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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 is the best indicator for the severity of mitral stenosis?
low in serum
OCPs - multiparity - breast feeding
The time interval between S2 and OS- the shorter the interval - the more intense
Purkinje system; AV node

2. Where does 90% of serotonin lie? What is this NT responsible?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
S. aureus
GI tract; mood!
I is more benign and can present later in adulthood

3. What actions increase venous return?
Squatting - sitting - lying supine - passive leg raising
When it invades the bm; carcinoma in situ
HSV and VZV
Nocardia

4. What type of disease has selective proteinuria? What is found in urine? What is not?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
NF- KB; responsible for cytokine production
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
SaO2 <92%

5. what hernia has a similar mechanism to hydrocele?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
AV node slowest - to allow time for diastole
Anti cholinergic effects of pupil dilation and lack of accomodation

6. What is difference between Arnold Chiari type I and II?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Increases
Inactivates kallikrein which activates kininogen into bradykinin
I is more benign and can present later in adulthood

7. What are the two growth factors associated with angiogenesis?
FGF and VEGF
Skin flushing and warmth; prostaglandins; give with aspirin
Because of vasodiation to skeletal muscles
Spongiosis

8. 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
Normal; low
MAO inhibitors; wine and cheese
Thymic tumor

9. What translocations can cause c - myc overexpression?
8 (myc protein) with 2 - 14 - 22 (iG chains)
transcription activation/suppression
Class I
Octreotide

10. how does increased ICP result in curlings ulcers?
Headaches and facial flushing; vasodilation in meninges and skin
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
ZDV or AZT
Vagus nerve stimulation

11. how does achalasia present? What does barium swallow show on dilated esophagus?
Vagus (auricular branch); vasovagal syncope!
MAC complex (C5b - C9 complement deficiency)
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Standing suddenly from supine position; valsalva maneuver

12. What is diagnostic (and possible therapeutic for intussusception)?
Barium enema
PDA open
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Acute interstitial nephritis

13. what happens with LDL receptor density in statin therapy?
Increases
Ig A deficiency
Hypothyroidism
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

14. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Terminal bronchioles; small bronchi
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Fat - fertile - forty - female
differentiate

15. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
No and yes
P53 mutation; DCC is also required for adenoma to carcinoma
Elevated GGT and macrocytosis
Intussusception

16. In what view of CXR is anterior part of heart best seen? anterior part of heart is formed by?right border of heart is formed by? left border?
Rare complication of measles (years later)- thought to be d/t certain type that doesnt have surface M protein antigen so goes unseen into CNS
Lateral; RV; RA; LV
Enterococci (e. faecalis)- found on genitalia area
Octreotide

17. what commonly happens in GI in response to acute physiologic stress?
differentiate
Acute gastric mucosal defects (superficial or full thickness)
By vascular permeability and vasodilation
Squatting - sitting - lying supine - passive leg raising

18. What is gardeners mydriasis? How is it treated?
Boiling - bleach - formalin - UV irradiation
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Reticulocytes
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

19. What does nitroprusside do to afterload? preload?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Mean greater than median greater than mode
Decreases both

20. What does protein M do in Group A strep<
Prevent phagocytosis
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
On cardiac tissue and renal juxtaglomerular cells
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

21. What are the first generation anti histamines?
Chlorpheniramine and diphenhydramine
Southern - western
Hypo or hyper pigmentations; after tanning
Strength of cell mediated immune response

22. What is the most common location of colonization of all s. aureus types?
Anterior nares
Selective alpha 1 (increases SVR)
Pulmonary hypertension
On cardiac tissue and renal juxtaglomerular cells

23. SIADH patients have normal blood volume but...
CGD; t cell dysfxn (diGeorge)
hyponatremia (aldosterone activation equilibrates body volume)
MAC complex (C5b - C9 complement deficiency)
only up to bronchi

24. What causes curlings ulcers?
Another type of aldosterone antagonist (like spironolactone)
Increase lymphatic drainage!
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

25. which RPGN is also called pauci immune GN? why?
Apocrine; eccrine
(urine PAH x urine flow rate)/plasma PAH
ANCA because of lack of Ig and C3 deposits on IF
Anterior circumflex (and axillary nerve)

26. what should you think of in 'smear of an oral ulcer base'?
Right before diastole (filling begins)
P53 mutation; DCC is also required for adenoma to carcinoma
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Tzanck smear

27. What is the most common cause of pyelonephritis in both adults and childre?
E. coli
RER; RER
Neisseria induced small cell vasculitis (including hands and soles)
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)

28. what color pigmentations are caused by malassezia furfur? when do they become more visible?
P53 mutation; AD
S. aureus
Hypo or hyper pigmentations; after tanning
Anti centromere; anti DNA topoisomerase

29. non ceruloplasmin deposition - ceruloplasmin is...
PDA open
Acute interstitial nephritis
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
low in serum

30. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Increases
Downs; regurgitant AV valves - ASDs
ANCA because of lack of Ig and C3 deposits on IF
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

31. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
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
TCAs and prazosin
Become beta pleated and then form neurofibrillary tangle!
Circular - outside nucleus; transport proteins - rRNA - tRNA

32. where are Beta 1 receptors found?
On cardiac tissue and renal juxtaglomerular cells
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
The term used to describe decreased drug responsiveness with repeated administration
Adeno

33. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
Neisseria induced small cell vasculitis (including hands and soles)
Curlings ulcers
Hexokinase
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

34. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Tibial
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

35. where are the two classical places that the ulnar nerve can be injured?

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36. why does variocele occur more in left side?
Bile soluble which means they are bile sensitive
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Vertical diplopia
Amiadarone

37. What are the potassium sparing diuretics?
Proteasome inhibitor; treatment for MM and waldenstroms
Amiloride - spironolactone - triamterene
Varying; erythema nodosum is common
APP on chrom 21 (this is why downs more susceptible)

38. What are the skin presentation in sarcoid?
II; I (I more abundant)
Pulmonic and systemic!
Varying; erythema nodosum is common
hyponatremia (aldosterone activation equilibrates body volume)

39. What causes vertical diplopia? horizontal?
ATP binding (resets the myosin head to contract again for next binding)
SaO2 <92%
Trochlear nerve (IV); abducens nerve (VI)
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

40. where are the vegetations on the valves of a libman sacks endocarditis?
Hyperkalemia; potassium sparing diuretics - potassium supplements
Both sides
Serum creatine kinase; reperfusion injury causes necrosis
chronic urticaria and allergic symptoms

41. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Amiadarone
Neisseria induced small cell vasculitis (including hands and soles)
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
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

42. What are the primary determinants of colon cancer risk in UC patients
Protamine sulfate
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Pulmonary hypertension
Duration and extent of disease

43. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Susceptible; soluble (unable to be cultured in bile)
Adductor
Pulmonic and systemic!
SVT; increases vagal tone; rectus abdominis

44. Where is the base of the heart? apex?
Well
Acute interstitial nephritis
indomethacin
Closer to head; closer to diaphragm

45. What are the acute effects of corticosteroids on the CBC?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
When it invades the bm; carcinoma in situ
No; MRI

46. What is the mc location of brain germinomas?What are the classic symptoms?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
No (unlike adenomyosis); yes
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Tissue redistribution (out of plasma) rather than metabolism

47. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
Regular insulin (Not fast acting - regular better)
Abnormal closing of the urethral folds
C3 decreased after 5-10 days; sulfonamides
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

48. What is 5- HETE and What does it do?
Leukotriene precursor and does neutrophil chemotaxis
T test; chi squared
Ether and other organic solvents
Bronchogenic carcinoma

49. What is the cause of rapid plasma decay of thiopental?
Right before diastole (filling begins)
Phencyclidine (PCP)
Tissue redistribution (out of plasma) rather than metabolism
Headaches and facial flushing; vasodilation in meninges and skin

50. What almost exclusively causes Epliglottitis?What type of capsule does it have? What are the symptoms?

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USMLE Prep 2

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