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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. sporadic colon cancer tend to arise From what type of polyps?
Brief psychotic disorder; schizophreniform; schizophrenia
Vancomycin
Single adenomatous ones
IgE

2. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
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
DIC; TTP- HUS dont bleed that much

3. What does VIP do to gastric acid secretion?
Inhibits it
Pulmonary hypertension
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
No (unlike adenomyosis); yes

4. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Recurrent larygneal
Measure of depth invasion (vertical!)

5. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Classical conditioning
Class I
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

6. Is there edema in primary Conns? secondary hyperaldosteronism? why?
I is more benign and can present later in adulthood
Drink plenty of fluids
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Ether and other organic solvents

7. PDAs are often asymptomatic. How do you treat?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
indomethacin

8. other than proteinuria - What can cause foamy froathy urine?
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
Bile salt accumulation in urine
Adeno
Spongiosis

9. How can renal blood flow be calculated from RPF?
RBF= PAH clearance/(1- hematocrit)
In ER of bile canaliculi
Turbulence
Hyperkalemia; potassium sparing diuretics - potassium supplements

10. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
Bronchogenic carcinoma
C3 decreased after 5-10 days; sulfonamides
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
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)

11. where are Beta 1 receptors found?
On cardiac tissue and renal juxtaglomerular cells
<1% - 55% - concentration dependent
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
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

12. Acyl coA synthetase is not...
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Increased reticulocytes
P53 mutation; DCC is also required for adenoma to carcinoma
liver specific

13. which two virus families have hemagluttinin on their surface?
P53 mutation; AD
Mean greater than median greater than mode
Hereditary angioedema; ACE inhibitors
Paramyxo and influenza

14. What is contraindicated in toxic mega colon?
SVT; increases vagal tone; rectus abdominis
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Hydrogen bonds dictate alpha or beta structure
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

15. Where is conduction in heart fastest? slowest?
SSRI; erectile dysfunction
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)
Tibial
Purkinje system; AV node

16. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
Sydenham chorea
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
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
RER; RER

17. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
women
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
differentiate
SVC and IVC; right below the aortic knob

18. What is the Na/Ca exchange used for?
Proteasome inhibitor; treatment for MM and waldenstroms
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
To pump calcium out in cardiac myocytes so that relaxation occurs
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

19. What are fenfluramine - phentermine?
Think Hb deformation diseases
NF- KB; responsible for cytokine production
Appetite suppressants
Tibial

20. what dissolves the lipid bilayer of a viral envelope?
RER; RER
Ether and other organic solvents
Tibial
Ig A deficiency

21. What are some side effects seen in TCAs?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
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
TCAs and prazosin
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

22. what commonly happens in GI in response to acute physiologic stress?
Acute gastric mucosal defects (superficial or full thickness)
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
G to T in p53; HCC
Brief psychotic disorder; schizophreniform; schizophrenia

23. Which is faster atrial muscle or ventricular muscle?
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)
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Atrial
Right heart failure

24. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
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)
Rabies encephalitis from cave bats; rabies killed vaccines
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
women

25. how does increased ICP result in curlings ulcers?
Appetite suppressants
Vagus nerve stimulation
glycerol kinase
Smoking

26. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
Medullary
RER; RER
Hydrogen bonds dictate alpha or beta structure
Vagus (auricular branch); vasovagal syncope!

27. 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
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
200-500
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

28. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
NF- KB; responsible for cytokine production
Increase lymphatic drainage!
SVT; increases vagal tone; rectus abdominis
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

29. What is the sole neurologic manifestation of acute rheumatic fever?
Sydenham chorea
Anti centromere; anti DNA topoisomerase
hyponatremia (aldosterone activation equilibrates body volume)
APP on chrom 21 (this is why downs more susceptible)

30. What causes curlings ulcers?
Prostate tumor and increased osteoclast activity
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
LT (LTD4 - E4 - C4) - and Ach
Radial nerve and deep brachial artery

31. What are the first generation anti histamines?
HSV ( also in utero: chlymadia - neisseria - group B strep)
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)
Chlorpheniramine and diphenhydramine
Hypothyroidism

32. what virus causes pharyngoconjuctival fever?
Adeno
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
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
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

33. how does achalasia present? What does barium swallow show on dilated esophagus?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
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
Prostate tumor and increased osteoclast activity

34. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
E. coli; staphylococcus saprophyticus
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Syringomelia
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

35. What type of bond is a disulfide bond?
No; MRI
Turners`
Covalent (between two cysteines)- allows protein to withstand denaturation
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

36. in B12 deficiency - what levels in blood rise very quickly and then drop?
Increase; decreased
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Reticulocytes
Radial nerve damage

37. Where does 90% of serotonin lie? What is this NT responsible?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Large stroke volumes with ventricular contraction; aortic regurg
GI tract; mood!
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

38. What are the primary determinants of colon cancer risk in UC patients
Duration and extent of disease
Dihydropyridine sensitive Ca channels (L type)
Spongiosis
Increases cytokine production

39. What is the precursor protein to beta amyloid and On what chromosome is it found?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
APP on chrom 21 (this is why downs more susceptible)
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
LT (LTD4 - E4 - C4) - and Ach

40. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
Vagus nerve stimulation
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
Curlings ulcers
High potassium conductance and some sodium conductance

41. What is the mutation type in thalassemias? what process is defective because of this?
Serum creatine kinase; reperfusion injury causes necrosis
Nonsense; mRNA processing
Localized dermatologic pain that persists for more than one month after zoster eruption
Common peroneal; bony fractures and compression; sciatic

42. What is a cell surface marker seen in liver angiosarcoma?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
manifestations - congenital (stretching of periventricular pyrimadal fibers)
SS +rNA
46 - 4N; 23 2N

43. What are some of the permissive effects of cortisol?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Drink plenty of fluids
Chorda tympani branch
I is more benign and can present later in adulthood

44. What are the acute effects of corticosteroids on the CBC?
No; yes
Amiloride - spironolactone - triamterene
Gluteus maximus; difficulty getting up from seated position and climbing chair
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

45. What is used to treat heparin toxicity?
Anti centromere; anti DNA topoisomerase
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Protamine sulfate
Trauma to stereociliated hair cells of the organ of corti

46. What is the stabilizing force for the secondary structure of proteins?
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
Hydrogen bonds dictate alpha or beta structure
CMV - HSV 1 - Candida
S. aureus

47. What is easiest way to treat nephrolithiasis?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
High potassium conductance and some sodium conductance
Drink plenty of fluids
Lateral; RV; RA; LV

48. What can long term leg cast wearing cause?
Vascular endothelium; protease
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
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

49. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
Serum FFA and serum triglyceride levels
Protamine sulfate
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
RBF= PAH clearance/(1- hematocrit)

50. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
DIC; TTP- HUS dont bleed that much