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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. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
MAO inhibitors; wine and cheese
Fat - fertile - forty - female

2. What is epleronone?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
The time interval between S2 and OS- the shorter the interval - the more intense
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Another type of aldosterone antagonist (like spironolactone)

3. What is damaged in early syringomelia? later?
Increases
Spongiosis
Downs; regurgitant AV valves - ASDs
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

4. on What part of the clavicle does the SCM attach?
Medial part
GI malignancies and Insulin resistance (acromegal for ex)
frameshift mutations (missense is substitution)
RBF= PAH clearance/(1- hematocrit)

5. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Varying; erythema nodosum is common
Inactivates kallikrein which activates kininogen into bradykinin
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
facultative intracellular

6. what makes bruits?
Env genes (for getting into target cells)
Myasthenia gravis
Turbulence
Minimal change disease

7. what protects the resting heart from arrhythmias?
Chrom 8
Highly negative resting potential
Excessive collagen formation during tissue repair in susceptible individuals
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

8. What is the presentation of angioedema? Where is most commonly affected?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Curlings ulcers
Clindamycin; covers anaerobic oral flora and aerobic bacteria
GI malignancies and Insulin resistance (acromegal for ex)

9. What does protein M do in Group A strep<
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Medullary
Prevent phagocytosis
Reticulocytes

10. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
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
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Inhibits it
Demargination of neutrophils from the vessel walls

11. how can HAV be inactivated?
Boiling - bleach - formalin - UV irradiation
Common peroneal; bony fractures and compression; sciatic
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Not lined by epithelium

12. at three years of age What are social - fine motor - gross motor and language developments?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Gluteus maximus; difficulty getting up from seated position and climbing chair

13. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Hypertension - edema - and proteinuria
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Protamine sulfate
Gluteus medius and minimus; positive trendelenberg

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

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15. which headaches are seen mostly in men - are severe - unilateral - periorbital - episodic (around same time every day) - temporal pain - with lacrimation - nasal congestion and ptosis?
8; 12
Trochlear nerve (IV); abducens nerve (VI)
Cluster
chronic urticaria and allergic symptoms

16. What three pathogens cause infectious esophagitis in HIV positive patients?
AV node slowest - to allow time for diastole
CMV - HSV 1 - Candida
Valproate
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

17. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Hyperkalemia; potassium sparing diuretics - potassium supplements
Nonsense; mRNA processing
Susceptible; soluble (unable to be cultured in bile)
Superior larygeal; cricothyroid; recurrent laryngeal

18. What is a cord factor and Which bugs have it? How do they appear on culture?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Minimal change disease
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Hypothyroidism

19. What can chronic vit A toxicity cause?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Spongiosis
SVT; increases vagal tone; rectus abdominis

20. What are the three causes of acute MI in context of normal coronary arteries ?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Brief psychotic disorder; schizophreniform; schizophrenia
Dissolved in plasma and attached to Hgb
IgE

21. Where does lysyl oxidase act? What is the cofactor for that?
No (unlike adenomyosis); yes
In the extracellular space for collagen cross linking; zinc
Minimal change disease
Anterior nares

22. What is the Na/Ca exchange used for?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
To pump calcium out in cardiac myocytes so that relaxation occurs
Ether and other organic solvents
FGF and VEGF

23. 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?
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
46 - 4N; 23 2N
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
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

24. When does neovascularization granulation tissue begin to form after severe ischemia and MI? what happens in 12-24 hours? 2 weeks to 2 months? 1-5 days? 0-4 hours? when do you see edema - hemorrhage - wavy fibers?
II; I (I more abundant)
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
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
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

25. What is used to compare means? categorical outcomes?
T test; chi squared
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Tibial

26. Where does 90% of serotonin lie? What is this NT responsible?
GI tract; mood!
Increase in permeability of two ions with equal and opposite equilibrium potentials
Smoking
Increases bronchial and vascular smooth muscle reactivity to catecholamines

27. what protein is increased in Crohns disease? What does it do?
To pump calcium out in cardiac myocytes so that relaxation occurs
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)
Reticulocytes
NF- KB; responsible for cytokine production

28. What are fenfluramine - phentermine?
No
Measure of depth invasion (vertical!)
Appetite suppressants
8; 12

29. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
Spongiosis
Bronchial dilation (bronchiectasis)
Octreotide
Vagus (auricular branch); vasovagal syncope!

30. 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?
Prepatellar
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Common peroneal; bony fractures and compression; sciatic
To pump calcium out in cardiac myocytes so that relaxation occurs

31. What are pancreatic pseudocysts called pseudo rather than true cysts?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Not lined by epithelium
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

32. What is medullary sponge kidney disease and how does it present? What does it lead to?
Neisseria induced small cell vasculitis (including hands and soles)
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
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)
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

33. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
Biphosphonate
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Fibronectin - laminin - collagen
Minimal change disease

34. other than increasing HDL levels - what else does niacin do?
Prevents hepatic VLDL production
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
ZDV or AZT
SVT; increases vagal tone; rectus abdominis

35. What is used to treat heparin toxicity?
Protamine sulfate
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Fat - fertile - forty - female

36. How do left sided colon adenocarcinomas present? right sided?
Acute interstitial nephritis
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
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Turbulence

37. why does neutrophila occur with corticosteroids?
Demargination of neutrophils from the vessel walls
ATP binding (resets the myosin head to contract again for next binding)
MAO inhibitors; wine and cheese
G to T in p53; HCC

38. What do you treat s. epidermidis with?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Insulin like growth factor 1 (just another name)
Medial circumflex artery; avascular necrosis
Vancomycin

39. which are the only glycosylated proteins in HIV virus?
I is more benign and can present later in adulthood
Env genes (for getting into target cells)
Squatting - sitting - lying supine - passive leg raising
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

40. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Skin flushing and warmth; prostaglandins; give with aspirin
Increase in permeability of two ions with equal and opposite equilibrium potentials
Right before diastole (filling begins)

41. Acyl coA synthetase is not...
Drink plenty of fluids
Downs; regurgitant AV valves - ASDs
liver specific
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

42. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Chrom 8
Strength of cell mediated immune response
Increased reticulocytes
Apocrine; eccrine

43. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Excessive collagen formation during tissue repair in susceptible individuals
Echinococcus granulosus; anaphylaxis
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
No; MRI

44. When is an S4 sound normal?
S. aureus
Well trained athletes and children
Medullary
Retinitis; mononucleosis

45. What antibodies are present in CREST? What is the most specific?
only up to bronchi
Chlorpheniramine and diphenhydramine
Anti centromere; anti DNA topoisomerase
Inactivates kallikrein which activates kininogen into bradykinin

46. what hernia has a similar mechanism to hydrocele?
Tissue redistribution (out of plasma) rather than metabolism
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

47. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Increase lymphatic drainage!
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Pan colitis and right sided colitis (more than left sided and proctitis)
S. saprophyticus - and s. epidermidis; novobiocin

48. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Cluster
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Prevents hepatic VLDL production

49. What are the acute effects of corticosteroids on the CBC?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Anterior nares
manifestations - congenital (stretching of periventricular pyrimadal fibers)
transcription activation/suppression

50. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
Amiloride - spironolactone - triamterene
Skin flushing and warmth; prostaglandins; give with aspirin
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)