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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 is an S4 sound normal?
Because of the low output from heart failure - they will have increased aldosterone levels
Well trained athletes and children
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Vagus (auricular branch); vasovagal syncope!

2. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Rabies encephalitis from cave bats; rabies killed vaccines
Vascular endothelium; protease
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Ceftriaxone; azithromycin

3. Where does terminal peptide cleavage of collagen fibrils take place?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
APP on chrom 21 (this is why downs more susceptible)
SVT; increases vagal tone; rectus abdominis
In the extracellular space

4. at three years of age What are social - fine motor - gross motor and language developments?
Covalent (between two cysteines)- allows protein to withstand denaturation
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Because of vasodiation to skeletal muscles
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences

5. How can renal blood flow be calculated from RPF?
Hypothyroidism
RBF= PAH clearance/(1- hematocrit)
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Congenital hypothyroidism - downs - amyloidosis - acromegaly

6. What type of disease has selective proteinuria? What is found in urine? What is not?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
IgE
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

7. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
transcription activation/suppression
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Diabetic microangiopathy
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

8. What is the mutation type in thalassemias? what process is defective because of this?
transcription activation/suppression
Nonsense; mRNA processing
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
As a CO2 carrier with the carboxylase enzyme

9. What causes vertical diplopia? horizontal?
Trochlear nerve (IV); abducens nerve (VI)
200-500
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Susceptible; soluble (unable to be cultured in bile)

10. are there signs of inflammation in avascular necrosis? then How do you diagnose?
Tissue redistribution (out of plasma) rather than metabolism
Pain reliever - reduces pain by locking substance P in the PNS
No; MRI
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

11. What does hypocapnia cause in teh brain? What is hypocapnia?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
HSV ( also in utero: chlymadia - neisseria - group B strep)

12. What does Rb protein do? what chrom is it on?
DIC; TTP- HUS dont bleed that much
Purkinje system; AV node
Smoking
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

13. what murmur is enhanced by decreased blood flow to the heart?
INTRApartum Abs (ampicillin/penicillin)
women
Hypothyroidism
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

14. What is the triad seen in pre eclampsia?
Southern - western
H. influenzae type B; polyribosyl phosphate (PRP); cherry red uvula - dysphagia - stridor (sometimes) - difficulty breathing - fever - drooling - positive 'thumbs up sign' on lateral xray of cervical region d/t swollen epiglottis
Reiter syndrome; B27
Hypertension - edema - and proteinuria

15. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Neisseria induced small cell vasculitis (including hands and soles)
Become beta pleated and then form neurofibrillary tangle!
Downs; regurgitant AV valves - ASDs
Nocardia

16. what should you think of in 'smear of an oral ulcer base'?
Turbulence
RER; RER
Tzanck smear
Close but purkinje system to ensure contraction in a bottom up fashion

17. what dissolves the lipid bilayer of a viral envelope?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Medial circumflex artery; avascular necrosis
Neisseria induced small cell vasculitis (including hands and soles)
Ether and other organic solvents

18. What antibiotic is best to treat alcoholic pulm infections? why?
Reticulocytes
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Syringomelia

19. 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
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Fibronectin - laminin - collagen

20. What is the mc manifestation of CMV in HIV patient? immunocompetent?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Smoking
Increases cytokine production
Retinitis; mononucleosis

21. What is the mcc of extrinsic allergic asthma?
Vertical diplopia
IgE
Inhaled animal dander allergens
Sarcoid

22. what indicates the severity of a mitral regurg ? mitral stenosis?
S3 gallop; S2 to opening snap interval
Dissolved in plasma and attached to Hgb
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Pulmonary hypertension

23. What can cause virilization of a mother during pregnancy?
Sickle cell; G6PD
Reiter syndrome; B27
Elevated GGT and macrocytosis
Aromatase deficiency in child

24. which virus inactivates both Rb and p53?
Kallmans
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
RER; copper
E6 and E7 of HPV knock off p53 and Rb suppressor genes

25. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Class I
Vertical diplopia
Rabies encephalitis from cave bats; rabies killed vaccines
HSV ( also in utero: chlymadia - neisseria - group B strep)

26. what hernia has a similar mechanism to hydrocele?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Brief psychotic disorder; schizophreniform; schizophrenia
TSh (in testicular tumors can cause hyperthyroidism)
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

27. What three pathogens cause infectious esophagitis in HIV positive patients?
Phencyclidine (PCP)
8; 12
Hypertension - edema - and proteinuria
CMV - HSV 1 - Candida

28. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Hereditary angioedema; ACE inhibitors
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

29. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
To pump calcium out in cardiac myocytes so that relaxation occurs
Selective alpha 1 (increases SVR)
Closer to head; closer to diaphragm
Anti - apoptotic (prevents going into apoptosis)- 18; 14

30. hypertonicity and hyperreflexity are ________________ of hydrocephalus
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Thymic tumor
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Phencyclidine (PCP)

31. How do you treat gonococcal infection? chlymadia?
Vagus (auricular branch); vasovagal syncope!
Ceftriaxone; azithromycin
Nocardia
gram positive organisms

32. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
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
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Dihydropyridine sensitive Ca channels (L type)
differentiate

33. What is the mainstay treatment for acute mania?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Pain reliever - reduces pain by locking substance P in the PNS
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

34. prostaglandin synthesis keeps...
Phencyclidine (PCP)
hyponatremia (aldosterone activation equilibrates body volume)
PDA open
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

35. What is used to treat heparin toxicity?
Pain reliever - reduces pain by locking substance P in the PNS
Anti cholinergic effects of pupil dilation and lack of accomodation
Syringomelia
Protamine sulfate

36. What is a keloid?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Excessive collagen formation during tissue repair in susceptible individuals
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

37. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Medial circumflex artery; avascular necrosis
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

38. What are fenfluramine - phentermine?
ATP binding (resets the myosin head to contract again for next binding)
Tzanck smear
Skin flushing and warmth; prostaglandins; give with aspirin
Appetite suppressants

39. What is epleronone?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Another type of aldosterone antagonist (like spironolactone)
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

40. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
11
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Increase in permeability of two ions with equal and opposite equilibrium potentials
Elastance

41. What is subacute sclerosisng encephalitis caused by?
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
Common peroneal; bony fractures and compression; sciatic
Measles and M3 AML`
Leukotriene precursor and does neutrophil chemotaxis

42. Where is aromatase used?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
<1% - 55% - concentration dependent
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

43. how can HAV be inactivated?
Closer to head; closer to diaphragm
Measles and M3 AML`
Tibial
Boiling - bleach - formalin - UV irradiation

44. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Downs; regurgitant AV valves - ASDs
In the extracellular space for collagen cross linking; zinc
Serum creatine kinase; reperfusion injury causes necrosis
Valproate

45. Is there edema in primary Conns? secondary hyperaldosteronism? why?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Enterococci (e. faecalis)- found on genitalia area
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
RER; RER

46. What type of bond is a disulfide bond?
Covalent (between two cysteines)- allows protein to withstand denaturation
TCAs and prazosin
Ceftriaxone; azithromycin
Single adenomatous ones

47. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Prevents hepatic VLDL production
S3 gallop; S2 to opening snap interval
Covalent (between two cysteines)- allows protein to withstand denaturation

48. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
HSV and VZV
Echinococcus granulosus; anaphylaxis
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
facultative intracellular

49. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Acute gastric mucosal defects (superficial or full thickness)
C3 decreased after 5-10 days; sulfonamides
FGF and VEGF

50. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
Measles and M3 AML`
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
TCAs and prazosin
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