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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 the two coagulase negative staphylococci? How do you distinguish them?
Large stroke volumes with ventricular contraction; aortic regurg
Think Hb deformation diseases
S. saprophyticus - and s. epidermidis; novobiocin
manifestations - congenital (stretching of periventricular pyrimadal fibers)

2. What is hypospadias caused by?
Elevated GGT and macrocytosis
Abnormal closing of the urethral folds
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

3. What are fenfluramine - phentermine?
Appetite suppressants
Pain reliever - reduces pain by locking substance P in the PNS
Rabies encephalitis from cave bats; rabies killed vaccines
Single adenomatous ones

4. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
Fat - fertile - forty - female
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
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Bile salt accumulation in urine

5. What is a clara cell?
Diabetic microangiopathy
Strength of cell mediated immune response
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
No (unlike adenomyosis); yes

6. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
Pulmonic and systemic!
Anti cholinergic effects of pupil dilation and lack of accomodation
The term used to describe decreased drug responsiveness with repeated administration
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

7. at three years of age What are social - fine motor - gross motor and language developments?
Vancomycin; histamine mediated
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
ZDV or AZT
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences

8. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
Hexokinase
RER; copper
When it invades the bm; carcinoma in situ
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

9. What is a cell surface marker seen in liver angiosarcoma?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
transcription activation/suppression
Atrial

10. what defines hypoxemia?
Myasthenia gravis
Paramyxo and influenza
SaO2 <92%
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

11. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Recurrent larygneal
Myasthenia gravis
Brief psychotic disorder; schizophreniform; schizophrenia
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

12. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Purkinje system; AV node
Terminal bronchioles; small bronchi
LT (LTD4 - E4 - C4) - and Ach
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

13. How do you treat gonococcal infection? chlymadia?
Ketone body production by preventing fatty acids into the mitochondria
Ceftriaxone; azithromycin
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Syringomelia

14. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
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`
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Folic acid treatment!

15. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
P53 mutation; DCC is also required for adenoma to carcinoma
Because of vasodiation to skeletal muscles
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Highly negative resting potential

16. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Downs; regurgitant AV valves - ASDs
Vancomycin; histamine mediated
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

17. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
No and yes
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Chlorpheniramine and diphenhydramine
When it invades the bm; carcinoma in situ

18. biotin is used By what in tissues responsible for gluconeogenesis
As a CO2 carrier with the carboxylase enzyme
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Duration and extent of disease
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

19. What is intussusception? how does ischemia and necrosis occur?
When it invades the bm; carcinoma in situ
Hypothyroidism
Tibial
An invagination of portion of intestine into the lumen of the adjacent intestinal segment; can lead to impaired venous return from the invaginated segment of the bowel which can cause ischemia and subsequent necrosis

20. how much percent of sodium is excreted? urea? glucose?
Biphosphonate
<1% - 55% - concentration dependent
Because of the low output from heart failure - they will have increased aldosterone levels
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

21. What is an abortive viral infection?
Little effect on cell and no change
Duration and extent of disease
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

22. What are the two growth factors associated with angiogenesis?
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
Joints d/t increased purine production and thus uric acid production
FGF and VEGF
Inhaled animal dander allergens

23. on which chromosome is wilms tumor found?
11
Neisseria induced small cell vasculitis (including hands and soles)
RBC mass; epo levels (secondary has high)
Increase lymphatic drainage!

24. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
4 - 4 - 9
Drug induced interstitial nephritis
Proteasome inhibitor; treatment for MM and waldenstroms
P53 mutation; AD

25. When is acid phosphatase elevated (Name two times)?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Prostate tumor and increased osteoclast activity
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Kallmans

26. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Tibial
11
Skin flushing and warmth; prostaglandins; give with aspirin
Anterior circumflex (and axillary nerve)

27. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
GI tract; mood!
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

28. What can chronic vit A toxicity cause?
Tibial
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
SS +rNA

29. What can worse neurologic dysfunction in cobalamic def?
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
Syncope - angina - dyspnea (SAD)
Folic acid treatment!
Excessive collagen formation during tissue repair in susceptible individuals

30. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Dihydropyridine sensitive Ca channels (L type)
Turbulence
OCPs - multiparity - breast feeding
Hyperkalemia; potassium sparing diuretics - potassium supplements

31. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
OCPs - multiparity - breast feeding
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Increased reticulocytes
Covalent (between two cysteines)- allows protein to withstand denaturation

32. sporadic colon cancer tend to arise From what type of polyps?
Ketone body production by preventing fatty acids into the mitochondria
Single adenomatous ones
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Underestimation of gestational age

33. What is a common complication of acute pancreatitis? What is it?
Ig A deficiency
Paramyxo and influenza
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
HSV ( also in utero: chlymadia - neisseria - group B strep)

34. how can HAV be inactivated?
Boiling - bleach - formalin - UV irradiation
Phencyclidine (PCP)
C3 decreased after 5-10 days; sulfonamides
Hypothyroidism

35. What is suggestive of complete central DI?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Increase by 50% in urine osmolality
PDA open
Recurrent larygneal

36. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
Bronchogenic carcinoma
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
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

37. What type of endocarditis is cytoscopy induced?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Octreotide
Enterococci (e. faecalis)- found on genitalia area
HSV ( also in utero: chlymadia - neisseria - group B strep)

38. name three pathological states that present with large tongues.
Vancomycin; histamine mediated
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Congenital hypothyroidism - downs - amyloidosis - acromegaly
AV node slowest - to allow time for diastole

39. what diseases can vit A be used to treat?
I is more benign and can present later in adulthood
Measles and M3 AML`
differentiate
Large stroke volumes with ventricular contraction; aortic regurg

40. SIADH patients have normal blood volume but...
Pulmonary hypertension
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
hyponatremia (aldosterone activation equilibrates body volume)
Rabies encephalitis from cave bats; rabies killed vaccines

41. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Common peroneal; bony fractures and compression; sciatic
Localized dermatologic pain that persists for more than one month after zoster eruption
P53 mutation; DCC is also required for adenoma to carcinoma
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

42. h1 receptor anatagonists are not effective in treatment of asthma only for...
chronic urticaria and allergic symptoms
Clindamycin; covers anaerobic oral flora and aerobic bacteria
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
Syncope - angina - dyspnea (SAD)

43. what phase do adenosine and acetylcholine act on? doing what?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
MAC complex (C5b - C9 complement deficiency)
Spongiosis
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

44. do patients with cor pulmonale have increased or decreased levels of aldosterone?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Because of the low output from heart failure - they will have increased aldosterone levels
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Pan colitis and right sided colitis (more than left sided and proctitis)

45. What is the immune deficinecy seen in ataxia telangactasia?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Fat - fertile - forty - female
Ig A deficiency

46. What is medullary sponge kidney disease and how does it present? What does it lead to?
Ether and other organic solvents
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
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)
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

47. within the right ventricle - What are maximum pressures? the pulm arter?
Dissolved in plasma and attached to Hgb
Duration and extent of disease
25; 25
Radial nerve damage

48. why should you not use ACE inhibitors with someone who had hereditary angioedema?
Echinococcus granulosus; anaphylaxis
Because of the low output from heart failure - they will have increased aldosterone levels
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
High potassium conductance and some sodium conductance

49. in overweight individuals What is thought to contribute to insulin resistance?
Bile salt accumulation in urine
Serum FFA and serum triglyceride levels
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Vancomycin; histamine mediated

50. What are examples of action that decrease venous return to the heart?
Standing suddenly from supine position; valsalva maneuver
11
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Appetite suppressants