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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 extraocular muscle weakness a common symptom of?
Paramyxo and influenza
liver specific
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Myasthenia gravis

2. which nerve is at risk when ligating the superior thyroid artery? Which is the only muscle this nerve innervates? what nerve innervates all the other laryngeal muscles?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
8; 12
46 - 4N; 23 2N
Superior larygeal; cricothyroid; recurrent laryngeal

3. What is a keloid?
Excessive collagen formation during tissue repair in susceptible individuals
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Selective alpha 1 (increases SVR)
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

4. 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?
Turners`
No; yes
T test; chi squared
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

5. other than increasing HDL levels - what else does niacin do?
Pain reliever - reduces pain by locking substance P in the PNS
By vascular permeability and vasodilation
Prevents hepatic VLDL production
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

6. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
When it invades the bm; carcinoma in situ
11 aa polypeptide; pain NT in CNS and PNS
Nocardia
Become beta pleated and then form neurofibrillary tangle!

7. What are the two growth factors associated with angiogenesis?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
FGF and VEGF
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

8. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Demargination of neutrophils from the vessel walls
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Env genes (for getting into target cells)
Relfex tachycardia; giving beta blockers

9. What type of bond is a disulfide bond?
Covalent (between two cysteines)- allows protein to withstand denaturation
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
C3 decreased after 5-10 days; sulfonamides
Coagulation factors are made in the liver

10. do Class IC agents prolong the QT interval?
HSV ( also in utero: chlymadia - neisseria - group B strep)
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
In the extracellular space
No

11. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Tibial
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
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

12. What are some side effects seen in TCAs?
No only for prophylaxis (even for treating staphylococcal endocarditis its as multi drug); this is to prevent drug resistance from spontaneous mutations by DNA dependent RNA polymerase
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Because gamma chains replace beta chains and then gamma chain formation wanes
Susceptible; soluble (unable to be cultured in bile)

13. What is epleronone?
Another type of aldosterone antagonist (like spironolactone)
Integration of viral DNA into genome of host hepatocytes
Congenital hypothyroidism - downs - amyloidosis - acromegaly
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

14. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

15. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Smoking
Medullary
Prepatellar

16. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Terminal bronchioles; small bronchi
Amiloride - spironolactone - triamterene
In the extracellular space

17. What are two indicators of chronic alcohol consumption?
Elevated GGT and macrocytosis
8; 12
Sydenham chorea
T test; chi squared

18. name three pathological states that present with large tongues.
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Common peroneal; bony fractures and compression; sciatic
Brief psychotic disorder; schizophreniform; schizophrenia
Congenital hypothyroidism - downs - amyloidosis - acromegaly

19. What is achalasia and how would this correlate on the esophageal mannometry?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Octreotide
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
Initiation - pointing; pincer grasp; walking; mama/dada

20. What is the most common location of colonization of all s. aureus types?
Anterior nares
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
RBC mass; epo levels (secondary has high)
Increases cytokine production

21. which two drug types can cause orthostatic hypotension (think depression and BPH)?
TCAs and prazosin
Reiter syndrome; B27
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

22. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Leukotriene precursor and does neutrophil chemotaxis
Tzanck smear
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

23. what happens with LDL receptor density in statin therapy?
Increases
Ig A deficiency
glycerol kinase
Anti centromere; anti DNA topoisomerase

24. What is the neurologic manifestation of ADPKD?
TCAs and prazosin
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Classical conditioning
Abnormal closing of the urethral folds

25. What causes wrist drop?
Radial nerve damage
Squatting - sitting - lying supine - passive leg raising
RER; RER
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

26. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
C3 decreased after 5-10 days; sulfonamides
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Common peroneal; bony fractures and compression; sciatic
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

27. What effects does cortisol have on catecholamines?
Pulmonary hypertension
CMV - HSV 1 - Candida
Large stroke volumes with ventricular contraction; aortic regurg
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

28. What type of calcium channels dictate the plateau in cardiac myocyte?
11
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Dihydropyridine sensitive Ca channels (L type)

29. What test would be best to determine if a gene is being transcribed? translated?
Southern - western
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Anti centromere; anti DNA topoisomerase
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

30. What is easiest way to treat nephrolithiasis?
differentiate
Proteasome inhibitor; treatment for MM and waldenstroms
Medial circumflex artery; avascular necrosis
Drink plenty of fluids

31. What is the mc manifestation of CMV in HIV patient? immunocompetent?
As a CO2 carrier with the carboxylase enzyme
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Retinitis; mononucleosis

32. how long is substance P? What does it do?
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Valproate
Normal; low
11 aa polypeptide; pain NT in CNS and PNS

33. How do you calculate atributable risk percent?
Abnormal closing of the urethral folds
Primary
Smoking
RR-1/RR

34. how does eos release MBP to kill protozoa etc?
Medial part
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

35. What does C1 esterase do other than inhibiting complement pathway?
Inactivates kallikrein which activates kininogen into bradykinin
C3 decreased after 5-10 days; sulfonamides
facultative intracellular
Regular insulin (Not fast acting - regular better)

36. What is the sole neurologic manifestation of acute rheumatic fever?
Chrom 8
Sydenham chorea
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Clindamycin; covers anaerobic oral flora and aerobic bacteria

37. a patient fearing all white coats is a phenomenon of what?
Adeno
only up to bronchi
Classical conditioning
Well trained athletes and children

38. What is epispadias caused by?
Faulty positioning of the genital tubercle
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Hypertension - edema - and proteinuria
Another type of aldosterone antagonist (like spironolactone)

39. What are three symptoms in s.typhi?
Adeno
Nocardia
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

40. in overweight individuals What is thought to contribute to insulin resistance?
Close but purkinje system to ensure contraction in a bottom up fashion
Serum FFA and serum triglyceride levels
Chrom 8
Strength of cell mediated immune response

41. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
differentiate
Ceftriaxone; azithromycin
Dissolved in plasma and attached to Hgb
Well trained athletes and children

42. how can HAV be inactivated?
Brief psychotic disorder; schizophreniform; schizophrenia
Hypertension - edema - and proteinuria
Barium enema
Boiling - bleach - formalin - UV irradiation

43. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
<1% - 55% - concentration dependent
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Susceptible; soluble (unable to be cultured in bile)

44. which RPGN is also called pauci immune GN? why?
ANCA because of lack of Ig and C3 deposits on IF
High potassium conductance and some sodium conductance
indomethacin
only up to bronchi

45. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
Strength of cell mediated immune response
Class I
Sickle cell; G6PD
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

46. what happens to sperm count and semineferous tubules in patient with cryptoorchidism? hormonal function? why do they need to be surgically descended?
Amiadarone
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
Increases cytokine production
Retinitis; mononucleosis

47. What does prolonged PT indicated? aPTT? bleeding time?
Increases
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
On cardiac tissue and renal juxtaglomerular cells
Extrinsic def; instrinsic def; platelet def

48. What are the skin presentation in sarcoid?
Protamine sulfate
Varying; erythema nodosum is common
chronic urticaria and allergic symptoms
Fibrosis; macrophages

49. When is acid phosphatase elevated (Name two times)?
Prostate tumor and increased osteoclast activity
Hexokinase
Localized dermatologic pain that persists for more than one month after zoster eruption
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

50. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
Fibronectin - laminin - collagen
Radial nerve and deep brachial artery
RER; RER
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