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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. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Vancomycin; histamine mediated
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Prepatellar

2. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Sickle cell; G6PD
RBF= PAH clearance/(1- hematocrit)
Chorda tympani branch

3. What is congestive hepatomegaly specific for?
Think Hb deformation diseases
Squatting - sitting - lying supine - passive leg raising
hyponatremia (aldosterone activation equilibrates body volume)
Right heart failure

4. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Increase; decreased
Faulty positioning of the genital tubercle
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Clindamycin; covers anaerobic oral flora and aerobic bacteria

5. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
RER; copper
Congenital hypothyroidism - downs - amyloidosis - acromegaly

6. What can cause virilization of a mother during pregnancy?
Sarcoid
Ether and other organic solvents
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Aromatase deficiency in child

7. how does achalasia present? What does barium swallow show on dilated esophagus?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
P53 mutation; DCC is also required for adenoma to carcinoma
Increases cytokine production
Rabies encephalitis from cave bats; rabies killed vaccines

8. What is normal fibrinogen levels?
Sickle cell; G6PD
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
200-500
I is more benign and can present later in adulthood

9. Where is conduction in heart fastest? slowest?
Purkinje system; AV node
Vancomycin
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

10. What three factors effect total oxygen content of blood?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Well
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

11. what receptors do first generation anti histamines block?
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
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Primary
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

12. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Large stroke volumes with ventricular contraction; aortic regurg
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Coagulation factors are made in the liver
Hypo or hyper pigmentations; after tanning

13. How do you calculate atributable risk percent?
GI tract; mood!
G to T in p53; HCC
RR-1/RR
8 (myc protein) with 2 - 14 - 22 (iG chains)

14. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
HSV and VZV
FGF and VEGF
C3 decreased after 5-10 days; sulfonamides
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

15. what vessel would a fracture to the neck of the of the humerus damage?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Inactivates kallikrein which activates kininogen into bradykinin
Anterior circumflex (and axillary nerve)
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)

16. What are diastolic (lowest) pressures in aorta? LV?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Medial circumflex artery; avascular necrosis
Around 70 (normal measured diastolic pressures); 9--
Ether and other organic solvents

17. What can chronic vit A toxicity cause?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Aromatase deficiency in child
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

18. Where does terminal peptide cleavage of collagen fibrils take place?
Skin flushing and warmth; prostaglandins; give with aspirin
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
In the extracellular space
Pulmonary hypertension

19. What is the most common initital symptom of ADPKD? what else?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Joints d/t increased purine production and thus uric acid production
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Little effect on cell and no change

20. In What type of nephritis would you see high serum eos count?
Increases
Drug induced interstitial nephritis
hyponatremia (aldosterone activation equilibrates body volume)
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

21. What is intussusception? how does ischemia and necrosis occur?
Increased reticulocytes
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
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
ATP binding (resets the myosin head to contract again for next binding)

22. What is 5- HETE and What does it do?
Leukotriene precursor and does neutrophil chemotaxis
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Anterior nares
Classical conditioning

23. in overweight individuals What is thought to contribute to insulin resistance?
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
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Serum FFA and serum triglyceride levels
Increase lymphatic drainage!

24. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
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
low in serum
11 aa polypeptide; pain NT in CNS and PNS
Turners`

25. Where does the aorta lie in relation to the pulmonary artery in transposition of the great arteries (is this right to left or left to right shunt?)?
Nonsense; mRNA processing
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
<1% - 55% - concentration dependent
Initiation - pointing; pincer grasp; walking; mama/dada

26. are there signs of inflammation in avascular necrosis? then How do you diagnose?
SVC and IVC; right below the aortic knob
Increase lymphatic drainage!
No; MRI
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

27. What causes release of myosin head from the actin filament?
ATP binding (resets the myosin head to contract again for next binding)
Barium enema
liver specific
Single adenomatous ones

28. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
G to T in p53; HCC
Medullary

29. What do you treat s. epidermidis with?
Hyperkalemia; potassium sparing diuretics - potassium supplements
Ig A deficiency
Vancomycin
Well trained athletes and children

30. What is the presentation of sever aortic stenosis?
Syncope - angina - dyspnea (SAD)
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
TSh (in testicular tumors can cause hyperthyroidism)
Aromatase deficiency in child

31. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
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)
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
On cardiac tissue and renal juxtaglomerular cells

32. What is capacitance inversely proportional to?
I is more benign and can present later in adulthood
Elastance
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

33. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
P53 mutation; DCC is also required for adenoma to carcinoma
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

34. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Tissue redistribution (out of plasma) rather than metabolism
Atrial
Fibronectin - laminin - collagen
Acute interstitial nephritis

35. What is hyaline arteriosclerosis usually a sign of ?
Pulmonic and systemic!
11
Underestimation of gestational age
Diabetic microangiopathy

36. What type of endocarditis is cytoscopy induced?
Coagulation factors are made in the liver
Enterococci (e. faecalis)- found on genitalia area
SSRI; erectile dysfunction
Trauma to stereociliated hair cells of the organ of corti

37. why does hypothyroidism cause increased CPK levels?
Aromatase deficiency in child
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Trauma to stereociliated hair cells of the organ of corti
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

38. What is the most important prognostic indicator in patients with malignant melanoma?
No
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Classical conditioning
Measure of depth invasion (vertical!)

39. What would a deflection of the membrane potential to near zero indicate?
Myasthenia gravis
Increase in permeability of two ions with equal and opposite equilibrium potentials
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

40. which staphylococci can do mannitol fermaentation?
Thymic tumor
Adductor
S. aureus
11 aa polypeptide; pain NT in CNS and PNS

41. What causes vertical diplopia? horizontal?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Faulty positioning of the genital tubercle
Common peroneal; bony fractures and compression; sciatic
Trochlear nerve (IV); abducens nerve (VI)

42. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
chronic urticaria and allergic symptoms
Ether and other organic solvents

43. What is somatomedin C?
MAC complex (C5b - C9 complement deficiency)
Insulin like growth factor 1 (just another name)
Amiloride - spironolactone - triamterene
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

44. Would alpha 1 agonists cause flushing? muscarinic antagonist?
Amiloride - spironolactone - triamterene
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
No; yes
C3 decreased after 5-10 days; sulfonamides

45. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Downs; regurgitant AV valves - ASDs
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

46. what has the greatest effect on prognosis when treating c. diptheriae?
Radial nerve damage
Excessive collagen formation during tissue repair in susceptible individuals
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Covalent (between two cysteines)- allows protein to withstand denaturation

47. What are the two growth factors associated with angiogenesis?
FGF and VEGF
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)
In the extracellular space for collagen cross linking; zinc
Another type of aldosterone antagonist (like spironolactone)

48. SIADH patients have normal blood volume but...
Sarcoid
Vertical diplopia
Vascular endothelium; protease
hyponatremia (aldosterone activation equilibrates body volume)

49. 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?
Folic acid treatment!
Amiadarone
Superior larygeal; cricothyroid; recurrent laryngeal
chronic urticaria and allergic symptoms

50. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Measles and M3 AML`
Sydenham chorea
Env genes (for getting into target cells)
Because of vasodiation to skeletal muscles