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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 is faster atrial muscle or ventricular muscle?
Anterior circumflex (and axillary nerve)
Paramyxo and influenza
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)
Atrial

2. name three pathological states that present with large tongues.
GI malignancies and Insulin resistance (acromegal for ex)
Vancomycin; histamine mediated
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Protamine sulfate

3. What are fenfluramine - phentermine?
Appetite suppressants
HSV and VZV
Amiadarone
SVT; increases vagal tone; rectus abdominis

4. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
Hexokinase
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Recurrent larygneal
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

5. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
In the extracellular space
Increased reticulocytes
CGD; t cell dysfxn (diGeorge)
Primary

6. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Kallmans
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

7. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Hypo or hyper pigmentations; after tanning
Joints d/t increased purine production and thus uric acid production
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

8. What is acanthosis nigricans associated with?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Elevated GGT and macrocytosis
GI malignancies and Insulin resistance (acromegal for ex)
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

9. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Fibronectin - laminin - collagen
Skin flushing and warmth; prostaglandins; give with aspirin
Chrom 8
No; yes

10. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
Extrinsic def; instrinsic def; platelet def
Syringomelia
E. coli; staphylococcus saprophyticus
Dihydropyridine sensitive Ca channels (L type)

11. ___________ is liver specific
glycerol kinase
Single adenomatous ones
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Valproate

12. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
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
Anterior circumflex (and axillary nerve)
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Congenital hypothyroidism - downs - amyloidosis - acromegaly

13. Where is the base of the heart? apex?
LT (LTD4 - E4 - C4) - and Ach
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Closer to head; closer to diaphragm
Serum FFA and serum triglyceride levels

14. Is there edema in primary Conns? secondary hyperaldosteronism? why?
When it invades the bm; carcinoma in situ
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Circular - outside nucleus; transport proteins - rRNA - tRNA

15. What is the presentation of angioedema? Where is most commonly affected?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Appetite suppressants
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
indomethacin

16. What would a deflection of the membrane potential to near zero indicate?
APP on chrom 21 (this is why downs more susceptible)
Serum creatine kinase; reperfusion injury causes necrosis
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Increase in permeability of two ions with equal and opposite equilibrium potentials

17. what has the greatest effect on prognosis when treating c. diptheriae?
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)
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
DIC; TTP- HUS dont bleed that much
...

18. What is epleronone?
Joints d/t increased purine production and thus uric acid production
I is more benign and can present later in adulthood
Another type of aldosterone antagonist (like spironolactone)
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

19. What type of endocarditis is cytoscopy induced?
ZDV or AZT
Enterococci (e. faecalis)- found on genitalia area
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Increase by 50% in urine osmolality

20. Where does 90% of serotonin lie? What is this NT responsible?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
GI tract; mood!

21. What is the preferred treatment for DKA?
To pump calcium out in cardiac myocytes so that relaxation occurs
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
RER; copper
Regular insulin (Not fast acting - regular better)

22. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Nonsense; mRNA processing
Chrom 8
Relfex tachycardia; giving beta blockers

23. which two virus families have hemagluttinin on their surface?
Localized dermatologic pain that persists for more than one month after zoster eruption
S3 gallop; S2 to opening snap interval
Duration and extent of disease
Paramyxo and influenza

24. neisseria are...
When it invades the bm; carcinoma in situ
Turners`
facultative intracellular
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

25. Where does conjugation of bilirubin take place?
Measure of depth invasion (vertical!)
In ER of bile canaliculi
Superior larygeal; cricothyroid; recurrent laryngeal
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

26. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Class I
glycerol kinase
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Intussusception

27. what virus causes pharyngoconjuctival fever?
Phencyclidine (PCP)
Boiling - bleach - formalin - UV irradiation
Adeno
Ketone body production by preventing fatty acids into the mitochondria

28. 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)
Syncope - angina - dyspnea (SAD)
Drug induced interstitial nephritis
Biphosphonate

29. When does opening snap begin?
Right before diastole (filling begins)
Clindamycin; covers anaerobic oral flora and aerobic bacteria
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
Hexokinase

30. What does 'oxygen' content in blood refer to?
Demargination of neutrophils from the vessel walls
Dissolved in plasma and attached to Hgb
Because of vasodiation to skeletal muscles
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

31. other than in pyelonephritis - where else are WBC casts seen?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Acute interstitial nephritis
OCPs - multiparity - breast feeding

32. What are the two growth factors associated with angiogenesis?
Demargination of neutrophils from the vessel walls
FGF and VEGF
Vagus nerve stimulation
Serum creatine kinase; reperfusion injury causes necrosis

33. What is tachyphylaxis?
Protamine sulfate
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
The term used to describe decreased drug responsiveness with repeated administration
Closer to head; closer to diaphragm

34. What are the long term consequences of hydrocephalus?
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
TSh (in testicular tumors can cause hyperthyroidism)
Prevents hepatic VLDL production
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

35. Where does lysyl oxidase act? What is the cofactor for that?
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
In the extracellular space for collagen cross linking; zinc
Anti cholinergic effects of pupil dilation and lack of accomodation
MAC complex (C5b - C9 complement deficiency)

36. What is normal fibrinogen levels?
200-500
Vancomycin
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Anterior circumflex (and axillary nerve)

37. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
P53 mutation; AD
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
Joints d/t increased purine production and thus uric acid production
Downs; regurgitant AV valves - ASDs

38. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Downs; regurgitant AV valves - ASDs
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

39. why does variocele occur more in left side?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Octreotide
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Phencyclidine (PCP)

40. 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?)?
Vascular endothelium; protease
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Increased reticulocytes

41. What is the cause of rapid plasma decay of thiopental?
CGD; t cell dysfxn (diGeorge)
ANCA because of lack of Ig and C3 deposits on IF
Southern - western
Tissue redistribution (out of plasma) rather than metabolism

42. What type of bond is a disulfide bond?
RER; copper
Vagus (auricular branch); vasovagal syncope!
Covalent (between two cysteines)- allows protein to withstand denaturation
Reticulocytes

43. what dictates the resting membrane potential of most cells?
Tzanck smear
PDA open
High potassium conductance and some sodium conductance
In ER of bile canaliculi

44. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Headaches and facial flushing; vasodilation in meninges and skin
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
GI malignancies and Insulin resistance (acromegal for ex)
I is more benign and can present later in adulthood

45. What antibodies are present in CREST? What is the most specific?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
IgE
Anti centromere; anti DNA topoisomerase
Dissolved in plasma and attached to Hgb

46. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Pan colitis and right sided colitis (more than left sided and proctitis)
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
No (unlike adenomyosis); yes

47. What is the most common initital symptom of ADPKD? what else?
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)
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Increase lymphatic drainage!
P450 mitochondrial monooxygenase

48. What does NF- KB do?
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
Increases cytokine production
Superior larygeal; cricothyroid; recurrent laryngeal
Recurrent larygneal

49. at three years of age What are social - fine motor - gross motor and language developments?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Valproate
SS +rNA

50. What is hypospadias caused by?
V fib; v. failure
Abnormal closing of the urethral folds
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
Squatting - sitting - lying supine - passive leg raising