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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. at 2 years of age - What are the social - fine motor - gross motor and language developments?
Increase in permeability of two ions with equal and opposite equilibrium potentials
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
TCAs and prazosin
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

2. What is epleronone?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Mean greater than median greater than mode
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Another type of aldosterone antagonist (like spironolactone)

3. which RPGN is also called pauci immune GN? why?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
ANCA because of lack of Ig and C3 deposits on IF
Highly negative resting potential
Raphe

4. Which nerve lies in close proximity to the inferior thyroid artery?
Recurrent larygneal
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

5. 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?
Pulmonic and systemic!
Tzanck smear
SVT; increases vagal tone; rectus abdominis
Apocrine; eccrine

6. What are some of the permissive effects of cortisol?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Raphe
II; I (I more abundant)

7. what indicates the severity of a mitral regurg ? mitral stenosis?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
S3 gallop; S2 to opening snap interval
Sydenham chorea
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

8. 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)
Syringomelia
Skin flushing and warmth; prostaglandins; give with aspirin
Drink plenty of fluids

9. there are mucus secreting cells in the bronchioles...
only up to bronchi
Octreotide
Barium enema
Susceptible; soluble (unable to be cultured in bile)

10. do Class IC agents prolong the QT interval?
No
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
Dihydropyridine sensitive Ca channels (L type)
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

11. What is used to compare means? categorical outcomes?
Folic acid treatment!
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
T test; chi squared
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

12. What causes wrist drop?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Syncope - angina - dyspnea (SAD)
Radial nerve damage
Terminal bronchioles; small bronchi

13. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Medial circumflex artery; avascular necrosis
Increased reticulocytes
S. saprophyticus - and s. epidermidis; novobiocin
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

14. What is the primary histologic finding in patients with eczematous dermatitis?
Turbulence
Spongiosis
Underestimation of gestational age
Amiadarone

15. what virus causes pharyngoconjuctival fever?
RBF= PAH clearance/(1- hematocrit)
Adeno
Inhibits it
Single adenomatous ones

16. What do you treat s. epidermidis with?
Recurrent larygneal
Vancomycin
G to T in p53; HCC
No; MRI

17. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Sickle cell; G6PD
Protamine sulfate
CMV - HSV 1 - Candida
Terminal bronchioles; small bronchi

18. In What type of nephritis would you see high serum eos count?
Drug induced interstitial nephritis
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Thymic tumor
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

19. What are the skin presentation in sarcoid?
Normal; low
transcription activation/suppression
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Varying; erythema nodosum is common

20. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Abnormal closing of the urethral folds
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)
Turners`
Reticulocytes

21. Which is faster atrial muscle or ventricular muscle?
RER; RER
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Atrial
Chlorpheniramine and diphenhydramine

22. 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?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
C3 decreased after 5-10 days; sulfonamides
Cluster
HSV ( also in utero: chlymadia - neisseria - group B strep)

23. What is best to prevent GBS infection in a baby?
Leukotriene precursor and does neutrophil chemotaxis
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
INTRApartum Abs (ampicillin/penicillin)
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

24. a patient fearing all white coats is a phenomenon of what?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Anti cholinergic effects of pupil dilation and lack of accomodation
Classical conditioning

25. What is pickwickian syndrome? What are the lab findings?
Squatting - sitting - lying supine - passive leg raising
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
manifestations - congenital (stretching of periventricular pyrimadal fibers)

26. What does prolonged PT indicated? aPTT? bleeding time?
Extrinsic def; instrinsic def; platelet def
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

27. What are the two mcc of focal brain lesions in HIV positive patients?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Superior larygeal; cricothyroid; recurrent laryngeal
Anti cholinergic effects of pupil dilation and lack of accomodation
only up to bronchi

28. What is diphenoxylate and What is it used for? what drug is it structurally similar to? What allows for potent anti diarrheal effect without signigicant opiate effects?
Vancomycin
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
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)

29. erythema nodosum - elevated ACE - scattered granulomas - arthralgias - hilar lymphadenoapthy are indicative of what?
Sarcoid
RBC mass; epo levels (secondary has high)
Anterior circumflex (and axillary nerve)
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

30. What type of vision is myopia? In What type of patients does it improve?
Southern - western
Increase in permeability of two ions with equal and opposite equilibrium potentials
Because gamma chains replace beta chains and then gamma chain formation wanes
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

31. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
Increased reticulocytes
P53 mutation; AD
Hypo or hyper pigmentations; after tanning
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

32. Where does 90% of serotonin lie? What is this NT responsible?
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)
Elevated GGT and macrocytosis
GI tract; mood!
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

33. What does C1 esterase do other than inhibiting complement pathway?
Inactivates kallikrein which activates kininogen into bradykinin
Measles and M3 AML`
Increased reticulocytes
Prevents hepatic VLDL production

34. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Trauma to stereociliated hair cells of the organ of corti
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Rabies encephalitis from cave bats; rabies killed vaccines

35. other than proteinuria - What can cause foamy froathy urine?
Bile salt accumulation in urine
Acute gastric mucosal defects (superficial or full thickness)
Vascular endothelium; protease
Sarcoid

36. What does protein M do in Group A strep<
Prevent phagocytosis
manifestations - congenital (stretching of periventricular pyrimadal fibers)
E. coli
Hyperkalemia; potassium sparing diuretics - potassium supplements

37. What is the mc location for avascular necrosis? What is it associated with?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
ATP binding (resets the myosin head to contract again for next binding)
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Vagus nerve stimulation

38. What can long term leg cast wearing cause?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Rabies encephalitis from cave bats; rabies killed vaccines
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
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

39. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
AV node slowest - to allow time for diastole
Gluteus medius and minimus; positive trendelenberg
hyponatremia (aldosterone activation equilibrates body volume)
Demargination of neutrophils from the vessel walls

40. what has the greatest effect on prognosis when treating c. diptheriae?
Turners`
Excessive collagen formation during tissue repair in susceptible individuals
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics

41. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
In ER of bile canaliculi
OCPs - multiparity - breast feeding
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
HSV and VZV

42. what vessel would a fracture to the neck of the of the humerus damage?
Serum FFA and serum triglyceride levels
Anterior circumflex (and axillary nerve)
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

43. What is a keloid?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Excessive collagen formation during tissue repair in susceptible individuals
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Normal; low

44. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
25; 25
APP on chrom 21 (this is why downs more susceptible)
Radial nerve damage
Bile soluble which means they are bile sensitive

45. What is the stabilizing force for the secondary structure of proteins?
Radial nerve and deep brachial artery
25; 25
Hydrogen bonds dictate alpha or beta structure
Increases bronchial and vascular smooth muscle reactivity to catecholamines

46. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Hydrogen bonds dictate alpha or beta structure
Downs; regurgitant AV valves - ASDs
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

47. which nucleus releases serotonin?
Normally close to systolic
Raphe
The time interval between S2 and OS- the shorter the interval - the more intense
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

48. What are the primary determinants of colon cancer risk in UC patients
Duration and extent of disease
C3 decreased after 5-10 days; sulfonamides
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Prevents hepatic VLDL production

49. What is the mc manifestation of CMV in HIV patient? immunocompetent?
Env genes (for getting into target cells)
Retinitis; mononucleosis
Pulmonary hypertension
Lateral; RV; RA; LV

50. What three factors effect total oxygen content of blood?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
GI tract; mood!
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2