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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 defines hypoxemia?
Increase in permeability of two ions with equal and opposite equilibrium potentials
Smoking
SaO2 <92%
IgE

2. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
CMV - HSV 1 - Candida
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Tibial
Terminal bronchioles; small bronchi

3. What causes the blurry vision side effects in first generation anti histamines?
25; 25
Drink plenty of fluids
Anti cholinergic effects of pupil dilation and lack of accomodation
I is more benign and can present later in adulthood

4. What is mcc of death pre hospital phase of MI? in hospital phase?
DIC; TTP- HUS dont bleed that much
SSRI
Increase by 50% in urine osmolality
V fib; v. failure

5. What causes wrist drop?
Pulmonic and systemic!
Radial nerve damage
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
E. coli; staphylococcus saprophyticus

6. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
High potassium conductance and some sodium conductance
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Little effect on cell and no change
Hypothyroidism

7. What is the most common cause of pyelonephritis in both adults and childre?
E. coli
RBC mass; epo levels (secondary has high)
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

8. In what form are mitochondrial DNA? What do they transcribe?
25; 25
Dissolved in plasma and attached to Hgb
Circular - outside nucleus; transport proteins - rRNA - tRNA
Abnormal closing of the urethral folds

9. What can cause aortic regurg? What is the heart sound you hear?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Around 70 (normal measured diastolic pressures); 9--
Increase lymphatic drainage!
ATP binding (resets the myosin head to contract again for next binding)

10. what bursa is affected when on knees like a maid/gardner?
Prepatellar
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Purkinje system; AV node
MAO inhibitors; wine and cheese

11. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Vancomycin
facultative intracellular
Syringomelia

12. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Hydrogen bonds dictate alpha or beta structure
Think Hb deformation diseases
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)
HSV ( also in utero: chlymadia - neisseria - group B strep)

13. What antibiotic is best to treat alcoholic pulm infections? why?
Adductor
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Vancomycin; histamine mediated

14. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Sarcoid
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Susceptible; soluble (unable to be cultured in bile)

15. When is an S4 sound normal?
Well trained athletes and children
Skin flushing and warmth; prostaglandins; give with aspirin
Boiling - bleach - formalin - UV irradiation
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

16. What is Bortezomib and What is it used for?
Proteasome inhibitor; treatment for MM and waldenstroms
Pulmonic and systemic!
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
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

17. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
Multiple miscarriages d/t hypercoaguability
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
<1% - 55% - concentration dependent
Hypo or hyper pigmentations; after tanning

18. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
S. aureus
Reticulocytes
Sickle cell; G6PD
Abnormal closing of the urethral folds

19. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
RR-1/RR
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Tissue redistribution (out of plasma) rather than metabolism
Echinococcus granulosus; anaphylaxis

20. Where does conjugation of bilirubin take place?
Increases
Drug induced interstitial nephritis
In ER of bile canaliculi
frameshift mutations (missense is substitution)

21. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Env genes (for getting into target cells)
Hexokinase
Vancomycin; histamine mediated
Increased reticulocytes

22. What does the tuberoinfundibular pathway connect? What is it responsible for?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Circular - outside nucleus; transport proteins - rRNA - tRNA
Large stroke volumes with ventricular contraction; aortic regurg

23. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Hypo or hyper pigmentations; after tanning
Because of vasodiation to skeletal muscles
11 aa polypeptide; pain NT in CNS and PNS
Tibial

24. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
CGD; t cell dysfxn (diGeorge)
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)
Underestimation of gestational age
Syringomelia

25. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
Dihydropyridine sensitive Ca channels (L type)
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
RER; RER
Selective alpha 1 (increases SVR)

26. which two virus families have hemagluttinin on their surface?
Ceftriaxone; azithromycin
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Pulmonic and systemic!
Paramyxo and influenza

27. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Leukotriene precursor and does neutrophil chemotaxis
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

28. what protein is increased in Crohns disease? What does it do?
GI tract; mood!
Bile salt accumulation in urine
NF- KB; responsible for cytokine production
transcription activation/suppression

29. What is extraocular muscle weakness a common symptom of?
MAC complex (C5b - C9 complement deficiency)
Hypothyroidism
Myasthenia gravis
frameshift mutations (missense is substitution)

30. 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
Vagus (auricular branch); vasovagal syncope!
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Vascular endothelium; protease

31. Where does lysyl oxidase act? What is the cofactor for that?
Fibronectin - laminin - collagen
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
In the extracellular space for collagen cross linking; zinc
gram positive organisms

32. Where does 90% of serotonin lie? What is this NT responsible?
Appetite suppressants
GI tract; mood!
The term used to describe decreased drug responsiveness with repeated administration
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

33. What are the three causes of acute MI in context of normal coronary arteries ?
Elastance
Because of vasodiation to skeletal muscles
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

34. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Ig A deficiency
Measles and M3 AML`
Increase lymphatic drainage!
Cluster

35. What translocations can cause c - myc overexpression?
No; yes
8 (myc protein) with 2 - 14 - 22 (iG chains)
Squatting - sitting - lying supine - passive leg raising
Hyperkalemia; potassium sparing diuretics - potassium supplements

36. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
P53 mutation; DCC is also required for adenoma to carcinoma
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

37. why are pregnant predisposed to cholelithiasis?
Underestimation of gestational age
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
TCAs and prazosin
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

38. what hormone is structurally similar to hCG?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
TSh (in testicular tumors can cause hyperthyroidism)
Elevated GGT and macrocytosis
Paramyxo and influenza

39. which are the only glycosylated proteins in HIV virus?
No; MRI
(urine PAH x urine flow rate)/plasma PAH
SS +rNA
Env genes (for getting into target cells)

40. what vessel would a fracture to the neck of the of the humerus damage?
Anterior circumflex (and axillary nerve)
transcription activation/suppression
P53 mutation; AD
Pulmonic and systemic!

41. within the right atrium - What is the maximum pressure? left atrium?
Chrom 8
Integration of viral DNA into genome of host hepatocytes
Well
8; 12

42. what induces bronchial squamous metaplasia?
Smoking
Class I
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
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

43. What does protein M do in Group A strep<
Env genes (for getting into target cells)
Prevent phagocytosis
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Underestimation of gestational age

44. What are the three dopaminergic systems and What are they responsible for? disease?
Abnormal closing of the urethral folds
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Octreotide
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)

45. What is a cell surface marker seen in liver angiosarcoma?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Large stroke volumes with ventricular contraction; aortic regurg
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Well

46. what protects the resting heart from arrhythmias?
TCAs and prazosin
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Highly negative resting potential
DIC; TTP- HUS dont bleed that much

47. What are the two coagulase negative staphylococci? How do you distinguish them?
Integration of viral DNA into genome of host hepatocytes
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
S. saprophyticus - and s. epidermidis; novobiocin

48. What is the immune deficinecy seen in ataxia telangactasia?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Hereditary angioedema; ACE inhibitors
Ig A deficiency
Spongiosis

49. In What type of nephritis would you see high serum eos count?
Inhibits it
Right heart failure
Terminal bronchioles; small bronchi
Drug induced interstitial nephritis

50. What is congestive hepatomegaly specific for?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Leukotriene precursor and does neutrophil chemotaxis
Right heart failure
Regular insulin (Not fast acting - regular better)