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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. who bleed more DIC or TTP- HUS patients?
No; MRI
Hexokinase
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
DIC; TTP- HUS dont bleed that much

2. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
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)
RBC mass; epo levels (secondary has high)
Congenital hypothyroidism - downs - amyloidosis - acromegaly

3. What is a common complication of acute pancreatitis? What is it?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

4. in overweight individuals What is thought to contribute to insulin resistance?
Covalent (between two cysteines)- allows protein to withstand denaturation
Serum FFA and serum triglyceride levels
Amiadarone
Amiloride - spironolactone - triamterene

5. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
Large stroke volumes with ventricular contraction; aortic regurg
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)
Hereditary angioedema; ACE inhibitors
Vancomycin; histamine mediated

6. h1 receptor anatagonists are not effective in treatment of asthma only for...
Well
differentiate
chronic urticaria and allergic symptoms
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

7. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Reiter syndrome; B27
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Clindamycin; covers anaerobic oral flora and aerobic bacteria

8. What causes wrist drop?
Radial nerve damage
Nocardia
Paramyxo and influenza
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. which virus inactivates both Rb and p53?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
SaO2 <92%
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Because of the low output from heart failure - they will have increased aldosterone levels

10. Where is conduction in heart fastest? slowest?
Radial nerve and deep brachial artery
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Bile soluble which means they are bile sensitive
Purkinje system; AV node

11. What is mcc of death pre hospital phase of MI? in hospital phase?
V fib; v. failure
No
women
Pan colitis and right sided colitis (more than left sided and proctitis)

12. What is congestive hepatomegaly specific for?
Right heart failure
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Varying; erythema nodosum is common
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

13. what has the greatest effect on prognosis when treating c. diptheriae?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Turbulence
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Drink plenty of fluids

14. What is pickwickian syndrome? What are the lab findings?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Prevents hepatic VLDL production
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

15. What pulmonary structural change can kartageners syndrome cause?
Bronchial dilation (bronchiectasis)
When it invades the bm; carcinoma in situ
Acute interstitial nephritis
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac

16. what induces bronchial squamous metaplasia?
Smoking
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Ceftriaxone; azithromycin

17. how does increased ICP result in curlings ulcers?
Serum FFA and serum triglyceride levels
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
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Vagus nerve stimulation

18. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
E. coli; staphylococcus saprophyticus
AV node slowest - to allow time for diastole
Trochlear nerve (IV); abducens nerve (VI)
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

19. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Increase in permeability of two ions with equal and opposite equilibrium potentials
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Increase; decreased

20. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
Vancomycin
frameshift mutations (missense is substitution)
RER; RER
SVT; increases vagal tone; rectus abdominis

21. which nerve provides innervation for plantar flexion and inversion?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Tibial
Think Hb deformation diseases
Because of vasodiation to skeletal muscles

22. How do you calculate excretion rate of a substance? How do you calculate the filtration rate of a substance? clearance of what substance estimates the GFR?
RER; RER
Anti centromere; anti DNA topoisomerase
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

23. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
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
Anterior nares
No; yes
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics

24. 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?
Brief psychotic disorder; schizophreniform; schizophrenia
Barium enema
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Common peroneal; bony fractures and compression; sciatic

25. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Anterior circumflex (and axillary nerve)
Demargination of neutrophils from the vessel walls

26. What is intussusception? how does ischemia and necrosis occur?
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
Adductor
Multiple miscarriages d/t hypercoaguability
By vascular permeability and vasodilation

27. What type of bond is a disulfide bond?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Vancomycin; histamine mediated
Valproate
Covalent (between two cysteines)- allows protein to withstand denaturation

28. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
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. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Hereditary angioedema; ACE inhibitors

29. What is diagnostic (and possible therapeutic for intussusception)?
Barium enema
On cardiac tissue and renal juxtaglomerular cells
Hypothyroidism
Lateral; RV; RA; LV

30. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
Tzanck smear
In the extracellular space
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

31. What is a clara cell?
Leukotriene precursor and does neutrophil chemotaxis
Smoking
Trauma to stereociliated hair cells of the organ of corti
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

32. What can cause virilization of a mother during pregnancy?
Aromatase deficiency in child
Recurrent larygneal
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
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)

33. why is crohns disease associated with oxaloacetate kidney stones?
Env genes (for getting into target cells)
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
E6 and E7 of HPV knock off p53 and Rb suppressor genes
SSRI

34. What is achalasia and how would this correlate on the esophageal mannometry?
P53 mutation; DCC is also required for adenoma to carcinoma
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Right before diastole (filling begins)
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

35. What is capacitance inversely proportional to?
Elastance
Amiloride - spironolactone - triamterene
women
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

36. when do ghon complexes form - primary or secondary TB?
Primary
E. coli; staphylococcus saprophyticus
46 - 4N; 23 2N
Both sides

37. What is the triad seen in pre eclampsia?
Hypertension - edema - and proteinuria
Because gamma chains replace beta chains and then gamma chain formation wanes
Injury to common peroneal nerve (d/t trauma or sustained pressure to neck of fibula) causing pain and numbness on dorsum of foot and inability to dorsiflex
Pain reliever - reduces pain by locking substance P in the PNS

38. a patient fearing all white coats is a phenomenon of what?
Classical conditioning
Well trained athletes and children
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Headaches and facial flushing; vasodilation in meninges and skin

39. How can renal blood flow be calculated from RPF?
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
RBF= PAH clearance/(1- hematocrit)
Chlorpheniramine and diphenhydramine
OCPs - multiparity - breast feeding

40. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Purkinje system; AV node
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Drink plenty of fluids
low in serum

41. What does 'oxygen' content in blood refer to?
PDA open
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
Dissolved in plasma and attached to Hgb
Ceftriaxone; azithromycin

42. what immune deficiency causes recurrent neisseria infections?
MAC complex (C5b - C9 complement deficiency)
The time interval between S2 and OS- the shorter the interval - the more intense
Prostate tumor and increased osteoclast activity
Chrom 8

43. What is capsaicin? Where does it work?
Pain reliever - reduces pain by locking substance P in the PNS
Standing suddenly from supine position; valsalva maneuver
C3 decreased after 5-10 days; sulfonamides
Increase by 50% in urine osmolality

44. what drug is useful for secretory diarrhea?
Single adenomatous ones
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Spongiosis
Octreotide

45. What is the cause of fixed splitting of S2? why?
Because gamma chains replace beta chains and then gamma chain formation wanes
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
hyponatremia (aldosterone activation equilibrates body volume)
Radial nerve and deep brachial artery

46. which nerve is at risk when ligating the superior thyroid artery? Which is the only muscle this nerve innervates? what nerve innervates all the other laryngeal muscles?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Superior larygeal; cricothyroid; recurrent laryngeal
IgE

47. If a patient has higher levels of HbF - What does this mean?
Think Hb deformation diseases
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

48. What are the two growth factors associated with angiogenesis?
II; I (I more abundant)
Initiation - pointing; pincer grasp; walking; mama/dada
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
FGF and VEGF

49. How do you calculate RPF from urine PAH?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Apocrine; eccrine
GI tract; mood!
(urine PAH x urine flow rate)/plasma PAH

50. What causes curlings ulcers?
The term used to describe decreased drug responsiveness with repeated administration
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Normally close to systolic