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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. ___________ is liver specific
glycerol kinase
CMV - HSV 1 - Candida
RER; copper
Another type of aldosterone antagonist (like spironolactone)

2. What is a keloid?
In the extracellular space
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
frameshift mutations (missense is substitution)
Excessive collagen formation during tissue repair in susceptible individuals

3. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Downs; regurgitant AV valves - ASDs
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Myasthenia gravis

4. other than increasing HDL levels - what else does niacin do?
Valproate
ANCA because of lack of Ig and C3 deposits on IF
In ER of bile canaliculi
Prevents hepatic VLDL production

5. What type of calcium channels dictate the plateau in cardiac myocyte?
Medial circumflex artery; avascular necrosis
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Atrial
Dihydropyridine sensitive Ca channels (L type)

6. What is damaged in early syringomelia? later?
Hereditary angioedema; ACE inhibitors
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
8; 12

7. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
MAO inhibitors; wine and cheese
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
transcription activation/suppression
Faulty positioning of the genital tubercle

8. What is the stabilizing force for the secondary structure of proteins?
Hydrogen bonds dictate alpha or beta structure
Inhibits it
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Increase in permeability of two ions with equal and opposite equilibrium potentials

9. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Hereditary angioedema; ACE inhibitors
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

10. What is easiest way to treat nephrolithiasis?
Drink plenty of fluids
T test; chi squared
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Serum creatine kinase; reperfusion injury causes necrosis

11. which RPGN is also called pauci immune GN? why?
ZDV or AZT
ANCA because of lack of Ig and C3 deposits on IF
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Ketone body production by preventing fatty acids into the mitochondria

12. What antibiotic is best to treat alcoholic pulm infections? why?
High potassium conductance and some sodium conductance
Abnormal closing of the urethral folds
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

13. Where does 90% of serotonin lie? What is this NT responsible?
Close but purkinje system to ensure contraction in a bottom up fashion
GI tract; mood!
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Rabies encephalitis from cave bats; rabies killed vaccines

14. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
Inactivates kallikrein which activates kininogen into bradykinin
Joints d/t increased purine production and thus uric acid production
No (unlike adenomyosis); yes
The time interval between S2 and OS- the shorter the interval - the more intense

15. What is the mc location for avascular necrosis? What is it associated with?
Covalent (between two cysteines)- allows protein to withstand denaturation
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Elastance

16. What is the most common initital symptom of ADPKD? what else?
E. coli
Downs; regurgitant AV valves - ASDs
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
SSRI

17. there are mucus secreting cells in the bronchioles...
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
only up to bronchi
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
C3 decreased after 5-10 days; sulfonamides

18. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Duration and extent of disease
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
transcription activation/suppression
Increase by 50% in urine osmolality

19. on which chromosome is wilms tumor found?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Hyperkalemia; potassium sparing diuretics - potassium supplements
Initiation - pointing; pincer grasp; walking; mama/dada
11

20. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
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)
CMV - HSV 1 - Candida

21. What is the mc malignancy in asbestosis?
OCPs - multiparity - breast feeding
To pump calcium out in cardiac myocytes so that relaxation occurs
Bronchogenic carcinoma
S. aureus

22. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Curlings ulcers
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
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

23. what marker should be followed in a patient with cirrhosis?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Underestimation of gestational age
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
hyponatremia (aldosterone activation equilibrates body volume)

24. What is the difference between additive and synergistic?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
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
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)
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

25. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
In the extracellular space for collagen cross linking; zinc
P53 mutation; AD
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

26. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
Large stroke volumes with ventricular contraction; aortic regurg
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Relfex tachycardia; giving beta blockers

27. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
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
11 aa polypeptide; pain NT in CNS and PNS
Anti centromere; anti DNA topoisomerase
In ER of bile canaliculi

28. What causes wrist drop?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Vascular endothelium; protease
Joints d/t increased purine production and thus uric acid production
Radial nerve damage

29. other than parvo B19 - what else is associated with red cell aplasia?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Thymic tumor
Elastance
Medial circumflex artery; avascular necrosis

30. Where is the base of the heart? apex?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Closer to head; closer to diaphragm
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Paramyxo and influenza

31. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Paramyxo and influenza
Gluteus medius and minimus; positive trendelenberg
S3 gallop; S2 to opening snap interval
Single adenomatous ones

32. which nucleus releases serotonin?
Minimal change disease
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Class I
Raphe

33. a patient fearing all white coats is a phenomenon of what?
RER; RER
G to T in p53; HCC
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Classical conditioning

34. What is the presentation of sever aortic stenosis?
women
Syncope - angina - dyspnea (SAD)
Become beta pleated and then form neurofibrillary tangle!
Classical conditioning

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

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36. what happens to sperm count and semineferous tubules in patient with cryptoorchidism? hormonal function? why do they need to be surgically descended?
Myasthenia gravis
Prevent phagocytosis
Relfex tachycardia; giving beta blockers
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

37. What is 5- HETE and What does it do?
On cardiac tissue and renal juxtaglomerular cells
I is more benign and can present later in adulthood
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
Leukotriene precursor and does neutrophil chemotaxis

38. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
DIC; TTP- HUS dont bleed that much
Covalent (between two cysteines)- allows protein to withstand denaturation
Decreases both
When it invades the bm; carcinoma in situ

39. What is the difference between paranoid personality disorder and delusional disorder?
Because gamma chains replace beta chains and then gamma chain formation wanes
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)
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Leukotriene precursor and does neutrophil chemotaxis

40. What can long term leg cast wearing cause?
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
Kallmans
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Varying; erythema nodosum is common

41. What causes release of myosin head from the actin filament?
P450 mitochondrial monooxygenase
ATP binding (resets the myosin head to contract again for next binding)
SaO2 <92%
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

42. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Hereditary angioedema; ACE inhibitors
Common peroneal; bony fractures and compression; sciatic
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

43. What does nitroprusside do to afterload? preload?
hyponatremia (aldosterone activation equilibrates body volume)
The term used to describe decreased drug responsiveness with repeated administration
Vancomycin
Decreases both

44. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
Squatting - sitting - lying supine - passive leg raising
Normally close to systolic
CGD; t cell dysfxn (diGeorge)
Drink plenty of fluids

45. other than in pyelonephritis - where else are WBC casts seen?
Another type of aldosterone antagonist (like spironolactone)
Acute interstitial nephritis
Vertical diplopia
Vagus (auricular branch); vasovagal syncope!

46. What do you treat s. epidermidis with?
frameshift mutations (missense is substitution)
APP on chrom 21 (this is why downs more susceptible)
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Vancomycin

47. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Single adenomatous ones
Octreotide
Turners`
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

48. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
Duration and extent of disease
RER; RER
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
To pump calcium out in cardiac myocytes so that relaxation occurs

49. when do ghon complexes form - primary or secondary TB?
Aromatase deficiency in child
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Primary
Turbulence

50. what dictates the resting membrane potential of most cells?
Serum creatine kinase; reperfusion injury causes necrosis
High potassium conductance and some sodium conductance
GI malignancies and Insulin resistance (acromegal for ex)
glycerol kinase