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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. Metronidizaole does not cover...
PDA open
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
gram positive organisms
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

2. What is the primary histologic finding in patients with eczematous dermatitis?
Multiple miscarriages d/t hypercoaguability
NF- KB; responsible for cytokine production
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Spongiosis

3. What is the Na/Ca exchange used for?
To pump calcium out in cardiac myocytes so that relaxation occurs
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Trauma to stereociliated hair cells of the organ of corti
Drug induced interstitial nephritis

4. which viruses require a protease?
SS +rNA
ATP binding (resets the myosin head to contract again for next binding)
low in serum
Common peroneal; bony fractures and compression; sciatic

5. What causes wrist drop?
Radial nerve damage
Sydenham chorea
Proteasome inhibitor; treatment for MM and waldenstroms
Covalent (between two cysteines)- allows protein to withstand denaturation

6. how does achalasia present? What does barium swallow show on dilated esophagus?
Decreases both
Apocrine; eccrine
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

7. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
The term used to describe decreased drug responsiveness with repeated administration
Rabies encephalitis from cave bats; rabies killed vaccines
Serum FFA and serum triglyceride levels
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

8. What is the neurologic manifestation of ADPKD?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
chronic urticaria and allergic symptoms

9. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
MAO inhibitors; wine and cheese
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
RER; RER
liver specific

10. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

11. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
APP on chrom 21 (this is why downs more susceptible)
Syringomelia

12. what nerve and artery course along the posterior aspect of the humerus?
Enterococci (e. faecalis)- found on genitalia area
MAO inhibitors; wine and cheese
Because of the low output from heart failure - they will have increased aldosterone levels
Radial nerve and deep brachial artery

13. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Think Hb deformation diseases
Classical conditioning
Valproate
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

14. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
E. coli; staphylococcus saprophyticus
Chorda tympani branch
11 aa polypeptide; pain NT in CNS and PNS
Demargination of neutrophils from the vessel walls

15. Where is the base of the heart? apex?
Little effect on cell and no change
ATP binding (resets the myosin head to contract again for next binding)
Closer to head; closer to diaphragm
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

16. neisseria are...
Recurrent larygneal
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Serum FFA and serum triglyceride levels
facultative intracellular

17. name three pathological states that present with large tongues.
No; yes
Phencyclidine (PCP)
Vancomycin
Congenital hypothyroidism - downs - amyloidosis - acromegaly

18. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Medial circumflex artery; avascular necrosis
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

19. What are three symptoms in s.typhi?
No; MRI
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Relfex tachycardia; giving beta blockers
Hydrogen bonds dictate alpha or beta structure

20. which headaches are seen mostly in men - are severe - unilateral - periorbital - episodic (around same time every day) - temporal pain - with lacrimation - nasal congestion and ptosis?
Circular - outside nucleus; transport proteins - rRNA - tRNA
Cluster
No; MRI
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

21. after a thrombus extraction - what serum enzyme shoots up and why?
Serum creatine kinase; reperfusion injury causes necrosis
Octreotide
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
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)

22. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin

23. What does 'oxygen' content in blood refer to?
Dissolved in plasma and attached to Hgb
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Little effect on cell and no change
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

24. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Superior larygeal; cricothyroid; recurrent laryngeal
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
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
Hexokinase

25. In what view of CXR is anterior part of heart best seen? anterior part of heart is formed by?right border of heart is formed by? left border?
Minimal change disease
Anterior circumflex (and axillary nerve)
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Lateral; RV; RA; LV

26. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
Dissolved in plasma and attached to Hgb
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

27. What are the three causes of acute MI in context of normal coronary arteries ?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Tissue redistribution (out of plasma) rather than metabolism
Anterior nares
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)

28. What are two indicators of chronic alcohol consumption?
Boiling - bleach - formalin - UV irradiation
Barium enema
Elevated GGT and macrocytosis
IgE

29. What does glycosylase do to DNA? endonuclease? lyase? What does the order here of enzymes represent? what other enzymes are needed?

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30. What can long term leg cast wearing cause?
No; yes
Acute gastric mucosal defects (superficial or full thickness)
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
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

31. 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?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Superior larygeal; cricothyroid; recurrent laryngeal
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
low in serum

32. other than mycobacterim wha other bacteria is acid fast?
OCPs - multiparity - breast feeding
Coagulation factors are made in the liver
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Nocardia

33. what color pigmentations are caused by malassezia furfur? when do they become more visible?
In ER of bile canaliculi
Abnormal closing of the urethral folds
The term used to describe decreased drug responsiveness with repeated administration
Hypo or hyper pigmentations; after tanning

34. what makes bruits?
Turbulence
Decreases both
P450 mitochondrial monooxygenase
Proteasome inhibitor; treatment for MM and waldenstroms

35. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Serum creatine kinase; reperfusion injury causes necrosis
Turbulence
Paramyxo and influenza

36. Which is faster atrial muscle or ventricular muscle?
RER; copper
Protamine sulfate
Underestimation of gestational age
Atrial

37. What test would be best to determine if a gene is being transcribed? translated?
Southern - western
Classical conditioning
LT (LTD4 - E4 - C4) - and Ach
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

38. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Tibial
Coagulation factors are made in the liver
4 - 4 - 9
Hereditary angioedema; ACE inhibitors

39. What is congestive hepatomegaly specific for?
Right heart failure
In the extracellular space
P53 mutation; AD
hyponatremia (aldosterone activation equilibrates body volume)

40. what protects the resting heart from arrhythmias?
APP on chrom 21 (this is why downs more susceptible)
Raphe
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Highly negative resting potential

41. What is a cord factor and Which bugs have it? How do they appear on culture?
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
S. aureus
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

42. What is epispadias caused by?
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
Demargination of neutrophils from the vessel walls
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Faulty positioning of the genital tubercle

43. what organ would an activating mutation in PRPP synthetase effect?
<1% - 55% - concentration dependent
Medullary
Joints d/t increased purine production and thus uric acid production
Diabetic microangiopathy

44. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Elastance
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
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

45. What are the primary determinants of colon cancer risk in UC patients
Duration and extent of disease
Hypertension - edema - and proteinuria
Abnormal closing of the urethral folds
Trauma to stereociliated hair cells of the organ of corti

46. What is the difference between paranoid personality disorder and delusional disorder?
By vascular permeability and vasodilation
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
glycerol kinase
II; I (I more abundant)

47. what drugs causes the red man syndrome? how does it occur?
Reiter syndrome; B27
Measles and M3 AML`
Vancomycin; histamine mediated
Another type of aldosterone antagonist (like spironolactone)

48. Is there edema in primary Conns? secondary hyperaldosteronism? why?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
INTRApartum Abs (ampicillin/penicillin)
Adductor
Squatting - sitting - lying supine - passive leg raising

49. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Adeno
Terminal bronchioles; small bronchi
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

50. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
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
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Amiadarone
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone