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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 indicates the severity of a mitral regurg ? mitral stenosis?
Increases cytokine production
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
<1% - 55% - concentration dependent
S3 gallop; S2 to opening snap interval

2. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
RBC mass; epo levels (secondary has high)
Both sides
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

3. How do you calculate RPF from urine PAH?
(urine PAH x urine flow rate)/plasma PAH
women
Fibrosis; macrophages
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

4. What can worse neurologic dysfunction in cobalamic def?
Increase by 50% in urine osmolality
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
Folic acid treatment!
The term used to describe decreased drug responsiveness with repeated administration

5. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
HSV ( also in utero: chlymadia - neisseria - group B strep)
Chorda tympani branch
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
Biphosphonate

6. What is the cause of fixed splitting of S2? why?
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)
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Relfex tachycardia; giving beta blockers

7. What are the long term consequences of hydrocephalus?
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Adeno

8. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Hexokinase
No and yes
SaO2 <92%

9. What almost exclusively causes Epliglottitis?What type of capsule does it have? What are the symptoms?

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10. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
Bile salt accumulation in urine
Insulin like growth factor 1 (just another name)
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
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

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

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12. What are the potassium sparing diuretics?
Amiloride - spironolactone - triamterene
No (unlike adenomyosis); yes
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Nonsense; mRNA processing

13. what makes bruits?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Turbulence
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

14. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Rabies encephalitis from cave bats; rabies killed vaccines
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

15. which are the only glycosylated proteins in HIV virus?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Env genes (for getting into target cells)
Excessive collagen formation during tissue repair in susceptible individuals
Because of the low output from heart failure - they will have increased aldosterone levels

16. what immune deficiency causes recurrent neisseria infections?
MAC complex (C5b - C9 complement deficiency)
Bronchial dilation (bronchiectasis)
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Duration and extent of disease

17. What is acanthosis nigricans associated with?
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
GI malignancies and Insulin resistance (acromegal for ex)
Prostate tumor and increased osteoclast activity
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

18. What is gardeners mydriasis? How is it treated?
Insulin like growth factor 1 (just another name)
differentiate
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
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

19. What is the sole neurologic manifestation of acute rheumatic fever?
Dissolved in plasma and attached to Hgb
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Skin flushing and warmth; prostaglandins; give with aspirin
Sydenham chorea

20. 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?
Hypothyroidism
46 - 4N; 23 2N
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Myasthenia gravis

21. When does opening snap begin?
TSh (in testicular tumors can cause hyperthyroidism)
Right before diastole (filling begins)
OCPs - multiparity - breast feeding
SaO2 <92%

22. why is glucagon used in beta blocker toxicitiy?
Fibrosis; macrophages
Anterior nares
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
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

23. which opponens muscle does ulnar innervate?
Adductor
SSRI
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
8; 12

24. do patients with cor pulmonale have increased or decreased levels of aldosterone?
Because of the low output from heart failure - they will have increased aldosterone levels
Ceftriaxone; azithromycin
Tibial
Pulmonic and systemic!

25. What is extraocular muscle weakness a common symptom of?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Myasthenia gravis
I is more benign and can present later in adulthood
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

26. what organ would an activating mutation in PRPP synthetase effect?
Primary
Rabies encephalitis from cave bats; rabies killed vaccines
Joints d/t increased purine production and thus uric acid production
Drink plenty of fluids

27. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
Anterior nares
Adeno
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

28. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Radial nerve and deep brachial artery
Normally close to systolic

29. What is the most common location of colonization of all s. aureus types?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Anterior nares
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

30. What is achalasia and how would this correlate on the esophageal mannometry?
II; I (I more abundant)
Lateral; RV; RA; LV
The LES is supposed to relax when food comes its way (from above) and in achalasia - a motor dysfunction - LES doesnt relax and seen as elevated pressure on the esophageal mannometry
Serum FFA and serum triglyceride levels

31. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
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
The time interval between S2 and OS- the shorter the interval - the more intense
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
MAO inhibitors; wine and cheese

32. carnitine deficiency impairs production of What and how?
Ketone body production by preventing fatty acids into the mitochondria
Think Hb deformation diseases
Extrinsic def; instrinsic def; platelet def
Apocrine; eccrine

33. do Class IC agents prolong the QT interval?
Appetite suppressants
Close but purkinje system to ensure contraction in a bottom up fashion
No
Closer to head; closer to diaphragm

34. What test would be best to determine if a gene is being transcribed? translated?
CGD; t cell dysfxn (diGeorge)
Southern - western
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
frameshift mutations (missense is substitution)

35. there are mucus secreting cells in the bronchioles...
Anti centromere; anti DNA topoisomerase
Downs; regurgitant AV valves - ASDs
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
only up to bronchi

36. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

37. What is capacitance inversely proportional to?
transcription activation/suppression
Elastance
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
ATP binding (resets the myosin head to contract again for next binding)

38. When is acid phosphatase elevated (Name two times)?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Prostate tumor and increased osteoclast activity

39. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
CMV - HSV 1 - Candida
Medullary
Vagus nerve stimulation
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

40. When is an S4 sound normal?
Recurrent larygneal
Insulin like growth factor 1 (just another name)
Well trained athletes and children
Mean greater than median greater than mode

41. 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
ATP binding (resets the myosin head to contract again for next binding)
Biphosphonate
Pulmonic and systemic!

42. are there signs of inflammation in avascular necrosis? then How do you diagnose?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Pulmonic and systemic!
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)
No; MRI

43. What does Rb protein do? what chrom is it on?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Drug induced interstitial nephritis
Serum FFA and serum triglyceride levels

44. What is normal fibrinogen levels?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Abnormal closing of the urethral folds
200-500

45. which nucleus releases serotonin?
Mean greater than median greater than mode
Tissue redistribution (out of plasma) rather than metabolism
Raphe
RR-1/RR

46. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Increase; decreased
Drug induced interstitial nephritis
Echinococcus granulosus; anaphylaxis
Anterior circumflex (and axillary nerve)

47. What is difference between Arnold Chiari type I and II?
RER; RER
Right before diastole (filling begins)
I is more benign and can present later in adulthood
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

48. what phase do adenosine and acetylcholine act on? doing what?
Ceftriaxone; azithromycin
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
FGF and VEGF

49. what nerve and artery course along the posterior aspect of the humerus?
SVT; increases vagal tone; rectus abdominis
Radial nerve and deep brachial artery
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Insulin like growth factor 1 (just another name)

50. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Hydrogen bonds dictate alpha or beta structure
Right heart failure
Initiation - pointing; pincer grasp; walking; mama/dada