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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. why does variocele occur more in left side?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Barium enema
Folic acid treatment!
DIC; TTP- HUS dont bleed that much

2. What is the cause of rapid plasma decay of thiopental?
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)
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Hereditary angioedema; ACE inhibitors
Tissue redistribution (out of plasma) rather than metabolism

3. IL4 is used for isotypye switching to what?
Bronchial dilation (bronchiectasis)
Circular - outside nucleus; transport proteins - rRNA - tRNA
IgE
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

4. What does hypocapnia cause in teh brain? What is hypocapnia?
Inactivates kallikrein which activates kininogen into bradykinin
Normally close to systolic
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

5. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
S. aureus
Cluster
Trauma to stereociliated hair cells of the organ of corti
differentiate

6. What is the mcc of elevated AFP leves in pregnancy>
11
Underestimation of gestational age
SVT; increases vagal tone; rectus abdominis
Diabetic microangiopathy

7. Where does 90% of serotonin lie? What is this NT responsible?
Extrinsic def; instrinsic def; platelet def
GI tract; mood!
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

8. What actions increase venous return?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
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
DIC; TTP- HUS dont bleed that much
Squatting - sitting - lying supine - passive leg raising

9. the rate of blood flow of which two circulations must equal each other at all times?
Pulmonic and systemic!
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
Measles and M3 AML`
RBC mass; epo levels (secondary has high)

10. What is the triad seen in pre eclampsia?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Hypertension - edema - and proteinuria
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Multiple miscarriages d/t hypercoaguability

11. What are the acute effects of corticosteroids on the CBC?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Fat - fertile - forty - female
Adeno

12. What is congestive hepatomegaly specific for?
Bile salt accumulation in urine
Right heart failure
Increase lymphatic drainage!
manifestations - congenital (stretching of periventricular pyrimadal fibers)

13. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
25; 25
SVC and IVC; right below the aortic knob
CMV - HSV 1 - Candida
Pulmonary hypertension

14. within the right atrium - What is the maximum pressure? left atrium?
facultative intracellular
8; 12
Class I
Bile soluble which means they are bile sensitive

15. What is the difference between additive and synergistic?
Prevent phagocytosis
Fibrosis; macrophages
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
Tibial

16. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
TCAs and prazosin
Hexokinase
Medial part

17. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
SVC and IVC; right below the aortic knob
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Radial nerve and deep brachial artery
SSRI; erectile dysfunction

18. What are fenfluramine - phentermine?
GI malignancies and Insulin resistance (acromegal for ex)
E. coli; staphylococcus saprophyticus
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Appetite suppressants

19. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
glycerol kinase
GI malignancies and Insulin resistance (acromegal for ex)
2 -3 BPG; glycolysis - instead of ATP; erythrocytes because want to right shift the oxygen dissociation curve so that oxygen is released from RBCs into tissue
Not lined by epithelium

20. What does p53 do? what chrom is it on?
Prevent phagocytosis
only up to bronchi
GI tract; mood!
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

21. which type of glands produce an initially odorless secretion but can become malodorous secondary to bacterial decompisition on the skin surface? which glands are present throughout the skin except on lips and glans penis?
Turbulence
Tzanck smear
Insulin like growth factor 1 (just another name)
Apocrine; eccrine

22. Where does terminal peptide cleavage of collagen fibrils take place?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Prostate tumor and increased osteoclast activity
Recurrent larygneal
In the extracellular space

23. what vessel would a fracture to the neck of the of the humerus damage?
25; 25
RBF= PAH clearance/(1- hematocrit)
Anterior circumflex (and axillary nerve)
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

24. what kind of drug is sertraline? What is a common side effect?
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
Susceptible; soluble (unable to be cultured in bile)
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

25. which viruses require a protease?
SS +rNA
Highly negative resting potential
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Ig A deficiency

26. 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
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Fibronectin - laminin - collagen
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

27. What is Tzanck smear used to detect?
HSV and VZV
Headaches and facial flushing; vasodilation in meninges and skin
Well trained athletes and children
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

28. What is somatomedin C?
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
Insulin like growth factor 1 (just another name)
P450 mitochondrial monooxygenase
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

29. other than increasing HDL levels - what else does niacin do?
Prevents hepatic VLDL production
Think Hb deformation diseases
Ketone body production by preventing fatty acids into the mitochondria
E. coli; staphylococcus saprophyticus

30. What is extraocular muscle weakness a common symptom of?
Myasthenia gravis
To pump calcium out in cardiac myocytes so that relaxation occurs
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
ATP binding (resets the myosin head to contract again for next binding)

31. why should you not use ACE inhibitors with someone who had hereditary angioedema?
Ceftriaxone; azithromycin
Because ACE blocks breakdown of bradykinin and hereditary angioedema patients have high levels of bradykinin; high levels of bradykinin - C3a - and C5a mediate edema by increasing vascular permeability and vasodilation
Vagus (auricular branch); vasovagal syncope!
Ig A deficiency

32. What is the mainstay treatment for acute mania?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
46 - 4N; 23 2N

33. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
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
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
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)
Terminal bronchioles; small bronchi

34. What does prolonged PT indicated? aPTT? bleeding time?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Extrinsic def; instrinsic def; platelet def
Adeno

35. SIADH patients have normal blood volume but...
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
hyponatremia (aldosterone activation equilibrates body volume)
Raphe
Become beta pleated and then form neurofibrillary tangle!

36. who bleed more DIC or TTP- HUS patients?
Pain reliever - reduces pain by locking substance P in the PNS
DIC; TTP- HUS dont bleed that much
No; MRI
Duration and extent of disease

37. What is the mutation type in thalassemias? what process is defective because of this?
Think Hb deformation diseases
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Nonsense; mRNA processing
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

38. Which nerve lies in close proximity to the inferior thyroid artery?
Protamine sulfate
Recurrent larygneal
46 - 4N; 23 2N
Adeno

39. at one year of age - What are the social - fine motor - gross motor and language developments?
Dissolved in plasma and attached to Hgb
Initiation - pointing; pincer grasp; walking; mama/dada
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

40. Where does the aorta lie in relation to the pulmonary artery in transposition of the great arteries (is this right to left or left to right shunt?)?
V fib; v. failure
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

41. a patient fearing all white coats is a phenomenon of what?
Brief psychotic disorder; schizophreniform; schizophrenia
Terminal bronchioles; small bronchi
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Classical conditioning

42. what has the greatest effect on prognosis when treating c. diptheriae?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Abnormal closing of the urethral folds
Regular insulin (Not fast acting - regular better)
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

43. What does 'oxygen' content in blood refer to?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Dissolved in plasma and attached to Hgb
Radial nerve and deep brachial artery
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

44. What is it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
CMV - HSV 1 - Candida
P53 mutation; DCC is also required for adenoma to carcinoma
Vertical diplopia
Cluster

45. which has better side effect profile - SSRI or TCA?
II; I (I more abundant)
SSRI
Sydenham chorea
G to T in p53; HCC

46. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Gluteus medius and minimus; positive trendelenberg
Vagus (auricular branch); vasovagal syncope!
11 aa polypeptide; pain NT in CNS and PNS
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

47. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
E. coli; staphylococcus saprophyticus
Nonsense; mRNA processing
Underestimation of gestational age

48. which nucleus releases serotonin?
Raphe
Appetite suppressants
Valproate
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

49. What causes release of myosin head from the actin filament?
ATP binding (resets the myosin head to contract again for next binding)
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Valproate
Faulty positioning of the genital tubercle

50. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Anti centromere; anti DNA topoisomerase
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
I is more benign and can present later in adulthood