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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. name three pathological states that present with large tongues.
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Kallmans
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Large stroke volumes with ventricular contraction; aortic regurg

2. h1 receptor anatagonists are not effective in treatment of asthma only for...
chronic urticaria and allergic symptoms
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
facultative intracellular

3. in essential fructosuria - what enzyme do patients use to metabolize fructose?
frameshift mutations (missense is substitution)
Anti centromere; anti DNA topoisomerase
Hexokinase
To pump calcium out in cardiac myocytes so that relaxation occurs

4. What is best to prevent GBS infection in a baby?
INTRApartum Abs (ampicillin/penicillin)
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Ceftriaxone; azithromycin
ATP binding (resets the myosin head to contract again for next binding)

5. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Spongiosis
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Chorda tympani branch

6. 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
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Pulmonic and systemic!
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

7. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Fibronectin - laminin - collagen
IgE
Nocardia
transcription activation/suppression

8. what drugs causes the red man syndrome? how does it occur?
Vancomycin; histamine mediated
As a CO2 carrier with the carboxylase enzyme
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
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

9. what locations of UC increase the risk of Colon cancer?
Reticulocytes
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Close but purkinje system to ensure contraction in a bottom up fashion
Pan colitis and right sided colitis (more than left sided and proctitis)

10. how does achalasia present? What does barium swallow show on dilated esophagus?
Normal; low
Initiation - pointing; pincer grasp; walking; mama/dada
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Medullary

11. 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?
Apocrine; eccrine
Myasthenia gravis
The time interval between S2 and OS- the shorter the interval - the more intense
Strength of cell mediated immune response

12. What is 5- HETE and What does it do?
Because of vasodiation to skeletal muscles
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
Leukotriene precursor and does neutrophil chemotaxis
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

13. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
In the extracellular space for collagen cross linking; zinc
G to T in p53; HCC
Gluteus medius and minimus; positive trendelenberg
LT (LTD4 - E4 - C4) - and Ach

14. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Relfex tachycardia; giving beta blockers
HSV ( also in utero: chlymadia - neisseria - group B strep)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Valproate

15. What does 'oxygen' content in blood refer to?
Amiloride - spironolactone - triamterene
Inhibits it
Dissolved in plasma and attached to Hgb
Rabies encephalitis from cave bats; rabies killed vaccines

16. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Headaches and facial flushing; vasodilation in meninges and skin
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)
Vagus (auricular branch); vasovagal syncope!

17. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Another type of aldosterone antagonist (like spironolactone)
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Elevated GGT and macrocytosis

18. how does noise induced hearing loss occur?
Inhibits it
NF- KB; responsible for cytokine production
Trauma to stereociliated hair cells of the organ of corti
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

19. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Skin flushing and warmth; prostaglandins; give with aspirin
Large stroke volumes with ventricular contraction; aortic regurg
Anti - apoptotic (prevents going into apoptosis)- 18; 14
By vascular permeability and vasodilation

20. what phase do adenosine and acetylcholine act on? doing what?
HSV ( also in utero: chlymadia - neisseria - group B strep)
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)
Sydenham chorea
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

21. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
MAO inhibitors; wine and cheese
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Tibial
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

22. What is epleronone?
Dihydropyridine sensitive Ca channels (L type)
Enterococci (e. faecalis)- found on genitalia area
Another type of aldosterone antagonist (like spironolactone)
Hydrogen bonds dictate alpha or beta structure

23. at four years of age - What are the social - fine motor - gross motor - and language developments?
Anti centromere; anti DNA topoisomerase
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Rabies encephalitis from cave bats; rabies killed vaccines
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

24. Acyl coA synthetase is not...
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
liver specific
SS +rNA
Prevent phagocytosis

25. what would be a sign of absence of cardiogenic pulm edem?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
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)
Intussusception

26. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
Excessive collagen formation during tissue repair in susceptible individuals
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
differentiate
Appetite suppressants

27. What does the tuberoinfundibular pathway connect? What is it responsible for?
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
S. saprophyticus - and s. epidermidis; novobiocin
Faulty positioning of the genital tubercle
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

28. What is the fibrinogen level in patient with TTP- HUS? DIC?
Tzanck smear
Skin flushing and warmth; prostaglandins; give with aspirin
Normal; low
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

29. which nucleus releases serotonin?
4 - 4 - 9
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Raphe
(urine PAH x urine flow rate)/plasma PAH

30. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Ketone body production by preventing fatty acids into the mitochondria
Prepatellar
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Adductor

31. Would alpha 1 agonists cause flushing? muscarinic antagonist?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
No; yes
Minimal change disease
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

32. What causes vertical diplopia? horizontal?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
<1% - 55% - concentration dependent
Trochlear nerve (IV); abducens nerve (VI)
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)

33. What is congestive hepatomegaly specific for?
No; MRI
Right heart failure
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

34. what defines hypoxemia?
SaO2 <92%
In the extracellular space
Because gamma chains replace beta chains and then gamma chain formation wanes
Bile salt accumulation in urine

35. what commonly happens in GI in response to acute physiologic stress?
SVT; increases vagal tone; rectus abdominis
II; I (I more abundant)
Acute gastric mucosal defects (superficial or full thickness)
Demargination of neutrophils from the vessel walls

36. When is an S4 sound normal?
Anti centromere; anti DNA topoisomerase
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Well trained athletes and children
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

37. What is the triad seen in pre eclampsia?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Hypertension - edema - and proteinuria
RBF= PAH clearance/(1- hematocrit)
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

38. What is the most common cause of pyelonephritis in both adults and childre?
To pump calcium out in cardiac myocytes so that relaxation occurs
E. coli
S. saprophyticus - and s. epidermidis; novobiocin
DIC; TTP- HUS dont bleed that much

39. What are the potassium sparing diuretics?
Amiloride - spironolactone - triamterene
Trochlear nerve (IV); abducens nerve (VI)
only up to bronchi
8 (myc protein) with 2 - 14 - 22 (iG chains)

40. biotin is used By what in tissues responsible for gluconeogenesis
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Joints d/t increased purine production and thus uric acid production
As a CO2 carrier with the carboxylase enzyme
Reticulocytes

41. What is mcc of death pre hospital phase of MI? in hospital phase?
P53 mutation; DCC is also required for adenoma to carcinoma
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
V fib; v. failure
200-500

42. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
PDA open
Kallmans
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

43. Which is slower AV node or ventricular muscle?
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
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Pulmonic and systemic!
AV node slowest - to allow time for diastole

44. SIADH patients have normal blood volume but...
As a CO2 carrier with the carboxylase enzyme
MAC complex (C5b - C9 complement deficiency)
hyponatremia (aldosterone activation equilibrates body volume)
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

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

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46. What is difference between Arnold Chiari type I and II?
Adductor
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Rabies encephalitis from cave bats; rabies killed vaccines
I is more benign and can present later in adulthood

47. What can cause virilization of a mother during pregnancy?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Folic acid treatment!
Well trained athletes and children
Aromatase deficiency in child

48. non ceruloplasmin deposition - ceruloplasmin is...
Serum creatine kinase; reperfusion injury causes necrosis
low in serum
In the extracellular space for collagen cross linking; zinc
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

49. what should you think of in 'smear of an oral ulcer base'?
Ceftriaxone; azithromycin
Because of the low output from heart failure - they will have increased aldosterone levels
PDA open
Tzanck smear

50. hypertonicity and hyperreflexity are ________________ of hydrocephalus
Faulty positioning of the genital tubercle
Hexokinase
In the extracellular space
manifestations - congenital (stretching of periventricular pyrimadal fibers)