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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 is the mc manifestation of CMV in HIV patient? immunocompetent?
SaO2 <92%
Proteasome inhibitor; treatment for MM and waldenstroms
Retinitis; mononucleosis
Both sides

2. other than proteinuria - What can cause foamy froathy urine?
Terminal bronchioles; small bronchi
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Bile salt accumulation in urine

3. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
Chlorpheniramine and diphenhydramine
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Leukotriene precursor and does neutrophil chemotaxis
No

4. What does extended consumption of appetite suppressants lead to?
Chorda tympani branch
OCPs - multiparity - breast feeding
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Pulmonary hypertension

5. which are the only glycosylated proteins in HIV virus?
GI malignancies and Insulin resistance (acromegal for ex)
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
C3 decreased after 5-10 days; sulfonamides
Env genes (for getting into target cells)

6. what drug is useful for secretory diarrhea?
Sarcoid
Octreotide
Sydenham chorea
Multiple miscarriages d/t hypercoaguability

7. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
Atrial
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
Initiation - pointing; pincer grasp; walking; mama/dada
No (unlike adenomyosis); yes

8. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
Hypothyroidism
Acute gastric mucosal defects (superficial or full thickness)
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

9. What is gardeners mydriasis? How is it treated?
Ether and other organic solvents
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
chronic urticaria and allergic symptoms

10. What are the three dopaminergic systems and What are they responsible for? disease?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Aromatase deficiency in child

11. 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
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
G to T in p53; HCC
Medial circumflex artery; avascular necrosis

12. What type of vision is myopia? In What type of patients does it improve?
FGF and VEGF
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 sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
To pump calcium out in cardiac myocytes so that relaxation occurs

13. Where is conduction in heart fastest? slowest?
Tibial
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Purkinje system; AV node
Joints d/t increased purine production and thus uric acid production

14. What would a deflection of the membrane potential to near zero indicate?
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Increase in permeability of two ions with equal and opposite equilibrium potentials
Chlorpheniramine and diphenhydramine
Large stroke volumes with ventricular contraction; aortic regurg

15. What is an abortive viral infection?
Common peroneal; bony fractures and compression; sciatic
Skin flushing and warmth; prostaglandins; give with aspirin
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Little effect on cell and no change

16. how does noise induced hearing loss occur?
Trauma to stereociliated hair cells of the organ of corti
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Atrial
Tissue redistribution (out of plasma) rather than metabolism

17. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
GI malignancies and Insulin resistance (acromegal for ex)
TCAs and prazosin
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
When it invades the bm; carcinoma in situ

18. What causes the blurry vision side effects in first generation anti histamines?
Anti cholinergic effects of pupil dilation and lack of accomodation
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Increase in permeability of two ions with equal and opposite equilibrium potentials
Boiling - bleach - formalin - UV irradiation

19. What is hypospadias caused by?
Increase in permeability of two ions with equal and opposite equilibrium potentials
Abnormal closing of the urethral folds
Reiter syndrome; B27
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

20. How do you treat gonococcal infection? chlymadia?
Ceftriaxone; azithromycin
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
frameshift mutations (missense is substitution)
Myasthenia gravis

21. what hernia has a similar mechanism to hydrocele?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Phencyclidine (PCP)
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

22. What does prolonged PT indicated? aPTT? bleeding time?
Extrinsic def; instrinsic def; platelet def
S. saprophyticus - and s. epidermidis; novobiocin
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)
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

23. What is the most important prognostic indicator in patients with malignant melanoma?
ANCA because of lack of Ig and C3 deposits on IF
Measure of depth invasion (vertical!)
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Elastance

24. What is best to prevent GBS infection in a baby?
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
Duration and extent of disease
INTRApartum Abs (ampicillin/penicillin)
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

25. h1 receptor anatagonists are not effective in treatment of asthma only for...
Chrom 8
chronic urticaria and allergic symptoms
Pulmonary hypertension
Drink plenty of fluids

26. What can long term leg cast wearing cause?
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
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
liver specific
Initiation - pointing; pincer grasp; walking; mama/dada

27. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
The term used to describe decreased drug responsiveness with repeated administration
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Strength of cell mediated immune response

28. What is achalasia and how would this correlate on the esophageal mannometry?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Localized dermatologic pain that persists for more than one month after zoster eruption
CGD; t cell dysfxn (diGeorge)
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

29. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Atrial
E. coli; staphylococcus saprophyticus
low in serum

30. What are some of the permissive effects of cortisol?
Anti cholinergic effects of pupil dilation and lack of accomodation
Chlorpheniramine and diphenhydramine
Susceptible; soluble (unable to be cultured in bile)
Increases bronchial and vascular smooth muscle reactivity to catecholamines

31. What is damaged in early syringomelia? later?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
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)
I is more benign and can present later in adulthood
facultative intracellular

32. What type of disease has selective proteinuria? What is found in urine? What is not?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Increases
Retinitis; mononucleosis
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences

33. how does achalasia present? What does barium swallow show on dilated esophagus?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Proteasome inhibitor; treatment for MM and waldenstroms
Little effect on cell and no change
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

34. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
S3 gallop; S2 to opening snap interval
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Intussusception

35. Where does terminal peptide cleavage of collagen fibrils take place?
Ether and other organic solvents
In the extracellular space
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Increase lymphatic drainage!

36. which virus inactivates both Rb and p53?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
RBC mass; epo levels (secondary has high)
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

37. What is epispadias caused by?
Atrial
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Faulty positioning of the genital tubercle
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

38. What is epleronone?
Inactivates kallikrein which activates kininogen into bradykinin
Another type of aldosterone antagonist (like spironolactone)
Barium enema
Closer to head; closer to diaphragm

39. which opponens muscle does ulnar innervate?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Adductor
Prevents hepatic VLDL production
manifestations - congenital (stretching of periventricular pyrimadal fibers)

40. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Minimal change disease
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Decreases both

41. What are pancreatic pseudocysts called pseudo rather than true cysts?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Not lined by epithelium
GI malignancies and Insulin resistance (acromegal for ex)
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

42. What is omalizumab and What is it used for?
Hereditary angioedema; ACE inhibitors
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Because ACE blocks breakdown of bradykinin and hereditary angioedema patients have high levels of bradykinin; high levels of bradykinin - C3a - and C5a mediate edema by increasing vascular permeability and vasodilation
Mean greater than median greater than mode

43. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Rabies encephalitis from cave bats; rabies killed vaccines
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
SVT; increases vagal tone; rectus abdominis

44. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Nocardia
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Hypertension - edema - and proteinuria
No

45. sporadic colon cancer tend to arise From what type of polyps?
Another type of aldosterone antagonist (like spironolactone)
Ig A deficiency
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Single adenomatous ones

46. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
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)
Acute gastric mucosal defects (superficial or full thickness)
Standing suddenly from supine position; valsalva maneuver
Brief psychotic disorder; schizophreniform; schizophrenia

47. where are the vegetations on the valves of a libman sacks endocarditis?
Susceptible; soluble (unable to be cultured in bile)
Kallmans
Both sides
Strength of cell mediated immune response

48. Where is the base of the heart? apex?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Closer to head; closer to diaphragm
No; MRI
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

49. How do you calculate atributable risk percent?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
RR-1/RR
Normally close to systolic
Regular insulin (Not fast acting - regular better)

50. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
Faulty positioning of the genital tubercle
Bile soluble which means they are bile sensitive
Ketone body production by preventing fatty acids into the mitochondria
Turners`