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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. why is glucagon used in beta blocker toxicitiy?
Medial part
Decreases both
Increases
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

2. What are two indicators of chronic alcohol consumption?
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Large stroke volumes with ventricular contraction; aortic regurg
HSV ( also in utero: chlymadia - neisseria - group B strep)
Elevated GGT and macrocytosis

3. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
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)
Measure of depth invasion (vertical!)
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Inhaled animal dander allergens

4. 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
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Sickle cell; G6PD
Phencyclidine (PCP)

5. 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
Relfex tachycardia; giving beta blockers
Pain reliever - reduces pain by locking substance P in the PNS
OCPs - multiparity - breast feeding

6. what virus causes pharyngoconjuctival fever?
Pulmonary hypertension
Adeno
RBF= PAH clearance/(1- hematocrit)
LT (LTD4 - E4 - C4) - and Ach

7. What is the immune deficinecy seen in ataxia telangactasia?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Hypo or hyper pigmentations; after tanning
Ig A deficiency

8. if there are keratin swirls does that mean well or poorly differentiated?
Hyperkalemia; potassium sparing diuretics - potassium supplements
Prostate tumor and increased osteoclast activity
Well
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

9. Metronidizaole does not cover...
gram positive organisms
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
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

10. in the LV and aorta - What are the pressures?
chronic urticaria and allergic symptoms
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
frameshift mutations (missense is substitution)
Normally close to systolic

11. What three factors effect total oxygen content of blood?
Diabetic microangiopathy
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
CMV - HSV 1 - Candida
Anterior nares

12. What is hypospadias caused by?
Env genes (for getting into target cells)
Abnormal closing of the urethral folds
Dissolved in plasma and attached to Hgb
Increase in permeability of two ions with equal and opposite equilibrium potentials

13. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
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
LT (LTD4 - E4 - C4) - and Ach
Normal; low

14. What causes release of myosin head from the actin filament?
(urine PAH x urine flow rate)/plasma PAH
ATP binding (resets the myosin head to contract again for next binding)
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
AV node slowest - to allow time for diastole

15. What does Rb protein do? what chrom is it on?
11 aa polypeptide; pain NT in CNS and PNS
Spongiosis
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
facultative intracellular

16. how can HAV be inactivated?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Abnormal closing of the urethral folds
Boiling - bleach - formalin - UV irradiation
Closer to head; closer to diaphragm

17. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
Appetite suppressants
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Elastance
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

18. prostaglandin synthesis keeps...
SVT; increases vagal tone; rectus abdominis
RER; copper
PDA open
Adductor

19. What is cataplexy and When is it seen?
T test; chi squared
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
In the extracellular space for collagen cross linking; zinc
Sudden loss of muscle tone without loss of consciousness; narcolepsy

20. 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
Dihydropyridine sensitive Ca channels (L type)
Adductor
Classical conditioning

21. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Hypertension - edema - and proteinuria
Strength of cell mediated immune response
Initiation - pointing; pincer grasp; walking; mama/dada
Increase; decreased

22. What is the most common neurologic complication of VZV reactivation?
Localized dermatologic pain that persists for more than one month after zoster eruption
Coagulation factors are made in the liver
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
Kallmans

23. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
Increases
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Reiter syndrome; B27
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

24. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
P53 mutation; DCC is also required for adenoma to carcinoma
Because of the low output from heart failure - they will have increased aldosterone levels
Aromatase deficiency in child

25. In What type of nephritis would you see high serum eos count?
Drug induced interstitial nephritis
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Extrinsic def; instrinsic def; platelet def
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

26. What is easiest way to treat nephrolithiasis?
Pulmonic and systemic!
RBC mass; epo levels (secondary has high)
Drink plenty of fluids
4 - 4 - 9

27. What causes wrist drop?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Hyperkalemia; potassium sparing diuretics - potassium supplements
Radial nerve damage
INTRApartum Abs (ampicillin/penicillin)

28. 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?
AV node slowest - to allow time for diastole
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Superior larygeal; cricothyroid; recurrent laryngeal
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

29. What is the diagnosis in delayed puberty plus anosmia?
Superior larygeal; cricothyroid; recurrent laryngeal
Nocardia
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Kallmans

30. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
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
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
differentiate
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

31. What test would be best to determine if a gene is being transcribed? translated?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Southern - western
Localized dermatologic pain that persists for more than one month after zoster eruption

32. What is capacitance inversely proportional to?
Increases cytokine production
Elastance
RBC mass; epo levels (secondary has high)
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

33. Acyl coA synthetase is not...
Because of vasodiation to skeletal muscles
25; 25
Inhibits it
liver specific

34. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
CGD; t cell dysfxn (diGeorge)
APP on chrom 21 (this is why downs more susceptible)
Measles and M3 AML`

35. what kind of drug is sertraline? What is a common side effect?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Nocardia
Radial nerve damage
SSRI; erectile dysfunction

36. What is capsaicin? Where does it work?
indomethacin
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
Pain reliever - reduces pain by locking substance P in the PNS
Radial nerve damage

37. How do you calculate atributable risk percent?
200-500
RR-1/RR
Prevent phagocytosis
Gluteus medius and minimus; positive trendelenberg

38. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
Aromatase deficiency in child
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Abnormal closing of the urethral folds
Susceptible; soluble (unable to be cultured in bile)

39. What is the primary histologic finding in patients with eczematous dermatitis?
hyponatremia (aldosterone activation equilibrates body volume)
8 (myc protein) with 2 - 14 - 22 (iG chains)
Primary
Spongiosis

40. What is the most important prognostic indicator in patients with malignant melanoma?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Hypertension - edema - and proteinuria
Measure of depth invasion (vertical!)
Measles and M3 AML`

41. which nerve provides innervation for plantar flexion and inversion?
Because of the low output from heart failure - they will have increased aldosterone levels
Tibial
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
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

42. What is normal fibrinogen levels?
200-500
OCPs - multiparity - breast feeding
FGF and VEGF
By vascular permeability and vasodilation

43. What type of disease has selective proteinuria? What is found in urine? What is not?
Tibial
Paramyxo and influenza
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Increase lymphatic drainage!

44. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Apocrine; eccrine
Echinococcus granulosus; anaphylaxis
Another type of aldosterone antagonist (like spironolactone)
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

45. what phase do adenosine and acetylcholine act on? doing what?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Prevents hepatic VLDL production
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

46. 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?
200-500
Aromatase deficiency in child
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Cluster

47. What triggers the neoplastic changes that are associated with HBV infecton?
Integration of viral DNA into genome of host hepatocytes
Octreotide
C3 decreased after 5-10 days; sulfonamides
Vancomycin

48. 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?)?
Sickle cell; G6PD
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Elevated GGT and macrocytosis
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

49. 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
Hypothyroidism
Large stroke volumes with ventricular contraction; aortic regurg
Vagus nerve stimulation

50. after a thrombus extraction - what serum enzyme shoots up and why?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Serum creatine kinase; reperfusion injury causes necrosis
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)