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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. where are the vegetations on the valves of a libman sacks endocarditis?
Pan colitis and right sided colitis (more than left sided and proctitis)
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Both sides
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

2. What is the Na/Ca exchange used for?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
To pump calcium out in cardiac myocytes so that relaxation occurs
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

3. What is hypospadias caused by?
CMV - HSV 1 - Candida
Medial circumflex artery; avascular necrosis
Abnormal closing of the urethral folds
Sarcoid

4. What causes release of myosin head from the actin filament?
Inhibits it
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
S. aureus
ATP binding (resets the myosin head to contract again for next binding)

5. which opponens muscle does ulnar innervate?
Adductor
No; yes
Criggler Najjar (UGT enzyme in bilirubin glucoronidation) ; Dubin Johnson (transport protein lacking - Black liver) and Rotor syndrome - defects in hepatic uptake and excretion of bile (numerous defect)
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

6. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Think Hb deformation diseases
OCPs - multiparity - breast feeding
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

7. in essential fructosuria - what enzyme do patients use to metabolize fructose?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Barium enema
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Hexokinase

8. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
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
No; yes
Multiple miscarriages d/t hypercoaguability

9. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Elevated GGT and macrocytosis
Amiloride - spironolactone - triamterene
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Fibronectin - laminin - collagen

10. which headaches are seen mostly in men - are severe - unilateral - periorbital - episodic (around same time every day) - temporal pain - with lacrimation - nasal congestion and ptosis?
Cluster
Fibrosis; macrophages
Reiter syndrome; B27
Reticulocytes

11. What are fenfluramine - phentermine?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Appetite suppressants
Vagus nerve stimulation
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

12. at 2 years of age - What are the social - fine motor - gross motor and language developments?
Headaches and facial flushing; vasodilation in meninges and skin
Neisseria induced small cell vasculitis (including hands and soles)
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

13. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Intussusception
Another type of aldosterone antagonist (like spironolactone)
Paramyxo and influenza

14. what clinical findings help distinguish small cell carcinoma?
transcription activation/suppression
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

15. What is the triad seen in pre eclampsia?
Hypertension - edema - and proteinuria
IgE
Neisseria induced small cell vasculitis (including hands and soles)
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

16. the rate of blood flow of which two circulations must equal each other at all times?
Tissue redistribution (out of plasma) rather than metabolism
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Diabetic microangiopathy
Pulmonic and systemic!

17. What is capsaicin? Where does it work?
INTRApartum Abs (ampicillin/penicillin)
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
Hypo or hyper pigmentations; after tanning
Pain reliever - reduces pain by locking substance P in the PNS

18. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
SVT; increases vagal tone; rectus abdominis
Hypo or hyper pigmentations; after tanning
Hyperkalemia; potassium sparing diuretics - potassium supplements
Boiling - bleach - formalin - UV irradiation

19. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Hypertension - edema - and proteinuria
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Inhaled animal dander allergens

20. What is contraindicated in toxic mega colon?
Fat - fertile - forty - female
Think Hb deformation diseases
Reticulocytes
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

21. What is achalasia and how would this correlate on the esophageal mannometry?
manifestations - congenital (stretching of periventricular pyrimadal fibers)
The LES is supposed to relax when food comes its way (from above) and in achalasia - a motor dysfunction - LES doesnt relax and seen as elevated pressure on the esophageal mannometry
Coagulation factors are made in the liver
Vagus nerve stimulation

22. Where does conjugation of bilirubin take place?
Skin flushing and warmth; prostaglandins; give with aspirin
HSV and VZV
In ER of bile canaliculi
Standing suddenly from supine position; valsalva maneuver

23. In What type of nephritis would you see high serum eos count?
Aromatase deficiency in child
chronic urticaria and allergic symptoms
Drug induced interstitial nephritis
Both sides

24. What are the long term consequences of hydrocephalus?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
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
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
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

25. a patient fearing all white coats is a phenomenon of what?
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
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Classical conditioning
Increases cytokine production

26. is Rifampin ever used as monotherapY? why either way?
Raphe
Myasthenia gravis
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
Amiadarone

27. what has the greatest effect on prognosis when treating c. diptheriae?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Pulmonary hypertension
Covalent (between two cysteines)- allows protein to withstand denaturation
E6 and E7 of HPV knock off p53 and Rb suppressor genes

28. What is the most important prognostic indicator in patients with malignant melanoma?
Measure of depth invasion (vertical!)
Squatting - sitting - lying supine - passive leg raising
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Abnormal closing of the urethral folds

29. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
Hypertension - edema - and proteinuria
Criggler Najjar (UGT enzyme in bilirubin glucoronidation) ; Dubin Johnson (transport protein lacking - Black liver) and Rotor syndrome - defects in hepatic uptake and excretion of bile (numerous defect)
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)
Minimal change disease

30. what dictates the resting membrane potential of most cells?
HSV and VZV
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
S. aureus
High potassium conductance and some sodium conductance

31. What is the fibrinogen level in patient with TTP- HUS? DIC?
Normal; low
Vertical diplopia
25; 25
TCAs and prazosin

32. What is mcc of death pre hospital phase of MI? in hospital phase?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Vagus (auricular branch); vasovagal syncope!
V fib; v. failure
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

33. there are mucus secreting cells in the bronchioles...
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Headaches and facial flushing; vasodilation in meninges and skin
only up to bronchi
Atrial

34. What type of mutation does aflatoxin cause? what cancer does this increase for?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Superior larygeal; cricothyroid; recurrent laryngeal
G to T in p53; HCC
TCAs and prazosin

35. 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
Rabies encephalitis from cave bats; rabies killed vaccines
Close but purkinje system to ensure contraction in a bottom up fashion
Vascular endothelium; protease

36. why should you not use ACE inhibitors with someone who had hereditary angioedema?
Raphe
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
Anterior circumflex (and axillary nerve)
25; 25

37. What is the cause of fixed splitting of S2? why?
Sydenham chorea
Ketone body production by preventing fatty acids into the mitochondria
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

38. SIADH patients have normal blood volume but...
hyponatremia (aldosterone activation equilibrates body volume)
No
Reiter syndrome; B27
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

39. What type of endocarditis is cytoscopy induced?
Standing suddenly from supine position; valsalva maneuver
To pump calcium out in cardiac myocytes so that relaxation occurs
Sarcoid
Enterococci (e. faecalis)- found on genitalia area

40. What does NF- KB do?
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)
Increases cytokine production
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Primary

41. which trisomy is associated with endocardial cushion defects? What does thsi mean>
chronic urticaria and allergic symptoms
Hexokinase
Mean greater than median greater than mode
Downs; regurgitant AV valves - ASDs

42. What are some of the permissive effects of cortisol?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Sickle cell; G6PD
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

43. in overweight individuals What is thought to contribute to insulin resistance?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Serum FFA and serum triglyceride levels
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Hypo or hyper pigmentations; after tanning

44. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Around 70 (normal measured diastolic pressures); 9--
Localized dermatologic pain that persists for more than one month after zoster eruption
I is more benign and can present later in adulthood
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

45. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Pulmonary hypertension
T test; chi squared
Medullary
Increase in permeability of two ions with equal and opposite equilibrium potentials

46. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
Prevents hepatic VLDL production
Apocrine; eccrine
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
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

47. What is damaged in early syringomelia? later?
Hypothyroidism
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Strength of cell mediated immune response
Single adenomatous ones

48. What is congestive hepatomegaly specific for?
As a CO2 carrier with the carboxylase enzyme
Right heart failure
In the extracellular space
Tzanck smear

49. what chromosome is c - myc found on?
Chrom 8
Cluster
In the extracellular space for collagen cross linking; zinc
Joints d/t increased purine production and thus uric acid production

50. what bursa is affected when on knees like a maid/gardner?
The LES is supposed to relax when food comes its way (from above) and in achalasia - a motor dysfunction - LES doesnt relax and seen as elevated pressure on the esophageal mannometry
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
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
Prepatellar