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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. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
Turners`
In ER of bile canaliculi
women
Gluteus medius and minimus; positive trendelenberg

2. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
Vancomycin
Tissue redistribution (out of plasma) rather than metabolism
Medial circumflex artery; avascular necrosis
No (unlike adenomyosis); yes

3. How do left sided colon adenocarcinomas present? right sided?
Reticulocytes
Proteasome inhibitor; treatment for MM and waldenstroms
Bronchogenic carcinoma
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

4. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Increases cytokine production
Increased reticulocytes
Superior larygeal; cricothyroid; recurrent laryngeal
Cluster

5. What can long term leg cast wearing cause?
Env genes (for getting into target cells)
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
By vascular permeability and vasodilation
GI malignancies and Insulin resistance (acromegal for ex)

6. biotin is used By what in tissues responsible for gluconeogenesis
P53 mutation; AD
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Faulty positioning of the genital tubercle
As a CO2 carrier with the carboxylase enzyme

7. at four years of age - What are the social - fine motor - gross motor - and language developments?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
By vascular permeability and vasodilation
P53 mutation; DCC is also required for adenoma to carcinoma
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

8. are there signs of inflammation in avascular necrosis? then How do you diagnose?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
As a CO2 carrier with the carboxylase enzyme
Anterior circumflex (and axillary nerve)
No; MRI

9. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Medial circumflex artery; avascular necrosis
AV node slowest - to allow time for diastole
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
8; 12

10. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Serum FFA and serum triglyceride levels
Intussusception
Prevents hepatic VLDL production

11. What causes wrist drop?
Vertical diplopia
Elevated GGT and macrocytosis
V fib; v. failure
Radial nerve damage

12. how does achalasia present? What does barium swallow show on dilated esophagus?
Tzanck smear
OCPs - multiparity - breast feeding
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
25; 25

13. what immune deficiency causes recurrent neisseria infections?
MAC complex (C5b - C9 complement deficiency)
Appetite suppressants
ANCA because of lack of Ig and C3 deposits on IF
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

14. a patient fearing all white coats is a phenomenon of what?
ZDV or AZT
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
Classical conditioning
Folic acid treatment!

15. How is dobutamine better than dopamine?
Serum FFA and serum triglyceride levels
Abnormal closing of the urethral folds
Hydrogen bonds dictate alpha or beta structure
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

16. What causes curlings ulcers?
Kallmans
Vagus (auricular branch); vasovagal syncope!
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

17. What are three symptoms in s.typhi?
No
Retinitis; mononucleosis
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

18. erythema nodosum - elevated ACE - scattered granulomas - arthralgias - hilar lymphadenoapthy are indicative of what?
Sarcoid
Apocrine; eccrine
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
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

19. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Hypo or hyper pigmentations; after tanning
Trochlear nerve (IV); abducens nerve (VI)
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Prepatellar

20. what receptors do first generation anti histamines block?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Medullary
8; 12

21. prostaglandin synthesis keeps...
Reiter syndrome; B27
Bile soluble which means they are bile sensitive
PDA open
NF- KB; responsible for cytokine production

22. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
E. coli; staphylococcus saprophyticus
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Susceptible; soluble (unable to be cultured in bile)
Well

23. what virus causes pharyngoconjuctival fever?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Adeno
Vancomycin
By vascular permeability and vasodilation

24. how can HAV be inactivated?
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Boiling - bleach - formalin - UV irradiation
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Think Hb deformation diseases

25. at three years of age What are social - fine motor - gross motor and language developments?
IgE
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Drink plenty of fluids

26. What is the presentation of sever aortic stenosis?
Ketone body production by preventing fatty acids into the mitochondria
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Octreotide
Syncope - angina - dyspnea (SAD)

27. What are the three predominant symptoms of VHL? What is its mode of inheritance?
P450 mitochondrial monooxygenase
Multiple miscarriages d/t hypercoaguability
Because gamma chains replace beta chains and then gamma chain formation wanes
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

28. after a thrombus extraction - what serum enzyme shoots up and why?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Anti cholinergic effects of pupil dilation and lack of accomodation
Serum creatine kinase; reperfusion injury causes necrosis
T test; chi squared

29. What is a primary HSV 1 infection like?
Susceptible; soluble (unable to be cultured in bile)
SaO2 <92%
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

30. What is the best indicator for the severity of mitral stenosis?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Chorda tympani branch
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
The time interval between S2 and OS- the shorter the interval - the more intense

31. Where does lysyl oxidase act? What is the cofactor for that?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Ceftriaxone; azithromycin
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
In the extracellular space for collagen cross linking; zinc

32. what dictates the resting membrane potential of most cells?
In the extracellular space
Smoking
High potassium conductance and some sodium conductance
Tissue redistribution (out of plasma) rather than metabolism

33. which virus inactivates both Rb and p53?
Aromatase deficiency in child
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Acute interstitial nephritis
E6 and E7 of HPV knock off p53 and Rb suppressor genes

34. What type of drug is alendronate?
Vascular endothelium; protease
Primary
Biphosphonate
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

35. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
As a CO2 carrier with the carboxylase enzyme
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
hyponatremia (aldosterone activation equilibrates body volume)
SVT; increases vagal tone; rectus abdominis

36. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Chorda tympani branch
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Sarcoid

37. what enzyme converts procarcinogens into carcinogens?
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
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
P450 mitochondrial monooxygenase
Raphe

38. which nerve provides innervation for plantar flexion and inversion?
S3 gallop; S2 to opening snap interval
Gluteus medius and minimus; positive trendelenberg
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Tibial

39. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
Bile soluble which means they are bile sensitive
Smoking
Duration and extent of disease
No

40. what defines hypoxemia?
Fibronectin - laminin - collagen
SaO2 <92%
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
No

41. What is the difference between paranoid personality disorder and delusional disorder?
Hypothyroidism
When it invades the bm; carcinoma in situ
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Increase by 50% in urine osmolality

42. When is an S4 sound normal?
Radial nerve damage
Well trained athletes and children
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Sickle cell; G6PD

43. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
SVT; increases vagal tone; rectus abdominis
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

44. where are the vegetations on the valves of a libman sacks endocarditis?
Both sides
Atrial
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Inhaled animal dander allergens

45. IL4 is used for isotypye switching to what?
IgE
Medial part
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
<1% - 55% - concentration dependent

46. which nucleus releases serotonin?
Increases cytokine production
Increases
Raphe
Sarcoid

47. is Rifampin ever used as monotherapY? why either way?
Medial part
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
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
4 - 4 - 9

48. What is omalizumab and What is it used for?
Aromatase deficiency in child
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Raphe
Excessive collagen formation during tissue repair in susceptible individuals

49. Where does 90% of serotonin lie? What is this NT responsible?
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
SS +rNA
Not lined by epithelium
GI tract; mood!

50. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Tzanck smear
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus