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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 mc location for avascular necrosis? What is it associated with?
Well trained athletes and children
Relfex tachycardia; giving beta blockers
AV node slowest - to allow time for diastole
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

2. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
8 (myc protein) with 2 - 14 - 22 (iG chains)
Curlings ulcers
liver specific
Because of vasodiation to skeletal muscles

3. the rate of blood flow of which two circulations must equal each other at all times?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
glycerol kinase
Pulmonic and systemic!
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

4. What can cause aortic regurg? What is the heart sound you hear?
SVC and IVC; right below the aortic knob
Right before diastole (filling begins)
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Initiation - pointing; pincer grasp; walking; mama/dada

5. What is a cord factor and Which bugs have it? How do they appear on culture?
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)
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

6. 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?
RER; copper
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Common peroneal; bony fractures and compression; sciatic
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

7. How is dobutamine better than dopamine?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Serum creatine kinase; reperfusion injury causes necrosis
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
SSRI

8. which virus inactivates both Rb and p53?
Diabetic microangiopathy
ANCA because of lack of Ig and C3 deposits on IF
Drink plenty of fluids
E6 and E7 of HPV knock off p53 and Rb suppressor genes

9. What translocations can cause c - myc overexpression?
Acute gastric mucosal defects (superficial or full thickness)
8 (myc protein) with 2 - 14 - 22 (iG chains)
11 aa polypeptide; pain NT in CNS and PNS
Abnormal closing of the urethral folds

10. SIADH patients have normal blood volume but...
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
gram positive organisms
Little effect on cell and no change
hyponatremia (aldosterone activation equilibrates body volume)

11. What is mcc of death pre hospital phase of MI? in hospital phase?
Hereditary angioedema; ACE inhibitors
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
V fib; v. failure
differentiate

12. which RPGN is also called pauci immune GN? why?
ANCA because of lack of Ig and C3 deposits on IF
...
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
RR-1/RR

13. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Chorda tympani branch
TCAs and prazosin
Gluteus maximus; difficulty getting up from seated position and climbing chair
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

14. How do you calculate RPF from urine PAH?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
(urine PAH x urine flow rate)/plasma PAH
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

15. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
Syringomelia
Gluteus medius and minimus; positive trendelenberg
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
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

16. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Class I
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Turners`
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

17. name three pathological states that present with large tongues.
Congenital hypothyroidism - downs - amyloidosis - acromegaly
II; I (I more abundant)
RBF= PAH clearance/(1- hematocrit)
Gluteus medius and minimus; positive trendelenberg

18. which cells produce surfactant? which ones mediate gas exchange?
Primary
indomethacin
II; I (I more abundant)
Covalent (between two cysteines)- allows protein to withstand denaturation

19. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
E. coli
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Inhibits it
HSV ( also in utero: chlymadia - neisseria - group B strep)

20. What is tachyphylaxis?
Hyperkalemia; potassium sparing diuretics - potassium supplements
RBC mass; epo levels (secondary has high)
The term used to describe decreased drug responsiveness with repeated administration
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac

21. What is the neurologic manifestation of ADPKD?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
8; 12
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

22. What causes curlings ulcers?
Retinitis; mononucleosis
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Pulmonic and systemic!

23. What antibiotic is best to treat alcoholic pulm infections? why?
G to T in p53; HCC
Folic acid treatment!
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Integration of viral DNA into genome of host hepatocytes

24. What agonists reduce the gradient across the LV outflow tract?
Selective alpha 1 (increases SVR)
As a CO2 carrier with the carboxylase enzyme
Large stroke volumes with ventricular contraction; aortic regurg
Terminal bronchioles; small bronchi

25. What is the most important prognostic indicator in patients with malignant melanoma?
Superior larygeal; cricothyroid; recurrent laryngeal
Leukotriene precursor and does neutrophil chemotaxis
Measure of depth invasion (vertical!)
Tissue redistribution (out of plasma) rather than metabolism

26. What are diastolic (lowest) pressures in aorta? LV?
Around 70 (normal measured diastolic pressures); 9--
Bile salt accumulation in urine
Abnormal closing of the urethral folds
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

27. on What part of the clavicle does the SCM attach?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
To pump calcium out in cardiac myocytes so that relaxation occurs
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Medial part

28. What is a primary HSV 1 infection like?
G to T in p53; HCC
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Abnormal closing of the urethral folds
Normally close to systolic

29. What are the acute effects of corticosteroids on the CBC?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
P450 mitochondrial monooxygenase
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

30. Which is faster purkinje system or atrial muscle?
Chlorpheniramine and diphenhydramine
Close but purkinje system to ensure contraction in a bottom up fashion
Ketone body production by preventing fatty acids into the mitochondria
Varying; erythema nodosum is common

31. what protein is increased in Crohns disease? What does it do?
No and yes
NF- KB; responsible for cytokine production
Nocardia
Amiadarone

32. what happens to sperm count and semineferous tubules in patient with cryptoorchidism? hormonal function? why do they need to be surgically descended?
Another type of aldosterone antagonist (like spironolactone)
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Anti - apoptotic (prevents going into apoptosis)- 18; 14
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

33. What does 'oxygen' content in blood refer to?
8 (myc protein) with 2 - 14 - 22 (iG chains)
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Dissolved in plasma and attached to Hgb

34. What is omalizumab and What is it used for?
Multiple miscarriages d/t hypercoaguability
Apocrine; eccrine
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

35. do Class IC agents prolong the QT interval?
C3 decreased after 5-10 days; sulfonamides
No
Raphe
Underestimation of gestational age

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

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37. What is cataplexy and When is it seen?
Prevent phagocytosis
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Regular insulin (Not fast acting - regular better)

38. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
OCPs - multiparity - breast feeding
Dissolved in plasma and attached to Hgb
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

39. within the right atrium - What is the maximum pressure? left atrium?
APP on chrom 21 (this is why downs more susceptible)
Primary
8; 12
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

40. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
Nocardia
When it invades the bm; carcinoma in situ
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Headaches and facial flushing; vasodilation in meninges and skin

41. What are the first generation anti histamines?
Downs; regurgitant AV valves - ASDs
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Chlorpheniramine and diphenhydramine

42. What is the most common cause of pyelonephritis in both adults and childre?
Faulty positioning of the genital tubercle
Both sides
E. coli
G to T in p53; HCC

43. other than proteinuria - What can cause foamy froathy urine?
Closer to head; closer to diaphragm
Bile salt accumulation in urine
RBF= PAH clearance/(1- hematocrit)
Increases bronchial and vascular smooth muscle reactivity to catecholamines

44. What does protein M do in Group A strep<
G to T in p53; HCC
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Prevent phagocytosis
GI tract; mood!

45. what hernia has a similar mechanism to hydrocele?
Diabetic microangiopathy
Nocardia
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

46. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Hereditary angioedema; ACE inhibitors
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Bronchogenic carcinoma
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

47. What is the best indicator for the severity of mitral stenosis?
Neisseria induced small cell vasculitis (including hands and soles)
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
The time interval between S2 and OS- the shorter the interval - the more intense
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

48. What can long term leg cast wearing cause?
Barium enema
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
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
CMV - HSV 1 - Candida

49. In what population does cholelithiasis occur?
Fat - fertile - forty - female
Skin flushing and warmth; prostaglandins; give with aspirin
Think Hb deformation diseases
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

50. What is achalasia and how would this correlate on the esophageal mannometry?
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
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
The term used to describe decreased drug responsiveness with repeated administration
HSV ( also in utero: chlymadia - neisseria - group B strep)