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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 murmur is enhanced by decreased blood flow to the heart?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Demargination of neutrophils from the vessel walls
Sickle cell; G6PD

2. What does C1 esterase do other than inhibiting complement pathway?
The time interval between S2 and OS- the shorter the interval - the more intense
Inactivates kallikrein which activates kininogen into bradykinin
Insulin like growth factor 1 (just another name)
Purkinje system; AV node

3. which two virus families have hemagluttinin on their surface?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Paramyxo and influenza
Elevated GGT and macrocytosis
Syncope - angina - dyspnea (SAD)

4. on which chromosome is wilms tumor found?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
11
Inactivates kallikrein which activates kininogen into bradykinin
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

5. what dictates the resting membrane potential of most cells?
Demargination of neutrophils from the vessel walls
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
II; I (I more abundant)
High potassium conductance and some sodium conductance

6. What is damaged in early syringomelia? later?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Increase lymphatic drainage!
APP on chrom 21 (this is why downs more susceptible)

7. What is the neurologic manifestation of ADPKD?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
ZDV or AZT
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

8. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
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)
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Highly negative resting potential

9. what drug is useful for secretory diarrhea?
Octreotide
Tibial
Because gamma chains replace beta chains and then gamma chain formation wanes
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

10. What is extraocular muscle weakness a common symptom of?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Myasthenia gravis
FGF and VEGF
Varying; erythema nodosum is common

11. Which is faster purkinje system or atrial muscle?
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Enterococci (e. faecalis)- found on genitalia area
Close but purkinje system to ensure contraction in a bottom up fashion
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

12. in B12 deficiency - what levels in blood rise very quickly and then drop?
T test; chi squared
Reticulocytes
Closer to head; closer to diaphragm
SSRI; erectile dysfunction

13. where are the vegetations on the valves of a libman sacks endocarditis?
Common peroneal; bony fractures and compression; sciatic
No
Both sides
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

14. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
Acute interstitial nephritis
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
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

15. What is the most common neurologic complication of VZV reactivation?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
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
Localized dermatologic pain that persists for more than one month after zoster eruption
Bile soluble which means they are bile sensitive

16. What does hypocapnia cause in teh brain? What is hypocapnia?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Primary
Hereditary angioedema; ACE inhibitors
Purkinje system; AV node

17. Where does complement bind on the Fc region of Ig chains?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
In ER of bile canaliculi
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Amiloride - spironolactone - triamterene

18. which nerve provides innervation for plantar flexion and inversion?
Paramyxo and influenza
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Tibial

19. What are the acute effects of corticosteroids on the CBC?
Measles and M3 AML`
Anti centromere; anti DNA topoisomerase
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Fibronectin - laminin - collagen

20. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Acute interstitial nephritis
SaO2 <92%
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

21. What does L/S stand for in fetal lung maturity? When does maturity occur?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Underestimation of gestational age
Pulmonary hypertension

22. What is the Na/Ca exchange used for?
No (unlike adenomyosis); yes
To pump calcium out in cardiac myocytes so that relaxation occurs
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
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

23. What are the first generation anti histamines?
Gluteus medius and minimus; positive trendelenberg
Chlorpheniramine and diphenhydramine
Vagus (auricular branch); vasovagal syncope!
hyponatremia (aldosterone activation equilibrates body volume)

24. other than mycobacterim wha other bacteria is acid fast?
Vagus (auricular branch); vasovagal syncope!
RER; copper
Squatting - sitting - lying supine - passive leg raising
Nocardia

25. What does sustained hand grip do to the C/V system?
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

26. at 2 years of age - What are the social - fine motor - gross motor and language developments?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Valproate
Susceptible; soluble (unable to be cultured in bile)

27. What is the primary histologic finding in patients with eczematous dermatitis?
Minimal change disease
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Spongiosis
II; I (I more abundant)

28. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
Circular - outside nucleus; transport proteins - rRNA - tRNA
Hypothyroidism
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Prepatellar

29. what diseases can vit A be used to treat?
Measles and M3 AML`
By vascular permeability and vasodilation
Echinococcus granulosus; anaphylaxis
frameshift mutations (missense is substitution)

30. When is acid phosphatase elevated (Name two times)?
Apocrine; eccrine
Because of the low output from heart failure - they will have increased aldosterone levels
Tissue redistribution (out of plasma) rather than metabolism
Prostate tumor and increased osteoclast activity

31. Which is slower AV node or ventricular muscle?
Anti centromere; anti DNA topoisomerase
Prevents hepatic VLDL production
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
AV node slowest - to allow time for diastole

32. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Vagus (auricular branch); vasovagal syncope!
hyponatremia (aldosterone activation equilibrates body volume)
Demargination of neutrophils from the vessel walls

33. How do left sided colon adenocarcinomas present? right sided?
Aromatase deficiency in child
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
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
Raphe

34. How do you treat gonococcal infection? chlymadia?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Ceftriaxone; azithromycin
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
Syringomelia

35. which nerve in the lower leg is easily injured and causes foot drop ? What are common causes? From what nerve does it branch off or?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Common peroneal; bony fractures and compression; sciatic
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

36. What do you treat s. epidermidis with?
Elastance
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Vancomycin
Anterior circumflex (and axillary nerve)

37. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Elevated GGT and macrocytosis
HSV ( also in utero: chlymadia - neisseria - group B strep)
To pump calcium out in cardiac myocytes so that relaxation occurs
Varying; erythema nodosum is common

38. What are some of the permissive effects of cortisol?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Large stroke volumes with ventricular contraction; aortic regurg
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
CMV - HSV 1 - Candida

39. what hormone is structurally similar to hCG?
Sydenham chorea
E. coli; staphylococcus saprophyticus
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
TSh (in testicular tumors can cause hyperthyroidism)

40. What is the most common cause of pyelonephritis in both adults and childre?
Initiation - pointing; pincer grasp; walking; mama/dada
Anterior circumflex (and axillary nerve)
E. coli
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

41. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Reiter syndrome; B27
Proteasome inhibitor; treatment for MM and waldenstroms
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Radial nerve damage

42. What is a primary HSV 1 infection like?
CMV - HSV 1 - Candida
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Tissue redistribution (out of plasma) rather than metabolism
Abnormal closing of the urethral folds

43. which cells produce surfactant? which ones mediate gas exchange?
Trauma to stereociliated hair cells of the organ of corti
II; I (I more abundant)
facultative intracellular
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

44. If a patient has higher levels of HbF - What does this mean?
CMV - HSV 1 - Candida
only up to bronchi
Think Hb deformation diseases
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

45. What is hypospadias caused by?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Vertical diplopia
Susceptible; soluble (unable to be cultured in bile)
Abnormal closing of the urethral folds

46. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
Aromatase deficiency in child
P53 mutation; AD
Bronchogenic carcinoma
AV node slowest - to allow time for diastole

47. Where does lysyl oxidase act? What is the cofactor for that?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
In the extracellular space for collagen cross linking; zinc
Radial nerve and deep brachial artery
Adeno

48. why should you not use ACE inhibitors with someone who had hereditary angioedema?
GI malignancies and Insulin resistance (acromegal for ex)
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
Dissolved in plasma and attached to Hgb
facultative intracellular

49. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
Elastance
Adeno
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

50. what drugs causes the red man syndrome? how does it occur?
200-500
Vancomycin; histamine mediated
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
No; yes