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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. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Env genes (for getting into target cells)
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Anti centromere; anti DNA topoisomerase

2. What are the two mcc of focal brain lesions in HIV positive patients?
S. saprophyticus - and s. epidermidis; novobiocin
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Amiadarone
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

3. which two drug types can cause orthostatic hypotension (think depression and BPH)?
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
Nonsense; mRNA processing
Adeno
TCAs and prazosin

4. What does anti phospholipid syndrome in SLE patients predispose them to?
Amiloride - spironolactone - triamterene
Multiple miscarriages d/t hypercoaguability
Adductor
ATP binding (resets the myosin head to contract again for next binding)

5. how much percent of sodium is excreted? urea? glucose?
Sickle cell; G6PD
Opiate anti diarrheal that binds to mu opiate receptors in GI tract and slows motility; meperidine; low doses - but therapeutic doses combined with atropine (under marked brand name lomotil)
<1% - 55% - concentration dependent
Circular - outside nucleus; transport proteins - rRNA - tRNA

6. what clinical findings help distinguish small cell carcinoma?
TSh (in testicular tumors can cause hyperthyroidism)
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Gluteus maximus; difficulty getting up from seated position and climbing chair

7. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
(urine PAH x urine flow rate)/plasma PAH
Inactivates kallikrein which activates kininogen into bradykinin

8. Where is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Normally close to systolic
Nocardia
8 (myc protein) with 2 - 14 - 22 (iG chains)

9. how can HAV be inactivated?
Boiling - bleach - formalin - UV irradiation
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Serum FFA and serum triglyceride levels
Gluteus maximus; difficulty getting up from seated position and climbing chair

10. What is the sole neurologic manifestation of acute rheumatic fever?
Sydenham chorea
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Atrial
Vancomycin

11. What is hypospadias caused by?
Increase by 50% in urine osmolality
Proteasome inhibitor; treatment for MM and waldenstroms
Abnormal closing of the urethral folds
Close but purkinje system to ensure contraction in a bottom up fashion

12. What is normal fibrinogen levels?
200-500
Brief psychotic disorder; schizophreniform; schizophrenia
Well trained athletes and children
Trauma to stereociliated hair cells of the organ of corti

13. What is the neurologic manifestation of ADPKD?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Paramyxo and influenza
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Acute interstitial nephritis

14. What can too much IgA in serum produces?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Octreotide
Prostate tumor and increased osteoclast activity
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

15. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
E. coli; staphylococcus saprophyticus
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
In the extracellular space
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

16. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Gluteus maximus; difficulty getting up from seated position and climbing chair
Southern - western
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
II; I (I more abundant)

17. what organ would an activating mutation in PRPP synthetase effect?
Joints d/t increased purine production and thus uric acid production
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

18. What does 'oxygen' content in blood refer to?
MAO inhibitors; wine and cheese
Dissolved in plasma and attached to Hgb
Terminal bronchioles; small bronchi
Covalent (between two cysteines)- allows protein to withstand denaturation

19. 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?
Superior larygeal; cricothyroid; recurrent laryngeal
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Retinitis; mononucleosis
Kallmans

20. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
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
Biphosphonate
Terminal bronchioles; small bronchi
Normally close to systolic

21. What do you treat s. epidermidis with?
Well
LT (LTD4 - E4 - C4) - and Ach
Class I
Vancomycin

22. What are examples of action that decrease venous return to the heart?
transcription activation/suppression
Normally close to systolic
Standing suddenly from supine position; valsalva maneuver
Integration of viral DNA into genome of host hepatocytes

23. What is medullary sponge kidney disease and how does it present? What does it lead to?
Gluteus maximus; difficulty getting up from seated position and climbing chair
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)
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

24. erythema nodosum - elevated ACE - scattered granulomas - arthralgias - hilar lymphadenoapthy are indicative of what?
RBC mass; epo levels (secondary has high)
Ketone body production by preventing fatty acids into the mitochondria
Sarcoid
Extrinsic def; instrinsic def; platelet def

25. Where does conjugation of bilirubin take place?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
In ER of bile canaliculi
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
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

26. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Increased reticulocytes
Opiate anti diarrheal that binds to mu opiate receptors in GI tract and slows motility; meperidine; low doses - but therapeutic doses combined with atropine (under marked brand name lomotil)
IgE

27. ___________ is liver specific
Pulmonary hypertension
only up to bronchi
IgE
glycerol kinase

28. What is a keloid?
Atrial
Recurrent larygneal
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Excessive collagen formation during tissue repair in susceptible individuals

29. at three years of age What are social - fine motor - gross motor and language developments?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
P53 mutation; AD
glycerol kinase

30. 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
glycerol kinase
Not lined by epithelium
Medial circumflex artery; avascular necrosis

31. What are some side effects seen in TCAs?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
GI tract; mood!
Anti centromere; anti DNA topoisomerase
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

32. Would alpha 1 agonists cause flushing? muscarinic antagonist?
No; yes
Decreases both
Increase in permeability of two ions with equal and opposite equilibrium potentials
Bile salt accumulation in urine

33. What is acanthosis nigricans associated with?
Closer to head; closer to diaphragm
Squatting - sitting - lying supine - passive leg raising
GI malignancies and Insulin resistance (acromegal for ex)
gram positive organisms

34. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
Protamine sulfate
RBC mass; epo levels (secondary has high)
Vertical diplopia
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

35. which trisomy is associated with endocardial cushion defects? What does thsi mean>
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Downs; regurgitant AV valves - ASDs
Coagulation factors are made in the liver
Selective alpha 1 (increases SVR)

36. what makes bruits?
Increase by 50% in urine osmolality
Serum FFA and serum triglyceride levels
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Turbulence

37. Where does terminal peptide cleavage of collagen fibrils take place?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
NF- KB; responsible for cytokine production
In the extracellular space
PDA open

38. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
S3 gallop; S2 to opening snap interval
transcription activation/suppression
Phencyclidine (PCP)
Chrom 8

39. which antiarrythmic is associated with blue gray discoloration ?
Localized dermatologic pain that persists for more than one month after zoster eruption
Strength of cell mediated immune response
Amiadarone
GI tract; mood!

40. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
Hypo or hyper pigmentations; after tanning
No; MRI
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Dihydropyridine sensitive Ca channels (L type)

41. which RPGN is also called pauci immune GN? why?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
ANCA because of lack of Ig and C3 deposits on IF
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Pain reliever - reduces pain by locking substance P in the PNS

42. prostaglandin synthesis keeps...
PDA open
Trauma to stereociliated hair cells of the organ of corti
Opiate anti diarrheal that binds to mu opiate receptors in GI tract and slows motility; meperidine; low doses - but therapeutic doses combined with atropine (under marked brand name lomotil)
By vascular permeability and vasodilation

43. What is difference between Arnold Chiari type I and II?
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Atrial
ZDV or AZT
I is more benign and can present later in adulthood

44. How do you treat gonococcal infection? chlymadia?
Ceftriaxone; azithromycin
Normally close to systolic
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Pulmonic and systemic!

45. What is damaged in early syringomelia? later?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Ether and other organic solvents

46. which has better side effect profile - SSRI or TCA?
PDA open
200-500
When it invades the bm; carcinoma in situ
SSRI

47. how long is substance P? What does it do?
Brief psychotic disorder; schizophreniform; schizophrenia
Vertical diplopia
PDA open
11 aa polypeptide; pain NT in CNS and PNS

48. What are the potassium sparing diuretics?
Amiloride - spironolactone - triamterene
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Gluteus maximus; difficulty getting up from seated position and climbing chair
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

49. What can long term leg cast wearing cause?
Enterococci (e. faecalis)- found on genitalia area
Reticulocytes
Injury to common peroneal nerve (d/t trauma or sustained pressure to neck of fibula) causing pain and numbness on dorsum of foot and inability to dorsiflex
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

50. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Serum creatine kinase; reperfusion injury causes necrosis
Susceptible; soluble (unable to be cultured in bile)
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Vascular endothelium; protease