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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. which nerve provides innervation for plantar flexion and inversion?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Tibial
G to T in p53; HCC
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

2. What is the mc location for avascular necrosis? What is it associated with?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Integration of viral DNA into genome of host hepatocytes
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

3. What is a cell surface marker seen in liver angiosarcoma?
Enterococci (e. faecalis)- found on genitalia area
Nonsense; mRNA processing
Anterior nares
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

4. what has the greatest effect on prognosis when treating c. diptheriae?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
transcription activation/suppression
Radial nerve and deep brachial artery

5. What is the preferred treatment for DKA?
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
Regular insulin (Not fast acting - regular better)
AV node slowest - to allow time for diastole
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

6. what drug is useful for secretory diarrhea?
Another type of aldosterone antagonist (like spironolactone)
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
Octreotide
Drug induced interstitial nephritis

7. What is mcc of death pre hospital phase of MI? in hospital phase?
V fib; v. failure
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
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Boiling - bleach - formalin - UV irradiation

8. what nerve and artery course along the posterior aspect of the humerus?
Radial nerve and deep brachial artery
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Vancomycin
No and yes

9. which two virus families have hemagluttinin on their surface?
Radial nerve damage
In the extracellular space
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Paramyxo and influenza

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

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11. name three pathological states that present with large tongues.
Anterior circumflex (and axillary nerve)
FGF and VEGF
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Inhaled animal dander allergens

12. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Well trained athletes and children
Large stroke volumes with ventricular contraction; aortic regurg
No; yes
Apocrine; eccrine

13. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Rabies encephalitis from cave bats; rabies killed vaccines
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

14. what clinical findings help distinguish small cell carcinoma?
Retinitis; mononucleosis
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Biphosphonate
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

15. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
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
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
No; yes

16. how does neisseria cause a petechial rash?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Neisseria induced small cell vasculitis (including hands and soles)
Spongiosis
Measles and M3 AML`

17. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
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
Turners`
Extrinsic def; instrinsic def; platelet def
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

18. What is somatomedin C?
Diabetic microangiopathy
Insulin like growth factor 1 (just another name)
High potassium conductance and some sodium conductance
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

19. What actions increase venous return?
Squatting - sitting - lying supine - passive leg raising
G to T in p53; HCC
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

20. which two drug types can cause orthostatic hypotension (think depression and BPH)?
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Excessive collagen formation during tissue repair in susceptible individuals
Hexokinase
TCAs and prazosin

21. What is the most common location of colonization of all s. aureus types?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
G to T in p53; HCC
Kallmans
Anterior nares

22. Where is conduction in heart fastest? slowest?
Chlorpheniramine and diphenhydramine
Nocardia
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Purkinje system; AV node

23. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
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)
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

24. Where does terminal peptide cleavage of collagen fibrils take place?
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)
In the extracellular space
Hexokinase
200-500

25. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
ZDV or AZT
Intussusception
Spongiosis
Gluteus maximus; difficulty getting up from seated position and climbing chair

26. who bleed more DIC or TTP- HUS patients?
MAO inhibitors; wine and cheese
MAC complex (C5b - C9 complement deficiency)
Bronchial dilation (bronchiectasis)
DIC; TTP- HUS dont bleed that much

27. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Valproate
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Adeno
II; I (I more abundant)

28. What is gardeners mydriasis? How is it treated?
Decreases both
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

29. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
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
Vascular endothelium; protease
frameshift mutations (missense is substitution)
Reiter syndrome; B27

30. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Class I
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Anti centromere; anti DNA topoisomerase
Localized dermatologic pain that persists for more than one month after zoster eruption

31. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Hypothyroidism
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Highly negative resting potential

32. SIADH patients have normal blood volume but...
hyponatremia (aldosterone activation equilibrates body volume)
Valproate
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Regular insulin (Not fast acting - regular better)

33. Where does conjugation of bilirubin take place?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Proteasome inhibitor; treatment for MM and waldenstroms
In ER of bile canaliculi
MAO inhibitors; wine and cheese

34. what drugs causes the red man syndrome? how does it occur?
Hydrogen bonds dictate alpha or beta structure
No
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Vancomycin; histamine mediated

35. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
SSRI; erectile dysfunction
The time interval between S2 and OS- the shorter the interval - the more intense
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Mean greater than median greater than mode

36. what happens with LDL receptor density in statin therapy?
Increases
Increased reticulocytes
Reiter syndrome; B27
Pulmonary hypertension

37. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Radial nerve and deep brachial artery
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
In ER of bile canaliculi

38. which nucleus releases serotonin?
Excessive collagen formation during tissue repair in susceptible individuals
Raphe
Phencyclidine (PCP)
Inactivates kallikrein which activates kininogen into bradykinin

39. What is 5- HETE and What does it do?
Leukotriene precursor and does neutrophil chemotaxis
frameshift mutations (missense is substitution)
GI tract; mood!
APP on chrom 21 (this is why downs more susceptible)

40. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
Increase lymphatic drainage!
Vagus nerve stimulation
Sickle cell; G6PD
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics

41. which type of glands produce an initially odorless secretion but can become malodorous secondary to bacterial decompisition on the skin surface? which glands are present throughout the skin except on lips and glans penis?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Serum FFA and serum triglyceride levels
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Apocrine; eccrine

42. which nerve is at risk when ligating the superior thyroid artery? Which is the only muscle this nerve innervates? what nerve innervates all the other laryngeal muscles?
SVC and IVC; right below the aortic knob
Nonsense; mRNA processing
Superior larygeal; cricothyroid; recurrent laryngeal
E6 and E7 of HPV knock off p53 and Rb suppressor genes

43. What is the mcc of extrinsic allergic asthma?
Superior larygeal; cricothyroid; recurrent laryngeal
S3 gallop; S2 to opening snap interval
Inhaled animal dander allergens
As a CO2 carrier with the carboxylase enzyme

44. where are the vegetations on the valves of a libman sacks endocarditis?
Both sides
Sydenham chorea
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

45. Is there edema in primary Conns? secondary hyperaldosteronism? why?
only up to bronchi
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Drug induced interstitial nephritis
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

46. What is the Na/Ca exchange used for?
OCPs - multiparity - breast feeding
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
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
To pump calcium out in cardiac myocytes so that relaxation occurs

47. How can renal blood flow be calculated from RPF?
T test; chi squared
RBF= PAH clearance/(1- hematocrit)
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Localized dermatologic pain that persists for more than one month after zoster eruption

48. within the right ventricle - What are maximum pressures? the pulm arter?
25; 25
Fibronectin - laminin - collagen
Because gamma chains replace beta chains and then gamma chain formation wanes
Susceptible; soluble (unable to be cultured in bile)

49. at three years of age What are social - fine motor - gross motor and language developments?
Acute interstitial nephritis
facultative intracellular
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Right before diastole (filling begins)

50. What are the two coagulase negative staphylococci? How do you distinguish them?
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)
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Apocrine; eccrine
S. saprophyticus - and s. epidermidis; novobiocin