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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 does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Boiling - bleach - formalin - UV irradiation
Medial circumflex artery; avascular necrosis
Gluteus medius and minimus; positive trendelenberg
Because gamma chains replace beta chains and then gamma chain formation wanes

2. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Kallmans
Reiter syndrome; B27
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

3. Which nerve lies in close proximity to the inferior thyroid artery?
Squatting - sitting - lying supine - passive leg raising
Recurrent larygneal
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Localized dermatologic pain that persists for more than one month after zoster eruption

4. What is hypospadias caused by?
Abnormal closing of the urethral folds
Brief psychotic disorder; schizophreniform; schizophrenia
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Turbulence

5. 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?
Syncope - angina - dyspnea (SAD)
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Common peroneal; bony fractures and compression; sciatic
Kallmans

6. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Myasthenia gravis
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Vascular endothelium; protease

7. What does hypocapnia cause in teh brain? What is hypocapnia?
Covalent (between two cysteines)- allows protein to withstand denaturation
Amiadarone
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Inhaled animal dander allergens

8. where are the vegetations on the valves of a libman sacks endocarditis?
P53 mutation; DCC is also required for adenoma to carcinoma
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Both sides

9. What translocations can cause c - myc overexpression?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
8 (myc protein) with 2 - 14 - 22 (iG chains)
Intussusception

10. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
OCPs - multiparity - breast feeding
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Increased reticulocytes

11. Where does conjugation of bilirubin take place?
In ER of bile canaliculi
200-500
Bronchial dilation (bronchiectasis)
NF- KB; responsible for cytokine production

12. What is the mutation type in thalassemias? what process is defective because of this?
Nonsense; mRNA processing
Thymic tumor
chronic urticaria and allergic symptoms
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

13. What is the mc location for avascular necrosis? What is it associated with?
SSRI; erectile dysfunction
APP on chrom 21 (this is why downs more susceptible)
<1% - 55% - concentration dependent
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

14. What can cause virilization of a mother during pregnancy?
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
SS +rNA
Aromatase deficiency in child

15. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
Vagus (auricular branch); vasovagal syncope!
Demargination of neutrophils from the vessel walls
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)
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

16. how does increased ICP result in curlings ulcers?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Increase lymphatic drainage!
Vagus nerve stimulation
Brief psychotic disorder; schizophreniform; schizophrenia

17. What is a cord factor and Which bugs have it? How do they appear on culture?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

18. What is Bortezomib and What is it used for?
Valproate
SVT; increases vagal tone; rectus abdominis
Proteasome inhibitor; treatment for MM and waldenstroms
Anti - apoptotic (prevents going into apoptosis)- 18; 14

19. within the right atrium - What is the maximum pressure? left atrium?
8; 12
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Fibrosis; macrophages
Anti - apoptotic (prevents going into apoptosis)- 18; 14

20. What is the mcc of elevated AFP leves in pregnancy>
Localized dermatologic pain that persists for more than one month after zoster eruption
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
HSV ( also in utero: chlymadia - neisseria - group B strep)
Underestimation of gestational age

21. which antiarrythmic is associated with blue gray discoloration ?
E. coli; staphylococcus saprophyticus
Bronchial dilation (bronchiectasis)
Bile salt accumulation in urine
Amiadarone

22. Where is the base of the heart? apex?
Closer to head; closer to diaphragm
Joints d/t increased purine production and thus uric acid production
Pan colitis and right sided colitis (more than left sided and proctitis)
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

23. What is 5- HETE and What does it do?
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)
Leukotriene precursor and does neutrophil chemotaxis
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Chorda tympani branch

24. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
Southern - western
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Chlorpheniramine and diphenhydramine
SVT; increases vagal tone; rectus abdominis

25. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Become beta pleated and then form neurofibrillary tangle!
Recurrent larygneal
Because gamma chains replace beta chains and then gamma chain formation wanes
FGF and VEGF

26. What is the precursor protein to beta amyloid and On what chromosome is it found?
Sarcoid
Varying; erythema nodosum is common
APP on chrom 21 (this is why downs more susceptible)
No and yes

27. which opponens muscle does ulnar innervate?
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Adductor
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Valproate

28. prostaglandin synthesis keeps...
Both sides
Bronchial dilation (bronchiectasis)
PDA open
Recurrent larygneal

29. at three years of age What are social - fine motor - gross motor and language developments?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Another type of aldosterone antagonist (like spironolactone)

30. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
Elevated GGT and macrocytosis
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)
Nonsense; mRNA processing
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

31. how does noise induced hearing loss occur?
Little effect on cell and no change
11
Turbulence
Trauma to stereociliated hair cells of the organ of corti

32. why does variocele occur more in left side?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Hereditary angioedema; ACE inhibitors
In the extracellular space
Fibronectin - laminin - collagen

33. What triggers the neoplastic changes that are associated with HBV infecton?
Thymic tumor
CMV - HSV 1 - Candida
Integration of viral DNA into genome of host hepatocytes
No; MRI

34. What is difference between Arnold Chiari type I and II?
I is more benign and can present later in adulthood
Duration and extent of disease
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Right before diastole (filling begins)

35. What does VIP do to gastric acid secretion?
Inhibits it
46 - 4N; 23 2N
On cardiac tissue and renal juxtaglomerular cells
IgE

36. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
Hexokinase
G to T in p53; HCC
RER; copper
Chrom 8

37. What is somatomedin C?
Trochlear nerve (IV); abducens nerve (VI)
Lateral; RV; RA; LV
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
Insulin like growth factor 1 (just another name)

38. neisseria are...
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
facultative intracellular
differentiate
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

39. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
G to T in p53; HCC
Downs; regurgitant AV valves - ASDs
NF- KB; responsible for cytokine production

40. IL4 is used for isotypye switching to what?
IgE
Relfex tachycardia; giving beta blockers
Biphosphonate
NF- KB; responsible for cytokine production

41. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Common peroneal; bony fractures and compression; sciatic
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

42. how does eos release MBP to kill protozoa etc?
Vagus (auricular branch); vasovagal syncope!
indomethacin
G to T in p53; HCC
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

43. What is subacute sclerosisng encephalitis caused by?
Anti centromere; anti DNA topoisomerase
...
Fibrosis; macrophages
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

44. name three pathological states that present with large tongues.
Vascular endothelium; protease
IgE
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Acute gastric mucosal defects (superficial or full thickness)

45. what makes bruits?
Valproate
Decreases both
Turbulence
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

46. Which is faster purkinje system or atrial muscle?
Close but purkinje system to ensure contraction in a bottom up fashion
No; MRI
Well
Pain reliever - reduces pain by locking substance P in the PNS

47. what protects the resting heart from arrhythmias?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Highly negative resting potential

48. What is the most common cause of pyelonephritis in both adults and childre?
E. coli
8; 12
HSV ( also in utero: chlymadia - neisseria - group B strep)
Biphosphonate

49. other than proteinuria - What can cause foamy froathy urine?
Bile salt accumulation in urine
Abnormal closing of the urethral folds
Become beta pleated and then form neurofibrillary tangle!
Single adenomatous ones

50. which RPGN is also called pauci immune GN? why?
Ig A deficiency
ANCA because of lack of Ig and C3 deposits on IF
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Ketone body production by preventing fatty acids into the mitochondria