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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 the primary histologic finding in patients with eczematous dermatitis?
Amiadarone
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Spongiosis
Chorda tympani branch

2. why does variocele occur more in left side?
Pain reliever - reduces pain by locking substance P in the PNS
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Hexokinase
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

3. how much percent of sodium is excreted? urea? glucose?
differentiate
No; yes
<1% - 55% - concentration dependent
Bile salt accumulation in urine

4. Where is aromatase used?
CMV - HSV 1 - Candida
Chlorpheniramine and diphenhydramine
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

5. What are the long term consequences of hydrocephalus?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Paramyxo and influenza
P53 mutation; AD
Anterior nares

6. What actions increase venous return?
ANCA because of lack of Ig and C3 deposits on IF
Squatting - sitting - lying supine - passive leg raising
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)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

7. why does neutrophila occur with corticosteroids?
Demargination of neutrophils from the vessel walls
Raphe
Multiple miscarriages d/t hypercoaguability
Aromatase deficiency in child

8. What are the two growth factors associated with angiogenesis?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
FGF and VEGF
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

9. What is easiest way to treat nephrolithiasis?
Drink plenty of fluids
Southern - western
C3 decreased after 5-10 days; sulfonamides
Adductor

10. What are the first generation anti histamines?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Serum creatine kinase; reperfusion injury causes necrosis
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Chlorpheniramine and diphenhydramine

11. What is the presentation of sever aortic stenosis?
Syncope - angina - dyspnea (SAD)
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
FGF and VEGF

12. What is best to prevent GBS infection in a baby?
Increase by 50% in urine osmolality
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
INTRApartum Abs (ampicillin/penicillin)
In ER of bile canaliculi

13. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
Increase in permeability of two ions with equal and opposite equilibrium potentials
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
No and yes
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

14. 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?
DIC; TTP- HUS dont bleed that much
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)
Increases cytokine production
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

15. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
Thymic tumor
Gluteus medius and minimus; positive trendelenberg
RBC mass; epo levels (secondary has high)
gram positive organisms

16. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
Drug induced interstitial nephritis
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
P53 mutation; DCC is also required for adenoma to carcinoma
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

17. prostaglandin synthesis keeps...
Mean greater than median greater than mode
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
PDA open
Abnormal closing of the urethral folds

18. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
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

19. What is the difference between additive and synergistic?
G to T in p53; HCC
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
Downs; regurgitant AV valves - ASDs
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin

20. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Both sides
HSV ( also in utero: chlymadia - neisseria - group B strep)
8; 12
To pump calcium out in cardiac myocytes so that relaxation occurs

21. What does extended consumption of appetite suppressants lead to?
Pulmonary hypertension
High potassium conductance and some sodium conductance
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Vagus (auricular branch); vasovagal syncope!

22. erythema nodosum - elevated ACE - scattered granulomas - arthralgias - hilar lymphadenoapthy are indicative of what?
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Trauma to stereociliated hair cells of the organ of corti
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Sarcoid

23. 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
E. coli; staphylococcus saprophyticus
Appetite suppressants
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

24. 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
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Trauma to stereociliated hair cells of the organ of corti
RBF= PAH clearance/(1- hematocrit)

25. What translocations can cause c - myc overexpression?
8 (myc protein) with 2 - 14 - 22 (iG chains)
Because of the low output from heart failure - they will have increased aldosterone levels
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
HSV and VZV

26. What is gardeners mydriasis? How is it treated?
Reticulocytes
Raphe
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Hyperkalemia; potassium sparing diuretics - potassium supplements

27. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
S3 gallop; S2 to opening snap interval
Mean greater than median greater than mode
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Demargination of neutrophils from the vessel walls

28. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
MAO inhibitors; wine and cheese
The term used to describe decreased drug responsiveness with repeated administration
Chrom 8

29. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Integration of viral DNA into genome of host hepatocytes
Folic acid treatment!
Chlorpheniramine and diphenhydramine
Turners`

30. Metronidizaole does not cover...
gram positive organisms
By vascular permeability and vasodilation
11
Pan colitis and right sided colitis (more than left sided and proctitis)

31. How do bradykinin - C3a and C5a cause edema?
Elevated GGT and macrocytosis
In ER of bile canaliculi
Sydenham chorea
By vascular permeability and vasodilation

32. What is the mc location for avascular necrosis? What is it associated with?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
RR-1/RR
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

33. What is the best indicator for the severity of mitral stenosis?
The time interval between S2 and OS- the shorter the interval - the more intense
Turners`
11 aa polypeptide; pain NT in CNS and PNS
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

34. What type of calcium channels dictate the plateau in cardiac myocyte?
Medial circumflex artery; avascular necrosis
Tzanck smear
NF- KB; responsible for cytokine production
Dihydropyridine sensitive Ca channels (L type)

35. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
200-500
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Boiling - bleach - formalin - UV irradiation
SVT; increases vagal tone; rectus abdominis

36. which headaches are seen mostly in men - are severe - unilateral - periorbital - episodic (around same time every day) - temporal pain - with lacrimation - nasal congestion and ptosis?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
...
Think Hb deformation diseases
Cluster

37. which antiarrythmic is associated with blue gray discoloration ?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Amiadarone
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Measure of depth invasion (vertical!)

38. What is mcc of death pre hospital phase of MI? in hospital phase?
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
Proteasome inhibitor; treatment for MM and waldenstroms
V fib; v. failure
Raphe

39. what protein is increased in Crohns disease? What does it do?
Insulin like growth factor 1 (just another name)
Enterococci (e. faecalis)- found on genitalia area
NF- KB; responsible for cytokine production
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

40. What causes vertical diplopia? horizontal?
Amiloride - spironolactone - triamterene
Trochlear nerve (IV); abducens nerve (VI)
Right before diastole (filling begins)
C3 decreased after 5-10 days; sulfonamides

41. What is acanthosis nigricans associated with?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
GI malignancies and Insulin resistance (acromegal for ex)
Hypothyroidism
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

42. other than in pyelonephritis - where else are WBC casts seen?
By vascular permeability and vasodilation
Acute interstitial nephritis
AV node slowest - to allow time for diastole
T test; chi squared

43. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Well
P53 mutation; DCC is also required for adenoma to carcinoma

44. Where is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
Pulmonary hypertension
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
SS +rNA

45. What is the most common neurologic complication of VZV reactivation?
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Closer to head; closer to diaphragm
Localized dermatologic pain that persists for more than one month after zoster eruption

46. What are fenfluramine - phentermine?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Pulmonic and systemic!
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Appetite suppressants

47. how does achalasia present? What does barium swallow show on dilated esophagus?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Multiple miscarriages d/t hypercoaguability
Think Hb deformation diseases
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

48. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
frameshift mutations (missense is substitution)
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
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

49. What is pickwickian syndrome? What are the lab findings?
Recurrent larygneal
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Folic acid treatment!
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

50. Where does complement bind on the Fc region of Ig chains?
facultative intracellular
Headaches and facial flushing; vasodilation in meninges and skin
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Protamine sulfate