (including hands and soles)
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

14. nucleotide deletions do not cause missense mutations - they cause...
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
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
frameshift mutations (missense is substitution)
C3 decreased after 5-10 days; sulfonamides

15. 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)
11
Sickle cell; G6PD
transcription activation/suppression

16. how does eos release MBP to kill protozoa etc?
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
CGD; t cell dysfxn (diGeorge)
Aromatase deficiency in child
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

17. which cells produce surfactant? which ones mediate gas exchange?
Integration of viral DNA into genome of host hepatocytes
Tissue redistribution (out of plasma) rather than metabolism
II; I (I more abundant)
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

18. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
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)
Pulmonary hypertension
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
No; yes

19. at four years of age - What are the social - fine motor - gross motor - and language developments?
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)
Anterior nares
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
On cardiac tissue and renal juxtaglomerular cells

20. What does sustained hand grip do to the C/V system?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Elevated GGT and macrocytosis
Vascular endothelium; protease

21. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
Regular insulin (Not fast acting - regular better)
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Drug induced interstitial nephritis
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

22. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Pulmonary hypertension
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Ketone body production by preventing fatty acids into the mitochondria
Downs; regurgitant AV valves - ASDs

23. Where does 90% of serotonin lie? What is this NT responsible?
Reticulocytes
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
GI tract; mood!

24. In What type of nephritis would you see high serum eos count?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
facultative intracellular
Proteasome inhibitor; treatment for MM and waldenstroms
Drug induced interstitial nephritis

25. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Syncope - angina - dyspnea (SAD)
Medullary
HSV ( also in utero: chlymadia - neisseria - group B strep)
I is more benign and can present later in adulthood

26. What is the difference between additive and synergistic?
Think Hb deformation diseases
V fib; v. failure
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
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

27. What are some of the permissive effects of cortisol?
Close but purkinje system to ensure contraction in a bottom up fashion
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

28. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
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
Radial nerve damage

29. What is the mc malignancy in asbestosis?
TCAs and prazosin
Tibial
Bronchogenic carcinoma
Appetite suppressants

30. is Rifampin ever used as monotherapY? why either way?
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
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
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
Decreases both

31. What is the mc manifestation of CMV in HIV patient? immunocompetent?
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Retinitis; mononucleosis
The term used to describe decreased drug responsiveness with repeated administration
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

32. What is tachyphylaxis?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Insulin like growth factor 1 (just another name)
The term used to describe decreased drug responsiveness with repeated administration
Increases

33. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Raphe
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Ig A deficiency

34. What are two indicators of chronic alcohol consumption?
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)
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Elevated GGT and macrocytosis
Chlorpheniramine and diphenhydramine

35. What is diagnostic (and possible therapeutic for intussusception)?
Tzanck smear
CGD; t cell dysfxn (diGeorge)
Barium enema
Skin flushing and warmth; prostaglandins; give with aspirin

36. What are the primary determinants of colon cancer risk in UC patients
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
S. aureus
Multiple miscarriages d/t hypercoaguability
Duration and extent of disease

37. 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?
Common peroneal; bony fractures and compression; sciatic
Acute gastric mucosal defects (superficial or full thickness)
Acute interstitial nephritis
Increased reticulocytes

38. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Lateral; RV; RA; LV
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Hyperkalemia; potassium sparing diuretics - potassium supplements
Well trained athletes and children

39. What type of mutation does aflatoxin cause? what cancer does this increase for?
Regular insulin (Not fast acting - regular better)
E6 and E7 of HPV knock off p53 and Rb suppressor genes
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
G to T in p53; HCC

40. What is a cord factor and Which bugs have it? How do they appear on culture?
Reiter syndrome; B27
Increase lymphatic drainage!
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Headaches and facial flushing; vasodilation in meninges and skin

41. What does extended consumption of appetite suppressants lead to?
Pulmonary hypertension
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Increase; decreased
Chorda tympani branch

42. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
Normal; low
Reticulocytes
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
DIC; TTP- HUS dont bleed that much

43. which are the only glycosylated proteins in HIV virus?
Env genes (for getting into target cells)
Neisseria induced small cell vasculitis (including hands and soles)
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
Sudden loss of muscle tone without loss of consciousness; narcolepsy

44. What is achalasia and how would this correlate on the esophageal mannometry?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Vancomycin; histamine mediated
Fibronectin - laminin - collagen
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

45. what induces bronchial squamous metaplasia?
Intussusception
Amiadarone
Smoking
Proteasome inhibitor; treatment for MM and waldenstroms

46. carnitine deficiency impairs production of What and how?
frameshift mutations (missense is substitution)
Ketone body production by preventing fatty acids into the mitochondria
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Chrom 8

47. What is best to prevent GBS infection in a baby?
INTRApartum Abs (ampicillin/penicillin)
Well trained athletes and children
Reticulocytes
Pulmonic and systemic!

48. What are the potassium sparing diuretics?
Amiloride - spironolactone - triamterene
Valproate
As a CO2 carrier with the carboxylase enzyme
Pan colitis and right sided colitis (more than left sided and proctitis)

49. What effects does cortisol have on catecholamines?
Downs; regurgitant AV valves - ASDs
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
Protamine sulfate
25; 25

50. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
In ER of bile canaliculi
ANCA because of lack of Ig and C3 deposits on IF
Echinococcus granulosus; anaphylaxis
E. coli; staphylococcus saprophyticus