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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 is acanthosis nigricans associated with?
E. coli; staphylococcus saprophyticus
Curlings ulcers
Trochlear nerve (IV); abducens nerve (VI)
GI malignancies and Insulin resistance (acromegal for ex)

2. What is diphenoxylate and What is it used for? what drug is it structurally similar to? What allows for potent anti diarrheal effect without signigicant opiate effects?
frameshift mutations (missense is substitution)
Purkinje system; AV node
Downs; regurgitant AV valves - ASDs
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)

3. at three years of age What are social - fine motor - gross motor and language developments?
Hereditary angioedema; ACE inhibitors
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Bile soluble which means they are bile sensitive
Hyperkalemia; potassium sparing diuretics - potassium supplements

4. What three factors effect total oxygen content of blood?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Phencyclidine (PCP)
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Duration and extent of disease

5. where are the vegetations on the valves of a libman sacks endocarditis?
ZDV or AZT
Both sides
Inhibits it
Closer to head; closer to diaphragm

6. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Downs; regurgitant AV valves - ASDs
Curlings ulcers
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

7. What is the mc location for avascular necrosis? What is it associated with?
gram positive organisms
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Medullary
Both sides

8. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
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
Inhaled animal dander allergens
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
RER; copper

9. What is a keloid?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Excessive collagen formation during tissue repair in susceptible individuals
4 - 4 - 9
manifestations - congenital (stretching of periventricular pyrimadal fibers)

10. do patients with cor pulmonale have increased or decreased levels of aldosterone?
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
T test; chi squared
Because of the low output from heart failure - they will have increased aldosterone levels
Hypo or hyper pigmentations; after tanning

11. prostaglandin synthesis keeps...
ANCA because of lack of Ig and C3 deposits on IF
<1% - 55% - concentration dependent
Drug induced interstitial nephritis
PDA open

12. Where is the base of the heart? apex?
Cluster
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Closer to head; closer to diaphragm
only up to bronchi

13. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
4 - 4 - 9
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
SVT; increases vagal tone; rectus abdominis

14. what marker should be followed in a patient with cirrhosis?
Proteasome inhibitor; treatment for MM and waldenstroms
Medial part
Nonsense; mRNA processing
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

15. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Hyperkalemia; potassium sparing diuretics - potassium supplements
Increase in permeability of two ions with equal and opposite equilibrium potentials
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Nonsense; mRNA processing

16. the rate of blood flow of which two circulations must equal each other at all times?
SSRI
Measles and M3 AML`
Pulmonic and systemic!
hyponatremia (aldosterone activation equilibrates body volume)

17. What is the mutation type in thalassemias? what process is defective because of this?
RER; copper
In ER of bile canaliculi
Nonsense; mRNA processing
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

18. 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
Because of the low output from heart failure - they will have increased aldosterone levels
No; yes
Appetite suppressants

19. What type of endocarditis is cytoscopy induced?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Enterococci (e. faecalis)- found on genitalia area
No; yes

20. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
Retinitis; mononucleosis
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
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

21. How do you calculate atributable risk percent?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
RR-1/RR
Echinococcus granulosus; anaphylaxis
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

22. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Drug induced interstitial nephritis
Prostate tumor and increased osteoclast activity
Because of vasodiation to skeletal muscles
Hereditary angioedema; ACE inhibitors

23. how does achalasia present? What does barium swallow show on dilated esophagus?
Chrom 8
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Hyperkalemia; potassium sparing diuretics - potassium supplements
Chorda tympani branch

24. What is diagnostic (and possible therapeutic for intussusception)?
Barium enema
Myasthenia gravis
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Acute interstitial nephritis

25. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Radial nerve and deep brachial artery
SVT; increases vagal tone; rectus abdominis
...
Become beta pleated and then form neurofibrillary tangle!

26. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
Underestimation of gestational age
Brief psychotic disorder; schizophreniform; schizophrenia
Barium enema
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

27. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Acute interstitial nephritis
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

28. are there signs of inflammation in avascular necrosis? then How do you diagnose?
Adeno
No; MRI
OCPs - multiparity - breast feeding
IgE

29. What causes vertical diplopia? horizontal?
Superior larygeal; cricothyroid; recurrent laryngeal
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Trochlear nerve (IV); abducens nerve (VI)
Vertical diplopia

30. in overweight individuals What is thought to contribute to insulin resistance?
Serum FFA and serum triglyceride levels
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Lateral; RV; RA; LV
Diabetic microangiopathy

31. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Both sides
Chorda tympani branch
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

32. What can cause aortic regurg? What is the heart sound you hear?
11 aa polypeptide; pain NT in CNS and PNS
Lateral; RV; RA; LV
Tibial
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

33. What does NF- KB do?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Nocardia
Increases cytokine production

34. What are pancreatic pseudocysts called pseudo rather than true cysts?
Covalent (between two cysteines)- allows protein to withstand denaturation
Inhaled animal dander allergens
Not lined by epithelium
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

35. Where does conjugation of bilirubin take place?
In ER of bile canaliculi
In the extracellular space for collagen cross linking; zinc
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

36. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
NF- KB; responsible for cytokine production
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

37. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
SS +rNA
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
Prepatellar

38. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Fibronectin - laminin - collagen
Hydrogen bonds dictate alpha or beta structure
Not lined by epithelium
Tzanck smear

39. what clinical findings help distinguish small cell carcinoma?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

40. What is a primary HSV 1 infection like?
Anti centromere; anti DNA topoisomerase
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Insulin like growth factor 1 (just another name)
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

41. which nucleus releases serotonin?
SSRI
Raphe
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

42. What is a cord factor and Which bugs have it? How do they appear on culture?
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Selective alpha 1 (increases SVR)

43. What type of drug is alendronate?
Biphosphonate
Lateral; RV; RA; LV
ST become atrophic and hyalinized (temp induced damage) and depressed sperm count becuase of that; hormonal function not impaired (test and LH levels normal) because Leydig cells not as temp sensitive so secondary sexual characteristics and sexual pe
Elevated GGT and macrocytosis

44. 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?)?
Intussusception
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Single adenomatous ones
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

45. How can renal blood flow be calculated from RPF?
Because of the low output from heart failure - they will have increased aldosterone levels
RBF= PAH clearance/(1- hematocrit)
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
MAC complex (C5b - C9 complement deficiency)

46. What are the two growth factors associated with angiogenesis?
GI malignancies and Insulin resistance (acromegal for ex)
Southern - western
FGF and VEGF
Bronchial dilation (bronchiectasis)

47. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
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
Bile soluble which means they are bile sensitive
11 aa polypeptide; pain NT in CNS and PNS
Boiling - bleach - formalin - UV irradiation

48. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
Sickle cell; G6PD
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
Prostate tumor and increased osteoclast activity
Boiling - bleach - formalin - UV irradiation

49. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Turners`
Primary
No

50. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
(urine PAH x urine flow rate)/plasma PAH
Both sides