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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.
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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 are three symptoms in s.typhi?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Measure of depth invasion (vertical!)
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
8; 12

2. why is glucagon used in beta blocker toxicitiy?
Increases cytokine production
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

3. What is the mcc of extrinsic allergic asthma?
Inhaled animal dander allergens
Chorda tympani branch
Well
Faulty positioning of the genital tubercle

4. PDAs are often asymptomatic. How do you treat?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
indomethacin
No
Medullary

5. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Multiple miscarriages d/t hypercoaguability
Smoking
Class I
Become beta pleated and then form neurofibrillary tangle!

6. in B12 deficiency - what levels in blood rise very quickly and then drop?
Reticulocytes
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)
IgE
High potassium conductance and some sodium conductance

7. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Elevated GGT and macrocytosis
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Hypertension - edema - and proteinuria

8. What does anti phospholipid syndrome in SLE patients predispose them to?
INTRApartum Abs (ampicillin/penicillin)
Multiple miscarriages d/t hypercoaguability
High potassium conductance and some sodium conductance
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

9. What are the acute effects of corticosteroids on the CBC?
Duration and extent of disease
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Anti centromere; anti DNA topoisomerase

10. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Multiple miscarriages d/t hypercoaguability
Regular insulin (Not fast acting - regular better)
Increase; decreased

11. do Class IC agents prolong the QT interval?
No
liver specific
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
SVT; increases vagal tone; rectus abdominis

12. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
GI malignancies and Insulin resistance (acromegal for ex)
Barium enema
RR-1/RR
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

13. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Proteasome inhibitor; treatment for MM and waldenstroms
Brief psychotic disorder; schizophreniform; schizophrenia
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

14. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
S. saprophyticus - and s. epidermidis; novobiocin
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

15. What is it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
Vagus nerve stimulation
Faulty positioning of the genital tubercle
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Vertical diplopia

16. if there are keratin swirls does that mean well or poorly differentiated?
Gluteus maximus; difficulty getting up from seated position and climbing chair
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Well

17. what virus causes pharyngoconjuctival fever?
Terminal bronchioles; small bronchi
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
Highly negative resting potential
Adeno

18. What is the most common neurologic complication of VZV reactivation?
Headaches and facial flushing; vasodilation in meninges and skin
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Localized dermatologic pain that persists for more than one month after zoster eruption
Paramyxo and influenza

19. how does noise induced hearing loss occur?
Trauma to stereociliated hair cells of the organ of corti
Minimal change disease
Smoking
Retinitis; mononucleosis

20. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
Excessive collagen formation during tissue repair in susceptible individuals
FGF and VEGF
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)
Spongiosis

21. other than increasing HDL levels - what else does niacin do?
Bile salt accumulation in urine
Prevents hepatic VLDL production
INTRApartum Abs (ampicillin/penicillin)
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

22. What are some of the permissive effects of cortisol?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Regular insulin (Not fast acting - regular better)
No and yes

23. What is achalasia and how would this correlate on the esophageal mannometry?
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
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

24. In what form are mitochondrial DNA? What do they transcribe?
Circular - outside nucleus; transport proteins - rRNA - tRNA
Criggler Najjar (UGT enzyme in bilirubin glucoronidation) ; Dubin Johnson (transport protein lacking - Black liver) and Rotor syndrome - defects in hepatic uptake and excretion of bile (numerous defect)
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)
Serum creatine kinase; reperfusion injury causes necrosis

25. what drug is useful for secretory diarrhea?
Elevated GGT and macrocytosis
Octreotide
Ig A deficiency
MAO inhibitors; wine and cheese

26. What does p53 do? what chrom is it on?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Headaches and facial flushing; vasodilation in meninges and skin

27. What are examples of action that decrease venous return to the heart?
facultative intracellular
Standing suddenly from supine position; valsalva maneuver
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Spongiosis

28. In What type of nephritis would you see high serum eos count?
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
Ether and other organic solvents
Drug induced interstitial nephritis
8 (myc protein) with 2 - 14 - 22 (iG chains)

29. What is Tzanck smear used to detect?
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Ceftriaxone; azithromycin
HSV and VZV
Localized dermatologic pain that persists for more than one month after zoster eruption

30. a patient fearing all white coats is a phenomenon of what?
Classical conditioning
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)
V fib; v. failure
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

31. how much percent of sodium is excreted? urea? glucose?
Increased reticulocytes
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
<1% - 55% - concentration dependent
women

32. where are the two classical places that the ulnar nerve can be injured?

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33. prostaglandin synthesis keeps...
Common peroneal; bony fractures and compression; sciatic
SSRI; erectile dysfunction
Close but purkinje system to ensure contraction in a bottom up fashion
PDA open

34. What is cataplexy and When is it seen?
Retinitis; mononucleosis
No
No; yes
Sudden loss of muscle tone without loss of consciousness; narcolepsy

35. What is difference between Arnold Chiari type I and II?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
I is more benign and can present later in adulthood
Biphosphonate
NF- KB; responsible for cytokine production

36. What is the most common initital symptom of ADPKD? what else?
GI tract; mood!
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Terminal bronchioles; small bronchi
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

37. what enzyme converts procarcinogens into carcinogens?
Gluteus maximus; difficulty getting up from seated position and climbing chair
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
P450 mitochondrial monooxygenase

38. within the right atrium - What is the maximum pressure? left atrium?
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
8; 12
Chlorpheniramine and diphenhydramine
G to T in p53; HCC

39. What type of endocarditis is cytoscopy induced?
Enterococci (e. faecalis)- found on genitalia area
V fib; v. failure
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

40. how does achalasia present? What does barium swallow show on dilated esophagus?
Adeno
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
No; yes
SSRI

41. what clinical findings help distinguish small cell carcinoma?
Hereditary angioedema; ACE inhibitors
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Varying; erythema nodosum is common
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

42. are there signs of inflammation in avascular necrosis? then How do you diagnose?
Increases
Intussusception
Bronchogenic carcinoma
No; MRI

43. What is a keloid?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Pulmonary hypertension
Adeno
Excessive collagen formation during tissue repair in susceptible individuals

44. what locations of UC increase the risk of Colon cancer?
Vancomycin; histamine mediated
Curlings ulcers
Pan colitis and right sided colitis (more than left sided and proctitis)
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

45. What is a cell surface marker seen in liver angiosarcoma?
Downs; regurgitant AV valves - ASDs
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Lateral; RV; RA; LV
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

46. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Relfex tachycardia; giving beta blockers
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Sickle cell; G6PD

47. What type of bond is a disulfide bond?
HSV ( also in utero: chlymadia - neisseria - group B strep)
Covalent (between two cysteines)- allows protein to withstand denaturation
Valproate
Skin flushing and warmth; prostaglandins; give with aspirin

48. What is easiest way to treat nephrolithiasis?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Selective alpha 1 (increases SVR)
Turbulence
Drink plenty of fluids

49. What is diagnostic (and possible therapeutic for intussusception)?
Little effect on cell and no change
Barium enema
Vagus nerve stimulation
Excessive collagen formation during tissue repair in susceptible individuals

50. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Right heart failure
P53 mutation; DCC is also required for adenoma to carcinoma
APP on chrom 21 (this is why downs more susceptible)