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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 are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Become beta pleated and then form neurofibrillary tangle!
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Neisseria induced small cell vasculitis (including hands and soles)

2. What are the three dopaminergic systems and What are they responsible for? disease?
Superior larygeal; cricothyroid; recurrent laryngeal
SSRI; erectile dysfunction
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
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

3. h1 receptor anatagonists are not effective in treatment of asthma only for...
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
High potassium conductance and some sodium conductance
chronic urticaria and allergic symptoms
Increases

4. What is a cord factor and Which bugs have it? How do they appear on culture?
Serum creatine kinase; reperfusion injury causes necrosis
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Bronchogenic carcinoma
Increase; decreased

5. What is the diagnosis in delayed puberty plus anosmia?
Sydenham chorea
RBC mass; epo levels (secondary has high)
Kallmans
Headaches and facial flushing; vasodilation in meninges and skin

6. What type of mutation does aflatoxin cause? what cancer does this increase for?
G to T in p53; HCC
RER; copper
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
Superior larygeal; cricothyroid; recurrent laryngeal

7. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
chronic urticaria and allergic symptoms
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

8. What is subacute sclerosisng encephalitis caused by?
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
Boiling - bleach - formalin - UV irradiation
women
Localized dermatologic pain that persists for more than one month after zoster eruption

9. do patients with cor pulmonale have increased or decreased levels of aldosterone?
Integration of viral DNA into genome of host hepatocytes
46 - 4N; 23 2N
Because of the low output from heart failure - they will have increased aldosterone levels
Acute interstitial nephritis

10. What is mcc of death pre hospital phase of MI? in hospital phase?
V fib; v. failure
Radial nerve damage
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Hypo or hyper pigmentations; after tanning

11. what phase do adenosine and acetylcholine act on? doing what?
Common peroneal; bony fractures and compression; sciatic
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Tzanck smear

12. What is Tzanck smear used to detect?
chronic urticaria and allergic symptoms
ANCA because of lack of Ig and C3 deposits on IF
PDA open
HSV and VZV

13. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Bile soluble which means they are bile sensitive
Measure of depth invasion (vertical!)

14. what drug is useful for secretory diarrhea?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Octreotide
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Neisseria induced small cell vasculitis (including hands and soles)

15. What is tachyphylaxis?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Headaches and facial flushing; vasodilation in meninges and skin
The term used to describe decreased drug responsiveness with repeated administration

16. what chromosome is c - myc found on?
Chrom 8
Fat - fertile - forty - female
IgE
Proteasome inhibitor; treatment for MM and waldenstroms

17. How is dobutamine better than dopamine?
Anterior circumflex (and axillary nerve)
Lateral; RV; RA; LV
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

18. What is a primary HSV 1 infection like?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Leukotriene precursor and does neutrophil chemotaxis
No; MRI
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

19. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
Ketone body production by preventing fatty acids into the mitochondria
facultative intracellular
No
Curlings ulcers

20. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
Selective alpha 1 (increases SVR)
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Vagus (auricular branch); vasovagal syncope!
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

21. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
Minimal change disease
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Classical conditioning
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

22. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Increase lymphatic drainage!
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
P53 mutation; DCC is also required for adenoma to carcinoma

23. in the LV and aorta - What are the pressures?
Relfex tachycardia; giving beta blockers
Hypothyroidism
Syringomelia
Normally close to systolic

24. why does hypothyroidism cause increased CPK levels?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Vascular endothelium; protease
Prevent phagocytosis
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

25. Where does terminal peptide cleavage of collagen fibrils take place?
Vagus (auricular branch); vasovagal syncope!
Sickle cell; G6PD
No
In the extracellular space

26. What is a keloid?
Excessive collagen formation during tissue repair in susceptible individuals
Trochlear nerve (IV); abducens nerve (VI)
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
...

27. what immune deficiency causes recurrent neisseria infections?
MAC complex (C5b - C9 complement deficiency)
8 (myc protein) with 2 - 14 - 22 (iG chains)
Tzanck smear
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

28. How can renal blood flow be calculated from RPF?
Hydrogen bonds dictate alpha or beta structure
Southern - western
Hexokinase
RBF= PAH clearance/(1- hematocrit)

29. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Acute interstitial nephritis
Mean greater than median greater than mode

30. What type of disease has selective proteinuria? What is found in urine? What is not?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Cluster
Regular insulin (Not fast acting - regular better)
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

31. What is the most common location of colonization of all s. aureus types?
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Measure of depth invasion (vertical!)
Anterior nares
SSRI; erectile dysfunction

32. What are the two mcc of focal brain lesions in HIV positive patients?
Terminal bronchioles; small bronchi
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
glycerol kinase
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

33. What is a cell surface marker seen in liver angiosarcoma?
Well
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Echinococcus granulosus; anaphylaxis
...

34. What would a deflection of the membrane potential to near zero indicate?
Aromatase deficiency in child
Increase in permeability of two ions with equal and opposite equilibrium potentials
Octreotide
No only for prophylaxis (even for treating staphylococcal endocarditis its as multi drug); this is to prevent drug resistance from spontaneous mutations by DNA dependent RNA polymerase

35. How do you explain the selective proteinuria of loss to albumin only in MCD?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
glycerol kinase
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Normal; low

36. What are the two coagulase negative staphylococci? How do you distinguish them?
S. saprophyticus - and s. epidermidis; novobiocin
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
Increase by 50% in urine osmolality
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

37. what should you think of in 'smear of an oral ulcer base'?
C3 decreased after 5-10 days; sulfonamides
Ether and other organic solvents
Tzanck smear
Enterococci (e. faecalis)- found on genitalia area

38. which opponens muscle does ulnar innervate?
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Integration of viral DNA into genome of host hepatocytes
Adductor
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

39. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
Dihydropyridine sensitive Ca channels (L type)
Chorda tympani branch
CGD; t cell dysfxn (diGeorge)
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

40. What is the Na/Ca exchange used for?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
To pump calcium out in cardiac myocytes so that relaxation occurs
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

41. What is cataplexy and When is it seen?
Classical conditioning
Inhaled animal dander allergens
Sudden loss of muscle tone without loss of consciousness; narcolepsy
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

42. 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?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
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
Ceftriaxone; azithromycin
46 - 4N; 23 2N

43. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Anti cholinergic effects of pupil dilation and lack of accomodation
Hexokinase
Superior larygeal; cricothyroid; recurrent laryngeal
Normally close to systolic

44. non ceruloplasmin deposition - ceruloplasmin is...
low in serum
Underestimation of gestational age
Large stroke volumes with ventricular contraction; aortic regurg
Acute gastric mucosal defects (superficial or full thickness)

45. what dictates the resting membrane potential of most cells?
AV node slowest - to allow time for diastole
High potassium conductance and some sodium conductance
Cluster
Radial nerve damage

46. When does neovascularization granulation tissue begin to form after severe ischemia and MI? what happens in 12-24 hours? 2 weeks to 2 months? 1-5 days? 0-4 hours? when do you see edema - hemorrhage - wavy fibers?
RBC mass; epo levels (secondary has high)
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Covalent (between two cysteines)- allows protein to withstand denaturation
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

47. Is there edema in primary Conns? secondary hyperaldosteronism? why?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Inhibits it
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
Thymic tumor

48. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Covalent (between two cysteines)- allows protein to withstand denaturation
Env genes (for getting into target cells)
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

49. Which is faster atrial muscle or ventricular muscle?
Atrial
Pain reliever - reduces pain by locking substance P in the PNS
Closer to head; closer to diaphragm
Measles and M3 AML`

50. What is hyaline arteriosclerosis usually a sign of ?
11
Decreases both
Diabetic microangiopathy
Recurrent larygneal