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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 can long term leg cast wearing cause?
Octreotide
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
SS +rNA
Hexokinase

2. erythema nodosum - elevated ACE - scattered granulomas - arthralgias - hilar lymphadenoapthy are indicative of what?
Sarcoid
chronic urticaria and allergic symptoms
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
No (unlike adenomyosis); yes

3. 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?)?
SSRI; erectile dysfunction
Medial part
No and yes
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

4. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
differentiate
Chlorpheniramine and diphenhydramine
Normal; low
Reiter syndrome; B27

5. What does sustained hand grip do to the C/V system?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
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)
LT (LTD4 - E4 - C4) - and Ach
Chlorpheniramine and diphenhydramine

6. What is the mc location of brain germinomas?What are the classic symptoms?
The term used to describe decreased drug responsiveness with repeated administration
I is more benign and can present later in adulthood
RBC mass; epo levels (secondary has high)
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

7. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
Anti centromere; anti DNA topoisomerase
Prostate tumor and increased osteoclast activity
women
Sickle cell; G6PD

8. What type of endocarditis is cytoscopy induced?
Sickle cell; G6PD
Enterococci (e. faecalis)- found on genitalia area
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
11

9. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
low in serum
Insulin like growth factor 1 (just another name)
Inhaled animal dander allergens
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

10. What is contraindicated in toxic mega colon?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Tissue redistribution (out of plasma) rather than metabolism
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
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

11. at one year of age - What are the social - fine motor - gross motor and language developments?
Ether and other organic solvents
Sarcoid
Initiation - pointing; pincer grasp; walking; mama/dada
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

12. Which is faster atrial muscle or ventricular muscle?
Atrial
8 (myc protein) with 2 - 14 - 22 (iG chains)
Common peroneal; bony fractures and compression; sciatic
gram positive organisms

13. What are the two coagulase negative staphylococci? How do you distinguish them?
E. coli; staphylococcus saprophyticus
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Faulty positioning of the genital tubercle
S. saprophyticus - and s. epidermidis; novobiocin

14. What is best to prevent GBS infection in a baby?
glycerol kinase
INTRApartum Abs (ampicillin/penicillin)
Hyperkalemia; potassium sparing diuretics - potassium supplements
Dissolved in plasma and attached to Hgb

15. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
E. coli
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
women
RBC mass; epo levels (secondary has high)

16. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
CMV - HSV 1 - Candida
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Skin flushing and warmth; prostaglandins; give with aspirin
gram positive organisms

17. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
P53 mutation; DCC is also required for adenoma to carcinoma
Medial part
Syringomelia
Adductor

18. What is used to compare means? categorical outcomes?
Chorda tympani branch
RR-1/RR
T test; chi squared
No; yes

19. What is gardeners mydriasis? How is it treated?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Nonsense; mRNA processing
P450 mitochondrial monooxygenase

20. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
Standing suddenly from supine position; valsalva maneuver
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Adductor
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

21. What does C1 esterase do other than inhibiting complement pathway?
In the extracellular space for collagen cross linking; zinc
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Inactivates kallikrein which activates kininogen into bradykinin
Drug induced interstitial nephritis

22. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
<1% - 55% - concentration dependent

23. what has the greatest effect on prognosis when treating c. diptheriae?
Prevent phagocytosis
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Turbulence

24. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
Multiple miscarriages d/t hypercoaguability
Primary
Adeno
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

25. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
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
HSV ( also in utero: chlymadia - neisseria - group B strep)
Atrial
Not lined by epithelium

26. What type of mutation does aflatoxin cause? what cancer does this increase for?
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
RBC mass; epo levels (secondary has high)
G to T in p53; HCC
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

27. How is dobutamine better than dopamine?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
CMV - HSV 1 - Candida
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
As a CO2 carrier with the carboxylase enzyme

28. neisseria are...
Brief psychotic disorder; schizophreniform; schizophrenia
Inhibits it
facultative intracellular
P53 mutation; DCC is also required for adenoma to carcinoma

29. What are the primary determinants of colon cancer risk in UC patients
Duration and extent of disease
Inhibits it
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Bile salt accumulation in urine

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

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31. What are some of the permissive effects of cortisol?
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Inhaled animal dander allergens

32. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
Myasthenia gravis
Tibial
indomethacin
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics

33. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Vancomycin
Right before diastole (filling begins)

34. What is medullary sponge kidney disease and how does it present? What does it lead to?
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)
Downs; regurgitant AV valves - ASDs
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Amiloride - spironolactone - triamterene

35. What is subacute sclerosisng encephalitis caused by?
ATP binding (resets the myosin head to contract again for next binding)
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
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
Coagulation factors are made in the liver

36. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Turbulence
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

37. How do you calculate excretion rate of a substance? How do you calculate the filtration rate of a substance? clearance of what substance estimates the GFR?
MAC complex (C5b - C9 complement deficiency)
Fat - fertile - forty - female
Right before diastole (filling begins)
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

38. What can cause virilization of a mother during pregnancy?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Chrom 8
RBC mass; epo levels (secondary has high)
Aromatase deficiency in child

39. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
Pan colitis and right sided colitis (more than left sided and proctitis)
Vancomycin; histamine mediated
Radial nerve damage
Hypothyroidism

40. which viruses require a protease?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
SS +rNA
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

41. What pulmonary structural change can kartageners syndrome cause?
Bronchial dilation (bronchiectasis)
Medial circumflex artery; avascular necrosis
Downs; regurgitant AV valves - ASDs
frameshift mutations (missense is substitution)

42. what drugs causes the red man syndrome? how does it occur?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
GI malignancies and Insulin resistance (acromegal for ex)
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Vancomycin; histamine mediated

43. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
P53 mutation; AD
glycerol kinase
Trochlear nerve (IV); abducens nerve (VI)
Medial part

44. what phase do adenosine and acetylcholine act on? doing what?
Increases cytokine production
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Regular insulin (Not fast acting - regular better)
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

45. on which chromosome is wilms tumor found?
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
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
Increases
11

46. How do you explain the selective proteinuria of loss to albumin only in MCD?
SaO2 <92%
Another type of aldosterone antagonist (like spironolactone)
Amiloride - spironolactone - triamterene
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

47. What is an abortive viral infection?
200-500
Little effect on cell and no change
Biphosphonate
Strength of cell mediated immune response

48. What is the cause of rapid plasma decay of thiopental?
SaO2 <92%
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Radial nerve damage
Tissue redistribution (out of plasma) rather than metabolism

49. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
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
Strength of cell mediated immune response
Skin flushing and warmth; prostaglandins; give with aspirin
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

50. What are the long term consequences of hydrocephalus?
Because of the low output from heart failure - they will have increased aldosterone levels
SVC and IVC; right below the aortic knob
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Paramyxo and influenza