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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.
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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 is the most common location of colonization of all s. aureus types?
46 - 4N; 23 2N
E. coli
Trochlear nerve (IV); abducens nerve (VI)
Anterior nares

2. what hernia has a similar mechanism to hydrocele?
Dihydropyridine sensitive Ca channels (L type)
Tzanck smear
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Because of the low output from heart failure - they will have increased aldosterone levels

3. what happens to capacitance with age?
...
Pulmonic and systemic!
Retinitis; mononucleosis
facultative intracellular

4. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Medullary
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Susceptible; soluble (unable to be cultured in bile)
High potassium conductance and some sodium conductance

5. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
S3 gallop; S2 to opening snap interval
Extrinsic def; instrinsic def; platelet def
Medial circumflex artery; avascular necrosis
differentiate

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

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7. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Vagus nerve stimulation
Adeno
Echinococcus granulosus; anaphylaxis
No (unlike adenomyosis); yes

8. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Mean greater than median greater than mode
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
INTRApartum Abs (ampicillin/penicillin)

9. What pulmonary structural change can kartageners syndrome cause?
S. aureus
Underestimation of gestational age
Become beta pleated and then form neurofibrillary tangle!
Bronchial dilation (bronchiectasis)

10. What three factors effect total oxygen content of blood?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
8 (myc protein) with 2 - 14 - 22 (iG chains)

11. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Octreotide
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Proteasome inhibitor; treatment for MM and waldenstroms
Chorda tympani branch

12. What is the triad seen in pre eclampsia?
Ceftriaxone; azithromycin
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Hypertension - edema - and proteinuria
Inactivates kallikrein which activates kininogen into bradykinin

13. do Class IC agents prolong the QT interval?
Pulmonic and systemic!
8 (myc protein) with 2 - 14 - 22 (iG chains)
transcription activation/suppression
No

14. Where does lysyl oxidase act? What is the cofactor for that?
facultative intracellular
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Covalent (between two cysteines)- allows protein to withstand denaturation
In the extracellular space for collagen cross linking; zinc

15. at four years of age - What are the social - fine motor - gross motor - and language developments?
Anterior nares
Acute gastric mucosal defects (superficial or full thickness)
Bile soluble which means they are bile sensitive
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

16. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Turners`
Drug induced interstitial nephritis
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Vertical diplopia

17. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Duration and extent of disease
Because of vasodiation to skeletal muscles
Elastance
Bile soluble which means they are bile sensitive

18. What is contraindicated in toxic mega colon?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Octreotide
Excessive collagen formation during tissue repair in susceptible individuals
GI tract; mood!

19. How do left sided colon adenocarcinomas present? right sided?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Superior larygeal; cricothyroid; recurrent laryngeal
HSV and VZV
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

20. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Chorda tympani branch
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Large stroke volumes with ventricular contraction; aortic regurg
<1% - 55% - concentration dependent

21. what organ would an activating mutation in PRPP synthetase effect?
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Bile salt accumulation in urine
Joints d/t increased purine production and thus uric acid production

22. What is capsaicin? Where does it work?
Medial circumflex artery; avascular necrosis
Pain reliever - reduces pain by locking substance P in the PNS
Relfex tachycardia; giving beta blockers
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

23. What is the most common neurologic complication of VZV reactivation?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Localized dermatologic pain that persists for more than one month after zoster eruption
PDA open
Single adenomatous ones

24. what induces bronchial squamous metaplasia?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Smoking
Inactivates kallikrein which activates kininogen into bradykinin
chronic urticaria and allergic symptoms

25. What is omalizumab and What is it used for?
Boiling - bleach - formalin - UV irradiation
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
SVC and IVC; right below the aortic knob
Congenital hypothyroidism - downs - amyloidosis - acromegaly

26. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Vancomycin
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Skin flushing and warmth; prostaglandins; give with aspirin
Fat - fertile - forty - female

27. which type of glands produce an initially odorless secretion but can become malodorous secondary to bacterial decompisition on the skin surface? which glands are present throughout the skin except on lips and glans penis?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
RER; copper
Apocrine; eccrine

28. what drug is useful for secretory diarrhea?
Octreotide
Nocardia
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Fibrosis; macrophages

29. nucleotide deletions do not cause missense mutations - they cause...
frameshift mutations (missense is substitution)
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Abnormal closing of the urethral folds
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

30. What are the acute effects of corticosteroids on the CBC?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Acute gastric mucosal defects (superficial or full thickness)
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

31. What does prolonged PT indicated? aPTT? bleeding time?
SSRI
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Extrinsic def; instrinsic def; platelet def
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

32. why does liver dysfunction cause coagulation disorders?
Because of vasodiation to skeletal muscles
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
Coagulation factors are made in the liver
T test; chi squared

33. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Demargination of neutrophils from the vessel walls
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Joints d/t increased purine production and thus uric acid production
Hyperkalemia; potassium sparing diuretics - potassium supplements

34. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
Barium enema
Myasthenia gravis
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

35. What are the primary determinants of colon cancer risk in UC patients
Duration and extent of disease
differentiate
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

36. What is suggestive of complete central DI?
Echinococcus granulosus; anaphylaxis
Medullary
Increase by 50% in urine osmolality
25; 25

37. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
Measles and M3 AML`
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
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
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

38. how does noise induced hearing loss occur?
Trauma to stereociliated hair cells of the organ of corti
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
low in serum

39. at three years of age What are social - fine motor - gross motor and language developments?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Standing suddenly from supine position; valsalva maneuver
Biphosphonate
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences

40. which nerve provides innervation for plantar flexion and inversion?
Tibial
Syringomelia
Class I
Bronchial dilation (bronchiectasis)

41. What can long term leg cast wearing cause?
chronic urticaria and allergic symptoms
Normal; low
In the extracellular space for collagen cross linking; zinc
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

42. What does hypocapnia cause in teh brain? What is hypocapnia?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
25; 25
Adductor

43. What type of bond is a disulfide bond?
Closer to head; closer to diaphragm
Covalent (between two cysteines)- allows protein to withstand denaturation
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Enterococci (e. faecalis)- found on genitalia area

44. Metronidizaole does not cover...
gram positive organisms
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Abnormal closing of the urethral folds

45. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Class I
Tzanck smear
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
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

46. What does sustained hand grip do to the C/V system?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Appetite suppressants
Hexokinase

47. why is crohns disease associated with oxaloacetate kidney stones?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Anti centromere; anti DNA topoisomerase
Reticulocytes
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

48. What do you treat s. epidermidis with?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Vancomycin
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
facultative intracellular

49. what murmur is enhanced by decreased blood flow to the heart?
Initiation - pointing; pincer grasp; walking; mama/dada
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Dissolved in plasma and attached to Hgb
Normally close to systolic

50. are there signs of inflammation in avascular necrosis? then How do you diagnose?
DIC; TTP- HUS dont bleed that much
No; MRI
P53 mutation; AD
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences