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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?
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Hydrogen bonds dictate alpha or beta structure
Not lined by epithelium
C3 decreased after 5-10 days; sulfonamides

2. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Regular insulin (Not fast acting - regular better)
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Lateral; RV; RA; LV
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

3. How do left sided colon adenocarcinomas present? right sided?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Increases cytokine production
Southern - western
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

4. What is the fibrinogen level in patient with TTP- HUS? DIC?
Normal; low
Right heart failure
Squatting - sitting - lying supine - passive leg raising
Sudden loss of muscle tone without loss of consciousness; narcolepsy

5. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Increased reticulocytes
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

6. how can HAV be inactivated?
Pan colitis and right sided colitis (more than left sided and proctitis)
Boiling - bleach - formalin - UV irradiation
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
RER; copper

7. 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
Chlorpheniramine and diphenhydramine
Hexokinase
I is more benign and can present later in adulthood

8. What type of endocarditis is cytoscopy induced?
Enterococci (e. faecalis)- found on genitalia area
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
8; 12
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

9. What pulmonary structural change can kartageners syndrome cause?
Bronchial dilation (bronchiectasis)
G to T in p53; HCC
Selective alpha 1 (increases SVR)
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

10. What is the presentation of angioedema? Where is most commonly affected?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Standing suddenly from supine position; valsalva maneuver
Atrial
As a CO2 carrier with the carboxylase enzyme

11. if there are keratin swirls does that mean well or poorly differentiated?
Trauma to stereociliated hair cells of the organ of corti
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Well
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

12. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
SSRI; erectile dysfunction
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
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

13. nucleotide deletions do not cause missense mutations - they cause...
Kallmans
Phencyclidine (PCP)
frameshift mutations (missense is substitution)
Trauma to stereociliated hair cells of the organ of corti

14. If a patient has higher levels of HbF - What does this mean?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Hypo or hyper pigmentations; after tanning
Think Hb deformation diseases

15. Where does 90% of serotonin lie? What is this NT responsible?
GI tract; mood!
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
In ER of bile canaliculi

16. What type of calcium channels dictate the plateau in cardiac myocyte?
Chorda tympani branch
Dihydropyridine sensitive Ca channels (L type)
8; 12
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

17. What does extended consumption of appetite suppressants lead to?
Pulmonary hypertension
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Increases
Medial circumflex artery; avascular necrosis

18. What are diastolic (lowest) pressures in aorta? LV?
differentiate
Around 70 (normal measured diastolic pressures); 9--
Brief psychotic disorder; schizophreniform; schizophrenia
hyponatremia (aldosterone activation equilibrates body volume)

19. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Nonsense; mRNA processing
Intussusception
transcription activation/suppression

20. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Ether and other organic solvents

21. What test would be best to determine if a gene is being transcribed? translated?
Southern - western
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
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

22. What is used to treat heparin toxicity?
Hexokinase
Vagus nerve stimulation
Nonsense; mRNA processing
Protamine sulfate

23. what kind of drug is sertraline? What is a common side effect?
Fat - fertile - forty - female
differentiate
8 (myc protein) with 2 - 14 - 22 (iG chains)
SSRI; erectile dysfunction

24. hypertonicity and hyperreflexity are ________________ of hydrocephalus
Common peroneal; bony fractures and compression; sciatic
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Right before diastole (filling begins)

25. what would be a sign of absence of cardiogenic pulm edem?
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
Fibrosis; macrophages
RR-1/RR
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

26. What is used to compare means? categorical outcomes?
T test; chi squared
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Radial nerve and deep brachial artery
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

27. Is there edema in primary Conns? secondary hyperaldosteronism? why?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
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
Increase lymphatic drainage!

28. why does neutrophila occur with corticosteroids?
Fibrosis; macrophages
Demargination of neutrophils from the vessel walls
Become beta pleated and then form neurofibrillary tangle!
No (unlike adenomyosis); yes

29. which viruses require a protease?
Dissolved in plasma and attached to Hgb
Duration and extent of disease
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
SS +rNA

30. what chromosome is c - myc found on?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Inhaled animal dander allergens
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Chrom 8

31. what makes bruits?
Measles and M3 AML`
S3 gallop; S2 to opening snap interval
Turbulence
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

32. What is intussusception? how does ischemia and necrosis occur?
FGF and VEGF
T test; chi squared
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
Primary

33. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Nocardia
facultative intracellular
Fibronectin - laminin - collagen
TSh (in testicular tumors can cause hyperthyroidism)

34. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
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
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)
8 (myc protein) with 2 - 14 - 22 (iG chains)

35. What is the primary histologic finding in patients with eczematous dermatitis?
Classical conditioning
Spongiosis
25; 25
ZDV or AZT

36. How do you calculate excretion rate of a substance? How do you calculate the filtration rate of a substance? clearance of what substance estimates the GFR?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Radial nerve damage
Reiter syndrome; B27

37. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Drug induced interstitial nephritis
CGD; t cell dysfxn (diGeorge)
women

38. why does hypothyroidism cause increased CPK levels?
Echinococcus granulosus; anaphylaxis
Hexokinase
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Mean greater than median greater than mode

39. How do you treat gonococcal infection? chlymadia?
Ceftriaxone; azithromycin
Normally close to systolic
Biphosphonate
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

40. How do you calculate RPF from urine PAH?
Nocardia
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Turbulence
(urine PAH x urine flow rate)/plasma PAH

41. which antiarrythmic is associated with blue gray discoloration ?
Amiadarone
Inhibits it
Hypothyroidism
Multiple miscarriages d/t hypercoaguability

42. what has the greatest effect on prognosis when treating c. diptheriae?
Anterior nares
Initiation - pointing; pincer grasp; walking; mama/dada
Well
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

43. within the right atrium - What is the maximum pressure? left atrium?
SVT; increases vagal tone; rectus abdominis
CMV - HSV 1 - Candida
8; 12
S. saprophyticus - and s. epidermidis; novobiocin

44. which two virus families have hemagluttinin on their surface?
Large stroke volumes with ventricular contraction; aortic regurg
Increase in permeability of two ions with equal and opposite equilibrium potentials
Because of vasodiation to skeletal muscles
Paramyxo and influenza

45. What is the Na/Ca exchange used for?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Regular insulin (Not fast acting - regular better)
PDA open
To pump calcium out in cardiac myocytes so that relaxation occurs

46. What is the most common initital symptom of ADPKD? what else?
GI malignancies and Insulin resistance (acromegal for ex)
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Medial part
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

47. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Susceptible; soluble (unable to be cultured in bile)
No and yes
Faulty positioning of the genital tubercle

48. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Neisseria induced small cell vasculitis (including hands and soles)
In ER of bile canaliculi
Skin flushing and warmth; prostaglandins; give with aspirin
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

49. What is extraocular muscle weakness a common symptom of?
V fib; v. failure
Serum creatine kinase; reperfusion injury causes necrosis
Myasthenia gravis
Increases

50. What does p53 do? what chrom is it on?
Raphe
Prevent phagocytosis
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17