Usmle Qquiz 2

Front 1

how calculate water deficit for 75kg woman with [Na]= 160mEq/L ?

Back 1

1. find nl body water-- 60% x 75kg= 45L; 2. determine nl [Na] in this woman--45L x 140mEq/L (nl [Na]) = 6300mEq; 3. current TBW= nl body [Na]/current [Na]--6300meQ/160mEg/L = 39L; 4. subtract

Front 2

what is Nelson's syndrome?

Back 2

excessive secretion of ACTH from a pituitary adenoma after b/l adrenalectomy to treat Cushing's--> extreme hyperpigmentation (adenoma no longer restrained by cortisol suppression)

Front 3

edema plus frothy urine suggests?

Back 3

nephrotic syndrome (urine with high protein is more able to form stable bubbles)

Front 4

what test reflects basic and higher level cognitive and neuro-sensory functioning of entire brain--good for post CNS trauma evals

Back 4

Halstead-Reitan battery

Front 5

significance of riluzole

Back 5

used in ALS, maybe extends survival/time til tracheostomy; MOA unknown

Front 6

glioblastoma multiforme characterized by? (stage-esque)

Back 6

brisk mitotic rate, multifocal necrosis, extreme nuclear pleomorphism (most common and most malignant of primary CNS neoplasms; astrocytoma)

Front 7

retropharyngeal space between what fascias?

Back 7

buccopharyngeal fascia and prevertebral fascia

Front 8

why HTN in adult polycystic kidney dz?

Back 8

cysts impair perfusion of glomeruli--> JGs release renin

Front 9

inheritance of NF1?

Back 9

AD with high penetrance but variable expressivity

Front 10

maximal ventricular Na+ channel conductance corresponds to what phase of AP and what phase of ECG?

Back 10

phase 0, QRS interval

Front 11

lancet-shaped gram positive cocci?

Back 11

strep pneumo

Front 12

boundaries of popliteal fossa

Back 12

biceps femoris (superiorlat); semimembranosus, semitendinosus (superomed); 2 heads of gastroc (inferolat/med)

Front 13

stage III of HL defined by?

Back 13

involvement of lymph nodes or extralymphatic organs on both side of diaphragm)

Front 14

A vs B in staging of HL?

Back 14

if constitutional sxs--> B; if not--> A

Front 15

Stave IV of HL defined by?

Back 15

multiple or disseminated dz foci in extralymphatic organs or tissues

Front 16

inability to "look down", distinctive axial rigidity, poverty of movement, dysarthric speech but better memory and intellect than initially apparent--> ?

Back 16

progressive supranuclear palsy (due to widespread neuronal loss and gliosis in subcortical sites)

Front 17

amyloid assoc'd with chronic hemodialysis?

Back 17

beta 2 microglobulin (related to high plasma levels)

Front 18

amyloid assoc'd with neuropathic hereditry syndromes

Back 18

prealbumin/transthyretin

Front 19

what is Ames test used for?

Back 19

to evaluate the mutagenicity of a compound; (bacteria w/mutations that prevent synthesis of his exposed to compound and then plated on his-free medium. How much reversion?)

Front 20

most common primary site of oral squamous cell carcinoma?

Back 20

floor of mouth

Front 21

most common site for development of embryonal rhabdomyosarcoma?

Back 21

head and neck

Front 22

clawing of toes with flexion of IP jnts and extension of MTP jnts due to atrophy of what muscles?

Back 22

lumbricals and interossei

Front 23

what is mellitin?

Back 23

found in bee venom, can cause direct degranulation of mast cells--> severe reaction to bee sting

Front 24

significance of amoxipine?

Back 24

TCA assoc'd with development of NMS

Front 25

conditions that can cause enamel hypoplasia (6)

Back 25

excess fluoride, inadequate calcium, inadequeate phosphorous, vit def (A, C, D); hypothyroidism; hypoparathyroidism

Front 26

what are aphthous ulcers?

Back 26

very common and exquisitely painful lesions of oral mucosa; etiology unclear; small necrotic shallow ulcers with erythematous border

Front 27

"negative" birefringence means

Back 27

appears yellow when parallel to polarizer, blue when perpendicular

Front 28

"locked in" syndrome often due to stroke to what artery?

Back 28

basilar (lg lesions in brainstem, at base of pons)

Front 29

ketorolac

Back 29

analgesic indicated for short term management of moderate pain. Similar to morphone but fewer GI and CNS effects; contraindicated for minor or chronic pain; serious ADR: hematologic toxicity

Front 30

therapy with what can significantly lower ammonia levels?

Back 30

lactulose--colonic metabolism generates short chain FA which lower the pH and ammonia protonated and trapped in GI

Front 31

what is daclizumab?

Back 31

monoclonal Ab with high affinity for IL-2 R on activated T cells

Front 32

MOA of sirolimus

Back 32

inhibits T cell proliferation by binding serine-threonine kinase (mTOR) which is necessary for cell cycle progression

Front 33

small patches of fibrosis and vacuolization of damaged myocytes (usually subendocardial) assoc'd with what heart condition?

Back 33

repeated episodes of stable angina

Front 34

most sensitive indicator of recent alcohol abuse?

Back 34

serum gamma-glutamyltranspeptidase

Front 35

pec major action?

Back 35

adduct and internally rotate humerus

Front 36

what nerve lies in tonsillar fossa?

Back 36

CN IX

Front 37

basophilic rhomboid crystals assoc'd with?

Back 37

pseduogout, deposition of calcium pyrophosphate crystals

Front 38

Potter syndrome usually caused by?

Back 38

failure of ureteric buds to develop.

Front 39

what percentage of Down syndrome pts have congenital CV dz?

Back 39

20 percent

Front 40

treatment of choice for HACEK endocarditis?

Back 40

ceftriaxone

Front 41

ab distension and tendernes + septicish findings in low birth wt baby just started on formula suggests?

Back 41

necrotizing enterocolitis; would find gangrene of terminal ileum and ascending colon

Front 42

painless enlargment of testis + elevated LDH suggests?

Back 42

seminoma

Front 43

pathophys of malignant hyperthermia

Back 43

AD, mutation in ryanodine R-gated calcium channel in SR of sk mm--> increased sensitivty to halothane and depolarizing agents

Front 44

classic PAN vs microscopic polyangiitis

Back 44

for one thing, classic is p-ANCA negative but microscopic is p-ANCA positive

Front 45

delta waves?

Back 45

low frequency high amplitude waveforms that herald arrival of stage 4 sleep (deepest type of nonREM)

Front 46

sleep spindles and K complexes characteristic of what stage of sleep?

Back 46

stage 2

Front 47

what is Leigh disease?

Back 47

subacute necrotizing encephalomyelophaty; v rare dz of mitochondrial DNA defect; often cytochrome oxidase def.; muscle and brain particularly affected

Front 48

what is CagA?

Back 48

pathogenicity island in dz-causing strains of H. pylori, contains cytotoxin assoc'd gene A and type II secretory system that injects CagA protein into host cells

Front 49

MOA of mycophenolate mofetil

Back 49

inhibits purine synthesis; convereted to active metabolite mycophenolic acid which inhibits de novo synthesis of guanine

Front 50

what thyroid dz --> increased risk of developing thyroid lymphoma?

Back 50

Hashimoto

Front 51

how does re-epithelialization occur when large areas of epidermis has been lost but dermis intact?

Back 51

ingroth of epidermal cells from underlying skin appendages (b/c have epi stem cells)

Front 52

most common side effect for treatment of person with antibodies to Delta agent?

Back 52

delta agt--assoc'd with active chronic Hep B. treatment is IFN. Side effect--depression

Front 53

what type of breast cancer has best prognosis?

Back 53

tubular carcinoma (well-formed tubules often mistaken for benign)

Front 54

Menkes dz due to?

Back 54

deficienct cross-linking of collagen fibers secondary to copper deficiency

Front 55

Menkes dz characterized by?

Back 55

depigmented lusterless hair, facial deformities (sagging cheeks, ears), depressed nasal bridge, high arched palate, seizure-like activity

Front 56

multiple localized whorls of CT plus precocious puberty

Back 56

McCune-Albright syndrome; polyostotic fibrous dysplasi, aslo café au lait (coast of Maine) skin macules

Front 57

anastomoses b/t foregut arterial supply and midgut arterial supply?

Back 57

superior pancreaticoduodenal artery (celiac trunk's common hepatic)) and inferior pancreaticoduodenal artery (SMA)

Front 58

hypnagogic vs hypnopompic hallucinations

Back 58

hypnagogic--on going to sleep; hypnapompic--on waking

Front 59

branchial sinus due to?

Back 59

incomplete obliteration of 2nd pharyngeal cleft

Front 60

which salivary gland is a)mostly mucinous? B) mostly serous?

Back 60

a) sublingual glad-mucinous; b) parotid gl-serous (submandibular--mixed)

Front 61

aprepitant-MOA and use?

Back 61

NK1 antagonist approved for chemotherapy induced N/V

Front 62

what is dronabinol?

Back 62

orally active cannabinoid used for chemotherapy induced N/V

Front 63

retinal angiomas seen in?

Back 63

von Hippel-Lindau dz

Front 64

embolization from infective endocarditis typcially causes?

Back 64

multiple, small parietal lob abscesses--> defect in spatial recog (depending on dominance)

Front 65

what is calreticulin?

Back 65

quality control chaperone in rER that binds misfolded membrane proteins; binds to oligosaccharides containing terminal glucose residues

Front 66

omalizumab?

Back 66

monoclonal Ab that binds human IgE and prevents release of mast cell mediators, etc. indicated for pts 12ys old+, mod-severe persistent asthma, sxs not controlled with 'roids

Front 67

name the muscle: arises from medial and lateral processes of calcaneus, inserts into lateral side of 5th toe prox phalanx

Back 67

abductor digiti minimi (lateral plantar n; helps act as "spring" during walking)

Front 68

secondary follicle defined by?

Back 68

formation of antrum (follicular cavity) with several layers of follicular cells

Front 69

what is confined placental mosaicism

Back 69

consequence of genetic aberration occurring in trophoblast or in extraembryonic progenitor cellsin inner cell mass-->abnl placental development and intrauterine growth retardation;

Front 70

uterus smooth muscle has what receptors?

Back 70

alpha 1 and beta 2

Front 71

what is a Warthin-Finkeldey giant cell?

Back 71

a giant cell with eosinophilic cytoplasmic and nuclear inclusion bodies, created by fusion of lymphocytes; pathognoonic for measles/live attenuated measles vaccine

Front 72

lamellar bodies within macrophages in DIP composed of?

Back 72

sufactant

Front 73

what nerve supplies anterior half of external ear canal?

Back 73

auriculotemporal nerve (CN V3 branch)

Front 74

what nerve supplies posterior half of external ear canal?

Back 74

auricular branch of vagus

Front 75

what nerve supplies cranial surface of upper part of auricle?

Back 75

lesser occipital nerve (ventral ramus of C2)

Front 76

what nerve supplies the lower part of the auricle

Back 76

greater auricular nerve (C2,C3)

Front 77

adult polycystic kidney dz--what csome? What gene? What gene product?

Back 77

csome 16, PKD1 mutation for polycystin 1 (a transmembrane protein involved in cell-matric interactions)

Front 78

truncal ataxia with headache and h/o smoking suggests?

Back 78

intracranial lung met to cerebellar vermis

Front 79

of the -cyclovirs, which has not been indicated for use in immunocompromised?

Back 79

valacylcovir--b/c assoc'd with TTP and HUS

Front 80

anti-RNP suggests?

Back 80

mixed connective tissue dz

Front 81

general organization of vental horn (lamina IX) wrt prox/distal and ext/flex?

Back 81

alpha motor neurons to trunk/prox--medial; to distal--lateral; to extensors--anterior; to flexors--posterior

Front 82

2 principal causes of rapidly progressive glomerulonephritis?

Back 82

anti-glomerular basement membrane (goodpasture's and isolate anti-GBM) ; and primary systemic vasculitis (Wegener's, microscopic polyarterirts, etc)

Front 83

mean is greater than median in what kind of distribution?

Back 83

positively skewed

Front 84

classic signs of congenital syphilis

Back 84

cleft palate, rhinitis, desquamating rash

Front 85

monoclonal abs against what have been shown to ameliorate effects of endotoxin shock?

Back 85

anti TNFalpha

Front 86

what is a worry when treating congenital syphilis (or any serious gram negative infection)

Back 86

Jarisch-Herxheimer reaction--LPS released from bugs--> endotoxin shock (give anti-TNFalpha)

Front 87

most common site of oral cancer?

Back 87

lower lip. If in mouth cavity--floor of mouth

Front 88

initial drug of choice in status epilepticus?

Back 88

diazepam

Front 89

palivizumab

Back 89

monoclonal antibody against the fusion protein of RSV

Front 90

tx for RSV in babies?

Back 90

ribavarin or palivizumab (ab against fusion protein of RSV)

Front 91

examples of permanent cells in adult human

Back 91

cardiac myocytes and neurons (have left cell cycle and can no longer undergo mitotic division)

Front 92

arteriolar rarefaction

Back 92

dissolution and loss of arterioles believed to result from longterm over-perfusion of tissues; seen in malignant HTN

Front 93

delayed separation of umbilical cord and omphalitis (infection of cord) are common manifestations of?

Back 93

leukocyte adhesion deficiency. LAD1--recurrent funaly/bacterial infections ,mutation in gene for C18 beta-2-leukocyte integrin subunit

Front 94

corneal reflex--afferent? Efferent?

Back 94

afferent--V1; efferent--facial

Front 95

decreased ESR seen in?

Back 95

polycythemia. ESR measures how fast RBC settle out. Also seen in sickle cell and CHF

Front 96

borderline personality disorder characterized by?

Back 96

short term psychotic episodes, self mutilation, "splitting", markely unstable interpersonal relationships

Front 97

serious cardiovascular complications of FXS?

Back 97

MVP and aortic root dilation