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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. which staphylococci can do mannitol fermaentation?
Ceftriaxone; azithromycin
Inhibits it
facultative intracellular
S. aureus

2. What almost exclusively causes Epliglottitis?What type of capsule does it have? What are the symptoms?

3. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
differentiate
Inhaled animal dander allergens
No (unlike adenomyosis); yes
Acute interstitial nephritis

4. 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
Enterococci (e. faecalis)- found on genitalia area
women
E. coli

5. What is epispadias caused by?
Trauma to stereociliated hair cells of the organ of corti
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
S. aureus
Faulty positioning of the genital tubercle

6. what chromosome is c - myc found on?
MAC complex (C5b - C9 complement deficiency)
On cardiac tissue and renal juxtaglomerular cells
Chrom 8
Pain reliever - reduces pain by locking substance P in the PNS

7. What is the presentation of angioedema? Where is most commonly affected?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Vascular endothelium; protease
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

8. What does VIP do to gastric acid secretion?
Inhibits it
INTRApartum Abs (ampicillin/penicillin)
Bile soluble which means they are bile sensitive
No

9. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
RER; RER
8; 12
25; 25

10. What are the acute effects of corticosteroids on the CBC?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Vascular endothelium; protease
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Anti centromere; anti DNA topoisomerase

11. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
G to T in p53; HCC
Biphosphonate
SaO2 <92%
Phencyclidine (PCP)

12. What is the most common location of colonization of all s. aureus types?
TCAs and prazosin
Multiple miscarriages d/t hypercoaguability
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Anterior nares

13. Where is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
SaO2 <92%

14. What is capacitance inversely proportional to?
Syringomelia
Elastance
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Medullary

15. What test would be best to determine if a gene is being transcribed? translated?
Southern - western
Paramyxo and influenza
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
Joints d/t increased purine production and thus uric acid production

16. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Localized dermatologic pain that persists for more than one month after zoster eruption
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)

17. What is the precursor protein to beta amyloid and On what chromosome is it found?
Protamine sulfate
APP on chrom 21 (this is why downs more susceptible)
V fib; v. failure
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

18. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Rabies encephalitis from cave bats; rabies killed vaccines
Skin flushing and warmth; prostaglandins; give with aspirin
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Vertical diplopia

19. how does achalasia present? What does barium swallow show on dilated esophagus?
As a CO2 carrier with the carboxylase enzyme
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Hereditary angioedema; ACE inhibitors
Around 70 (normal measured diastolic pressures); 9--

20. What is damaged in early syringomelia? later?
CMV - HSV 1 - Candida
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Clindamycin; covers anaerobic oral flora and aerobic bacteria
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

21. What is the most common neurologic complication of VZV reactivation?
Multiple miscarriages d/t hypercoaguability
Localized dermatologic pain that persists for more than one month after zoster eruption
Headaches and facial flushing; vasodilation in meninges and skin
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

22. What is omalizumab and What is it used for?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Faulty positioning of the genital tubercle
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

23. What is difference between Arnold Chiari type I and II?
I is more benign and can present later in adulthood
frameshift mutations (missense is substitution)
11
Minimal change disease

24. What does anti phospholipid syndrome in SLE patients predispose them to?
Multiple miscarriages d/t hypercoaguability
Insulin like growth factor 1 (just another name)
Downs; regurgitant AV valves - ASDs
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

25. What is cataplexy and When is it seen?
II; I (I more abundant)
Right before diastole (filling begins)
Sudden loss of muscle tone without loss of consciousness; narcolepsy
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)

26. What is a keloid?
Think Hb deformation diseases
Anterior circumflex (and axillary nerve)
Both sides
Excessive collagen formation during tissue repair in susceptible individuals

27. What is the cause of rapid plasma decay of thiopental?
Tissue redistribution (out of plasma) rather than metabolism
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
OCPs - multiparity - breast feeding

28. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
Elastance
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
CGD; t cell dysfxn (diGeorge)

29. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Right heart failure
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

30. What are the two growth factors associated with angiogenesis?
Well
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
FGF and VEGF

31. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Barium enema
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Integration of viral DNA into genome of host hepatocytes
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

32. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
The time interval between S2 and OS- the shorter the interval - the more intense
Both sides
Brief psychotic disorder; schizophreniform; schizophrenia

33. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Trochlear nerve (IV); abducens nerve (VI)
IgE
RER; RER
Echinococcus granulosus; anaphylaxis

34. What are the three causes of acute MI in context of normal coronary arteries ?
Vertical diplopia
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
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
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

35. where are Beta 1 receptors found?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Thymic tumor
On cardiac tissue and renal juxtaglomerular cells

36. What is the cause of fixed splitting of S2? why?
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
11
Well

37. erythema nodosum - elevated ACE - scattered granulomas - arthralgias - hilar lymphadenoapthy are indicative of what?
APP on chrom 21 (this is why downs more susceptible)
Sarcoid
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
Prepatellar

38. What is congestive hepatomegaly specific for?
Gluteus maximus; difficulty getting up from seated position and climbing chair
Reticulocytes
Right heart failure
Faulty positioning of the genital tubercle

39. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
RER; copper
Chrom 8
APP on chrom 21 (this is why downs more susceptible)
Lateral; RV; RA; LV

40. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Gluteus maximus; difficulty getting up from seated position and climbing chair
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

41. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Hyperkalemia; potassium sparing diuretics - potassium supplements
On cardiac tissue and renal juxtaglomerular cells
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

42. what bursa is affected when on knees like a maid/gardner?
Prepatellar
MAO inhibitors; wine and cheese
LT (LTD4 - E4 - C4) - and Ach
AV node slowest - to allow time for diastole

43. What does NF- KB do?
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)
Increases cytokine production
Gluteus medius and minimus; positive trendelenberg
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

44. h1 receptor anatagonists are not effective in treatment of asthma only for...
HSV and VZV
chronic urticaria and allergic symptoms
Increase; decreased
No (unlike adenomyosis); yes

45. why does hypothyroidism cause increased CPK levels?
indomethacin
Myasthenia gravis
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

46. which nerve provides innervation for plantar flexion and inversion?
Tibial
FGF and VEGF
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
Intussusception

47. what makes bruits?
Turbulence
Superior larygeal; cricothyroid; recurrent laryngeal
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Leukotriene precursor and does neutrophil chemotaxis

48. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
No; yes
Trauma to stereociliated hair cells of the organ of corti
Biphosphonate

49. What effects does cortisol have on catecholamines?
Syncope - angina - dyspnea (SAD)
Permissive - sensitizes vasoconstrictive response from catecholamines - doesnt actually act on them but increases transcription of some genes that creates permissive effect (not additive or synergistic becuase cortisol alone doesnt have any effect on
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)
Increased reticulocytes

50. what protein is increased in Crohns disease? What does it do?
Because of vasodiation to skeletal muscles
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
NF- KB; responsible for cytokine production
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(