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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 diagnostic (and possible therapeutic for intussusception)?
Barium enema
Fat - fertile - forty - female
INTRApartum Abs (ampicillin/penicillin)
No

2. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Hydrogen bonds dictate alpha or beta structure
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Smoking

3. What does protein M do in Group A strep<
Minimal change disease
Initiation - pointing; pincer grasp; walking; mama/dada
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Prevent phagocytosis

4. 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
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Curlings ulcers

5. which two virus families have hemagluttinin on their surface?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
High potassium conductance and some sodium conductance
Paramyxo and influenza
Covalent (between two cysteines)- allows protein to withstand denaturation

6. What is a common complication of acute pancreatitis? What is it?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
To pump calcium out in cardiac myocytes so that relaxation occurs
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
CGD; t cell dysfxn (diGeorge)

7. what phase do adenosine and acetylcholine act on? doing what?
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
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
The time interval between S2 and OS- the shorter the interval - the more intense

8. what receptors do first generation anti histamines block?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
GI malignancies and Insulin resistance (acromegal for ex)
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Decreases both

9. other than parvo B19 - what else is associated with red cell aplasia?
ZDV or AZT
DIC; TTP- HUS dont bleed that much
Measure of depth invasion (vertical!)
Thymic tumor

10. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
MAO inhibitors; wine and cheese
Env genes (for getting into target cells)
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Echinococcus granulosus; anaphylaxis

11. What is the mc manifestation of CMV in HIV patient? immunocompetent?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Retinitis; mononucleosis
women
Downs; regurgitant AV valves - ASDs

12. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Medial circumflex artery; avascular necrosis
Duration and extent of disease
Relfex tachycardia; giving beta blockers
Become beta pleated and then form neurofibrillary tangle!

13. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
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
Increase; decreased
Hypothyroidism
Gluteus medius and minimus; positive trendelenberg

14. why are pregnant predisposed to cholelithiasis?
SVC and IVC; right below the aortic knob
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
Strength of cell mediated immune response
Medial circumflex artery; avascular necrosis

15. on What part of the clavicle does the SCM attach?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Localized dermatologic pain that persists for more than one month after zoster eruption
Medullary
Medial part

16. at four years of age - What are the social - fine motor - gross motor - and language developments?
Tzanck smear
Rabies encephalitis from cave bats; rabies killed vaccines
Cluster
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

17. Where is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
Duration and extent of disease
Hypo or hyper pigmentations; after tanning
GI malignancies and Insulin resistance (acromegal for ex)
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

18. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
The time interval between S2 and OS- the shorter the interval - the more intense
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

19. how long is substance P? What does it do?
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
11 aa polypeptide; pain NT in CNS and PNS
Normally close to systolic
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

20. What is the mc location of brain germinomas?What are the classic symptoms?
Well trained athletes and children
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
ZDV or AZT
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

21. which are the only glycosylated proteins in HIV virus?
Demargination of neutrophils from the vessel walls
Hydrogen bonds dictate alpha or beta structure
Env genes (for getting into target cells)
Headaches and facial flushing; vasodilation in meninges and skin

22. What antibiotic is best to treat alcoholic pulm infections? why?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Around 70 (normal measured diastolic pressures); 9--
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Inactivates kallikrein which activates kininogen into bradykinin

23. what has the greatest effect on prognosis when treating c. diptheriae?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Terminal bronchioles; small bronchi
No (unlike adenomyosis); yes
Well trained athletes and children

24. what happens to capacitance with age?
Medial circumflex artery; avascular necrosis
...
Dihydropyridine sensitive Ca channels (L type)
TCAs and prazosin

25. within the right atrium - What is the maximum pressure? left atrium?
Inhibits it
8; 12
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
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)

26. which trisomy is associated with endocardial cushion defects? What does thsi mean>
AV node slowest - to allow time for diastole
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
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)
Downs; regurgitant AV valves - ASDs

27. What can cause virilization of a mother during pregnancy?
Aromatase deficiency in child
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
When it invades the bm; carcinoma in situ
RR-1/RR

28. which opponens muscle does ulnar innervate?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
indomethacin
Demargination of neutrophils from the vessel walls
Adductor

29. What are diastolic (lowest) pressures in aorta? LV?
Medial part
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
Around 70 (normal measured diastolic pressures); 9--
women

30. What is the cause of rapid plasma decay of thiopental?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Hyperkalemia; potassium sparing diuretics - potassium supplements
SVT; increases vagal tone; rectus abdominis
Tissue redistribution (out of plasma) rather than metabolism

31. What is tachyphylaxis?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
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
G to T in p53; HCC
The term used to describe decreased drug responsiveness with repeated administration

32. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
Ig A deficiency
As a CO2 carrier with the carboxylase enzyme
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
LT (LTD4 - E4 - C4) - and Ach

33. What are two indicators of chronic alcohol consumption?
Elevated GGT and macrocytosis
Single adenomatous ones
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Kallmans

34. What agonists reduce the gradient across the LV outflow tract?
Paramyxo and influenza
Varying; erythema nodosum is common
Tzanck smear
Selective alpha 1 (increases SVR)

35. what protein is increased in Crohns disease? What does it do?
High potassium conductance and some sodium conductance
NF- KB; responsible for cytokine production
RR-1/RR
Reticulocytes

36. What can worse neurologic dysfunction in cobalamic def?
Folic acid treatment!
S. aureus
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

37. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
glycerol kinase
E. coli; staphylococcus saprophyticus
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

38. What does p53 do? what chrom is it on?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Pulmonic and systemic!
HSV ( also in utero: chlymadia - neisseria - group B strep)
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

39. What is the presentation of sever aortic stenosis?
Anterior circumflex (and axillary nerve)
Prostate tumor and increased osteoclast activity
Syncope - angina - dyspnea (SAD)
Turbulence

40. why does liver dysfunction cause coagulation disorders?
Coagulation factors are made in the liver
IgE
Around 70 (normal measured diastolic pressures); 9--
Increase lymphatic drainage!

41. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
Fat - fertile - forty - female
Bile soluble which means they are bile sensitive
Hyperkalemia; potassium sparing diuretics - potassium supplements
No and yes

42. what enzyme converts procarcinogens into carcinogens?
Around 70 (normal measured diastolic pressures); 9--
P450 mitochondrial monooxygenase
In the extracellular space
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

43. What are the two growth factors associated with angiogenesis?
RR-1/RR
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
FGF and VEGF
Chorda tympani branch

44. Where does conjugation of bilirubin take place?
liver specific
Hypo or hyper pigmentations; after tanning
In ER of bile canaliculi
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

45. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
Sickle cell; G6PD
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Syncope - angina - dyspnea (SAD)
Ig A deficiency

46. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
G to T in p53; HCC
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
No; yes
Nonsense; mRNA processing

47. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
RER; copper
Gluteus medius and minimus; positive trendelenberg

48. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
E. coli; staphylococcus saprophyticus
46 - 4N; 23 2N
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)
Inactivates kallikrein which activates kininogen into bradykinin

49. which nucleus releases serotonin?
Duration and extent of disease
Standing suddenly from supine position; valsalva maneuver
Raphe
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

50. What is somatomedin C?
Insulin like growth factor 1 (just another name)
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Become beta pleated and then form neurofibrillary tangle!
RR-1/RR