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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. If a patient has higher levels of HbF - What does this mean?
Lateral; RV; RA; LV
Right before diastole (filling begins)
Think Hb deformation diseases
Single adenomatous ones

2. what indicates the severity of a mitral regurg ? mitral stenosis?
No only for prophylaxis (even for treating staphylococcal endocarditis its as multi drug); this is to prevent drug resistance from spontaneous mutations by DNA dependent RNA polymerase
Amiadarone
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)
S3 gallop; S2 to opening snap interval

3. where are Beta 1 receptors found?
Terminal bronchioles; small bronchi
On cardiac tissue and renal juxtaglomerular cells
Large stroke volumes with ventricular contraction; aortic regurg
GI tract; mood!

4. at one year of age - What are the social - fine motor - gross motor and language developments?
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
Initiation - pointing; pincer grasp; walking; mama/dada
Hydrogen bonds dictate alpha or beta structure
Insulin like growth factor 1 (just another name)

5. What causes the blurry vision side effects in first generation anti histamines?
Reiter syndrome; B27
ZDV or AZT
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Anti cholinergic effects of pupil dilation and lack of accomodation

6. how much percent of sodium is excreted? urea? glucose?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
<1% - 55% - concentration dependent
Faulty positioning of the genital tubercle

7. a patient fearing all white coats is a phenomenon of what?
Hyperkalemia; potassium sparing diuretics - potassium supplements
Ketone body production by preventing fatty acids into the mitochondria
Classical conditioning
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

8. How do you calculate RPF from urine PAH?
Hypertension - edema - and proteinuria
(urine PAH x urine flow rate)/plasma PAH
Serum FFA and serum triglyceride levels
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

9. what drugs causes the red man syndrome? how does it occur?
Vancomycin; histamine mediated
Right heart failure
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 the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

10. What is the sole neurologic manifestation of acute rheumatic fever?
Cluster
low in serum
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Sydenham chorea

11. in overweight individuals What is thought to contribute to insulin resistance?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Serum FFA and serum triglyceride levels
IgE
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

12. What is easiest way to treat nephrolithiasis?
Drink plenty of fluids
Purkinje system; AV node
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
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

13. What is achalasia and how would this correlate on the esophageal mannometry?
MAO inhibitors; wine and cheese
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Tibial
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

14. What is epleronone?
Prepatellar
Another type of aldosterone antagonist (like spironolactone)
RBC mass; epo levels (secondary has high)
Become beta pleated and then form neurofibrillary tangle!

15. What is the presentation of angioedema? Where is most commonly affected?
Right heart failure
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

16. are there signs of inflammation in avascular necrosis? then How do you diagnose?
Drink plenty of fluids
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Hereditary angioedema; ACE inhibitors
No; MRI

17. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
glycerol kinase
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
frameshift mutations (missense is substitution)

18. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Valproate
liver specific
chronic urticaria and allergic symptoms
Inactivates kallikrein which activates kininogen into bradykinin

19. why does hypothyroidism cause increased CPK levels?
Headaches and facial flushing; vasodilation in meninges and skin
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Syringomelia
Vertical diplopia

20. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
differentiate
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)
Circular - outside nucleus; transport proteins - rRNA - tRNA
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

21. What causes curlings ulcers?
Spongiosis
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
The time interval between S2 and OS- the shorter the interval - the more intense

22. In what view of CXR is anterior part of heart best seen? anterior part of heart is formed by?right border of heart is formed by? left border?
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
Trochlear nerve (IV); abducens nerve (VI)
Lateral; RV; RA; LV
Syncope - angina - dyspnea (SAD)

23. What are pancreatic pseudocysts called pseudo rather than true cysts?
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Not lined by epithelium
Neisseria induced small cell vasculitis (including hands and soles)

24. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
Well
CGD; t cell dysfxn (diGeorge)
8 (myc protein) with 2 - 14 - 22 (iG chains)
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

25. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
glycerol kinase
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

26. What test would be best to determine if a gene is being transcribed? translated?
Thymic tumor
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Purkinje system; AV node
Southern - western

27. What is difference between Arnold Chiari type I and II?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
I is more benign and can present later in adulthood
Phencyclidine (PCP)
Medial circumflex artery; avascular necrosis

28. What can too much IgA in serum produces?
200-500
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
SVC and IVC; right below the aortic knob
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

29. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
Anterior nares
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
P53 mutation; DCC is also required for adenoma to carcinoma

30. how does noise induced hearing loss occur?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Trauma to stereociliated hair cells of the organ of corti
Bile salt accumulation in urine

31. in the LV and aorta - What are the pressures?
Normally close to systolic
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Reticulocytes
Increases

32. how can HAV be inactivated?
Ether and other organic solvents
Boiling - bleach - formalin - UV irradiation
Insulin like growth factor 1 (just another name)
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

33. What is a cord factor and Which bugs have it? How do they appear on culture?
Dihydropyridine sensitive Ca channels (L type)
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
On cardiac tissue and renal juxtaglomerular cells
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

34. How do bradykinin - C3a and C5a cause edema?
Diabetic microangiopathy
...
Relfex tachycardia; giving beta blockers
By vascular permeability and vasodilation

35. What does NF- KB do?
CGD; t cell dysfxn (diGeorge)
Drink plenty of fluids
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Increases cytokine production

36. What does the severity of leprosy depend on?
Reticulocytes
SSRI
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Strength of cell mediated immune response

37. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
Chrom 8
Decreases both
Acute interstitial nephritis
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

38. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
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)

39. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Phencyclidine (PCP)
Trochlear nerve (IV); abducens nerve (VI)
Amiadarone
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

40. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
G to T in p53; HCC
Raphe
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

41. what drug is useful for secretory diarrhea?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Octreotide
Curlings ulcers
When it invades the bm; carcinoma in situ

42. what defines hypoxemia?
Pulmonic and systemic!
SaO2 <92%
Drug induced interstitial nephritis
Duration and extent of disease

43. What is contraindicated in toxic mega colon?
Hypothyroidism
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Not lined by epithelium

44. PDAs are often asymptomatic. How do you treat?
Nonsense; mRNA processing
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)
Little effect on cell and no change
indomethacin

45. What are the skin presentation in sarcoid?
Increases cytokine production
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
Inhaled animal dander allergens
Varying; erythema nodosum is common

46. How do you calculate atributable risk percent?
RR-1/RR
Increase in permeability of two ions with equal and opposite equilibrium potentials
Localized dermatologic pain that persists for more than one month after zoster eruption
Ceftriaxone; azithromycin

47. ___________ is liver specific
Large stroke volumes with ventricular contraction; aortic regurg
glycerol kinase
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

48. What does sustained hand grip do to the C/V system?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Trauma to stereociliated hair cells of the organ of corti
Abnormal closing of the urethral folds
Common and benign congenital disorder characterized by cystic dilation of the medullary collecting ducts (cortex is spared); painless hematuria or asymptomatic; mc is development of kidney stones (benign disease)

49. What is the stabilizing force for the secondary structure of proteins?
ZDV or AZT
Turners`
Bronchogenic carcinoma
Hydrogen bonds dictate alpha or beta structure

50. What are the three causes of acute MI in context of normal coronary arteries ?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Well
differentiate
On cardiac tissue and renal juxtaglomerular cells