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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. When does opening snap begin?
Syringomelia
Classical conditioning
Right before diastole (filling begins)
Mean greater than median greater than mode

2. What is an abortive viral infection?
25; 25
Little effect on cell and no change
Amiloride - spironolactone - triamterene
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

3. What is a common complication of acute pancreatitis? What is it?
Amiloride - spironolactone - triamterene
Barium enema
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Minimal change disease

4. Which is slower AV node or ventricular muscle?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Hexokinase
E. coli; staphylococcus saprophyticus
AV node slowest - to allow time for diastole

5. Where does conjugation of bilirubin take place?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
200-500
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
In ER of bile canaliculi

6. What is used to prevent vertical transmission of HIV?
Because of vasodiation to skeletal muscles
ZDV or AZT
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
SVT; increases vagal tone; rectus abdominis

7. Metronidizaole does not cover...
Prevents hepatic VLDL production
IgE
gram positive organisms
Duration and extent of disease

8. What does protein M do in Group A strep<
Primary
Pan colitis and right sided colitis (more than left sided and proctitis)
Dihydropyridine sensitive Ca channels (L type)
Prevent phagocytosis

9. Where does complement bind on the Fc region of Ig chains?
11
liver specific
Fibronectin - laminin - collagen
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

10. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
Headaches and facial flushing; vasodilation in meninges and skin
TCAs and prazosin
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

11. what kind of drug is sertraline? What is a common side effect?
Chlorpheniramine and diphenhydramine
indomethacin
SSRI; erectile dysfunction
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

12. what immune deficiency causes recurrent neisseria infections?
CGD; t cell dysfxn (diGeorge)
MAC complex (C5b - C9 complement deficiency)
Think Hb deformation diseases
Coagulation factors are made in the liver

13. What are pancreatic pseudocysts called pseudo rather than true cysts?
Because of vasodiation to skeletal muscles
Not lined by epithelium
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
MAO inhibitors; wine and cheese

14. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
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
Become beta pleated and then form neurofibrillary tangle!
E6 and E7 of HPV knock off p53 and Rb suppressor genes
No only for prophylaxis (even for treating staphylococcal endocarditis its as multi drug); this is to prevent drug resistance from spontaneous mutations by DNA dependent RNA polymerase

15. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
Bile soluble which means they are bile sensitive
Abnormal closing of the urethral folds
DIC; TTP- HUS dont bleed that much
FGF and VEGF

16. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Turners`
Decreases both
S3 gallop; S2 to opening snap interval
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

17. What would a deflection of the membrane potential to near zero indicate?
Chrom 8
Anterior circumflex (and axillary nerve)
Abnormal closing of the urethral folds
Increase in permeability of two ions with equal and opposite equilibrium potentials

18. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Anterior circumflex (and axillary nerve)
RER; copper

19. what happens with LDL receptor density in statin therapy?
differentiate
Increases
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

20. If a patient has higher levels of HbF - What does this mean?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Paramyxo and influenza
Think Hb deformation diseases
Prevents hepatic VLDL production

21. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Increase; decreased
Trochlear nerve (IV); abducens nerve (VI)
FGF and VEGF
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

22. In what view of CXR is anterior part of heart best seen? anterior part of heart is formed by?right border of heart is formed by? left border?
Lateral; RV; RA; LV
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
Acute gastric mucosal defects (superficial or full thickness)
women

23. What does the severity of leprosy depend on?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Nocardia
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Strength of cell mediated immune response

24. which staphylococci can do mannitol fermaentation?
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
P53 mutation; DCC is also required for adenoma to carcinoma
S. aureus
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

25. What does prolonged PT indicated? aPTT? bleeding time?
Phencyclidine (PCP)
Extrinsic def; instrinsic def; platelet def
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

26. what drugs causes the red man syndrome? how does it occur?
Vancomycin
Trochlear nerve (IV); abducens nerve (VI)
Vancomycin; histamine mediated
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

27. What is 5- HETE and What does it do?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Leukotriene precursor and does neutrophil chemotaxis
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
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

28. What does TGF beta do? What produces it?
Fibrosis; macrophages
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
Ether and other organic solvents

29. Which nerve lies in close proximity to the inferior thyroid artery?
Decreases both
gram positive organisms
Insulin like growth factor 1 (just another name)
Recurrent larygneal

30. Which is faster atrial muscle or ventricular muscle?
Increased reticulocytes
Atrial
Sydenham chorea
ZDV or AZT

31. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
Proteasome inhibitor; treatment for MM and waldenstroms
Syringomelia
Because gamma chains replace beta chains and then gamma chain formation wanes
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

32. What is difference between Arnold Chiari type I and II?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
I is more benign and can present later in adulthood
Secretin stimulates the exocrine pancrease; S enteroendocrine cells in duodenal mucosa in response to acid secrete secretin (HCL is most potent stimulus for secretin release)
Coagulation factors are made in the liver

33. what clinical findings help distinguish small cell carcinoma?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Boiling - bleach - formalin - UV irradiation
Measure of depth invasion (vertical!)

34. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
P53 mutation; DCC is also required for adenoma to carcinoma
Amiadarone
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

35. what hormone is structurally similar to hCG?
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
Pan colitis and right sided colitis (more than left sided and proctitis)
HSV ( also in utero: chlymadia - neisseria - group B strep)
TSh (in testicular tumors can cause hyperthyroidism)

36. what protects the resting heart from arrhythmias?
No (unlike adenomyosis); yes
Radial nerve damage
Highly negative resting potential
Increase lymphatic drainage!

37. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
Syringomelia
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
On cardiac tissue and renal juxtaglomerular cells
Increase; decreased

38. What is the best indicator for the severity of mitral stenosis?
TCAs and prazosin
Varying; erythema nodosum is common
Aromatase deficiency in child
The time interval between S2 and OS- the shorter the interval - the more intense

39. what would be a sign of absence of cardiogenic pulm edem?
Ether and other organic solvents
Nonsense; mRNA processing
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Another type of aldosterone antagonist (like spironolactone)

40. which are the only glycosylated proteins in HIV virus?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Pulmonic and systemic!
Env genes (for getting into target cells)
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

41. What causes release of myosin head from the actin filament?
Pain reliever - reduces pain by locking substance P in the PNS
Hypothyroidism
Extrinsic def; instrinsic def; platelet def
ATP binding (resets the myosin head to contract again for next binding)

42. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
No
Radial nerve and deep brachial artery
P53 mutation; DCC is also required for adenoma to carcinoma
SVC and IVC; right below the aortic knob

43. How is dobutamine better than dopamine?
CMV - HSV 1 - Candida
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Recurrent larygneal

44. what commonly happens in GI in response to acute physiologic stress?
Acute gastric mucosal defects (superficial or full thickness)
Classical conditioning
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
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

45. other than parvo B19 - what else is associated with red cell aplasia?
only up to bronchi
Octreotide
Thymic tumor
Large stroke volumes with ventricular contraction; aortic regurg

46. What causes the blurry vision side effects in first generation anti histamines?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Prostate tumor and increased osteoclast activity
Anti cholinergic effects of pupil dilation and lack of accomodation
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

47. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
only up to bronchi
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Brief psychotic disorder; schizophreniform; schizophrenia
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

48. What actions increase venous return?
Squatting - sitting - lying supine - passive leg raising
Curlings ulcers
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Anti - apoptotic (prevents going into apoptosis)- 18; 14

49. What is extraocular muscle weakness a common symptom of?
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)
Increased reticulocytes
Myasthenia gravis
CMV - HSV 1 - Candida

50. what enzyme converts procarcinogens into carcinogens?
Right heart failure
High potassium conductance and some sodium conductance
Pulmonic and systemic!
P450 mitochondrial monooxygenase