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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. which staphylococci can do mannitol fermaentation?
Radial nerve damage
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
S. aureus
Vertical diplopia

2. What are the skin presentation in sarcoid?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Varying; erythema nodosum is common
Appetite suppressants
manifestations - congenital (stretching of periventricular pyrimadal fibers)

3. What can cause aortic regurg? What is the heart sound you hear?
Fibronectin - laminin - collagen
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
In ER of bile canaliculi
Valproate

4. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Nocardia
Skin flushing and warmth; prostaglandins; give with aspirin
women
On cardiac tissue and renal juxtaglomerular cells

5. the rate of blood flow of which two circulations must equal each other at all times?
Pulmonic and systemic!
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
DIC; TTP- HUS dont bleed that much
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

6. What is the immune deficinecy seen in ataxia telangactasia?
INTRApartum Abs (ampicillin/penicillin)
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
APP on chrom 21 (this is why downs more susceptible)
Ig A deficiency

7. What effects does cortisol have on catecholamines?
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Pain reliever - reduces pain by locking substance P in the PNS
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
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

8. what should you think of in 'smear of an oral ulcer base'?
Bronchogenic carcinoma
Nocardia
Tzanck smear
Dihydropyridine sensitive Ca channels (L type)

9. What is hypospadias caused by?
Right heart failure
Abnormal closing of the urethral folds
On cardiac tissue and renal juxtaglomerular cells
E. coli; staphylococcus saprophyticus

10. What are the potassium sparing diuretics?
Another type of aldosterone antagonist (like spironolactone)
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Amiloride - spironolactone - triamterene
RER; RER

11. What is extraocular muscle weakness a common symptom of?
Bile soluble which means they are bile sensitive
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
Myasthenia gravis
Leukotriene precursor and does neutrophil chemotaxis

12. In what view of CXR is anterior part of heart best seen? anterior part of heart is formed by?right border of heart is formed by? left border?
Lateral; RV; RA; LV
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Curlings ulcers
Radial nerve damage

13. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Lateral; RV; RA; LV
Prepatellar
Rabies encephalitis from cave bats; rabies killed vaccines
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

14. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
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
Large stroke volumes with ventricular contraction; aortic regurg
Insulin like growth factor 1 (just another name)
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

15. which two virus families have hemagluttinin on their surface?
SVT; increases vagal tone; rectus abdominis
Rabies encephalitis from cave bats; rabies killed vaccines
Paramyxo and influenza
Measles and M3 AML`

16. which RPGN is also called pauci immune GN? why?
Cluster
ANCA because of lack of Ig and C3 deposits on IF
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
No

17. what happens with LDL receptor density in statin therapy?
chronic urticaria and allergic symptoms
Increases
Inhibits it
Tibial

18. What is the triad seen in pre eclampsia?
Hypertension - edema - and proteinuria
Enterococci (e. faecalis)- found on genitalia area
OCPs - multiparity - breast feeding
Vagus nerve stimulation

19. at three years of age What are social - fine motor - gross motor and language developments?
Joints d/t increased purine production and thus uric acid production
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Increase in permeability of two ions with equal and opposite equilibrium potentials

20. why does liver dysfunction cause coagulation disorders?
transcription activation/suppression
Coagulation factors are made in the liver
RBC mass; epo levels (secondary has high)
Sydenham chorea

21. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
By vascular permeability and vasodilation
liver specific
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

22. Where does conjugation of bilirubin take place?
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
Intussusception
In ER of bile canaliculi
Gluteus medius and minimus; positive trendelenberg

23. why are pregnant predisposed to cholelithiasis?
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
No and yes
2 -3 BPG; glycolysis - instead of ATP; erythrocytes because want to right shift the oxygen dissociation curve so that oxygen is released from RBCs into tissue
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

24. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
Turbulence
LT (LTD4 - E4 - C4) - and Ach
25; 25
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

25. What are three symptoms in s.typhi?
HSV and VZV
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
FGF and VEGF
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

26. which cells produce surfactant? which ones mediate gas exchange?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
APP on chrom 21 (this is why downs more susceptible)
II; I (I more abundant)
Measles and M3 AML`

27. What are examples of action that decrease venous return to the heart?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Tibial
Standing suddenly from supine position; valsalva maneuver
Diabetic microangiopathy

28. What type of bond is a disulfide bond?
8 (myc protein) with 2 - 14 - 22 (iG chains)
Covalent (between two cysteines)- allows protein to withstand denaturation
OCPs - multiparity - breast feeding
Inhibits it

29. neisseria are...
Chorda tympani branch
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
facultative intracellular
Increase by 50% in urine osmolality

30. What is the sole neurologic manifestation of acute rheumatic fever?
Curlings ulcers
Bile salt accumulation in urine
Sydenham chorea
low in serum

31. sporadic colon cancer tend to arise From what type of polyps?
Vagus nerve stimulation
Minimal change disease
Single adenomatous ones
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

32. what chromosome is c - myc found on?
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Pan colitis and right sided colitis (more than left sided and proctitis)
Chrom 8
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

33. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
indomethacin
HSV ( also in utero: chlymadia - neisseria - group B strep)
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
women

34. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Anterior nares
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
RER; copper

35. IL4 is used for isotypye switching to what?
IgE
Drug induced interstitial nephritis
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
AV node slowest - to allow time for diastole

36. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
differentiate
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
G to T in p53; HCC

37. In what form are mitochondrial DNA? What do they transcribe?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Sydenham chorea
HSV and VZV
Circular - outside nucleus; transport proteins - rRNA - tRNA

38. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
Kallmans
E6 and E7 of HPV knock off p53 and Rb suppressor genes
MAO inhibitors; wine and cheese
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

39. within the right ventricle - What are maximum pressures? the pulm arter?
Drink plenty of fluids
Because of vasodiation to skeletal muscles
only up to bronchi
25; 25

40. What is achalasia and how would this correlate on the esophageal mannometry?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Aromatase deficiency in child
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
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

41. what diseases can vit A be used to treat?
MAC complex (C5b - C9 complement deficiency)
manifestations - congenital (stretching of periventricular pyrimadal fibers)
8 (myc protein) with 2 - 14 - 22 (iG chains)
Measles and M3 AML`

42. What does glycosylase do to DNA? endonuclease? lyase? What does the order here of enzymes represent? what other enzymes are needed?

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43. are there signs of inflammation in avascular necrosis? then How do you diagnose?
The time interval between S2 and OS- the shorter the interval - the more intense
No; MRI
Proteasome inhibitor; treatment for MM and waldenstroms
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

44. What is the presentation of sever aortic stenosis?
Sydenham chorea
Fat - fertile - forty - female
Syncope - angina - dyspnea (SAD)
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

45. What is Bortezomib and What is it used for?
PDA open
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Valproate
Proteasome inhibitor; treatment for MM and waldenstroms

46. What is tachyphylaxis?
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
Little effect on cell and no change
The term used to describe decreased drug responsiveness with repeated administration
Vagus (auricular branch); vasovagal syncope!

47. what organ would an activating mutation in PRPP synthetase effect?
Medial circumflex artery; avascular necrosis
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Joints d/t increased purine production and thus uric acid production
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

48. Where does 90% of serotonin lie? What is this NT responsible?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
GI tract; mood!
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
Ether and other organic solvents

49. how does increased ICP result in curlings ulcers?
Hereditary angioedema; ACE inhibitors
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Vagus nerve stimulation
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

50. What is the presentation of angioedema? Where is most commonly affected?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)