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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 primary determinants of colon cancer risk in UC patients
Duration and extent of disease
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Highly negative resting potential
GI malignancies and Insulin resistance (acromegal for ex)

2. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
Intussusception
Fibronectin - laminin - collagen
Enterococci (e. faecalis)- found on genitalia area
In the extracellular space for collagen cross linking; zinc

3. other than in pyelonephritis - where else are WBC casts seen?
Acute interstitial nephritis
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Increase by 50% in urine osmolality
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

4. What agonists reduce the gradient across the LV outflow tract?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Selective alpha 1 (increases SVR)
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

5. which cells produce surfactant? which ones mediate gas exchange?
Initiation - pointing; pincer grasp; walking; mama/dada
Hexokinase
Pain reliever - reduces pain by locking substance P in the PNS
II; I (I more abundant)

6. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Selective alpha 1 (increases SVR)
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
RBC mass; epo levels (secondary has high)

7. What are the three dopaminergic systems and What are they responsible for? disease?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
RBF= PAH clearance/(1- hematocrit)
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

8. How do you calculate atributable risk percent?
RR-1/RR
25; 25
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)
Anti - apoptotic (prevents going into apoptosis)- 18; 14

9. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
differentiate
MAO inhibitors; wine and cheese
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
In the extracellular space

10. what dissolves the lipid bilayer of a viral envelope?
NF- KB; responsible for cytokine production
Ether and other organic solvents
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Right before diastole (filling begins)

11. What is the preferred treatment for DKA?
Retinitis; mononucleosis
Regular insulin (Not fast acting - regular better)
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
MAO inhibitors; wine and cheese

12. What is the difference between paranoid personality disorder and delusional disorder?
E. coli
GI tract; mood!
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

13. what virus causes pharyngoconjuctival fever?
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
Adeno
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

14. What are the long term consequences of hydrocephalus?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Chlorpheniramine and diphenhydramine
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

15. What is difference between Arnold Chiari type I and II?
transcription activation/suppression
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
I is more benign and can present later in adulthood

16. What does the severity of leprosy depend on?
V fib; v. failure
Strength of cell mediated immune response
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
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

17. What are the two coagulase negative staphylococci? How do you distinguish them?
S. saprophyticus - and s. epidermidis; novobiocin
Acute interstitial nephritis
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

18. What is congestive hepatomegaly specific for?
Right heart failure
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
Strength of cell mediated immune response
SSRI

19. What is the fibrinogen level in patient with TTP- HUS? DIC?
The time interval between S2 and OS- the shorter the interval - the more intense
E. coli
Normal; low
Gluteus medius and minimus; positive trendelenberg

20. What causes release of myosin head from the actin filament?
Syncope - angina - dyspnea (SAD)
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
ATP binding (resets the myosin head to contract again for next binding)
Fibrosis; macrophages

21. What are the lab findings in poststreptococcal GN?
Anti centromere; anti DNA topoisomerase
Fat - fertile - forty - female
LT (LTD4 - E4 - C4) - and Ach
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

22. What pulmonary structural change can kartageners syndrome cause?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Bronchial dilation (bronchiectasis)
When it invades the bm; carcinoma in situ
Vagus (auricular branch); vasovagal syncope!

23. What is the best indicator for the severity of mitral stenosis?
Sarcoid
SVC and IVC; right below the aortic knob
Ether and other organic solvents
The time interval between S2 and OS- the shorter the interval - the more intense

24. What are two indicators of chronic alcohol consumption?
hyponatremia (aldosterone activation equilibrates body volume)
Elevated GGT and macrocytosis
Downs; regurgitant AV valves - ASDs
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

25. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Become beta pleated and then form neurofibrillary tangle!
Increase by 50% in urine osmolality
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

26. which viruses require a protease?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
SS +rNA
Fibrosis; macrophages
Squatting - sitting - lying supine - passive leg raising

27. What are pancreatic pseudocysts called pseudo rather than true cysts?
Increase lymphatic drainage!
Not lined by epithelium
In ER of bile canaliculi
frameshift mutations (missense is substitution)

28. What is the mc location for avascular necrosis? What is it associated with?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Paramyxo and influenza
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Nonsense; mRNA processing

29. What is a keloid?
Superior larygeal; cricothyroid; recurrent laryngeal
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Excessive collagen formation during tissue repair in susceptible individuals

30. What test would be best to determine if a gene is being transcribed? translated?
Increased reticulocytes
Southern - western
Skin flushing and warmth; prostaglandins; give with aspirin
Brief psychotic disorder; schizophreniform; schizophrenia

31. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
25; 25
Both sides
ANCA because of lack of Ig and C3 deposits on IF

32. What does extended consumption of appetite suppressants lead to?
Pulmonary hypertension
Ether and other organic solvents
TCAs and prazosin
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

33. What is used to prevent vertical transmission of HIV?
ZDV or AZT
Pain reliever - reduces pain by locking substance P in the PNS
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Sudden loss of muscle tone without loss of consciousness; narcolepsy

34. What is somatomedin C?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
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)
Insulin like growth factor 1 (just another name)
Think Hb deformation diseases

35. What can long term leg cast wearing cause?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
8 (myc protein) with 2 - 14 - 22 (iG chains)
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
ATP binding (resets the myosin head to contract again for next binding)

36. how does increased ICP result in curlings ulcers?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Gluteus maximus; difficulty getting up from seated position and climbing chair
E. coli
Vagus nerve stimulation

37. What does p53 do? what chrom is it on?
Trauma to stereociliated hair cells of the organ of corti
Regular insulin (Not fast acting - regular better)
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Pulmonic and systemic!

38. what phase do adenosine and acetylcholine act on? doing what?
Chrom 8
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Drink plenty of fluids

39. what immune deficiency causes recurrent neisseria infections?
MAC complex (C5b - C9 complement deficiency)
Atrial
differentiate
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

40. how long is substance P? What does it do?
IgE
11 aa polypeptide; pain NT in CNS and PNS
Covalent (between two cysteines)- allows protein to withstand denaturation
RBC mass; epo levels (secondary has high)

41. Where does lysyl oxidase act? What is the cofactor for that?
S3 gallop; S2 to opening snap interval
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
Increase in permeability of two ions with equal and opposite equilibrium potentials
In the extracellular space for collagen cross linking; zinc

42. what defines hypoxemia?
Inhaled animal dander allergens
P450 mitochondrial monooxygenase
SaO2 <92%
8 (myc protein) with 2 - 14 - 22 (iG chains)

43. what locations of UC increase the risk of Colon cancer?
Nonsense; mRNA processing
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Prevents hepatic VLDL production
Pan colitis and right sided colitis (more than left sided and proctitis)

44. what clinical findings help distinguish small cell carcinoma?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Normally close to systolic
Curlings ulcers
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

45. Where does terminal peptide cleavage of collagen fibrils take place?
chronic urticaria and allergic symptoms
Kallmans
Rabies encephalitis from cave bats; rabies killed vaccines
In the extracellular space

46. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Tibial
Paramyxo and influenza
Medial part

47. Which is faster purkinje system or atrial muscle?
Close but purkinje system to ensure contraction in a bottom up fashion
TSh (in testicular tumors can cause hyperthyroidism)
Atrial
Boiling - bleach - formalin - UV irradiation

48. What is the Na/Ca exchange used for?
Enterococci (e. faecalis)- found on genitalia area
To pump calcium out in cardiac myocytes so that relaxation occurs
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Medial part

49. erythema nodosum - elevated ACE - scattered granulomas - arthralgias - hilar lymphadenoapthy are indicative of what?
Integration of viral DNA into genome of host hepatocytes
Proteasome inhibitor; treatment for MM and waldenstroms
Sarcoid
Well

50. which nerve provides innervation for plantar flexion and inversion?
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Tibial
C3 decreased after 5-10 days; sulfonamides
Bile soluble which means they are bile sensitive