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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 should you think of in 'smear of an oral ulcer base'?
Tibial
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Relfex tachycardia; giving beta blockers
Tzanck smear

2. What effects does cortisol have on catecholamines?
Tzanck smear
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Radial nerve and deep brachial artery
Permissive - sensitizes vasoconstrictive response from catecholamines - doesnt actually act on them but increases transcription of some genes that creates permissive effect (not additive or synergistic becuase cortisol alone doesnt have any effect on

3. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
G to T in p53; HCC
Normally close to systolic
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

4. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

5. What can too much IgA in serum produces?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Elastance

6. SIADH patients have normal blood volume but...
Normally close to systolic
FGF and VEGF
hyponatremia (aldosterone activation equilibrates body volume)
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

7. what protein is increased in Crohns disease? What does it do?
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
Enterococci (e. faecalis)- found on genitalia area
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
NF- KB; responsible for cytokine production

8. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
No
Inhibits it
differentiate
8; 12

9. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
Vagus (auricular branch); vasovagal syncope!
Echinococcus granulosus; anaphylaxis
No (unlike adenomyosis); yes
On cardiac tissue and renal juxtaglomerular cells

10. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
Valproate
DIC; TTP- HUS dont bleed that much
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

11. carnitine deficiency impairs production of What and how?
Ketone body production by preventing fatty acids into the mitochondria
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
E. coli
Anti - apoptotic (prevents going into apoptosis)- 18; 14

12. Which is faster atrial muscle or ventricular muscle?
Vancomycin
differentiate
Atrial
Highly negative resting potential

13. why does variocele occur more in left side?
Excessive collagen formation during tissue repair in susceptible individuals
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Acute gastric mucosal defects (superficial or full thickness)
Pain reliever - reduces pain by locking substance P in the PNS

14. What are three symptoms in s.typhi?
Normally close to systolic
Reticulocytes
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

15. PDAs are often asymptomatic. How do you treat?
indomethacin
Serum creatine kinase; reperfusion injury causes necrosis
E. coli
Lateral; RV; RA; LV

16. What causes vertical diplopia? horizontal?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Sydenham chorea
ZDV or AZT
Trochlear nerve (IV); abducens nerve (VI)

17. what hernia has a similar mechanism to hydrocele?
Permissive - sensitizes vasoconstrictive response from catecholamines - doesnt actually act on them but increases transcription of some genes that creates permissive effect (not additive or synergistic becuase cortisol alone doesnt have any effect on
200-500
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Elevated GGT and macrocytosis

18. What is mcc of death pre hospital phase of MI? in hospital phase?
Demargination of neutrophils from the vessel walls
Valproate
V fib; v. failure
200-500

19. How do bradykinin - C3a and C5a cause edema?
By vascular permeability and vasodilation
Radial nerve and deep brachial artery
V fib; v. failure
Permissive - sensitizes vasoconstrictive response from catecholamines - doesnt actually act on them but increases transcription of some genes that creates permissive effect (not additive or synergistic becuase cortisol alone doesnt have any effect on

20. what nerve and artery course along the posterior aspect of the humerus?
I is more benign and can present later in adulthood
G to T in p53; HCC
Radial nerve and deep brachial artery
The time interval between S2 and OS- the shorter the interval - the more intense

21. What pulmonary structural change can kartageners syndrome cause?
Medullary
Faulty positioning of the genital tubercle
Kallmans
Bronchial dilation (bronchiectasis)

22. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
frameshift mutations (missense is substitution)
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Cluster
Increase; decreased

23. on What part of the clavicle does the SCM attach?
Bronchial dilation (bronchiectasis)
Medial part
Right heart failure
only up to bronchi

24. What is acanthosis nigricans associated with?
GI malignancies and Insulin resistance (acromegal for ex)
RER; RER
Extrinsic def; instrinsic def; platelet def
Increases cytokine production

25. What is the difference between paranoid personality disorder and delusional disorder?
hyponatremia (aldosterone activation equilibrates body volume)
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Not lined by epithelium
S3 gallop; S2 to opening snap interval

26. What does L/S stand for in fetal lung maturity? When does maturity occur?
Both sides
Elastance
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

27. What is a clara cell?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
HSV ( also in utero: chlymadia - neisseria - group B strep)
Selective alpha 1 (increases SVR)

28. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Pulmonic and systemic!
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
manifestations - congenital (stretching of periventricular pyrimadal fibers)

29. What is the mcc of extrinsic allergic asthma?
Inhaled animal dander allergens
Because of vasodiation to skeletal muscles
Both sides
On cardiac tissue and renal juxtaglomerular cells

30. What is the mainstay treatment for acute mania?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
ATP binding (resets the myosin head to contract again for next binding)
P53 mutation; DCC is also required for adenoma to carcinoma
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

31. What triggers the neoplastic changes that are associated with HBV infecton?
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
Vascular endothelium; protease
Integration of viral DNA into genome of host hepatocytes
Nonsense; mRNA processing

32. do patients with cor pulmonale have increased or decreased levels of aldosterone?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Initiation - pointing; pincer grasp; walking; mama/dada
Because of the low output from heart failure - they will have increased aldosterone levels
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

33. how much percent of sodium is excreted? urea? glucose?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Hexokinase
Think Hb deformation diseases
<1% - 55% - concentration dependent

34. which are the only glycosylated proteins in HIV virus?
Env genes (for getting into target cells)
HSV ( also in utero: chlymadia - neisseria - group B strep)
Vancomycin; histamine mediated
E. coli

35. What do you treat s. epidermidis with?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
200-500
GI tract; mood!
Vancomycin

36. What is the best indicator for the severity of mitral stenosis?
The time interval between S2 and OS- the shorter the interval - the more intense
Syringomelia
Serum FFA and serum triglyceride levels
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

37. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
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
Ig A deficiency
Increase lymphatic drainage!
Underestimation of gestational age

38. What are the first generation anti histamines?
AV node slowest - to allow time for diastole
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Excessive collagen formation during tissue repair in susceptible individuals
Chlorpheniramine and diphenhydramine

39. What is Bortezomib and What is it used for?
Initiation - pointing; pincer grasp; walking; mama/dada
Hypertension - edema - and proteinuria
Proteasome inhibitor; treatment for MM and waldenstroms
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

40. What is the primary histologic finding in patients with eczematous dermatitis?
Spongiosis
Large stroke volumes with ventricular contraction; aortic regurg
chronic urticaria and allergic symptoms
Covalent (between two cysteines)- allows protein to withstand denaturation

41. in B12 deficiency - what levels in blood rise very quickly and then drop?
Reticulocytes
Susceptible; soluble (unable to be cultured in bile)
LT (LTD4 - E4 - C4) - and Ach
Coagulation factors are made in the liver

42. What is the most common initital symptom of ADPKD? what else?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Elevated GGT and macrocytosis

43. What actions increase venous return?
RR-1/RR
Squatting - sitting - lying supine - passive leg raising
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Serum FFA and serum triglyceride levels

44. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Purkinje system; AV node
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Appetite suppressants

45. why are beta thal major patients asymptomatic at birth?
Bronchial dilation (bronchiectasis)
RR-1/RR
Because gamma chains replace beta chains and then gamma chain formation wanes
46 - 4N; 23 2N

46. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
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)
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
IgE
Relfex tachycardia; giving beta blockers

47. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Terminal bronchioles; small bronchi
SSRI; erectile dysfunction
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

48. What is the cause of rapid plasma decay of thiopental?
Ig A deficiency
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Tissue redistribution (out of plasma) rather than metabolism
Curlings ulcers

49. within the right atrium - What is the maximum pressure? left atrium?
8; 12
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Cluster
46 - 4N; 23 2N

50. In what population does cholelithiasis occur?
Fat - fertile - forty - female
Chlorpheniramine and diphenhydramine
Because of the low output from heart failure - they will have increased aldosterone levels
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)