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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. why are pregnant predisposed to cholelithiasis?
SVC and IVC; right below the aortic knob
Reticulocytes
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
GI tract; mood!

2. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Close but purkinje system to ensure contraction in a bottom up fashion
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
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

3. Which is faster atrial muscle or ventricular muscle?
Atrial
Increase; decreased
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Medial circumflex artery; avascular necrosis

4. What antibodies are present in CREST? What is the most specific?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Pulmonary hypertension
Lateral; RV; RA; LV
Anti centromere; anti DNA topoisomerase

5. which two virus families have hemagluttinin on their surface?
Little effect on cell and no change
P53 mutation; AD
Dissolved in plasma and attached to Hgb
Paramyxo and influenza

6. What is the mainstay treatment for acute mania?
IgE
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Increases
To pump calcium out in cardiac myocytes so that relaxation occurs

7. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
women
No
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Primary

8. What is contraindicated in toxic mega colon?
Primary
Increase in permeability of two ions with equal and opposite equilibrium potentials
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

9. What does sustained hand grip do to the C/V system?
Proteasome inhibitor; treatment for MM and waldenstroms
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Phencyclidine (PCP)
SSRI

10. how does increased ICP result in curlings ulcers?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Protamine sulfate
Vagus nerve stimulation

11. What is subacute sclerosisng encephalitis caused by?
OCPs - multiparity - breast feeding
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
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

12. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
No and yes
Because of vasodiation to skeletal muscles
The time interval between S2 and OS- the shorter the interval - the more intense

13. why is crohns disease associated with oxaloacetate kidney stones?
Downs; regurgitant AV valves - ASDs
In the extracellular space
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

14. where are Beta 1 receptors found?
On cardiac tissue and renal juxtaglomerular cells
Pan colitis and right sided colitis (more than left sided and proctitis)
Strength of cell mediated immune response
Gluteus maximus; difficulty getting up from seated position and climbing chair

15. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Chorda tympani branch
Underestimation of gestational age
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Classical conditioning

16. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Increases
P53 mutation; AD

17. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Apocrine; eccrine
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Class I
Little effect on cell and no change

18. do patients with cor pulmonale have increased or decreased levels of aldosterone?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Ceftriaxone; azithromycin
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Because of the low output from heart failure - they will have increased aldosterone levels

19. What is a cord factor and Which bugs have it? How do they appear on culture?
Adeno
E. coli
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

20. other than increasing HDL levels - what else does niacin do?
Initiation - pointing; pincer grasp; walking; mama/dada
AV node slowest - to allow time for diastole
Prevents hepatic VLDL production
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences

21. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
Curlings ulcers
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Joints d/t increased purine production and thus uric acid production
Increase lymphatic drainage!

22. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Not lined by epithelium
CGD; t cell dysfxn (diGeorge)
Hyperkalemia; potassium sparing diuretics - potassium supplements

23. what vessel would a fracture to the neck of the of the humerus damage?
Excessive collagen formation during tissue repair in susceptible individuals
Hydrogen bonds dictate alpha or beta structure
G to T in p53; HCC
Anterior circumflex (and axillary nerve)

24. What is easiest way to treat nephrolithiasis?
Drink plenty of fluids
On cardiac tissue and renal juxtaglomerular cells
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

25. What is the immune deficinecy seen in ataxia telangactasia?
Ig A deficiency
Pulmonic and systemic!
Nocardia
Folic acid treatment!

26. what enzyme converts procarcinogens into carcinogens?
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
P450 mitochondrial monooxygenase
frameshift mutations (missense is substitution)
Classical conditioning

27. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Hexokinase
Anterior nares
PDA open

28. what marker should be followed in a patient with cirrhosis?
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
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
RER; RER
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

29. Metronidizaole does not cover...
gram positive organisms
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
Abnormal closing of the urethral folds
Excessive collagen formation during tissue repair in susceptible individuals

30. What type of vision is myopia? In What type of patients does it improve?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Coagulation factors are made in the liver
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Think Hb deformation diseases

31. What can nitrates lead to that is bad for angina therapy? How do you counter this?
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
Relfex tachycardia; giving beta blockers
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
T test; chi squared

32. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
No (unlike adenomyosis); yes
Ketone body production by preventing fatty acids into the mitochondria
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)

33. What do you treat s. epidermidis with?
Vancomycin
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

34. What does nitroprusside do to afterload? preload?
Pain reliever - reduces pain by locking substance P in the PNS
Vascular endothelium; protease
Decreases both
transcription activation/suppression

35. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
Atrial
Acute interstitial nephritis
Ether and other organic solvents
P53 mutation; DCC is also required for adenoma to carcinoma

36. what makes bruits?
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Large stroke volumes with ventricular contraction; aortic regurg
Turbulence
...

37. 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?
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)
No; yes
Anti cholinergic effects of pupil dilation and lack of accomodation
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

38. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Tibial
Medial circumflex artery; avascular necrosis
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
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

39. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
Mean greater than median greater than mode
Serum FFA and serum triglyceride levels
Syringomelia
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

40. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
Vancomycin
LT (LTD4 - E4 - C4) - and Ach
Anti - apoptotic (prevents going into apoptosis)- 18; 14
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

41. Where does 90% of serotonin lie? What is this NT responsible?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
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
GI tract; mood!

42. What is the presentation of sever aortic stenosis?
Because of vasodiation to skeletal muscles
Reticulocytes
Downs; regurgitant AV valves - ASDs
Syncope - angina - dyspnea (SAD)

43. what nerve and artery course along the posterior aspect of the humerus?
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
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Demargination of neutrophils from the vessel walls
Radial nerve and deep brachial artery

44. What are the two growth factors associated with angiogenesis?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Sarcoid
Dissolved in plasma and attached to Hgb
FGF and VEGF

45. what drug is useful for secretory diarrhea?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Octreotide
Dihydropyridine sensitive Ca channels (L type)

46. What is somatomedin C?
25; 25
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Hypothyroidism
Insulin like growth factor 1 (just another name)

47. where are the two classical places that the ulnar nerve can be injured?

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48. What does C1 esterase do other than inhibiting complement pathway?
Amiadarone
Inactivates kallikrein which activates kininogen into bradykinin
Vascular endothelium; protease
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

49. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Inhibits it
Medullary
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)
Hexokinase

50. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Nonsense; mRNA processing
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)