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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 diagnostic (and possible therapeutic for intussusception)?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Underestimation of gestational age
Barium enema

2. which two virus families have hemagluttinin on their surface?
Paramyxo and influenza
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Vancomycin; histamine mediated

3. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Common peroneal; bony fractures and compression; sciatic
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

4. What can cause aortic regurg? What is the heart sound you hear?
Pan colitis and right sided colitis (more than left sided and proctitis)
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Radial nerve and deep brachial artery
Adeno

5. What is medullary sponge kidney disease and how does it present? What does it lead to?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
As a CO2 carrier with the carboxylase enzyme
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)
ANCA because of lack of Ig and C3 deposits on IF

6. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
Well trained athletes and children
low in serum
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Strength of cell mediated immune response

7. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
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
Around 70 (normal measured diastolic pressures); 9--
P53 mutation; DCC is also required for adenoma to carcinoma
Become beta pleated and then form neurofibrillary tangle!

8. What can worse neurologic dysfunction in cobalamic def?
Hereditary angioedema; ACE inhibitors
Folic acid treatment!
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

9. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
HSV ( also in utero: chlymadia - neisseria - group B strep)
Around 70 (normal measured diastolic pressures); 9--

10. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
Intussusception
Acute interstitial nephritis
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

11. What is somatomedin C?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Localized dermatologic pain that persists for more than one month after zoster eruption
Integration of viral DNA into genome of host hepatocytes
Insulin like growth factor 1 (just another name)

12. what protects the resting heart from arrhythmias?
Highly negative resting potential
Susceptible; soluble (unable to be cultured in bile)
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
AV node slowest - to allow time for diastole

13. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Drink plenty of fluids
Trochlear nerve (IV); abducens nerve (VI)
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

14. what phase do adenosine and acetylcholine act on? doing what?
Inhaled animal dander allergens
Prostate tumor and increased osteoclast activity
Measles and M3 AML`
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

15. when arrested in prophase of meiosis I - What are primary oocytes chrom number? What about the secondary oocytes that are stuck in metaphase of Meiosis II?
46 - 4N; 23 2N
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Hypertension - edema - and proteinuria
Prevents hepatic VLDL production

16. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
SaO2 <92%
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
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Prepatellar

17. What can chronic vit A toxicity cause?
women
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Another type of aldosterone antagonist (like spironolactone)
Because of the low output from heart failure - they will have increased aldosterone levels

18. which virus inactivates both Rb and p53?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
SVC and IVC; right below the aortic knob
The term used to describe decreased drug responsiveness with repeated administration

19. how does noise induced hearing loss occur?
Duration and extent of disease
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Trauma to stereociliated hair cells of the organ of corti

20. What causes release of myosin head from the actin filament?
ATP binding (resets the myosin head to contract again for next binding)
Dihydropyridine sensitive Ca channels (L type)
Reiter syndrome; B27
Boiling - bleach - formalin - UV irradiation

21. What is easiest way to treat nephrolithiasis?
Minimal change disease
Acute gastric mucosal defects (superficial or full thickness)
Reiter syndrome; B27
Drink plenty of fluids

22. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Thymic tumor
Amiloride - spironolactone - triamterene
Because of vasodiation to skeletal muscles

23. Metronidizaole does not cover...
SVC and IVC; right below the aortic knob
Thymic tumor
gram positive organisms
Increase; decreased

24. What is the preferred treatment for DKA?
8; 12
AV node slowest - to allow time for diastole
PDA open
Regular insulin (Not fast acting - regular better)

25. in B12 deficiency - what levels in blood rise very quickly and then drop?
Curlings ulcers
No (unlike adenomyosis); yes
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Reticulocytes

26. what has the greatest effect on prognosis when treating c. diptheriae?
Integration of viral DNA into genome of host hepatocytes
Increase by 50% in urine osmolality
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

27. What are the long term consequences of hydrocephalus?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Vagus (auricular branch); vasovagal syncope!
Increase lymphatic drainage!
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

28. biotin is used By what in tissues responsible for gluconeogenesis
Adductor
11
Because gamma chains replace beta chains and then gamma chain formation wanes
As a CO2 carrier with the carboxylase enzyme

29. How do you treat gonococcal infection? chlymadia?
Ceftriaxone; azithromycin
hyponatremia (aldosterone activation equilibrates body volume)
Barium enema
Bronchogenic carcinoma

30. What type of calcium channels dictate the plateau in cardiac myocyte?
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
RR-1/RR
Dihydropyridine sensitive Ca channels (L type)
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

31. why does liver dysfunction cause coagulation disorders?
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
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
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Coagulation factors are made in the liver

32. What do you treat s. epidermidis with?
GI tract; mood!
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
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
Vancomycin

33. What causes curlings ulcers?
RER; RER
No (unlike adenomyosis); yes
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

34. What is hypospadias caused by?
Abnormal closing of the urethral folds
Insulin like growth factor 1 (just another name)
only up to bronchi
Hereditary angioedema; ACE inhibitors

35. What antibodies are present in CREST? What is the most specific?
Ceftriaxone; azithromycin
Acute interstitial nephritis
Anti centromere; anti DNA topoisomerase
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

36. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
Anti cholinergic effects of pupil dilation and lack of accomodation
LT (LTD4 - E4 - C4) - and Ach
TCAs and prazosin
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

37. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
8; 12
II; I (I more abundant)

38. which nucleus releases serotonin?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Raphe
Highly negative resting potential
Radial nerve damage

39. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
Pan colitis and right sided colitis (more than left sided and proctitis)
Relatively selective B1 adrenergic agonist; acute heart failure with decreased myocardial contractility (cardiogenic shock); increases myocardial contractility; can induce arrhythmias because increases cardiac conduction velocity
Curlings ulcers
Think Hb deformation diseases

40. Where is the base of the heart? apex?
Prevents hepatic VLDL production
Because of the low output from heart failure - they will have increased aldosterone levels
Echinococcus granulosus; anaphylaxis
Closer to head; closer to diaphragm

41. What translocations can cause c - myc overexpression?
G to T in p53; HCC
8 (myc protein) with 2 - 14 - 22 (iG chains)
Duration and extent of disease
Varying; erythema nodosum is common

42. What are the lab findings in poststreptococcal GN?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Increases bronchial and vascular smooth muscle reactivity to catecholamines
HSV ( also in utero: chlymadia - neisseria - group B strep)

43. prostaglandin synthesis keeps...
DIC; TTP- HUS dont bleed that much
Chrom 8
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)
PDA open

44. What type of bond is a disulfide bond?
Appetite suppressants
Acute gastric mucosal defects (superficial or full thickness)
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Covalent (between two cysteines)- allows protein to withstand denaturation

45. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
NF- KB; responsible for cytokine production

46. What is the most important prognostic indicator in patients with malignant melanoma?
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
Ether and other organic solvents
Susceptible; soluble (unable to be cultured in bile)
Measure of depth invasion (vertical!)

47. what diseases can vit A be used to treat?
Close but purkinje system to ensure contraction in a bottom up fashion
(urine PAH x urine flow rate)/plasma PAH
Syringomelia
Measles and M3 AML`

48. other than in pyelonephritis - where else are WBC casts seen?
OCPs - multiparity - breast feeding
Dissolved in plasma and attached to Hgb
Acute interstitial nephritis
Intussusception

49. What does VIP do to gastric acid secretion?
Increases cytokine production
Inhibits it
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

50. What is used to compare means? categorical outcomes?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Anti centromere; anti DNA topoisomerase
Standing suddenly from supine position; valsalva maneuver
T test; chi squared