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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 intussusception? how does ischemia and necrosis occur?
facultative intracellular
Multiple miscarriages d/t hypercoaguability
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
Neisseria induced small cell vasculitis (including hands and soles)

2. What does anti phospholipid syndrome in SLE patients predispose them to?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Multiple miscarriages d/t hypercoaguability
Radial nerve and deep brachial artery
E. coli

3. how much percent of sodium is excreted? urea? glucose?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Bronchial dilation (bronchiectasis)
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
<1% - 55% - concentration dependent

4. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
Kallmans
P53 mutation; DCC is also required for adenoma to carcinoma
Pulmonary hypertension
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

5. what drug is useful for secretory diarrhea?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Octreotide
Hydrogen bonds dictate alpha or beta structure
Varying; erythema nodosum is common

6. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Measure of depth invasion (vertical!)
Appetite suppressants
Valproate
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)

7. What is the mutation type in thalassemias? what process is defective because of this?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Appetite suppressants
Nonsense; mRNA processing
Normal; low

8. 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
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
Not lined by epithelium
Diabetic microangiopathy

9. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
PDA open
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
E. coli
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

10. What is capacitance inversely proportional to?
Hydrogen bonds dictate alpha or beta structure
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Duration and extent of disease
Elastance

11. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
hyponatremia (aldosterone activation equilibrates body volume)
P53 mutation; DCC is also required for adenoma to carcinoma
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Brief psychotic disorder; schizophreniform; schizophrenia

12. What does hypocapnia cause in teh brain? What is hypocapnia?
Dissolved in plasma and attached to Hgb
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
RER; RER
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

13. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Both sides
Not lined by epithelium

14. How is dobutamine better than dopamine?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Integration of viral DNA into genome of host hepatocytes
Relfex tachycardia; giving beta blockers
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

15. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
RER; copper
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
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
Well trained athletes and children

16. what happens to capacitance with age?
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
The term used to describe decreased drug responsiveness with repeated administration
Normally close to systolic
...

17. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Gluteus maximus; difficulty getting up from seated position and climbing chair
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Elevated GGT and macrocytosis
Initiation - pointing; pincer grasp; walking; mama/dada

18. What is the presentation of sever aortic stenosis?
Southern - western
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Syncope - angina - dyspnea (SAD)
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

19. at one year of age - What are the social - fine motor - gross motor and language developments?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Initiation - pointing; pincer grasp; walking; mama/dada
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

20. what protects the resting heart from arrhythmias?
Highly negative resting potential
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
facultative intracellular
Ceftriaxone; azithromycin

21. 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?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Cluster
Tissue redistribution (out of plasma) rather than metabolism
The time interval between S2 and OS- the shorter the interval - the more intense

22. what vessel would a fracture to the neck of the of the humerus damage?
frameshift mutations (missense is substitution)
Anterior circumflex (and axillary nerve)
Because of the low output from heart failure - they will have increased aldosterone levels
Octreotide

23. Acyl coA synthetase is not...
Serum creatine kinase; reperfusion injury causes necrosis
Valproate
liver specific
In the extracellular space for collagen cross linking; zinc

24. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
SaO2 <92%
Inhaled animal dander allergens
Adductor
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

25. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Increased reticulocytes
Circular - outside nucleus; transport proteins - rRNA - tRNA
only up to bronchi
Pain reliever - reduces pain by locking substance P in the PNS

26. what induces bronchial squamous metaplasia?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Increase in permeability of two ions with equal and opposite equilibrium potentials
Smoking
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

27. nucleotide deletions do not cause missense mutations - they cause...
frameshift mutations (missense is substitution)
Prostate tumor and increased osteoclast activity
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

28. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Skin flushing and warmth; prostaglandins; give with aspirin
Abnormal closing of the urethral folds
ATP binding (resets the myosin head to contract again for next binding)
Tissue redistribution (out of plasma) rather than metabolism

29. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
SVC and IVC; right below the aortic knob
Ig A deficiency
Initiation - pointing; pincer grasp; walking; mama/dada
CMV - HSV 1 - Candida

30. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Hyperkalemia; potassium sparing diuretics - potassium supplements
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

31. What are two common side effects of both acute and long acting nitrates? What causes them?
Headaches and facial flushing; vasodilation in meninges and skin
Elastance
Regular insulin (Not fast acting - regular better)
S. aureus

32. 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?)?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Become beta pleated and then form neurofibrillary tangle!
Raphe

33. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
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
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

34. When does opening snap begin?
Circular - outside nucleus; transport proteins - rRNA - tRNA
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Hereditary angioedema; ACE inhibitors
Right before diastole (filling begins)

35. what makes bruits?
Localized dermatologic pain that persists for more than one month after zoster eruption
Turbulence
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
46 - 4N; 23 2N

36. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Extrinsic def; instrinsic def; platelet def
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
Diabetic microangiopathy
Anti - apoptotic (prevents going into apoptosis)- 18; 14

37. What do you treat s. epidermidis with?
MAC complex (C5b - C9 complement deficiency)
Tzanck smear
Vancomycin
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

38. What are examples of action that decrease venous return to the heart?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
CMV - HSV 1 - Candida
Standing suddenly from supine position; valsalva maneuver

39. What is suggestive of complete central DI?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Reticulocytes
liver specific
Increase by 50% in urine osmolality

40. h1 receptor anatagonists are not effective in treatment of asthma only for...
Vertical diplopia
Hyperkalemia; potassium sparing diuretics - potassium supplements
chronic urticaria and allergic symptoms
Excessive collagen formation during tissue repair in susceptible individuals

41. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Downs; regurgitant AV valves - ASDs
TSh (in testicular tumors can cause hyperthyroidism)
In the extracellular space for collagen cross linking; zinc
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

42. do Class IC agents prolong the QT interval?
facultative intracellular
Measure of depth invasion (vertical!)
No and yes
No

43. which two virus families have hemagluttinin on their surface?
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
Sydenham chorea
Paramyxo and influenza
In the extracellular space for collagen cross linking; zinc

44. which RPGN is also called pauci immune GN? why?
Insulin like growth factor 1 (just another name)
Syringomelia
ANCA because of lack of Ig and C3 deposits on IF
I is more benign and can present later in adulthood

45. What can chronic vit A toxicity cause?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Syncope - angina - dyspnea (SAD)
Hereditary angioedema; ACE inhibitors
...

46. What type of vision is myopia? In What type of patients does it improve?
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
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Paramyxo and influenza
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

47. What type of calcium channels dictate the plateau in cardiac myocyte?
Dihydropyridine sensitive Ca channels (L type)
Southern - western
RBF= PAH clearance/(1- hematocrit)
Hypothyroidism

48. What is epleronone?
Right heart failure
Another type of aldosterone antagonist (like spironolactone)
INTRApartum Abs (ampicillin/penicillin)
RER; copper

49. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
SSRI; erectile dysfunction
Serum creatine kinase; reperfusion injury causes necrosis
Increases cytokine production
differentiate

50. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Criggler Najjar (UGT enzyme in bilirubin glucoronidation) ; Dubin Johnson (transport protein lacking - Black liver) and Rotor syndrome - defects in hepatic uptake and excretion of bile (numerous defect)
Anti centromere; anti DNA topoisomerase
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity