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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. which two virus families have hemagluttinin on their surface?
Paramyxo and influenza
Brief psychotic disorder; schizophreniform; schizophrenia
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Chrom 8

2. What is Tzanck smear used to detect?
women
HSV and VZV
Coagulation factors are made in the liver
Pan colitis and right sided colitis (more than left sided and proctitis)

3. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
P53 mutation; AD
E. coli; staphylococcus saprophyticus
Hypothyroidism
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

4. What is medullary sponge kidney disease and how does it present? What does it lead to?
...
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)
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

5. In what population does cholelithiasis occur?
Localized dermatologic pain that persists for more than one month after zoster eruption
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
Fat - fertile - forty - female
Trochlear nerve (IV); abducens nerve (VI)

6. What is a primary HSV 1 infection like?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
CMV - HSV 1 - Candida
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

7. if there are keratin swirls does that mean well or poorly differentiated?
8; 12
Common peroneal; bony fractures and compression; sciatic
Well
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

8. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
Not lined by epithelium
P53 mutation; DCC is also required for adenoma to carcinoma
Faulty positioning of the genital tubercle
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

9. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Hyperkalemia; potassium sparing diuretics - potassium supplements
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

10. What can worse neurologic dysfunction in cobalamic def?
Folic acid treatment!
Sickle cell; G6PD
Regular insulin (Not fast acting - regular better)
Pain reliever - reduces pain by locking substance P in the PNS

11. What does 'oxygen' content in blood refer to?
When it invades the bm; carcinoma in situ
Dissolved in plasma and attached to Hgb
transcription activation/suppression
25; 25

12. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
G to T in p53; HCC
RER; RER
Fibronectin - laminin - collagen
...

13. what protects the resting heart from arrhythmias?
An invagination of portion of intestine into the lumen of the adjacent intestinal segment; can lead to impaired venous return from the invaginated segment of the bowel which can cause ischemia and subsequent necrosis
Single adenomatous ones
Brief psychotic disorder; schizophreniform; schizophrenia
Highly negative resting potential

14. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Dissolved in plasma and attached to Hgb
Reticulocytes
Serum creatine kinase; reperfusion injury causes necrosis
Medial circumflex artery; avascular necrosis

15. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Prevent phagocytosis
Because of vasodiation to skeletal muscles
S. saprophyticus - and s. epidermidis; novobiocin
Minimal change disease

16. What is congestive hepatomegaly specific for?
No (unlike adenomyosis); yes
Apocrine; eccrine
Nocardia
Right heart failure

17. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Neisseria induced small cell vasculitis (including hands and soles)
Large stroke volumes with ventricular contraction; aortic regurg
Curlings ulcers
Class I

18. what murmur is enhanced by decreased blood flow to the heart?
E. coli
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Single adenomatous ones
Anti centromere; anti DNA topoisomerase

19. What are the acute effects of corticosteroids on the CBC?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Hereditary angioedema; ACE inhibitors
Measure of depth invasion (vertical!)
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

20. What can cause aortic regurg? What is the heart sound you hear?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Env genes (for getting into target cells)
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

21. which viruses require a protease?
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
SS +rNA
46 - 4N; 23 2N
Thymic tumor

22. which nerve provides innervation for plantar flexion and inversion?
Tibial
MAO inhibitors; wine and cheese
Well trained athletes and children
G to T in p53; HCC

23. there are mucus secreting cells in the bronchioles...
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Well
only up to bronchi
Selective alpha 1 (increases SVR)

24. What can chronic vit A toxicity cause?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
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)
Vancomycin; histamine mediated

25. What is normal fibrinogen levels?
200-500
Right before diastole (filling begins)
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Headaches and facial flushing; vasodilation in meninges and skin

26. what kind of drug is sertraline? What is a common side effect?
frameshift mutations (missense is substitution)
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
In the extracellular space for collagen cross linking; zinc
SSRI; erectile dysfunction

27. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Retinitis; mononucleosis
Phencyclidine (PCP)
25; 25
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

28. in the LV and aorta - What are the pressures?
Chlorpheniramine and diphenhydramine
Bronchogenic carcinoma
Normally close to systolic
SaO2 <92%

29. what nerve and artery course along the posterior aspect of the humerus?
Myasthenia gravis
Diabetic microangiopathy
Ceftriaxone; azithromycin
Radial nerve and deep brachial artery

30. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
200-500
Pulmonic and systemic!
8; 12
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

31. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Close but purkinje system to ensure contraction in a bottom up fashion
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Reiter syndrome; B27
In the extracellular space

32. What is the most common initital symptom of ADPKD? what else?
Both sides
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Underestimation of gestational age
TCAs and prazosin

33. What is the presentation of sever aortic stenosis?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Sickle cell; G6PD
Not lined by epithelium
Syncope - angina - dyspnea (SAD)

34. What is the triad seen in pre eclampsia?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
8; 12
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Hypertension - edema - and proteinuria

35. h1 receptor anatagonists are not effective in treatment of asthma only for...
In ER of bile canaliculi
Ketone body production by preventing fatty acids into the mitochondria
chronic urticaria and allergic symptoms
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

36. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
11
Nonsense; mRNA processing
Brief psychotic disorder; schizophreniform; schizophrenia

37. who bleed more DIC or TTP- HUS patients?
DIC; TTP- HUS dont bleed that much
Prepatellar
Abnormal closing of the urethral folds
Intussusception

38. What is the immune deficinecy seen in ataxia telangactasia?
Ig A deficiency
RER; RER
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

39. What does protein M do in Group A strep<
Prevent phagocytosis
Initiation - pointing; pincer grasp; walking; mama/dada
RR-1/RR
Phencyclidine (PCP)

40. What three pathogens cause infectious esophagitis in HIV positive patients?
Abnormal closing of the urethral folds
Lateral; RV; RA; LV
CMV - HSV 1 - Candida
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

41. what hernia has a similar mechanism to hydrocele?
Fibrosis; macrophages
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Radial nerve and deep brachial artery

42. What is used to compare means? categorical outcomes?
Pan colitis and right sided colitis (more than left sided and proctitis)
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
T test; chi squared

43. What translocations can cause c - myc overexpression?
Vagus (auricular branch); vasovagal syncope!
Anti cholinergic effects of pupil dilation and lack of accomodation
Trochlear nerve (IV); abducens nerve (VI)
8 (myc protein) with 2 - 14 - 22 (iG chains)

44. where are the two classical places that the ulnar nerve can be injured?

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45. What is the most important prognostic indicator in patients with malignant melanoma?
Measure of depth invasion (vertical!)
Increases
Anti - apoptotic (prevents going into apoptosis)- 18; 14
RBF= PAH clearance/(1- hematocrit)

46. what defines hypoxemia?
Boiling - bleach - formalin - UV irradiation
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Amiloride - spironolactone - triamterene
SaO2 <92%

47. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Relfex tachycardia; giving beta blockers
Hypo or hyper pigmentations; after tanning
Skin flushing and warmth; prostaglandins; give with aspirin

48. What causes curlings ulcers?
Anterior circumflex (and axillary nerve)
Susceptible; soluble (unable to be cultured in bile)
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

49. What does C1 esterase do other than inhibiting complement pathway?
AV node slowest - to allow time for diastole
Inactivates kallikrein which activates kininogen into bradykinin
chronic urticaria and allergic symptoms
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

50. What can long term leg cast wearing cause?
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
Anterior nares
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
Strength of cell mediated immune response