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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. Which nerve lies in close proximity to the inferior thyroid artery?
Recurrent larygneal
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Vascular endothelium; protease

2. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Skin flushing and warmth; prostaglandins; give with aspirin
Serum creatine kinase; reperfusion injury causes necrosis
Extrinsic def; instrinsic def; platelet def
Susceptible; soluble (unable to be cultured in bile)

3. What is suggestive of complete central DI?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
INTRApartum Abs (ampicillin/penicillin)
Increase by 50% in urine osmolality
Aromatase deficiency in child

4. When is an S4 sound normal?
E. coli
Susceptible; soluble (unable to be cultured in bile)
200-500
Well trained athletes and children

5. other than proteinuria - What can cause foamy froathy urine?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Covalent (between two cysteines)- allows protein to withstand denaturation
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)
Bile salt accumulation in urine

6. What is the most common initital symptom of ADPKD? what else?
Retinitis; mononucleosis
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Demargination of neutrophils from the vessel walls
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

7. What are two indicators of chronic alcohol consumption?
<1% - 55% - concentration dependent
Hypertension - edema - and proteinuria
Elevated GGT and macrocytosis
Joints d/t increased purine production and thus uric acid production

8. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
In the extracellular space for collagen cross linking; zinc
SVT; increases vagal tone; rectus abdominis

9. What is cataplexy and When is it seen?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Bronchogenic carcinoma
On cardiac tissue and renal juxtaglomerular cells
Sudden loss of muscle tone without loss of consciousness; narcolepsy

10. how does neisseria cause a petechial rash?
G to T in p53; HCC
Neisseria induced small cell vasculitis (including hands and soles)
Drug induced interstitial nephritis
Gluteus medius and minimus; positive trendelenberg

11. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
No; yes
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Close but purkinje system to ensure contraction in a bottom up fashion
differentiate

12. What are the two coagulase negative staphylococci? How do you distinguish them?
Because of vasodiation to skeletal muscles
S. saprophyticus - and s. epidermidis; novobiocin
Covalent (between two cysteines)- allows protein to withstand denaturation
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

13. which nerve in the lower leg is easily injured and causes foot drop ? What are common causes? From what nerve does it branch off or?
Common peroneal; bony fractures and compression; sciatic
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
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
HSV ( also in utero: chlymadia - neisseria - group B strep)

14. What is achalasia and how would this correlate on the esophageal mannometry?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
In ER of bile canaliculi
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
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

15. What can cause aortic regurg? What is the heart sound you hear?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
GI tract; mood!
Increases

16. what makes bruits?
frameshift mutations (missense is substitution)
Southern - western
Turbulence
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

17. Where does 90% of serotonin lie? What is this NT responsible?
GI tract; mood!
HSV and VZV
Rabies encephalitis from cave bats; rabies killed vaccines
11

18. Which is faster purkinje system or atrial muscle?
facultative intracellular
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Close but purkinje system to ensure contraction in a bottom up fashion
Nonsense; mRNA processing

19. What are the potassium sparing diuretics?
Amiloride - spironolactone - triamterene
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
GI tract; mood!

20. What is difference between Arnold Chiari type I and II?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
only up to bronchi
Recurrent larygneal
I is more benign and can present later in adulthood

21. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
Hypothyroidism
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
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
Pulmonary hypertension

22. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
LT (LTD4 - E4 - C4) - and Ach
Hypertension - edema - and proteinuria
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Vagus (auricular branch); vasovagal syncope!

23. what immune deficiency causes recurrent neisseria infections?
Little effect on cell and no change
MAC complex (C5b - C9 complement deficiency)
frameshift mutations (missense is substitution)
...

24. What is the mc manifestation of CMV in HIV patient? immunocompetent?
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Decreases both
Retinitis; mononucleosis

25. What are some side effects seen in TCAs?
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Adductor
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

26. What is the mc location of brain germinomas?What are the classic symptoms?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Strength of cell mediated immune response
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

27. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Syringomelia
Medullary
Not lined by epithelium
Southern - western

28. what protein is increased in Crohns disease? What does it do?
Apocrine; eccrine
NF- KB; responsible for cytokine production
frameshift mutations (missense is substitution)
Highly negative resting potential

29. What is the cause of fixed splitting of S2? why?
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Anti - apoptotic (prevents going into apoptosis)- 18; 14
8 (myc protein) with 2 - 14 - 22 (iG chains)
LT (LTD4 - E4 - C4) - and Ach

30. What is the immune deficinecy seen in ataxia telangactasia?
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
Ig A deficiency
No; yes
Terminal bronchioles; small bronchi

31. biotin is used By what in tissues responsible for gluconeogenesis
Serum FFA and serum triglyceride levels
Smoking
As a CO2 carrier with the carboxylase enzyme
Elevated GGT and macrocytosis

32. What is a cell surface marker seen in liver angiosarcoma?
P53 mutation; AD
TSh (in testicular tumors can cause hyperthyroidism)
Paramyxo and influenza
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

33. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
25; 25
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Apocrine; eccrine
Increase in permeability of two ions with equal and opposite equilibrium potentials

34. what has the greatest effect on prognosis when treating c. diptheriae?
Skin flushing and warmth; prostaglandins; give with aspirin
In the extracellular space
Acute gastric mucosal defects (superficial or full thickness)
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

35. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
women
When it invades the bm; carcinoma in situ
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Neisseria induced small cell vasculitis (including hands and soles)

36. What does protein M do in Group A strep<
AV node slowest - to allow time for diastole
Myasthenia gravis
Prevent phagocytosis
In the extracellular space for collagen cross linking; zinc

37. What is capsaicin? Where does it work?
Leukotriene precursor and does neutrophil chemotaxis
Pain reliever - reduces pain by locking substance P in the PNS
Well trained athletes and children
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

38. what receptors do first generation anti histamines block?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Tissue redistribution (out of plasma) rather than metabolism
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

39. what vessel would a fracture to the neck of the of the humerus damage?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Anterior circumflex (and axillary nerve)
Think Hb deformation diseases
Measles and M3 AML`

40. What are the three causes of acute MI in context of normal coronary arteries ?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
C3 decreased after 5-10 days; sulfonamides
Kallmans

41. What is Bortezomib and What is it used for?
S3 gallop; S2 to opening snap interval
Proteasome inhibitor; treatment for MM and waldenstroms
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Southern - western

42. name three pathological states that present with large tongues.
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)
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Tibial
Reticulocytes

43. how can HAV be inactivated?
Paramyxo and influenza
Boiling - bleach - formalin - UV irradiation
GI malignancies and Insulin resistance (acromegal for ex)
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

44. When does neovascularization granulation tissue begin to form after severe ischemia and MI? what happens in 12-24 hours? 2 weeks to 2 months? 1-5 days? 0-4 hours? when do you see edema - hemorrhage - wavy fibers?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
S. aureus
Opiate anti diarrheal that binds to mu opiate receptors in GI tract and slows motility; meperidine; low doses - but therapeutic doses combined with atropine (under marked brand name lomotil)

45. What is the sole neurologic manifestation of acute rheumatic fever?
Protamine sulfate
Sydenham chorea
Ether and other organic solvents
Another type of aldosterone antagonist (like spironolactone)

46. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Coagulation factors are made in the liver
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

47. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Fibronectin - laminin - collagen
P53 mutation; DCC is also required for adenoma to carcinoma
Ig A deficiency
Reticulocytes

48. If a patient has higher levels of HbF - What does this mean?
Think Hb deformation diseases
Downs; regurgitant AV valves - ASDs
manifestations - congenital (stretching of periventricular pyrimadal fibers)
The time interval between S2 and OS- the shorter the interval - the more intense

49. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
Extrinsic def; instrinsic def; platelet def
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
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
Circular - outside nucleus; transport proteins - rRNA - tRNA

50. What is the most common location of colonization of all s. aureus types?
Inactivates kallikrein which activates kininogen into bradykinin
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Inhaled animal dander allergens
Anterior nares