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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 mcc of nephrotic syndrome in children and can occur in adults as wel?
Minimal change disease
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Strength of cell mediated immune response
Fibronectin - laminin - collagen

2. What is the most common neurologic complication of VZV reactivation?
Thymic tumor
Localized dermatologic pain that persists for more than one month after zoster eruption
Southern - western
Pan colitis and right sided colitis (more than left sided and proctitis)

3. what bursa is affected when on knees like a maid/gardner?
Appetite suppressants
Prepatellar
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
By vascular permeability and vasodilation

4. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
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
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
MAC complex (C5b - C9 complement deficiency)

5. How do left sided colon adenocarcinomas present? right sided?
Enterococci (e. faecalis)- found on genitalia area
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
Downs; regurgitant AV valves - ASDs
Well trained athletes and children

6. 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?
Terminal bronchioles; small bronchi
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Chorda tympani branch
Common peroneal; bony fractures and compression; sciatic

7. When does opening snap begin?
Right before diastole (filling begins)
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
V fib; v. failure
Gluteus maximus; difficulty getting up from seated position and climbing chair

8. Is there edema in primary Conns? secondary hyperaldosteronism? why?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Nocardia
Excessive collagen formation during tissue repair in susceptible individuals
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

9. What does C1 esterase do other than inhibiting complement pathway?
No; MRI
Sydenham chorea
Inactivates kallikrein which activates kininogen into bradykinin
Adductor

10. In What type of nephritis would you see high serum eos count?
Drug induced interstitial nephritis
S3 gallop; S2 to opening snap interval
SaO2 <92%
Extrinsic def; instrinsic def; platelet def

11. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Right heart failure
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

12. on which chromosome is wilms tumor found?
Brief psychotic disorder; schizophreniform; schizophrenia
11
Nonsense; mRNA processing
Demargination of neutrophils from the vessel walls

13. 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
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Because of vasodiation to skeletal muscles
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

14. What is the most common initital symptom of ADPKD? what else?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Pulmonary hypertension
HSV ( also in utero: chlymadia - neisseria - group B strep)
P53 mutation; AD

15. What would a deflection of the membrane potential to near zero indicate?
Initiation - pointing; pincer grasp; walking; mama/dada
Become beta pleated and then form neurofibrillary tangle!
Increase in permeability of two ions with equal and opposite equilibrium potentials
Multiple miscarriages d/t hypercoaguability

16. other than mycobacterim wha other bacteria is acid fast?
low in serum
Nocardia
GI malignancies and Insulin resistance (acromegal for ex)
glycerol kinase

17. what enzyme converts procarcinogens into carcinogens?
S. aureus
Proteasome inhibitor; treatment for MM and waldenstroms
LT (LTD4 - E4 - C4) - and Ach
P450 mitochondrial monooxygenase

18. What causes wrist drop?
Radial nerve damage
Right heart failure
11 aa polypeptide; pain NT in CNS and PNS
Chorda tympani branch

19. what drug is useful for secretory diarrhea?
Octreotide
Chrom 8
Inhibits it
Reiter syndrome; B27

20. how does achalasia present? What does barium swallow show on dilated esophagus?
11
Valproate
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

21. carnitine deficiency impairs production of What and how?
C3 decreased after 5-10 days; sulfonamides
Octreotide
Ketone body production by preventing fatty acids into the mitochondria
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

22. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Skin flushing and warmth; prostaglandins; give with aspirin
only up to bronchi
CGD; t cell dysfxn (diGeorge)
Anti cholinergic effects of pupil dilation and lack of accomodation

23. What is congestive hepatomegaly specific for?
Varying; erythema nodosum is common
Right heart failure
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Folic acid treatment!

24. What is the most common cause of pyelonephritis in both adults and childre?
8 (myc protein) with 2 - 14 - 22 (iG chains)
E. coli
Standing suddenly from supine position; valsalva maneuver
P53 mutation; DCC is also required for adenoma to carcinoma

25. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
T test; chi squared
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Biphosphonate

26. What does hypocapnia cause in teh brain? What is hypocapnia?
Turners`
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Lateral; RV; RA; LV

27. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
Acute gastric mucosal defects (superficial or full thickness)
Intussusception
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

28. what protects the resting heart from arrhythmias?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Valproate
Highly negative resting potential
Hyperkalemia; potassium sparing diuretics - potassium supplements

29. What is the difference between paranoid personality disorder and delusional disorder?
The time interval between S2 and OS- the shorter the interval - the more intense
Env genes (for getting into target cells)
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Anti cholinergic effects of pupil dilation and lack of accomodation

30. 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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31. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Large stroke volumes with ventricular contraction; aortic regurg
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

32. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
HSV ( also in utero: chlymadia - neisseria - group B strep)
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Serum FFA and serum triglyceride levels

33. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Ig A deficiency
Elastance
Because of vasodiation to skeletal muscles
Increases bronchial and vascular smooth muscle reactivity to catecholamines

34. 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)
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Common and benign congenital disorder characterized by cystic dilation of the medullary collecting ducts (cortex is spared); painless hematuria or asymptomatic; mc is development of kidney stones (benign disease)
Increased reticulocytes

35. what protein is increased in Crohns disease? What does it do?
Downs; regurgitant AV valves - ASDs
Measure of depth invasion (vertical!)
NF- KB; responsible for cytokine production
In the extracellular space for collagen cross linking; zinc

36. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
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
No; yes
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
E. coli; staphylococcus saprophyticus

37. why is glucagon used in beta blocker toxicitiy?
chronic urticaria and allergic symptoms
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
By vascular permeability and vasodilation
Lateral; RV; RA; LV

38. What is epleronone?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Another type of aldosterone antagonist (like spironolactone)
Well

39. What is the mc location for avascular necrosis? What is it associated with?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Protamine sulfate
Terminal bronchioles; small bronchi
4 - 4 - 9

40. within the right ventricle - What are maximum pressures? the pulm arter?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Spongiosis
25; 25
Amiloride - spironolactone - triamterene

41. name three pathological states that present with large tongues.
Abnormal closing of the urethral folds
200-500
P450 mitochondrial monooxygenase
Congenital hypothyroidism - downs - amyloidosis - acromegaly

42. how long is substance P? What does it do?
11 aa polypeptide; pain NT in CNS and PNS
Barium enema
Regular insulin (Not fast acting - regular better)
Vancomycin

43. What type of calcium channels dictate the plateau in cardiac myocyte?
Increase in permeability of two ions with equal and opposite equilibrium potentials
Bile soluble which means they are bile sensitive
No (unlike adenomyosis); yes
Dihydropyridine sensitive Ca channels (L type)

44. what hormone is structurally similar to hCG?
TSh (in testicular tumors can cause hyperthyroidism)
NF- KB; responsible for cytokine production
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
hyponatremia (aldosterone activation equilibrates body volume)

45. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Superior larygeal; cricothyroid; recurrent laryngeal
Gluteus medius and minimus; positive trendelenberg
Because gamma chains replace beta chains and then gamma chain formation wanes

46. What antibodies are present in CREST? What is the most specific?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Anti centromere; anti DNA topoisomerase
Chrom 8
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

47. what virus causes pharyngoconjuctival fever?
TCAs and prazosin
Adeno
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
Bile salt accumulation in urine

48. at 2 years of age - What are the social - fine motor - gross motor and language developments?
SS +rNA
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Because of the low output from heart failure - they will have increased aldosterone levels
hyponatremia (aldosterone activation equilibrates body volume)

49. What can too much IgA in serum produces?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
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
Sarcoid

50. What translocations can cause c - myc overexpression?
8 (myc protein) with 2 - 14 - 22 (iG chains)
Skin flushing and warmth; prostaglandins; give with aspirin
Barium enema
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