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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. on which chromosome is wilms tumor found?
Nocardia
11
Raphe
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

2. what vessel would a fracture to the neck of the of the humerus damage?
SS +rNA
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
Hypertension - edema - and proteinuria
Anterior circumflex (and axillary nerve)

3. why is crohns disease associated with oxaloacetate kidney stones?
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
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Classical conditioning

4. if there are keratin swirls does that mean well or poorly differentiated?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Measles and M3 AML`
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Well

5. in B12 deficiency - what levels in blood rise very quickly and then drop?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
25; 25
Because of vasodiation to skeletal muscles
Reticulocytes

6. What is Bortezomib and What is it used for?
Proteasome inhibitor; treatment for MM and waldenstroms
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Hypo or hyper pigmentations; after tanning
liver specific

7. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
Initiation - pointing; pincer grasp; walking; mama/dada
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Smoking
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

8. what dissolves the lipid bilayer of a viral envelope?
Not lined by epithelium
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Right before diastole (filling begins)
Ether and other organic solvents

9. 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?
RR-1/RR
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Chlorpheniramine and diphenhydramine
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)

10. What actions increase venous return?
Squatting - sitting - lying supine - passive leg raising
Increased reticulocytes
Headaches and facial flushing; vasodilation in meninges and skin
Pulmonary hypertension

11. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Think Hb deformation diseases
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Single adenomatous ones

12. What is the mc manifestation of CMV in HIV patient? immunocompetent?
Retinitis; mononucleosis
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
By vascular permeability and vasodilation
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

13. When does opening snap begin?
Tibial
Right before diastole (filling begins)
Another type of aldosterone antagonist (like spironolactone)
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

14. What is the most common location of colonization of all s. aureus types?
S3 gallop; S2 to opening snap interval
Because of vasodiation to skeletal muscles
To pump calcium out in cardiac myocytes so that relaxation occurs
Anterior nares

15. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
transcription activation/suppression
Coagulation factors are made in the liver
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
In ER of bile canaliculi

16. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Transported to liver - glycerol kinase converts it to glycerol 3 phosphate Which is then converted to DHAP which can either join glycolysis for ATP or be used to make glucose
Insulin like growth factor 1 (just another name)
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

17. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
Vagus (auricular branch); vasovagal syncope!
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Smoking
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

18. why does liver dysfunction cause coagulation disorders?
Tissue redistribution (out of plasma) rather than metabolism
Transported to liver - glycerol kinase converts it to glycerol 3 phosphate Which is then converted to DHAP which can either join glycolysis for ATP or be used to make glucose
RR-1/RR
Coagulation factors are made in the liver

19. the rate of blood flow of which two circulations must equal each other at all times?
Pulmonic and systemic!
Right before diastole (filling begins)
II; I (I more abundant)
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

20. What does nitroprusside do to afterload? preload?
Apocrine; eccrine
Decreases both
S. aureus
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics

21. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
C3 decreased after 5-10 days; sulfonamides
IgE

22. prostaglandin synthesis keeps...
Acute interstitial nephritis
Smoking
PDA open
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

23. What are three symptoms in s.typhi?
S. saprophyticus - and s. epidermidis; novobiocin
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
The time interval between S2 and OS- the shorter the interval - the more intense
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

24. where are Beta 1 receptors found?
CMV - HSV 1 - Candida
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
manifestations - congenital (stretching of periventricular pyrimadal fibers)
On cardiac tissue and renal juxtaglomerular cells

25. What can long term leg cast wearing cause?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Bile soluble which means they are bile sensitive
Fibrosis; macrophages
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

26. on What part of the clavicle does the SCM attach?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Serum FFA and serum triglyceride levels
Rabies encephalitis from cave bats; rabies killed vaccines
Medial part

27. PDAs are often asymptomatic. How do you treat?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
indomethacin
Kallmans
Reticulocytes

28. What is the preferred treatment for DKA?
Regular insulin (Not fast acting - regular better)
No
The LES is supposed to relax when food comes its way (from above) and in achalasia - a motor dysfunction - LES doesnt relax and seen as elevated pressure on the esophageal mannometry
RER; RER

29. What three factors effect total oxygen content of blood?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Hyperkalemia; potassium sparing diuretics - potassium supplements
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Elevated GGT and macrocytosis

30. What pulmonary structural change can kartageners syndrome cause?
Bronchial dilation (bronchiectasis)
Chorda tympani branch
Joints d/t increased purine production and thus uric acid production
Pulmonary hypertension

31. do Class IC agents prolong the QT interval?
No
Leukotriene precursor and does neutrophil chemotaxis
Fibrosis; macrophages
Joints d/t increased purine production and thus uric acid production

32. What is the fibrinogen level in patient with TTP- HUS? DIC?
Normal; low
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

33. What is somatomedin C?
Ig A deficiency
Insulin like growth factor 1 (just another name)
HSV ( also in utero: chlymadia - neisseria - group B strep)
Minimal change disease

34. 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?
Another type of aldosterone antagonist (like spironolactone)
Downs; regurgitant AV valves - ASDs
Superior larygeal; cricothyroid; recurrent laryngeal
Biphosphonate

35. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Medial part
Class I
Classical conditioning

36. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
TSh (in testicular tumors can cause hyperthyroidism)

37. What does NF- KB do?
Increases cytokine production
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
RR-1/RR
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

38. other than parvo B19 - what else is associated with red cell aplasia?
Thymic tumor
LT (LTD4 - E4 - C4) - and Ach
Sarcoid
T test; chi squared

39. how does achalasia present? What does barium swallow show on dilated esophagus?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Mean greater than median greater than mode
SaO2 <92%
OCPs - multiparity - breast feeding

40. What is medullary sponge kidney disease and how does it present? What does it lead to?
Boiling - bleach - formalin - UV irradiation
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
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)
Congenital hypothyroidism - downs - amyloidosis - acromegaly

41. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
SaO2 <92%
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Chrom 8
Turners`

42. What are two common side effects of both acute and long acting nitrates? What causes them?
Neisseria induced small cell vasculitis (including hands and soles)
Headaches and facial flushing; vasodilation in meninges and skin
SSRI; erectile dysfunction
Common peroneal; bony fractures and compression; sciatic

43. which viruses require a protease?
SS +rNA
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
In the extracellular space for collagen cross linking; zinc
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

44. what would be a sign of absence of cardiogenic pulm edem?
SSRI
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

45. how much percent of sodium is excreted? urea? glucose?
<1% - 55% - concentration dependent
Valproate
Biphosphonate
CMV - HSV 1 - Candida

46. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
Rabies encephalitis from cave bats; rabies killed vaccines
Become beta pleated and then form neurofibrillary tangle!
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
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

47. What does the tuberoinfundibular pathway connect? What is it responsible for?
Normally close to systolic
Increase; decreased
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin

48. What are the three causes of acute MI in context of normal coronary arteries ?
Pain reliever - reduces pain by locking substance P in the PNS
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

49. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
Lateral; RV; RA; LV
Spongiosis
No (unlike adenomyosis); yes
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

50. at 2 years of age - What are the social - fine motor - gross motor and language developments?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Around 70 (normal measured diastolic pressures); 9--
Demargination of neutrophils from the vessel walls
Think Hb deformation diseases