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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 is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
RER; copper
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
Because of the low output from heart failure - they will have increased aldosterone levels
Sarcoid

2. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
APP on chrom 21 (this is why downs more susceptible)
Medullary
Gluteus maximus; difficulty getting up from seated position and climbing chair

3. what enzyme converts procarcinogens into carcinogens?
Minimal change disease
P450 mitochondrial monooxygenase
differentiate
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

4. which type of glands produce an initially odorless secretion but can become malodorous secondary to bacterial decompisition on the skin surface? which glands are present throughout the skin except on lips and glans penis?
Apocrine; eccrine
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Standing suddenly from supine position; valsalva maneuver
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

5. What does hypocapnia cause in teh brain? What is hypocapnia?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Multiple miscarriages d/t hypercoaguability
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Anti cholinergic effects of pupil dilation and lack of accomodation

6. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Terminal bronchioles; small bronchi
Extrinsic def; instrinsic def; platelet def
Squatting - sitting - lying supine - passive leg raising
Turbulence

7. What is suggestive of complete central DI?
Appetite suppressants
Increase by 50% in urine osmolality
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

8. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Class I
Ceftriaxone; azithromycin
SaO2 <92%
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

9. what happens with LDL receptor density in statin therapy?
Folic acid treatment!
Reticulocytes
SSRI
Increases

10. Which is slower AV node or ventricular muscle?
AV node slowest - to allow time for diastole
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Excessive collagen formation during tissue repair in susceptible individuals
Increase; decreased

11. what hormone is structurally similar to hCG?
Relfex tachycardia; giving beta blockers
TSh (in testicular tumors can cause hyperthyroidism)
Faulty positioning of the genital tubercle
No and yes

12. what dissolves the lipid bilayer of a viral envelope?
Acute interstitial nephritis
Ether and other organic solvents
GI tract; mood!
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

13. what hernia has a similar mechanism to hydrocele?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Increase; decreased
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Retinitis; mononucleosis

14. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Ketone body production by preventing fatty acids into the mitochondria
RBC mass; epo levels (secondary has high)
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

15. What type of bond is a disulfide bond?
Become beta pleated and then form neurofibrillary tangle!
Covalent (between two cysteines)- allows protein to withstand denaturation
Anti - apoptotic (prevents going into apoptosis)- 18; 14
E. coli; staphylococcus saprophyticus

16. What is the presentation of sever aortic stenosis?
No; yes
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Pulmonary hypertension
Syncope - angina - dyspnea (SAD)

17. what virus causes pharyngoconjuctival fever?
Adeno
Relfex tachycardia; giving beta blockers
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Curlings ulcers

18. 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?)?
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
Bile salt accumulation in urine
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
No; MRI

19. What causes vertical diplopia? horizontal?
Proteasome inhibitor; treatment for MM and waldenstroms
Coagulation factors are made in the liver
Lateral; RV; RA; LV
Trochlear nerve (IV); abducens nerve (VI)

20. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
Radial nerve damage
Prostate tumor and increased osteoclast activity
Brief psychotic disorder; schizophreniform; schizophrenia
Radial nerve and deep brachial artery

21. what nerve and artery course along the posterior aspect of the humerus?
Radial nerve and deep brachial artery
Echinococcus granulosus; anaphylaxis
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

22. What is the most important prognostic indicator in patients with malignant melanoma?
Because gamma chains replace beta chains and then gamma chain formation wanes
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Measure of depth invasion (vertical!)
Bronchial dilation (bronchiectasis)

23. Where does terminal peptide cleavage of collagen fibrils take place?
differentiate
8; 12
In the extracellular space
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

24. What is a cord factor and Which bugs have it? How do they appear on culture?
...
Normally close to systolic
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

25. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
Duration and extent of disease
Closer to head; closer to diaphragm
LT (LTD4 - E4 - C4) - and Ach
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

26. what chromosome is c - myc found on?
Sydenham chorea
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Fibrosis; macrophages
Chrom 8

27. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
OCPs - multiparity - breast feeding
Sickle cell; G6PD
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

28. What does C1 esterase do other than inhibiting complement pathway?
Inactivates kallikrein which activates kininogen into bradykinin
MAO inhibitors; wine and cheese
As a CO2 carrier with the carboxylase enzyme
Multiple miscarriages d/t hypercoaguability

29. the rate of blood flow of which two circulations must equal each other at all times?
Pulmonic and systemic!
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Right heart failure
SSRI; erectile dysfunction

30. What are diastolic (lowest) pressures in aorta? LV?
Right before diastole (filling begins)
Increase; decreased
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Around 70 (normal measured diastolic pressures); 9--

31. which staphylococci can do mannitol fermaentation?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
S. aureus
By vascular permeability and vasodilation
When it invades the bm; carcinoma in situ

32. Metronidizaole does not cover...
OCPs - multiparity - breast feeding
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
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
gram positive organisms

33. what drugs causes the red man syndrome? how does it occur?
Vancomycin; histamine mediated
Think Hb deformation diseases
Common peroneal; bony fractures and compression; sciatic
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

34. What does nitroprusside do to afterload? preload?
Circular - outside nucleus; transport proteins - rRNA - tRNA
The term used to describe decreased drug responsiveness with repeated administration
Localized dermatologic pain that persists for more than one month after zoster eruption
Decreases both

35. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
differentiate
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Intussusception
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

36. what receptors do first generation anti histamines block?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
ATP binding (resets the myosin head to contract again for next binding)
Myasthenia gravis

37. What can too much IgA in serum produces?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
P53 mutation; DCC is also required for adenoma to carcinoma
Purkinje system; AV node

38. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
RR-1/RR
Gluteus medius and minimus; positive trendelenberg
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

39. which antiarrythmic is associated with blue gray discoloration ?
Amiadarone
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Insulin like growth factor 1 (just another name)
facultative intracellular

40. What is the stabilizing force for the secondary structure of proteins?
When it invades the bm; carcinoma in situ
8; 12
Dissolved in plasma and attached to Hgb
Hydrogen bonds dictate alpha or beta structure

41. other than proteinuria - What can cause foamy froathy urine?
In the extracellular space
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Excessive collagen formation during tissue repair in susceptible individuals
Bile salt accumulation in urine

42. What does extended consumption of appetite suppressants lead to?
APP on chrom 21 (this is why downs more susceptible)
Pulmonary hypertension
8; 12
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

43. where exactly is ACE expressed in the lungs? What type of enzyme is it?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Vascular endothelium; protease
Localized dermatologic pain that persists for more than one month after zoster eruption
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

44. Where does lysyl oxidase act? What is the cofactor for that?
Varying; erythema nodosum is common
In the extracellular space for collagen cross linking; zinc
CMV - HSV 1 - Candida
Minimal change disease

45. what vessel would a fracture to the neck of the of the humerus damage?
Anterior circumflex (and axillary nerve)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Myasthenia gravis
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

46. what makes bruits?
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
Turbulence
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Headaches and facial flushing; vasodilation in meninges and skin

47. what drug is useful for secretory diarrhea?
Measles and M3 AML`
Octreotide
Minimal change disease
Paramyxo and influenza

48. a patient fearing all white coats is a phenomenon of what?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Hydrogen bonds dictate alpha or beta structure
Classical conditioning
Turners`

49. How is dobutamine better than dopamine?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
E. coli; staphylococcus saprophyticus
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Acute gastric mucosal defects (superficial or full thickness)

50. What effects does cortisol have on catecholamines?
(urine PAH x urine flow rate)/plasma PAH
Hydrogen bonds dictate alpha or beta structure
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
Close but purkinje system to ensure contraction in a bottom up fashion