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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 lab findings in poststreptococcal GN?
HSV and VZV
Fat - fertile - forty - female
MAO inhibitors; wine and cheese
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

2. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Bronchial dilation (bronchiectasis)
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
No and yes

3. which two drug types can cause orthostatic hypotension (think depression and BPH)?
Decreases both
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Folic acid treatment!
TCAs and prazosin

4. What does p53 do? what chrom is it on?
FGF and VEGF
Ether and other organic solvents
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Valproate

5. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Pulmonary hypertension
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

6. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Right before diastole (filling begins)
Susceptible; soluble (unable to be cultured in bile)

7. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
gram positive organisms
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
When it invades the bm; carcinoma in situ
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

8. What is the difference between additive and synergistic?
Localized dermatologic pain that persists for more than one month after zoster eruption
liver specific
Sudden loss of muscle tone without loss of consciousness; narcolepsy
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

9. What is a common complication of acute pancreatitis? What is it?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Tzanck smear
Both sides

10. What is hypospadias caused by?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
P53 mutation; DCC is also required for adenoma to carcinoma
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Abnormal closing of the urethral folds

11. what has the greatest effect on prognosis when treating c. diptheriae?
Ceftriaxone; azithromycin
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
...
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

12. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Increase; decreased
Medial circumflex artery; avascular necrosis
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

13. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
V fib; v. failure
Think Hb deformation diseases
C3 decreased after 5-10 days; sulfonamides

14. What pulmonary structural change can kartageners syndrome cause?
Gluteus maximus; difficulty getting up from seated position and climbing chair
Bronchial dilation (bronchiectasis)
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Hypo or hyper pigmentations; after tanning

15. why are beta thal major patients asymptomatic at birth?
Because gamma chains replace beta chains and then gamma chain formation wanes
Gluteus medius and minimus; positive trendelenberg
Medullary
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

16. what clinical findings help distinguish small cell carcinoma?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Nonsense; mRNA processing
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

17. What is Bortezomib and What is it used for?
Radial nerve and deep brachial artery
As a CO2 carrier with the carboxylase enzyme
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Proteasome inhibitor; treatment for MM and waldenstroms

18. where are the two classical places that the ulnar nerve can be injured?

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19. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
Extrinsic def; instrinsic def; platelet def
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
HSV and VZV

20. nucleotide deletions do not cause missense mutations - they cause...
Well trained athletes and children
frameshift mutations (missense is substitution)
hyponatremia (aldosterone activation equilibrates body volume)
No

21. Which is faster purkinje system or atrial muscle?
Thymic tumor
Decreases both
Underestimation of gestational age
Close but purkinje system to ensure contraction in a bottom up fashion

22. What is the difference between paranoid personality disorder and delusional disorder?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Cluster
Reticulocytes

23. What can cause aortic regurg? What is the heart sound you hear?
TSh (in testicular tumors can cause hyperthyroidism)
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Vancomycin
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

24. What does hypocapnia cause in teh brain? What is hypocapnia?
Radial nerve damage
Acute gastric mucosal defects (superficial or full thickness)
Susceptible; soluble (unable to be cultured in bile)
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

25. how does noise induced hearing loss occur?
Trauma to stereociliated hair cells of the organ of corti
Fat - fertile - forty - female
11
CMV - HSV 1 - Candida

26. What does VIP do to gastric acid secretion?
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Inhibits it
Insulin like growth factor 1 (just another name)
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

27. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Tzanck smear
Become beta pleated and then form neurofibrillary tangle!
Little effect on cell and no change
Acute gastric mucosal defects (superficial or full thickness)

28. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
OCPs - multiparity - breast feeding
Phencyclidine (PCP)
only up to bronchi

29. What is the cause of fixed splitting of S2? why?
Reticulocytes
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
Congenital hypothyroidism - downs - amyloidosis - acromegaly
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

30. which antiarrythmic is associated with blue gray discoloration ?
Kallmans
Amiadarone
Vascular endothelium; protease
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

31. What are the two coagulase negative staphylococci? How do you distinguish them?
Kallmans
Trauma to stereociliated hair cells of the organ of corti
S. saprophyticus - and s. epidermidis; novobiocin
Right heart failure

32. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Drink plenty of fluids
Chorda tympani branch
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Sydenham chorea

33. What does NF- KB do?
Increases cytokine production
Hydrogen bonds dictate alpha or beta structure
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
indomethacin

34. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Elastance
Hexokinase
Diabetic microangiopathy
Chorda tympani branch

35. In What type of nephritis would you see high serum eos count?
ATP binding (resets the myosin head to contract again for next binding)
Excessive collagen formation during tissue repair in susceptible individuals
Drug induced interstitial nephritis
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

36. 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?
I is more benign and can present later in adulthood
200-500
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Common peroneal; bony fractures and compression; sciatic

37. What three pathogens cause infectious esophagitis in HIV positive patients?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Anterior nares
I is more benign and can present later in adulthood
CMV - HSV 1 - Candida

38. What is difference between Arnold Chiari type I and II?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
I is more benign and can present later in adulthood
Hydrogen bonds dictate alpha or beta structure
SVT; increases vagal tone; rectus abdominis

39. What type of vision is myopia? In What type of patients does it improve?
G to T in p53; HCC
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Superior larygeal; cricothyroid; recurrent laryngeal
Anti cholinergic effects of pupil dilation and lack of accomodation

40. after a thrombus extraction - what serum enzyme shoots up and why?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Become beta pleated and then form neurofibrillary tangle!
Serum creatine kinase; reperfusion injury causes necrosis
AV node slowest - to allow time for diastole

41. which headaches are seen mostly in men - are severe - unilateral - periorbital - episodic (around same time every day) - temporal pain - with lacrimation - nasal congestion and ptosis?
Inhibits it
Cluster
Pan colitis and right sided colitis (more than left sided and proctitis)
Env genes (for getting into target cells)

42. What causes curlings ulcers?
Medial part
RER; copper
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
RR-1/RR

43. at four years of age - What are the social - fine motor - gross motor - and language developments?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Strength of cell mediated immune response

44. What is the mc location of brain germinomas?What are the classic symptoms?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Vagus (auricular branch); vasovagal syncope!
Integration of viral DNA into genome of host hepatocytes
OCPs - multiparity - breast feeding

45. what hernia has a similar mechanism to hydrocele?
SSRI; erectile dysfunction
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Boiling - bleach - formalin - UV irradiation
Intussusception

46. how does increased ICP result in curlings ulcers?
Vagus nerve stimulation
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Leukotriene precursor and does neutrophil chemotaxis
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

47. What is contraindicated in toxic mega colon?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Smoking
Common peroneal; bony fractures and compression; sciatic
TCAs and prazosin

48. What are examples of action that decrease venous return to the heart?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Hypertension - edema - and proteinuria
Standing suddenly from supine position; valsalva maneuver
The time interval between S2 and OS- the shorter the interval - the more intense

49. What are the skin presentation in sarcoid?
Right heart failure
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Serum creatine kinase; reperfusion injury causes necrosis
Varying; erythema nodosum is common

50. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Sickle cell; G6PD
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
P53 mutation; DCC is also required for adenoma to carcinoma
Increase lymphatic drainage!