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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. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
low in serum
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
Cluster
No and yes

2. which type of glands produce an initially odorless secretion but can become malodorous secondary to bacterial decompisition on the skin surface? which glands are present throughout the skin except on lips and glans penis?
E. coli; staphylococcus saprophyticus
Dihydropyridine sensitive Ca channels (L type)
V fib; v. failure
Apocrine; eccrine

3. what would be a sign of absence of cardiogenic pulm edem?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
OCPs - multiparity - breast feeding
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Become beta pleated and then form neurofibrillary tangle!

4. How do bradykinin - C3a and C5a cause edema?
Fibronectin - laminin - collagen
Bronchogenic carcinoma
By vascular permeability and vasodilation
RER; copper

5. 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)
Selective alpha 1 (increases SVR)
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Downs; regurgitant AV valves - ASDs

6. What is the diagnosis in delayed puberty plus anosmia?
Think Hb deformation diseases
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Kallmans
NF- KB; responsible for cytokine production

7. on which chromosome is wilms tumor found?
Demargination of neutrophils from the vessel walls
Trauma to stereociliated hair cells of the organ of corti
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
11

8. Where does the aorta lie in relation to the pulmonary artery in transposition of the great arteries (is this right to left or left to right shunt?)?
Fibronectin - laminin - collagen
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)
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)
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

9. where are Beta 1 receptors found?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
On cardiac tissue and renal juxtaglomerular cells
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Increase by 50% in urine osmolality

10. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Elastance
Another type of aldosterone antagonist (like spironolactone)
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

11. other than proteinuria - What can cause foamy froathy urine?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Atrial
Tzanck smear
Bile salt accumulation in urine

12. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Pan colitis and right sided colitis (more than left sided and proctitis)
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Dihydropyridine sensitive Ca channels (L type)
Tissue redistribution (out of plasma) rather than metabolism

13. What is the mc manifestation of CMV in HIV patient? immunocompetent?
Hypertension - edema - and proteinuria
Bile soluble which means they are bile sensitive
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Retinitis; mononucleosis

14. Where does 90% of serotonin lie? What is this NT responsible?
Selective alpha 1 (increases SVR)
GI tract; mood!
Hereditary angioedema; ACE inhibitors
Turners`

15. what drugs causes the red man syndrome? how does it occur?
Vancomycin; histamine mediated
HSV and VZV
Appetite suppressants
liver specific

16. What is the primary histologic finding in patients with eczematous dermatitis?
SaO2 <92%
Medial part
Around 70 (normal measured diastolic pressures); 9--
Spongiosis

17. What is the mainstay treatment for acute mania?
Adductor
Joints d/t increased purine production and thus uric acid production
Aromatase deficiency in child
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

18. What does sustained hand grip do to the C/V system?
MAC complex (C5b - C9 complement deficiency)
Increases
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Varying; erythema nodosum is common

19. What is epispadias caused by?
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)
Faulty positioning of the genital tubercle
Relatively selective B1 adrenergic agonist; acute heart failure with decreased myocardial contractility (cardiogenic shock); increases myocardial contractility; can induce arrhythmias because increases cardiac conduction velocity

20. How do you explain the selective proteinuria of loss to albumin only in MCD?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Duration and extent of disease
SS +rNA

21. When is an S4 sound normal?
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
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Well trained athletes and children
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

22. What is used to prevent vertical transmission of HIV?
Amiloride - spironolactone - triamterene
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)
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
ZDV or AZT

23. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Skin flushing and warmth; prostaglandins; give with aspirin
TSh (in testicular tumors can cause hyperthyroidism)
ANCA because of lack of Ig and C3 deposits on IF

24. what organ would an activating mutation in PRPP synthetase effect?
Joints d/t increased purine production and thus uric acid production
Spongiosis
Susceptible; soluble (unable to be cultured in bile)
Sydenham chorea

25. which virus inactivates both Rb and p53?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
4 - 4 - 9
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)
E6 and E7 of HPV knock off p53 and Rb suppressor genes

26. which RPGN is also called pauci immune GN? why?
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
ANCA because of lack of Ig and C3 deposits on IF
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Terminal bronchioles; small bronchi

27. What does protein M do in Group A strep<
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Prevent phagocytosis
Diabetic microangiopathy

28. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
Apocrine; eccrine
S. saprophyticus - and s. epidermidis; novobiocin
Class I
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

29. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
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)
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
P53 mutation; AD

30. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Vagus (auricular branch); vasovagal syncope!
PDA open
Increased reticulocytes

31. how long is substance P? What does it do?
Recurrent larygneal
11 aa polypeptide; pain NT in CNS and PNS
CGD; t cell dysfxn (diGeorge)
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

32. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Env genes (for getting into target cells)
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

33. What causes curlings ulcers?
Squatting - sitting - lying supine - passive leg raising
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
liver specific

34. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
Selective alpha 1 (increases SVR)
Think Hb deformation diseases
Minimal change disease
Ig A deficiency

35. What are the skin presentation in sarcoid?
AV node slowest - to allow time for diastole
Because gamma chains replace beta chains and then gamma chain formation wanes
Varying; erythema nodosum is common
Headaches and facial flushing; vasodilation in meninges and skin

36. What is best to prevent GBS infection in a baby?
Coagulation factors are made in the liver
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
INTRApartum Abs (ampicillin/penicillin)
Thymic tumor

37. What is difference between Arnold Chiari type I and II?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Underestimation of gestational age
I is more benign and can present later in adulthood
Because gamma chains replace beta chains and then gamma chain formation wanes

38. which opponens muscle does ulnar innervate?
Syringomelia
Adductor
Localized dermatologic pain that persists for more than one month after zoster eruption
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

39. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Class I
I is more benign and can present later in adulthood
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

40. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Southern - western
Aromatase deficiency in child
Downs; regurgitant AV valves - ASDs
TCAs and prazosin

41. Where is the base of the heart? apex?
Closer to head; closer to diaphragm
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Pan colitis and right sided colitis (more than left sided and proctitis)
Bronchial dilation (bronchiectasis)

42. Which is faster atrial muscle or ventricular muscle?
Boiling - bleach - formalin - UV irradiation
Valproate
Increases
Atrial

43. What is epleronone?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
E. coli
Another type of aldosterone antagonist (like spironolactone)
Right heart failure

44. What can too much IgA in serum produces?
Squatting - sitting - lying supine - passive leg raising
RER; RER
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

45. What is the mcc of extrinsic allergic asthma?
SaO2 <92%
Abnormal closing of the urethral folds
Inhaled animal dander allergens
S3 gallop; S2 to opening snap interval

46. What are the two growth factors associated with angiogenesis?
FGF and VEGF
In ER of bile canaliculi
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Headaches and facial flushing; vasodilation in meninges and skin

47. why does variocele occur more in left side?
Headaches and facial flushing; vasodilation in meninges and skin
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Minimal change disease

48. What type of vision is myopia? In What type of patients does it improve?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
SVT; increases vagal tone; rectus abdominis
Localized dermatologic pain that persists for more than one month after zoster eruption
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

49. 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
The term used to describe decreased drug responsiveness with repeated administration
Selective alpha 1 (increases SVR)
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

50. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Standing suddenly from supine position; valsalva maneuver
RER; copper
Susceptible; soluble (unable to be cultured in bile)