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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 suggestive of complete central DI?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Increase by 50% in urine osmolality
Intussusception
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

2. within the right ventricle - What are maximum pressures? the pulm arter?
Radial nerve and deep brachial artery
25; 25
Trochlear nerve (IV); abducens nerve (VI)
Fat - fertile - forty - female

3. What is the most common neurologic complication of VZV reactivation?
Standing suddenly from supine position; valsalva maneuver
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Localized dermatologic pain that persists for more than one month after zoster eruption
To pump calcium out in cardiac myocytes so that relaxation occurs

4. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Highly negative resting potential
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Thymic tumor

5. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
4 - 4 - 9
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Circular - outside nucleus; transport proteins - rRNA - tRNA

6. What triggers the neoplastic changes that are associated with HBV infecton?
DIC; TTP- HUS dont bleed that much
No; yes
Enterococci (e. faecalis)- found on genitalia area
Integration of viral DNA into genome of host hepatocytes

7. Where does conjugation of bilirubin take place?
OCPs - multiparity - breast feeding
In ER of bile canaliculi
Pulmonic and systemic!
Standing suddenly from supine position; valsalva maneuver

8. are there signs of inflammation in avascular necrosis? then How do you diagnose?
Fibrosis; macrophages
Close but purkinje system to ensure contraction in a bottom up fashion
No; MRI
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

9. What are the three predominant symptoms of VHL? What is its mode of inheritance?
E. coli; staphylococcus saprophyticus
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
The term used to describe decreased drug responsiveness with repeated administration

10. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Sarcoid
46 - 4N; 23 2N
Fat - fertile - forty - female
Large stroke volumes with ventricular contraction; aortic regurg

11. which two virus families have hemagluttinin on their surface?
gram positive organisms
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
E. coli; staphylococcus saprophyticus
Paramyxo and influenza

12. What almost exclusively causes Epliglottitis?What type of capsule does it have? What are the symptoms?

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13. at one year of age - What are the social - fine motor - gross motor and language developments?
Turners`
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)
Initiation - pointing; pincer grasp; walking; mama/dada
Selective alpha 1 (increases SVR)

14. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
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)
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
8; 12
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

15. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
hyponatremia (aldosterone activation equilibrates body volume)
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Class I

16. how does increased ICP result in curlings ulcers?
Coagulation factors are made in the liver
Vagus nerve stimulation
C3 decreased after 5-10 days; sulfonamides
Hypo or hyper pigmentations; after tanning

17. carnitine deficiency impairs production of What and how?
Ketone body production by preventing fatty acids into the mitochondria
Abnormal closing of the urethral folds
Medial circumflex artery; avascular necrosis
Vascular endothelium; protease

18. What is the mcc of elevated AFP leves in pregnancy>
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Underestimation of gestational age

19. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
Drug induced interstitial nephritis
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
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)
hyponatremia (aldosterone activation equilibrates body volume)

20. why is glucagon used in beta blocker toxicitiy?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
ANCA because of lack of Ig and C3 deposits on IF
Valproate
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

21. why are pregnant predisposed to cholelithiasis?
indomethacin
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
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
No; yes

22. What does VIP do to gastric acid secretion?
Prevents hepatic VLDL production
Diabetic microangiopathy
Inhibits it
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

23. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
The time interval between S2 and OS- the shorter the interval - the more intense
Highly negative resting potential
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

24. which RPGN is also called pauci immune GN? why?
In the extracellular space
Increases
SSRI
ANCA because of lack of Ig and C3 deposits on IF

25. Metronidizaole does not cover...
FGF and VEGF
gram positive organisms
SS +rNA
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

26. What is the precursor protein to beta amyloid and On what chromosome is it found?
Echinococcus granulosus; anaphylaxis
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)
APP on chrom 21 (this is why downs more susceptible)
I is more benign and can present later in adulthood

27. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
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)
Gluteus medius and minimus; positive trendelenberg
Atrial

28. What is diphenoxylate and What is it used for? what drug is it structurally similar to? What allows for potent anti diarrheal effect without signigicant opiate effects?
Folic acid treatment!
Octreotide
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
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)

29. What is used to compare means? categorical outcomes?
T test; chi squared
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
SVT; increases vagal tone; rectus abdominis
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

30. How can renal blood flow be calculated from RPF?
RBF= PAH clearance/(1- hematocrit)
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Because of vasodiation to skeletal muscles
only up to bronchi

31. What is the diagnosis in delayed puberty plus anosmia?
Coagulation factors are made in the liver
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Kallmans
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

32. What is the mainstay treatment for acute mania?
Thymic tumor
Tibial
Turbulence
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

33. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
P53 mutation; DCC is also required for adenoma to carcinoma
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Diabetic microangiopathy
Apocrine; eccrine

34. In What type of nephritis would you see high serum eos count?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Drug induced interstitial nephritis
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Measure of depth invasion (vertical!)

35. 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?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Right before diastole (filling begins)
Pulmonic and systemic!
Cluster

36. What is the primary histologic finding in patients with eczematous dermatitis?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
SVT; increases vagal tone; rectus abdominis
Spongiosis
Because of the low output from heart failure - they will have increased aldosterone levels

37. What is Bortezomib and What is it used for?
Increase lymphatic drainage!
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
Measles and M3 AML`
Proteasome inhibitor; treatment for MM and waldenstroms

38. What type of bond is a disulfide bond?
Covalent (between two cysteines)- allows protein to withstand denaturation
Varying; erythema nodosum is common
Boiling - bleach - formalin - UV irradiation
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

39. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
Vagus (auricular branch); vasovagal syncope!
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Retinitis; mononucleosis
Normally close to systolic

40. which nerve provides innervation for plantar flexion and inversion?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Syncope - angina - dyspnea (SAD)
Leukotriene precursor and does neutrophil chemotaxis
Tibial

41. the rate of blood flow of which two circulations must equal each other at all times?
Insulin like growth factor 1 (just another name)
Susceptible; soluble (unable to be cultured in bile)
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
Pulmonic and systemic!

42. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
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
Elevated GGT and macrocytosis
Kallmans
No (unlike adenomyosis); yes

43. SIADH patients have normal blood volume but...
hyponatremia (aldosterone activation equilibrates body volume)
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
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
OCPs - multiparity - breast feeding

44. What are two indicators of chronic alcohol consumption?
V fib; v. failure
Elevated GGT and macrocytosis
RER; RER
ZDV or AZT

45. prostaglandin synthesis keeps...
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
PDA open
Ig A deficiency

46. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
Myasthenia gravis
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
By vascular permeability and vasodilation
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

47. how can HAV be inactivated?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Boiling - bleach - formalin - UV irradiation
glycerol kinase
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

48. What are fenfluramine - phentermine?
E. coli; staphylococcus saprophyticus
OCPs - multiparity - breast feeding
Appetite suppressants
Radial nerve damage

49. What causes wrist drop?
Southern - western
On cardiac tissue and renal juxtaglomerular cells
Radial nerve damage
SSRI

50. What does prolonged PT indicated? aPTT? bleeding time?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Extrinsic def; instrinsic def; platelet def
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Leukotriene precursor and does neutrophil chemotaxis