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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 are pancreatic pseudocysts called pseudo rather than true cysts?
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
S. saprophyticus - and s. epidermidis; novobiocin
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)
Not lined by epithelium

2. What is the precursor protein to beta amyloid and On what chromosome is it found?
Vagus (auricular branch); vasovagal syncope!
Multiple miscarriages d/t hypercoaguability
APP on chrom 21 (this is why downs more susceptible)
Pan colitis and right sided colitis (more than left sided and proctitis)

3. What is capsaicin? Where does it work?
Pain reliever - reduces pain by locking substance P in the PNS
No; MRI
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

4. What type of vision is myopia? In What type of patients does it improve?
No
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
facultative intracellular

5. What are the three dopaminergic systems and What are they responsible for? disease?
Prevents hepatic VLDL production
P53 mutation; AD
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
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

6. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Medial circumflex artery; avascular necrosis
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac

7. What can worse neurologic dysfunction in cobalamic def?
Highly negative resting potential
Valproate
Circular - outside nucleus; transport proteins - rRNA - tRNA
Folic acid treatment!

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

9. What is the mc malignancy in asbestosis?
Bronchogenic carcinoma
Hyperkalemia; potassium sparing diuretics - potassium supplements
Ether and other organic solvents
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

10. What are the two growth factors associated with angiogenesis?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
FGF and VEGF
Acute gastric mucosal defects (superficial or full thickness)
P53 mutation; AD

11. other than mycobacterim wha other bacteria is acid fast?
(urine PAH x urine flow rate)/plasma PAH
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Close but purkinje system to ensure contraction in a bottom up fashion
Nocardia

12. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Normally close to systolic
Sickle cell; G6PD
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase

13. Would alpha 1 agonists cause flushing? muscarinic antagonist?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
P53 mutation; AD
Hyperkalemia; potassium sparing diuretics - potassium supplements
No; yes

14. what organ would an activating mutation in PRPP synthetase effect?
Apocrine; eccrine
Inhaled animal dander allergens
Because ACE blocks breakdown of bradykinin and hereditary angioedema patients have high levels of bradykinin; high levels of bradykinin - C3a - and C5a mediate edema by increasing vascular permeability and vasodilation
Joints d/t increased purine production and thus uric acid production

15. what diseases can vit A be used to treat?
Right heart failure
Selective alpha 1 (increases SVR)
Single adenomatous ones
Measles and M3 AML`

16. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
Drink plenty of fluids
Chrom 8
When it invades the bm; carcinoma in situ
E. coli

17. What is medullary sponge kidney disease and how does it present? What does it lead to?
Common and benign congenital disorder characterized by cystic dilation of the medullary collecting ducts (cortex is spared); painless hematuria or asymptomatic; mc is development of kidney stones (benign disease)
S3 gallop; S2 to opening snap interval
Southern - western
IgE

18. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Atrial
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
gram positive organisms
Aromatase deficiency in child

19. do patients with cor pulmonale have increased or decreased levels of aldosterone?
Because of the low output from heart failure - they will have increased aldosterone levels
High potassium conductance and some sodium conductance
women
Boiling - bleach - formalin - UV irradiation

20. what clinical findings help distinguish small cell carcinoma?
Minimal change disease
Myasthenia gravis
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Congenital hypothyroidism - downs - amyloidosis - acromegaly

21. what nerve and artery course along the posterior aspect of the humerus?
Radial nerve and deep brachial artery
S. aureus
HSV ( also in utero: chlymadia - neisseria - group B strep)
Vascular endothelium; protease

22. When is an S4 sound normal?
Closer to head; closer to diaphragm
Class I
Well trained athletes and children
Apocrine; eccrine

23. What does VIP do to gastric acid secretion?
Inhibits it
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
As a CO2 carrier with the carboxylase enzyme
Medial part

24. which antiarrythmic is associated with blue gray discoloration ?
FGF and VEGF
Amiadarone
RBF= PAH clearance/(1- hematocrit)
The time interval between S2 and OS- the shorter the interval - the more intense

25. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Highly negative resting potential
Minimal change disease
Headaches and facial flushing; vasodilation in meninges and skin

26. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Increase lymphatic drainage!
Multiple miscarriages d/t hypercoaguability
Turbulence

27. what drugs causes the red man syndrome? how does it occur?
Become beta pleated and then form neurofibrillary tangle!
Vancomycin; histamine mediated
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

28. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
P53 mutation; AD
25; 25
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
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

29. What causes curlings ulcers?
Gluteus maximus; difficulty getting up from seated position and climbing chair
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
Neisseria induced small cell vasculitis (including hands and soles)

30. How do left sided colon adenocarcinomas present? right sided?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Right heart failure
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
Syringomelia

31. in B12 deficiency - what levels in blood rise very quickly and then drop?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Ether and other organic solvents
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Reticulocytes

32. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Trochlear nerve (IV); abducens nerve (VI)
Vagus (auricular branch); vasovagal syncope!
E. coli

33. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Think Hb deformation diseases
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Anti - apoptotic (prevents going into apoptosis)- 18; 14

34. What is contraindicated in toxic mega colon?
Close but purkinje system to ensure contraction in a bottom up fashion
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
ZDV or AZT
IgE

35. What is congestive hepatomegaly specific for?
46 - 4N; 23 2N
Right heart failure
Multiple miscarriages d/t hypercoaguability
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

36. when arrested in prophase of meiosis I - What are primary oocytes chrom number? What about the secondary oocytes that are stuck in metaphase of Meiosis II?
11 aa polypeptide; pain NT in CNS and PNS
46 - 4N; 23 2N
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

37. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
Right heart failure
Common peroneal; bony fractures and compression; sciatic
OCPs - multiparity - breast feeding
Not lined by epithelium

38. What does nitroprusside do to afterload? preload?
DIC; TTP- HUS dont bleed that much
Neisseria induced small cell vasculitis (including hands and soles)
Trochlear nerve (IV); abducens nerve (VI)
Decreases both

39. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
Squatting - sitting - lying supine - passive leg raising
E. coli
Ig A deficiency
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

40. How do you calculate RPF from urine PAH?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
(urine PAH x urine flow rate)/plasma PAH
No and yes
Downs; regurgitant AV valves - ASDs

41. What is subacute sclerosisng encephalitis caused by?
Paramyxo and influenza
Bile soluble which means they are bile sensitive
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
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

42. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
Bronchogenic carcinoma
women
Adductor
Biphosphonate

43. What are the first generation anti histamines?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Intussusception
Chlorpheniramine and diphenhydramine

44. Where does conjugation of bilirubin take place?
In ER of bile canaliculi
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
No; yes
Recurrent larygneal

45. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Chorda tympani branch
RBC mass; epo levels (secondary has high)
11
<1% - 55% - concentration dependent

46. What are two indicators of chronic alcohol consumption?
Elevated GGT and macrocytosis
Joints d/t increased purine production and thus uric acid production
AV node slowest - to allow time for diastole
P450 mitochondrial monooxygenase

47. within the right ventricle - What are maximum pressures? the pulm arter?
25; 25
...
No; yes
differentiate

48. What is hypospadias caused by?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Abnormal closing of the urethral folds
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
G to T in p53; HCC

49. What is best to prevent GBS infection in a baby?
200-500
Coagulation factors are made in the liver
Curlings ulcers
INTRApartum Abs (ampicillin/penicillin)

50. when do ghon complexes form - primary or secondary TB?
Primary
Radial nerve and deep brachial artery
Ketone body production by preventing fatty acids into the mitochondria
No (unlike adenomyosis); yes