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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 bursa is affected when on knees like a maid/gardner?
Radial nerve and deep brachial artery
11 aa polypeptide; pain NT in CNS and PNS
Prepatellar
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

2. 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?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Anterior nares
ANCA because of lack of Ig and C3 deposits on IF
Rabies encephalitis from cave bats; rabies killed vaccines

3. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Turbulence
No (unlike adenomyosis); yes
Increased reticulocytes
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

4. other than in pyelonephritis - where else are WBC casts seen?
SSRI; erectile dysfunction
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Acute interstitial nephritis
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

5. What type of drug is alendronate?
Right before diastole (filling begins)
Biphosphonate
Increase; decreased
Normal; low

6. What is gardeners mydriasis? How is it treated?
G to T in p53; HCC
Minimal change disease
INTRApartum Abs (ampicillin/penicillin)
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

7. What are three symptoms in s.typhi?
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
E. coli; staphylococcus saprophyticus
Spongiosis

8. What is hypospadias caused by?
Abnormal closing of the urethral folds
Increase lymphatic drainage!
<1% - 55% - concentration dependent
CMV - HSV 1 - Candida

9. Which is faster purkinje system or atrial muscle?
Close but purkinje system to ensure contraction in a bottom up fashion
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
NF- KB; responsible for cytokine production
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

10. non ceruloplasmin deposition - ceruloplasmin is...
Medial circumflex artery; avascular necrosis
RR-1/RR
low in serum
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

11. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
Hypothyroidism
Acute interstitial nephritis
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

12. What is the mc location for avascular necrosis? What is it associated with?
Vascular endothelium; protease
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Measure of depth invasion (vertical!)
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

13. within the right atrium - What is the maximum pressure? left atrium?
Barium enema
8; 12
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
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

14. What is tachyphylaxis?
The term used to describe decreased drug responsiveness with repeated administration
SVC and IVC; right below the aortic knob
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

15. What would a deflection of the membrane potential to near zero indicate?
Increase in permeability of two ions with equal and opposite equilibrium potentials
Barium enema
Syringomelia
4 - 4 - 9

16. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Fibronectin - laminin - collagen
11
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

17. What is the neurologic manifestation of ADPKD?
Hyperkalemia; potassium sparing diuretics - potassium supplements
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
liver specific

18. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
P450 mitochondrial monooxygenase
Curlings ulcers
Multiple miscarriages d/t hypercoaguability
S. aureus

19. What causes the blurry vision side effects in first generation anti histamines?
<1% - 55% - concentration dependent
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Diabetic microangiopathy
Anti cholinergic effects of pupil dilation and lack of accomodation

20. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
glycerol kinase
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
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

21. which antiarrythmic is associated with blue gray discoloration ?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
liver specific
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Amiadarone

22. why are beta thal major patients asymptomatic at birth?
Thymic tumor
Hypo or hyper pigmentations; after tanning
In the extracellular space for collagen cross linking; zinc
Because gamma chains replace beta chains and then gamma chain formation wanes

23. What is the presentation of angioedema? Where is most commonly affected?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Intussusception
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Vagus nerve stimulation

24. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Vancomycin; histamine mediated
Rabies encephalitis from cave bats; rabies killed vaccines
Apocrine; eccrine

25. What are the three causes of acute MI in context of normal coronary arteries ?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Abnormal closing of the urethral folds
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Increases

26. at three years of age What are social - fine motor - gross motor and language developments?
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
PDA open
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences

27. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
NF- KB; responsible for cytokine production
RBF= PAH clearance/(1- hematocrit)
AV node slowest - to allow time for diastole
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

28. What is the mcc of extrinsic allergic asthma?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Sudden loss of muscle tone without loss of consciousness; narcolepsy
S. aureus
Inhaled animal dander allergens

29. within the right ventricle - What are maximum pressures? the pulm arter?
Ketone body production by preventing fatty acids into the mitochondria
In ER of bile canaliculi
SSRI; erectile dysfunction
25; 25

30. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
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
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

31. What causes wrist drop?
Radial nerve damage
Hereditary angioedema; ACE inhibitors
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Anti cholinergic effects of pupil dilation and lack of accomodation

32. In what form are mitochondrial DNA? What do they transcribe?
Prostate tumor and increased osteoclast activity
Demargination of neutrophils from the vessel walls
No; yes
Circular - outside nucleus; transport proteins - rRNA - tRNA

33. Acyl coA synthetase is not...
Pain reliever - reduces pain by locking substance P in the PNS
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)
liver specific
Diabetic microangiopathy

34. Which is slower AV node or ventricular muscle?
AV node slowest - to allow time for diastole
SaO2 <92%
Closer to head; closer to diaphragm
Headaches and facial flushing; vasodilation in meninges and skin

35. What is pickwickian syndrome? What are the lab findings?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

36. What is cataplexy and When is it seen?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
RER; copper
Initiation - pointing; pincer grasp; walking; mama/dada
Decreases both

37. What is medullary sponge kidney disease and how does it present? What does it lead to?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
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)

38. What is the most common cause of pyelonephritis in both adults and childre?
E. coli
Sydenham chorea
Pan colitis and right sided colitis (more than left sided and proctitis)
Congenital hypothyroidism - downs - amyloidosis - acromegaly

39. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Hypo or hyper pigmentations; after tanning
OCPs - multiparity - breast feeding
Increase; decreased
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

40. what enzyme converts procarcinogens into carcinogens?
P450 mitochondrial monooxygenase
Hydrogen bonds dictate alpha or beta structure
Initiation - pointing; pincer grasp; walking; mama/dada
Pan colitis and right sided colitis (more than left sided and proctitis)

41. What are the two coagulase negative staphylococci? How do you distinguish them?
Medial part
Abnormal closing of the urethral folds
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
S. saprophyticus - and s. epidermidis; novobiocin

42. What are the skin presentation in sarcoid?
Env genes (for getting into target cells)
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Varying; erythema nodosum is common
Normally close to systolic

43. What is used to compare means? categorical outcomes?
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
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
T test; chi squared

44. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
TSh (in testicular tumors can cause hyperthyroidism)
P53 mutation; DCC is also required for adenoma to carcinoma

45. How do you explain the selective proteinuria of loss to albumin only in MCD?
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Vascular endothelium; protease
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Biphosphonate

46. PDAs are often asymptomatic. How do you treat?
Downs; regurgitant AV valves - ASDs
indomethacin
Strength of cell mediated immune response
RBC mass; epo levels (secondary has high)

47. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
P53 mutation; DCC is also required for adenoma to carcinoma
Medullary
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Serum creatine kinase; reperfusion injury causes necrosis

48. What are the two growth factors associated with angiogenesis?
NF- KB; responsible for cytokine production
FGF and VEGF
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
11

49. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Increase lymphatic drainage!
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Elastance
P53 mutation; DCC is also required for adenoma to carcinoma

50. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Right before diastole (filling begins)
Well trained athletes and children
Echinococcus granulosus; anaphylaxis
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased