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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. What is extraocular muscle weakness a common symptom of?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Joints d/t increased purine production and thus uric acid production
Myasthenia gravis
Regular insulin (Not fast acting - regular better)

2. What is the fibrinogen level in patient with TTP- HUS? DIC?
Anti cholinergic effects of pupil dilation and lack of accomodation
Chrom 8
Normal; low
Brief psychotic disorder; schizophreniform; schizophrenia

3. What is the cause of fixed splitting of S2? why?
INTRApartum Abs (ampicillin/penicillin)
Increase lymphatic drainage!
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Well trained athletes and children

4. What is mcc of death pre hospital phase of MI? in hospital phase?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
V fib; v. failure
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
(urine PAH x urine flow rate)/plasma PAH

5. where are Beta 1 receptors found?
On cardiac tissue and renal juxtaglomerular cells
11 aa polypeptide; pain NT in CNS and PNS
II; I (I more abundant)
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

6. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
No (unlike adenomyosis); yes
Susceptible; soluble (unable to be cultured in bile)
Fibrosis; macrophages
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

7. What three factors effect total oxygen content of blood?
transcription activation/suppression
11 aa polypeptide; pain NT in CNS and PNS
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

8. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Medial circumflex artery; avascular necrosis
Smoking
Paramyxo and influenza
Classical conditioning

9. What can long term leg cast wearing cause?
Inactivates kallikrein which activates kininogen into bradykinin
Reiter syndrome; B27
Terminal bronchioles; small bronchi
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

10. What is the mainstay treatment for acute mania?
Env genes (for getting into target cells)
Proteasome inhibitor; treatment for MM and waldenstroms
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Congenital hypothyroidism - downs - amyloidosis - acromegaly

11. when arrested in prophase of meiosis I - What are primary oocytes chrom number? What about the secondary oocytes that are stuck in metaphase of Meiosis II?
Dihydropyridine sensitive Ca channels (L type)
46 - 4N; 23 2N
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Increased reticulocytes

12. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
11 aa polypeptide; pain NT in CNS and PNS
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

13. Which is faster purkinje system or atrial muscle?
8; 12
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Close but purkinje system to ensure contraction in a bottom up fashion
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

14. What effects does cortisol have on catecholamines?
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
Tibial
Well trained athletes and children
Biphosphonate

15. What agonists reduce the gradient across the LV outflow tract?
Diabetic microangiopathy
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Selective alpha 1 (increases SVR)
Raphe

16. What is the most common initital symptom of ADPKD? what else?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Pain reliever - reduces pain by locking substance P in the PNS
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Adeno

17. What causes release of myosin head from the actin filament?
ATP binding (resets the myosin head to contract again for next binding)
Circular - outside nucleus; transport proteins - rRNA - tRNA
Fat - fertile - forty - female
Little effect on cell and no change

18. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Skin flushing and warmth; prostaglandins; give with aspirin
Pain reliever - reduces pain by locking substance P in the PNS
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

19. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
Mean greater than median greater than mode
CMV - HSV 1 - Candida
MAO inhibitors; wine and cheese
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

20. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
S. saprophyticus - and s. epidermidis; novobiocin
Increase lymphatic drainage!
Joints d/t increased purine production and thus uric acid production
Both sides

21. in B12 deficiency - what levels in blood rise very quickly and then drop?
Reticulocytes
SVT; increases vagal tone; rectus abdominis
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
<1% - 55% - concentration dependent

22. What is the mc location of brain germinomas?What are the classic symptoms?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Southern - western
RBC mass; epo levels (secondary has high)

23. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Medial circumflex artery; avascular necrosis
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Neisseria induced small cell vasculitis (including hands and soles)
Large stroke volumes with ventricular contraction; aortic regurg

24. Acyl coA synthetase is not...
Atrial
S. aureus
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
liver specific

25. do Class IC agents prolong the QT interval?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
No
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Abnormal closing of the urethral folds

26. how does achalasia present? What does barium swallow show on dilated esophagus?
Gluteus medius and minimus; positive trendelenberg
Aromatase deficiency in child
PDA open
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

27. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Increase lymphatic drainage!
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Fibronectin - laminin - collagen
Clindamycin; covers anaerobic oral flora and aerobic bacteria

28. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
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)
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Normal; low

29. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
Large stroke volumes with ventricular contraction; aortic regurg
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Enterococci (e. faecalis)- found on genitalia area
No and yes

30. When is acid phosphatase elevated (Name two times)?
Bronchial dilation (bronchiectasis)
Bronchogenic carcinoma
Prostate tumor and increased osteoclast activity
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)

31. how long is substance P? What does it do?
11 aa polypeptide; pain NT in CNS and PNS
Varying; erythema nodosum is common
Anterior circumflex (and axillary nerve)
Inactivates kallikrein which activates kininogen into bradykinin

32. Where does the aorta lie in relation to the pulmonary artery in transposition of the great arteries (is this right to left or left to right shunt?)?
Curlings ulcers
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
GI malignancies and Insulin resistance (acromegal for ex)
E. coli

33. What is diphenoxylate and What is it used for? what drug is it structurally similar to? What allows for potent anti diarrheal effect without signigicant opiate effects?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Standing suddenly from supine position; valsalva maneuver
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)
Rabies encephalitis from cave bats; rabies killed vaccines

34. Where does 90% of serotonin lie? What is this NT responsible?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
APP on chrom 21 (this is why downs more susceptible)
GI tract; mood!

35. What does prolonged PT indicated? aPTT? bleeding time?
G to T in p53; HCC
Extrinsic def; instrinsic def; platelet def
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

36. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Increase; decreased
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

37. what protects the resting heart from arrhythmias?
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Highly negative resting potential
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Decreases both

38. What is the mc manifestation of CMV in HIV patient? immunocompetent?
On cardiac tissue and renal juxtaglomerular cells
Retinitis; mononucleosis
Relfex tachycardia; giving beta blockers
MAO inhibitors; wine and cheese

39. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
Proteasome inhibitor; treatment for MM and waldenstroms
Primary
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
SVC and IVC; right below the aortic knob

40. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
HSV ( also in utero: chlymadia - neisseria - group B strep)
Chrom 8
V fib; v. failure
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

41. What is the most common neurologic complication of VZV reactivation?
INTRApartum Abs (ampicillin/penicillin)
Localized dermatologic pain that persists for more than one month after zoster eruption
Protamine sulfate
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

42. What are the long term consequences of hydrocephalus?
HSV ( also in utero: chlymadia - neisseria - group B strep)
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)
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
GI malignancies and Insulin resistance (acromegal for ex)

43. What is omalizumab and What is it used for?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Clindamycin; covers anaerobic oral flora and aerobic bacteria
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)

44. Where is aromatase used?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Anterior circumflex (and axillary nerve)
Trauma to stereociliated hair cells of the organ of corti

45. In What type of nephritis would you see high serum eos count?
Drug induced interstitial nephritis
S. aureus
Prepatellar
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

46. in the LV and aorta - What are the pressures?
Thymic tumor
Abnormal closing of the urethral folds
Syringomelia
Normally close to systolic

47. which nucleus releases serotonin?
Syringomelia
Raphe
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
NF- KB; responsible for cytokine production

48. SIADH patients have normal blood volume but...
hyponatremia (aldosterone activation equilibrates body volume)
facultative intracellular
Primary
Reticulocytes

49. What is capsaicin? Where does it work?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Sickle cell; G6PD
Excessive collagen formation during tissue repair in susceptible individuals
Pain reliever - reduces pain by locking substance P in the PNS

50. What is diagnostic (and possible therapeutic for intussusception)?
APP on chrom 21 (this is why downs more susceptible)
Medial part
Barium enema
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine