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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 the neurologic manifestation of ADPKD?
By vascular permeability and vasodilation
Coagulation factors are made in the liver
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

2. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Prevent phagocytosis
Become beta pleated and then form neurofibrillary tangle!
Around 70 (normal measured diastolic pressures); 9--

3. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Inhaled animal dander allergens
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
When it invades the bm; carcinoma in situ

4. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
<1% - 55% - concentration dependent
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Because of vasodiation to skeletal muscles

5. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Drink plenty of fluids
women
Amiloride - spironolactone - triamterene

6. What are the primary determinants of colon cancer risk in UC patients
Pulmonic and systemic!
In the extracellular space
Duration and extent of disease
Vagus nerve stimulation

7. What is acanthosis nigricans associated with?
Enterococci (e. faecalis)- found on genitalia area
C3 decreased after 5-10 days; sulfonamides
Vagus (auricular branch); vasovagal syncope!
GI malignancies and Insulin resistance (acromegal for ex)

8. What is the primary histologic finding in patients with eczematous dermatitis?
Spongiosis
Circular - outside nucleus; transport proteins - rRNA - tRNA
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

9. What is extraocular muscle weakness a common symptom of?
On cardiac tissue and renal juxtaglomerular cells
P53 mutation; DCC is also required for adenoma to carcinoma
Myasthenia gravis
frameshift mutations (missense is substitution)

10. what marker should be followed in a patient with cirrhosis?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
RER; RER
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Spongiosis

11. How do you treat gonococcal infection? chlymadia?
Apocrine; eccrine
CGD; t cell dysfxn (diGeorge)
Ceftriaxone; azithromycin
II; I (I more abundant)

12. if there are keratin swirls does that mean well or poorly differentiated?
Well
200-500
On cardiac tissue and renal juxtaglomerular cells
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

13. what color pigmentations are caused by malassezia furfur? when do they become more visible?
hyponatremia (aldosterone activation equilibrates body volume)
Medial part
Hypo or hyper pigmentations; after tanning
Strength of cell mediated immune response

14. carnitine deficiency impairs production of What and how?
Pain reliever - reduces pain by locking substance P in the PNS
Ketone body production by preventing fatty acids into the mitochondria
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
In the extracellular space for collagen cross linking; zinc

15. at 2 years of age - What are the social - fine motor - gross motor and language developments?
Abnormal closing of the urethral folds
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
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Inactivates kallikrein which activates kininogen into bradykinin

16. how does noise induced hearing loss occur?
Syncope - angina - dyspnea (SAD)
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Trauma to stereociliated hair cells of the organ of corti
S. saprophyticus - and s. epidermidis; novobiocin

17. biotin is used By what in tissues responsible for gluconeogenesis
As a CO2 carrier with the carboxylase enzyme
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Tibial
CGD; t cell dysfxn (diGeorge)

18. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Class I
Pain reliever - reduces pain by locking substance P in the PNS
NF- KB; responsible for cytokine production

19. What is normal fibrinogen levels?
200-500
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Insulin like growth factor 1 (just another name)
Excessive collagen formation during tissue repair in susceptible individuals

20. What are examples of action that decrease venous return to the heart?
RER; copper
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Serum creatine kinase; reperfusion injury causes necrosis
Standing suddenly from supine position; valsalva maneuver

21. What is gardeners mydriasis? How is it treated?
Vertical diplopia
...
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

22. What does protein M do in Group A strep<
Anterior nares
Become beta pleated and then form neurofibrillary tangle!
Extrinsic def; instrinsic def; platelet def
Prevent phagocytosis

23. What is the presentation of sever aortic stenosis?
Syncope - angina - dyspnea (SAD)
Well trained athletes and children
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
To pump calcium out in cardiac myocytes so that relaxation occurs

24. which cells produce surfactant? which ones mediate gas exchange?
II; I (I more abundant)
Additive is equal to the sum of the two actions (lets say agonists at a receptor) and synergistic is when the sum is greater than just their two effects together
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Prevent phagocytosis

25. what should you think of in 'smear of an oral ulcer base'?
liver specific
Tzanck smear
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
HSV ( also in utero: chlymadia - neisseria - group B strep)

26. What does VIP do to gastric acid secretion?
11
RER; RER
Inhibits it
Biphosphonate

27. How is dobutamine better than dopamine?
Fibrosis; macrophages
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Dihydropyridine sensitive Ca channels (L type)
INTRApartum Abs (ampicillin/penicillin)

28. What are diastolic (lowest) pressures in aorta? LV?
Demargination of neutrophils from the vessel walls
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Around 70 (normal measured diastolic pressures); 9--

29. why does variocele occur more in left side?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
11
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

30. What are the long term consequences of hydrocephalus?
The term used to describe decreased drug responsiveness with repeated administration
Kallmans
Sickle cell; G6PD
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

31. What does L/S stand for in fetal lung maturity? When does maturity occur?
Multiple miscarriages d/t hypercoaguability
Pulmonic and systemic!
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
V fib; v. failure

32. What is the difference between paranoid personality disorder and delusional disorder?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Env genes (for getting into target cells)
Drug induced interstitial nephritis
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

33. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
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
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

34. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
gram positive organisms
Turners`
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

35. What are the lab findings in poststreptococcal GN?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Around 70 (normal measured diastolic pressures); 9--
Bronchogenic carcinoma
Gluteus medius and minimus; positive trendelenberg

36. What is mcc of death pre hospital phase of MI? in hospital phase?
Integration of viral DNA into genome of host hepatocytes
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)
Closer to head; closer to diaphragm
V fib; v. failure

37. the rate of blood flow of which two circulations must equal each other at all times?
women
Pulmonic and systemic!
Adductor
Turbulence

38. 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
Increases cytokine production
Hydrogen bonds dictate alpha or beta structure
Drug induced interstitial nephritis

39. hypertonicity and hyperreflexity are ________________ of hydrocephalus
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
MAO inhibitors; wine and cheese
Classical conditioning
manifestations - congenital (stretching of periventricular pyrimadal fibers)

40. what indicates the severity of a mitral regurg ? mitral stenosis?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
S3 gallop; S2 to opening snap interval

41. why does neutrophila occur with corticosteroids?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Chrom 8
Demargination of neutrophils from the vessel walls
Insulin like growth factor 1 (just another name)

42. What type of mutation does aflatoxin cause? what cancer does this increase for?
G to T in p53; HCC
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Trauma to stereociliated hair cells of the organ of corti

43. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
S3 gallop; S2 to opening snap interval
I is more benign and can present later in adulthood
Rabies encephalitis from cave bats; rabies killed vaccines
P450 mitochondrial monooxygenase

44. What is capacitance inversely proportional to?
glycerol kinase
II; I (I more abundant)
Elastance
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

45. Is there edema in primary Conns? secondary hyperaldosteronism? why?
On cardiac tissue and renal juxtaglomerular cells
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
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
Strength of cell mediated immune response

46. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
P53 mutation; AD
Relfex tachycardia; giving beta blockers
SSRI; erectile dysfunction
HSV ( also in utero: chlymadia - neisseria - group B strep)

47. What can too much IgA in serum produces?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
RER; RER

48. Which is faster purkinje system or atrial muscle?
Folic acid treatment!
Close but purkinje system to ensure contraction in a bottom up fashion
Prostate tumor and increased osteoclast activity
SSRI; erectile dysfunction

49. nucleotide deletions do not cause missense mutations - they cause...
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
Anti cholinergic effects of pupil dilation and lack of accomodation
frameshift mutations (missense is substitution)
TSh (in testicular tumors can cause hyperthyroidism)

50. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
CGD; t cell dysfxn (diGeorge)
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
On cardiac tissue and renal juxtaglomerular cells
Well