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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 somatomedin C?
Gluteus medius and minimus; positive trendelenberg
Insulin like growth factor 1 (just another name)
Spongiosis
In the extracellular space for collagen cross linking; zinc

2. What do you treat s. epidermidis with?
Vancomycin
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Pain reliever - reduces pain by locking substance P in the PNS
Ketone body production by preventing fatty acids into the mitochondria

3. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Thymic tumor
Acute interstitial nephritis
Medullary
H. influenzae type B; polyribosyl phosphate (PRP); cherry red uvula - dysphagia - stridor (sometimes) - difficulty breathing - fever - drooling - positive 'thumbs up sign' on lateral xray of cervical region d/t swollen epiglottis

4. Where is the base of the heart? apex?
Drink plenty of fluids
Anti cholinergic effects of pupil dilation and lack of accomodation
Closer to head; closer to diaphragm
Inhibits it

5. What is epispadias caused by?
Faulty positioning of the genital tubercle
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
TSh (in testicular tumors can cause hyperthyroidism)
11

6. other than increasing HDL levels - what else does niacin do?
Folic acid treatment!
chronic urticaria and allergic symptoms
Prevents hepatic VLDL production
Measles and M3 AML`

7. In what population does cholelithiasis occur?
Normal; low
Not lined by epithelium
Fat - fertile - forty - female
II; I (I more abundant)

8. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Tibial
Reiter syndrome; B27
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Normally close to systolic

9. what vessel would a fracture to the neck of the of the humerus damage?
Selective alpha 1 (increases SVR)
Anterior circumflex (and axillary nerve)
Atrial
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

10. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
V fib; v. failure
Minimal change disease
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

11. What effects does cortisol have on catecholamines?
Common peroneal; bony fractures and compression; sciatic
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Measure of depth invasion (vertical!)
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

12. What is extraocular muscle weakness a common symptom of?
AV node slowest - to allow time for diastole
Myasthenia gravis
Anti cholinergic effects of pupil dilation and lack of accomodation
Bronchial dilation (bronchiectasis)

13. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
Prevents hepatic VLDL production
No and yes
Faulty positioning of the genital tubercle
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

14. What is used to treat heparin toxicity?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Protamine sulfate
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
Lateral; RV; RA; LV

15. Where does 90% of serotonin lie? What is this NT responsible?
RBF= PAH clearance/(1- hematocrit)
facultative intracellular
GI tract; mood!
SSRI; erectile dysfunction

16. What type of drug is alendronate?
Biphosphonate
Because of vasodiation to skeletal muscles
Radial nerve damage
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

17. What can long term leg cast wearing cause?
Prepatellar
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
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
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

18. What does prolonged PT indicated? aPTT? bleeding time?
Standing suddenly from supine position; valsalva maneuver
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Tzanck smear
Extrinsic def; instrinsic def; platelet def

19. What can chronic vit A toxicity cause?
Boiling - bleach - formalin - UV irradiation
11 aa polypeptide; pain NT in CNS and PNS
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
RBF= PAH clearance/(1- hematocrit)

20. h1 receptor anatagonists are not effective in treatment of asthma only for...
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Hydrogen bonds dictate alpha or beta structure
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
chronic urticaria and allergic symptoms

21. What is the mutation type in thalassemias? what process is defective because of this?
In ER of bile canaliculi
Nonsense; mRNA processing
In the extracellular space for collagen cross linking; zinc
Chorda tympani branch

22. What is medullary sponge kidney disease and how does it present? What does it lead to?
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)
Coagulation factors are made in the liver
INTRApartum Abs (ampicillin/penicillin)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

23. which opponens muscle does ulnar innervate?
Adeno
low in serum
Adductor
CMV - HSV 1 - Candida

24. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Echinococcus granulosus; anaphylaxis

25. What is the primary histologic finding in patients with eczematous dermatitis?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Spongiosis
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Circular - outside nucleus; transport proteins - rRNA - tRNA

26. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Kallmans
ZDV or AZT
Hypo or hyper pigmentations; after tanning
Recurrent larygneal

27. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
Covalent (between two cysteines)- allows protein to withstand denaturation
Anti cholinergic effects of pupil dilation and lack of accomodation
Think Hb deformation diseases
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

28. at 2 years of age - What are the social - fine motor - gross motor and language developments?
Tibial
Because gamma chains replace beta chains and then gamma chain formation wanes
liver specific
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

29. what protein is increased in Crohns disease? What does it do?
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
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
NF- KB; responsible for cytokine production
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

30. What is gardeners mydriasis? How is it treated?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
SVT; increases vagal tone; rectus abdominis
S3 gallop; S2 to opening snap interval
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

31. What is epleronone?
Syringomelia
Another type of aldosterone antagonist (like spironolactone)
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Insulin like growth factor 1 (just another name)

32. the rate of blood flow of which two circulations must equal each other at all times?
Nocardia
Pulmonic and systemic!
<1% - 55% - concentration dependent
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

33. when do ghon complexes form - primary or secondary TB?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Primary
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

34. PDAs are often asymptomatic. How do you treat?
High potassium conductance and some sodium conductance
Because of the low output from heart failure - they will have increased aldosterone levels
indomethacin
Serum FFA and serum triglyceride levels

35. How do you calculate excretion rate of a substance? How do you calculate the filtration rate of a substance? clearance of what substance estimates the GFR?
Biphosphonate
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
In ER of bile canaliculi

36. erythema nodosum - elevated ACE - scattered granulomas - arthralgias - hilar lymphadenoapthy are indicative of what?
Gluteus maximus; difficulty getting up from seated position and climbing chair
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
Sarcoid
In the extracellular space

37. on What part of the clavicle does the SCM attach?
Medial part
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
200-500
Smoking

38. sporadic colon cancer tend to arise From what type of polyps?
Single adenomatous ones
Medullary
Duration and extent of disease
Pan colitis and right sided colitis (more than left sided and proctitis)

39. where exactly is ACE expressed in the lungs? What type of enzyme is it?
Coagulation factors are made in the liver
Vascular endothelium; protease
Recurrent larygneal
LT (LTD4 - E4 - C4) - and Ach

40. do patients with cor pulmonale have increased or decreased levels of aldosterone?
Around 70 (normal measured diastolic pressures); 9--
Because of the low output from heart failure - they will have increased aldosterone levels
Inhibits it
Vancomycin; histamine mediated

41. What is the neurologic manifestation of ADPKD?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Adeno
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

42. what nerve and artery course along the posterior aspect of the humerus?
Diabetic microangiopathy
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Radial nerve and deep brachial artery
Biphosphonate

43. Metronidizaole does not cover...
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Appetite suppressants
gram positive organisms
P450 mitochondrial monooxygenase

44. What is damaged in early syringomelia? later?
Relfex tachycardia; giving beta blockers
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
No
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

45. 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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46. what happens to sperm count and semineferous tubules in patient with cryptoorchidism? hormonal function? why do they need to be surgically descended?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Trauma to stereociliated hair cells of the organ of corti
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

47. Where is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
Amiadarone
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Single adenomatous ones
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

48. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Hyperkalemia; potassium sparing diuretics - potassium supplements
Downs; regurgitant AV valves - ASDs
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

49. what locations of UC increase the risk of Colon cancer?
Medial circumflex artery; avascular necrosis
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Serum FFA and serum triglyceride levels
Pan colitis and right sided colitis (more than left sided and proctitis)

50. What is used to prevent vertical transmission of HIV?
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)
Closer to head; closer to diaphragm
ZDV or AZT
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system