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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 the difference between paranoid personality disorder and delusional disorder?
As a CO2 carrier with the carboxylase enzyme
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Vertical diplopia
Tibial

2. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Little effect on cell and no change
PDA open
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

3. what dictates the resting membrane potential of most cells?
Multiple miscarriages d/t hypercoaguability
Trochlear nerve (IV); abducens nerve (VI)
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
High potassium conductance and some sodium conductance

4. What is difference between Arnold Chiari type I and II?
Turners`
Localized dermatologic pain that persists for more than one month after zoster eruption
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
I is more benign and can present later in adulthood

5. What is cataplexy and When is it seen?
Because of vasodiation to skeletal muscles
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

6. What does p53 do? what chrom is it on?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Classical conditioning
Measles and M3 AML`
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

7. how can HAV be inactivated?
Multiple miscarriages d/t hypercoaguability
Gluteus maximus; difficulty getting up from seated position and climbing chair
Boiling - bleach - formalin - UV irradiation
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

8. if there are keratin swirls does that mean well or poorly differentiated?
Well
Prevent phagocytosis
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

9. Where does 90% of serotonin lie? What is this NT responsible?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Appetite suppressants
Pain reliever - reduces pain by locking substance P in the PNS
GI tract; mood!

10. What antibiotic is best to treat alcoholic pulm infections? why?
SVC and IVC; right below the aortic knob
Clindamycin; covers anaerobic oral flora and aerobic bacteria
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
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

11. what happens to sperm count and semineferous tubules in patient with cryptoorchidism? hormonal function? why do they need to be surgically descended?
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
Pulmonary hypertension
Lateral; RV; RA; LV
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

12. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
Prostate tumor and increased osteoclast activity
women
Pulmonary hypertension
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

13. What is somatomedin C?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Insulin like growth factor 1 (just another name)
In the extracellular space for collagen cross linking; zinc

14. What three factors effect total oxygen content of blood?
Well
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Proteasome inhibitor; treatment for MM and waldenstroms
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

15. erythema nodosum - elevated ACE - scattered granulomas - arthralgias - hilar lymphadenoapthy are indicative of what?
<1% - 55% - concentration dependent
Sarcoid
Neisseria induced small cell vasculitis (including hands and soles)
Paramyxo and influenza

16. what makes bruits?
In the extracellular space
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Serum FFA and serum triglyceride levels
Turbulence

17. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
RBC mass; epo levels (secondary has high)
Sudden loss of muscle tone without loss of consciousness; narcolepsy
SVT; increases vagal tone; rectus abdominis
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

18. What almost exclusively causes Epliglottitis?What type of capsule does it have? What are the symptoms?

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19. What triggers the neoplastic changes that are associated with HBV infecton?
Measure of depth invasion (vertical!)
FGF and VEGF
Integration of viral DNA into genome of host hepatocytes
Thymic tumor

20. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
S. aureus
E. coli; staphylococcus saprophyticus
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

21. What is it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
Not lined by epithelium
Gluteus maximus; difficulty getting up from seated position and climbing chair
Vertical diplopia
Increase; decreased

22. in the LV and aorta - What are the pressures?
Standing suddenly from supine position; valsalva maneuver
Echinococcus granulosus; anaphylaxis
Prepatellar
Normally close to systolic

23. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Relfex tachycardia; giving beta blockers
Initiation - pointing; pincer grasp; walking; mama/dada
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Both sides

24. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Hypo or hyper pigmentations; after tanning
Excessive collagen formation during tissue repair in susceptible individuals
Increase lymphatic drainage!
RBC mass; epo levels (secondary has high)

25. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
Strength of cell mediated immune response
Minimal change disease
Sarcoid
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

26. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
P53 mutation; DCC is also required for adenoma to carcinoma
Fibronectin - laminin - collagen
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

27. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
No (unlike adenomyosis); yes
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Gluteus medius and minimus; positive trendelenberg
Brief psychotic disorder; schizophreniform; schizophrenia

28. what commonly happens in GI in response to acute physiologic stress?
Acute gastric mucosal defects (superficial or full thickness)
Fat - fertile - forty - female
Normally close to systolic
Strength of cell mediated immune response

29. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Integration of viral DNA into genome of host hepatocytes
200-500
Bile soluble which means they are bile sensitive

30. What is the triad seen in pre eclampsia?
Think Hb deformation diseases
Hypertension - edema - and proteinuria
The term used to describe decreased drug responsiveness with repeated administration
Prevent phagocytosis

31. what defines hypoxemia?
Intussusception
SaO2 <92%
Chlorpheniramine and diphenhydramine
Circular - outside nucleus; transport proteins - rRNA - tRNA

32. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
gram positive organisms
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Skin flushing and warmth; prostaglandins; give with aspirin
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

33. what phase do adenosine and acetylcholine act on? doing what?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Fat - fertile - forty - female
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

34. What type of calcium channels dictate the plateau in cardiac myocyte?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Dihydropyridine sensitive Ca channels (L type)
Diabetic microangiopathy
Syringomelia

35. do Class IC agents prolong the QT interval?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Anti - apoptotic (prevents going into apoptosis)- 18; 14
No
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

36. What do you treat s. epidermidis with?
Vancomycin
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Prostate tumor and increased osteoclast activity
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

37. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Gluteus medius and minimus; positive trendelenberg
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Anti cholinergic effects of pupil dilation and lack of accomodation
Valproate

38. why does neutrophila occur with corticosteroids?
Demargination of neutrophils from the vessel walls
S. aureus
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
FGF and VEGF

39. What does C1 esterase do other than inhibiting complement pathway?
Inactivates kallikrein which activates kininogen into bradykinin
Classical conditioning
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Right before diastole (filling begins)

40. How can renal blood flow be calculated from RPF?
RBF= PAH clearance/(1- hematocrit)
S3 gallop; S2 to opening snap interval
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
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

41. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
ANCA because of lack of Ig and C3 deposits on IF
Curlings ulcers
Apocrine; eccrine
Acute gastric mucosal defects (superficial or full thickness)

42. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Atrial
frameshift mutations (missense is substitution)
Integration of viral DNA into genome of host hepatocytes
Medullary

43. What is the precursor protein to beta amyloid and On what chromosome is it found?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
By vascular permeability and vasodilation
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
APP on chrom 21 (this is why downs more susceptible)

44. which opponens muscle does ulnar innervate?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
frameshift mutations (missense is substitution)
Adductor
11

45. 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
Chlorpheniramine and diphenhydramine
No
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

46. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
Gluteus medius and minimus; positive trendelenberg
...
No (unlike adenomyosis); yes
Hypo or hyper pigmentations; after tanning

47. 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?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
4 - 4 - 9
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)
Southern - western

48. What is Bortezomib and What is it used for?
Terminal bronchioles; small bronchi
Proteasome inhibitor; treatment for MM and waldenstroms
only up to bronchi
Increases

49. What is a keloid?
Excessive collagen formation during tissue repair in susceptible individuals
SVC and IVC; right below the aortic knob
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Lateral; RV; RA; LV

50. What is the mc location of brain germinomas?What are the classic symptoms?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Serum creatine kinase; reperfusion injury causes necrosis