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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. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Hexokinase
Both sides
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Squatting - sitting - lying supine - passive leg raising

2. What does p53 do? what chrom is it on?
Fibronectin - laminin - collagen
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
only up to bronchi
Initiation - pointing; pincer grasp; walking; mama/dada

3. Where is conduction in heart fastest? slowest?
Purkinje system; AV node
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
RER; RER
Valproate

4. What are the two mcc of focal brain lesions in HIV positive patients?
Vancomycin
Intussusception
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

5. why are beta thal major patients asymptomatic at birth?
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
TSh (in testicular tumors can cause hyperthyroidism)
Because gamma chains replace beta chains and then gamma chain formation wanes
Covalent (between two cysteines)- allows protein to withstand denaturation

6. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Proteasome inhibitor; treatment for MM and waldenstroms
Increase; decreased
hyponatremia (aldosterone activation equilibrates body volume)

7. What causes release of myosin head from the actin filament?
liver specific
Hyperkalemia; potassium sparing diuretics - potassium supplements
ATP binding (resets the myosin head to contract again for next binding)
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

8. hypertonicity and hyperreflexity are ________________ of hydrocephalus
Extrinsic def; instrinsic def; platelet def
8 (myc protein) with 2 - 14 - 22 (iG chains)
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
manifestations - congenital (stretching of periventricular pyrimadal fibers)

9. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
Vagus (auricular branch); vasovagal syncope!
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Appetite suppressants

10. What is extraocular muscle weakness a common symptom of?
Neisseria induced small cell vasculitis (including hands and soles)
Myasthenia gravis
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
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

11. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Hypo or hyper pigmentations; after tanning
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Medial circumflex artery; avascular necrosis

12. which staphylococci can do mannitol fermaentation?
Intussusception
Decreases both
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
S. aureus

13. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Localized dermatologic pain that persists for more than one month after zoster eruption
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

14. sporadic colon cancer tend to arise From what type of polyps?
Single adenomatous ones
Terminal bronchioles; small bronchi
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Prostate tumor and increased osteoclast activity

15. What does prolonged PT indicated? aPTT? bleeding time?
Extrinsic def; instrinsic def; platelet def
Serum creatine kinase; reperfusion injury causes necrosis
RER; copper
Atrial

16. What three pathogens cause infectious esophagitis in HIV positive patients?
LT (LTD4 - E4 - C4) - and Ach
SaO2 <92%
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
CMV - HSV 1 - Candida

17. how does eos release MBP to kill protozoa etc?
Bile salt accumulation in urine
Raphe
P53 mutation; AD
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

18. What can long term leg cast wearing cause?
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
Folic acid treatment!
Bronchial dilation (bronchiectasis)
Superior larygeal; cricothyroid; recurrent laryngeal

19. What is easiest way to treat nephrolithiasis?
Right before diastole (filling begins)
Drink plenty of fluids
only up to bronchi
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

20. What are examples of action that decrease venous return to the heart?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Standing suddenly from supine position; valsalva maneuver
Underestimation of gestational age
E. coli; staphylococcus saprophyticus

21. What causes curlings ulcers?
Brief psychotic disorder; schizophreniform; schizophrenia
FGF and VEGF
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
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)

22. What does anti phospholipid syndrome in SLE patients predispose them to?
Multiple miscarriages d/t hypercoaguability
Pulmonic and systemic!
Class I
DIC; TTP- HUS dont bleed that much

23. If a patient has higher levels of HbF - What does this mean?
E. coli
Hypertension - edema - and proteinuria
...
Think Hb deformation diseases

24. which nerve provides innervation for plantar flexion and inversion?
Tibial
Little effect on cell and no change
Chlorpheniramine and diphenhydramine
Underestimation of gestational age

25. What type of vision is myopia? In What type of patients does it improve?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Acute gastric mucosal defects (superficial or full thickness)
P53 mutation; DCC is also required for adenoma to carcinoma

26. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Echinococcus granulosus; anaphylaxis
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
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

27. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
Thymic tumor
When it invades the bm; carcinoma in situ
Turners`
Medullary

28. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
RBC mass; epo levels (secondary has high)
In the extracellular space for collagen cross linking; zinc
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
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

29. who bleed more DIC or TTP- HUS patients?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
liver specific
DIC; TTP- HUS dont bleed that much
Intussusception

30. 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?
Tzanck smear
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Coagulation factors are made in the liver
Common peroneal; bony fractures and compression; sciatic

31. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Because of vasodiation to skeletal muscles
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
No; yes

32. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
Intussusception
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Nocardia
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

33. How can renal blood flow be calculated from RPF?
RBF= PAH clearance/(1- hematocrit)
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Acute interstitial nephritis

34. non ceruloplasmin deposition - ceruloplasmin is...
low in serum
Standing suddenly from supine position; valsalva maneuver
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

35. When does neovascularization granulation tissue begin to form after severe ischemia and MI? what happens in 12-24 hours? 2 weeks to 2 months? 1-5 days? 0-4 hours? when do you see edema - hemorrhage - wavy fibers?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Large stroke volumes with ventricular contraction; aortic regurg

36. What are the first generation anti histamines?
Purkinje system; AV node
Chlorpheniramine and diphenhydramine
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
T test; chi squared

37. carnitine deficiency impairs production of What and how?
Ketone body production by preventing fatty acids into the mitochondria
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
women

38. What is the most common location of colonization of all s. aureus types?
Drink plenty of fluids
Anterior nares
SaO2 <92%
chronic urticaria and allergic symptoms

39. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
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
AV node slowest - to allow time for diastole
OCPs - multiparity - breast feeding
Env genes (for getting into target cells)

40. What does the tuberoinfundibular pathway connect? What is it responsible for?
Medullary
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Hyperkalemia; potassium sparing diuretics - potassium supplements
...

41. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
Bile soluble which means they are bile sensitive
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
S. saprophyticus - and s. epidermidis; novobiocin
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

42. what commonly happens in GI in response to acute physiologic stress?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Tibial
Acute gastric mucosal defects (superficial or full thickness)
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

43. which two drug types can cause orthostatic hypotension (think depression and BPH)?
TCAs and prazosin
Appetite suppressants
RER; copper
SVC and IVC; right below the aortic knob

44. What is it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
Vertical diplopia
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Varying; erythema nodosum is common
Pan colitis and right sided colitis (more than left sided and proctitis)

45. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Octreotide
Proteasome inhibitor; treatment for MM and waldenstroms

46. what nerve and artery course along the posterior aspect of the humerus?
Radial nerve and deep brachial artery
DIC; TTP- HUS dont bleed that much
Fibronectin - laminin - collagen
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

47. Where is the base of the heart? apex?
Minimal change disease
Closer to head; closer to diaphragm
Pulmonary hypertension
Hyperkalemia; potassium sparing diuretics - potassium supplements

48. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Increase lymphatic drainage!
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Gluteus maximus; difficulty getting up from seated position and climbing chair

49. Metronidizaole does not cover...
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
gram positive organisms
Anti cholinergic effects of pupil dilation and lack of accomodation
Hypothyroidism

50. Where does conjugation of bilirubin take place?
In ER of bile canaliculi
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Increase in permeability of two ions with equal and opposite equilibrium potentials
<1% - 55% - concentration dependent