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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. how much percent of sodium is excreted? urea? glucose?
<1% - 55% - concentration dependent
Nocardia
Octreotide
Downs; regurgitant AV valves - ASDs

2. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Rabies encephalitis from cave bats; rabies killed vaccines
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
HSV ( also in utero: chlymadia - neisseria - group B strep)
Opiate anti diarrheal that binds to mu opiate receptors in GI tract and slows motility; meperidine; low doses - but therapeutic doses combined with atropine (under marked brand name lomotil)

3. What is difference between Arnold Chiari type I and II?
I is more benign and can present later in adulthood
High potassium conductance and some sodium conductance
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Dissolved in plasma and attached to Hgb

4. What is the mcc of extrinsic allergic asthma?
11 aa polypeptide; pain NT in CNS and PNS
SSRI
8 (myc protein) with 2 - 14 - 22 (iG chains)
Inhaled animal dander allergens

5. at 2 years of age - What are the social - fine motor - gross motor and language developments?
46 - 4N; 23 2N
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

6. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
Terminal bronchioles; small bronchi
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Criggler Najjar (UGT enzyme in bilirubin glucoronidation) ; Dubin Johnson (transport protein lacking - Black liver) and Rotor syndrome - defects in hepatic uptake and excretion of bile (numerous defect)
Squatting - sitting - lying supine - passive leg raising

7. which nerve provides innervation for plantar flexion and inversion?
Tibial
Atrial
PDA open
Prevent phagocytosis

8. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Class I
Elevated GGT and macrocytosis
Become beta pleated and then form neurofibrillary tangle!

9. Where is conduction in heart fastest? slowest?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Hydrogen bonds dictate alpha or beta structure
Purkinje system; AV node
Inhibits it

10. which two virus families have hemagluttinin on their surface?
liver specific
Paramyxo and influenza
Pain reliever - reduces pain by locking substance P in the PNS
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

11. what phase do adenosine and acetylcholine act on? doing what?
Dihydropyridine sensitive Ca channels (L type)
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

12. ___________ is liver specific
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
25; 25
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
glycerol kinase

13. What does L/S stand for in fetal lung maturity? When does maturity occur?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
IgE
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

14. which RPGN is also called pauci immune GN? why?
Bronchial dilation (bronchiectasis)
transcription activation/suppression
Cluster
ANCA because of lack of Ig and C3 deposits on IF

15. what happens to capacitance with age?
Tissue redistribution (out of plasma) rather than metabolism
Downs; regurgitant AV valves - ASDs
...
Normally close to systolic

16. what immune deficiency causes recurrent neisseria infections?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Ketone body production by preventing fatty acids into the mitochondria
CMV - HSV 1 - Candida
MAC complex (C5b - C9 complement deficiency)

17. What is cataplexy and When is it seen?
Proteasome inhibitor; treatment for MM and waldenstroms
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
chronic urticaria and allergic symptoms

18. why should you not use ACE inhibitors with someone who had hereditary angioedema?
P53 mutation; DCC is also required for adenoma to carcinoma
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
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

19. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
To pump calcium out in cardiac myocytes so that relaxation occurs
PDA open
On cardiac tissue and renal juxtaglomerular cells

20. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Curlings ulcers
Fibrosis; macrophages

21. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Phencyclidine (PCP)
Increase in permeability of two ions with equal and opposite equilibrium potentials
Highly negative resting potential
Skin flushing and warmth; prostaglandins; give with aspirin

22. In What type of nephritis would you see high serum eos count?
Turners`
Normal; low
Opiate anti diarrheal that binds to mu opiate receptors in GI tract and slows motility; meperidine; low doses - but therapeutic doses combined with atropine (under marked brand name lomotil)
Drug induced interstitial nephritis

23. What is the best indicator for the severity of mitral stenosis?
Class I
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Close but purkinje system to ensure contraction in a bottom up fashion
The time interval between S2 and OS- the shorter the interval - the more intense

24. What type of drug is alendronate?
Sydenham chorea
Biphosphonate
Circular - outside nucleus; transport proteins - rRNA - tRNA
By vascular permeability and vasodilation

25. What agonists reduce the gradient across the LV outflow tract?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Gluteus maximus; difficulty getting up from seated position and climbing chair
Selective alpha 1 (increases SVR)
Dissolved in plasma and attached to Hgb

26. prostaglandin synthesis keeps...
PDA open
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
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
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

27. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Covalent (between two cysteines)- allows protein to withstand denaturation

28. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
only up to bronchi
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
ATP binding (resets the myosin head to contract again for next binding)
P53 mutation; AD

29. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Southern - western
MAO inhibitors; wine and cheese
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Relfex tachycardia; giving beta blockers

30. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
RBF= PAH clearance/(1- hematocrit)
Skin flushing and warmth; prostaglandins; give with aspirin
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Folic acid treatment!

31. What is the preferred treatment for DKA?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
SSRI
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Regular insulin (Not fast acting - regular better)

32. What causes vertical diplopia? horizontal?
Single adenomatous ones
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Trochlear nerve (IV); abducens nerve (VI)

33. in essential fructosuria - what enzyme do patients use to metabolize fructose?
E. coli; staphylococcus saprophyticus
Hexokinase
Faulty positioning of the genital tubercle
Well trained athletes and children

34. What can chronic vit A toxicity cause?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Increases cytokine production
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Aromatase deficiency in child

35. what hernia has a similar mechanism to hydrocele?
Closer to head; closer to diaphragm
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
Bile salt accumulation in urine
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

36. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Large stroke volumes with ventricular contraction; aortic regurg
CMV - HSV 1 - Candida
Because of the low output from heart failure - they will have increased aldosterone levels
Hypo or hyper pigmentations; after tanning

37. what murmur is enhanced by decreased blood flow to the heart?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Elevated GGT and macrocytosis
RR-1/RR
Joints d/t increased purine production and thus uric acid production

38. When is an S4 sound normal?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Vancomycin
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)
Well trained athletes and children

39. 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
Biphosphonate
Anterior nares
IgE

40. what makes bruits?
Medial circumflex artery; avascular necrosis
8; 12
Gluteus maximus; difficulty getting up from seated position and climbing chair
Turbulence

41. What does prolonged PT indicated? aPTT? bleeding time?
Tibial
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
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
Extrinsic def; instrinsic def; platelet def

42. What are the two growth factors associated with angiogenesis?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Octreotide
FGF and VEGF

43. what happens with LDL receptor density in statin therapy?
Increases
Medial part
S3 gallop; S2 to opening snap interval
Thymic tumor

44. Where is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
V fib; v. failure
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

45. 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?
<1% - 55% - concentration dependent
FGF and VEGF
Cluster
Medial part

46. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
RBC mass; epo levels (secondary has high)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Covalent (between two cysteines)- allows protein to withstand denaturation

47. What would a deflection of the membrane potential to near zero indicate?
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Multiple miscarriages d/t hypercoaguability
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Increase in permeability of two ions with equal and opposite equilibrium potentials

48. when do ghon complexes form - primary or secondary TB?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Primary
Atrial
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

49. what commonly happens in GI in response to acute physiologic stress?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Hypertension - edema - and proteinuria
Acute gastric mucosal defects (superficial or full thickness)
Headaches and facial flushing; vasodilation in meninges and skin

50. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
Because gamma chains replace beta chains and then gamma chain formation wanes
P53 mutation; AD
Coagulation factors are made in the liver
Vancomycin; histamine mediated