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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. 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?
No; MRI
46 - 4N; 23 2N
AV node slowest - to allow time for diastole
2 -3 BPG; glycolysis - instead of ATP; erythrocytes because want to right shift the oxygen dissociation curve so that oxygen is released from RBCs into tissue

2. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Acute gastric mucosal defects (superficial or full thickness)
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
No
Hexokinase

3. What is hypospadias caused by?
ANCA because of lack of Ig and C3 deposits on IF
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Abnormal closing of the urethral folds
Pan colitis and right sided colitis (more than left sided and proctitis)

4. What is the most important prognostic indicator in patients with malignant melanoma?
200-500
Abnormal closing of the urethral folds
Measure of depth invasion (vertical!)
Pan colitis and right sided colitis (more than left sided and proctitis)

5. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Reiter syndrome; B27
T test; chi squared
Vagus (auricular branch); vasovagal syncope!
No and yes

6. why does hypothyroidism cause increased CPK levels?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Kallmans

7. What causes curlings ulcers?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Paramyxo and influenza
Common peroneal; bony fractures and compression; sciatic
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

8. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Proteasome inhibitor; treatment for MM and waldenstroms
differentiate
HSV ( also in utero: chlymadia - neisseria - group B strep)
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics

9. 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
P53 mutation; AD
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
Tzanck smear

10. What is the cause of rapid plasma decay of thiopental?
Tissue redistribution (out of plasma) rather than metabolism
Radial nerve damage
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
Fat - fertile - forty - female

11. What does protein M do in Group A strep<
Prevent phagocytosis
Octreotide
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
Extrinsic def; instrinsic def; platelet def

12. What is pickwickian syndrome? What are the lab findings?
No
Classical conditioning
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Prepatellar

13. What is contraindicated in toxic mega colon?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
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
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Chrom 8

14. What can cause aortic regurg? What is the heart sound you hear?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
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)
Trochlear nerve (IV); abducens nerve (VI)
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

15. what drug is useful for secretory diarrhea?
Estrogen induced cholesterol hypersecretion (increase HMG CoA reductase activity) and progesterone induced gallbladder hypomotility (decreases bile acid secretion)-- both these conditions predispose cholesterole to insolubilize out
Measles and M3 AML`
Octreotide
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

16. at one year of age - What are the social - fine motor - gross motor and language developments?
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Superior larygeal; cricothyroid; recurrent laryngeal
200-500
Initiation - pointing; pincer grasp; walking; mama/dada

17. prostaglandin synthesis keeps...
Amiloride - spironolactone - triamterene
Turbulence
PDA open
SVT; increases vagal tone; rectus abdominis

18. What are the acute effects of corticosteroids on the CBC?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Single adenomatous ones
<1% - 55% - concentration dependent
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

19. What is Tzanck smear used to detect?
TSh (in testicular tumors can cause hyperthyroidism)
Pain reliever - reduces pain by locking substance P in the PNS
HSV and VZV
CMV - HSV 1 - Candida

20. What causes the blurry vision side effects in first generation anti histamines?
GI tract; mood!
Little effect on cell and no change
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Anti cholinergic effects of pupil dilation and lack of accomodation

21. Where is conduction in heart fastest? slowest?
Anterior nares
Purkinje system; AV node
Rabies encephalitis from cave bats; rabies killed vaccines
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

22. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
transcription activation/suppression
Demargination of neutrophils from the vessel walls
Fibrosis; macrophages
In the extracellular space for collagen cross linking; zinc

23. what phase do adenosine and acetylcholine act on? doing what?
Increase; decreased
liver specific
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Insulin like growth factor 1 (just another name)

24. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
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)
Relfex tachycardia; giving beta blockers
Hereditary angioedema; ACE inhibitors

25. 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?
Superior larygeal; cricothyroid; recurrent laryngeal
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
II; I (I more abundant)

26. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
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
Mean greater than median greater than mode
Close but purkinje system to ensure contraction in a bottom up fashion
Echinococcus granulosus; anaphylaxis

27. What is extraocular muscle weakness a common symptom of?
Myasthenia gravis
IgE
Anterior nares
Barium enema

28. What are pancreatic pseudocysts called pseudo rather than true cysts?
Not lined by epithelium
Tzanck smear
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Fibronectin - laminin - collagen

29. What does anti phospholipid syndrome in SLE patients predispose them to?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Raphe
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Multiple miscarriages d/t hypercoaguability

30. What are the skin presentation in sarcoid?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Varying; erythema nodosum is common
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
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

31. What is tachyphylaxis?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
The term used to describe decreased drug responsiveness with repeated administration
women
Pan colitis and right sided colitis (more than left sided and proctitis)

32. in B12 deficiency - what levels in blood rise very quickly and then drop?
Reticulocytes
Increase lymphatic drainage!
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
SaO2 <92%

33. what should you think of in 'smear of an oral ulcer base'?
Tzanck smear
Sydenham chorea
P53 mutation; DCC is also required for adenoma to carcinoma
Because gamma chains replace beta chains and then gamma chain formation wanes

34. What type of vision is myopia? In What type of patients does it improve?
Aromatase deficiency in child
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Echinococcus granulosus; anaphylaxis
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

35. What are examples of action that decrease venous return to the heart?
chronic urticaria and allergic symptoms
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Standing suddenly from supine position; valsalva maneuver
I is more benign and can present later in adulthood

36. What is Bortezomib and What is it used for?
Because of vasodiation to skeletal muscles
Skin flushing and warmth; prostaglandins; give with aspirin
Become beta pleated and then form neurofibrillary tangle!
Proteasome inhibitor; treatment for MM and waldenstroms

37. What are the two coagulase negative staphylococci? How do you distinguish them?
S. saprophyticus - and s. epidermidis; novobiocin
Turbulence
2 -3 BPG; glycolysis - instead of ATP; erythrocytes because want to right shift the oxygen dissociation curve so that oxygen is released from RBCs into tissue
Sickle cell; G6PD

38. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Squatting - sitting - lying supine - passive leg raising
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
TCAs and prazosin

39. What agonists reduce the gradient across the LV outflow tract?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Selective alpha 1 (increases SVR)
Kallmans
Radial nerve and deep brachial artery

40. What is used to treat heparin toxicity?
chronic urticaria and allergic symptoms
Protamine sulfate
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
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)

41. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Downs; regurgitant AV valves - ASDs
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Sudden loss of muscle tone without loss of consciousness; narcolepsy

42. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Right heart failure
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

43. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Biphosphonate
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

44. what dissolves the lipid bilayer of a viral envelope?
Ether and other organic solvents
Not lined by epithelium
Terminal bronchioles; small bronchi
SSRI; erectile dysfunction

45. what defines hypoxemia?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Vagus nerve stimulation
SaO2 <92%
Because ACE blocks breakdown of bradykinin and hereditary angioedema patients have high levels of bradykinin; high levels of bradykinin - C3a - and C5a mediate edema by increasing vascular permeability and vasodilation

46. where are the vegetations on the valves of a libman sacks endocarditis?
Vagus nerve stimulation
differentiate
Dihydropyridine sensitive Ca channels (L type)
Both sides

47. Where does 90% of serotonin lie? What is this NT responsible?
Abnormal closing of the urethral folds
8 (myc protein) with 2 - 14 - 22 (iG chains)
GI tract; mood!
On cardiac tissue and renal juxtaglomerular cells

48. How do you calculate excretion rate of a substance? How do you calculate the filtration rate of a substance? clearance of what substance estimates the GFR?
Minimal change disease
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

49. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
Elastance
Estrogen induced cholesterol hypersecretion (increase HMG CoA reductase activity) and progesterone induced gallbladder hypomotility (decreases bile acid secretion)-- both these conditions predispose cholesterole to insolubilize out
differentiate
Recurrent larygneal

50. on which chromosome is wilms tumor found?
C3 decreased after 5-10 days; sulfonamides
Relfex tachycardia; giving beta blockers
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
11