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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 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?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Serum FFA and serum triglyceride levels
Both sides
Superior larygeal; cricothyroid; recurrent laryngeal

2. at four years of age - What are the social - fine motor - gross motor - and language developments?
Well trained athletes and children
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Another type of aldosterone antagonist (like spironolactone)
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

3. What are the skin presentation in sarcoid?
8 (myc protein) with 2 - 14 - 22 (iG chains)
Varying; erythema nodosum is common
Chlorpheniramine and diphenhydramine
Pan colitis and right sided colitis (more than left sided and proctitis)

4. in the LV and aorta - What are the pressures?
Boiling - bleach - formalin - UV irradiation
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Normally close to systolic
Little effect on cell and no change

5. What are pancreatic pseudocysts called pseudo rather than true cysts?
Highly negative resting potential
S. aureus
Not lined by epithelium
women

6. What is a common complication of acute pancreatitis? What is it?
The term used to describe decreased drug responsiveness with repeated administration
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
P53 mutation; AD
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

7. What is the most important prognostic indicator in patients with malignant melanoma?
Susceptible; soluble (unable to be cultured in bile)
Folic acid treatment!
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Measure of depth invasion (vertical!)

8. What does glycosylase do to DNA? endonuclease? lyase? What does the order here of enzymes represent? what other enzymes are needed?

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9. What is the fibrinogen level in patient with TTP- HUS? DIC?
SVT; increases vagal tone; rectus abdominis
Normal; low
SVC and IVC; right below the aortic knob
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

10. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
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)
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
In ER of bile canaliculi
FGF and VEGF

11. on What part of the clavicle does the SCM attach?
Increase lymphatic drainage!
Acute gastric mucosal defects (superficial or full thickness)
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Medial part

12. what murmur is enhanced by decreased blood flow to the heart?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
liver specific
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

13. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Purkinje system; AV node
indomethacin
Medial circumflex artery; avascular necrosis
Susceptible; soluble (unable to be cultured in bile)

14. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
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
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

15. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Apocrine; eccrine
Increase; decreased
Terminal bronchioles; small bronchi
E. coli; staphylococcus saprophyticus

16. why should you not use ACE inhibitors with someone who had hereditary angioedema?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Adductor
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

17. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
Syringomelia
In ER of bile canaliculi
CGD; t cell dysfxn (diGeorge)
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

18. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
HSV ( also in utero: chlymadia - neisseria - group B strep)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
FGF and VEGF
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

19. What is the immune deficinecy seen in ataxia telangactasia?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Ig A deficiency
...
Superior larygeal; cricothyroid; recurrent laryngeal

20. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Fibrosis; macrophages
Gluteus medius and minimus; positive trendelenberg
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Duration and extent of disease

21. What is hyaline arteriosclerosis usually a sign of ?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Diabetic microangiopathy
Elevated GGT and macrocytosis
Anterior nares

22. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Headaches and facial flushing; vasodilation in meninges and skin
Minimal change disease
Fibrosis; macrophages

23. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
ATP binding (resets the myosin head to contract again for next binding)

24. What antibodies are present in CREST? What is the most specific?
Anti centromere; anti DNA topoisomerase
P53 mutation; DCC is also required for adenoma to carcinoma
P53 mutation; AD
RBC mass; epo levels (secondary has high)

25. When does opening snap begin?
Right before diastole (filling begins)
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Elastance
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

26. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
No (unlike adenomyosis); yes
Hereditary angioedema; ACE inhibitors
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

27. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Chorda tympani branch
Decreases both
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
HSV ( also in utero: chlymadia - neisseria - group B strep)

28. which cells produce surfactant? which ones mediate gas exchange?
II; I (I more abundant)
Mean greater than median greater than mode
Well trained athletes and children
Myasthenia gravis

29. which antiarrythmic is associated with blue gray discoloration ?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
...
Amiadarone
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

30. how long is substance P? What does it do?
Strength of cell mediated immune response
11 aa polypeptide; pain NT in CNS and PNS
Bronchial dilation (bronchiectasis)
Pulmonic and systemic!

31. 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?
RR-1/RR
Because of the low output from heart failure - they will have increased aldosterone levels
Large stroke volumes with ventricular contraction; aortic regurg
Common peroneal; bony fractures and compression; sciatic

32. What can chronic vit A toxicity cause?
Paramyxo and influenza
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
ZDV or AZT
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

33. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Turners`
Fibronectin - laminin - collagen
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)
Trochlear nerve (IV); abducens nerve (VI)

34. What can worse neurologic dysfunction in cobalamic def?
Folic acid treatment!
Turners`
Large stroke volumes with ventricular contraction; aortic regurg
Localized dermatologic pain that persists for more than one month after zoster eruption

35. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
CMV - HSV 1 - Candida
Leukotriene precursor and does neutrophil chemotaxis
Drink plenty of fluids
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

36. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Raphe
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
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

37. What is the mainstay treatment for acute mania?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Nonsense; mRNA processing

38. What is epleronone?
Another type of aldosterone antagonist (like spironolactone)
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Echinococcus granulosus; anaphylaxis
Tzanck smear

39. what locations of UC increase the risk of Colon cancer?
Pan colitis and right sided colitis (more than left sided and proctitis)
Elastance
Anterior nares
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

40. hypertonicity and hyperreflexity are ________________ of hydrocephalus
Another type of aldosterone antagonist (like spironolactone)
CGD; t cell dysfxn (diGeorge)
Hydrogen bonds dictate alpha or beta structure
manifestations - congenital (stretching of periventricular pyrimadal fibers)

41. What is congestive hepatomegaly specific for?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Right heart failure
Intussusception
Localized dermatologic pain that persists for more than one month after zoster eruption

42. What can cause aortic regurg? What is the heart sound you hear?
SaO2 <92%
G to T in p53; HCC
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

43. What would a deflection of the membrane potential to near zero indicate?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Increase in permeability of two ions with equal and opposite equilibrium potentials
liver specific
manifestations - congenital (stretching of periventricular pyrimadal fibers)

44. What is Bortezomib and What is it used for?
Proteasome inhibitor; treatment for MM and waldenstroms
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Tissue redistribution (out of plasma) rather than metabolism
No; MRI

45. on which chromosome is wilms tumor found?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
No (unlike adenomyosis); yes
11
Underestimation of gestational age

46. What is subacute sclerosisng encephalitis caused by?
Echinococcus granulosus; anaphylaxis
Classical conditioning
RER; copper
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

47. What is intussusception? how does ischemia and necrosis occur?
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
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)
Well trained athletes and children
Insulin like growth factor 1 (just another name)

48. What triggers the neoplastic changes that are associated with HBV infecton?
Integration of viral DNA into genome of host hepatocytes
Close but purkinje system to ensure contraction in a bottom up fashion
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Echinococcus granulosus; anaphylaxis

49. What are the potassium sparing diuretics?
P450 mitochondrial monooxygenase
ZDV or AZT
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Amiloride - spironolactone - triamterene

50. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
differentiate
Become beta pleated and then form neurofibrillary tangle!
Sydenham chorea
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt