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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 is the most common location of colonization of all s. aureus types?
Bile salt accumulation in urine
HSV ( also in utero: chlymadia - neisseria - group B strep)
Anterior nares
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

2. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
Elevated GGT and macrocytosis
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

3. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Susceptible; soluble (unable to be cultured in bile)
Class I
Medial circumflex artery; avascular necrosis
In ER of bile canaliculi

4. 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?
Syncope - angina - dyspnea (SAD)
Superior larygeal; cricothyroid; recurrent laryngeal
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Think Hb deformation diseases

5. a patient fearing all white coats is a phenomenon of what?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Classical conditioning
Chorda tympani branch
low in serum

6. what receptors do first generation anti histamines block?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
P53 mutation; DCC is also required for adenoma to carcinoma
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

7. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
MAO inhibitors; wine and cheese
Sydenham chorea
Gluteus medius and minimus; positive trendelenberg

8. What does L/S stand for in fetal lung maturity? When does maturity occur?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
46 - 4N; 23 2N
Pain reliever - reduces pain by locking substance P in the PNS

9. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Turbulence
Hydrogen bonds dictate alpha or beta structure
Chorda tympani branch
As a CO2 carrier with the carboxylase enzyme

10. How do you treat gonococcal infection? chlymadia?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Ceftriaxone; azithromycin
Myasthenia gravis
Brief psychotic disorder; schizophreniform; schizophrenia

11. metabolism of 1 gram of protein produces How many calories? carb? fat?
differentiate
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
4 - 4 - 9

12. What are some side effects seen in TCAs?
Tibial
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Sydenham chorea

13. which nerve provides innervation for plantar flexion and inversion?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
RR-1/RR
Tibial
Increases cytokine production

14. What is epleronone?
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
Another type of aldosterone antagonist (like spironolactone)
The time interval between S2 and OS- the shorter the interval - the more intense
FGF and VEGF

15. what commonly happens in GI in response to acute physiologic stress?
8; 12
Increased reticulocytes
Right before diastole (filling begins)
Acute gastric mucosal defects (superficial or full thickness)

16. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
LT (LTD4 - E4 - C4) - and Ach
Because ACE blocks breakdown of bradykinin and hereditary angioedema patients have high levels of bradykinin; high levels of bradykinin - C3a - and C5a mediate edema by increasing vascular permeability and vasodilation
Bile soluble which means they are bile sensitive

17. what virus causes pharyngoconjuctival fever?
NF- KB; responsible for cytokine production
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
Adeno
E6 and E7 of HPV knock off p53 and Rb suppressor genes

18. What is the sole neurologic manifestation of acute rheumatic fever?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
E. coli
Pan colitis and right sided colitis (more than left sided and proctitis)
Sydenham chorea

19. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
Elevated GGT and macrocytosis
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)
Curlings ulcers
4 - 4 - 9

20. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
Radial nerve damage
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
E. coli
46 - 4N; 23 2N

21. at four years of age - What are the social - fine motor - gross motor - and language developments?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Hypertension - edema - and proteinuria

22. What translocations can cause c - myc overexpression?
Well
8 (myc protein) with 2 - 14 - 22 (iG chains)
11 aa polypeptide; pain NT in CNS and PNS
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

23. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
In the extracellular space for collagen cross linking; zinc
GI tract; mood!
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

24. Which nerve lies in close proximity to the inferior thyroid artery?
Recurrent larygneal
Demargination of neutrophils from the vessel walls
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
Increases

25. how does eos release MBP to kill protozoa etc?
Vancomycin
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
On cardiac tissue and renal juxtaglomerular cells
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

26. What is tachyphylaxis?
Acute gastric mucosal defects (superficial or full thickness)
The term used to describe decreased drug responsiveness with repeated administration
Downs; regurgitant AV valves - ASDs
Proteasome inhibitor; treatment for MM and waldenstroms

27. what locations of UC increase the risk of Colon cancer?
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
RER; copper
Pan colitis and right sided colitis (more than left sided and proctitis)
Well

28. which has better side effect profile - SSRI or TCA?
Tissue redistribution (out of plasma) rather than metabolism
SSRI
differentiate
46 - 4N; 23 2N

29. What is the mainstay treatment for acute mania?
Measles and M3 AML`
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
RER; copper

30. what makes bruits?
hyponatremia (aldosterone activation equilibrates body volume)
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Turbulence

31. What is contraindicated in toxic mega colon?
By vascular permeability and vasodilation
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
differentiate
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

32. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
No and yes
hyponatremia (aldosterone activation equilibrates body volume)
Prevents hepatic VLDL production
Kallmans

33. What are the first generation anti histamines?
Chlorpheniramine and diphenhydramine
Increases bronchial and vascular smooth muscle reactivity to catecholamines
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
Localized dermatologic pain that persists for more than one month after zoster eruption

34. What are pancreatic pseudocysts called pseudo rather than true cysts?
Anterior nares
Not lined by epithelium
Vertical diplopia
Syncope - angina - dyspnea (SAD)

35. What does C1 esterase do other than inhibiting complement pathway?
Inactivates kallikrein which activates kininogen into bradykinin
Gluteus medius and minimus; positive trendelenberg
Become beta pleated and then form neurofibrillary tangle!
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

36. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
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
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
CGD; t cell dysfxn (diGeorge)

37. which opponens muscle does ulnar innervate?
Increases
Adductor
CGD; t cell dysfxn (diGeorge)
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

38. What are fenfluramine - phentermine?
Squatting - sitting - lying supine - passive leg raising
Appetite suppressants
Cluster
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

39. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
No and yes
Bile soluble which means they are bile sensitive
Circular - outside nucleus; transport proteins - rRNA - tRNA

40. 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
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Trochlear nerve (IV); abducens nerve (VI)

41. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
Syncope - angina - dyspnea (SAD)
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Mean greater than median greater than mode
G to T in p53; HCC

42. which headaches are seen mostly in men - are severe - unilateral - periorbital - episodic (around same time every day) - temporal pain - with lacrimation - nasal congestion and ptosis?
No (unlike adenomyosis); yes
women
Raphe
Cluster

43. at three years of age What are social - fine motor - gross motor and language developments?
S. saprophyticus - and s. epidermidis; novobiocin
GI tract; mood!
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Because of the low output from heart failure - they will have increased aldosterone levels

44. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
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
Increase in permeability of two ions with equal and opposite equilibrium potentials
P53 mutation; AD

45. How do you calculate atributable risk percent?
Closer to head; closer to diaphragm
Ketone body production by preventing fatty acids into the mitochondria
RR-1/RR
By vascular permeability and vasodilation

46. what dictates the resting membrane potential of most cells?
Adductor
High potassium conductance and some sodium conductance
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

47. What is the mc manifestation of CMV in HIV patient? immunocompetent?
GI tract; mood!
Retinitis; mononucleosis
gram positive organisms
Anti cholinergic effects of pupil dilation and lack of accomodation

48. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Both sides
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Amiloride - spironolactone - triamterene

49. What is somatomedin C?
Serum creatine kinase; reperfusion injury causes necrosis
Insulin like growth factor 1 (just another name)
Env genes (for getting into target cells)
Amiloride - spironolactone - triamterene

50. What is mcc of death pre hospital phase of MI? in hospital phase?
V fib; v. failure
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
No and yes
Think Hb deformation diseases