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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 can chronic vit A toxicity cause?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Primary
Because of vasodiation to skeletal muscles
Syncope - angina - dyspnea (SAD)

2. What is the most common initital symptom of ADPKD? what else?
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Hereditary angioedema; ACE inhibitors
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

3. hypertonicity and hyperreflexity are ________________ of hydrocephalus
Sydenham chorea
Sarcoid
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

4. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
SSRI
Hypothyroidism
Kallmans
Primary

5. What are two common side effects of both acute and long acting nitrates? What causes them?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Headaches and facial flushing; vasodilation in meninges and skin
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin

6. 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
4 - 4 - 9
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

7. Which is faster purkinje system or atrial muscle?
Close but purkinje system to ensure contraction in a bottom up fashion
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
4 - 4 - 9

8. Where is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Because of vasodiation to skeletal muscles
Increase; decreased
Congenital hypothyroidism - downs - amyloidosis - acromegaly

9. What can too much IgA in serum produces?
TCAs and prazosin
Amiadarone
Drug induced interstitial nephritis
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

10. What type of disease has selective proteinuria? What is found in urine? What is not?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Turners`
Sudden loss of muscle tone without loss of consciousness; narcolepsy
On cardiac tissue and renal juxtaglomerular cells

11. what has the greatest effect on prognosis when treating c. diptheriae?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Faulty positioning of the genital tubercle
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

12. which two drug types can cause orthostatic hypotension (think depression and BPH)?
ZDV or AZT
TCAs and prazosin
Because gamma chains replace beta chains and then gamma chain formation wanes
Circular - outside nucleus; transport proteins - rRNA - tRNA

13. what protein is increased in Crohns disease? What does it do?
NF- KB; responsible for cytokine production
C3 decreased after 5-10 days; sulfonamides
RR-1/RR
Southern - western

14. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
HSV ( also in utero: chlymadia - neisseria - group B strep)

15. What is normal fibrinogen levels?
200-500
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
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)
Chrom 8

16. SIADH patients have normal blood volume but...
No and yes
hyponatremia (aldosterone activation equilibrates body volume)
Well
Smoking

17. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Increases
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)
Skin flushing and warmth; prostaglandins; give with aspirin

18. What is the cause of fixed splitting of S2? why?
Pulmonary hypertension
Normally close to systolic
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Adductor

19. What is a cord factor and Which bugs have it? How do they appear on culture?
Amiloride - spironolactone - triamterene
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Inhaled animal dander allergens
Boiling - bleach - formalin - UV irradiation

20. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Trauma to stereociliated hair cells of the organ of corti
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics

21. What antibodies are present in CREST? What is the most specific?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Dihydropyridine sensitive Ca channels (L type)
Adductor
Anti centromere; anti DNA topoisomerase

22. What is achalasia and how would this correlate on the esophageal mannometry?
Think Hb deformation diseases
Smoking
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
only up to bronchi

23. What is difference between Arnold Chiari type I and II?
...
Nonsense; mRNA processing
I is more benign and can present later in adulthood
Recurrent larygneal

24. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
TCAs and prazosin
Reiter syndrome; B27
No and yes
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

25. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Phencyclidine (PCP)
Not lined by epithelium
Syncope - angina - dyspnea (SAD)
Nocardia

26. What is it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
11
4 - 4 - 9
Vertical diplopia
Thymic tumor

27. why does liver dysfunction cause coagulation disorders?
E. coli
Think Hb deformation diseases
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Coagulation factors are made in the liver

28. what immune deficiency causes recurrent neisseria infections?
Demargination of neutrophils from the vessel walls
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
MAC complex (C5b - C9 complement deficiency)
Turbulence

29. What does the severity of leprosy depend on?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Highly negative resting potential
Skin flushing and warmth; prostaglandins; give with aspirin
Strength of cell mediated immune response

30. What is used to compare means? categorical outcomes?
T test; chi squared
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
Adeno
By vascular permeability and vasodilation

31. What is the neurologic manifestation of ADPKD?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Downs; regurgitant AV valves - ASDs
Anti - apoptotic (prevents going into apoptosis)- 18; 14

32. What are diastolic (lowest) pressures in aorta? LV?
Brief psychotic disorder; schizophreniform; schizophrenia
Around 70 (normal measured diastolic pressures); 9--
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

33. why are pregnant predisposed to cholelithiasis?
Standing suddenly from supine position; valsalva maneuver
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
DIC; TTP- HUS dont bleed that much
P53 mutation; DCC is also required for adenoma to carcinoma

34. what makes bruits?
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
Turbulence
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac

35. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Turners`
Become beta pleated and then form neurofibrillary tangle!
Sudden loss of muscle tone without loss of consciousness; narcolepsy
FGF and VEGF

36. What is the mcc of elevated AFP leves in pregnancy>
T test; chi squared
Underestimation of gestational age
Diabetic microangiopathy
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

37. What does VIP do to gastric acid secretion?
Inhibits it
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Underestimation of gestational age
Ether and other organic solvents

38. When is an S4 sound normal?
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
Primary
Well trained athletes and children
Spongiosis

39. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
When it invades the bm; carcinoma in situ
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Increases
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

40. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
Pulmonary hypertension
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
C3 decreased after 5-10 days; sulfonamides
Trauma to stereociliated hair cells of the organ of corti

41. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
Neisseria induced small cell vasculitis (including hands and soles)
CGD; t cell dysfxn (diGeorge)
RBC mass; epo levels (secondary has high)
Aromatase deficiency in child

42. What type of calcium channels dictate the plateau in cardiac myocyte?
Raphe
Dihydropyridine sensitive Ca channels (L type)
The term used to describe decreased drug responsiveness with repeated administration
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

43. What is the difference between paranoid personality disorder and delusional disorder?
Little effect on cell and no change
differentiate
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

44. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
(urine PAH x urine flow rate)/plasma PAH
Reiter syndrome; B27
Underestimation of gestational age
Around 70 (normal measured diastolic pressures); 9--

45. What is the diagnosis in delayed puberty plus anosmia?
Radial nerve damage
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
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
Kallmans

46. What does protein M do in Group A strep<
SaO2 <92%
Chorda tympani branch
Prevent phagocytosis
Drug induced interstitial nephritis

47. What is contraindicated in toxic mega colon?
Env genes (for getting into target cells)
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
8 (myc protein) with 2 - 14 - 22 (iG chains)
Abnormal closing of the urethral folds

48. What agonists reduce the gradient across the LV outflow tract?
GI tract; mood!
low in serum
Selective alpha 1 (increases SVR)
High potassium conductance and some sodium conductance

49. other than parvo B19 - what else is associated with red cell aplasia?
APP on chrom 21 (this is why downs more susceptible)
Thymic tumor
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
Become beta pleated and then form neurofibrillary tangle!

50. how much percent of sodium is excreted? urea? glucose?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G 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
E. coli; staphylococcus saprophyticus
<1% - 55% - concentration dependent