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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 key lab finding seen in type III serum sickness? What are some drugs that can induce it?
8 (myc protein) with 2 - 14 - 22 (iG chains)
C3 decreased after 5-10 days; sulfonamides
RBC mass; epo levels (secondary has high)
E. coli

2. What does sustained hand grip do to the C/V system?
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)
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Medial part
Common peroneal; bony fractures and compression; sciatic

3. which nerve is at risk when ligating the superior thyroid artery? Which is the only muscle this nerve innervates? what nerve innervates all the other laryngeal muscles?
Superior larygeal; cricothyroid; recurrent laryngeal
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Barium enema
Prepatellar

4. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Valproate
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
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)
Bile soluble which means they are bile sensitive

5. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Abnormal closing of the urethral folds
Close but purkinje system to ensure contraction in a bottom up fashion
Aromatase deficiency in child

6. What is the cause of fixed splitting of S2? why?
H. influenzae type B; polyribosyl phosphate (PRP); cherry red uvula - dysphagia - stridor (sometimes) - difficulty breathing - fever - drooling - positive 'thumbs up sign' on lateral xray of cervical region d/t swollen epiglottis
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Prepatellar

7. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Increase; decreased
Increase lymphatic drainage!
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

8. which two virus families have hemagluttinin on their surface?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Paramyxo and influenza
Chlorpheniramine and diphenhydramine
Thymic tumor

9. how long is substance P? What does it do?
Hypo or hyper pigmentations; after tanning
Anterior nares
Medial circumflex artery; avascular necrosis
11 aa polypeptide; pain NT in CNS and PNS

10. What is the difference between additive and synergistic?
11 aa polypeptide; pain NT in CNS and PNS
Ketone body production by preventing fatty acids into the mitochondria
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
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

11. which headaches are seen mostly in men - are severe - unilateral - periorbital - episodic (around same time every day) - temporal pain - with lacrimation - nasal congestion and ptosis?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Increases cytokine production
Normally close to systolic
Cluster

12. What is the sole neurologic manifestation of acute rheumatic fever?
Vagus (auricular branch); vasovagal syncope!
Sydenham chorea
Highly negative resting potential
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

13. 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
Smoking
Inhibits it
Anti centromere; anti DNA topoisomerase

14. What is the most common cause of pyelonephritis in both adults and childre?
E. coli
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Little effect on cell and no change

15. What is an abortive viral infection?
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Bronchial dilation (bronchiectasis)
Prepatellar
Little effect on cell and no change

16. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
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
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Standing suddenly from supine position; valsalva maneuver

17. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
Valproate
Increase by 50% in urine osmolality
differentiate
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

18. SIADH patients have normal blood volume but...
Elastance
hyponatremia (aldosterone activation equilibrates body volume)
SSRI; erectile dysfunction
Sydenham chorea

19. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Intussusception
Become beta pleated and then form neurofibrillary tangle!
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

20. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
OCPs - multiparity - breast feeding
Increased reticulocytes
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
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

21. why does liver dysfunction cause coagulation disorders?
Coagulation factors are made in the liver
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Hereditary angioedema; ACE inhibitors

22. which has better side effect profile - SSRI or TCA?
Drink plenty of fluids
Raphe
SSRI
Recurrent larygneal

23. what happens to capacitance with age?
...
Amiadarone
Become beta pleated and then form neurofibrillary tangle!
Reticulocytes

24. What does VIP do to gastric acid secretion?
Barium enema
Medullary
Inhibits it
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

25. how does increased ICP result in curlings ulcers?
Vagus nerve stimulation
Drink plenty of fluids
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
DIC; TTP- HUS dont bleed that much

26. do patients with cor pulmonale have increased or decreased levels of aldosterone?
Turbulence
Inhaled animal dander allergens
Pan colitis and right sided colitis (more than left sided and proctitis)
Because of the low output from heart failure - they will have increased aldosterone levels

27. What type of drug is alendronate?
Chorda tympani branch
Superior larygeal; cricothyroid; recurrent laryngeal
Biphosphonate
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

28. other than increasing HDL levels - what else does niacin do?
Standing suddenly from supine position; valsalva maneuver
Drink plenty of fluids
Tzanck smear
Prevents hepatic VLDL production

29. what bursa is affected when on knees like a maid/gardner?
Brief psychotic disorder; schizophreniform; schizophrenia
Prepatellar
Elevated GGT and macrocytosis
In ER of bile canaliculi

30. What is a cell surface marker seen in liver angiosarcoma?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
APP on chrom 21 (this is why downs more susceptible)
S. aureus

31. What is 5- HETE and What does it do?
Leukotriene precursor and does neutrophil chemotaxis
ANCA because of lack of Ig and C3 deposits on IF
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Hypertension - edema - and proteinuria

32. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
V fib; v. failure
Both sides
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
When it invades the bm; carcinoma in situ

33. What is the fibrinogen level in patient with TTP- HUS? DIC?
gram positive organisms
In ER of bile canaliculi
Normal; low
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

34. the rate of blood flow of which two circulations must equal each other at all times?
Pulmonic and systemic!
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Integration of viral DNA into genome of host hepatocytes
<1% - 55% - concentration dependent

35. What is acanthosis nigricans associated with?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
GI malignancies and Insulin resistance (acromegal for ex)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
S. aureus

36. What is cataplexy and When is it seen?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Close but purkinje system to ensure contraction in a bottom up fashion
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Rabies encephalitis from cave bats; rabies killed vaccines

37. What three pathogens cause infectious esophagitis in HIV positive patients?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
CMV - HSV 1 - Candida
Normal; low
MAO inhibitors; wine and cheese

38. What are the first generation anti histamines?
Hypertension - edema - and proteinuria
No; MRI
Chlorpheniramine and diphenhydramine
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

39. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Turners`
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
In ER of bile canaliculi

40. What are the primary determinants of colon cancer risk in UC patients
Duration and extent of disease
Regular insulin (Not fast acting - regular better)
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Intussusception

41. What agonists reduce the gradient across the LV outflow tract?
P53 mutation; DCC is also required for adenoma to carcinoma
Selective alpha 1 (increases SVR)
Apocrine; eccrine
Class I

42. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Reiter syndrome; B27
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
I is more benign and can present later in adulthood
Chorda tympani branch

43. where are Beta 1 receptors found?
On cardiac tissue and renal juxtaglomerular cells
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
TSh (in testicular tumors can cause hyperthyroidism)
Increases

44. What is omalizumab and What is it used for?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Inhaled animal dander allergens
The term used to describe decreased drug responsiveness with repeated administration
Pulmonary hypertension

45. what nerve and artery course along the posterior aspect of the humerus?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Radial nerve and deep brachial artery
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Proteasome inhibitor; treatment for MM and waldenstroms

46. What is the preferred treatment for DKA?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Regular insulin (Not fast acting - regular better)
Another type of aldosterone antagonist (like spironolactone)
Serum FFA and serum triglyceride levels

47. What is the most common neurologic complication of VZV reactivation?
HSV ( also in utero: chlymadia - neisseria - group B strep)
Localized dermatologic pain that persists for more than one month after zoster eruption
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
RER; RER

48. What is hypospadias caused by?
Well
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
Abnormal closing of the urethral folds
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

49. IL4 is used for isotypye switching to what?
IgE
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
TCAs and prazosin
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

50. What are diastolic (lowest) pressures in aorta? LV?
Around 70 (normal measured diastolic pressures); 9--
Ketone body production by preventing fatty acids into the mitochondria
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Protamine sulfate