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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 should you think of in 'smear of an oral ulcer base'?
Tzanck smear
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Kallmans

2. What are the three causes of acute MI in context of normal coronary arteries ?
HSV ( also in utero: chlymadia - neisseria - group B strep)
Closer to head; closer to diaphragm
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Diabetic microangiopathy

3. What is the most common cause of pyelonephritis in both adults and childre?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Headaches and facial flushing; vasodilation in meninges and skin
E. coli
11

4. What is hypospadias caused by?
Chlorpheniramine and diphenhydramine
Abnormal closing of the urethral folds
Initiation - pointing; pincer grasp; walking; mama/dada
Thymic tumor

5. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
Amiloride - spironolactone - triamterene
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Intussusception
Purkinje system; AV node

6. What is the most common neurologic complication of VZV reactivation?
ATP binding (resets the myosin head to contract again for next binding)
Localized dermatologic pain that persists for more than one month after zoster eruption
25; 25
SS +rNA

7. What are some side effects seen in TCAs?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
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
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

8. Is there edema in primary Conns? secondary hyperaldosteronism? why?
V fib; v. failure
Nonsense; mRNA processing
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Boiling - bleach - formalin - UV irradiation

9. how can HAV be inactivated?
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)
Boiling - bleach - formalin - UV irradiation
RER; copper
Serum FFA and serum triglyceride levels

10. which opponens muscle does ulnar innervate?
Chorda tympani branch
Adductor
Initiation - pointing; pincer grasp; walking; mama/dada
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

11. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
As a CO2 carrier with the carboxylase enzyme
SVT; increases vagal tone; rectus abdominis
SSRI; erectile dysfunction
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

12. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Hexokinase
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Increases cytokine production
Radial nerve and deep brachial artery

13. Would alpha 1 agonists cause flushing? muscarinic antagonist?
Retinitis; mononucleosis
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
No; yes
Prevent phagocytosis

14. in overweight individuals What is thought to contribute to insulin resistance?
Serum FFA and serum triglyceride levels
Fibronectin - laminin - collagen
indomethacin
Octreotide

15. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
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
Faulty positioning of the genital tubercle
Increase by 50% in urine osmolality

16. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
women
Syncope - angina - dyspnea (SAD)
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Leukotriene precursor and does neutrophil chemotaxis

17. What do you treat s. epidermidis with?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Vancomycin
Think Hb deformation diseases

18. What is the presentation of sever aortic stenosis?
Syncope - angina - dyspnea (SAD)
GI malignancies and Insulin resistance (acromegal for ex)
transcription activation/suppression
The time interval between S2 and OS- the shorter the interval - the more intense

19. what protects the resting heart from arrhythmias?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Highly negative resting potential
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

20. What is the precursor protein to beta amyloid and On what chromosome is it found?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Gluteus maximus; difficulty getting up from seated position and climbing chair
APP on chrom 21 (this is why downs more susceptible)
glycerol kinase

21. What translocations can cause c - myc overexpression?
Elastance
8 (myc protein) with 2 - 14 - 22 (iG chains)
Duration and extent of disease
RER; copper

22. What is difference between Arnold Chiari type I and II?
I is more benign and can present later in adulthood
Inhibits it
INTRApartum Abs (ampicillin/penicillin)
AV node slowest - to allow time for diastole

23. what nerve and artery course along the posterior aspect of the humerus?
Increases
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Anterior nares
Radial nerve and deep brachial artery

24. how long is substance P? What does it do?
11 aa polypeptide; pain NT in CNS and PNS
Env genes (for getting into target cells)
Trochlear nerve (IV); abducens nerve (VI)
RR-1/RR

25. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
SaO2 <92%
Echinococcus granulosus; anaphylaxis
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
P450 mitochondrial monooxygenase

26. What are the three dopaminergic systems and What are they responsible for? disease?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Increases bronchial and vascular smooth muscle reactivity to catecholamines
By vascular permeability and vasodilation
No; yes

27. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
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
Large stroke volumes with ventricular contraction; aortic regurg
Underestimation of gestational age
Congenital hypothyroidism - downs - amyloidosis - acromegaly

28. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Drug induced interstitial nephritis
Purkinje system; AV node
Phencyclidine (PCP)
APP on chrom 21 (this is why downs more susceptible)

29. What is gardeners mydriasis? How is it treated?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Drug induced interstitial nephritis
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
RR-1/RR

30. why are beta thal major patients asymptomatic at birth?
The LES is supposed to relax when food comes its way (from above) and in achalasia - a motor dysfunction - LES doesnt relax and seen as elevated pressure on the esophageal mannometry
<1% - 55% - concentration dependent
Because gamma chains replace beta chains and then gamma chain formation wanes
P450 mitochondrial monooxygenase

31. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
GI tract; mood!
IgE
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Abnormal closing of the urethral folds

32. which nerve in the lower leg is easily injured and causes foot drop ? What are common causes? From what nerve does it branch off or?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Medial circumflex artery; avascular necrosis
Common peroneal; bony fractures and compression; sciatic
RER; RER

33. What is the sole neurologic manifestation of acute rheumatic fever?
Sydenham chorea
Thymic tumor
46 - 4N; 23 2N
The LES is supposed to relax when food comes its way (from above) and in achalasia - a motor dysfunction - LES doesnt relax and seen as elevated pressure on the esophageal mannometry

34. the rate of blood flow of which two circulations must equal each other at all times?
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
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
women
Pulmonic and systemic!

35. What type of calcium channels dictate the plateau in cardiac myocyte?
Chorda tympani branch
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Dihydropyridine sensitive Ca channels (L type)
Inactivates kallikrein which activates kininogen into bradykinin

36. What does extended consumption of appetite suppressants lead to?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Pulmonary hypertension
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Because gamma chains replace beta chains and then gamma chain formation wanes

37. What is a primary HSV 1 infection like?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Tzanck smear
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

38. What are examples of action that decrease venous return to the heart?
Standing suddenly from supine position; valsalva maneuver
Regular insulin (Not fast acting - regular better)
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

39. Where is aromatase used?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Neisseria induced small cell vasculitis (including hands and soles)

40. What is the difference between additive and synergistic?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
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
Tzanck smear
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

41. why does neutrophila occur with corticosteroids?
Large stroke volumes with ventricular contraction; aortic regurg
Demargination of neutrophils from the vessel walls
Southern - western
SSRI

42. erythema nodosum - elevated ACE - scattered granulomas - arthralgias - hilar lymphadenoapthy are indicative of what?
V fib; v. failure
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Close but purkinje system to ensure contraction in a bottom up fashion
Sarcoid

43. When is an S4 sound normal?
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
Abnormal closing of the urethral folds
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Well trained athletes and children

44. What is the stabilizing force for the secondary structure of proteins?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
P450 mitochondrial monooxygenase
Hydrogen bonds dictate alpha or beta structure

45. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Reiter syndrome; B27
ANCA because of lack of Ig and C3 deposits on IF
Gluteus maximus; difficulty getting up from seated position and climbing chair
Initiation - pointing; pincer grasp; walking; mama/dada

46. What are two indicators of chronic alcohol consumption?
Elevated GGT and macrocytosis
S. aureus
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
8; 12

47. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
Phencyclidine (PCP)
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
low in serum
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

48. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Hereditary angioedema; ACE inhibitors
low in serum
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Mean greater than median greater than mode

49. there are mucus secreting cells in the bronchioles...
TCAs and prazosin
only up to bronchi
Initiation - pointing; pincer grasp; walking; mama/dada
Little effect on cell and no change

50. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
S. saprophyticus - and s. epidermidis; novobiocin
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Gluteus medius and minimus; positive trendelenberg