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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. why is crohns disease associated with oxaloacetate kidney stones?
Mean greater than median greater than mode
Well trained athletes and children
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
Relfex tachycardia; giving beta blockers

2. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
differentiate
INTRApartum Abs (ampicillin/penicillin)
E6 and E7 of HPV knock off p53 and Rb suppressor genes
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac

3. What is used to compare means? categorical outcomes?
indomethacin
Inhibits it
T test; chi squared
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

4. What is difference between Arnold Chiari type I and II?
Medullary
...
GI malignancies and Insulin resistance (acromegal for ex)
I is more benign and can present later in adulthood

5. why are pregnant predisposed to cholelithiasis?
DIC; TTP- HUS dont bleed that much
S. aureus
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Estrogen induced cholesterol hypersecretion (increase HMG CoA reductase activity) and progesterone induced gallbladder hypomotility (decreases bile acid secretion)-- both these conditions predispose cholesterole to insolubilize out

6. what happens with LDL receptor density in statin therapy?
Increases
Trochlear nerve (IV); abducens nerve (VI)
Increase by 50% in urine osmolality
Anti cholinergic effects of pupil dilation and lack of accomodation

7. What type of disease has selective proteinuria? What is found in urine? What is not?
Minimal change disease
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Ig A deficiency
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

8. which nucleus releases serotonin?
Not lined by epithelium
Raphe
Prevent phagocytosis
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

9. what has the greatest effect on prognosis when treating c. diptheriae?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Classical conditioning
Prevents hepatic VLDL production
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

10. What does prolonged PT indicated? aPTT? bleeding time?
Extrinsic def; instrinsic def; platelet def
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Diabetic microangiopathy

11. What is capacitance inversely proportional to?
8 (myc protein) with 2 - 14 - 22 (iG chains)
liver specific
Initiation - pointing; pincer grasp; walking; mama/dada
Elastance

12. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Become beta pleated and then form neurofibrillary tangle!
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
Classical conditioning

13. Acyl coA synthetase is not...
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Nonsense; mRNA processing
liver specific

14. PDAs are often asymptomatic. How do you treat?
indomethacin
Covalent (between two cysteines)- allows protein to withstand denaturation
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Hexokinase

15. on What part of the clavicle does the SCM attach?
Medial part
Bronchial dilation (bronchiectasis)
Class I
Because of the low output from heart failure - they will have increased aldosterone levels

16. What is Bortezomib and What is it used for?
Proteasome inhibitor; treatment for MM and waldenstroms
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Right before diastole (filling begins)
Integration of viral DNA into genome of host hepatocytes

17. IL4 is used for isotypye switching to what?
IgE
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)
SS +rNA
Increase in permeability of two ions with equal and opposite equilibrium potentials

18. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
OCPs - multiparity - breast feeding
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
No (unlike adenomyosis); yes
Medial circumflex artery; avascular necrosis

19. which viruses require a protease?
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
indomethacin
transcription activation/suppression
SS +rNA

20. What is the difference between additive and synergistic?
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
Reiter syndrome; B27
E. coli
S. saprophyticus - and s. epidermidis; novobiocin

21. What is the presentation of sever aortic stenosis?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Syncope - angina - dyspnea (SAD)
P53 mutation; DCC is also required for adenoma to carcinoma
SVC and IVC; right below the aortic knob

22. other than increasing HDL levels - what else does niacin do?
Prevents hepatic VLDL production
G to T in p53; HCC
Excessive collagen formation during tissue repair in susceptible individuals
Circular - outside nucleus; transport proteins - rRNA - tRNA

23. when do ghon complexes form - primary or secondary TB?
hyponatremia (aldosterone activation equilibrates body volume)
Primary
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

24. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
CGD; t cell dysfxn (diGeorge)
Fibronectin - laminin - collagen
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

25. 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)
S3 gallop; S2 to opening snap interval
46 - 4N; 23 2N
RBF= PAH clearance/(1- hematocrit)

26. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
Prevents hepatic VLDL production
Vascular endothelium; protease
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

27. Where is aromatase used?
P53 mutation; DCC is also required for adenoma to carcinoma
SS +rNA
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Env genes (for getting into target cells)

28. What does TGF beta do? What produces it?
Diabetic microangiopathy
Nocardia
Fibrosis; macrophages
Trochlear nerve (IV); abducens nerve (VI)

29. What is intussusception? how does ischemia and necrosis occur?
Bronchogenic carcinoma
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
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

30. Is there edema in primary Conns? secondary hyperaldosteronism? why?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
S3 gallop; S2 to opening snap interval
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Cluster

31. How is dobutamine better than dopamine?
Skin flushing and warmth; prostaglandins; give with aspirin
Highly negative resting potential
As a CO2 carrier with the carboxylase enzyme
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

32. What type of endocarditis is cytoscopy induced?
Enterococci (e. faecalis)- found on genitalia area
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Proteasome inhibitor; treatment for MM and waldenstroms
Integration of viral DNA into genome of host hepatocytes

33. What are two indicators of chronic alcohol consumption?
Elevated GGT and macrocytosis
Thymic tumor
low in serum
Localized dermatologic pain that persists for more than one month after zoster eruption

34. What are the primary determinants of colon cancer risk in UC patients
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Duration and extent of disease
No and yes
LT (LTD4 - E4 - C4) - and Ach

35. What are the three predominant symptoms of VHL? What is its mode of inheritance?
On cardiac tissue and renal juxtaglomerular cells
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
hyponatremia (aldosterone activation equilibrates body volume)
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

36. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
IgE
Brief psychotic disorder; schizophreniform; schizophrenia
Sarcoid
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

37. 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?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
SVT; increases vagal tone; rectus abdominis
Large stroke volumes with ventricular contraction; aortic regurg
46 - 4N; 23 2N

38. what vessel would a fracture to the neck of the of the humerus damage?
Anterior circumflex (and axillary nerve)
hyponatremia (aldosterone activation equilibrates body volume)
Raphe
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

39. What is easiest way to treat nephrolithiasis?
Vagus (auricular branch); vasovagal syncope!
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Drink plenty of fluids
Diabetic microangiopathy

40. How do you calculate atributable risk percent?
RR-1/RR
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
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
200-500

41. When is acid phosphatase elevated (Name two times)?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Neisseria induced small cell vasculitis (including hands and soles)
Coagulation factors are made in the liver
Prostate tumor and increased osteoclast activity

42. which two virus families have hemagluttinin on their surface?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Paramyxo and influenza
Extrinsic def; instrinsic def; platelet def
Vertical diplopia

43. Where is the base of the heart? apex?
Classical conditioning
Closer to head; closer to diaphragm
RR-1/RR
Protamine sulfate

44. why does liver dysfunction cause coagulation disorders?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Coagulation factors are made in the liver
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac

45. What is congestive hepatomegaly specific for?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Right heart failure
MAO inhibitors; wine and cheese
Retinitis; mononucleosis

46. What is diphenoxylate and What is it used for? what drug is it structurally similar to? What allows for potent anti diarrheal effect without signigicant opiate effects?
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)
Myasthenia gravis
Mean greater than median greater than mode
PDA open

47. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
RBC mass; epo levels (secondary has high)
Curlings ulcers
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
Hypo or hyper pigmentations; after tanning

48. What are some side effects seen in TCAs?
By vascular permeability and vasodilation
LT (LTD4 - E4 - C4) - and Ach
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

49. In what population does cholelithiasis occur?
Turbulence
Fat - fertile - forty - female
differentiate
P53 mutation; AD

50. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Pan colitis and right sided colitis (more than left sided and proctitis)
Acute gastric mucosal defects (superficial or full thickness)
Rabies encephalitis from cave bats; rabies killed vaccines
Radial nerve and deep brachial artery