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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. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
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
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Biphosphonate
Joints d/t increased purine production and thus uric acid production

2. how can HAV be inactivated?
Fibrosis; macrophages
Boiling - bleach - formalin - UV irradiation
Localized dermatologic pain that persists for more than one month after zoster eruption
Think Hb deformation diseases

3. In what population does cholelithiasis occur?
Fat - fertile - forty - female
CGD; t cell dysfxn (diGeorge)
Vertical diplopia
Anti cholinergic effects of pupil dilation and lack of accomodation

4. what locations of UC increase the risk of Colon cancer?
Pan colitis and right sided colitis (more than left sided and proctitis)
Relfex tachycardia; giving beta blockers
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
gram positive organisms

5. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Chorda tympani branch
LT (LTD4 - E4 - C4) - and Ach
Prepatellar
TSh (in testicular tumors can cause hyperthyroidism)

6. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Hexokinase
Valproate
Integration of viral DNA into genome of host hepatocytes
Phencyclidine (PCP)

7. 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
I is more benign and can present later in adulthood
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
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

8. what murmur is enhanced by decreased blood flow to the heart?
Because gamma chains replace beta chains and then gamma chain formation wanes
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Turners`

9. What is the difference between paranoid personality disorder and delusional disorder?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Superior larygeal; cricothyroid; recurrent laryngeal
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

10. What is extraocular muscle weakness a common symptom of?
Myasthenia gravis
By vascular permeability and vasodilation
SS +rNA
Increase in permeability of two ions with equal and opposite equilibrium potentials

11. What does nitroprusside do to afterload? preload?
Decreases both
chronic urticaria and allergic symptoms
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

12. what marker should be followed in a patient with cirrhosis?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

13. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
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
Fat - fertile - forty - female
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
8; 12

14. what organ would an activating mutation in PRPP synthetase effect?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Joints d/t increased purine production and thus uric acid production
ATP binding (resets the myosin head to contract again for next binding)
The time interval between S2 and OS- the shorter the interval - the more intense

15. What can chronic vit A toxicity cause?
P53 mutation; AD
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
4 - 4 - 9
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

16. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
Hyperkalemia; potassium sparing diuretics - potassium supplements
Regular insulin (Not fast acting - regular better)
Vagus (auricular branch); vasovagal syncope!
Intussusception

17. What antibodies are present in CREST? What is the most specific?
Raphe
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Anti centromere; anti DNA topoisomerase
Neisseria induced small cell vasculitis (including hands and soles)

18. other than in pyelonephritis - where else are WBC casts seen?
To pump calcium out in cardiac myocytes so that relaxation occurs
Acute interstitial nephritis
Around 70 (normal measured diastolic pressures); 9--
On cardiac tissue and renal juxtaglomerular cells

19. What causes vertical diplopia? horizontal?
200-500
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Pan colitis and right sided colitis (more than left sided and proctitis)
Trochlear nerve (IV); abducens nerve (VI)

20. How do you calculate excretion rate of a substance? How do you calculate the filtration rate of a substance? clearance of what substance estimates the GFR?
Hexokinase
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Lateral; RV; RA; LV
C3 decreased after 5-10 days; sulfonamides

21. What is subacute sclerosisng encephalitis caused by?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Dihydropyridine sensitive Ca channels (L type)
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
Radial nerve damage

22. Where is aromatase used?
Vertical diplopia
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Protamine sulfate
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac

23. which type of glands produce an initially odorless secretion but can become malodorous secondary to bacterial decompisition on the skin surface? which glands are present throughout the skin except on lips and glans penis?
Classical conditioning
SVT; increases vagal tone; rectus abdominis
SSRI
Apocrine; eccrine

24. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Medial circumflex artery; avascular necrosis
Gluteus medius and minimus; positive trendelenberg

25. What is gardeners mydriasis? How is it treated?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
P53 mutation; AD
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Paramyxo and influenza

26. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
frameshift mutations (missense is substitution)
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Well

27. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
Rabies encephalitis from cave bats; rabies killed vaccines
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
Hypo or hyper pigmentations; after tanning
Minimal change disease

28. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
Pulmonary hypertension
P53 mutation; DCC is also required for adenoma to carcinoma
women
Anti - apoptotic (prevents going into apoptosis)- 18; 14

29. What is mcc of death pre hospital phase of MI? in hospital phase?
V fib; v. failure
Diabetic microangiopathy
Primary
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

30. What is hyaline arteriosclerosis usually a sign of ?
Diabetic microangiopathy
Regular insulin (Not fast acting - regular better)
Fibronectin - laminin - collagen
Congenital hypothyroidism - downs - amyloidosis - acromegaly

31. What does C1 esterase do other than inhibiting complement pathway?
P450 mitochondrial monooxygenase
Normal; low
Inactivates kallikrein which activates kininogen into bradykinin
GI tract; mood!

32. why does neutrophila occur with corticosteroids?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Pan colitis and right sided colitis (more than left sided and proctitis)
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Demargination of neutrophils from the vessel walls

33. which are the only glycosylated proteins in HIV virus?
Env genes (for getting into target cells)
G to T in p53; HCC
Because of vasodiation to skeletal muscles
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

34. Where does 90% of serotonin lie? What is this NT responsible?
Pain reliever - reduces pain by locking substance P in the PNS
Acute interstitial nephritis
GI tract; mood!
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

35. What is contraindicated in toxic mega colon?
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
Sydenham chorea
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
8; 12

36. why does hypothyroidism cause increased CPK levels?
Bronchial dilation (bronchiectasis)
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Mean greater than median greater than mode
Kallmans

37. where are Beta 1 receptors found?
Recurrent larygneal
II; I (I more abundant)
On cardiac tissue and renal juxtaglomerular cells
Highly negative resting potential

38. Which is faster purkinje system or atrial muscle?
Close but purkinje system to ensure contraction in a bottom up fashion
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Anti - apoptotic (prevents going into apoptosis)- 18; 14
DIC; TTP- HUS dont bleed that much

39. How do you explain the selective proteinuria of loss to albumin only in MCD?
Because of vasodiation to skeletal muscles
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
SSRI
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

40. What are the lab findings in poststreptococcal GN?
Covalent (between two cysteines)- allows protein to withstand denaturation
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
When it invades the bm; carcinoma in situ

41. What is omalizumab and What is it used for?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Skin flushing and warmth; prostaglandins; give with aspirin
RER; copper
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

42. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
OCPs - multiparity - breast feeding
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
C3 decreased after 5-10 days; sulfonamides
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

43. Where does the aorta lie in relation to the pulmonary artery in transposition of the great arteries (is this right to left or left to right shunt?)?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Reticulocytes
I is more benign and can present later in adulthood
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

44. When is an S4 sound normal?
Well trained athletes and children
S3 gallop; S2 to opening snap interval
Localized dermatologic pain that persists for more than one month after zoster eruption
The term used to describe decreased drug responsiveness with repeated administration

45. hypertonicity and hyperreflexity are ________________ of hydrocephalus
Chorda tympani branch
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Serum FFA and serum triglyceride levels
Underestimation of gestational age

46. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
Increased reticulocytes
ST become atrophic and hyalinized (temp induced damage) and depressed sperm count becuase of that; hormonal function not impaired (test and LH levels normal) because Leydig cells not as temp sensitive so secondary sexual characteristics and sexual pe
RER; RER
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase

47. erythema nodosum - elevated ACE - scattered granulomas - arthralgias - hilar lymphadenoapthy are indicative of what?
Ether and other organic solvents
G to T in p53; HCC
Sarcoid
Increase; decreased

48. a patient fearing all white coats is a phenomenon of what?
Classical conditioning
8 (myc protein) with 2 - 14 - 22 (iG chains)
S. saprophyticus - and s. epidermidis; novobiocin
Duration and extent of disease

49. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Valproate
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
Classical conditioning
Circular - outside nucleus; transport proteins - rRNA - tRNA

50. how does neisseria cause a petechial rash?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
SVT; increases vagal tone; rectus abdominis
Neisseria induced small cell vasculitis (including hands and soles)
Radial nerve and deep brachial artery