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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 does anti phospholipid syndrome in SLE patients predispose them to?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Multiple miscarriages d/t hypercoaguability

2. which type of glands produce an initially odorless secretion but can become malodorous secondary to bacterial decompisition on the skin surface? which glands are present throughout the skin except on lips and glans penis?
Apocrine; eccrine
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
SS +rNA
RBC mass; epo levels (secondary has high)

3. IL4 is used for isotypye switching to what?
<1% - 55% - concentration dependent
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
IgE
S3 gallop; S2 to opening snap interval

4. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Medullary
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
ANCA because of lack of Ig and C3 deposits on IF

5. What are three symptoms in s.typhi?
CGD; t cell dysfxn (diGeorge)
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
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
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

6. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
Curlings ulcers
Kallmans
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Increases cytokine production

7. what induces bronchial squamous metaplasia?
46 - 4N; 23 2N
Myasthenia gravis
Smoking
II; I (I more abundant)

8. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
No; MRI
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Syringomelia
Elevated GGT and macrocytosis

9. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Echinococcus granulosus; anaphylaxis
SS +rNA
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
I is more benign and can present later in adulthood

10. what bursa is affected when on knees like a maid/gardner?
SaO2 <92%
Prepatellar
CGD; t cell dysfxn (diGeorge)
Appetite suppressants

11. What is damaged in early syringomelia? later?
low in serum
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

12. What is easiest way to treat nephrolithiasis?
Drink plenty of fluids
indomethacin
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Increases bronchial and vascular smooth muscle reactivity to catecholamines

13. What is the presentation of sever aortic stenosis?
Syncope - angina - dyspnea (SAD)
Another type of aldosterone antagonist (like spironolactone)
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Terminal bronchioles; small bronchi

14. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Rabies encephalitis from cave bats; rabies killed vaccines
Susceptible; soluble (unable to be cultured in bile)
When it invades the bm; carcinoma in situ
FGF and VEGF

15. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

16. which nerve in the lower leg is easily injured and causes foot drop ? What are common causes? From what nerve does it branch off or?
Recurrent larygneal
Barium enema
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Common peroneal; bony fractures and compression; sciatic

17. What are the three predominant symptoms of VHL? What is its mode of inheritance?
46 - 4N; 23 2N
glycerol kinase
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

18. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Southern - western
low in serum
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

19. How do bradykinin - C3a and C5a cause edema?
By vascular permeability and vasodilation
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Bile soluble which means they are bile sensitive
Paramyxo and influenza

20. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
Classical conditioning
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
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)
Fibrosis; macrophages

21. What can cause aortic regurg? What is the heart sound you hear?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
P450 mitochondrial monooxygenase
Tibial
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

22. at three years of age What are social - fine motor - gross motor and language developments?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

23. Where is aromatase used?
Boiling - bleach - formalin - UV irradiation
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Duration and extent of disease

24. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
HSV and VZV
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Sudden loss of muscle tone without loss of consciousness; narcolepsy

25. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Increase; decreased
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Elastance
Closer to head; closer to diaphragm

26. What can cause virilization of a mother during pregnancy?
Turners`
Trauma to stereociliated hair cells of the organ of corti
Acute interstitial nephritis
Aromatase deficiency in child

27. What is subacute sclerosisng encephalitis caused by?
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
Brief psychotic disorder; schizophreniform; schizophrenia
Coagulation factors are made in the liver
200-500

28. What are the primary determinants of colon cancer risk in UC patients
Class I
Adductor
Gluteus maximus; difficulty getting up from seated position and climbing chair
Duration and extent of disease

29. at four years of age - What are the social - fine motor - gross motor - and language developments?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Medial part
Superior larygeal; cricothyroid; recurrent laryngeal
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

30. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
RBC mass; epo levels (secondary has high)
200-500
(urine PAH x urine flow rate)/plasma PAH

31. What is the mc location for avascular necrosis? What is it associated with?
Ceftriaxone; azithromycin
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Kallmans
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

32. What is the primary histologic finding in patients with eczematous dermatitis?
Spongiosis
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Both sides

33. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Skin flushing and warmth; prostaglandins; give with aspirin
Gluteus medius and minimus; positive trendelenberg
Both sides
Intussusception

34. What is used to prevent vertical transmission of HIV?
ZDV or AZT
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Nonsense; mRNA processing
GI malignancies and Insulin resistance (acromegal for ex)

35. How is dobutamine better than dopamine?
Hexokinase
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Sydenham chorea
Covalent (between two cysteines)- allows protein to withstand denaturation

36. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Terminal bronchioles; small bronchi
Strength of cell mediated immune response
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

37. what happens with LDL receptor density in statin therapy?
GI malignancies and Insulin resistance (acromegal for ex)
Increases
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Circular - outside nucleus; transport proteins - rRNA - tRNA

38. Which is faster purkinje system or atrial muscle?
Insulin like growth factor 1 (just another name)
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Close but purkinje system to ensure contraction in a bottom up fashion
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

39. What is the most important prognostic indicator in patients with malignant melanoma?
Measure of depth invasion (vertical!)
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
IgE
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

40. Acyl coA synthetase is not...
liver specific
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)
Underestimation of gestational age
The time interval between S2 and OS- the shorter the interval - the more intense

41. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
Brief psychotic disorder; schizophreniform; schizophrenia
Turbulence
Extrinsic def; instrinsic def; platelet def
Serum FFA and serum triglyceride levels

42. What does VIP do to gastric acid secretion?
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Inhibits it
Prostate tumor and increased osteoclast activity
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

43. carnitine deficiency impairs production of What and how?
Ketone body production by preventing fatty acids into the mitochondria
Nocardia
In the extracellular space
Decreases both

44. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Increase; decreased
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Hydrogen bonds dictate alpha or beta structure
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

45. What is the difference between additive and synergistic?
S. aureus
Additive is equal to the sum of the two actions (lets say agonists at a receptor) and synergistic is when the sum is greater than just their two effects together
Measles and M3 AML`
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

46. What is a clara cell?
Joints d/t increased purine production and thus uric acid production
Serum creatine kinase; reperfusion injury causes necrosis
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
LT (LTD4 - E4 - C4) - and Ach

47. In What type of nephritis would you see high serum eos count?
Drug induced interstitial nephritis
Abnormal closing of the urethral folds
Anti centromere; anti DNA topoisomerase
Hypertension - edema - and proteinuria

48. within the right atrium - What is the maximum pressure? left atrium?
8; 12
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Valproate
Sudden loss of muscle tone without loss of consciousness; narcolepsy

49. What does L/S stand for in fetal lung maturity? When does maturity occur?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Highly negative resting potential
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
Drink plenty of fluids

50. the rate of blood flow of which two circulations must equal each other at all times?
Pulmonic and systemic!
II; I (I more abundant)
indomethacin
HSV ( also in utero: chlymadia - neisseria - group B strep)