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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 are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
Enterococci (e. faecalis)- found on genitalia area
LT (LTD4 - E4 - C4) - and Ach
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

2. What is difference between Arnold Chiari type I and II?
Vancomycin; histamine mediated
SS +rNA
Thymic tumor
I is more benign and can present later in adulthood

3. What does the severity of leprosy depend on?
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Prepatellar
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Strength of cell mediated immune response

4. which staphylococci can do mannitol fermaentation?
Fibrosis; macrophages
S. aureus
Initiation - pointing; pincer grasp; walking; mama/dada
Closer to head; closer to diaphragm

5. What is the neurologic manifestation of ADPKD?
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
transcription activation/suppression
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

6. What is the primary histologic finding in patients with eczematous dermatitis?
Spongiosis
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)
Superior larygeal; cricothyroid; recurrent laryngeal
Hexokinase

7. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Think Hb deformation diseases
frameshift mutations (missense is substitution)
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

8. What are the lab findings in poststreptococcal GN?
Skin flushing and warmth; prostaglandins; give with aspirin
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Normal; low
8; 12

9. What can long term leg cast wearing cause?
Both sides
Nonsense; mRNA processing
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
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

10. which two virus families have hemagluttinin on their surface?
Retinitis; mononucleosis
Mean greater than median greater than mode
Apocrine; eccrine
Paramyxo and influenza

11. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Tzanck smear
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Proteasome inhibitor; treatment for MM and waldenstroms

12. What agonists reduce the gradient across the LV outflow tract?
Selective alpha 1 (increases SVR)
ANCA because of lack of Ig and C3 deposits on IF
Diabetic microangiopathy
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

13. why are beta thal major patients asymptomatic at birth?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
S3 gallop; S2 to opening snap interval
Because gamma chains replace beta chains and then gamma chain formation wanes
Classical conditioning

14. What type of drug is alendronate?
Neisseria induced small cell vasculitis (including hands and soles)
Biphosphonate
Adeno
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

15. What is the most common cause of pyelonephritis in both adults and childre?
In the extracellular space for collagen cross linking; zinc
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
E. coli

16. What is the mcc of elevated AFP leves in pregnancy>
transcription activation/suppression
SS +rNA
Underestimation of gestational age
25; 25

17. Where is conduction in heart fastest? slowest?
Env genes (for getting into target cells)
Closer to head; closer to diaphragm
Purkinje system; AV node
Ceftriaxone; azithromycin

18. What does TGF beta do? What produces it?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Drug induced interstitial nephritis
Fibrosis; macrophages
frameshift mutations (missense is substitution)

19. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
4 - 4 - 9
Drug induced interstitial nephritis
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
MAO inhibitors; wine and cheese

20. What would a deflection of the membrane potential to near zero indicate?
Drink plenty of fluids
Rabies encephalitis from cave bats; rabies killed vaccines
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Increase in permeability of two ions with equal and opposite equilibrium potentials

21. what organ would an activating mutation in PRPP synthetase effect?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Joints d/t increased purine production and thus uric acid production
Trauma to stereociliated hair cells of the organ of corti
Hypertension - edema - and proteinuria

22. What does the tuberoinfundibular pathway connect? What is it responsible for?
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

23. How do bradykinin - C3a and C5a cause edema?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Cluster
By vascular permeability and vasodilation
Nonsense; mRNA processing

24. 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?
SVC and IVC; right below the aortic knob
Diabetic microangiopathy
Demargination of neutrophils from the vessel walls
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

25. What is best to prevent GBS infection in a baby?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
LT (LTD4 - E4 - C4) - and Ach
Closer to head; closer to diaphragm
INTRApartum Abs (ampicillin/penicillin)

26. carnitine deficiency impairs production of What and how?
Ketone body production by preventing fatty acids into the mitochondria
NF- KB; responsible for cytokine production
Adeno
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

27. What is the mc malignancy in asbestosis?
Bronchogenic carcinoma
Chlorpheniramine and diphenhydramine
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Squatting - sitting - lying supine - passive leg raising

28. sporadic colon cancer tend to arise From what type of polyps?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
8; 12
Cluster
Single adenomatous ones

29. how does noise induced hearing loss occur?
Localized dermatologic pain that persists for more than one month after zoster eruption
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Trauma to stereociliated hair cells of the organ of corti
Regular insulin (Not fast acting - regular better)

30. what would be a sign of absence of cardiogenic pulm edem?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Decreases both
Reiter syndrome; B27

31. do patients with cor pulmonale have increased or decreased levels of aldosterone?
Squatting - sitting - lying supine - passive leg raising
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Because of the low output from heart failure - they will have increased aldosterone levels
Drug induced interstitial nephritis

32. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Because of vasodiation to skeletal muscles
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
E. coli
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

33. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
Because of the low output from heart failure - they will have increased aldosterone levels
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Appetite suppressants

34. What is the most common location of colonization of all s. aureus types?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Hydrogen bonds dictate alpha or beta structure
IgE
Anterior nares

35. What is the triad seen in pre eclampsia?
Curlings ulcers
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Hypertension - edema - and proteinuria
facultative intracellular

36. What effects does cortisol have on catecholamines?
Anti cholinergic effects of pupil dilation and lack of accomodation
Drug induced interstitial nephritis
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
Medullary

37. Where is the base of the heart? apex?
RER; RER
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Anterior circumflex (and axillary nerve)
Closer to head; closer to diaphragm

38. What is the difference between additive and synergistic?
Right before diastole (filling begins)
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
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

39. are there signs of inflammation in avascular necrosis? then How do you diagnose?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
No; MRI
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)
Vagus nerve stimulation

40. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Medial circumflex artery; avascular necrosis
Large stroke volumes with ventricular contraction; aortic regurg
In the extracellular space
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

41. Where does lysyl oxidase act? What is the cofactor for that?
In the extracellular space for collagen cross linking; zinc
Anterior circumflex (and axillary nerve)
Ether and other organic solvents
Around 70 (normal measured diastolic pressures); 9--

42. Which is faster atrial muscle or ventricular muscle?
Atrial
I is more benign and can present later in adulthood
Phencyclidine (PCP)
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

43. How do left sided colon adenocarcinomas present? right sided?
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
Brief psychotic disorder; schizophreniform; schizophrenia
Folic acid treatment!
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

44. other than in pyelonephritis - where else are WBC casts seen?
differentiate
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Acute interstitial nephritis
Anti centromere; anti DNA topoisomerase

45. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
Elevated GGT and macrocytosis
Trochlear nerve (IV); abducens nerve (VI)
No and yes
Increase lymphatic drainage!

46. What is extraocular muscle weakness a common symptom of?
The time interval between S2 and OS- the shorter the interval - the more intense
RR-1/RR
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Myasthenia gravis

47. how much percent of sodium is excreted? urea? glucose?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
<1% - 55% - concentration dependent
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
CMV - HSV 1 - Candida

48. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
Rabies encephalitis from cave bats; rabies killed vaccines
Inactivates kallikrein which activates kininogen into bradykinin
Increase; decreased
SVT; increases vagal tone; rectus abdominis

49. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Anti - apoptotic (prevents going into apoptosis)- 18; 14
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
No; yes

50. When does opening snap begin?
RBF= PAH clearance/(1- hematocrit)
IgE
Right before diastole (filling begins)
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin