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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 most common neurologic complication of VZV reactivation?
Localized dermatologic pain that persists for more than one month after zoster eruption
Serum creatine kinase; reperfusion injury causes necrosis
Fibronectin - laminin - collagen
Become beta pleated and then form neurofibrillary tangle!

2. 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?
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
Vascular endothelium; protease
Common peroneal; bony fractures and compression; sciatic
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)

3. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Large stroke volumes with ventricular contraction; aortic regurg
HSV ( also in utero: chlymadia - neisseria - group B strep)
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Normal; low

4. How do bradykinin - C3a and C5a cause edema?
Vancomycin; histamine mediated
By vascular permeability and vasodilation
Vascular endothelium; protease
Primary

5. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Echinococcus granulosus; anaphylaxis
Right before diastole (filling begins)
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Syncope - angina - dyspnea (SAD)

6. what murmur is enhanced by decreased blood flow to the heart?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Thymic tumor
Vancomycin
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

7. what locations of UC increase the risk of Colon cancer?
Become beta pleated and then form neurofibrillary tangle!
Pan colitis and right sided colitis (more than left sided and proctitis)
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)
Chorda tympani branch

8. What triggers the neoplastic changes that are associated with HBV infecton?
The time interval between S2 and OS- the shorter the interval - the more intense
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Integration of viral DNA into genome of host hepatocytes
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

9. How do you explain the selective proteinuria of loss to albumin only in MCD?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
On cardiac tissue and renal juxtaglomerular cells
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Lateral; RV; RA; LV

10. what diseases can vit A be used to treat?
Measles and M3 AML`
Chlorpheniramine and diphenhydramine
Enterococci (e. faecalis)- found on genitalia area
The time interval between S2 and OS- the shorter the interval - the more intense

11. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
Curlings ulcers
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
SSRI; erectile dysfunction

12. In What type of nephritis would you see high serum eos count?
Trochlear nerve (IV); abducens nerve (VI)
Closer to head; closer to diaphragm
Drug induced interstitial nephritis
Prostate tumor and increased osteoclast activity

13. What does hypocapnia cause in teh brain? What is hypocapnia?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Hypertension - edema - and proteinuria

14. What is Bortezomib and What is it used for?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Proteasome inhibitor; treatment for MM and waldenstroms
Folic acid treatment!

15. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
Pan colitis and right sided colitis (more than left sided and proctitis)
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Increase by 50% in urine osmolality
Proteasome inhibitor; treatment for MM and waldenstroms

16. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
No (unlike adenomyosis); yes
No; yes

17. What is a common complication of acute pancreatitis? What is it?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Hereditary angioedema; ACE inhibitors
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

18. What is easiest way to treat nephrolithiasis?
Drink plenty of fluids
Prepatellar
Fat - fertile - forty - female
Elastance

19. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
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
Vascular endothelium; protease
Inactivates kallikrein which activates kininogen into bradykinin
Minimal change disease

20. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Downs; regurgitant AV valves - ASDs
APP on chrom 21 (this is why downs more susceptible)
ZDV or AZT
Reiter syndrome; B27

21. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
frameshift mutations (missense is substitution)
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)
Think Hb deformation diseases
Aromatase deficiency in child

22. do Class IC agents prolong the QT interval?
No
No and yes
Medial part
Tibial

23. when do ghon complexes form - primary or secondary TB?
Primary
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
E. coli; staphylococcus saprophyticus
Congenital hypothyroidism - downs - amyloidosis - acromegaly

24. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
200-500
Terminal bronchioles; small bronchi
Trochlear nerve (IV); abducens nerve (VI)

25. What is a cell surface marker seen in liver angiosarcoma?
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
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
indomethacin

26. Which is faster purkinje system or atrial muscle?
Measure of depth invasion (vertical!)
Downs; regurgitant AV valves - ASDs
Close but purkinje system to ensure contraction in a bottom up fashion
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

27. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
By vascular permeability and vasodilation
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Ig A deficiency
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

28. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Nocardia
Medullary
Leukotriene precursor and does neutrophil chemotaxis
Minimal change disease

29. Where is conduction in heart fastest? slowest?
Vancomycin
Valproate
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Purkinje system; AV node

30. What is the most common cause of pyelonephritis in both adults and childre?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
E. coli
Close but purkinje system to ensure contraction in a bottom up fashion
Susceptible; soluble (unable to be cultured in bile)

31. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
facultative intracellular
Rabies encephalitis from cave bats; rabies killed vaccines
Protamine sulfate

32. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
Brief psychotic disorder; schizophreniform; schizophrenia
Turners`
Vagus nerve stimulation
Appetite suppressants

33. What is an abortive viral infection?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Little effect on cell and no change
Fibrosis; macrophages
Pulmonic and systemic!

34. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
Fibronectin - laminin - collagen
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

35. What type of calcium channels dictate the plateau in cardiac myocyte?
Dihydropyridine sensitive Ca channels (L type)
Headaches and facial flushing; vasodilation in meninges and skin
Anterior nares
low in serum

36. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
Inhaled animal dander allergens
Smoking
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
INTRApartum Abs (ampicillin/penicillin)

37. What antibodies are present in CREST? What is the most specific?
Anti centromere; anti DNA topoisomerase
Bronchogenic carcinoma
P53 mutation; AD
Serum FFA and serum triglyceride levels

38. What do you treat s. epidermidis with?
Vancomycin
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Underestimation of gestational age
Terminal bronchioles; small bronchi

39. other than in pyelonephritis - where else are WBC casts seen?
Acute interstitial nephritis
Vascular endothelium; protease
Leukotriene precursor and does neutrophil chemotaxis
Echinococcus granulosus; anaphylaxis

40. What is gardeners mydriasis? How is it treated?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
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
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Classical conditioning

41. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
frameshift mutations (missense is substitution)
Skin flushing and warmth; prostaglandins; give with aspirin
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

42. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
Elevated GGT and macrocytosis
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
No
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)

43. how much percent of sodium is excreted? urea? glucose?
P53 mutation; AD
<1% - 55% - concentration dependent
Retinitis; mononucleosis
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

44. what protein is increased in Crohns disease? What does it do?
NF- KB; responsible for cytokine production
Drink plenty of fluids
Normal; low
Enterococci (e. faecalis)- found on genitalia area

45. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
Syncope - angina - dyspnea (SAD)
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Nonsense; mRNA processing
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

46. What type of drug is alendronate?
P53 mutation; DCC is also required for adenoma to carcinoma
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Mean greater than median greater than mode
Biphosphonate

47. What is used to compare means? categorical outcomes?
Folic acid treatment!
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
T test; chi squared
TSh (in testicular tumors can cause hyperthyroidism)

48. how long is substance P? What does it do?
Lateral; RV; RA; LV
11 aa polypeptide; pain NT in CNS and PNS
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Sudden loss of muscle tone without loss of consciousness; narcolepsy

49. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
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)
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
Sickle cell; G6PD

50. What is the mc location of brain germinomas?What are the classic symptoms?
II; I (I more abundant)
No; MRI
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
SSRI