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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 three pathogens cause infectious esophagitis in HIV positive patients?
Raphe
CMV - HSV 1 - Candida
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

2. What do you treat s. epidermidis with?
INTRApartum Abs (ampicillin/penicillin)
Vagus nerve stimulation
Vancomycin
Dihydropyridine sensitive Ca channels (L type)

3. What does 'oxygen' content in blood refer to?
Dissolved in plasma and attached to Hgb
S. saprophyticus - and s. epidermidis; novobiocin
Brief psychotic disorder; schizophreniform; schizophrenia
Anterior nares

4. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
SSRI; erectile dysfunction
Skin flushing and warmth; prostaglandins; give with aspirin
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
ANCA because of lack of Ig and C3 deposits on IF

5. Where does complement bind on the Fc region of Ig chains?
Multiple miscarriages d/t hypercoaguability
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Duration and extent of disease
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

6. what happens to sperm count and semineferous tubules in patient with cryptoorchidism? hormonal function? why do they need to be surgically descended?
Syncope - angina - dyspnea (SAD)
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
Pan colitis and right sided colitis (more than left sided and proctitis)
frameshift mutations (missense is substitution)

7. What are some side effects seen in TCAs?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Sickle cell; G6PD
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Susceptible; soluble (unable to be cultured in bile)

8. What is used to treat heparin toxicity?
Ketone body production by preventing fatty acids into the mitochondria
Minimal change disease
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Protamine sulfate

9. What type of vision is myopia? In What type of patients does it improve?
Valproate
To pump calcium out in cardiac myocytes so that relaxation occurs
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Adductor

10. What does protein M do in Group A strep<
Prevent phagocytosis
chronic urticaria and allergic symptoms
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
SVC and IVC; right below the aortic knob

11. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Hexokinase
Fibronectin - laminin - collagen
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

12. When is an S4 sound normal?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Neisseria induced small cell vasculitis (including hands and soles)
Barium enema
Well trained athletes and children

13. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
Brief psychotic disorder; schizophreniform; schizophrenia
Enterococci (e. faecalis)- found on genitalia area
Measure of depth invasion (vertical!)
Minimal change disease

14. what indicates the severity of a mitral regurg ? mitral stenosis?
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
LT (LTD4 - E4 - C4) - and Ach
S3 gallop; S2 to opening snap interval
Inhibits it

15. What is congestive hepatomegaly specific for?
Right heart failure
High potassium conductance and some sodium conductance
Excessive collagen formation during tissue repair in susceptible individuals
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

16. What is the cause of fixed splitting of S2? why?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Leukotriene precursor and does neutrophil chemotaxis
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

17. what happens with LDL receptor density in statin therapy?
Leukotriene precursor and does neutrophil chemotaxis
Ig A deficiency
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Increases

18. what locations of UC increase the risk of Colon cancer?
ATP binding (resets the myosin head to contract again for next binding)
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Vancomycin
Pan colitis and right sided colitis (more than left sided and proctitis)

19. what makes bruits?
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
Protamine sulfate
Turbulence
Nocardia

20. What is damaged in early syringomelia? later?
RBC mass; epo levels (secondary has high)
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
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
Right heart failure

21. which two virus families have hemagluttinin on their surface?
Chrom 8
Paramyxo and influenza
E. coli; staphylococcus saprophyticus
Adductor

22. What are the acute effects of corticosteroids on the CBC?
MAC complex (C5b - C9 complement deficiency)
Hereditary angioedema; ACE inhibitors
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Ether and other organic solvents

23. What translocations can cause c - myc overexpression?
8 (myc protein) with 2 - 14 - 22 (iG chains)
Medial part
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Right heart failure

24. What does C1 esterase do other than inhibiting complement pathway?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Rabies encephalitis from cave bats; rabies killed vaccines
Because of vasodiation to skeletal muscles
Inactivates kallikrein which activates kininogen into bradykinin

25. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
No (unlike adenomyosis); yes
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
GI tract; mood!

26. How do you calculate atributable risk percent?
Octreotide
Both sides
RR-1/RR
Prevent phagocytosis

27. What is the mc location for avascular necrosis? What is it associated with?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Both sides
Pan colitis and right sided colitis (more than left sided and proctitis)

28. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Fat - fertile - forty - female
In the extracellular space for collagen cross linking; zinc
Vascular endothelium; protease

29. Which nerve lies in close proximity to the inferior thyroid artery?
Multiple miscarriages d/t hypercoaguability
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Recurrent larygneal
Terminal bronchioles; small bronchi

30. What is best to prevent GBS infection in a baby?
Increase by 50% in urine osmolality
INTRApartum Abs (ampicillin/penicillin)
Increase; decreased
No; yes

31. which cells produce surfactant? which ones mediate gas exchange?
hyponatremia (aldosterone activation equilibrates body volume)
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
II; I (I more abundant)
Drink plenty of fluids

32. What are three symptoms in s.typhi?
Regular insulin (Not fast acting - regular better)
Southern - western
Protamine sulfate
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

33. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
S. aureus
Become beta pleated and then form neurofibrillary tangle!
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Recurrent larygneal

34. What is the primary histologic finding in patients with eczematous dermatitis?
No and yes
Spongiosis
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Sudden loss of muscle tone without loss of consciousness; narcolepsy

35. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
APP on chrom 21 (this is why downs more susceptible)
Valproate
SSRI; erectile dysfunction

36. What is easiest way to treat nephrolithiasis?
Anti cholinergic effects of pupil dilation and lack of accomodation
Drink plenty of fluids
Acute interstitial nephritis
CGD; t cell dysfxn (diGeorge)

37. which has better side effect profile - SSRI or TCA?
Elevated GGT and macrocytosis
SSRI
Ketone body production by preventing fatty acids into the mitochondria
I is more benign and can present later in adulthood

38. How do you explain the selective proteinuria of loss to albumin only in MCD?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Radial nerve damage
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Duration and extent of disease

39. what nerve and artery course along the posterior aspect of the humerus?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
LT (LTD4 - E4 - C4) - and Ach
Radial nerve and deep brachial artery
Proteasome inhibitor; treatment for MM and waldenstroms

40. How do bradykinin - C3a and C5a cause edema?
V fib; v. failure
Adductor
By vascular permeability and vasodilation
Both sides

41. name three pathological states that present with large tongues.
liver specific
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

42. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
OCPs - multiparity - breast feeding
Chorda tympani branch
(urine PAH x urine flow rate)/plasma PAH
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

43. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
Purkinje system; AV node
Acute interstitial nephritis
Vancomycin; histamine mediated
Syringomelia

44. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Leukotriene precursor and does neutrophil chemotaxis
Tzanck smear
MAO inhibitors; wine and cheese

45. What pulmonary structural change can kartageners syndrome cause?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Bronchial dilation (bronchiectasis)
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
Proteasome inhibitor; treatment for MM and waldenstroms

46. What does the severity of leprosy depend on?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Reiter syndrome; B27
Strength of cell mediated immune response
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

47. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Susceptible; soluble (unable to be cultured in bile)
No and yes
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Hereditary angioedema; ACE inhibitors

48. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
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
Turners`
Hypertension - edema - and proteinuria
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

49. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Medial circumflex artery; avascular necrosis
Sickle cell; G6PD
women

50. carnitine deficiency impairs production of What and how?
Ketone body production by preventing fatty acids into the mitochondria
S3 gallop; S2 to opening snap interval
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
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