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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. is Rifampin ever used as monotherapY? why either way?
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
8 (myc protein) with 2 - 14 - 22 (iG chains)
No only for prophylaxis (even for treating staphylococcal endocarditis its as multi drug); this is to prevent drug resistance from spontaneous mutations by DNA dependent RNA polymerase
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

2. How do left sided colon adenocarcinomas present? right sided?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Obstruction because they infiltrate the intestinal wall and encircle causing decrease in size of lumen - constipation - abdominal distension - abdominal pain - changes in stool caliber; right sided are often exophytic masses iron def anemia and syste

3. how does increased ICP result in curlings ulcers?
Apocrine; eccrine
Classical conditioning
Acute interstitial nephritis
Vagus nerve stimulation

4. what enzyme converts procarcinogens into carcinogens?
SVC and IVC; right below the aortic knob
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)
P450 mitochondrial monooxygenase
facultative intracellular

5. what hormone is structurally similar to hCG?
TSh (in testicular tumors can cause hyperthyroidism)
Right before diastole (filling begins)
Raphe
Because of the low output from heart failure - they will have increased aldosterone levels

6. what phase do adenosine and acetylcholine act on? doing what?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Biphosphonate
GI malignancies and Insulin resistance (acromegal for ex)
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

7. What causes wrist drop?
Radial nerve damage
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Tzanck smear

8. What is gardeners mydriasis? How is it treated?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Vancomycin; histamine mediated
Proteasome inhibitor; treatment for MM and waldenstroms

9. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Faulty positioning of the genital tubercle
Gluteus maximus; difficulty getting up from seated position and climbing chair
Hexokinase
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

10. Where does conjugation of bilirubin take place?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
In ER of bile canaliculi
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

11. How do you explain the selective proteinuria of loss to albumin only in MCD?
Thymic tumor
Kallmans
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

12. other than parvo B19 - what else is associated with red cell aplasia?
Thymic tumor
Decreases both
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Radial nerve and deep brachial artery

13. neisseria are...
indomethacin
Gluteus maximus; difficulty getting up from seated position and climbing chair
Around 70 (normal measured diastolic pressures); 9--
facultative intracellular

14. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
TSh (in testicular tumors can cause hyperthyroidism)
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Anti - apoptotic (prevents going into apoptosis)- 18; 14
V fib; v. failure

15. What is intussusception? how does ischemia and necrosis occur?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
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
CMV - HSV 1 - Candida
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

16. erythema nodosum - elevated ACE - scattered granulomas - arthralgias - hilar lymphadenoapthy are indicative of what?
LT (LTD4 - E4 - C4) - and Ach
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Sarcoid

17. 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?
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)
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Not lined by epithelium
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

18. What is epispadias caused by?
Syringomelia
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
Faulty positioning of the genital tubercle

19. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
Rabies encephalitis from cave bats; rabies killed vaccines
Brief psychotic disorder; schizophreniform; schizophrenia
Measure of depth invasion (vertical!)
On cardiac tissue and renal juxtaglomerular cells

20. what has the greatest effect on prognosis when treating c. diptheriae?
Ketone body production by preventing fatty acids into the mitochondria
Increase; decreased
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Covalent (between two cysteines)- allows protein to withstand denaturation

21. other than mycobacterim wha other bacteria is acid fast?
Mean greater than median greater than mode
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Nocardia
Anti centromere; anti DNA topoisomerase

22. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Closer to head; closer to diaphragm
Folic acid treatment!
Faulty positioning of the genital tubercle
Reiter syndrome; B27

23. on What part of the clavicle does the SCM attach?
Medial part
ATP binding (resets the myosin head to contract again for next binding)
Prevents hepatic VLDL production
Coagulation factors are made in the liver

24. In What type of nephritis would you see high serum eos count?
Drug induced interstitial nephritis
Myasthenia gravis
Abnormal closing of the urethral folds
low in serum

25. What does protein M do in Group A strep<
Single adenomatous ones
Because of the low output from heart failure - they will have increased aldosterone levels
Prevent phagocytosis
Measles and M3 AML`

26. What are examples of action that decrease venous return to the heart?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Standing suddenly from supine position; valsalva maneuver
Become beta pleated and then form neurofibrillary tangle!
Fibrosis; macrophages

27. which nerve provides innervation for plantar flexion and inversion?
Pan colitis and right sided colitis (more than left sided and proctitis)
Diabetic microangiopathy
Leukotriene precursor and does neutrophil chemotaxis
Tibial

28. what immune deficiency causes recurrent neisseria infections?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Integration of viral DNA into genome of host hepatocytes
Because of vasodiation to skeletal muscles
MAC complex (C5b - C9 complement deficiency)

29. how can HAV be inactivated?
Medullary
Boiling - bleach - formalin - UV irradiation
Env genes (for getting into target cells)
Normal; low

30. What is the mutation type in thalassemias? what process is defective because of this?
Pain reliever - reduces pain by locking substance P in the PNS
Aromatase deficiency in child
Nonsense; mRNA processing
Apocrine; eccrine

31. what diseases can vit A be used to treat?
II; I (I more abundant)
Anterior nares
Because gamma chains replace beta chains and then gamma chain formation wanes
Measles and M3 AML`

32. what should you think of in 'smear of an oral ulcer base'?
ATP binding (resets the myosin head to contract again for next binding)
Tzanck smear
Medial part
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

33. nucleotide deletions do not cause missense mutations - they cause...
Fibrosis; macrophages
frameshift mutations (missense is substitution)
Anterior circumflex (and axillary nerve)
G to T in p53; HCC

34. how much percent of sodium is excreted? urea? glucose?
<1% - 55% - concentration dependent
Increase in permeability of two ions with equal and opposite equilibrium potentials
8 (myc protein) with 2 - 14 - 22 (iG chains)
Integration of viral DNA into genome of host hepatocytes

35. why does liver dysfunction cause coagulation disorders?
Demargination of neutrophils from the vessel walls
Around 70 (normal measured diastolic pressures); 9--
IgE
Coagulation factors are made in the liver

36. which cells produce surfactant? which ones mediate gas exchange?
Relfex tachycardia; giving beta blockers
Turbulence
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
II; I (I more abundant)

37. the rate of blood flow of which two circulations must equal each other at all times?
SSRI; erectile dysfunction
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
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)
Pulmonic and systemic!

38. what protein is increased in Crohns disease? What does it do?
NF- KB; responsible for cytokine production
Brief psychotic disorder; schizophreniform; schizophrenia
No
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

39. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
Fat - fertile - forty - female
In the extracellular space for collagen cross linking; zinc
indomethacin
Sickle cell; G6PD

40. What is the difference between paranoid personality disorder and delusional disorder?
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Because of vasodiation to skeletal muscles

41. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Hypothyroidism
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Gluteus medius and minimus; positive trendelenberg
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

42. What are two indicators of chronic alcohol consumption?
Underestimation of gestational age
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Elevated GGT and macrocytosis
Because of vasodiation to skeletal muscles

43. What is hyaline arteriosclerosis usually a sign of ?
Vagus nerve stimulation
Diabetic microangiopathy
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Pain reliever - reduces pain by locking substance P in the PNS

44. what vessel would a fracture to the neck of the of the humerus damage?
<1% - 55% - concentration dependent
P53 mutation; DCC is also required for adenoma to carcinoma
(urine PAH x urine flow rate)/plasma PAH
Anterior circumflex (and axillary nerve)

45. 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?)?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Raphe
Anti centromere; anti DNA topoisomerase
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)

46. What can long term leg cast wearing cause?
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
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Joints d/t increased purine production and thus uric acid production
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

47. What type of calcium channels dictate the plateau in cardiac myocyte?
OCPs - multiparity - breast feeding
Well trained athletes and children
Dihydropyridine sensitive Ca channels (L type)
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

48. What can chronic vit A toxicity cause?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Close but purkinje system to ensure contraction in a bottom up fashion
Pain reliever - reduces pain by locking substance P in the PNS

49. What are pancreatic pseudocysts called pseudo rather than true cysts?
Minimal change disease
Not lined by epithelium
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
ATP binding (resets the myosin head to contract again for next binding)

50. do patients with cor pulmonale have increased or decreased levels of aldosterone?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
11
Because of the low output from heart failure - they will have increased aldosterone levels
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