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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. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Class I
P53 mutation; DCC is also required for adenoma to carcinoma
Valproate
Ether and other organic solvents

2. Acyl coA synthetase is not...
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Prostate tumor and increased osteoclast activity
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
liver specific

3. What actions increase venous return?
Squatting - sitting - lying supine - passive leg raising
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Curlings ulcers
SSRI

4. What are the common causes of metabolic alkalosis? How do you differentiate between them?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
II; I (I more abundant)

5. what nerve and artery course along the posterior aspect of the humerus?
Radial nerve and deep brachial artery
On cardiac tissue and renal juxtaglomerular cells
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Chlorpheniramine and diphenhydramine

6. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
transcription activation/suppression
8; 12
Inhaled animal dander allergens
<1% - 55% - concentration dependent

7. what protein is increased in Crohns disease? What does it do?
Elastance
NF- KB; responsible for cytokine production
Another type of aldosterone antagonist (like spironolactone)
Obstruction because they infiltrate the intestinal wall and encircle causing decrease in size of lumen - constipation - abdominal distension - abdominal pain - changes in stool caliber; right sided are often exophytic masses iron def anemia and syste

8. what murmur is enhanced by decreased blood flow to the heart?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Trochlear nerve (IV); abducens nerve (VI)
11

9. What is used to treat heparin toxicity?
Increase in permeability of two ions with equal and opposite equilibrium potentials
Protamine sulfate
Drug induced interstitial nephritis
indomethacin

10. which cells produce surfactant? which ones mediate gas exchange?
II; I (I more abundant)
Terminal bronchioles; small bronchi
NF- KB; responsible for cytokine production
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

11. 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?
Recurrent larygneal
Common peroneal; bony fractures and compression; sciatic
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)
P450 mitochondrial monooxygenase

12. What is the triad seen in pre eclampsia?
Hypertension - edema - and proteinuria
Skin flushing and warmth; prostaglandins; give with aspirin
Mean greater than median greater than mode
Increases

13. If a patient has higher levels of HbF - What does this mean?
Lateral; RV; RA; LV
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
High potassium conductance and some sodium conductance
Think Hb deformation diseases

14. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Joints d/t increased purine production and thus uric acid production
Mean greater than median greater than mode
GI malignancies and Insulin resistance (acromegal for ex)
Increased reticulocytes

15. What does the tuberoinfundibular pathway connect? What is it responsible for?
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
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
No

16. What is the immune deficinecy seen in ataxia telangactasia?
Ketone body production by preventing fatty acids into the mitochondria
Ig A deficiency
Tibial
indomethacin

17. why are beta thal major patients asymptomatic at birth?
Because gamma chains replace beta chains and then gamma chain formation wanes
Joints d/t increased purine production and thus uric acid production
Turners`
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

18. What is used to compare means? categorical outcomes?
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Highly negative resting potential
T test; chi squared
Amiloride - spironolactone - triamterene

19. What is a common complication of acute pancreatitis? What is it?
Faulty positioning of the genital tubercle
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

20. Where is aromatase used?
Gluteus medius and minimus; positive trendelenberg
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
11 aa polypeptide; pain NT in CNS and PNS
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

21. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
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
Not lined by epithelium
Ceftriaxone; azithromycin
Abnormal closing of the urethral folds

22. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
Phencyclidine (PCP)
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Relfex tachycardia; giving beta blockers
Retinitis; mononucleosis

23. which are the only glycosylated proteins in HIV virus?
DIC; TTP- HUS dont bleed that much
Selective alpha 1 (increases SVR)
Env genes (for getting into target cells)
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

24. which virus inactivates both Rb and p53?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Dissolved in plasma and attached to Hgb
Think Hb deformation diseases
E6 and E7 of HPV knock off p53 and Rb suppressor genes

25. What is gardeners mydriasis? How is it treated?
No; MRI
RER; RER
Extrinsic def; instrinsic def; platelet def
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

26. What can worse neurologic dysfunction in cobalamic def?
Rabies encephalitis from cave bats; rabies killed vaccines
Another type of aldosterone antagonist (like spironolactone)
Aromatase deficiency in child
Folic acid treatment!

27. What is the mc location of brain germinomas?What are the classic symptoms?
RBF= PAH clearance/(1- hematocrit)
Adeno
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
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

28. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Turbulence
manifestations - congenital (stretching of periventricular pyrimadal fibers)
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Medial circumflex artery; avascular necrosis

29. which type of glands produce an initially odorless secretion but can become malodorous secondary to bacterial decompisition on the skin surface? which glands are present throughout the skin except on lips and glans penis?
TCAs and prazosin
Downs; regurgitant AV valves - ASDs
Apocrine; eccrine
The time interval between S2 and OS- the shorter the interval - the more intense

30. why does hypothyroidism cause increased CPK levels?
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Lateral; RV; RA; LV
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Enterococci (e. faecalis)- found on genitalia area

31. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Ether and other organic solvents
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
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Terminal bronchioles; small bronchi

32. What is pickwickian syndrome? What are the lab findings?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

33. What is the precursor protein to beta amyloid and On what chromosome is it found?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Reiter syndrome; B27
APP on chrom 21 (this is why downs more susceptible)
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

34. which nerve provides innervation for plantar flexion and inversion?
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Tibial
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

35. How do you treat gonococcal infection? chlymadia?
Ceftriaxone; azithromycin
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Trauma to stereociliated hair cells of the organ of corti
Inhibits it

36. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
No (unlike adenomyosis); yes
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
GI malignancies and Insulin resistance (acromegal for ex)

37. What is tachyphylaxis?
Because gamma chains replace beta chains and then gamma chain formation wanes
Adductor
The term used to describe decreased drug responsiveness with repeated administration
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

38. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
Sydenham chorea
Amiadarone
S. aureus
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)

39. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Obstruction because they infiltrate the intestinal wall and encircle causing decrease in size of lumen - constipation - abdominal distension - abdominal pain - changes in stool caliber; right sided are often exophytic masses iron def anemia and syste
RR-1/RR
Echinococcus granulosus; anaphylaxis
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

40. What causes the blurry vision side effects in first generation anti histamines?
Serum creatine kinase; reperfusion injury causes necrosis
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
MAC complex (C5b - C9 complement deficiency)
Anti cholinergic effects of pupil dilation and lack of accomodation

41. Where does 90% of serotonin lie? What is this NT responsible?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
GI tract; mood!
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
ZDV or AZT

42. what locations of UC increase the risk of Colon cancer?
(urine PAH x urine flow rate)/plasma PAH
Aromatase deficiency in child
No and yes
Pan colitis and right sided colitis (more than left sided and proctitis)

43. What is a cell surface marker seen in liver angiosarcoma?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
APP on chrom 21 (this is why downs more susceptible)
Normal; low

44. 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
Atrial
ANCA because of lack of Ig and C3 deposits on IF
E. coli

45. at one year of age - What are the social - fine motor - gross motor and language developments?
OCPs - multiparity - breast feeding
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Obstruction because they infiltrate the intestinal wall and encircle causing decrease in size of lumen - constipation - abdominal distension - abdominal pain - changes in stool caliber; right sided are often exophytic masses iron def anemia and syste
Initiation - pointing; pincer grasp; walking; mama/dada

46. Which is slower AV node or ventricular muscle?
CMV - HSV 1 - Candida
Amiadarone
AV node slowest - to allow time for diastole
(urine PAH x urine flow rate)/plasma PAH

47. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
Southern - western
Coagulation factors are made in the liver
Well trained athletes and children
Vagus (auricular branch); vasovagal syncope!

48. What does the severity of leprosy depend on?
glycerol kinase
Strength of cell mediated immune response
As a CO2 carrier with the carboxylase enzyme
LT (LTD4 - E4 - C4) - and Ach

49. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
women
Recurrent larygneal
liver specific
Tissue redistribution (out of plasma) rather than metabolism

50. What would a deflection of the membrane potential to near zero indicate?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Increase in permeability of two ions with equal and opposite equilibrium potentials
Normally close to systolic