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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. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Drug induced interstitial nephritis
P450 mitochondrial monooxygenase
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Both sides

2. Where does terminal peptide cleavage of collagen fibrils take place?
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
<1% - 55% - concentration dependent
In the extracellular space
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

3. What are pancreatic pseudocysts called pseudo rather than true cysts?
manifestations - congenital (stretching of periventricular pyrimadal fibers)
SS +rNA
Not lined by epithelium
Medullary

4. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Aromatase deficiency in child
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Hexokinase
Elastance

5. which nerve provides innervation for plantar flexion and inversion?
Tibial
In ER of bile canaliculi
MAC complex (C5b - C9 complement deficiency)
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

6. other than increasing HDL levels - what else does niacin do?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Standing suddenly from supine position; valsalva maneuver
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Prevents hepatic VLDL production

7. What type of bond is a disulfide bond?
Anterior nares
indomethacin
Covalent (between two cysteines)- allows protein to withstand denaturation
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

8. What are fenfluramine - phentermine?
Vagus nerve stimulation
indomethacin
Think Hb deformation diseases
Appetite suppressants

9. What does TGF beta do? What produces it?
Enterococci (e. faecalis)- found on genitalia area
Fibrosis; macrophages
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Prevent phagocytosis

10. What is 5- HETE and What does it do?
Leukotriene precursor and does neutrophil chemotaxis
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
46 - 4N; 23 2N

11. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
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)
E. coli; staphylococcus saprophyticus

12. what enzyme converts procarcinogens into carcinogens?
Cluster
P450 mitochondrial monooxygenase
Chorda tympani branch
Hypothyroidism

13. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Elevated GGT and macrocytosis
Myasthenia gravis
Increase lymphatic drainage!
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

14. other than parvo B19 - what else is associated with red cell aplasia?
The term used to describe decreased drug responsiveness with repeated administration
Adeno
Thymic tumor
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

15. What is the mc manifestation of CMV in HIV patient? immunocompetent?
IgE
Retinitis; mononucleosis
11 aa polypeptide; pain NT in CNS and PNS
GI tract; mood!

16. What are diastolic (lowest) pressures in aorta? LV?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Around 70 (normal measured diastolic pressures); 9--
CGD; t cell dysfxn (diGeorge)
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

17. What is used to compare means? categorical outcomes?
T test; chi squared
Vagus (auricular branch); vasovagal syncope!
Appetite suppressants
Inhibits it

18. which has better side effect profile - SSRI or TCA?
Enterococci (e. faecalis)- found on genitalia area
Underestimation of gestational age
Dissolved in plasma and attached to Hgb
SSRI

19. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
Anti cholinergic effects of pupil dilation and lack of accomodation
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Reiter syndrome; B27
Vagus (auricular branch); vasovagal syncope!

20. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Another type of aldosterone antagonist (like spironolactone)
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

21. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
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
Folic acid treatment!
Initiation - pointing; pincer grasp; walking; mama/dada
Hereditary angioedema; ACE inhibitors

22. What is difference between Arnold Chiari type I and II?
I is more benign and can present later in adulthood
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
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

23. What is the most common initital symptom of ADPKD? what else?
TCAs and prazosin
Extrinsic def; instrinsic def; platelet def
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

24. What is the neurologic manifestation of ADPKD?
SaO2 <92%
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Curlings ulcers

25. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Myasthenia gravis
Insulin like growth factor 1 (just another name)
Class I

26. What translocations can cause c - myc overexpression?
8 (myc protein) with 2 - 14 - 22 (iG chains)
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

27. What antibodies are present in CREST? What is the most specific?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Anti centromere; anti DNA topoisomerase
Nocardia
Common peroneal; bony fractures and compression; sciatic

28. what bursa is affected when on knees like a maid/gardner?
Prepatellar
Chlorpheniramine and diphenhydramine
Downs; regurgitant AV valves - ASDs
Trochlear nerve (IV); abducens nerve (VI)

29. What are some side effects seen in TCAs?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Myasthenia gravis
Right before diastole (filling begins)
Tibial

30. when do ghon complexes form - primary or secondary TB?
Primary
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
GI malignancies and Insulin resistance (acromegal for ex)
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

31. in overweight individuals What is thought to contribute to insulin resistance?
Serum FFA and serum triglyceride levels
AV node slowest - to allow time for diastole
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Medullary

32. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Increase in permeability of two ions with equal and opposite equilibrium potentials
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Medullary
Not lined by epithelium

33. What pulmonary structural change can kartageners syndrome cause?
frameshift mutations (missense is substitution)
AV node slowest - to allow time for diastole
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Bronchial dilation (bronchiectasis)

34. h1 receptor anatagonists are not effective in treatment of asthma only for...
chronic urticaria and allergic symptoms
Varying; erythema nodosum is common
glycerol kinase
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)

35. When does opening snap begin?
Right before diastole (filling begins)
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
SS +rNA
Standing suddenly from supine position; valsalva maneuver

36. 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?
Ether and other organic solvents
Cluster
II; I (I more abundant)
Env genes (for getting into target cells)

37. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Closer to head; closer to diaphragm
RBF= PAH clearance/(1- hematocrit)
Reiter syndrome; B27
Radial nerve damage

38. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Valproate
Downs; regurgitant AV valves - ASDs
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)
Standing suddenly from supine position; valsalva maneuver

39. 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?)?
Hereditary angioedema; ACE inhibitors
Integration of viral DNA into genome of host hepatocytes
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Relfex tachycardia; giving beta blockers

40. What is somatomedin C?
S. saprophyticus - and s. epidermidis; novobiocin
E. coli
Insulin like growth factor 1 (just another name)
Turbulence

41. on What part of the clavicle does the SCM attach?
TSh (in testicular tumors can cause hyperthyroidism)
Class I
Medial part
Insulin like growth factor 1 (just another name)

42. 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
P53 mutation; AD
facultative intracellular
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

43. Where does conjugation of bilirubin take place?
Medial part
In ER of bile canaliculi
Brief psychotic disorder; schizophreniform; schizophrenia
Tibial

44. What is subacute sclerosisng encephalitis caused by?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Nonsense; mRNA processing
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

45. What is the precursor protein to beta amyloid and On what chromosome is it found?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Faulty positioning of the genital tubercle
APP on chrom 21 (this is why downs more susceptible)
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

46. why is glucagon used in beta blocker toxicitiy?
H. influenzae type B; polyribosyl phosphate (PRP); cherry red uvula - dysphagia - stridor (sometimes) - difficulty breathing - fever - drooling - positive 'thumbs up sign' on lateral xray of cervical region d/t swollen epiglottis
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Not lined by epithelium
P450 mitochondrial monooxygenase

47. 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?
RR-1/RR
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
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

48. In what view of CXR is anterior part of heart best seen? anterior part of heart is formed by?right border of heart is formed by? left border?
Lateral; RV; RA; LV
Anti - apoptotic (prevents going into apoptosis)- 18; 14
IgE
4 - 4 - 9

49. What is Bortezomib and What is it used for?
Chorda tympani branch
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Proteasome inhibitor; treatment for MM and waldenstroms
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

50. what induces bronchial squamous metaplasia?
Dihydropyridine sensitive Ca channels (L type)
Smoking
Tzanck smear
Southern - western