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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 nerve and artery course along the posterior aspect of the humerus?
In the extracellular space
Radial nerve and deep brachial artery
High potassium conductance and some sodium conductance
Increased reticulocytes

2. where exactly is ACE expressed in the lungs? What type of enzyme is it?
Vascular endothelium; protease
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
Adductor
Classical conditioning

3. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Southern - western
Neisseria induced small cell vasculitis (including hands and soles)
Increase lymphatic drainage!
Right heart failure

4. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Susceptible; soluble (unable to be cultured in bile)
Increase; decreased
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

5. What triggers the neoplastic changes that are associated with HBV infecton?
Headaches and facial flushing; vasodilation in meninges and skin
Integration of viral DNA into genome of host hepatocytes
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
gram positive organisms

6. what induces bronchial squamous metaplasia?
only up to bronchi
S. aureus
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Smoking

7. 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
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
By vascular permeability and vasodilation
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

8. What causes wrist drop?
Radial nerve damage
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Hypertension - edema - and proteinuria
In the extracellular space

9. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Chrom 8
differentiate
Bronchial dilation (bronchiectasis)

10. PDAs are often asymptomatic. How do you treat?
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
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Anti - apoptotic (prevents going into apoptosis)- 18; 14
indomethacin

11. What can too much IgA in serum produces?
Dissolved in plasma and attached to Hgb
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Aromatase deficiency in child
The time interval between S2 and OS- the shorter the interval - the more intense

12. What is the diagnosis in delayed puberty plus anosmia?
P450 mitochondrial monooxygenase
Prevents hepatic VLDL production
Retinitis; mononucleosis
Kallmans

13. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
Octreotide
46 - 4N; 23 2N
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

14. Which is faster purkinje system or atrial muscle?
Close but purkinje system to ensure contraction in a bottom up fashion
Curlings ulcers
Env genes (for getting into target cells)
Neisseria induced small cell vasculitis (including hands and soles)

15. why does variocele occur more in left side?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
PDA open
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

16. How do you calculate RPF from urine PAH?
hyponatremia (aldosterone activation equilibrates body volume)
E. coli
(urine PAH x urine flow rate)/plasma PAH
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

17. What does p53 do? what chrom is it on?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
differentiate
No

18. What is epispadias caused by?
Faulty positioning of the genital tubercle
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
RBF= PAH clearance/(1- hematocrit)
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

19. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
Proteasome inhibitor; treatment for MM and waldenstroms
Abnormal closing of the urethral folds
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
OCPs - multiparity - breast feeding

20. what dissolves the lipid bilayer of a viral envelope?
FGF and VEGF
Ether and other organic solvents
HSV ( also in utero: chlymadia - neisseria - group B strep)
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

21. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
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
SS +rNA
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Phencyclidine (PCP)

22. What is the sole neurologic manifestation of acute rheumatic fever?
Sydenham chorea
Vertical diplopia
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Barium enema

23. is Rifampin ever used as monotherapY? why either way?
In the extracellular space
On cardiac tissue and renal juxtaglomerular cells
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
manifestations - congenital (stretching of periventricular pyrimadal fibers)

24. at four years of age - What are the social - fine motor - gross motor - and language developments?
Because of vasodiation to skeletal muscles
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

25. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Pulmonic and systemic!
11
DIC; TTP- HUS dont bleed that much

26. What is Tzanck smear used to detect?
HSV and VZV
GI malignancies and Insulin resistance (acromegal for ex)
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
11 aa polypeptide; pain NT in CNS and PNS

27. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Elastance
Little effect on cell and no change
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

28. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
Right before diastole (filling begins)
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
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
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

29. What does protein M do in Group A strep<
Prevent phagocytosis
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Elevated GGT and macrocytosis
OCPs - multiparity - breast feeding

30. How do you explain the selective proteinuria of loss to albumin only in MCD?
Fibronectin - laminin - collagen
ANCA because of lack of Ig and C3 deposits on IF
Prevents hepatic VLDL production
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

31. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
SVC and IVC; right below the aortic knob
Closer to head; closer to diaphragm
Prevent phagocytosis
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

32. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
Increase by 50% in urine osmolality
SSRI
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Pain reliever - reduces pain by locking substance P in the PNS

33. what phase do adenosine and acetylcholine act on? doing what?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
8 (myc protein) with 2 - 14 - 22 (iG chains)
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
SVC and IVC; right below the aortic knob

34. carnitine deficiency impairs production of What and how?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Neisseria induced small cell vasculitis (including hands and soles)
Ketone body production by preventing fatty acids into the mitochondria
By vascular permeability and vasodilation

35. 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
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
PDA open

36. What is capsaicin? Where does it work?
Headaches and facial flushing; vasodilation in meninges and skin
Paramyxo and influenza
Because of the low output from heart failure - they will have increased aldosterone levels
Pain reliever - reduces pain by locking substance P in the PNS

37. what organ would an activating mutation in PRPP synthetase effect?
Closer to head; closer to diaphragm
Joints d/t increased purine production and thus uric acid production
No (unlike adenomyosis); yes
RER; RER

38. What are pancreatic pseudocysts called pseudo rather than true cysts?
Not lined by epithelium
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

39. which nucleus releases serotonin?
Echinococcus granulosus; anaphylaxis
Raphe
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

40. what indicates the severity of a mitral regurg ? mitral stenosis?
S3 gallop; S2 to opening snap interval
200-500
Coagulation factors are made in the liver
Increases cytokine production

41. which two virus families have hemagluttinin on their surface?
Neisseria induced small cell vasculitis (including hands and soles)
Retinitis; mononucleosis
Paramyxo and influenza
DIC; TTP- HUS dont bleed that much

42. where are the vegetations on the valves of a libman sacks endocarditis?
MAC complex (C5b - C9 complement deficiency)
Neisseria induced small cell vasculitis (including hands and soles)
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Both sides

43. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Brief psychotic disorder; schizophreniform; schizophrenia
RBC mass; epo levels (secondary has high)
Curlings ulcers

44. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
Vagus (auricular branch); vasovagal syncope!
Syringomelia
No (unlike adenomyosis); yes
SVC and IVC; right below the aortic knob

45. What is the most common neurologic complication of VZV reactivation?
Dihydropyridine sensitive Ca channels (L type)
Localized dermatologic pain that persists for more than one month after zoster eruption
Purkinje system; AV node
Env genes (for getting into target cells)

46. what happens to capacitance with age?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
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
...
No and yes

47. in B12 deficiency - what levels in blood rise very quickly and then drop?
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
Reticulocytes
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

48. What is capacitance inversely proportional to?
No (unlike adenomyosis); yes
G to T in p53; HCC
Susceptible; soluble (unable to be cultured in bile)
Elastance

49. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
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
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
HSV ( also in utero: chlymadia - neisseria - group B strep)
When it invades the bm; carcinoma in situ

50. what hernia has a similar mechanism to hydrocele?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Increases bronchial and vascular smooth muscle reactivity to catecholamines