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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 usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Turbulence
P53 mutation; DCC is also required for adenoma to carcinoma
25; 25

2. What is the most common initital symptom of ADPKD? what else?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Ceftriaxone; azithromycin
GI malignancies and Insulin resistance (acromegal for ex)

3. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
Ketone body production by preventing fatty acids into the mitochondria
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Reticulocytes
No (unlike adenomyosis); yes

4. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Vagus nerve stimulation
Medial circumflex artery; avascular necrosis
Vagus (auricular branch); vasovagal syncope!
RR-1/RR

5. What is somatomedin C?
Insulin like growth factor 1 (just another name)
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Medullary
glycerol kinase

6. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
Curlings ulcers
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Primary
11

7. ___________ is liver specific
glycerol kinase
Rabies encephalitis from cave bats; rabies killed vaccines
HSV ( also in utero: chlymadia - neisseria - group B strep)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

8. What are some of the permissive effects of cortisol?
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
Vascular endothelium; protease
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Phencyclidine (PCP)

9. What is hypospadias caused by?
Radial nerve and deep brachial artery
Close but purkinje system to ensure contraction in a bottom up fashion
Abnormal closing of the urethral folds
GI malignancies and Insulin resistance (acromegal for ex)

10. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
Gluteus maximus; difficulty getting up from seated position and climbing chair
P450 mitochondrial monooxygenase
OCPs - multiparity - breast feeding
Normal; low

11. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Hyperkalemia; potassium sparing diuretics - potassium supplements
RER; RER
High potassium conductance and some sodium conductance
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences

12. 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
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
By vascular permeability and vasodilation
Increases bronchial and vascular smooth muscle reactivity to catecholamines

13. what organ would an activating mutation in PRPP synthetase effect?
When it invades the bm; carcinoma in situ
Pain reliever - reduces pain by locking substance P in the PNS
Joints d/t increased purine production and thus uric acid production
SSRI; erectile dysfunction

14. what locations of UC increase the risk of Colon cancer?
Adeno
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Pan colitis and right sided colitis (more than left sided and proctitis)
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

15. sporadic colon cancer tend to arise From what type of polyps?
Right heart failure
Sarcoid
Single adenomatous ones
Initiation - pointing; pincer grasp; walking; mama/dada

16. why does variocele occur more in left side?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Chlorpheniramine and diphenhydramine

17. What type of mutation does aflatoxin cause? what cancer does this increase for?
NF- KB; responsible for cytokine production
chronic urticaria and allergic symptoms
Around 70 (normal measured diastolic pressures); 9--
G to T in p53; HCC

18. which two virus families have hemagluttinin on their surface?
Initiation - pointing; pincer grasp; walking; mama/dada
Paramyxo and influenza
Radial nerve damage
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

19. at four years of age - What are the social - fine motor - gross motor - and language developments?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Relfex tachycardia; giving beta blockers
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

20. What is the neurologic manifestation of ADPKD?
Anti cholinergic effects of pupil dilation and lack of accomodation
Acute interstitial nephritis
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

21. What is extraocular muscle weakness a common symptom of?
Myasthenia gravis
Insulin like growth factor 1 (just another name)
Sarcoid
Another type of aldosterone antagonist (like spironolactone)

22. What is damaged in early syringomelia? later?
Well
No; MRI
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

23. What does sustained hand grip do to the C/V system?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
chronic urticaria and allergic symptoms
Boiling - bleach - formalin - UV irradiation

24. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
Normally close to systolic
RER; copper
<1% - 55% - concentration dependent
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

25. 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?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Anti centromere; anti DNA topoisomerase
Around 70 (normal measured diastolic pressures); 9--

26. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
RER; copper
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Dihydropyridine sensitive Ca channels (L type)
Sydenham chorea

27. why are pregnant predisposed to cholelithiasis?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
chronic urticaria and allergic symptoms
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
Gluteus medius and minimus; positive trendelenberg

28. what protects the resting heart from arrhythmias?
Strength of cell mediated immune response
Highly negative resting potential
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Vagus nerve stimulation

29. other than parvo B19 - what else is associated with red cell aplasia?
Thymic tumor
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
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

30. What does VIP do to gastric acid secretion?
Inhibits it
Hyperkalemia; potassium sparing diuretics - potassium supplements
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Headaches and facial flushing; vasodilation in meninges and skin

31. What is pickwickian syndrome? What are the lab findings?
LT (LTD4 - E4 - C4) - and Ach
Well trained athletes and children
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

32. How can renal blood flow be calculated from RPF?
DIC; TTP- HUS dont bleed that much
Another type of aldosterone antagonist (like spironolactone)
RBF= PAH clearance/(1- hematocrit)
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

33. What causes vertical diplopia? horizontal?
Selective alpha 1 (increases SVR)
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Southern - western
Trochlear nerve (IV); abducens nerve (VI)

34. what happens to sperm count and semineferous tubules in patient with cryptoorchidism? hormonal function? why do they need to be surgically descended?
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
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
P450 mitochondrial monooxygenase
S. saprophyticus - and s. epidermidis; novobiocin

35. prostaglandin synthesis keeps...
GI tract; mood!
Localized dermatologic pain that persists for more than one month after zoster eruption
Medial circumflex artery; avascular necrosis
PDA open

36. How do you explain the selective proteinuria of loss to albumin only in MCD?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
ZDV or AZT
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Right before diastole (filling begins)

37. in overweight individuals What is thought to contribute to insulin resistance?
Neisseria induced small cell vasculitis (including hands and soles)
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
RBF= PAH clearance/(1- hematocrit)
Serum FFA and serum triglyceride levels

38. where are the vegetations on the valves of a libman sacks endocarditis?
Increased reticulocytes
Both sides
Enterococci (e. faecalis)- found on genitalia area
Atrial

39. What is the most common neurologic complication of VZV reactivation?
Localized dermatologic pain that persists for more than one month after zoster eruption
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
women
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

40. 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?
Vancomycin; histamine mediated
Superior larygeal; cricothyroid; recurrent laryngeal
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
46 - 4N; 23 2N

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
Measure of depth invasion (vertical!)
Sydenham chorea
Anterior circumflex (and axillary nerve)

42. erythema nodosum - elevated ACE - scattered granulomas - arthralgias - hilar lymphadenoapthy are indicative of what?
Sarcoid
Prevents hepatic VLDL production
E. coli; staphylococcus saprophyticus
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

43. 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?
Little effect on cell and no change
Myasthenia gravis
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Common peroneal; bony fractures and compression; sciatic

44. How do you treat gonococcal infection? chlymadia?
Because gamma chains replace beta chains and then gamma chain formation wanes
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)
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Ceftriaxone; azithromycin

45. What is the most important prognostic indicator in patients with malignant melanoma?
Measure of depth invasion (vertical!)
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

46. What is the presentation of sever aortic stenosis?
Elastance
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Syncope - angina - dyspnea (SAD)
T test; chi squared

47. where are Beta 1 receptors found?
11 aa polypeptide; pain NT in CNS and PNS
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
On cardiac tissue and renal juxtaglomerular cells
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

48. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
ANCA because of lack of Ig and C3 deposits on IF
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
P53 mutation; DCC is also required for adenoma to carcinoma
Reticulocytes

49. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
GI tract; mood!
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Clindamycin; covers anaerobic oral flora and aerobic bacteria

50. what chromosome is c - myc found on?
MAO inhibitors; wine and cheese
Chrom 8
Kallmans
Increase in permeability of two ions with equal and opposite equilibrium potentials