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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. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Because gamma chains replace beta chains and then gamma chain formation wanes
Atrial
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Both sides

2. which virus inactivates both Rb and p53?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
E6 and E7 of HPV knock off p53 and Rb suppressor genes

3. What is the difference between additive and synergistic?
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
Fibronectin - laminin - collagen
Leukotriene precursor and does neutrophil chemotaxis
Adeno

4. What type of drug is alendronate?
frameshift mutations (missense is substitution)
Biphosphonate
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
When it invades the bm; carcinoma in situ

5. What are the potassium sparing diuretics?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Fat - fertile - forty - female
Amiloride - spironolactone - triamterene
Large stroke volumes with ventricular contraction; aortic regurg

6. Which is faster atrial muscle or ventricular muscle?
Atrial
Enterococci (e. faecalis)- found on genitalia area
Right before diastole (filling begins)
Acute gastric mucosal defects (superficial or full thickness)

7. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
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)
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Another type of aldosterone antagonist (like spironolactone)

8. What antibodies are present in CREST? What is the most specific?
Because gamma chains replace beta chains and then gamma chain formation wanes
Both sides
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Anti centromere; anti DNA topoisomerase

9. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
Prevents hepatic VLDL production
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Elevated GGT and macrocytosis
LT (LTD4 - E4 - C4) - and Ach

10. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
Dihydropyridine sensitive Ca channels (L type)
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
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
MAO inhibitors; wine and cheese

11. What does p53 do? what chrom is it on?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Pain reliever - reduces pain by locking substance P in the PNS
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
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

12. What does hypocapnia cause in teh brain? What is hypocapnia?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Atrial
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Skin flushing and warmth; prostaglandins; give with aspirin

13. What is the primary histologic finding in patients with eczematous dermatitis?
P53 mutation; DCC is also required for adenoma to carcinoma
Spongiosis
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
P450 mitochondrial monooxygenase

14. What does the severity of leprosy depend on?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Strength of cell mediated immune response
RER; RER

15. What causes release of myosin head from the actin filament?
No and yes
Prepatellar
ATP binding (resets the myosin head to contract again for next binding)
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

16. What does NF- KB do?
Hereditary angioedema; ACE inhibitors
Increases cytokine production
Increase in permeability of two ions with equal and opposite equilibrium potentials
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

17. What is an abortive viral infection?
Little effect on cell and no change
Bronchogenic carcinoma
Extrinsic def; instrinsic def; platelet def
No and yes

18. biotin is used By what in tissues responsible for gluconeogenesis
As a CO2 carrier with the carboxylase enzyme
High potassium conductance and some sodium conductance
Ceftriaxone; azithromycin
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

19. how does increased ICP result in curlings ulcers?
Vagus nerve stimulation
RER; copper
Pain reliever - reduces pain by locking substance P in the PNS
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

20. What are the primary determinants of colon cancer risk in UC patients
Primary
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Duration and extent of disease
AV node slowest - to allow time for diastole

21. What would a deflection of the membrane potential to near zero indicate?
Increase in permeability of two ions with equal and opposite equilibrium potentials
Thymic tumor
Coagulation factors are made in the liver
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

22. What is congestive hepatomegaly specific for?
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
In the extracellular space
Right heart failure
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

23. Where does complement bind on the Fc region of Ig chains?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
8; 12
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac

24. where exactly is ACE expressed in the lungs? What type of enzyme is it?
Cluster
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Vascular endothelium; protease

25. What test would be best to determine if a gene is being transcribed? translated?
Southern - western
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
P450 mitochondrial monooxygenase
FGF and VEGF

26. which two drug types can cause orthostatic hypotension (think depression and BPH)?
Ketone body production by preventing fatty acids into the mitochondria
Turners`
Decreases both
TCAs and prazosin

27. What is the precursor protein to beta amyloid and On what chromosome is it found?
No
S. saprophyticus - and s. epidermidis; novobiocin
Class I
APP on chrom 21 (this is why downs more susceptible)

28. What is the best indicator for the severity of mitral stenosis?
liver specific
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
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
The time interval between S2 and OS- the shorter the interval - the more intense

29. what has the greatest effect on prognosis when treating c. diptheriae?
frameshift mutations (missense is substitution)
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Vagus (auricular branch); vasovagal syncope!

30. What causes wrist drop?
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Radial nerve damage
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Downs; regurgitant AV valves - ASDs

31. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
Pain reliever - reduces pain by locking substance P in the PNS
In the extracellular space for collagen cross linking; zinc
As a CO2 carrier with the carboxylase enzyme
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

32. What is the most common neurologic complication of VZV reactivation?
Localized dermatologic pain that persists for more than one month after zoster eruption
Bronchogenic carcinoma
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac

33. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
APP on chrom 21 (this is why downs more susceptible)
OCPs - multiparity - breast feeding

34. 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?
Sickle cell; G6PD
Hexokinase
Common peroneal; bony fractures and compression; sciatic
RBF= PAH clearance/(1- hematocrit)

35. What triggers the neoplastic changes that are associated with HBV infecton?
Apocrine; eccrine
Integration of viral DNA into genome of host hepatocytes
Think Hb deformation diseases
Well

36. What can too much IgA in serum produces?
High potassium conductance and some sodium conductance
<1% - 55% - concentration dependent
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

37. What are the skin presentation in sarcoid?
Varying; erythema nodosum is common
Atrial
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Become beta pleated and then form neurofibrillary tangle!

38. what virus causes pharyngoconjuctival fever?
Adeno
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Prostate tumor and increased osteoclast activity
Pain reliever - reduces pain by locking substance P in the PNS

39. What is used to prevent vertical transmission of HIV?
ZDV or AZT
When it invades the bm; carcinoma in situ
No and yes
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac

40. How can renal blood flow be calculated from RPF?
IgE
Chorda tympani branch
Varying; erythema nodosum is common
RBF= PAH clearance/(1- hematocrit)

41. What can cause virilization of a mother during pregnancy?
Ketone body production by preventing fatty acids into the mitochondria
Aromatase deficiency in child
Nonsense; mRNA processing
IgE

42. at one year of age - What are the social - fine motor - gross motor and language developments?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Hypertension - edema - and proteinuria
Integration of viral DNA into genome of host hepatocytes
Initiation - pointing; pincer grasp; walking; mama/dada

43. non ceruloplasmin deposition - ceruloplasmin is...
Curlings ulcers
low in serum
Regular insulin (Not fast acting - regular better)
IgE

44. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Chlorpheniramine and diphenhydramine
Medullary
Increase lymphatic drainage!
Barium enema

45. What almost exclusively causes Epliglottitis?What type of capsule does it have? What are the symptoms?

46. what drug is useful for secretory diarrhea?
11
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Drug induced interstitial nephritis
Octreotide

47. 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
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
OCPs - multiparity - breast feeding
Drink plenty of fluids

48. What can worse neurologic dysfunction in cobalamic def?
Folic acid treatment!
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

49. What causes vertical diplopia? horizontal?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Regular insulin (Not fast acting - regular better)
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Trochlear nerve (IV); abducens nerve (VI)

50. In what form are mitochondrial DNA? What do they transcribe?
Circular - outside nucleus; transport proteins - rRNA - tRNA
11 aa polypeptide; pain NT in CNS and PNS
Prepatellar
women