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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. why does neutrophila occur with corticosteroids?
Drink plenty of fluids
Demargination of neutrophils from the vessel walls
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Ceftriaxone; azithromycin

2. In what population does cholelithiasis occur?
Little effect on cell and no change
Fat - fertile - forty - female
OCPs - multiparity - breast feeding
Atrial

3. What is the triad seen in pre eclampsia?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Hypertension - edema - and proteinuria
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)
To pump calcium out in cardiac myocytes so that relaxation occurs

4. What causes curlings ulcers?
Inhaled animal dander allergens
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

5. What are pancreatic pseudocysts called pseudo rather than true cysts?
Not lined by epithelium
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
As a CO2 carrier with the carboxylase enzyme
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

6. What are the first generation anti histamines?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Highly negative resting potential
Vascular endothelium; protease
Chlorpheniramine and diphenhydramine

7. What are fenfluramine - phentermine?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Strength of cell mediated immune response
TCAs and prazosin
Appetite suppressants

8. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Headaches and facial flushing; vasodilation in meninges and skin
Tibial
Increases
Increased reticulocytes

9. which two virus families have hemagluttinin on their surface?
Paramyxo and influenza
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

10. do Class IC agents prolong the QT interval?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
No
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
HSV and VZV

11. when do ghon complexes form - primary or secondary TB?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Syringomelia
Primary
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

12. What does prolonged PT indicated? aPTT? bleeding time?
Biphosphonate
Extrinsic def; instrinsic def; platelet def
Measure of depth invasion (vertical!)
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

13. What is difference between Arnold Chiari type I and II?
Skin flushing and warmth; prostaglandins; give with aspirin
I is more benign and can present later in adulthood
Duration and extent of disease
low in serum

14. other than in pyelonephritis - where else are WBC casts seen?
LT (LTD4 - E4 - C4) - and Ach
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
OCPs - multiparity - breast feeding
Acute interstitial nephritis

15. What type of mutation does aflatoxin cause? what cancer does this increase for?
G to T in p53; HCC
Chorda tympani branch
SaO2 <92%
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

16. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
glycerol kinase
ANCA because of lack of Ig and C3 deposits on IF
Rabies encephalitis from cave bats; rabies killed vaccines

17. What actions increase venous return?
indomethacin
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)
Paramyxo and influenza
Squatting - sitting - lying supine - passive leg raising

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

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19. which nerve provides innervation for plantar flexion and inversion?
P53 mutation; AD
Tibial
Turbulence
Nocardia

20. which cells produce surfactant? which ones mediate gas exchange?
only up to bronchi
Inhaled animal dander allergens
Squatting - sitting - lying supine - passive leg raising
II; I (I more abundant)

21. what drug is useful for secretory diarrhea?
Octreotide
Trauma to stereociliated hair cells of the organ of corti
transcription activation/suppression
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)

22. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Medial circumflex artery; avascular necrosis
Neisseria induced small cell vasculitis (including hands and soles)
Bronchial dilation (bronchiectasis)
Pan colitis and right sided colitis (more than left sided and proctitis)

23. which staphylococci can do mannitol fermaentation?
Normally close to systolic
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
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)
S. aureus

24. When is an S4 sound normal?
E. coli; staphylococcus saprophyticus
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Well trained athletes and children
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

25. what enzyme converts procarcinogens into carcinogens?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Fibrosis; macrophages
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
P450 mitochondrial monooxygenase

26. What is the most common cause of pyelonephritis in both adults and childre?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Regular insulin (Not fast acting - regular better)
Downs; regurgitant AV valves - ASDs
E. coli

27. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
8 (myc protein) with 2 - 14 - 22 (iG chains)
No (unlike adenomyosis); yes
only up to bronchi
Sickle cell; G6PD

28. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Hyperkalemia; potassium sparing diuretics - potassium supplements
Chorda tympani branch
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
P450 mitochondrial monooxygenase

29. what kind of drug is sertraline? What is a common side effect?
Anti centromere; anti DNA topoisomerase
Elevated GGT and macrocytosis
11
SSRI; erectile dysfunction

30. What does p53 do? what chrom is it on?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Not lined by epithelium
Ketone body production by preventing fatty acids into the mitochondria
Ether and other organic solvents

31. What is Tzanck smear used to detect?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Phencyclidine (PCP)
HSV and VZV
Apocrine; eccrine

32. 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?
ATP binding (resets the myosin head to contract again for next binding)
Superior larygeal; cricothyroid; recurrent laryngeal
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
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

33. What is omalizumab and What is it used for?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Rabies encephalitis from cave bats; rabies killed vaccines
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

34. What can long term leg cast wearing cause?
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
Purkinje system; AV node
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
RER; copper

35. Where does complement bind on the Fc region of Ig chains?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Trauma to stereociliated hair cells of the organ of corti
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Sydenham chorea

36. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
E. coli
Increase; decreased

37. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
By vascular permeability and vasodilation
Skin flushing and warmth; prostaglandins; give with aspirin
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

38. What is hyaline arteriosclerosis usually a sign of ?
<1% - 55% - concentration dependent
Diabetic microangiopathy
C3 decreased after 5-10 days; sulfonamides
Primary

39. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Increase in permeability of two ions with equal and opposite equilibrium potentials
Not lined by epithelium
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

40. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
Reticulocytes
Prostate tumor and increased osteoclast activity
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Single adenomatous ones

41. what hormone is structurally similar to hCG?
Ceftriaxone; azithromycin
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
TSh (in testicular tumors can cause hyperthyroidism)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

42. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
Curlings ulcers
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
RBC mass; epo levels (secondary has high)
Headaches and facial flushing; vasodilation in meninges and skin

43. what nerve and artery course along the posterior aspect of the humerus?
In the extracellular space for collagen cross linking; zinc
Radial nerve and deep brachial artery
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)
No; MRI

44. How can renal blood flow be calculated from RPF?
RBF= PAH clearance/(1- hematocrit)
Increases cytokine production
Measure of depth invasion (vertical!)
Hexokinase

45. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Superior larygeal; cricothyroid; recurrent laryngeal
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Leukotriene precursor and does neutrophil chemotaxis
Normally close to systolic

46. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Protamine sulfate
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Hypo or hyper pigmentations; after tanning
Radial nerve and deep brachial artery

47. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
only up to bronchi
Headaches and facial flushing; vasodilation in meninges and skin
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

48. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
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)
ANCA because of lack of Ig and C3 deposits on IF
Around 70 (normal measured diastolic pressures); 9--

49. IL4 is used for isotypye switching to what?
Hexokinase
Increased reticulocytes
IgE
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

50. What is the cause of rapid plasma decay of thiopental?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
low in serum
Regular insulin (Not fast acting - regular better)
Tissue redistribution (out of plasma) rather than metabolism