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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. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Acute gastric mucosal defects (superficial or full thickness)
Boiling - bleach - formalin - UV irradiation
Both sides
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

2. which opponens muscle does ulnar innervate?
...
Adductor
Classical conditioning
Inhibits it

3. where are the vegetations on the valves of a libman sacks endocarditis?
Both sides
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)
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

4. which two drug types can cause orthostatic hypotension (think depression and BPH)?
Ceftriaxone; azithromycin
PDA open
TCAs and prazosin
ATP binding (resets the myosin head to contract again for next binding)

5. What is the triad seen in pre eclampsia?
Susceptible; soluble (unable to be cultured in bile)
Hypertension - edema - and proteinuria
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Single adenomatous ones

6. what locations of UC increase the risk of Colon cancer?
Pan colitis and right sided colitis (more than left sided and proctitis)
Retinitis; mononucleosis
Atrial
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

7. What is a cell surface marker seen in liver angiosarcoma?
Vagus nerve stimulation
chronic urticaria and allergic symptoms
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

8. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Integration of viral DNA into genome of host hepatocytes
indomethacin
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Both sides

9. what protein is increased in Crohns disease? What does it do?
Neisseria induced small cell vasculitis (including hands and soles)
T test; chi squared
Close but purkinje system to ensure contraction in a bottom up fashion
NF- KB; responsible for cytokine production

10. What does Rb protein do? what chrom is it on?
Acute gastric mucosal defects (superficial or full thickness)
Insulin like growth factor 1 (just another name)
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

11. What is capsaicin? Where does it work?
Pain reliever - reduces pain by locking substance P in the PNS
Prostate tumor and increased osteoclast activity
Nocardia
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

12. Where does conjugation of bilirubin take place?
In ER of bile canaliculi
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
Hyperkalemia; potassium sparing diuretics - potassium supplements
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

13. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
Close but purkinje system to ensure contraction in a bottom up fashion
Vagus nerve stimulation
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)
RER; RER

14. When does neovascularization granulation tissue begin to form after severe ischemia and MI? what happens in 12-24 hours? 2 weeks to 2 months? 1-5 days? 0-4 hours? when do you see edema - hemorrhage - wavy fibers?
Become beta pleated and then form neurofibrillary tangle!
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
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Increases cytokine production

15. What is the most common neurologic complication of VZV reactivation?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
P53 mutation; DCC is also required for adenoma to carcinoma
G to T in p53; HCC
Localized dermatologic pain that persists for more than one month after zoster eruption

16. What is suggestive of complete central DI?
Increase by 50% in urine osmolality
Mean greater than median greater than mode
No; yes
Medullary

17. What is used to treat heparin toxicity?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Barium enema
Protamine sulfate
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

18. what dissolves the lipid bilayer of a viral envelope?
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
Protamine sulfate
Nocardia
Ether and other organic solvents

19. if there are keratin swirls does that mean well or poorly differentiated?
Anti cholinergic effects of pupil dilation and lack of accomodation
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Well
8; 12

20. name three pathological states that present with large tongues.
<1% - 55% - concentration dependent
Inactivates kallikrein which activates kininogen into bradykinin
Congenital hypothyroidism - downs - amyloidosis - acromegaly
SVC and IVC; right below the aortic knob

21. SIADH patients have normal blood volume but...
In the extracellular space
hyponatremia (aldosterone activation equilibrates body volume)
Increase by 50% in urine osmolality
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

22. What does NF- KB do?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Spongiosis
Increases cytokine production
(urine PAH x urine flow rate)/plasma PAH

23. Which nerve lies in close proximity to the inferior thyroid artery?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Recurrent larygneal
Prevent phagocytosis
P450 mitochondrial monooxygenase

24. at three years of age What are social - fine motor - gross motor and language developments?
SaO2 <92%
Clindamycin; covers anaerobic oral flora and aerobic bacteria
P450 mitochondrial monooxygenase
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences

25. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Trochlear nerve (IV); abducens nerve (VI)
C3 decreased after 5-10 days; sulfonamides
S3 gallop; S2 to opening snap interval
Susceptible; soluble (unable to be cultured in bile)

26. What can long term leg cast wearing cause?
Initiation - pointing; pincer grasp; walking; mama/dada
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
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
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

27. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
HSV and VZV
E. coli; staphylococcus saprophyticus
Trauma to stereociliated hair cells of the organ of corti
Chrom 8

28. why does liver dysfunction cause coagulation disorders?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Coagulation factors are made in the liver
Trauma to stereociliated hair cells of the organ of corti
25; 25

29. Where is aromatase used?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Hereditary angioedema; ACE inhibitors
Medullary
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

30. What are fenfluramine - phentermine?
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
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Decreases both
Appetite suppressants

31. What is the mc location for avascular necrosis? What is it associated with?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Intussusception
Classical conditioning
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

32. sporadic colon cancer tend to arise From what type of polyps?
Hexokinase
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Serum creatine kinase; reperfusion injury causes necrosis
Single adenomatous ones

33. What is the cause of rapid plasma decay of thiopental?
Insulin like growth factor 1 (just another name)
Tissue redistribution (out of plasma) rather than metabolism
Medullary
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

34. hypertonicity and hyperreflexity are ________________ of hydrocephalus
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Increases bronchial and vascular smooth muscle reactivity to catecholamines

35. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
Hexokinase
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Biphosphonate
Hypertension - edema - and proteinuria

36. What triggers the neoplastic changes that are associated with HBV infecton?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Integration of viral DNA into genome of host hepatocytes
E. coli

37. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Dihydropyridine sensitive Ca channels (L type)
Rabies encephalitis from cave bats; rabies killed vaccines
LT (LTD4 - E4 - C4) - and Ach
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

38. nucleotide deletions do not cause missense mutations - they cause...
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Ig A deficiency
frameshift mutations (missense is substitution)

39. What can too much IgA in serum produces?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Pain reliever - reduces pain by locking substance P in the PNS
Anti centromere; anti DNA topoisomerase
glycerol kinase

40. What are the two growth factors associated with angiogenesis?
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Inhaled animal dander allergens
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
FGF and VEGF

41. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Abnormal closing of the urethral folds
Fibronectin - laminin - collagen
Sickle cell; G6PD
Downs; regurgitant AV valves - ASDs

42. which nerve provides innervation for plantar flexion and inversion?
Prostate tumor and increased osteoclast activity
Relfex tachycardia; giving beta blockers
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Tibial

43. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Trochlear nerve (IV); abducens nerve (VI)
11 aa polypeptide; pain NT in CNS and PNS

44. what organ would an activating mutation in PRPP synthetase effect?
Joints d/t increased purine production and thus uric acid production
Tissue redistribution (out of plasma) rather than metabolism
TSh (in testicular tumors can cause hyperthyroidism)
Circular - outside nucleus; transport proteins - rRNA - tRNA

45. When is an S4 sound normal?
Strength of cell mediated immune response
Well trained athletes and children
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Env genes (for getting into target cells)

46. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Boiling - bleach - formalin - UV irradiation
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
TSh (in testicular tumors can cause hyperthyroidism)

47. what hernia has a similar mechanism to hydrocele?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
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)
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

48. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Excessive collagen formation during tissue repair in susceptible individuals
Cluster
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Phencyclidine (PCP)

49. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
Anti cholinergic effects of pupil dilation and lack of accomodation
GI tract; mood!
Adductor
MAO inhibitors; wine and cheese

50. How can renal blood flow be calculated from RPF?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Echinococcus granulosus; anaphylaxis
RBF= PAH clearance/(1- hematocrit)
25; 25