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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 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)
SaO2 <92%
RBC mass; epo levels (secondary has high)
Bronchial dilation (bronchiectasis)

2. What is contraindicated in toxic mega colon?
46 - 4N; 23 2N
Pulmonic and systemic!
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

3. What is the mc malignancy in asbestosis?
DIC; TTP- HUS dont bleed that much
Hypo or hyper pigmentations; after tanning
Chlorpheniramine and diphenhydramine
Bronchogenic carcinoma

4. why does variocele occur more in left side?
Squatting - sitting - lying supine - passive leg raising
CMV - HSV 1 - Candida
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
GI malignancies and Insulin resistance (acromegal for ex)

5. What is the mc manifestation of CMV in HIV patient? immunocompetent?
Ether and other organic solvents
Retinitis; mononucleosis
Extrinsic def; instrinsic def; platelet def
SVT; increases vagal tone; rectus abdominis

6. What type of drug is alendronate?
II; I (I more abundant)
Sickle cell; G6PD
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
Biphosphonate

7. Which is faster atrial muscle or ventricular muscle?
Atrial
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
SSRI
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

8. at four years of age - What are the social - fine motor - gross motor - and language developments?
Normally close to systolic
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
...
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

9. at one year of age - What are the social - fine motor - gross motor and language developments?
P53 mutation; DCC is also required for adenoma to carcinoma
Initiation - pointing; pincer grasp; walking; mama/dada
Varying; erythema nodosum is common
Chrom 8

10. what bursa is affected when on knees like a maid/gardner?
No and yes
FGF and VEGF
200-500
Prepatellar

11. Metronidizaole does not cover...
LT (LTD4 - E4 - C4) - and Ach
Covalent (between two cysteines)- allows protein to withstand denaturation
only up to bronchi
gram positive organisms

12. which nerve in the lower leg is easily injured and causes foot drop ? What are common causes? From what nerve does it branch off or?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Lateral; RV; RA; LV
Common peroneal; bony fractures and compression; sciatic
Bronchogenic carcinoma

13. What does Rb protein do? what chrom is it on?
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
S. aureus
Turners`
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

14. what should you think of in 'smear of an oral ulcer base'?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
II; I (I more abundant)
Tzanck smear
IgE

15. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Diabetic microangiopathy
Susceptible; soluble (unable to be cultured in bile)
Another type of aldosterone antagonist (like spironolactone)
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

16. nucleotide deletions do not cause missense mutations - they cause...
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
frameshift mutations (missense is substitution)
Little effect on cell and no change
S3 gallop; S2 to opening snap interval

17. other than parvo B19 - what else is associated with red cell aplasia?
Thymic tumor
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Neisseria induced small cell vasculitis (including hands and soles)
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

18. What causes wrist drop?
SS +rNA
Radial nerve damage
Proteasome inhibitor; treatment for MM and waldenstroms
Hypothyroidism

19. What is capsaicin? Where does it work?
Measure of depth invasion (vertical!)
Barium enema
8; 12
Pain reliever - reduces pain by locking substance P in the PNS

20. What type of disease has selective proteinuria? What is found in urine? What is not?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Increase by 50% in urine osmolality
Prostate tumor and increased osteoclast activity

21. what diseases can vit A be used to treat?
V fib; v. failure
RR-1/RR
Measles and M3 AML`
Integration of viral DNA into genome of host hepatocytes

22. how long is substance P? What does it do?
Normal; low
Fat - fertile - forty - female
Vascular endothelium; protease
11 aa polypeptide; pain NT in CNS and PNS

23. ___________ is liver specific
Both sides
glycerol kinase
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Tissue redistribution (out of plasma) rather than metabolism

24. non ceruloplasmin deposition - ceruloplasmin is...
low in serum
Because of vasodiation to skeletal muscles
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)
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

25. if there are keratin swirls does that mean well or poorly differentiated?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Well
S. saprophyticus - and s. epidermidis; novobiocin
Adductor

26. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Acute interstitial nephritis
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

27. What triggers the neoplastic changes that are associated with HBV infecton?
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
Regular insulin (Not fast acting - regular better)
Integration of viral DNA into genome of host hepatocytes
As a CO2 carrier with the carboxylase enzyme

28. What does glycosylase do to DNA? endonuclease? lyase? What does the order here of enzymes represent? what other enzymes are needed?

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29. how can HAV be inactivated?
Boiling - bleach - formalin - UV irradiation
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

30. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
MAO inhibitors; wine and cheese
SSRI
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Standing suddenly from supine position; valsalva maneuver

31. What translocations can cause c - myc overexpression?
8 (myc protein) with 2 - 14 - 22 (iG chains)
Increase in permeability of two ions with equal and opposite equilibrium potentials
S3 gallop; S2 to opening snap interval
Anti cholinergic effects of pupil dilation and lack of accomodation

32. Where does 90% of serotonin lie? What is this NT responsible?
Adductor
Class I
GI tract; mood!
Selective alpha 1 (increases SVR)

33. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Turners`
Classical conditioning
Radial nerve damage

34. What are the skin presentation in sarcoid?
Hypertension - edema - and proteinuria
Varying; erythema nodosum is common
Acute interstitial nephritis
Adductor

35. What is used to treat heparin toxicity?
Protamine sulfate
ANCA because of lack of Ig and C3 deposits on IF
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

36. What is difference between Arnold Chiari type I and II?
I is more benign and can present later in adulthood
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Aromatase deficiency in child
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

37. What is the cause of rapid plasma decay of thiopental?
Paramyxo and influenza
Protamine sulfate
Tissue redistribution (out of plasma) rather than metabolism
Tzanck smear

38. What effects does cortisol have on catecholamines?
ANCA because of lack of Ig and C3 deposits on IF
CGD; t cell dysfxn (diGeorge)
Thymic tumor
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

39. what phase do adenosine and acetylcholine act on? doing what?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Standing suddenly from supine position; valsalva maneuver
Measles and M3 AML`

40. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
Sickle cell; G6PD
Purkinje system; AV node
Hypertension - edema - and proteinuria
C3 decreased after 5-10 days; sulfonamides

41. What is the neurologic manifestation of ADPKD?
RR-1/RR
Class I
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

42. What can cause virilization of a mother during pregnancy?
Folic acid treatment!
Aromatase deficiency in child
Varying; erythema nodosum is common
Inactivates kallikrein which activates kininogen into bradykinin

43. in B12 deficiency - what levels in blood rise very quickly and then drop?
Reticulocytes
Adeno
MAC complex (C5b - C9 complement deficiency)
Drug induced interstitial nephritis

44. what drugs causes the red man syndrome? how does it occur?
Acute interstitial nephritis
Dissolved in plasma and attached to Hgb
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Vancomycin; histamine mediated

45. What is capacitance inversely proportional to?
Inactivates kallikrein which activates kininogen into bradykinin
Elastance
Increase; decreased
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

46. What is the mainstay treatment for acute mania?
Hereditary angioedema; ACE inhibitors
...
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Rabies encephalitis from cave bats; rabies killed vaccines

47. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
Because gamma chains replace beta chains and then gamma chain formation wanes
Inhibits it
S. aureus
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac

48. what drug is useful for secretory diarrhea?
The time interval between S2 and OS- the shorter the interval - the more intense
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Octreotide
Dissolved in plasma and attached to Hgb

49. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Right before diastole (filling begins)
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Large stroke volumes with ventricular contraction; aortic regurg
glycerol kinase

50. metabolism of 1 gram of protein produces How many calories? carb? fat?
OCPs - multiparity - breast feeding
RER; copper
4 - 4 - 9
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)