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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 the difference between paranoid personality disorder and delusional disorder?
Gluteus medius and minimus; positive trendelenberg
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)
Skin flushing and warmth; prostaglandins; give with aspirin
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

2. 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?
Increase in permeability of two ions with equal and opposite equilibrium potentials
P53 mutation; AD
Apocrine; eccrine
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

3. What is normal fibrinogen levels?
200-500
DIC; TTP- HUS dont bleed that much
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Fibrosis; macrophages

4. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
Pain reliever - reduces pain by locking substance P in the PNS
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Sudden loss of muscle tone without loss of consciousness; narcolepsy
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

5. why does neutrophila occur with corticosteroids?
TCAs and prazosin
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Demargination of neutrophils from the vessel walls
P53 mutation; DCC is also required for adenoma to carcinoma

6. What is difference between Arnold Chiari type I and II?
I is more benign and can present later in adulthood
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Multiple miscarriages d/t hypercoaguability
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

7. What is the mcc of extrinsic allergic asthma?
Echinococcus granulosus; anaphylaxis
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Inhaled animal dander allergens
DIC; TTP- HUS dont bleed that much

8. What would a deflection of the membrane potential to near zero indicate?
Increase in permeability of two ions with equal and opposite equilibrium potentials
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
liver specific
Sarcoid

9. What type of mutation does aflatoxin cause? what cancer does this increase for?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
G to T in p53; HCC
Raphe
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac

10. What can chronic vit A toxicity cause?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Amiloride - spironolactone - triamterene
Regular insulin (Not fast acting - regular better)
Ceftriaxone; azithromycin

11. What is a common complication of acute pancreatitis? What is it?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Duration and extent of disease
Folic acid treatment!
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

12. neisseria are...
Dissolved in plasma and attached to Hgb
Increases
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
facultative intracellular

13. what happens to capacitance with age?
P53 mutation; AD
Strength of cell mediated immune response
...
Circular - outside nucleus; transport proteins - rRNA - tRNA

14. what immune deficiency causes recurrent neisseria infections?
11
Octreotide
MAC complex (C5b - C9 complement deficiency)
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

15. do Class IC agents prolong the QT interval?
Increase in permeability of two ions with equal and opposite equilibrium potentials
No
<1% - 55% - concentration dependent
Tissue redistribution (out of plasma) rather than metabolism

16. What translocations can cause c - myc overexpression?
Hexokinase
Chorda tympani branch
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
8 (myc protein) with 2 - 14 - 22 (iG chains)

17. at four years of age - What are the social - fine motor - gross motor - and language developments?
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
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
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
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

18. h1 receptor anatagonists are not effective in treatment of asthma only for...
In ER of bile canaliculi
chronic urticaria and allergic symptoms
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Clindamycin; covers anaerobic oral flora and aerobic bacteria

19. What agonists reduce the gradient across the LV outflow tract?
Tibial
Medullary
Selective alpha 1 (increases SVR)
Boiling - bleach - formalin - UV irradiation

20. SIADH patients have normal blood volume but...
indomethacin
By vascular permeability and vasodilation
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
hyponatremia (aldosterone activation equilibrates body volume)

21. what phase do adenosine and acetylcholine act on? doing what?
ZDV or AZT
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Radial nerve and deep brachial artery
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

22. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
DIC; TTP- HUS dont bleed that much
Headaches and facial flushing; vasodilation in meninges and skin
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Gluteus maximus; difficulty getting up from seated position and climbing chair

23. When does opening snap begin?
RBF= PAH clearance/(1- hematocrit)
Right before diastole (filling begins)
Bronchial dilation (bronchiectasis)
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

24. name three pathological states that present with large tongues.
P53 mutation; AD
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Increase by 50% in urine osmolality
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

25. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
low in serum
Vascular endothelium; protease

26. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
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
Ketone body production by preventing fatty acids into the mitochondria
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Bile soluble which means they are bile sensitive

27. what hernia has a similar mechanism to hydrocele?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Biphosphonate
Protamine sulfate
Because of the low output from heart failure - they will have increased aldosterone levels

28. how much percent of sodium is excreted? urea? glucose?
<1% - 55% - concentration dependent
Bronchogenic carcinoma
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

29. What are the two mcc of focal brain lesions in HIV positive patients?
Minimal change disease
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
T test; chi squared
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

30. What does L/S stand for in fetal lung maturity? When does maturity occur?
Vancomycin; histamine mediated
Lateral; RV; RA; LV
Localized dermatologic pain that persists for more than one month after zoster eruption
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

31. other than proteinuria - What can cause foamy froathy urine?
Serum creatine kinase; reperfusion injury causes necrosis
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Bile salt accumulation in urine
Elevated GGT and macrocytosis

32. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
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)
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
T test; chi squared
Vancomycin; histamine mediated

33. What are the long term consequences of hydrocephalus?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

34. which are the only glycosylated proteins in HIV virus?
Increased reticulocytes
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
Env genes (for getting into target cells)
AV node slowest - to allow time for diastole

35. What is Bortezomib and What is it used for?
Downs; regurgitant AV valves - ASDs
PDA open
Increase by 50% in urine osmolality
Proteasome inhibitor; treatment for MM and waldenstroms

36. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
Vagus (auricular branch); vasovagal syncope!
Kallmans
By vascular permeability and vasodilation
Atrial

37. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Increase; decreased
Neisseria induced small cell vasculitis (including hands and soles)
only up to bronchi

38. what defines hypoxemia?
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
SaO2 <92%
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

39. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
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
Become beta pleated and then form neurofibrillary tangle!
When it invades the bm; carcinoma in situ
Medial part

40. What type of drug is alendronate?
Biphosphonate
S3 gallop; S2 to opening snap interval
LT (LTD4 - E4 - C4) - and Ach
Increased reticulocytes

41. other than in pyelonephritis - where else are WBC casts seen?
Phencyclidine (PCP)
Spongiosis
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Acute interstitial nephritis

42. which virus inactivates both Rb and p53?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

43. What does extended consumption of appetite suppressants lead to?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Prostate tumor and increased osteoclast activity
Pulmonary hypertension
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

44. What is the most important prognostic indicator in patients with malignant melanoma?
Class I
Measure of depth invasion (vertical!)
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
46 - 4N; 23 2N

45. Where does complement bind on the Fc region of Ig chains?
Vertical diplopia
By vascular permeability and vasodilation
Atrial
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

46. What is mcc of death pre hospital phase of MI? in hospital phase?
V fib; v. failure
Tibial
Tissue redistribution (out of plasma) rather than metabolism
Leukotriene precursor and does neutrophil chemotaxis

47. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
manifestations - congenital (stretching of periventricular pyrimadal fibers)
P53 mutation; AD
Hypothyroidism
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

48. carnitine deficiency impairs production of What and how?
Vancomycin; histamine mediated
Southern - western
Ketone body production by preventing fatty acids into the mitochondria
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

49. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
LT (LTD4 - E4 - C4) - and Ach
Ketone body production by preventing fatty acids into the mitochondria
Another type of aldosterone antagonist (like spironolactone)
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences

50. What is used to compare means? categorical outcomes?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
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
T test; chi squared
Ig A deficiency