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USMLE Prep 2

Instructions:

Answer 50 questions in 15 minutes.
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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 the cause of rapid plasma decay of thiopental?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Tissue redistribution (out of plasma) rather than metabolism
...
C3 decreased after 5-10 days; sulfonamides

2. What is damaged in early syringomelia? later?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Anti centromere; anti DNA topoisomerase
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

3. When is an S4 sound normal?
Tzanck smear
Inhaled animal dander allergens
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
Well trained athletes and children

4. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
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
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)
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Tzanck smear

5. What is diagnostic (and possible therapeutic for intussusception)?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Prostate tumor and increased osteoclast activity
Barium enema
frameshift mutations (missense is substitution)

6. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Transported to liver - glycerol kinase converts it to glycerol 3 phosphate Which is then converted to DHAP which can either join glycolysis for ATP or be used to make glucose
SVT; increases vagal tone; rectus abdominis
V fib; v. failure

7. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Intussusception
Acute gastric mucosal defects (superficial or full thickness)
Measure of depth invasion (vertical!)

8. What type of mutation does aflatoxin cause? what cancer does this increase for?
G to T in p53; HCC
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Serum FFA and serum triglyceride levels

9. What actions increase venous return?
Squatting - sitting - lying supine - passive leg raising
LT (LTD4 - E4 - C4) - and Ach
Decreases both
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac

10. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Bile soluble which means they are bile sensitive
Classical conditioning
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
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

11. how does achalasia present? What does barium swallow show on dilated esophagus?
Hypothyroidism
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Pulmonic and systemic!
Hydrogen bonds dictate alpha or beta structure

12. What can cause virilization of a mother during pregnancy?
Aromatase deficiency in child
Chorda tympani branch
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Amiadarone

13. what dissolves the lipid bilayer of a viral envelope?
P53 mutation; AD
On cardiac tissue and renal juxtaglomerular cells
Ether and other organic solvents
Sarcoid

14. what enzyme converts procarcinogens into carcinogens?
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
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
P450 mitochondrial monooxygenase
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

15. what commonly happens in GI in response to acute physiologic stress?
V fib; v. failure
On cardiac tissue and renal juxtaglomerular cells
TCAs and prazosin
Acute gastric mucosal defects (superficial or full thickness)

16. What is used to prevent vertical transmission of HIV?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
gram positive organisms
46 - 4N; 23 2N
ZDV or AZT

17. What is the precursor protein to beta amyloid and On what chromosome is it found?
APP on chrom 21 (this is why downs more susceptible)
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Bile soluble which means they are bile sensitive
Another type of aldosterone antagonist (like spironolactone)

18. how does neisseria cause a petechial rash?
Neisseria induced small cell vasculitis (including hands and soles)
Purkinje system; AV node
Turners`
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

19. What is a keloid?
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
Excessive collagen formation during tissue repair in susceptible individuals
No; MRI
G to T in p53; HCC

20. What is the sole neurologic manifestation of acute rheumatic fever?
Sydenham chorea
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Protamine sulfate
Around 70 (normal measured diastolic pressures); 9--

21. why is crohns disease associated with oxaloacetate kidney stones?
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
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
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Abnormal closing of the urethral folds

22. What is the triad seen in pre eclampsia?
Increase by 50% in urine osmolality
Hypertension - edema - and proteinuria
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Diabetic microangiopathy

23. at one year of age - What are the social - fine motor - gross motor and language developments?
<1% - 55% - concentration dependent
Initiation - pointing; pincer grasp; walking; mama/dada
Pulmonic and systemic!
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

24. When does neovascularization granulation tissue begin to form after severe ischemia and MI? what happens in 12-24 hours? 2 weeks to 2 months? 1-5 days? 0-4 hours? when do you see edema - hemorrhage - wavy fibers?
Spongiosis
Aromatase deficiency in child
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
As a CO2 carrier with the carboxylase enzyme

25. which two drug types can cause orthostatic hypotension (think depression and BPH)?
CMV - HSV 1 - Candida
<1% - 55% - concentration dependent
TCAs and prazosin
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences

26. what hormone is structurally similar to hCG?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Medial circumflex artery; avascular necrosis
Sarcoid
TSh (in testicular tumors can cause hyperthyroidism)

27. hypertonicity and hyperreflexity are ________________ of hydrocephalus
manifestations - congenital (stretching of periventricular pyrimadal fibers)
In ER of bile canaliculi
No; MRI
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)

28. What are the first generation anti histamines?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Chlorpheniramine and diphenhydramine

29. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Susceptible; soluble (unable to be cultured in bile)
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
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)
Terminal bronchioles; small bronchi

30. What is gardeners mydriasis? How is it treated?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Radial nerve and deep brachial artery
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

31. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
Retinitis; mononucleosis
differentiate
Large stroke volumes with ventricular contraction; aortic regurg
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

32. which nerve is at risk when ligating the superior thyroid artery? Which is the only muscle this nerve innervates? what nerve innervates all the other laryngeal muscles?
SVC and IVC; right below the aortic knob
Extrinsic def; instrinsic def; platelet def
Superior larygeal; cricothyroid; recurrent laryngeal
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

33. why does variocele occur more in left side?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
In the extracellular space for collagen cross linking; zinc
Drink plenty of fluids

34. What test would be best to determine if a gene is being transcribed? translated?
Closer to head; closer to diaphragm
Southern - western
Think Hb deformation diseases
CGD; t cell dysfxn (diGeorge)

35. What does 'oxygen' content in blood refer to?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Insulin like growth factor 1 (just another name)
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Dissolved in plasma and attached to Hgb

36. Which is faster purkinje system or atrial muscle?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Close but purkinje system to ensure contraction in a bottom up fashion
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

37. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
ANCA because of lack of Ig and C3 deposits on IF
Vagus nerve stimulation
By vascular permeability and vasodilation

38. What is contraindicated in toxic mega colon?
I is more benign and can present later in adulthood
glycerol kinase
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

39. Where is aromatase used?
RR-1/RR
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

40. what indicates the severity of a mitral regurg ? mitral stenosis?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Nonsense; mRNA processing
S3 gallop; S2 to opening snap interval
Hereditary angioedema; ACE inhibitors

41. In what population does cholelithiasis occur?
Retinitis; mononucleosis
SVC and IVC; right below the aortic knob
Fat - fertile - forty - female
Turbulence

42. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Class I
Neisseria induced small cell vasculitis (including hands and soles)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

43. what drugs causes the red man syndrome? how does it occur?
Acute interstitial nephritis
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Gluteus medius and minimus; positive trendelenberg
Vancomycin; histamine mediated

44. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
MAO inhibitors; wine and cheese

45. what would be a sign of absence of cardiogenic pulm edem?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
II; I (I more abundant)

46. What is a cord factor and Which bugs have it? How do they appear on culture?
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Increase in permeability of two ions with equal and opposite equilibrium potentials

47. which viruses require a protease?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
SS +rNA
On cardiac tissue and renal juxtaglomerular cells
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

48. What is cataplexy and When is it seen?
Underestimation of gestational age
Squatting - sitting - lying supine - passive leg raising
RER; RER
Sudden loss of muscle tone without loss of consciousness; narcolepsy

49. which two virus families have hemagluttinin on their surface?
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Susceptible; soluble (unable to be cultured in bile)
High potassium conductance and some sodium conductance
Paramyxo and influenza

50. What are two common side effects of both acute and long acting nitrates? What causes them?
Turners`
Headaches and facial flushing; vasodilation in meninges and skin
Circular - outside nucleus; transport proteins - rRNA - tRNA
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)