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USMLE Prep 2

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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 diseases can vit A be used to treat?
MAO inhibitors; wine and cheese
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Measles and M3 AML`
Underestimation of gestational age

2. what bursa is affected when on knees like a maid/gardner?
Serum creatine kinase; reperfusion injury causes necrosis
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)
Hypo or hyper pigmentations; after tanning
Prepatellar

3. How do bradykinin - C3a and C5a cause edema?
8 (myc protein) with 2 - 14 - 22 (iG chains)
By vascular permeability and vasodilation
Radial nerve and deep brachial artery
Measure of depth invasion (vertical!)

4. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Varying; erythema nodosum is common
Fibrosis; macrophages
Ig A deficiency

5. non ceruloplasmin deposition - ceruloplasmin is...
Circular - outside nucleus; transport proteins - rRNA - tRNA
Rabies encephalitis from cave bats; rabies killed vaccines
low in serum
Hyperkalemia; potassium sparing diuretics - potassium supplements

6. do Class IC agents prolong the QT interval?
Headaches and facial flushing; vasodilation in meninges and skin
No
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Hypo or hyper pigmentations; after tanning

7. which staphylococci can do mannitol fermaentation?
S3 gallop; S2 to opening snap interval
Increase by 50% in urine osmolality
Joints d/t increased purine production and thus uric acid production
S. aureus

8. When is an S4 sound normal?
Anterior circumflex (and axillary nerve)
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Well trained athletes and children
Anti cholinergic effects of pupil dilation and lack of accomodation

9. 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?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Serum creatine kinase; reperfusion injury causes necrosis
Apocrine; eccrine
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

10. which antiarrythmic is associated with blue gray discoloration ?
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
Amiadarone
indomethacin
Neisseria induced small cell vasculitis (including hands and soles)

11. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
C3 decreased after 5-10 days; sulfonamides
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Skin flushing and warmth; prostaglandins; give with aspirin
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

12. how does achalasia present? What does barium swallow show on dilated esophagus?
Vancomycin
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Demargination of neutrophils from the vessel walls

13. What does extended consumption of appetite suppressants lead to?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Pulmonary hypertension
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

14. What are examples of action that decrease venous return to the heart?
Not lined by epithelium
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Standing suddenly from supine position; valsalva maneuver

15. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Selective alpha 1 (increases SVR)
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
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Southern - western

16. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Turners`
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Serum creatine kinase; reperfusion injury causes necrosis
Coagulation factors are made in the liver

17. What are the two coagulase negative staphylococci? How do you distinguish them?
S. saprophyticus - and s. epidermidis; novobiocin
Sarcoid
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
SS +rNA

18. what murmur is enhanced by decreased blood flow to the heart?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Right heart failure
Integration of viral DNA into genome of host hepatocytes
Hexokinase

19. What agonists reduce the gradient across the LV outflow tract?
DIC; TTP- HUS dont bleed that much
Measure of depth invasion (vertical!)
(urine PAH x urine flow rate)/plasma PAH
Selective alpha 1 (increases SVR)

20. When is acid phosphatase elevated (Name two times)?
Serum creatine kinase; reperfusion injury causes necrosis
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
High potassium conductance and some sodium conductance
Prostate tumor and increased osteoclast activity

21. What does the severity of leprosy depend on?
Strength of cell mediated immune response
Regular insulin (Not fast acting - regular better)
Localized dermatologic pain that persists for more than one month after zoster eruption
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

22. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Rabies encephalitis from cave bats; rabies killed vaccines
Turners`
Acute gastric mucosal defects (superficial or full thickness)
Squatting - sitting - lying supine - passive leg raising

23. What are three symptoms in s.typhi?
11 aa polypeptide; pain NT in CNS and PNS
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
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
transcription activation/suppression

24. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Hexokinase
RER; copper
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)
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

25. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Normally close to systolic
SVC and IVC; right below the aortic knob
Localized dermatologic pain that persists for more than one month after zoster eruption
HSV ( also in utero: chlymadia - neisseria - group B strep)

26. 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)
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
S. aureus
Pan colitis and right sided colitis (more than left sided and proctitis)

27. ___________ is liver specific
Closer to head; closer to diaphragm
glycerol kinase
Single adenomatous ones
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

28. What pulmonary structural change can kartageners syndrome cause?
Superior larygeal; cricothyroid; recurrent laryngeal
Turners`
Bronchial dilation (bronchiectasis)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

29. What type of endocarditis is cytoscopy induced?
Leukotriene precursor and does neutrophil chemotaxis
Enterococci (e. faecalis)- found on genitalia area
Ceftriaxone; azithromycin
<1% - 55% - concentration dependent

30. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
SSRI
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
By vascular permeability and vasodilation
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac

31. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
Mean greater than median greater than mode
46 - 4N; 23 2N
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Vascular endothelium; protease

32. what marker should be followed in a patient with cirrhosis?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
P450 mitochondrial monooxygenase
46 - 4N; 23 2N
Leukotriene precursor and does neutrophil chemotaxis

33. what would be a sign of absence of cardiogenic pulm edem?
Curlings ulcers
P53 mutation; AD
GI tract; mood!
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

34. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Recurrent larygneal
Medial circumflex artery; avascular necrosis
Skin flushing and warmth; prostaglandins; give with aspirin
Enterococci (e. faecalis)- found on genitalia area

35. after a thrombus extraction - what serum enzyme shoots up and why?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Inhibits it
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Serum creatine kinase; reperfusion injury causes necrosis

36. What are the two growth factors associated with angiogenesis?
Initiation - pointing; pincer grasp; walking; mama/dada
Closer to head; closer to diaphragm
FGF and VEGF
Increase lymphatic drainage!

37. sporadic colon cancer tend to arise From what type of polyps?
ZDV or AZT
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Single adenomatous ones
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

38. What actions increase venous return?
Ceftriaxone; azithromycin
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Fibronectin - laminin - collagen
Squatting - sitting - lying supine - passive leg raising

39. What are the first generation anti histamines?
Right before diastole (filling begins)
Vancomycin; histamine mediated
Chlorpheniramine and diphenhydramine
Prevent phagocytosis

40. What causes curlings ulcers?
Prepatellar
transcription activation/suppression
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Downs; regurgitant AV valves - ASDs

41. What is the mainstay treatment for acute mania?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Bronchogenic carcinoma
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
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

42. What is the triad seen in pre eclampsia?
Vagus (auricular branch); vasovagal syncope!
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Hypertension - edema - and proteinuria

43. What test would be best to determine if a gene is being transcribed? translated?
Neisseria induced small cell vasculitis (including hands and soles)
Southern - western
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
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

44. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Ceftriaxone; azithromycin
Susceptible; soluble (unable to be cultured in bile)
Medullary
Hypo or hyper pigmentations; after tanning

45. Would alpha 1 agonists cause flushing? muscarinic antagonist?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
No; yes
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
Diabetic microangiopathy

46. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Increase; decreased
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Prostate tumor and increased osteoclast activity
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

47. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
Phencyclidine (PCP)
Vagus (auricular branch); vasovagal syncope!
When it invades the bm; carcinoma in situ
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

48. within the right ventricle - What are maximum pressures? the pulm arter?
Demargination of neutrophils from the vessel walls
Hypo or hyper pigmentations; after tanning
25; 25
Intussusception

49. are there signs of inflammation in avascular necrosis? then How do you diagnose?
No; MRI
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
G to T in p53; HCC
Vancomycin; histamine mediated

50. 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)
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Duration and extent of disease
200-500

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