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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 is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Anti cholinergic effects of pupil dilation and lack of accomodation
S. aureus
Reticulocytes

2. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Ceftriaxone; azithromycin
Gluteus maximus; difficulty getting up from seated position and climbing chair
APP on chrom 21 (this is why downs more susceptible)
E. coli

3. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
Medial part
IgE
MAO inhibitors; wine and cheese
Radial nerve and deep brachial artery

4. What is the mcc of elevated AFP leves in pregnancy>
Underestimation of gestational age
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Become beta pleated and then form neurofibrillary tangle!
I is more benign and can present later in adulthood

5. what organ would an activating mutation in PRPP synthetase effect?
chronic urticaria and allergic symptoms
Joints d/t increased purine production and thus uric acid production
Hereditary angioedema; ACE inhibitors
Tibial

6. at one year of age - What are the social - fine motor - gross motor and language developments?
Initiation - pointing; pincer grasp; walking; mama/dada
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
No

7. what bursa is affected when on knees like a maid/gardner?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Syncope - angina - dyspnea (SAD)
Standing suddenly from supine position; valsalva maneuver
Prepatellar

8. why does liver dysfunction cause coagulation disorders?
Coagulation factors are made in the liver
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Enterococci (e. faecalis)- found on genitalia area

9. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
ATP binding (resets the myosin head to contract again for next binding)
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
Purkinje system; AV node
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

10. What causes vertical diplopia? horizontal?
chronic urticaria and allergic symptoms
Trochlear nerve (IV); abducens nerve (VI)
OCPs - multiparity - breast feeding
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

11. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Because of the low output from heart failure - they will have increased aldosterone levels
Radial nerve and deep brachial artery
4 - 4 - 9

12. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
OCPs - multiparity - breast feeding
Brief psychotic disorder; schizophreniform; schizophrenia
Hexokinase
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

13. if there are keratin swirls does that mean well or poorly differentiated?
Well
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
Covalent (between two cysteines)- allows protein to withstand denaturation

14. name three pathological states that present with large tongues.
LT (LTD4 - E4 - C4) - and Ach
Medial circumflex artery; avascular necrosis
Mean greater than median greater than mode
Congenital hypothyroidism - downs - amyloidosis - acromegaly

15. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
Coagulation factors are made in the liver
Myasthenia gravis
S3 gallop; S2 to opening snap interval
Intussusception

16. the rate of blood flow of which two circulations must equal each other at all times?
Biphosphonate
Pulmonic and systemic!
Thymic tumor
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

17. What causes release of myosin head from the actin filament?
Anterior circumflex (and axillary nerve)
ATP binding (resets the myosin head to contract again for next binding)
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

18. What is Bortezomib and What is it used for?
Proteasome inhibitor; treatment for MM and waldenstroms
HSV and VZV
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Ketone body production by preventing fatty acids into the mitochondria

19. what diseases can vit A be used to treat?
Measles and M3 AML`
T test; chi squared
Reticulocytes
HSV ( also in utero: chlymadia - neisseria - group B strep)

20. What is a common complication of acute pancreatitis? What is it?
Vancomycin
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
SVT; increases vagal tone; rectus abdominis
CGD; t cell dysfxn (diGeorge)

21. What are fenfluramine - phentermine?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Appetite suppressants
Medial circumflex artery; avascular necrosis
CMV - HSV 1 - Candida

22. What do you treat s. epidermidis with?
C3 decreased after 5-10 days; sulfonamides
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Kallmans
Vancomycin

23. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Syncope - angina - dyspnea (SAD)
Curlings ulcers
Hypo or hyper pigmentations; after tanning

24. What effects does cortisol have on catecholamines?
Insulin like growth factor 1 (just another name)
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
Apocrine; eccrine
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

25. What type of mutation does aflatoxin cause? what cancer does this increase for?
low in serum
Ceftriaxone; azithromycin
G to T in p53; HCC
RR-1/RR

26. What is the difference between additive and synergistic?
Excessive collagen formation during tissue repair in susceptible individuals
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Valproate
Additive is equal to the sum of the two actions (lets say agonists at a receptor) and synergistic is when the sum is greater than just their two effects together

27. What does hypocapnia cause in teh brain? What is hypocapnia?
Anterior circumflex (and axillary nerve)
In ER of bile canaliculi
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
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

28. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
C3 decreased after 5-10 days; sulfonamides
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
MAC complex (C5b - C9 complement deficiency)
Clindamycin; covers anaerobic oral flora and aerobic bacteria

29. What is hypospadias caused by?
On cardiac tissue and renal juxtaglomerular cells
Tissue redistribution (out of plasma) rather than metabolism
Abnormal closing of the urethral folds
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

30. What are the first generation anti histamines?
Hypothyroidism
Chlorpheniramine and diphenhydramine
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Paramyxo and influenza

31. What are diastolic (lowest) pressures in aorta? LV?
Around 70 (normal measured diastolic pressures); 9--
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
SVT; increases vagal tone; rectus abdominis
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

32. why does neutrophila occur with corticosteroids?
Demargination of neutrophils from the vessel walls
Brief psychotic disorder; schizophreniform; schizophrenia
Underestimation of gestational age
Clindamycin; covers anaerobic oral flora and aerobic bacteria

33. Where does complement bind on the Fc region of Ig chains?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Fibrosis; macrophages
Anterior circumflex (and axillary nerve)
8 (myc protein) with 2 - 14 - 22 (iG chains)

34. What is the mutation type in thalassemias? what process is defective because of this?
Nonsense; mRNA processing
Circular - outside nucleus; transport proteins - rRNA - tRNA
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Spongiosis

35. What does nitroprusside do to afterload? preload?
Smoking
only up to bronchi
SSRI
Decreases both

36. which two drug types can cause orthostatic hypotension (think depression and BPH)?
Because of the low output from heart failure - they will have increased aldosterone levels
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Increase by 50% in urine osmolality
TCAs and prazosin

37. 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
No
Vertical diplopia
Covalent (between two cysteines)- allows protein to withstand denaturation

38. where are Beta 1 receptors found?
(urine PAH x urine flow rate)/plasma PAH
On cardiac tissue and renal juxtaglomerular cells
ATP binding (resets the myosin head to contract again for next binding)
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences

39. What is the neurologic manifestation of ADPKD?
Tibial
Normal; low
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

40. What antibodies are present in CREST? What is the most specific?
Anti centromere; anti DNA topoisomerase
8; 12
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
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

41. What is subacute sclerosisng encephalitis caused by?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
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
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Anti - apoptotic (prevents going into apoptosis)- 18; 14

42. hypertonicity and hyperreflexity are ________________ of hydrocephalus
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Barium enema
Additive is equal to the sum of the two actions (lets say agonists at a receptor) and synergistic is when the sum is greater than just their two effects together
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

43. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
PDA open
Covalent (between two cysteines)- allows protein to withstand denaturation
Leukotriene precursor and does neutrophil chemotaxis
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

44. Where does lysyl oxidase act? What is the cofactor for that?
In the extracellular space for collagen cross linking; zinc
RER; RER
Turners`
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

45. What is intussusception? how does ischemia and necrosis occur?
Hypothyroidism
Chlorpheniramine and diphenhydramine
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
Varying; erythema nodosum is common

46. what kind of drug is sertraline? What is a common side effect?
SSRI; erectile dysfunction
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Medial part
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

47. when arrested in prophase of meiosis I - What are primary oocytes chrom number? What about the secondary oocytes that are stuck in metaphase of Meiosis II?
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
46 - 4N; 23 2N
Drug induced interstitial nephritis
Medial part

48. which nucleus releases serotonin?
Prepatellar
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Raphe
CMV - HSV 1 - Candida

49. when do ghon complexes form - primary or secondary TB?
Octreotide
Primary
S. aureus
Sudden loss of muscle tone without loss of consciousness; narcolepsy

50. What is pickwickian syndrome? What are the lab findings?
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
frameshift mutations (missense is substitution)
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Rabies encephalitis from cave bats; rabies killed vaccines