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USMLE Prep 2

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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 makes bruits?
Protamine sulfate
Class I
Gluteus medius and minimus; positive trendelenberg
Turbulence

2. what drugs causes the red man syndrome? how does it occur?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Vancomycin; histamine mediated
RR-1/RR
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

3. which nucleus releases serotonin?
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
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Raphe
Tzanck smear

4. other than parvo B19 - what else is associated with red cell aplasia?
P450 mitochondrial monooxygenase
Brief psychotic disorder; schizophreniform; schizophrenia
RBF= PAH clearance/(1- hematocrit)
Thymic tumor

5. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
Appetite suppressants
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
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)
C3 decreased after 5-10 days; sulfonamides

6. which has better side effect profile - SSRI or TCA?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Adductor
SSRI

7. at four years of age - What are the social - fine motor - gross motor - and language developments?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Inhaled animal dander allergens
RBF= PAH clearance/(1- hematocrit)
Echinococcus granulosus; anaphylaxis

8. What is normal fibrinogen levels?
TSh (in testicular tumors can cause hyperthyroidism)
200-500
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
Because of vasodiation to skeletal muscles

9. What causes the blurry vision side effects in first generation anti histamines?
Prevents hepatic VLDL production
Permissive - sensitizes vasoconstrictive response from catecholamines - doesnt actually act on them but increases transcription of some genes that creates permissive effect (not additive or synergistic becuase cortisol alone doesnt have any effect on
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Anti cholinergic effects of pupil dilation and lack of accomodation

10. What is acanthosis nigricans associated with?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Right before diastole (filling begins)
GI malignancies and Insulin resistance (acromegal for ex)

11. What are pancreatic pseudocysts called pseudo rather than true cysts?
Not lined by epithelium
Increased reticulocytes
Sickle cell; G6PD
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

12. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
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
In the extracellular space for collagen cross linking; zinc
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

13. Metronidizaole does not cover...
gram positive organisms
Inactivates kallikrein which activates kininogen into bradykinin
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

14. What is a primary HSV 1 infection like?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

15. What is subacute sclerosisng encephalitis caused by?
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Inhibits it
S. saprophyticus - and s. epidermidis; novobiocin
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

16. what commonly happens in GI in response to acute physiologic stress?
Acute gastric mucosal defects (superficial or full thickness)
Amiadarone
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
By vascular permeability and vasodilation

17. What is the difference between paranoid personality disorder and delusional disorder?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Duration and extent of disease

18. What can chronic vit A toxicity cause?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Recurrent larygneal
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
women

19. what hormone is structurally similar to hCG?
8; 12
Chorda tympani branch
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
TSh (in testicular tumors can cause hyperthyroidism)

20. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Circular - outside nucleus; transport proteins - rRNA - tRNA
HSV ( also in utero: chlymadia - neisseria - group B strep)
Thymic tumor
Close but purkinje system to ensure contraction in a bottom up fashion

21. What is the Na/Ca exchange used for?
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
To pump calcium out in cardiac myocytes so that relaxation occurs
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Superior larygeal; cricothyroid; recurrent laryngeal

22. What is achalasia and how would this correlate on the esophageal mannometry?
Echinococcus granulosus; anaphylaxis
Adeno
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
Lateral; RV; RA; LV

23. Which is faster purkinje system or atrial muscle?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Close but purkinje system to ensure contraction in a bottom up fashion
Dihydropyridine sensitive Ca channels (L type)

24. What is the most common neurologic complication of VZV reactivation?
Excessive collagen formation during tissue repair in susceptible individuals
Localized dermatologic pain that persists for more than one month after zoster eruption
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)
200-500

25. what vessel would a fracture to the neck of the of the humerus damage?
Raphe
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Anterior circumflex (and axillary nerve)
Tibial

26. What is used to treat heparin toxicity?
Medial circumflex artery; avascular necrosis
Protamine sulfate
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
E. coli

27. What are two common side effects of both acute and long acting nitrates? What causes them?
Headaches and facial flushing; vasodilation in meninges and skin
Because gamma chains replace beta chains and then gamma chain formation wanes
Normally close to systolic
SSRI; erectile dysfunction

28. Where is the base of the heart? apex?
Closer to head; closer to diaphragm
Tzanck smear
By vascular permeability and vasodilation
In the extracellular space

29. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Adeno
8 (myc protein) with 2 - 14 - 22 (iG chains)
Tzanck smear
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

30. 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?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Abnormal closing of the urethral folds
Cluster
ZDV or AZT

31. what should you think of in 'smear of an oral ulcer base'?
Aromatase deficiency in child
Serum FFA and serum triglyceride levels
Circular - outside nucleus; transport proteins - rRNA - tRNA
Tzanck smear

32. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
Common peroneal; bony fractures and compression; sciatic
No (unlike adenomyosis); yes
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

33. what virus causes pharyngoconjuctival fever?
Adeno
Pan colitis and right sided colitis (more than left sided and proctitis)
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
8 (myc protein) with 2 - 14 - 22 (iG chains)

34. In What type of nephritis would you see high serum eos count?
Drug induced interstitial nephritis
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Prevents hepatic VLDL production

35. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Turbulence
Paramyxo and influenza
Gluteus maximus; difficulty getting up from seated position and climbing chair

36. where exactly is ACE expressed in the lungs? What type of enzyme is it?
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
Vascular endothelium; protease
Duration and extent of disease
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

37. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Large stroke volumes with ventricular contraction; aortic regurg
V fib; v. failure
Hypo or hyper pigmentations; after tanning
Downs; regurgitant AV valves - ASDs

38. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
Increase by 50% in urine osmolality
ZDV or AZT
Bile soluble which means they are bile sensitive
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

39. why does liver dysfunction cause coagulation disorders?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
low in serum
Coagulation factors are made in the liver
Sudden loss of muscle tone without loss of consciousness; narcolepsy

40. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Anterior circumflex (and axillary nerve)
Echinococcus granulosus; anaphylaxis
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)
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

41. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
To pump calcium out in cardiac myocytes so that relaxation occurs
Turners`
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

42. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Tissue redistribution (out of plasma) rather than metabolism
Anterior circumflex (and axillary nerve)
Fat - fertile - forty - female

43. What is the most common initital symptom of ADPKD? what else?
Aromatase deficiency in child
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
As a CO2 carrier with the carboxylase enzyme
Sickle cell; G6PD

44. why should you not use ACE inhibitors with someone who had hereditary angioedema?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
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
To pump calcium out in cardiac myocytes so that relaxation occurs
II; I (I more abundant)

45. What is omalizumab and What is it used for?
Drug induced interstitial nephritis
OCPs - multiparity - breast feeding
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

46. What is the most important prognostic indicator in patients with malignant melanoma?
Measure of depth invasion (vertical!)
Syringomelia
Boiling - bleach - formalin - UV irradiation
differentiate

47. Where does terminal peptide cleavage of collagen fibrils take place?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
In the extracellular space
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Ig A deficiency

48. what diseases can vit A be used to treat?
Measles and M3 AML`
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Lateral; RV; RA; LV
Minimal change disease

49. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Valproate
Serum creatine kinase; reperfusion injury causes necrosis
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

50. In what view of CXR is anterior part of heart best seen? anterior part of heart is formed by?right border of heart is formed by? left border?
Lateral; RV; RA; LV
II; I (I more abundant)
No (unlike adenomyosis); yes
Not lined by epithelium

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USMLE Prep 2

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