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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 color pigmentations are caused by malassezia furfur? when do they become more visible?
Hypo or hyper pigmentations; after tanning
Smoking
Drug induced interstitial nephritis
Drink plenty of fluids

2. What actions increase venous return?
Squatting - sitting - lying supine - passive leg raising
Reticulocytes
Dihydropyridine sensitive Ca channels (L type)
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

3. carnitine deficiency impairs production of What and how?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Secretin stimulates the exocrine pancrease; S enteroendocrine cells in duodenal mucosa in response to acid secrete secretin (HCL is most potent stimulus for secretin release)
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Ketone body production by preventing fatty acids into the mitochondria

4. what marker should be followed in a patient with cirrhosis?
Adductor
Normal; low
Increased reticulocytes
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

5. metabolism of 1 gram of protein produces How many calories? carb? fat?
4 - 4 - 9
Lateral; RV; RA; LV
Leukotriene precursor and does neutrophil chemotaxis
Joints d/t increased purine production and thus uric acid production

6. What is Bortezomib and What is it used for?
SSRI; erectile dysfunction
Radial nerve damage
Proteasome inhibitor; treatment for MM and waldenstroms
Hyperkalemia; potassium sparing diuretics - potassium supplements

7. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
SS +rNA
Barium enema
Ether and other organic solvents
Syringomelia

8. What is subacute sclerosisng encephalitis caused by?
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
Trauma to stereociliated hair cells of the organ of corti
Single adenomatous ones
Spongiosis

9. What is capacitance inversely proportional to?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Elastance
Another type of aldosterone antagonist (like spironolactone)
Proteasome inhibitor; treatment for MM and waldenstroms

10. What is the diagnosis in delayed puberty plus anosmia?
Recurrent larygneal
Kallmans
LT (LTD4 - E4 - C4) - and Ach
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

11. what protects the resting heart from arrhythmias?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
HSV and VZV
Highly negative resting potential
8 (myc protein) with 2 - 14 - 22 (iG chains)

12. What is a keloid?
P53 mutation; DCC is also required for adenoma to carcinoma
DIC; TTP- HUS dont bleed that much
Excessive collagen formation during tissue repair in susceptible individuals
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

13. What are the potassium sparing diuretics?
Amiloride - spironolactone - triamterene
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

14. What type of bond is a disulfide bond?
Fat - fertile - forty - female
Covalent (between two cysteines)- allows protein to withstand denaturation
Syncope - angina - dyspnea (SAD)
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

15. What is the difference between paranoid personality disorder and delusional disorder?
Around 70 (normal measured diastolic pressures); 9--
Covalent (between two cysteines)- allows protein to withstand denaturation
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

16. What are the three causes of acute MI in context of normal coronary arteries ?
indomethacin
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Drug induced interstitial nephritis
MAO inhibitors; wine and cheese

17. which are the only glycosylated proteins in HIV virus?
Env genes (for getting into target cells)
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
Susceptible; soluble (unable to be cultured in bile)
Headaches and facial flushing; vasodilation in meninges and skin

18. What are some of the permissive effects of cortisol?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Thymic tumor
Env genes (for getting into target cells)

19. 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?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Apocrine; eccrine
Drug induced interstitial nephritis
Phencyclidine (PCP)

20. If a patient has higher levels of HbF - What does this mean?
Think Hb deformation diseases
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Strength of cell mediated immune response

21. Where does conjugation of bilirubin take place?
Valproate
Trauma to stereociliated hair cells of the organ of corti
FGF and VEGF
In ER of bile canaliculi

22. how does noise induced hearing loss occur?
T test; chi squared
Terminal bronchioles; small bronchi
Trauma to stereociliated hair cells of the organ of corti
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

23. which nerve is at risk when ligating the superior thyroid artery? Which is the only muscle this nerve innervates? what nerve innervates all the other laryngeal muscles?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
liver specific
Well trained athletes and children
Superior larygeal; cricothyroid; recurrent laryngeal

24. What does C1 esterase do other than inhibiting complement pathway?
Sarcoid
Inactivates kallikrein which activates kininogen into bradykinin
Standing suddenly from supine position; valsalva maneuver
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

25. at one year of age - What are the social - fine motor - gross motor and language developments?
Initiation - pointing; pincer grasp; walking; mama/dada
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Because ACE blocks breakdown of bradykinin and hereditary angioedema patients have high levels of bradykinin; high levels of bradykinin - C3a - and C5a mediate edema by increasing vascular permeability and vasodilation

26. what organ would an activating mutation in PRPP synthetase effect?
Vagus nerve stimulation
Joints d/t increased purine production and thus uric acid production
Turbulence
DIC; TTP- HUS dont bleed that much

27. What are the two mcc of focal brain lesions in HIV positive patients?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Bronchogenic carcinoma
Acute interstitial nephritis
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

28. What is the neurologic manifestation of ADPKD?
Nonsense; mRNA processing
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Well trained athletes and children
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

29. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
In the extracellular space
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Intussusception
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

30. What are diastolic (lowest) pressures in aorta? LV?
Around 70 (normal measured diastolic pressures); 9--
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
No; yes
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

31. What is the mcc of extrinsic allergic asthma?
Extrinsic def; instrinsic def; platelet def
Coagulation factors are made in the liver
Inhaled animal dander allergens
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

32. which nerve provides innervation for plantar flexion and inversion?
Tibial
The term used to describe decreased drug responsiveness with repeated administration
E. coli
Fibrosis; macrophages

33. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Elevated GGT and macrocytosis
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Increase in permeability of two ions with equal and opposite equilibrium potentials

34. What causes curlings ulcers?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Large stroke volumes with ventricular contraction; aortic regurg
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Terminal bronchioles; small bronchi

35. What type of drug is alendronate?
Terminal bronchioles; small bronchi
Chrom 8
Fat - fertile - forty - female
Biphosphonate

36. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Increase; decreased
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Right heart failure

37. how long is substance P? What does it do?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
11 aa polypeptide; pain NT in CNS and PNS
Trochlear nerve (IV); abducens nerve (VI)
Secretin stimulates the exocrine pancrease; S enteroendocrine cells in duodenal mucosa in response to acid secrete secretin (HCL is most potent stimulus for secretin release)

38. What is contraindicated in toxic mega colon?
Boiling - bleach - formalin - UV irradiation
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Appetite suppressants

39. a patient fearing all white coats is a phenomenon of what?
Trauma to stereociliated hair cells of the organ of corti
Classical conditioning
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
chronic urticaria and allergic symptoms

40. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
Fibrosis; macrophages
CGD; t cell dysfxn (diGeorge)
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
Prostate tumor and increased osteoclast activity

41. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
MAO inhibitors; wine and cheese

42. other than parvo B19 - what else is associated with red cell aplasia?
Dissolved in plasma and attached to Hgb
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)
Drug induced interstitial nephritis
Thymic tumor

43. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
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
Reticulocytes
Sydenham chorea
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

44. other than in pyelonephritis - where else are WBC casts seen?
Thymic tumor
Boiling - bleach - formalin - UV irradiation
Syringomelia
Acute interstitial nephritis

45. Where does the aorta lie in relation to the pulmonary artery in transposition of the great arteries (is this right to left or left to right shunt?)?
Vancomycin
Gluteus maximus; difficulty getting up from seated position and climbing chair
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
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

46. What causes wrist drop?
II; I (I more abundant)
Radial nerve damage
glycerol kinase
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

47. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
hyponatremia (aldosterone activation equilibrates body volume)
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Retinitis; mononucleosis
Gluteus maximus; difficulty getting up from seated position and climbing chair

48. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
Medial circumflex artery; avascular necrosis
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Increase by 50% in urine osmolality
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

49. In What type of nephritis would you see high serum eos count?
Drug induced interstitial nephritis
Because gamma chains replace beta chains and then gamma chain formation wanes
Downs; regurgitant AV valves - ASDs
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

50. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
SS +rNA
Amiloride - spironolactone - triamterene
Pan colitis and right sided colitis (more than left sided and proctitis)
Gluteus medius and minimus; positive trendelenberg