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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 it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
Integration of viral DNA into genome of host hepatocytes
Vertical diplopia
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
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

2. What is a common complication of acute pancreatitis? What is it?
Fibrosis; macrophages
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Skin flushing and warmth; prostaglandins; give with aspirin
only up to bronchi

3. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Curlings ulcers
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

4. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
Class I
chronic urticaria and allergic symptoms
Sickle cell; G6PD
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

5. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Phencyclidine (PCP)
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Gluteus medius and minimus; positive trendelenberg
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

6. how does noise induced hearing loss occur?
Chorda tympani branch
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Trauma to stereociliated hair cells of the organ of corti
Well trained athletes and children

7. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
I is more benign and can present later in adulthood
Skin flushing and warmth; prostaglandins; give with aspirin
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
Prevents hepatic VLDL production

8. If a patient has higher levels of HbF - What does this mean?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Think Hb deformation diseases
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
When it invades the bm; carcinoma in situ

9. What is capacitance inversely proportional to?
Around 70 (normal measured diastolic pressures); 9--
Elastance
Cluster
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

10. What type of bond is a disulfide bond?
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)
differentiate
Intussusception
Covalent (between two cysteines)- allows protein to withstand denaturation

11. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
E. coli; staphylococcus saprophyticus
Pan colitis and right sided colitis (more than left sided and proctitis)
Tzanck smear

12. What are the three predominant symptoms of VHL? What is its mode of inheritance?
chronic urticaria and allergic symptoms
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Dihydropyridine sensitive Ca channels (L type)

13. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
P53 mutation; DCC is also required for adenoma to carcinoma
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

14. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
APP on chrom 21 (this is why downs more susceptible)
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Tissue redistribution (out of plasma) rather than metabolism
Amiadarone

15. how does eos release MBP to kill protozoa etc?
Ether and other organic solvents
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Abnormal closing of the urethral folds

16. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
Right before diastole (filling begins)
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
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)

17. What pulmonary structural change can kartageners syndrome cause?
Demargination of neutrophils from the vessel walls
APP on chrom 21 (this is why downs more susceptible)
Adeno
Bronchial dilation (bronchiectasis)

18. there are mucus secreting cells in the bronchioles...
HSV and VZV
Headaches and facial flushing; vasodilation in meninges and skin
only up to bronchi
Anti cholinergic effects of pupil dilation and lack of accomodation

19. What are the two coagulase negative staphylococci? How do you distinguish them?
Smoking
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
S. saprophyticus - and s. epidermidis; novobiocin
APP on chrom 21 (this is why downs more susceptible)

20. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
SVC and IVC; right below the aortic knob
Myasthenia gravis
High potassium conductance and some sodium conductance
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

21. How do bradykinin - C3a and C5a cause edema?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Medial part
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
By vascular permeability and vasodilation

22. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
ANCA because of lack of Ig and C3 deposits on IF
Chrom 8
Hereditary angioedema; ACE inhibitors
glycerol kinase

23. What causes release of myosin head from the actin filament?
Prepatellar
ATP binding (resets the myosin head to contract again for next binding)
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
P450 mitochondrial monooxygenase

24. Would alpha 1 agonists cause flushing? muscarinic antagonist?
G to T in p53; HCC
No; yes
Relfex tachycardia; giving beta blockers
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

25. What is epispadias caused by?
Hypertension - edema - and proteinuria
Faulty positioning of the genital tubercle
Close but purkinje system to ensure contraction in a bottom up fashion
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

26. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Serum creatine kinase; reperfusion injury causes necrosis
Rabies encephalitis from cave bats; rabies killed vaccines
Tissue redistribution (out of plasma) rather than metabolism
Vertical diplopia

27. at one year of age - What are the social - fine motor - gross motor and language developments?
Minimal change disease
Regular insulin (Not fast acting - regular better)
Increase in permeability of two ions with equal and opposite equilibrium potentials
Initiation - pointing; pincer grasp; walking; mama/dada

28. h1 receptor anatagonists are not effective in treatment of asthma only for...
11 aa polypeptide; pain NT in CNS and PNS
SSRI; erectile dysfunction
Anterior nares
chronic urticaria and allergic symptoms

29. What is the mc manifestation of CMV in HIV patient? immunocompetent?
Fibronectin - laminin - collagen
G to T in p53; HCC
Brief psychotic disorder; schizophreniform; schizophrenia
Retinitis; mononucleosis

30. What antibodies are present in CREST? What is the most specific?
8; 12
Increases cytokine production
Hypertension - edema - and proteinuria
Anti centromere; anti DNA topoisomerase

31. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
Think Hb deformation diseases
Syringomelia
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
OCPs - multiparity - breast feeding

32. which nucleus releases serotonin?
Raphe
MAC complex (C5b - C9 complement deficiency)
Become beta pleated and then form neurofibrillary tangle!
Common peroneal; bony fractures and compression; sciatic

33. What are two indicators of chronic alcohol consumption?
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
Elevated GGT and macrocytosis
Little effect on cell and no change
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

34. which staphylococci can do mannitol fermaentation?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
I is more benign and can present later in adulthood
Appetite suppressants
S. aureus

35. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Proteasome inhibitor; treatment for MM and waldenstroms
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Turners`
Paramyxo and influenza

36. What are the long term consequences of hydrocephalus?
Vagus nerve stimulation
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

37. What is intussusception? how does ischemia and necrosis occur?
Trauma to stereociliated hair cells of the organ of corti
An invagination of portion of intestine into the lumen of the adjacent intestinal segment; can lead to impaired venous return from the invaginated segment of the bowel which can cause ischemia and subsequent necrosis
IgE
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

38. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Cluster
Minimal change disease
Protamine sulfate

39. What are the first generation anti histamines?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
E. coli; staphylococcus saprophyticus
Medial circumflex artery; avascular necrosis
Chlorpheniramine and diphenhydramine

40. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
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
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)
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

41. what immune deficiency causes recurrent neisseria infections?
Coagulation factors are made in the liver
MAC complex (C5b - C9 complement deficiency)
Mean greater than median greater than mode
Sudden loss of muscle tone without loss of consciousness; narcolepsy

42. what organ would an activating mutation in PRPP synthetase effect?
Anti centromere; anti DNA topoisomerase
Joints d/t increased purine production and thus uric acid production
Increase; decreased
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

43. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Superior larygeal; cricothyroid; recurrent laryngeal
SSRI

44. What is the difference between additive and synergistic?
Env genes (for getting into target cells)
AV node slowest - to allow time for diastole
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
liver specific

45. within the right atrium - What is the maximum pressure? left atrium?
8; 12
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
Drug induced interstitial nephritis
Ketone body production by preventing fatty acids into the mitochondria

46. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
differentiate
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

47. What is the cause of rapid plasma decay of thiopental?
<1% - 55% - concentration dependent
Ceftriaxone; azithromycin
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Tissue redistribution (out of plasma) rather than metabolism

48. What are some side effects seen in TCAs?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Nonsense; mRNA processing
Increase by 50% in urine osmolality

49. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
P53 mutation; AD
gram positive organisms
Because of the low output from heart failure - they will have increased aldosterone levels

50. What are pancreatic pseudocysts called pseudo rather than true cysts?
IgE
Octreotide
Not lined by epithelium
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours