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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 does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Tibial
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Gluteus maximus; difficulty getting up from seated position and climbing chair
Measure of depth invasion (vertical!)

2. what commonly happens in GI in response to acute physiologic stress?
Relfex tachycardia; giving beta blockers
Acute gastric mucosal defects (superficial or full thickness)
Sarcoid
Circular - outside nucleus; transport proteins - rRNA - tRNA

3. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
No and yes
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

4. What is the most common cause of pyelonephritis in both adults and childre?
Kallmans
By vascular permeability and vasodilation
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
E. coli

5. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
TCAs and prazosin

6. What is the most common location of colonization of all s. aureus types?
Octreotide
Anti centromere; anti DNA topoisomerase
Anterior nares
Increase in permeability of two ions with equal and opposite equilibrium potentials

7. What does prolonged PT indicated? aPTT? bleeding time?
Extrinsic def; instrinsic def; platelet def
Bronchial dilation (bronchiectasis)
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
gram positive organisms

8. What is pickwickian syndrome? What are the lab findings?
Paramyxo and influenza
G to T in p53; HCC
liver specific
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

9. What is capsaicin? Where does it work?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Pain reliever - reduces pain by locking substance P in the PNS
Become beta pleated and then form neurofibrillary tangle!
Acute gastric mucosal defects (superficial or full thickness)

10. h1 receptor anatagonists are not effective in treatment of asthma only for...
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Prepatellar
chronic urticaria and allergic symptoms
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

11. at one year of age - What are the social - fine motor - gross motor and language developments?
Gluteus medius and minimus; positive trendelenberg
Initiation - pointing; pincer grasp; walking; mama/dada
Headaches and facial flushing; vasodilation in meninges and skin
Little effect on cell and no change

12. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Intussusception
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Hexokinase
CGD; t cell dysfxn (diGeorge)

13. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
Atrial
Squatting - sitting - lying supine - passive leg raising
Kallmans
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

14. what dictates the resting membrane potential of most cells?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Vancomycin; histamine mediated
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
High potassium conductance and some sodium conductance

15. What do you treat s. epidermidis with?
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)
Vancomycin
In the extracellular space for collagen cross linking; zinc
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

16. why is crohns disease associated with oxaloacetate kidney stones?
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
Env genes (for getting into target cells)
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

17. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Chorda tympani branch
transcription activation/suppression
Increase by 50% in urine osmolality
Brief psychotic disorder; schizophreniform; schizophrenia

18. 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?
11
Aromatase deficiency in child
46 - 4N; 23 2N
chronic urticaria and allergic symptoms

19. which nucleus releases serotonin?
Raphe
Anti centromere; anti DNA topoisomerase
Increase in permeability of two ions with equal and opposite equilibrium potentials
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

20. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
PDA open
Anterior nares
Intussusception
Circular - outside nucleus; transport proteins - rRNA - tRNA

21. What is the mutation type in thalassemias? what process is defective because of this?
Medial circumflex artery; avascular necrosis
Nonsense; mRNA processing
E. coli; staphylococcus saprophyticus
Varying; erythema nodosum is common

22. What is Tzanck smear used to detect?
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
HSV and VZV

23. where exactly is ACE expressed in the lungs? What type of enzyme is it?
Vascular endothelium; protease
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
APP on chrom 21 (this is why downs more susceptible)

24. What are three symptoms in s.typhi?
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
women
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

25. What can worse neurologic dysfunction in cobalamic def?
Common peroneal; bony fractures and compression; sciatic
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Duration and extent of disease
Folic acid treatment!

26. What is the difference between paranoid personality disorder and delusional disorder?
Primary
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Abnormal closing of the urethral folds

27. What is the neurologic manifestation of ADPKD?
Duration and extent of disease
Syncope - angina - dyspnea (SAD)
HSV and VZV
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

28. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Increase lymphatic drainage!
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
RER; copper
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

29. which viruses require a protease?
SS +rNA
MAO inhibitors; wine and cheese
No; MRI
Mean greater than median greater than mode

30. Where does 90% of serotonin lie? What is this NT responsible?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Well trained athletes and children
GI tract; mood!
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

31. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
E. coli; staphylococcus saprophyticus
LT (LTD4 - E4 - C4) - and Ach
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Hexokinase

32. What translocations can cause c - myc overexpression?
TSh (in testicular tumors can cause hyperthyroidism)
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
8 (myc protein) with 2 - 14 - 22 (iG chains)
Measles and M3 AML`

33. What is the precursor protein to beta amyloid and On what chromosome is it found?
FGF and VEGF
Relfex tachycardia; giving beta blockers
Nonsense; mRNA processing
APP on chrom 21 (this is why downs more susceptible)

34. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
Secretin stimulates the exocrine pancrease; S enteroendocrine cells in duodenal mucosa in response to acid secrete secretin (HCL is most potent stimulus for secretin release)
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Adductor
Retinitis; mononucleosis

35. What is the mc location of brain germinomas?What are the classic symptoms?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
manifestations - congenital (stretching of periventricular pyrimadal fibers)
The time interval between S2 and OS- the shorter the interval - the more intense

36. If a patient has higher levels of HbF - What does this mean?
Think Hb deformation diseases
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Bronchogenic carcinoma
Because gamma chains replace beta chains and then gamma chain formation wanes

37. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
Vascular endothelium; protease
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Paramyxo and influenza
Hexokinase

38. what indicates the severity of a mitral regurg ? mitral stenosis?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Leukotriene precursor and does neutrophil chemotaxis
Close but purkinje system to ensure contraction in a bottom up fashion
S3 gallop; S2 to opening snap interval

39. How do you calculate atributable risk percent?
RR-1/RR
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Purkinje system; AV node
No; yes

40. Where does terminal peptide cleavage of collagen fibrils take place?
Multiple miscarriages d/t hypercoaguability
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
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
In the extracellular space

41. which two drug types can cause orthostatic hypotension (think depression and BPH)?
TCAs and prazosin
To pump calcium out in cardiac myocytes so that relaxation occurs
Hydrogen bonds dictate alpha or beta structure
transcription activation/suppression

42. What is best to prevent GBS infection in a baby?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
INTRApartum Abs (ampicillin/penicillin)
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
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

43. What is the best indicator for the severity of mitral stenosis?
Normally close to systolic
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
The time interval between S2 and OS- the shorter the interval - the more intense
Myasthenia gravis

44. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Class I
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Echinococcus granulosus; anaphylaxis

45. What three factors effect total oxygen content of blood?
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Classical conditioning
Biphosphonate
High potassium conductance and some sodium conductance

46. What is used to treat heparin toxicity?
Aromatase deficiency in child
P53 mutation; DCC is also required for adenoma to carcinoma
Protamine sulfate
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

47. When is an S4 sound normal?
Increased reticulocytes
Well trained athletes and children
No
Sydenham chorea

48. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Mean greater than median greater than mode
4 - 4 - 9

49. PDAs are often asymptomatic. How do you treat?
8; 12
Standing suddenly from supine position; valsalva maneuver
indomethacin
Chrom 8

50. at three years of age What are social - fine motor - gross motor and language developments?
Localized dermatologic pain that persists for more than one month after zoster eruption
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Hydrogen bonds dictate alpha or beta structure
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences