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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 a common complication of acute pancreatitis? What is it?
liver specific
Sarcoid
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

2. who bleed more DIC or TTP- HUS patients?
Sarcoid
DIC; TTP- HUS dont bleed that much
Brief psychotic disorder; schizophreniform; schizophrenia
Anti - apoptotic (prevents going into apoptosis)- 18; 14

3. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
Intussusception
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
IgE
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

4. Where is the base of the heart? apex?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Closer to head; closer to diaphragm
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

5. what marker should be followed in a patient with cirrhosis?
By vascular permeability and vasodilation
Insulin like growth factor 1 (just another name)
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
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

6. What are the primary determinants of colon cancer risk in UC patients
Duration and extent of disease
Inhibits it
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
25; 25

7. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
FGF and VEGF
Decreases both
Reiter syndrome; B27
Fibronectin - laminin - collagen

8. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
Pulmonic and systemic!
Underestimation of gestational age
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
S. aureus

9. What almost exclusively causes Epliglottitis?What type of capsule does it have? What are the symptoms?

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10. What is the mainstay treatment for acute mania?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Fibronectin - laminin - collagen

11. What is the cause of fixed splitting of S2? why?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
ANCA because of lack of Ig and C3 deposits on IF
Nocardia

12. what drugs causes the red man syndrome? how does it occur?
Hydrogen bonds dictate alpha or beta structure
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Vancomycin; histamine mediated
In the extracellular space

13. What does TGF beta do? What produces it?
S3 gallop; S2 to opening snap interval
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Faulty positioning of the genital tubercle
Fibrosis; macrophages

14. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Vertical diplopia
Headaches and facial flushing; vasodilation in meninges and skin
Gluteus maximus; difficulty getting up from seated position and climbing chair
FGF and VEGF

15. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Intussusception
Because of vasodiation to skeletal muscles
HSV ( also in utero: chlymadia - neisseria - group B strep)
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

16. 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
Chlorpheniramine and diphenhydramine
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
High potassium conductance and some sodium conductance

17. In What type of nephritis would you see high serum eos count?
Drug induced interstitial nephritis
TSh (in testicular tumors can cause hyperthyroidism)
V fib; v. failure
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

18. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
Faulty positioning of the genital tubercle
Measles and M3 AML`
No and yes
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

19. 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
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Phencyclidine (PCP)
Hexokinase

20. what enzyme converts procarcinogens into carcinogens?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
P450 mitochondrial monooxygenase
Measure of depth invasion (vertical!)
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

21. why does liver dysfunction cause coagulation disorders?
low in serum
Coagulation factors are made in the liver
No; yes
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

22. which nucleus releases serotonin?
Raphe
Prepatellar
Tibial
Acute interstitial nephritis

23. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
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)
Bile soluble which means they are bile sensitive
When it invades the bm; carcinoma in situ

24. what locations of UC increase the risk of Colon cancer?
Pan colitis and right sided colitis (more than left sided and proctitis)
Radial nerve damage
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
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

25. where are Beta 1 receptors found?
On cardiac tissue and renal juxtaglomerular cells
TCAs and prazosin
Think Hb deformation diseases
Well trained athletes and children

26. What type of drug is alendronate?
Serum creatine kinase; reperfusion injury causes necrosis
Biphosphonate
Curlings ulcers
E. coli; staphylococcus saprophyticus

27. What are the two growth factors associated with angiogenesis?
FGF and VEGF
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
Anti cholinergic effects of pupil dilation and lack of accomodation
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

28. What is an abortive viral infection?
Little effect on cell and no change
Kallmans
E. coli
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

29. how can HAV be inactivated?
Boiling - bleach - formalin - UV irradiation
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
LT (LTD4 - E4 - C4) - and Ach
differentiate

30. Which is faster atrial muscle or ventricular muscle?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
In the extracellular space for collagen cross linking; zinc
Atrial

31. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
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
Nocardia
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
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)

32. neisseria are...
In the extracellular space
facultative intracellular
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Apocrine; eccrine

33. what hernia has a similar mechanism to hydrocele?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Susceptible; soluble (unable to be cultured in bile)

34. What are fenfluramine - phentermine?
Appetite suppressants
Around 70 (normal measured diastolic pressures); 9--
Syncope - angina - dyspnea (SAD)
Drink plenty of fluids

35. metabolism of 1 gram of protein produces How many calories? carb? fat?
DIC; TTP- HUS dont bleed that much
Env genes (for getting into target cells)
4 - 4 - 9
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase

36. What effects does cortisol have on catecholamines?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
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
Standing suddenly from supine position; valsalva maneuver
manifestations - congenital (stretching of periventricular pyrimadal fibers)

37. What is the Na/Ca exchange used for?
To pump calcium out in cardiac myocytes so that relaxation occurs
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Large stroke volumes with ventricular contraction; aortic regurg
Regular insulin (Not fast acting - regular better)

38. What is used to prevent vertical transmission of HIV?
Bronchial dilation (bronchiectasis)
ZDV or AZT
Bile soluble which means they are bile sensitive
<1% - 55% - concentration dependent

39. 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?
Regular insulin (Not fast acting - regular better)
Around 70 (normal measured diastolic pressures); 9--
8; 12
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)

40. What is the neurologic manifestation of ADPKD?
Hyperkalemia; potassium sparing diuretics - potassium supplements
Chrom 8
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

41. how does noise induced hearing loss occur?
Dihydropyridine sensitive Ca channels (L type)
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Trauma to stereociliated hair cells of the organ of corti
Kallmans

42. What does glycosylase do to DNA? endonuclease? lyase? What does the order here of enzymes represent? what other enzymes are needed?

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43. When does opening snap begin?
Mean greater than median greater than mode
Right before diastole (filling begins)
SSRI; erectile dysfunction
only up to bronchi

44. What is the presentation of angioedema? Where is most commonly affected?
Hypo or hyper pigmentations; after tanning
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
hyponatremia (aldosterone activation equilibrates body volume)
Gluteus medius and minimus; positive trendelenberg

45. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Prepatellar
Become beta pleated and then form neurofibrillary tangle!
Excessive collagen formation during tissue repair in susceptible individuals
Measles and M3 AML`

46. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
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
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
NF- KB; responsible for cytokine production

47. What is a keloid?
Prevent phagocytosis
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
glycerol kinase
Excessive collagen formation during tissue repair in susceptible individuals

48. why should you not use ACE inhibitors with someone who had hereditary angioedema?
Curlings ulcers
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
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
Amiloride - spironolactone - triamterene

49. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
Curlings ulcers
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
ANCA because of lack of Ig and C3 deposits on IF
Ceftriaxone; azithromycin

50. at 2 years of age - What are the social - fine motor - gross motor and language developments?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
In ER of bile canaliculi
Chlorpheniramine and diphenhydramine
C3 decreased after 5-10 days; sulfonamides