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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 are three symptoms in s.typhi?
CMV - HSV 1 - Candida
Become beta pleated and then form neurofibrillary tangle!
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
S3 gallop; S2 to opening snap interval

2. what protein is increased in Crohns disease? What does it do?
Turners`
Highly negative resting potential
Gluteus maximus; difficulty getting up from seated position and climbing chair
NF- KB; responsible for cytokine production

3. 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)
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Localized dermatologic pain that persists for more than one month after zoster eruption
Intussusception

4. after a thrombus extraction - what serum enzyme shoots up and why?
11
25; 25
Serum creatine kinase; reperfusion injury causes necrosis
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

5. What are the acute effects of corticosteroids on the CBC?
Ether and other organic solvents
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

6. What type of vision is myopia? In What type of patients does it improve?
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
The time interval between S2 and OS- the shorter the interval - the more intense
Measles and M3 AML`

7. name three pathological states that present with large tongues.
Congenital hypothyroidism - downs - amyloidosis - acromegaly
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)
Tissue redistribution (out of plasma) rather than metabolism
Because of vasodiation to skeletal muscles

8. What are the lab findings in poststreptococcal GN?
V fib; v. failure
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Hyperkalemia; potassium sparing diuretics - potassium supplements
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

9. What is the neurologic manifestation of ADPKD?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Fat - fertile - forty - female
Acute interstitial nephritis
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

10. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
S3 gallop; S2 to opening snap interval
SVC and IVC; right below the aortic knob
Not lined by epithelium
Squatting - sitting - lying supine - passive leg raising

11. why does hypothyroidism cause increased CPK levels?
RER; copper
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Myasthenia gravis
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

12. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
SSRI; erectile dysfunction
LT (LTD4 - E4 - C4) - and Ach
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

13. IL4 is used for isotypye switching to what?
Highly negative resting potential
Measure of depth invasion (vertical!)
Acute gastric mucosal defects (superficial or full thickness)
IgE

14. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Diabetic microangiopathy
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Radial nerve damage
Because of vasodiation to skeletal muscles

15. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Medullary
Drug induced interstitial nephritis
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Large stroke volumes with ventricular contraction; aortic regurg

16. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
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
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Smoking

17. Where does conjugation of bilirubin take place?
In ER of bile canaliculi
Not lined by epithelium
ZDV or AZT
Selective alpha 1 (increases SVR)

18. what happens to capacitance with age?
Drug induced interstitial nephritis
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
...
T test; chi squared

19. what receptors do first generation anti histamines block?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Standing suddenly from supine position; valsalva maneuver
Cluster

20. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
low in serum
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
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Increase; decreased

21. What is the most important prognostic indicator in patients with malignant melanoma?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
SSRI; erectile dysfunction
Enterococci (e. faecalis)- found on genitalia area
Measure of depth invasion (vertical!)

22. how long is substance P? What does it do?
No; yes
Vancomycin; histamine mediated
Measure of depth invasion (vertical!)
11 aa polypeptide; pain NT in CNS and PNS

23. is Rifampin ever used as monotherapY? why either way?
G to T in p53; HCC
Highly negative resting potential
INTRApartum Abs (ampicillin/penicillin)
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

24. What are the two growth factors associated with angiogenesis?
Become beta pleated and then form neurofibrillary tangle!
liver specific
Excessive collagen formation during tissue repair in susceptible individuals
FGF and VEGF

25. What is acanthosis nigricans associated with?
GI malignancies and Insulin resistance (acromegal for ex)
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Pulmonary hypertension
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

26. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
High potassium conductance and some sodium conductance
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Ig A deficiency
Serum FFA and serum triglyceride levels

27. which cells produce surfactant? which ones mediate gas exchange?
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
PDA open
II; I (I more abundant)
Drink plenty of fluids

28. What is the mc manifestation of CMV in HIV patient? immunocompetent?
Rabies encephalitis from cave bats; rabies killed vaccines
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
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
Retinitis; mononucleosis

29. why does neutrophila occur with corticosteroids?
Hereditary angioedema; ACE inhibitors
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
RBC mass; epo levels (secondary has high)
Demargination of neutrophils from the vessel walls

30. SIADH patients have normal blood volume but...
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
hyponatremia (aldosterone activation equilibrates body volume)
Turners`
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

31. erythema nodosum - elevated ACE - scattered granulomas - arthralgias - hilar lymphadenoapthy are indicative of what?
Abnormal closing of the urethral folds
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Classical conditioning
Sarcoid

32. What is congestive hepatomegaly specific for?
Because gamma chains replace beta chains and then gamma chain formation wanes
When it invades the bm; carcinoma in situ
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Right heart failure

33. how can HAV be inactivated?
Duration and extent of disease
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Boiling - bleach - formalin - UV irradiation
Serum creatine kinase; reperfusion injury causes necrosis

34. h1 receptor anatagonists are not effective in treatment of asthma only for...
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Hypothyroidism
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
chronic urticaria and allergic symptoms

35. in overweight individuals What is thought to contribute to insulin resistance?
Another type of aldosterone antagonist (like spironolactone)
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Serum FFA and serum triglyceride levels
Elastance

36. What are the two mcc of focal brain lesions in HIV positive patients?
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)
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
No and yes
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

37. What is the fibrinogen level in patient with TTP- HUS? DIC?
Inactivates kallikrein which activates kininogen into bradykinin
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
Anterior circumflex (and axillary nerve)
Normal; low

38. What is a keloid?
Excessive collagen formation during tissue repair in susceptible individuals
indomethacin
Well trained athletes and children
Env genes (for getting into target cells)

39. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Medial part
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

40. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Excessive collagen formation during tissue repair in susceptible individuals
Chorda tympani branch
PDA open

41. Where is aromatase used?
Inhaled animal dander allergens
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Medial circumflex artery; avascular necrosis

42. What type of endocarditis is cytoscopy induced?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
HSV and VZV
Enterococci (e. faecalis)- found on genitalia area
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

43. How do bradykinin - C3a and C5a cause edema?
By vascular permeability and vasodilation
...
DIC; TTP- HUS dont bleed that much
Echinococcus granulosus; anaphylaxis

44. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
No; MRI
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Right before diastole (filling begins)

45. What are fenfluramine - phentermine?
Trauma to stereociliated hair cells of the organ of corti
Multiple miscarriages d/t hypercoaguability
Appetite suppressants
Nocardia

46. What are the three dopaminergic systems and What are they responsible for? disease?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Increased reticulocytes
MAO inhibitors; wine and cheese
Pulmonic and systemic!

47. what clinical findings help distinguish small cell carcinoma?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
SaO2 <92%
T test; chi squared

48. What is the mc location of brain germinomas?What are the classic symptoms?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
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
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Strength of cell mediated immune response

49. Which is faster atrial muscle or ventricular muscle?
NF- KB; responsible for cytokine production
Atrial
Diabetic microangiopathy
Proteasome inhibitor; treatment for MM and waldenstroms

50. PDAs are often asymptomatic. How do you treat?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Tibial
Ig A deficiency
indomethacin