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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 a clara cell?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Tissue redistribution (out of plasma) rather than metabolism
Increases cytokine production
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

2. What is diagnostic (and possible therapeutic for intussusception)?
Myasthenia gravis
SaO2 <92%
Barium enema
Increases bronchial and vascular smooth muscle reactivity to catecholamines

3. what vessel would a fracture to the neck of the of the humerus damage?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Measles and M3 AML`
Anterior circumflex (and axillary nerve)
Octreotide

4. other than proteinuria - What can cause foamy froathy urine?
Bile salt accumulation in urine
Around 70 (normal measured diastolic pressures); 9--
SSRI; erectile dysfunction
Hypertension - edema - and proteinuria

5. What is Tzanck smear used to detect?
Terminal bronchioles; small bronchi
HSV and VZV
TSh (in testicular tumors can cause hyperthyroidism)
Sudden loss of muscle tone without loss of consciousness; narcolepsy

6. How do bradykinin - C3a and C5a cause edema?
By vascular permeability and vasodilation
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
8 (myc protein) with 2 - 14 - 22 (iG chains)
Acute gastric mucosal defects (superficial or full thickness)

7. why should you not use ACE inhibitors with someone who had hereditary angioedema?
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
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Anterior nares
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

8. What does C1 esterase do other than inhibiting complement pathway?
Medial circumflex artery; avascular necrosis
Ketone body production by preventing fatty acids into the mitochondria
Inactivates kallikrein which activates kininogen into bradykinin
Downs; regurgitant AV valves - ASDs

9. do Class IC agents prolong the QT interval?
No
Primary
Protamine sulfate
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

10. carnitine deficiency impairs production of What and how?
Abnormal closing of the urethral folds
Duration and extent of disease
Ketone body production by preventing fatty acids into the mitochondria
RBF= PAH clearance/(1- hematocrit)

11. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Terminal bronchioles; small bronchi
Right before diastole (filling begins)
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

12. What is a cord factor and Which bugs have it? How do they appear on culture?
4 - 4 - 9
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Raphe
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

13. What does hypocapnia cause in teh brain? What is hypocapnia?
Smoking
In the extracellular space for collagen cross linking; zinc
Chrom 8
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

14. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
Class I
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Syncope - angina - dyspnea (SAD)
Become beta pleated and then form neurofibrillary tangle!

15. What are some side effects seen in TCAs?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Well trained athletes and children
Hypo or hyper pigmentations; after tanning
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

16. Which is faster atrial muscle or ventricular muscle?
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Atrial
By vascular permeability and vasodilation
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

17. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
No (unlike adenomyosis); yes
Criggler Najjar (UGT enzyme in bilirubin glucoronidation) ; Dubin Johnson (transport protein lacking - Black liver) and Rotor syndrome - defects in hepatic uptake and excretion of bile (numerous defect)
S. saprophyticus - and s. epidermidis; novobiocin
Reticulocytes

18. What is the best indicator for the severity of mitral stenosis?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
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
The time interval between S2 and OS- the shorter the interval - the more intense
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

19. what bursa is affected when on knees like a maid/gardner?
Prepatellar
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Radial nerve and deep brachial artery
Think Hb deformation diseases

20. What pulmonary structural change can kartageners syndrome cause?
Reiter syndrome; B27
Bronchial dilation (bronchiectasis)
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Paramyxo and influenza

21. What are the acute effects of corticosteroids on the CBC?
Normal; low
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin

22. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
Boiling - bleach - formalin - UV irradiation
SVT; increases vagal tone; rectus abdominis
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
Tissue redistribution (out of plasma) rather than metabolism

23. What is the most common initital symptom of ADPKD? what else?
No; MRI
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

24. which opponens muscle does ulnar innervate?
Adductor
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Joints d/t increased purine production and thus uric acid production
RBF= PAH clearance/(1- hematocrit)

25. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
differentiate
P53 mutation; DCC is also required for adenoma to carcinoma
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Inactivates kallikrein which activates kininogen into bradykinin

26. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
8; 12
P53 mutation; AD
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

27. What causes vertical diplopia? horizontal?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Apocrine; eccrine
Anterior circumflex (and axillary nerve)
Trochlear nerve (IV); abducens nerve (VI)

28. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
C3 decreased after 5-10 days; sulfonamides
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
ANCA because of lack of Ig and C3 deposits on IF

29. at one year of age - What are the social - fine motor - gross motor and language developments?
Initiation - pointing; pincer grasp; walking; mama/dada
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Inhibits it

30. sporadic colon cancer tend to arise From what type of polyps?
Syncope - angina - dyspnea (SAD)
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Single adenomatous ones
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

31. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
200-500
CGD; t cell dysfxn (diGeorge)
Increase; decreased
Insulin like growth factor 1 (just another name)

32. Would alpha 1 agonists cause flushing? muscarinic antagonist?
No and yes
No; MRI
No; yes
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

33. 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?
APP on chrom 21 (this is why downs more susceptible)
Lateral; RV; RA; LV
Pain reliever - reduces pain by locking substance P in the PNS
Enterococci (e. faecalis)- found on genitalia area

34. What is the triad seen in pre eclampsia?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Hypertension - edema - and proteinuria
Integration of viral DNA into genome of host hepatocytes
G to T in p53; HCC

35. Where does lysyl oxidase act? What is the cofactor for that?
In the extracellular space for collagen cross linking; zinc
Initiation - pointing; pincer grasp; walking; mama/dada
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Dihydropyridine sensitive Ca channels (L type)

36. What is medullary sponge kidney disease and how does it present? What does it lead to?
Ketone body production by preventing fatty acids into the mitochondria
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)
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
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

37. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
DIC; TTP- HUS dont bleed that much
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
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
SSRI

38. Where does 90% of serotonin lie? What is this NT responsible?
GI tract; mood!
Selective alpha 1 (increases SVR)
25; 25
Right before diastole (filling begins)

39. How do you calculate excretion rate of a substance? How do you calculate the filtration rate of a substance? clearance of what substance estimates the GFR?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
SVT; increases vagal tone; rectus abdominis
Tibial

40. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
Turbulence
Hexokinase
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
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

41. What does p53 do? what chrom is it on?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
The term used to describe decreased drug responsiveness with repeated administration
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

42. prostaglandin synthesis keeps...
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
PDA open
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
P53 mutation; DCC is also required for adenoma to carcinoma

43. in the LV and aorta - What are the pressures?
Vascular endothelium; protease
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Normally close to systolic
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

44. Where is conduction in heart fastest? slowest?
Purkinje system; AV node
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
low in serum
Think Hb deformation diseases

45. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Radial nerve and deep brachial artery
When it invades the bm; carcinoma in situ
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase

46. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Gluteus medius and minimus; positive trendelenberg
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Spongiosis
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

47. what drug is useful for secretory diarrhea?
SSRI
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Reticulocytes
Octreotide

48. name three pathological states that present with large tongues.
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Vascular endothelium; protease
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Another type of aldosterone antagonist (like spironolactone)

49. What is best to prevent GBS infection in a baby?
P53 mutation; DCC is also required for adenoma to carcinoma
Drug induced interstitial nephritis
Myasthenia gravis
INTRApartum Abs (ampicillin/penicillin)

50. What is 5- HETE and What does it do?
Close but purkinje system to ensure contraction in a bottom up fashion
Leukotriene precursor and does neutrophil chemotaxis
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Integration of viral DNA into genome of host hepatocytes