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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. How do bradykinin - C3a and C5a cause edema?
Well trained athletes and children
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
By vascular permeability and vasodilation
Adeno

2. What is a common complication of acute pancreatitis? What is it?
Amiloride - spironolactone - triamterene
Excessive collagen formation during tissue repair in susceptible individuals
Little effect on cell and no change
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

3. how long is substance P? What does it do?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Reiter syndrome; B27
Anterior nares
11 aa polypeptide; pain NT in CNS and PNS

4. What are the acute effects of corticosteroids on the CBC?
Tibial
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
IgE

5. What three factors effect total oxygen content of blood?
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
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
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Inhibits it

6. How do you explain the selective proteinuria of loss to albumin only in MCD?
Radial nerve and deep brachial artery
liver specific
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Well

7. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
P53 mutation; DCC is also required for adenoma to carcinoma
No and yes
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Fibrosis; macrophages

8. What three pathogens cause infectious esophagitis in HIV positive patients?
By vascular permeability and vasodilation
Increases cytokine production
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
CMV - HSV 1 - Candida

9. 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?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Cluster
Increase; decreased

10. What is the mcc of elevated AFP leves in pregnancy>
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Underestimation of gestational age
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

11. Where is conduction in heart fastest? slowest?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Pan colitis and right sided colitis (more than left sided and proctitis)
Bile soluble which means they are bile sensitive
Purkinje system; AV node

12. why does hypothyroidism cause increased CPK levels?
Regular insulin (Not fast acting - regular better)
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
P53 mutation; DCC is also required for adenoma to carcinoma

13. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
Close but purkinje system to ensure contraction in a bottom up fashion
T test; chi squared
Curlings ulcers
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)

14. What does the tuberoinfundibular pathway connect? What is it responsible for?
Valproate
Radial nerve damage
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Right heart failure

15. are there signs of inflammation in avascular necrosis? then How do you diagnose?
Lateral; RV; RA; LV
Increase in permeability of two ions with equal and opposite equilibrium potentials
No; MRI
Inhibits it

16. what receptors do first generation anti histamines block?
Folic acid treatment!
Bile salt accumulation in urine
Thymic tumor
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

17. What does p53 do? what chrom is it on?
Pan colitis and right sided colitis (more than left sided and proctitis)
Because of vasodiation to skeletal muscles
Bronchogenic carcinoma
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

18. What does VIP do to gastric acid secretion?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
I is more benign and can present later in adulthood
Inhibits it
Hypothyroidism

19. What is hyaline arteriosclerosis usually a sign of ?
Fibrosis; macrophages
Hexokinase
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Diabetic microangiopathy

20. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
T test; chi squared
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Thymic tumor

21. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Proteasome inhibitor; treatment for MM and waldenstroms
FGF and VEGF
When it invades the bm; carcinoma in situ
Hexokinase

22. What is the mcc of extrinsic allergic asthma?
TSh (in testicular tumors can cause hyperthyroidism)
Inhaled animal dander allergens
transcription activation/suppression
Localized dermatologic pain that persists for more than one month after zoster eruption

23. why are pregnant predisposed to cholelithiasis?
Hereditary angioedema; ACE inhibitors
Pan colitis and right sided colitis (more than left sided and proctitis)
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
Appetite suppressants

24. when arrested in prophase of meiosis I - What are primary oocytes chrom number? What about the secondary oocytes that are stuck in metaphase of Meiosis II?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
46 - 4N; 23 2N
Class I
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

25. other than in pyelonephritis - where else are WBC casts seen?
Increase; decreased
low in serum
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Acute interstitial nephritis

26. which type of glands produce an initially odorless secretion but can become malodorous secondary to bacterial decompisition on the skin surface? which glands are present throughout the skin except on lips and glans penis?
Apocrine; eccrine
IgE
Rabies encephalitis from cave bats; rabies killed vaccines
<1% - 55% - concentration dependent

27. What is the mc location of brain germinomas?What are the classic symptoms?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Hypo or hyper pigmentations; after tanning
No
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

28. what makes bruits?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Turbulence
Drug induced interstitial nephritis
Common peroneal; bony fractures and compression; sciatic

29. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
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
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
E. coli; staphylococcus saprophyticus
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

30. What is it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Vertical diplopia
S. saprophyticus - and s. epidermidis; novobiocin
Prevent phagocytosis

31. other than proteinuria - What can cause foamy froathy urine?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Bile salt accumulation in urine
ZDV or AZT
Circular - outside nucleus; transport proteins - rRNA - tRNA

32. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
Aromatase deficiency in child
P53 mutation; AD
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Vagus nerve stimulation

33. How do you calculate RPF from urine PAH?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Echinococcus granulosus; anaphylaxis
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
(urine PAH x urine flow rate)/plasma PAH

34. ___________ is liver specific
Syringomelia
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
glycerol kinase

35. how much percent of sodium is excreted? urea? glucose?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Diabetic microangiopathy
ANCA because of lack of Ig and C3 deposits on IF
<1% - 55% - concentration dependent

36. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
Chorda tympani branch
C3 decreased after 5-10 days; sulfonamides
I is more benign and can present later in adulthood
SS +rNA

37. PDAs are often asymptomatic. How do you treat?
Mean greater than median greater than mode
Turners`
indomethacin
Appetite suppressants

38. 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?
Superior larygeal; cricothyroid; recurrent laryngeal
Echinococcus granulosus; anaphylaxis
8; 12
Fibronectin - laminin - collagen

39. where exactly is ACE expressed in the lungs? What type of enzyme is it?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Vascular endothelium; protease
chronic urticaria and allergic symptoms
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

40. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Medial circumflex artery; avascular necrosis
Vascular endothelium; protease
HSV ( also in utero: chlymadia - neisseria - group B strep)
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

41. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Gluteus maximus; difficulty getting up from seated position and climbing chair
Medial part
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

42. what vessel would a fracture to the neck of the of the humerus damage?
Brief psychotic disorder; schizophreniform; schizophrenia
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
SS +rNA
Anterior circumflex (and axillary nerve)

43. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Sydenham chorea
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Prevents hepatic VLDL production
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

44. What can chronic vit A toxicity cause?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
PDA open
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

45. What is the mc malignancy in asbestosis?
Bronchogenic carcinoma
Circular - outside nucleus; transport proteins - rRNA - tRNA
Recurrent larygneal
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

46. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Drink plenty of fluids
Dihydropyridine sensitive Ca channels (L type)
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Medial part

47. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Biphosphonate
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Boiling - bleach - formalin - UV irradiation

48. in B12 deficiency - what levels in blood rise very quickly and then drop?
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
Mean greater than median greater than mode
Reticulocytes
Enterococci (e. faecalis)- found on genitalia area

49. What type of disease has selective proteinuria? What is found in urine? What is not?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Elastance

50. which cells produce surfactant? which ones mediate gas exchange?
Radial nerve and deep brachial artery
II; I (I more abundant)
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
Echinococcus granulosus; anaphylaxis