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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 intussusception? how does ischemia and necrosis occur?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
transcription activation/suppression
Paramyxo and influenza
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

2. What is a cord factor and Which bugs have it? How do they appear on culture?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
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

3. How do left sided colon adenocarcinomas present? right sided?
Boiling - bleach - formalin - UV irradiation
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
Elevated GGT and macrocytosis
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

4. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Gluteus maximus; difficulty getting up from seated position and climbing chair
Skin flushing and warmth; prostaglandins; give with aspirin
AV node slowest - to allow time for diastole

5. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
Well trained athletes and children
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
HSV and VZV
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

6. which antiarrythmic is associated with blue gray discoloration ?
Anterior circumflex (and axillary nerve)
Amiadarone
Inactivates kallikrein which activates kininogen into bradykinin
Brief psychotic disorder; schizophreniform; schizophrenia

7. What is cataplexy and When is it seen?
Duration and extent of disease
Turbulence
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

8. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
Syringomelia
T test; chi squared
Pan colitis and right sided colitis (more than left sided and proctitis)
Right heart failure

9. What is the most important prognostic indicator in patients with malignant melanoma?
Measure of depth invasion (vertical!)
II; I (I more abundant)
Pulmonic and systemic!
High potassium conductance and some sodium conductance

10. What actions increase venous return?
Squatting - sitting - lying supine - passive leg raising
Anterior nares
11 aa polypeptide; pain NT in CNS and PNS
Ig A deficiency

11. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Hereditary angioedema; ACE inhibitors
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Extrinsic def; instrinsic def; platelet def

12. What is used to compare means? categorical outcomes?
T test; chi squared
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
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

13. what drugs causes the red man syndrome? how does it occur?
Normally close to systolic
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Vancomycin; histamine mediated

14. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
Susceptible; soluble (unable to be cultured in bile)
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Varying; erythema nodosum is common
When it invades the bm; carcinoma in situ

15. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Turners`
Acute interstitial nephritis
Octreotide
Squatting - sitting - lying supine - passive leg raising

16. what kind of drug is sertraline? What is a common side effect?
SSRI; erectile dysfunction
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
RER; RER
Drink plenty of fluids

17. why are pregnant predisposed to cholelithiasis?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Sarcoid
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
gram positive organisms

18. which viruses require a protease?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
SS +rNA
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
CGD; t cell dysfxn (diGeorge)

19. What is a primary HSV 1 infection like?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Gluteus maximus; difficulty getting up from seated position and climbing chair
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Increased reticulocytes

20. do Class IC agents prolong the QT interval?
Medial part
Brief psychotic disorder; schizophreniform; schizophrenia
No
When it invades the bm; carcinoma in situ

21. IL4 is used for isotypye switching to what?
TSh (in testicular tumors can cause hyperthyroidism)
Increase lymphatic drainage!
IgE
SS +rNA

22. what chromosome is c - myc found on?
Hypertension - edema - and proteinuria
Ether and other organic solvents
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Chrom 8

23. what enzyme converts procarcinogens into carcinogens?
P450 mitochondrial monooxygenase
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
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
No (unlike adenomyosis); yes

24. What is best to prevent GBS infection in a baby?
INTRApartum Abs (ampicillin/penicillin)
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Thymic tumor
MAO inhibitors; wine and cheese

25. What does Rb protein do? what chrom is it on?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
GI tract; mood!
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Enterococci (e. faecalis)- found on genitalia area

26. What are pancreatic pseudocysts called pseudo rather than true cysts?
Bronchial dilation (bronchiectasis)
Around 70 (normal measured diastolic pressures); 9--
Adductor
Not lined by epithelium

27. What causes release of myosin head from the actin filament?
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
Vancomycin; histamine mediated
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
ATP binding (resets the myosin head to contract again for next binding)

28. other than in pyelonephritis - where else are WBC casts seen?
Acute interstitial nephritis
High potassium conductance and some sodium conductance
Multiple miscarriages d/t hypercoaguability
200-500

29. where are the vegetations on the valves of a libman sacks endocarditis?
SVT; increases vagal tone; rectus abdominis
Duration and extent of disease
No
Both sides

30. other than proteinuria - What can cause foamy froathy urine?
Bile salt accumulation in urine
Drug induced interstitial nephritis
Amiadarone
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

31. how much percent of sodium is excreted? urea? glucose?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
<1% - 55% - concentration dependent
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

32. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
Classical conditioning
RBC mass; epo levels (secondary has high)
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Little effect on cell and no change

33. What is the preferred treatment for DKA?
TSh (in testicular tumors can cause hyperthyroidism)
Regular insulin (Not fast acting - regular better)
Intussusception
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

34. What does the severity of leprosy depend on?
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Around 70 (normal measured diastolic pressures); 9--
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Strength of cell mediated immune response

35. What is the cause of fixed splitting of S2? why?
Apocrine; eccrine
Right heart failure
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

36. What are three symptoms in s.typhi?
G to T in p53; HCC
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

37. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Anti cholinergic effects of pupil dilation and lack of accomodation
Excessive collagen formation during tissue repair in susceptible individuals
GI tract; mood!

38. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
No
Smoking
Chorda tympani branch

39. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Hypothyroidism
Fat - fertile - forty - female
CGD; t cell dysfxn (diGeorge)

40. What does protein M do in Group A strep<
Because of vasodiation to skeletal muscles
Integration of viral DNA into genome of host hepatocytes
Prevent phagocytosis
46 - 4N; 23 2N

41. What do you treat s. epidermidis with?
Skin flushing and warmth; prostaglandins; give with aspirin
Well trained athletes and children
Vancomycin
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

42. What is the mcc of extrinsic allergic asthma?
Ether and other organic solvents
Syringomelia
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Inhaled animal dander allergens

43. there are mucus secreting cells in the bronchioles...
Faulty positioning of the genital tubercle
Not lined by epithelium
Squatting - sitting - lying supine - passive leg raising
only up to bronchi

44. What is diagnostic (and possible therapeutic for intussusception)?
In the extracellular space
Barium enema
Chorda tympani branch
Drink plenty of fluids

45. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Mean greater than median greater than mode
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

46. Metronidizaole does not cover...
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)
Hexokinase
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
gram positive organisms

47. Where is conduction in heart fastest? slowest?
Purkinje system; AV node
Valproate
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
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

48. What causes wrist drop?
Acute gastric mucosal defects (superficial or full thickness)
Primary
Radial nerve damage
ANCA because of lack of Ig and C3 deposits on IF

49. sporadic colon cancer tend to arise From what type of polyps?
Increase lymphatic drainage!
Single adenomatous ones
manifestations - congenital (stretching of periventricular pyrimadal fibers)
IgE

50. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
low in serum
Localized dermatologic pain that persists for more than one month after zoster eruption
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic