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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. In what population does cholelithiasis occur?
8; 12
Fat - fertile - forty - female
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
Elevated GGT and macrocytosis

2. What is a keloid?
Tissue redistribution (out of plasma) rather than metabolism
MAC complex (C5b - C9 complement deficiency)
Excessive collagen formation during tissue repair in susceptible individuals
glycerol kinase

3. How do you calculate RPF from urine PAH?
HSV ( also in utero: chlymadia - neisseria - group B strep)
I is more benign and can present later in adulthood
(urine PAH x urine flow rate)/plasma PAH
Pulmonic and systemic!

4. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Drink plenty of fluids
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)
Increases
Reiter syndrome; B27

5. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Hexokinase
P53 mutation; DCC is also required for adenoma to carcinoma
To pump calcium out in cardiac myocytes so that relaxation occurs
Atrial

6. 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?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
AV node slowest - to allow time for diastole
Cluster

7. What translocations can cause c - myc overexpression?
Pain reliever - reduces pain by locking substance P in the PNS
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Enterococci (e. faecalis)- found on genitalia area
8 (myc protein) with 2 - 14 - 22 (iG chains)

8. IL4 is used for isotypye switching to what?
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)
IgE
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Leukotriene precursor and does neutrophil chemotaxis

9. What are the lab findings in poststreptococcal GN?
Sarcoid
11 aa polypeptide; pain NT in CNS and PNS
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

10. What type of vision is myopia? In What type of patients does it improve?
liver specific
Vancomycin
Fibronectin - laminin - collagen
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

11. What does sustained hand grip do to the C/V system?
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
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Mean greater than median greater than mode
Trauma to stereociliated hair cells of the organ of corti

12. What is subacute sclerosisng encephalitis caused by?
Classical conditioning
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
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
S. aureus

13. When is acid phosphatase elevated (Name two times)?
Prostate tumor and increased osteoclast activity
Serum creatine kinase; reperfusion injury causes necrosis
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
In the extracellular space

14. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
25; 25
By vascular permeability and vasodilation
E. coli; staphylococcus saprophyticus
Because of the low output from heart failure - they will have increased aldosterone levels

15. What can too much IgA in serum produces?
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Little effect on cell and no change
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

16. What are two common side effects of both acute and long acting nitrates? What causes them?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Regular insulin (Not fast acting - regular better)
Aromatase deficiency in child
Headaches and facial flushing; vasodilation in meninges and skin

17. What is the mcc of extrinsic allergic asthma?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Radial nerve damage
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
Inhaled animal dander allergens

18. Where does conjugation of bilirubin take place?
In ER of bile canaliculi
AV node slowest - to allow time for diastole
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
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

19. What is hyaline arteriosclerosis usually a sign of ?
Diabetic microangiopathy
Not lined by epithelium
TCAs and prazosin
P53 mutation; DCC is also required for adenoma to carcinoma

20. on What part of the clavicle does the SCM attach?
Paramyxo and influenza
Medial part
An invagination of portion of intestine into the lumen of the adjacent intestinal segment; can lead to impaired venous return from the invaginated segment of the bowel which can cause ischemia and subsequent necrosis
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

21. how does eos release MBP to kill protozoa etc?
Nocardia
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Paramyxo and influenza
Thymic tumor

22. What is achalasia and how would this correlate on the esophageal mannometry?
Measure of depth invasion (vertical!)
Prostate tumor and increased osteoclast activity
No (unlike adenomyosis); yes
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

23. why are beta thal major patients asymptomatic at birth?
Barium enema
Because gamma chains replace beta chains and then gamma chain formation wanes
As a CO2 carrier with the carboxylase enzyme
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

24. which nerve provides innervation for plantar flexion and inversion?
Tissue redistribution (out of plasma) rather than metabolism
OCPs - multiparity - breast feeding
Hypertension - edema - and proteinuria
Tibial

25. What is cataplexy and When is it seen?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Because of the low output from heart failure - they will have increased aldosterone levels
Folic acid treatment!

26. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Atrial
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Highly negative resting potential

27. What does the severity of leprosy depend on?
Strength of cell mediated immune response
SVT; increases vagal tone; rectus abdominis
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
ZDV or AZT

28. What is congestive hepatomegaly specific for?
Right heart failure
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
No; MRI
Pan colitis and right sided colitis (more than left sided and proctitis)

29. What can cause virilization of a mother during pregnancy?
Aromatase deficiency in child
Lateral; RV; RA; LV
Prepatellar
Ceftriaxone; azithromycin

30. What is a cord factor and Which bugs have it? How do they appear on culture?
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Skin flushing and warmth; prostaglandins; give with aspirin
Syringomelia

31. What causes vertical diplopia? horizontal?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Trochlear nerve (IV); abducens nerve (VI)
Gluteus maximus; difficulty getting up from seated position and climbing chair
Sarcoid

32. What does extended consumption of appetite suppressants lead to?
Ceftriaxone; azithromycin
Minimal change disease
Pulmonary hypertension
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

33. What effects does cortisol have on catecholamines?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Permissive - sensitizes vasoconstrictive response from catecholamines - doesnt actually act on them but increases transcription of some genes that creates permissive effect (not additive or synergistic becuase cortisol alone doesnt have any effect on
Hypo or hyper pigmentations; after tanning
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

34. Which is faster purkinje system or atrial muscle?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Close but purkinje system to ensure contraction in a bottom up fashion
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase

35. Where does lysyl oxidase act? What is the cofactor for that?
Transported to liver - glycerol kinase converts it to glycerol 3 phosphate Which is then converted to DHAP which can either join glycolysis for ATP or be used to make glucose
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
By vascular permeability and vasodilation
In the extracellular space for collagen cross linking; zinc

36. What is acanthosis nigricans associated with?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
GI malignancies and Insulin resistance (acromegal for ex)
Tzanck smear
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

37. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
No and yes
Recurrent larygneal
IgE
RER; RER

38. What is the neurologic manifestation of ADPKD?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Increases cytokine production
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

39. which RPGN is also called pauci immune GN? why?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
RER; copper
ANCA because of lack of Ig and C3 deposits on IF
II; I (I more abundant)

40. What is the difference between additive and synergistic?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Joints d/t increased purine production and thus uric acid production
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
No

41. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
Faulty positioning of the genital tubercle
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
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

42. Which nerve lies in close proximity to the inferior thyroid artery?
Downs; regurgitant AV valves - ASDs
Recurrent larygneal
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

43. What is the most common initital symptom of ADPKD? what else?
Adductor
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Reiter syndrome; B27
Increase; decreased

44. erythema nodosum - elevated ACE - scattered granulomas - arthralgias - hilar lymphadenoapthy are indicative of what?
Sarcoid
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Insulin like growth factor 1 (just another name)
Retinitis; mononucleosis

45. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
C3 decreased after 5-10 days; sulfonamides
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Faulty positioning of the genital tubercle

46. which are the only glycosylated proteins in HIV virus?
Drink plenty of fluids
Common peroneal; bony fractures and compression; sciatic
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Env genes (for getting into target cells)

47. which two drug types can cause orthostatic hypotension (think depression and BPH)?
Faulty positioning of the genital tubercle
TCAs and prazosin
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

48. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
OCPs - multiparity - breast feeding
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
CGD; t cell dysfxn (diGeorge)
RER; copper

49. What is the mainstay treatment for acute mania?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Coagulation factors are made in the liver
Biphosphonate
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

50. do Class IC agents prolong the QT interval?
No
When it invades the bm; carcinoma in situ
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Barium enema