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USMLE Prep 2

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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 primary histologic finding in patients with eczematous dermatitis?
Spongiosis
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
S. aureus

2. What can long term leg cast wearing cause?
Intussusception
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
AV node slowest - to allow time for diastole
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

3. what dissolves the lipid bilayer of a viral envelope?
Ether and other organic solvents
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
RER; copper
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

4. which has better side effect profile - SSRI or TCA?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
SSRI
Chlorpheniramine and diphenhydramine
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

5. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Medullary
Ig A deficiency
Aromatase deficiency in child
Prostate tumor and increased osteoclast activity

6. What are diastolic (lowest) pressures in aorta? LV?
Around 70 (normal measured diastolic pressures); 9--
Little effect on cell and no change
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Spongiosis

7. What is the triad seen in pre eclampsia?
46 - 4N; 23 2N
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Amiadarone
Hypertension - edema - and proteinuria

8. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Sydenham chorea
G to T in p53; HCC

9. What does 'oxygen' content in blood refer to?
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
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Dissolved in plasma and attached to Hgb
Hypothyroidism

10. In What type of nephritis would you see high serum eos count?
Vancomycin
Drug induced interstitial nephritis
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Measles and M3 AML`

11. What does protein M do in Group A strep<
Amiloride - spironolactone - triamterene
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Smoking
Prevent phagocytosis

12. What is the cause of rapid plasma decay of thiopental?
Hypo or hyper pigmentations; after tanning
Tissue redistribution (out of plasma) rather than metabolism
Abnormal closing of the urethral folds
Selective alpha 1 (increases SVR)

13. Metronidizaole does not cover...
Bile salt accumulation in urine
gram positive organisms
SSRI
Covalent (between two cysteines)- allows protein to withstand denaturation

14. What is used to prevent vertical transmission of HIV?
Vascular endothelium; protease
8; 12
Because of vasodiation to skeletal muscles
ZDV or AZT

15. where are Beta 1 receptors found?
On cardiac tissue and renal juxtaglomerular cells
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Joints d/t increased purine production and thus uric acid production
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

16. how long is substance P? What does it do?
11 aa polypeptide; pain NT in CNS and PNS
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
No; yes
Pulmonary hypertension

17. what kind of drug is sertraline? What is a common side effect?
SSRI; erectile dysfunction
RER; RER
E. coli
IgE

18. what protein is increased in Crohns disease? What does it do?
NF- KB; responsible for cytokine production
Squatting - sitting - lying supine - passive leg raising
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Inhibits it

19. what marker should be followed in a patient with cirrhosis?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
IgE
Susceptible; soluble (unable to be cultured in bile)

20. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Class I
Primary
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
Tibial

21. how does increased ICP result in curlings ulcers?
Vagus nerve stimulation
Neisseria induced small cell vasculitis (including hands and soles)
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
V fib; v. failure

22. What is somatomedin C?
liver specific
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
Insulin like growth factor 1 (just another name)
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

23. 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?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
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
46 - 4N; 23 2N

24. What is congestive hepatomegaly specific for?
Right heart failure
liver specific
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

25. ___________ is liver specific
differentiate
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
glycerol kinase
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

26. where exactly is ACE expressed in the lungs? What type of enzyme is it?
Vascular endothelium; protease
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Medial part

27. What is achalasia and how would this correlate on the esophageal mannometry?
Kallmans
C3 decreased after 5-10 days; sulfonamides
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)
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

28. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
Little effect on cell and no change
Dissolved in plasma and attached to Hgb
Hypothyroidism
T test; chi squared

29. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Relfex tachycardia; giving beta blockers
Hydrogen bonds dictate alpha or beta structure
SSRI; erectile dysfunction
As a CO2 carrier with the carboxylase enzyme

30. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Joints d/t increased purine production and thus uric acid production
OCPs - multiparity - breast feeding

31. what commonly happens in GI in response to acute physiologic stress?
Acute gastric mucosal defects (superficial or full thickness)
Bile salt accumulation in urine
MAO inhibitors; wine and cheese
Inhaled animal dander allergens

32. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Fibronectin - laminin - collagen
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
IgE
V fib; v. failure

33. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Single adenomatous ones
Echinococcus granulosus; anaphylaxis
Think Hb deformation diseases
Abnormal closing of the urethral folds

34. What are the long term consequences of hydrocephalus?
Neisseria induced small cell vasculitis (including hands and soles)
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
APP on chrom 21 (this is why downs more susceptible)
Increases cytokine production

35. How is dobutamine better than dopamine?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Sydenham chorea
Aromatase deficiency in child

36. which nerve is at risk when ligating the superior thyroid artery? Which is the only muscle this nerve innervates? what nerve innervates all the other laryngeal muscles?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Relfex tachycardia; giving beta blockers
Superior larygeal; cricothyroid; recurrent laryngeal

37. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Right heart failure
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Gluteus medius and minimus; positive trendelenberg

38. within the right ventricle - What are maximum pressures? the pulm arter?
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
25; 25
In ER of bile canaliculi
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

39. how does noise induced hearing loss occur?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
In the extracellular space
Dihydropyridine sensitive Ca channels (L type)
Trauma to stereociliated hair cells of the organ of corti

40. What does prolonged PT indicated? aPTT? bleeding time?
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
On cardiac tissue and renal juxtaglomerular cells
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Extrinsic def; instrinsic def; platelet def

41. in the LV and aorta - What are the pressures?
Joints d/t increased purine production and thus uric acid production
Inhibits it
Relfex tachycardia; giving beta blockers
Normally close to systolic

42. What is the stabilizing force for the secondary structure of proteins?
Aromatase deficiency in child
SaO2 <92%
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Hydrogen bonds dictate alpha or beta structure

43. In what population does cholelithiasis occur?
As a CO2 carrier with the carboxylase enzyme
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Fat - fertile - forty - female
Neisseria induced small cell vasculitis (including hands and soles)

44. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Chrom 8
TCAs and prazosin
Highly negative resting potential
Reiter syndrome; B27

45. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
No and yes
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
transcription activation/suppression
When it invades the bm; carcinoma in situ

46. carnitine deficiency impairs production of What and how?
200-500
Coagulation factors are made in the liver
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Ketone body production by preventing fatty acids into the mitochondria

47. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
SVC and IVC; right below the aortic knob
Increase by 50% in urine osmolality
Paramyxo and influenza
Smoking

48. how does achalasia present? What does barium swallow show on dilated esophagus?
Closer to head; closer to diaphragm
Medial part
Chorda tympani branch
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

49. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Medial circumflex artery; avascular necrosis
Pain reliever - reduces pain by locking substance P in the PNS
Increase; decreased
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

50. What is suggestive of complete central DI?
Superior larygeal; cricothyroid; recurrent laryngeal
Increase by 50% in urine osmolality
Diabetic microangiopathy
Acute interstitial nephritis

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USMLE Prep 2

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