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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. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
Normal; low
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Closer to head; closer to diaphragm
Amiloride - spironolactone - triamterene

2. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
low in serum
Initiation - pointing; pincer grasp; walking; mama/dada
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Multiple miscarriages d/t hypercoaguability

3. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Increases cytokine production
Nocardia
Sudden loss of muscle tone without loss of consciousness; narcolepsy

4. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
Bile soluble which means they are bile sensitive
Downs; regurgitant AV valves - ASDs
Syncope - angina - dyspnea (SAD)
liver specific

5. How do you explain the selective proteinuria of loss to albumin only in MCD?
Increase by 50% in urine osmolality
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Curlings ulcers
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

6. What does extended consumption of appetite suppressants lead to?
Pulmonary hypertension
Hydrogen bonds dictate alpha or beta structure
Lateral; RV; RA; LV
Normally close to systolic

7. sporadic colon cancer tend to arise From what type of polyps?
Another type of aldosterone antagonist (like spironolactone)
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
TCAs and prazosin
Single adenomatous ones

8. What is used to treat heparin toxicity?
Measles and M3 AML`
Protamine sulfate
Underestimation of gestational age
No and yes

9. What is the neurologic manifestation of ADPKD?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Inhaled animal dander allergens
Squatting - sitting - lying supine - passive leg raising
Transported to liver - glycerol kinase converts it to glycerol 3 phosphate Which is then converted to DHAP which can either join glycolysis for ATP or be used to make glucose

10. which nerve provides innervation for plantar flexion and inversion?
Raphe
Increase lymphatic drainage!
Tibial
No; MRI

11. 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?
Well trained athletes and children
11
Cluster
Southern - western

12. in the LV and aorta - What are the pressures?
25; 25
Normally close to systolic
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Insulin like growth factor 1 (just another name)

13. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Underestimation of gestational age
Well
Gluteus maximus; difficulty getting up from seated position and climbing chair
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

14. hypertonicity and hyperreflexity are ________________ of hydrocephalus
SVT; increases vagal tone; rectus abdominis
manifestations - congenital (stretching of periventricular pyrimadal fibers)
AV node slowest - to allow time for diastole
Close but purkinje system to ensure contraction in a bottom up fashion

15. what phase do adenosine and acetylcholine act on? doing what?
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
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Turners`
Paramyxo and influenza

16. Which is faster purkinje system or atrial muscle?
II; I (I more abundant)
S3 gallop; S2 to opening snap interval
Close but purkinje system to ensure contraction in a bottom up fashion
Anterior nares

17. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Hyperkalemia; potassium sparing diuretics - potassium supplements
Close but purkinje system to ensure contraction in a bottom up fashion
Biphosphonate

18. where exactly is ACE expressed in the lungs? What type of enzyme is it?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Vascular endothelium; protease
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
Common peroneal; bony fractures and compression; sciatic

19. carnitine deficiency impairs production of What and how?
Drink plenty of fluids
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Ketone body production by preventing fatty acids into the mitochondria
Bronchogenic carcinoma

20. What is somatomedin C?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Decreases both
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
Insulin like growth factor 1 (just another name)

21. how does eos release MBP to kill protozoa etc?
Close but purkinje system to ensure contraction in a bottom up fashion
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Squatting - sitting - lying supine - passive leg raising
women

22. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
Purkinje system; AV node
Neisseria induced small cell vasculitis (including hands and soles)
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)
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

23. What is used to compare means? categorical outcomes?
T test; chi squared
Inhibits it
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
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

24. what makes bruits?
glycerol kinase
Turbulence
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

25. what commonly happens in GI in response to acute physiologic stress?
Increase by 50% in urine osmolality
Increase in permeability of two ions with equal and opposite equilibrium potentials
Acute gastric mucosal defects (superficial or full thickness)
Fat - fertile - forty - female

26. What are the long term consequences of hydrocephalus?
Because of the low output from heart failure - they will have increased aldosterone levels
8 (myc protein) with 2 - 14 - 22 (iG chains)
Squatting - sitting - lying supine - passive leg raising
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

27. what murmur is enhanced by decreased blood flow to the heart?
P53 mutation; DCC is also required for adenoma to carcinoma
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Because of the low output from heart failure - they will have increased aldosterone levels

28. What three pathogens cause infectious esophagitis in HIV positive patients?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Increase lymphatic drainage!
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
CMV - HSV 1 - Candida

29. What antibodies are present in CREST? What is the most specific?
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
Anti centromere; anti DNA topoisomerase
No; yes
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

30. Where does terminal peptide cleavage of collagen fibrils take place?
TCAs and prazosin
Selective alpha 1 (increases SVR)
In the extracellular space
Medial part

31. How can renal blood flow be calculated from RPF?
When it invades the bm; carcinoma in situ
Measure of depth invasion (vertical!)
RBF= PAH clearance/(1- hematocrit)
Prepatellar

32. If a patient has higher levels of HbF - What does this mean?
Think Hb deformation diseases
Trauma to stereociliated hair cells of the organ of corti
Well trained athletes and children
Barium enema

33. What is a keloid?
Increase by 50% in urine osmolality
Chorda tympani branch
RBC mass; epo levels (secondary has high)
Excessive collagen formation during tissue repair in susceptible individuals

34. where are the vegetations on the valves of a libman sacks endocarditis?
Both sides
In the extracellular space
Squatting - sitting - lying supine - passive leg raising
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

35. What is the presentation of angioedema? Where is most commonly affected?
Downs; regurgitant AV valves - ASDs
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
High potassium conductance and some sodium conductance
Apocrine; eccrine

36. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Strength of cell mediated immune response
Octreotide
Closer to head; closer to diaphragm
Medullary

37. who bleed more DIC or TTP- HUS patients?
SaO2 <92%
DIC; TTP- HUS dont bleed that much
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Because of the low output from heart failure - they will have increased aldosterone levels

38. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
As a CO2 carrier with the carboxylase enzyme
Mean greater than median greater than mode
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

39. which opponens muscle does ulnar innervate?
Gluteus maximus; difficulty getting up from seated position and climbing chair
Right before diastole (filling begins)
High potassium conductance and some sodium conductance
Adductor

40. What does VIP do to gastric acid secretion?
Coagulation factors are made in the liver
Anti cholinergic effects of pupil dilation and lack of accomodation
Inhibits it
Normal; low

41. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
RER; copper
Because of vasodiation to skeletal muscles
Sickle cell; G6PD
Rabies encephalitis from cave bats; rabies killed vaccines

42. What are the first generation anti histamines?
Barium enema
P53 mutation; AD
Chlorpheniramine and diphenhydramine
Sickle cell; G6PD

43. what vessel would a fracture to the neck of the of the humerus damage?
Insulin like growth factor 1 (just another name)
Lateral; RV; RA; LV
Anterior circumflex (and axillary nerve)
Apocrine; eccrine

44. What is the most common location of colonization of all s. aureus types?
No; MRI
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Anterior nares
Apocrine; eccrine

45. what chromosome is c - myc found on?
Chrom 8
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
Atrial
gram positive organisms

46. What is the mainstay treatment for acute mania?
Covalent (between two cysteines)- allows protein to withstand denaturation
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
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
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

47. why should you not use ACE inhibitors with someone who had hereditary angioedema?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
As a CO2 carrier with the carboxylase enzyme
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
On cardiac tissue and renal juxtaglomerular cells

48. What agonists reduce the gradient across the LV outflow tract?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Selective alpha 1 (increases SVR)
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Rare complication of measles (years later)- thought to be d/t certain type that doesnt have surface M protein antigen so goes unseen into CNS

49. are there signs of inflammation in avascular necrosis? then How do you diagnose?
Increase lymphatic drainage!
Drink plenty of fluids
Anterior nares
No; MRI

50. What is the preferred treatment for DKA?
Acute interstitial nephritis
8; 12
Regular insulin (Not fast acting - regular better)
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness