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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 is a cell surface marker seen in liver angiosarcoma?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
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
differentiate
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

2. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Faulty positioning of the genital tubercle
Increase by 50% in urine osmolality

3. what happens with LDL receptor density in statin therapy?
Bronchogenic carcinoma
Increases
Increase in permeability of two ions with equal and opposite equilibrium potentials
Chrom 8

4. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
Recurrent larygneal
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Inhaled animal dander allergens
Hypothyroidism

5. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Increase lymphatic drainage!
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)
Amiadarone
liver specific

6. other than mycobacterim wha other bacteria is acid fast?
Nocardia
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
Headaches and facial flushing; vasodilation in meninges and skin
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

7. which two drug types can cause orthostatic hypotension (think depression and BPH)?
NF- KB; responsible for cytokine production
TCAs and prazosin
Gluteus maximus; difficulty getting up from seated position and climbing chair
MAO inhibitors; wine and cheese

8. What is the difference between paranoid personality disorder and delusional disorder?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Syringomelia

9. What is the mutation type in thalassemias? what process is defective because of this?
Nonsense; mRNA processing
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Serum FFA and serum triglyceride levels
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

10. What is the immune deficinecy seen in ataxia telangactasia?
V fib; v. failure
Ig A deficiency
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

11. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Increase; decreased
Kallmans
Hereditary angioedema; ACE inhibitors

12. What are the acute effects of corticosteroids on the CBC?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Gluteus medius and minimus; positive trendelenberg
Right before diastole (filling begins)
Atrial

13. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Fibrosis; macrophages
Sickle cell; G6PD
Reiter syndrome; B27
8; 12

14. What is diphenoxylate and What is it used for? what drug is it structurally similar to? What allows for potent anti diarrheal effect without signigicant opiate effects?
GI malignancies and Insulin resistance (acromegal for ex)
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Barium enema
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)

15. What are some side effects seen in TCAs?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
G to T in p53; HCC
LT (LTD4 - E4 - C4) - and Ach
11 aa polypeptide; pain NT in CNS and PNS

16. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Increase in permeability of two ions with equal and opposite equilibrium potentials
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Acute interstitial nephritis

17. what drug is useful for secretory diarrhea?
S3 gallop; S2 to opening snap interval
25; 25
Increase lymphatic drainage!
Octreotide

18. What does L/S stand for in fetal lung maturity? When does maturity occur?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Raphe
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

19. 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
Nocardia
Faulty positioning of the genital tubercle
Ceftriaxone; azithromycin

20. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
No and yes
Underestimation of gestational age

21. What is the neurologic manifestation of ADPKD?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Vancomycin
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 medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

22. what should you think of in 'smear of an oral ulcer base'?
Because of vasodiation to skeletal muscles
Measure of depth invasion (vertical!)
Tzanck smear
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

23. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Amiadarone
Sydenham chorea
Fibronectin - laminin - collagen
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

24. which has better side effect profile - SSRI or TCA?
SSRI
glycerol kinase
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
GI tract; mood!

25. where are Beta 1 receptors found?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
On cardiac tissue and renal juxtaglomerular cells
Pulmonic and systemic!
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

26. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Large stroke volumes with ventricular contraction; aortic regurg
CGD; t cell dysfxn (diGeorge)
Ether and other organic solvents
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 does sustained hand grip do to the C/V system?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
No (unlike adenomyosis); yes
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
SSRI; erectile dysfunction

28. Which nerve lies in close proximity to the inferior thyroid artery?
differentiate
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
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
Recurrent larygneal

29. why does liver dysfunction cause coagulation disorders?
CMV - HSV 1 - Candida
Coagulation factors are made in the liver
8 (myc protein) with 2 - 14 - 22 (iG chains)
Sydenham chorea

30. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
MAO inhibitors; wine and cheese
Hypothyroidism
SVT; increases vagal tone; rectus abdominis
Ceftriaxone; azithromycin

31. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Acute interstitial nephritis
Reticulocytes
Southern - western
Gluteus maximus; difficulty getting up from seated position and climbing chair

32. What is congestive hepatomegaly specific for?
Right heart failure
PDA open
Increase in permeability of two ions with equal and opposite equilibrium potentials
25; 25

33. what enzyme converts procarcinogens into carcinogens?
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)
P450 mitochondrial monooxygenase
Vertical diplopia
Vagus nerve stimulation

34. What does prolonged PT indicated? aPTT? bleeding time?
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
S. saprophyticus - and s. epidermidis; novobiocin
DIC; TTP- HUS dont bleed that much
Extrinsic def; instrinsic def; platelet def

35. What is achalasia and how would this correlate on the esophageal mannometry?
Ceftriaxone; azithromycin
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
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
Coagulation factors are made in the liver

36. What are the lab findings in poststreptococcal GN?
Closer to head; closer to diaphragm
Underestimation of gestational age
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
8 (myc protein) with 2 - 14 - 22 (iG chains)

37. what indicates the severity of a mitral regurg ? mitral stenosis?
S3 gallop; S2 to opening snap interval
Retinitis; mononucleosis
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Diabetic microangiopathy

38. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
In the extracellular space
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)
Proteasome inhibitor; treatment for MM and waldenstroms
OCPs - multiparity - breast feeding

39. 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?
PDA open
Demargination of neutrophils from the vessel walls
Common peroneal; bony fractures and compression; sciatic
P53 mutation; DCC is also required for adenoma to carcinoma

40. What is pickwickian syndrome? What are the lab findings?
No; yes
Bronchial dilation (bronchiectasis)
The time interval between S2 and OS- the shorter the interval - the more intense
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

41. What is the mc location of brain germinomas?What are the classic symptoms?
Proteasome inhibitor; treatment for MM and waldenstroms
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Circular - outside nucleus; transport proteins - rRNA - tRNA

42. why should you not use ACE inhibitors with someone who had hereditary angioedema?
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
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Paramyxo and influenza
Not lined by epithelium

43. non ceruloplasmin deposition - ceruloplasmin is...
GI tract; mood!
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
low in serum

44. what defines hypoxemia?
SaO2 <92%
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Increase; decreased
HSV ( also in utero: chlymadia - neisseria - group B strep)

45. do Class IC agents prolong the QT interval?
OCPs - multiparity - breast feeding
No
Strength of cell mediated immune response
Anterior nares

46. what makes bruits?
Turbulence
Hyperkalemia; potassium sparing diuretics - potassium supplements
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

47. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Chorda tympani branch
Sickle cell; G6PD
...
Drink plenty of fluids

48. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Integration of viral DNA into genome of host hepatocytes
11
Gluteus medius and minimus; positive trendelenberg
Initiation - pointing; pincer grasp; walking; mama/dada

49. Would alpha 1 agonists cause flushing? muscarinic antagonist?
Tzanck smear
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
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
No; yes

50. after a thrombus extraction - what serum enzyme shoots up and why?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Gluteus medius and minimus; positive trendelenberg
When it invades the bm; carcinoma in situ
Serum creatine kinase; reperfusion injury causes necrosis