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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. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
women
Varying; erythema nodosum is common
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
<1% - 55% - concentration dependent

2. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
No; yes
Because gamma chains replace beta chains and then gamma chain formation wanes
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

3. What is used to treat heparin toxicity?
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Class I
Protamine sulfate
Enterococci (e. faecalis)- found on genitalia area

4. which nerve provides innervation for plantar flexion and inversion?
In the extracellular space for collagen cross linking; zinc
glycerol kinase
Syringomelia
Tibial

5. PDAs are often asymptomatic. How do you treat?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
indomethacin
Headaches and facial flushing; vasodilation in meninges and skin
Turbulence

6. What is a keloid?
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
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Excessive collagen formation during tissue repair in susceptible individuals
Thymic tumor

7. on What part of the clavicle does the SCM attach?
Vascular endothelium; protease
Well
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Medial part

8. What are the two mcc of focal brain lesions in HIV positive patients?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

9. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Selective alpha 1 (increases SVR)
HSV ( also in utero: chlymadia - neisseria - group B strep)
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
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

10. do Class IC agents prolong the QT interval?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
No
Insulin like growth factor 1 (just another name)
Chrom 8

11. What is capacitance inversely proportional to?
Tibial
Elastance
Prepatellar
Anti centromere; anti DNA topoisomerase

12. other than parvo B19 - what else is associated with red cell aplasia?
MAC complex (C5b - C9 complement deficiency)
Thymic tumor
Vancomycin; histamine mediated
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

13. prostaglandin synthesis keeps...
PDA open
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Barium enema
Elevated GGT and macrocytosis

14. What does anti phospholipid syndrome in SLE patients predispose them to?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Multiple miscarriages d/t hypercoaguability
To pump calcium out in cardiac myocytes so that relaxation occurs
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

15. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Covalent (between two cysteines)- allows protein to withstand denaturation
Syringomelia
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

16. What does VIP do to gastric acid secretion?
200-500
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
Excessive collagen formation during tissue repair in susceptible individuals

17. ___________ is liver specific
Prevent phagocytosis
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
glycerol kinase

18. What are pancreatic pseudocysts called pseudo rather than true cysts?
Not lined by epithelium
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Medullary

19. What is pickwickian syndrome? What are the lab findings?
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
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

20. What is achalasia and how would this correlate on the esophageal mannometry?
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
Fibronectin - laminin - collagen
Because of the low output from heart failure - they will have increased aldosterone levels
frameshift mutations (missense is substitution)

21. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
Inhaled animal dander allergens
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Hexokinase

22. What is mcc of death pre hospital phase of MI? in hospital phase?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Vagus nerve stimulation
V fib; v. failure
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

23. What is omalizumab and What is it used for?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Protamine sulfate
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

24. what drug is useful for secretory diarrhea?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
GI tract; mood!
ZDV or AZT
Octreotide

25. what phase do adenosine and acetylcholine act on? doing what?
As a CO2 carrier with the carboxylase enzyme
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Because of the low output from heart failure - they will have increased aldosterone levels
Tibial

26. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
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
CMV - HSV 1 - Candida
OCPs - multiparity - breast feeding
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)

27. What is used to prevent vertical transmission of HIV?
ZDV or AZT
No (unlike adenomyosis); yes
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Hexokinase

28. in the LV and aorta - What are the pressures?
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)
Normally close to systolic
women
Chorda tympani branch

29. What type of mutation does aflatoxin cause? what cancer does this increase for?
Fibronectin - laminin - collagen
G to T in p53; HCC
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
Syringomelia

30. what bursa is affected when on knees like a maid/gardner?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Around 70 (normal measured diastolic pressures); 9--
Prepatellar
Fibronectin - laminin - collagen

31. there are mucus secreting cells in the bronchioles...
Smoking
only up to bronchi
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Purkinje system; AV node

32. What can cause aortic regurg? What is the heart sound you hear?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Drug induced interstitial nephritis

33. What does 'oxygen' content in blood refer to?
Tzanck smear
Drink plenty of fluids
Dissolved in plasma and attached to Hgb
Well

34. What is the mc malignancy in asbestosis?
Tzanck smear
Bronchogenic carcinoma
Spongiosis
Relfex tachycardia; giving beta blockers

35. which viruses require a protease?
HSV ( also in utero: chlymadia - neisseria - group B strep)
Leukotriene precursor and does neutrophil chemotaxis
Right heart failure
SS +rNA

36. What pulmonary structural change can kartageners syndrome cause?
Increase lymphatic drainage!
Common peroneal; bony fractures and compression; sciatic
Right before diastole (filling begins)
Bronchial dilation (bronchiectasis)

37. a patient fearing all white coats is a phenomenon of what?
Classical conditioning
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
PDA open
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

38. within the right atrium - What is the maximum pressure? left atrium?
8; 12
Radial nerve and deep brachial artery
<1% - 55% - concentration dependent
On cardiac tissue and renal juxtaglomerular cells

39. what drugs causes the red man syndrome? how does it occur?
On cardiac tissue and renal juxtaglomerular cells
Vancomycin; histamine mediated
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Joints d/t increased purine production and thus uric acid production

40. Where does complement bind on the Fc region of Ig chains?
The term used to describe decreased drug responsiveness with repeated administration
Vagus nerve stimulation
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
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

41. How do you calculate excretion rate of a substance? How do you calculate the filtration rate of a substance? clearance of what substance estimates the GFR?
Hypertension - edema - and proteinuria
Excessive collagen formation during tissue repair in susceptible individuals
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
MAC complex (C5b - C9 complement deficiency)

42. what hormone is structurally similar to hCG?
Underestimation of gestational age
TSh (in testicular tumors can cause hyperthyroidism)
P450 mitochondrial monooxygenase
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

43. What is capsaicin? Where does it work?
Gluteus medius and minimus; positive trendelenberg
High potassium conductance and some sodium conductance
Pain reliever - reduces pain by locking substance P in the PNS
Multiple miscarriages d/t hypercoaguability

44. What is the mcc of elevated AFP leves in pregnancy>
Medullary
Underestimation of gestational age
HSV and VZV
Aromatase deficiency in child

45. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
SS +rNA
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Octreotide

46. In what form are mitochondrial DNA? What do they transcribe?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Circular - outside nucleus; transport proteins - rRNA - tRNA
SSRI; erectile dysfunction
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

47. what diseases can vit A be used to treat?
Amiadarone
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Strength of cell mediated immune response
Measles and M3 AML`

48. which trisomy is associated with endocardial cushion defects? What does thsi mean>
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Downs; regurgitant AV valves - ASDs
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin

49. what indicates the severity of a mitral regurg ? mitral stenosis?
Insulin like growth factor 1 (just another name)
Nocardia
Squatting - sitting - lying supine - passive leg raising
S3 gallop; S2 to opening snap interval

50. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
Vancomycin
Sydenham chorea
Intussusception
Nonsense; mRNA processing