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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 would a deflection of the membrane potential to near zero indicate?
Increase in permeability of two ions with equal and opposite equilibrium potentials
P53 mutation; DCC is also required for adenoma to carcinoma
Vagus (auricular branch); vasovagal syncope!
Lateral; RV; RA; LV

2. What antibodies are present in CREST? What is the most specific?
Anti centromere; anti DNA topoisomerase
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

3. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
ATP binding (resets the myosin head to contract again for next binding)
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Increase by 50% in urine osmolality

4. what bursa is affected when on knees like a maid/gardner?
Serum creatine kinase; reperfusion injury causes necrosis
Elastance
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)
Prepatellar

5. How do you treat gonococcal infection? chlymadia?
Ceftriaxone; azithromycin
Closer to head; closer to diaphragm
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
GI malignancies and Insulin resistance (acromegal for ex)

6. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
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
Increases
Common peroneal; bony fractures and compression; sciatic
Paramyxo and influenza

7. what commonly happens in GI in response to acute physiologic stress?
Amiadarone
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Acute gastric mucosal defects (superficial or full thickness)
Regular insulin (Not fast acting - regular better)

8. hypertonicity and hyperreflexity are ________________ of hydrocephalus
Atrial
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

9. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Increase lymphatic drainage!
Superior larygeal; cricothyroid; recurrent laryngeal
Localized dermatologic pain that persists for more than one month after zoster eruption
Well trained athletes and children

10. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
MAO inhibitors; wine and cheese
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
Hyperkalemia; potassium sparing diuretics - potassium supplements
Well trained athletes and children

11. What is the cause of fixed splitting of S2? why?
Chrom 8
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

12. What can too much IgA in serum produces?
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
TCAs and prazosin
(urine PAH x urine flow rate)/plasma PAH

13. How do you calculate excretion rate of a substance? How do you calculate the filtration rate of a substance? clearance of what substance estimates the GFR?
Leukotriene precursor and does neutrophil chemotaxis
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Squatting - sitting - lying supine - passive leg raising

14. How do you calculate RPF from urine PAH?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
(urine PAH x urine flow rate)/plasma PAH
Biphosphonate

15. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Chrom 8
Chorda tympani branch
OCPs - multiparity - breast feeding

16. other than mycobacterim wha other bacteria is acid fast?
Nocardia
Around 70 (normal measured diastolic pressures); 9--
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
SVT; increases vagal tone; rectus abdominis

17. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
HSV ( also in utero: chlymadia - neisseria - group B strep)
Terminal bronchioles; small bronchi
Phencyclidine (PCP)
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

18. What type of mutation does aflatoxin cause? what cancer does this increase for?
Hereditary angioedema; ACE inhibitors
G to T in p53; HCC
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

19. What is the Na/Ca exchange used for?
Paramyxo and influenza
Ketone body production by preventing fatty acids into the mitochondria
V fib; v. failure
To pump calcium out in cardiac myocytes so that relaxation occurs

20. why does hypothyroidism cause increased CPK levels?
Insulin like growth factor 1 (just another name)
Diabetic microangiopathy
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
No

21. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Terminal bronchioles; small bronchi
Congenital hypothyroidism - downs - amyloidosis - acromegaly
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
Primary

22. 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
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
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
Drink plenty of fluids

23. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
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

24. in B12 deficiency - what levels in blood rise very quickly and then drop?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Reticulocytes
Kallmans

25. What does L/S stand for in fetal lung maturity? When does maturity occur?
46 - 4N; 23 2N
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
hyponatremia (aldosterone activation equilibrates body volume)
Measles and M3 AML`

26. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
C3 decreased after 5-10 days; sulfonamides
Anti centromere; anti DNA topoisomerase
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

27. What are pancreatic pseudocysts called pseudo rather than true cysts?
Syringomelia
Not lined by epithelium
SaO2 <92%
RBF= PAH clearance/(1- hematocrit)

28. why does neutrophila occur with corticosteroids?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
SS +rNA
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Demargination of neutrophils from the vessel walls

29. why are beta thal major patients asymptomatic at birth?
Because gamma chains replace beta chains and then gamma chain formation wanes
E. coli; staphylococcus saprophyticus
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Vascular endothelium; protease

30. other than parvo B19 - what else is associated with red cell aplasia?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Thymic tumor
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Pain reliever - reduces pain by locking substance P in the PNS

31. What are the two mcc of focal brain lesions in HIV positive patients?
G to T in p53; HCC
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Syringomelia
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

32. What is the diagnosis in delayed puberty plus anosmia?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
AV node slowest - to allow time for diastole
Kallmans

33. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
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
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
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

34. Which is slower AV node or ventricular muscle?
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
AV node slowest - to allow time for diastole
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
Multiple miscarriages d/t hypercoaguability

35. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
Drink plenty of fluids
Ceftriaxone; azithromycin
P53 mutation; AD
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

36. What are the skin presentation in sarcoid?
Amiadarone
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Highly negative resting potential
Varying; erythema nodosum is common

37. what happens to capacitance with age?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Bile soluble which means they are bile sensitive
...

38. which nucleus releases serotonin?
Normally close to systolic
Raphe
Coagulation factors are made in the liver
Sickle cell; G6PD

39. biotin is used By what in tissues responsible for gluconeogenesis
As a CO2 carrier with the carboxylase enzyme
Dihydropyridine sensitive Ca channels (L type)
Because gamma chains replace beta chains and then gamma chain formation wanes
Increased reticulocytes

40. What is a keloid?
women
Excessive collagen formation during tissue repair in susceptible individuals
To pump calcium out in cardiac myocytes so that relaxation occurs
Anti - apoptotic (prevents going into apoptosis)- 18; 14

41. What is gardeners mydriasis? How is it treated?
Adeno
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

42. what happens to sperm count and semineferous tubules in patient with cryptoorchidism? hormonal function? why do they need to be surgically descended?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Vagus (auricular branch); vasovagal syncope!
Serum FFA and serum triglyceride levels
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

43. what locations of UC increase the risk of Colon cancer?
Increase; decreased
Gluteus maximus; difficulty getting up from seated position and climbing chair
Underestimation of gestational age
Pan colitis and right sided colitis (more than left sided and proctitis)

44. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
Minimal change disease
When it invades the bm; carcinoma in situ
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Class I

45. on which chromosome is wilms tumor found?
11
8 (myc protein) with 2 - 14 - 22 (iG chains)
Syncope - angina - dyspnea (SAD)
Varying; erythema nodosum is common

46. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Fibrosis; macrophages
Dihydropyridine sensitive Ca channels (L type)
Phencyclidine (PCP)
Anti - apoptotic (prevents going into apoptosis)- 18; 14

47. What is acanthosis nigricans associated with?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
INTRApartum Abs (ampicillin/penicillin)
ANCA because of lack of Ig and C3 deposits on IF
GI malignancies and Insulin resistance (acromegal for ex)

48. What is epispadias caused by?
Faulty positioning of the genital tubercle
Amiadarone
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Sudden loss of muscle tone without loss of consciousness; narcolepsy

49. which two drug types can cause orthostatic hypotension (think depression and BPH)?
DIC; TTP- HUS dont bleed that much
RER; copper
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
TCAs and prazosin

50. What is the mc malignancy in asbestosis?
Bronchogenic carcinoma
Prepatellar
Pain reliever - reduces pain by locking substance P in the PNS
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)