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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. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Apocrine; eccrine
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Well trained athletes and children
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)

2. IL4 is used for isotypye switching to what?
Prevent phagocytosis
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Radial nerve damage
IgE

3. What can long term leg cast wearing cause?
TSh (in testicular tumors can cause hyperthyroidism)
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
SSRI
PDA open

4. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
RR-1/RR
Fibrosis; macrophages
Aromatase deficiency in child
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

5. What is the mainstay treatment for acute mania?
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)
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Trauma to stereociliated hair cells of the organ of corti
Spongiosis

6. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
Well
High potassium conductance and some sodium conductance
Syringomelia
Vagus nerve stimulation

7. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Medial part
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Coagulation factors are made in the liver

8. What are some of the permissive effects of cortisol?
Common peroneal; bony fractures and compression; sciatic
Kallmans
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

9. What does C1 esterase do other than inhibiting complement pathway?
Recurrent larygneal
Inactivates kallikrein which activates kininogen into bradykinin
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Drug induced interstitial nephritis

10. In What type of nephritis would you see high serum eos count?
Elastance
Drug induced interstitial nephritis
Bronchogenic carcinoma
Appetite suppressants

11. In what population does cholelithiasis occur?
Bile salt accumulation in urine
Prevents hepatic VLDL production
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Fat - fertile - forty - female

12. What is the most common location of colonization of all s. aureus types?
Increases cytokine production
Anterior nares
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
<1% - 55% - concentration dependent

13. What is intussusception? how does ischemia and necrosis occur?
E. coli; staphylococcus saprophyticus
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
HSV and VZV
CMV - HSV 1 - Candida

14. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
RER; RER
Ketone body production by preventing fatty acids into the mitochondria
P53 mutation; DCC is also required for adenoma to carcinoma

15. What is medullary sponge kidney disease and how does it present? What does it lead to?
Normal; low
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)
The time interval between S2 and OS- the shorter the interval - the more intense
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

16. What is tachyphylaxis?
The term used to describe decreased drug responsiveness with repeated administration
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Hydrogen bonds dictate alpha or beta structure
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

17. What causes wrist drop?
Radial nerve damage
Not lined by epithelium
Normally close to systolic
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin

18. What is the mcc of elevated AFP leves in pregnancy>
Underestimation of gestational age
T test; chi squared
Tissue redistribution (out of plasma) rather than metabolism
Aromatase deficiency in child

19. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Headaches and facial flushing; vasodilation in meninges and skin
Drug induced interstitial nephritis
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

20. What is the cause of fixed splitting of S2? why?
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Ketone body production by preventing fatty acids into the mitochondria
Normally close to systolic
GI malignancies and Insulin resistance (acromegal for ex)

21. What is the presentation of angioedema? Where is most commonly affected?
Phencyclidine (PCP)
Reticulocytes
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Increase by 50% in urine osmolality

22. which are the only glycosylated proteins in HIV virus?
No
Nocardia
Env genes (for getting into target cells)
Squatting - sitting - lying supine - passive leg raising

23. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
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)
Serum FFA and serum triglyceride levels
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

24. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
Downs; regurgitant AV valves - ASDs
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Apocrine; eccrine
Retinitis; mononucleosis

25. What is congestive hepatomegaly specific for?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Vagus (auricular branch); vasovagal syncope!
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Right heart failure

26. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
Joints d/t increased purine production and thus uric acid production
Multiple miscarriages d/t hypercoaguability
In the extracellular space for collagen cross linking; zinc
C3 decreased after 5-10 days; sulfonamides

27. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
RR-1/RR
Minimal change disease
Smoking

28. What are examples of action that decrease venous return to the heart?
In the extracellular space
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Sarcoid
Standing suddenly from supine position; valsalva maneuver

29. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Chrom 8
Radial nerve damage
Skin flushing and warmth; prostaglandins; give with aspirin
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

30. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Gluteus medius and minimus; positive trendelenberg
Syringomelia
Increased reticulocytes

31. How do you explain the selective proteinuria of loss to albumin only in MCD?
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 of the low output from heart failure - they will have increased aldosterone levels
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
TCAs and prazosin

32. what virus causes pharyngoconjuctival fever?
Class I
Fibrosis; macrophages
Adeno
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

33. 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?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
gram positive organisms

34. What is the neurologic manifestation of ADPKD?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Increase by 50% in urine osmolality

35. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
SS +rNA
Downs; regurgitant AV valves - ASDs
Reiter syndrome; B27

36. what immune deficiency causes recurrent neisseria infections?
TCAs and prazosin
MAC complex (C5b - C9 complement deficiency)
Aromatase deficiency in child
Syncope - angina - dyspnea (SAD)

37. What is best to prevent GBS infection in a baby?
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)
INTRApartum Abs (ampicillin/penicillin)
Standing suddenly from supine position; valsalva maneuver
Acute interstitial nephritis

38. What is capacitance inversely proportional to?
Syncope - angina - dyspnea (SAD)
Insulin like growth factor 1 (just another name)
OCPs - multiparity - breast feeding
Elastance

39. What is the immune deficinecy seen in ataxia telangactasia?
Ig A deficiency
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
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Lateral; RV; RA; LV

40. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
E6 and E7 of HPV knock off p53 and Rb suppressor genes
FGF and VEGF
Classical conditioning

41. What are the two mcc of focal brain lesions in HIV positive patients?
SVC and IVC; right below the aortic knob
Anti cholinergic effects of pupil dilation and lack of accomodation
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
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

42. What does the tuberoinfundibular pathway connect? What is it responsible for?
Leukotriene precursor and does neutrophil chemotaxis
Bronchial dilation (bronchiectasis)
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin

43. 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?
Vagus (auricular branch); vasovagal syncope!
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Leukotriene precursor and does neutrophil chemotaxis
Cluster

44. what protein is increased in Crohns disease? What does it do?
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Because of the low output from heart failure - they will have increased aldosterone levels
NF- KB; responsible for cytokine production
Reiter syndrome; B27

45. what phase do adenosine and acetylcholine act on? doing what?
Myasthenia gravis
Strength of cell mediated immune response
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
AV node slowest - to allow time for diastole

46. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
Common peroneal; bony fractures and compression; sciatic
Transported to liver - glycerol kinase converts it to glycerol 3 phosphate Which is then converted to DHAP which can either join glycolysis for ATP or be used to make glucose
Anti centromere; anti DNA topoisomerase
E6 and E7 of HPV knock off p53 and Rb suppressor genes

47. What effects does cortisol have on catecholamines?
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
4 - 4 - 9
ANCA because of lack of Ig and C3 deposits on IF

48. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Turners`
Lateral; RV; RA; LV

49. 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?)?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Trochlear nerve (IV); abducens nerve (VI)

50. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Increased reticulocytes
Brief psychotic disorder; schizophreniform; schizophrenia
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