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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 are the lab findings in poststreptococcal GN?
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Class I
Regular insulin (Not fast acting - regular better)

2. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
46 - 4N; 23 2N
Gluteus medius and minimus; positive trendelenberg
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
T test; chi squared

3. Which is faster atrial muscle or ventricular muscle?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Atrial
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Excessive collagen formation during tissue repair in susceptible individuals

4. What type of calcium channels dictate the plateau in cardiac myocyte?
Dihydropyridine sensitive Ca channels (L type)
Extrinsic def; instrinsic def; platelet def
AV node slowest - to allow time for diastole
Reiter syndrome; B27

5. What is the mcc of extrinsic allergic asthma?
Inhaled animal dander allergens
low in serum
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Myasthenia gravis

6. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
Dissolved in plasma and attached to Hgb
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
NF- KB; responsible for cytokine production
SaO2 <92%

7. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
In the extracellular space
<1% - 55% - concentration dependent

8. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
Fat - fertile - forty - female
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

9. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
facultative intracellular
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
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
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

10. what immune deficiency causes recurrent neisseria infections?
MAC complex (C5b - C9 complement deficiency)
SVT; increases vagal tone; rectus abdominis
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Medullary

11. What is the mcc of elevated AFP leves in pregnancy>
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Coagulation factors are made in the liver
liver specific
Underestimation of gestational age

12. what clinical findings help distinguish small cell carcinoma?
Barium enema
Ether and other organic solvents
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

13. carnitine deficiency impairs production of What and how?
Ketone body production by preventing fatty acids into the mitochondria
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
MAO inhibitors; wine and cheese
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

14. hypertonicity and hyperreflexity are ________________ of hydrocephalus
Increase by 50% in urine osmolality
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Sickle cell; G6PD
manifestations - congenital (stretching of periventricular pyrimadal fibers)

15. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Pain reliever - reduces pain by locking substance P in the PNS
gram positive organisms
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
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

16. what should you think of in 'smear of an oral ulcer base'?
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
Tzanck smear
Amiadarone
Minimal change disease

17. What triggers the neoplastic changes that are associated with HBV infecton?
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
low in serum
MAC complex (C5b - C9 complement deficiency)
Integration of viral DNA into genome of host hepatocytes

18. How do bradykinin - C3a and C5a cause edema?
By vascular permeability and vasodilation
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
S. aureus
GI malignancies and Insulin resistance (acromegal for ex)

19. Which nerve lies in close proximity to the inferior thyroid artery?
Ether and other organic solvents
Recurrent larygneal
Integration of viral DNA into genome of host hepatocytes
gram positive organisms

20. which opponens muscle does ulnar innervate?
Adductor
Mean greater than median greater than mode
Tissue redistribution (out of plasma) rather than metabolism
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

21. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
differentiate
gram positive organisms
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)

22. How do you calculate RPF from urine PAH?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
(urine PAH x urine flow rate)/plasma PAH
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Right heart failure

23. what organ would an activating mutation in PRPP synthetase effect?
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)
To pump calcium out in cardiac myocytes so that relaxation occurs
Joints d/t increased purine production and thus uric acid production
Dissolved in plasma and attached to Hgb

24. sporadic colon cancer tend to arise From what type of polyps?
Single adenomatous ones
INTRApartum Abs (ampicillin/penicillin)
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Right before diastole (filling begins)

25. which two virus families have hemagluttinin on their surface?
Right before diastole (filling begins)
Paramyxo and influenza
RER; copper
Nocardia

26. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Enterococci (e. faecalis)- found on genitalia area
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Phencyclidine (PCP)
Demargination of neutrophils from the vessel walls

27. there are mucus secreting cells in the bronchioles...
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
11
only up to bronchi
Duration and extent of disease

28. What is subacute sclerosisng encephalitis caused by?
Turbulence
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
High potassium conductance and some sodium conductance
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

29. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
TCAs and prazosin
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Rabies encephalitis from cave bats; rabies killed vaccines
OCPs - multiparity - breast feeding

30. What is contraindicated in toxic mega colon?
Sickle cell; G6PD
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Hyperkalemia; potassium sparing diuretics - potassium supplements
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

31. which are the only glycosylated proteins in HIV virus?
Env genes (for getting into target cells)
Selective alpha 1 (increases SVR)
DIC; TTP- HUS dont bleed that much
Decreases both

32. if there are keratin swirls does that mean well or poorly differentiated?
SSRI
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
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
Well

33. What is diagnostic (and possible therapeutic for intussusception)?
Barium enema
(urine PAH x urine flow rate)/plasma PAH
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Around 70 (normal measured diastolic pressures); 9--

34. 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
Purkinje system; AV node
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Multiple miscarriages d/t hypercoaguability

35. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
hyponatremia (aldosterone activation equilibrates body volume)
Curlings ulcers
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Env genes (for getting into target cells)

36. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Gluteus maximus; difficulty getting up from seated position and climbing chair
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Bile salt accumulation in urine

37. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
E. coli
Echinococcus granulosus; anaphylaxis
Phencyclidine (PCP)
Nonsense; mRNA processing

38. What does TGF beta do? What produces it?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Chlorpheniramine and diphenhydramine
Increase by 50% in urine osmolality
Fibrosis; macrophages

39. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
Cluster
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Syringomelia
...

40. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
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
Octreotide
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Paramyxo and influenza

41. which nerve is at risk when ligating the superior thyroid artery? Which is the only muscle this nerve innervates? what nerve innervates all the other laryngeal muscles?
Increase by 50% in urine osmolality
Superior larygeal; cricothyroid; recurrent laryngeal
APP on chrom 21 (this is why downs more susceptible)
Proteasome inhibitor; treatment for MM and waldenstroms

42. what hormone is structurally similar to hCG?
Think Hb deformation diseases
Syncope - angina - dyspnea (SAD)
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)
TSh (in testicular tumors can cause hyperthyroidism)

43. nucleotide deletions do not cause missense mutations - they cause...
Retinitis; mononucleosis
Because of vasodiation to skeletal muscles
frameshift mutations (missense is substitution)
Thymic tumor

44. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Medial circumflex artery; avascular necrosis
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

45. What does C1 esterase do other than inhibiting complement pathway?
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
indomethacin
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)
Inactivates kallikrein which activates kininogen into bradykinin

46. What is the best indicator for the severity of mitral stenosis?
Strength of cell mediated immune response
Acute gastric mucosal defects (superficial or full thickness)
The time interval between S2 and OS- the shorter the interval - the more intense
RR-1/RR

47. in essential fructosuria - what enzyme do patients use to metabolize fructose?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Hexokinase
Elastance

48. Where is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
Folic acid treatment!
Adeno
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
TSh (in testicular tumors can cause hyperthyroidism)

49. What causes wrist drop?
Radial nerve damage
Ketone body production by preventing fatty acids into the mitochondria
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

50. What is the mainstay treatment for acute mania?
Regular insulin (Not fast acting - regular better)
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Myasthenia gravis
Amiadarone