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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 is damaged in early syringomelia? later?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Anterior circumflex (and axillary nerve)
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

2. What can worse neurologic dysfunction in cobalamic def?
Octreotide
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
CMV - HSV 1 - Candida
Folic acid treatment!

3. how long is substance P? What does it do?
11 aa polypeptide; pain NT in CNS and PNS
Smoking
Joints d/t increased purine production and thus uric acid production
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

4. What is used to treat heparin toxicity?
Insulin like growth factor 1 (just another name)
Transported to liver - glycerol kinase converts it to glycerol 3 phosphate Which is then converted to DHAP which can either join glycolysis for ATP or be used to make glucose
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Protamine sulfate

5. which are the only glycosylated proteins in HIV virus?
Ether and other organic solvents
Anterior circumflex (and axillary nerve)
Env genes (for getting into target cells)
Localized dermatologic pain that persists for more than one month after zoster eruption

6. what vessel would a fracture to the neck of the of the humerus damage?
Rabies encephalitis from cave bats; rabies killed vaccines
Anterior circumflex (and axillary nerve)
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Extrinsic def; instrinsic def; platelet def

7. how can HAV be inactivated?
Not lined by epithelium
Amiadarone
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Boiling - bleach - formalin - UV irradiation

8. SIADH patients have normal blood volume but...
hyponatremia (aldosterone activation equilibrates body volume)
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Ig A deficiency
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

9. What causes wrist drop?
Folic acid treatment!
Radial nerve damage
Myasthenia gravis
MAC complex (C5b - C9 complement deficiency)

10. What is used to prevent vertical transmission of HIV?
Acute gastric mucosal defects (superficial or full thickness)
ZDV or AZT
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Medial part

11. at one year of age - What are the social - fine motor - gross motor and language developments?
Ether and other organic solvents
Initiation - pointing; pincer grasp; walking; mama/dada
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

12. What is the mc manifestation of CMV in HIV patient? immunocompetent?
In ER of bile canaliculi
Retinitis; mononucleosis
Hydrogen bonds dictate alpha or beta structure
Medial circumflex artery; avascular necrosis

13. What is omalizumab and What is it used for?
Sickle cell; G6PD
Biphosphonate
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

14. after a thrombus extraction - what serum enzyme shoots up and why?
Dissolved in plasma and attached to Hgb
IgE
Serum creatine kinase; reperfusion injury causes necrosis
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

15. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

16. Which is faster purkinje system or atrial muscle?
Gluteus medius and minimus; positive trendelenberg
Close but purkinje system to ensure contraction in a bottom up fashion
Boiling - bleach - formalin - UV irradiation
Sydenham chorea

17. In What type of nephritis would you see high serum eos count?
Large stroke volumes with ventricular contraction; aortic regurg
Drug induced interstitial nephritis
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
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

18. what commonly happens in GI in response to acute physiologic stress?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Bile soluble which means they are bile sensitive
Acute gastric mucosal defects (superficial or full thickness)
Inactivates kallikrein which activates kininogen into bradykinin

19. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
RER; RER
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

20. Where is conduction in heart fastest? slowest?
Brief psychotic disorder; schizophreniform; schizophrenia
Increase in permeability of two ions with equal and opposite equilibrium potentials
Purkinje system; AV node
Vancomycin; histamine mediated

21. how much percent of sodium is excreted? urea? glucose?
Brief psychotic disorder; schizophreniform; schizophrenia
<1% - 55% - concentration dependent
Prepatellar
Trauma to stereociliated hair cells of the organ of corti

22. What agonists reduce the gradient across the LV outflow tract?
Hexokinase
S. aureus
Vagus nerve stimulation
Selective alpha 1 (increases SVR)

23. Which nerve lies in close proximity to the inferior thyroid artery?
GI malignancies and Insulin resistance (acromegal for ex)
Recurrent larygneal
Turbulence
Normal; low

24. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
P53 mutation; DCC is also required for adenoma to carcinoma
Multiple miscarriages d/t hypercoaguability
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
RBF= PAH clearance/(1- hematocrit)

25. which nucleus releases serotonin?
Kallmans
The term used to describe decreased drug responsiveness with repeated administration
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
Raphe

26. why does variocele occur more in left side?
Sarcoid
ST become atrophic and hyalinized (temp induced damage) and depressed sperm count becuase of that; hormonal function not impaired (test and LH levels normal) because Leydig cells not as temp sensitive so secondary sexual characteristics and sexual pe
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Vancomycin

27. What is the most common initital symptom of ADPKD? what else?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

28. What does 'oxygen' content in blood refer to?
Excessive collagen formation during tissue repair in susceptible individuals
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Dissolved in plasma and attached to Hgb

29. What does NF- KB do?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Increases cytokine production
ST become atrophic and hyalinized (temp induced damage) and depressed sperm count becuase of that; hormonal function not impaired (test and LH levels normal) because Leydig cells not as temp sensitive so secondary sexual characteristics and sexual pe
manifestations - congenital (stretching of periventricular pyrimadal fibers)

30. where are the two classical places that the ulnar nerve can be injured?

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31. Where is aromatase used?
Anterior circumflex (and axillary nerve)
Single adenomatous ones
Sickle cell; G6PD
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

32. which nerve provides innervation for plantar flexion and inversion?
Tibial
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Right before diastole (filling begins)
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

33. What is congestive hepatomegaly specific for?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Right heart failure
Measles and M3 AML`
chronic urticaria and allergic symptoms

34. which opponens muscle does ulnar innervate?
Adductor
AV node slowest - to allow time for diastole
Gluteus medius and minimus; positive trendelenberg
Nocardia

35. 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?
Turners`
Barium enema
Closer to head; closer to diaphragm
Common peroneal; bony fractures and compression; sciatic

36. what virus causes pharyngoconjuctival fever?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Adeno
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Anti centromere; anti DNA topoisomerase

37. how does neisseria cause a petechial rash?
Elevated GGT and macrocytosis
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
V fib; v. failure
Neisseria induced small cell vasculitis (including hands and soles)

38. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
S. saprophyticus - and s. epidermidis; novobiocin
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)
Folic acid treatment!
Duration and extent of disease

39. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
25; 25
SVC and IVC; right below the aortic knob
frameshift mutations (missense is substitution)
Skin flushing and warmth; prostaglandins; give with aspirin

40. What is acanthosis nigricans associated with?
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
GI malignancies and Insulin resistance (acromegal for ex)
Covalent (between two cysteines)- allows protein to withstand denaturation
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

41. What do you treat s. epidermidis with?
Vancomycin
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Not lined by epithelium
Headaches and facial flushing; vasodilation in meninges and skin

42. 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?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Octreotide
Superior larygeal; cricothyroid; recurrent laryngeal
CMV - HSV 1 - Candida

43. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Reiter syndrome; B27
V fib; v. failure
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Gluteus medius and minimus; positive trendelenberg

44. What is medullary sponge kidney disease and how does it present? What does it lead to?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Medial circumflex artery; avascular necrosis
Increase by 50% in urine osmolality
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)

45. What are two indicators of chronic alcohol consumption?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Elevated GGT and macrocytosis
Southern - western
CGD; t cell dysfxn (diGeorge)

46. prostaglandin synthesis keeps...
Prostate tumor and increased osteoclast activity
PDA open
Vagus nerve stimulation
Barium enema

47. What type of calcium channels dictate the plateau in cardiac myocyte?
Inhibits it
Dihydropyridine sensitive Ca channels (L type)
Tissue redistribution (out of plasma) rather than metabolism
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

48. What is the immune deficinecy seen in ataxia telangactasia?
C3 decreased after 5-10 days; sulfonamides
Ig A deficiency
NF- KB; responsible for cytokine production
Brief psychotic disorder; schizophreniform; schizophrenia

49. Where does complement bind on the Fc region of Ig chains?
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
S. aureus
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

50. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
Around 70 (normal measured diastolic pressures); 9--
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia