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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 three things can reduce the risk of non hereditary ovarian and endometrial cancer?
Right before diastole (filling begins)
OCPs - multiparity - breast feeding
Trauma to stereociliated hair cells of the organ of corti
No; yes

2. What is contraindicated in toxic mega colon?
4 - 4 - 9
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Kallmans
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

3. What is used to compare means? categorical outcomes?
Acute gastric mucosal defects (superficial or full thickness)
T test; chi squared
Single adenomatous ones
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

4. What is extraocular muscle weakness a common symptom of?
MAO inhibitors; wine and cheese
Inactivates kallikrein which activates kininogen into bradykinin
Myasthenia gravis
RR-1/RR

5. what immune deficiency causes recurrent neisseria infections?
MAC complex (C5b - C9 complement deficiency)
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

6. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
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

7. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Boiling - bleach - formalin - UV irradiation
Selective alpha 1 (increases SVR)

8. What is acanthosis nigricans associated with?
Insulin like growth factor 1 (just another name)
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
25; 25
GI malignancies and Insulin resistance (acromegal for ex)

9. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
On cardiac tissue and renal juxtaglomerular cells
Susceptible; soluble (unable to be cultured in bile)
RBC mass; epo levels (secondary has high)
Classical conditioning

10. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
Measles and M3 AML`
AV node slowest - to allow time for diastole
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac

11. there are mucus secreting cells in the bronchioles...
APP on chrom 21 (this is why downs more susceptible)
25; 25
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
only up to bronchi

12. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Normally close to systolic
Increase by 50% in urine osmolality
CGD; t cell dysfxn (diGeorge)

13. What is hyaline arteriosclerosis usually a sign of ?
RER; copper
Medial part
No
Diabetic microangiopathy

14. at four years of age - What are the social - fine motor - gross motor - and language developments?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Increase; decreased
The time interval between S2 and OS- the shorter the interval - the more intense
Pan colitis and right sided colitis (more than left sided and proctitis)

15. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
46 - 4N; 23 2N
liver specific

16. What is the difference between additive and synergistic?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Clindamycin; covers anaerobic oral flora and aerobic bacteria
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
Fibronectin - laminin - collagen

17. What is gardeners mydriasis? How is it treated?
Joints d/t increased purine production and thus uric acid production
4 - 4 - 9
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

18. What is the sole neurologic manifestation of acute rheumatic fever?
Turbulence
Recurrent larygneal
Sydenham chorea
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

19. In what population does cholelithiasis occur?
Susceptible; soluble (unable to be cultured in bile)
Fat - fertile - forty - female
In ER of bile canaliculi
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

20. what indicates the severity of a mitral regurg ? mitral stenosis?
S3 gallop; S2 to opening snap interval
Gluteus maximus; difficulty getting up from seated position and climbing chair
No (unlike adenomyosis); yes
RR-1/RR

21. What is a primary HSV 1 infection like?
NF- KB; responsible for cytokine production
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
...
Abnormal closing of the urethral folds

22. What does the severity of leprosy depend on?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Reiter syndrome; B27
Strength of cell mediated immune response
Medullary

23. What is the mc malignancy in asbestosis?
Bronchogenic carcinoma
Intussusception
Ketone body production by preventing fatty acids into the mitochondria
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac

24. What can too much IgA in serum produces?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Valproate
NF- KB; responsible for cytokine production

25. What three factors effect total oxygen content of blood?
Recurrent larygneal
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Tibial

26. What is hypospadias caused by?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Serum FFA and serum triglyceride levels
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Abnormal closing of the urethral folds

27. How do you treat gonococcal infection? chlymadia?
Common peroneal; bony fractures and compression; sciatic
Pulmonary hypertension
Ceftriaxone; azithromycin
liver specific

28. What does extended consumption of appetite suppressants lead to?
Pulmonary hypertension
Radial nerve and deep brachial artery
GI tract; mood!
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

29. What is diagnostic (and possible therapeutic for intussusception)?
The time interval between S2 and OS- the shorter the interval - the more intense
Little effect on cell and no change
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Barium enema

30. what dissolves the lipid bilayer of a viral envelope?
Ether and other organic solvents
Pulmonic and systemic!
In the extracellular space
Around 70 (normal measured diastolic pressures); 9--

31. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
No; MRI
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
SSRI
When it invades the bm; carcinoma in situ

32. how long is substance P? What does it do?
11 aa polypeptide; pain NT in CNS and PNS
chronic urticaria and allergic symptoms
Coagulation factors are made in the liver
Both sides

33. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
transcription activation/suppression
P450 mitochondrial monooxygenase
Cluster

34. 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?
Superior larygeal; cricothyroid; recurrent laryngeal
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Brief psychotic disorder; schizophreniform; schizophrenia
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

35. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Turbulence
Medial circumflex artery; avascular necrosis
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Hereditary angioedema; ACE inhibitors

36. in the LV and aorta - What are the pressures?
LT (LTD4 - E4 - C4) - and Ach
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Hexokinase
Normally close to systolic

37. how does increased ICP result in curlings ulcers?
No (unlike adenomyosis); yes
Tzanck smear
facultative intracellular
Vagus nerve stimulation

38. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Medullary
S3 gallop; S2 to opening snap interval
Atrial
Amiloride - spironolactone - triamterene

39. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
RER; RER
Echinococcus granulosus; anaphylaxis
...
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

40. other than increasing HDL levels - what else does niacin do?
Multiple miscarriages d/t hypercoaguability
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)
Prevents hepatic VLDL production
Not lined by epithelium

41. What is the triad seen in pre eclampsia?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Hypertension - edema - and proteinuria
Because of vasodiation to skeletal muscles
Inhaled animal dander allergens

42. What is the mutation type in thalassemias? what process is defective because of this?
Relfex tachycardia; giving beta blockers
V fib; v. failure
Nonsense; mRNA processing
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

43. what drug is useful for secretory diarrhea?
Hydrogen bonds dictate alpha or beta structure
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Close but purkinje system to ensure contraction in a bottom up fashion
Octreotide

44. what makes bruits?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Amiloride - spironolactone - triamterene
Gluteus maximus; difficulty getting up from seated position and climbing chair
Turbulence

45. What are the primary determinants of colon cancer risk in UC patients
Duration and extent of disease
SaO2 <92%
V fib; v. failure
Localized dermatologic pain that persists for more than one month after zoster eruption

46. Where does terminal peptide cleavage of collagen fibrils take place?
Regular insulin (Not fast acting - regular better)
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Southern - western
In the extracellular space

47. What are the three dopaminergic systems and What are they responsible for? disease?
Fibrosis; macrophages
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
manifestations - congenital (stretching of periventricular pyrimadal fibers)
HSV ( also in utero: chlymadia - neisseria - group B strep)

48. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
P53 mutation; AD
Right before diastole (filling begins)
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Increases bronchial and vascular smooth muscle reactivity to catecholamines

49. What is an abortive viral infection?
Classical conditioning
Turbulence
Little effect on cell and no change
200-500

50. what happens to capacitance with age?
Protamine sulfate
...
gram positive organisms
MAO inhibitors; wine and cheese