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USMLE Prep 2

Instructions:

Answer 50 questions in 15 minutes.
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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 can cause aortic regurg? What is the heart sound you hear?
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
E. coli
Leukotriene precursor and does neutrophil chemotaxis
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

2. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Turners`
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Increases
Smoking

3. What is the diagnosis in delayed puberty plus anosmia?
Coagulation factors are made in the liver
Kallmans
E. coli
By vascular permeability and vasodilation

4. If a patient has higher levels of HbF - What does this mean?
8; 12
Purkinje system; AV node
Fibronectin - laminin - collagen
Think Hb deformation diseases

5. What is the mcc of extrinsic allergic asthma?
Because gamma chains replace beta chains and then gamma chain formation wanes
Inhaled animal dander allergens
Right heart failure
Multiple miscarriages d/t hypercoaguability

6. on which chromosome is wilms tumor found?
Increases cytokine production
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
11

7. What antibiotic is best to treat alcoholic pulm infections? why?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
RR-1/RR
Spongiosis
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

8. What is the mc location of brain germinomas?What are the classic symptoms?
Bronchogenic carcinoma
Gluteus maximus; difficulty getting up from seated position and climbing chair
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

9. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Normally close to systolic
Mean greater than median greater than mode
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

10. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
SVT; increases vagal tone; rectus abdominis
APP on chrom 21 (this is why downs more susceptible)
The time interval between S2 and OS- the shorter the interval - the more intense
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

11. What is somatomedin C?
Single adenomatous ones
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Insulin like growth factor 1 (just another name)

12. What are the first generation anti histamines?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
IgE
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
Chlorpheniramine and diphenhydramine

13. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Radial nerve damage
Relfex tachycardia; giving beta blockers
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

14. What pulmonary structural change can kartageners syndrome cause?
Ig A deficiency
To pump calcium out in cardiac myocytes so that relaxation occurs
SaO2 <92%
Bronchial dilation (bronchiectasis)

15. What is a cord factor and Which bugs have it? How do they appear on culture?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
MAO inhibitors; wine and cheese
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Regular insulin (Not fast acting - regular better)

16. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Hypo or hyper pigmentations; after tanning
Normal; low
facultative intracellular
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

17. What does L/S stand for in fetal lung maturity? When does maturity occur?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
In the extracellular space for collagen cross linking; zinc
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

18. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
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
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
...
In ER of bile canaliculi

19. prostaglandin synthesis keeps...
PDA open
Anterior circumflex (and axillary nerve)
Little effect on cell and no change
No and yes

20. What does p53 do? what chrom is it on?
Measure of depth invasion (vertical!)
Acute gastric mucosal defects (superficial or full thickness)
Fibronectin - laminin - collagen
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

21. hypertonicity and hyperreflexity are ________________ of hydrocephalus
Underestimation of gestational age
Susceptible; soluble (unable to be cultured in bile)
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
manifestations - congenital (stretching of periventricular pyrimadal fibers)

22. What are some of the permissive effects of cortisol?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
transcription activation/suppression
Elastance
On cardiac tissue and renal juxtaglomerular cells

23. what has the greatest effect on prognosis when treating c. diptheriae?
Joints d/t increased purine production and thus uric acid production
frameshift mutations (missense is substitution)
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
When it invades the bm; carcinoma in situ

24. which opponens muscle does ulnar innervate?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Adductor
Southern - western
The time interval between S2 and OS- the shorter the interval - the more intense

25. What does protein M do in Group A strep<
Prevent phagocytosis
S. saprophyticus - and s. epidermidis; novobiocin
Pain reliever - reduces pain by locking substance P in the PNS
Increase by 50% in urine osmolality

26. What almost exclusively causes Epliglottitis?What type of capsule does it have? What are the symptoms?

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27. What are the acute effects of corticosteroids on the CBC?
Apocrine; eccrine
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
low in serum

28. what receptors do first generation anti histamines block?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Reticulocytes
ANCA because of lack of Ig and C3 deposits on IF
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

29. what immune deficiency causes recurrent neisseria infections?
Folic acid treatment!
MAC complex (C5b - C9 complement deficiency)
SVT; increases vagal tone; rectus abdominis
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)

30. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
25; 25
Vertical diplopia
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

31. What is capsaicin? Where does it work?
Pain reliever - reduces pain by locking substance P in the PNS
E. coli
Downs; regurgitant AV valves - ASDs
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

32. What is damaged in early syringomelia? later?
Increase lymphatic drainage!
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Retinitis; mononucleosis

33. Where is conduction in heart fastest? slowest?
IgE
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Turners`
Purkinje system; AV node

34. What type of mutation does aflatoxin cause? what cancer does this increase for?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
SVT; increases vagal tone; rectus abdominis
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
G to T in p53; HCC

35. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
Barium enema
differentiate
Initiation - pointing; pincer grasp; walking; mama/dada
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

36. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
Because of vasodiation to skeletal muscles
Reticulocytes
Insulin like growth factor 1 (just another name)
women

37. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
Syringomelia
MAO inhibitors; wine and cheese
Brief psychotic disorder; schizophreniform; schizophrenia
MAC complex (C5b - C9 complement deficiency)

38. What is a clara cell?
MAO inhibitors; wine and cheese
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
TSh (in testicular tumors can cause hyperthyroidism)
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

39. What does hypocapnia cause in teh brain? What is hypocapnia?
Downs; regurgitant AV valves - ASDs
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
V fib; v. failure
Mean greater than median greater than mode

40. how can HAV be inactivated?
S. saprophyticus - and s. epidermidis; novobiocin
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Boiling - bleach - formalin - UV irradiation
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

41. IL4 is used for isotypye switching to what?
IgE
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Apocrine; eccrine
To pump calcium out in cardiac myocytes so that relaxation occurs

42. which staphylococci can do mannitol fermaentation?
Serum FFA and serum triglyceride levels
differentiate
S. aureus
Lateral; RV; RA; LV

43. What does 'oxygen' content in blood refer to?
Fibrosis; macrophages
Regular insulin (Not fast acting - regular better)
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Dissolved in plasma and attached to Hgb

44. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
Mean greater than median greater than mode
Bile soluble which means they are bile sensitive
Minimal change disease
Prevent phagocytosis

45. what hernia has a similar mechanism to hydrocele?
S3 gallop; S2 to opening snap interval
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
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
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

46. is Rifampin ever used as monotherapY? why either way?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
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
As a CO2 carrier with the carboxylase enzyme
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

47. What is achalasia and how would this correlate on the esophageal mannometry?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
AV node slowest - to allow time for diastole
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
Curlings ulcers

48. What causes vertical diplopia? horizontal?
Gluteus medius and minimus; positive trendelenberg
Decreases both
Trochlear nerve (IV); abducens nerve (VI)
T test; chi squared

49. which two virus families have hemagluttinin on their surface?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Inactivates kallikrein which activates kininogen into bradykinin
Proteasome inhibitor; treatment for MM and waldenstroms
Paramyxo and influenza

50. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
ZDV or AZT
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria