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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 causes release of myosin head from the actin filament?
ATP binding (resets the myosin head to contract again for next binding)
Trochlear nerve (IV); abducens nerve (VI)
S. saprophyticus - and s. epidermidis; novobiocin
Vertical diplopia

2. what protects the resting heart from arrhythmias?
Fat - fertile - forty - female
Highly negative resting potential
Another type of aldosterone antagonist (like spironolactone)
Closer to head; closer to diaphragm

3. What is a keloid?
Demargination of neutrophils from the vessel walls
Selective alpha 1 (increases SVR)
Excessive collagen formation during tissue repair in susceptible individuals
T test; chi squared

4. which viruses require a protease?
SS +rNA
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Serum creatine kinase; reperfusion injury causes necrosis
Regular insulin (Not fast acting - regular better)

5. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
SS +rNA
Increases
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
C3 decreased after 5-10 days; sulfonamides

6. What is somatomedin C?
Insulin like growth factor 1 (just another name)
V fib; v. failure
In the extracellular space for collagen cross linking; zinc
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

7. other than mycobacterim wha other bacteria is acid fast?
Nocardia
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
4 - 4 - 9
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

8. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
TCAs and prazosin
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
P53 mutation; AD
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

9. What causes the blurry vision side effects in first generation anti histamines?
Anti cholinergic effects of pupil dilation and lack of accomodation
Acute gastric mucosal defects (superficial or full thickness)
Coagulation factors are made in the liver
indomethacin

10. What can cause virilization of a mother during pregnancy?
Hereditary angioedema; ACE inhibitors
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
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Aromatase deficiency in child

11. What type of disease has selective proteinuria? What is found in urine? What is not?
Purkinje system; AV node
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Adductor
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

12. what has the greatest effect on prognosis when treating c. diptheriae?
Vascular endothelium; protease
Normal; low
Inhibits it
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

13. How do you calculate atributable risk percent?
Rabies encephalitis from cave bats; rabies killed vaccines
No
RR-1/RR
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

14. which trisomy is associated with endocardial cushion defects? What does thsi mean>
200-500
Downs; regurgitant AV valves - ASDs
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
Integration of viral DNA into genome of host hepatocytes

15. neisseria are...
SaO2 <92%
Atrial
Minimal change disease
facultative intracellular

16. What is used to compare means? categorical outcomes?
Large stroke volumes with ventricular contraction; aortic regurg
T test; chi squared
Paramyxo and influenza
Chrom 8

17. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Trochlear nerve (IV); abducens nerve (VI)
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Prepatellar

18. What is easiest way to treat nephrolithiasis?
S3 gallop; S2 to opening snap interval
Hexokinase
ANCA because of lack of Ig and C3 deposits on IF
Drink plenty of fluids

19. Where does complement bind on the Fc region of Ig chains?
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
II; I (I more abundant)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Medial circumflex artery; avascular necrosis

20. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
CMV - HSV 1 - Candida
No and yes
Because of the low output from heart failure - they will have increased aldosterone levels
Medial circumflex artery; avascular necrosis

21. why are pregnant predisposed to cholelithiasis?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
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
Clindamycin; covers anaerobic oral flora and aerobic bacteria
MAO inhibitors; wine and cheese

22. biotin is used By what in tissues responsible for gluconeogenesis
Inhibits it
Barium enema
Highly negative resting potential
As a CO2 carrier with the carboxylase enzyme

23. What is subacute sclerosisng encephalitis caused by?
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
C3 decreased after 5-10 days; sulfonamides
G to T in p53; HCC
Protamine sulfate

24. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
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
Southern - western
Fibronectin - laminin - collagen
Medial circumflex artery; avascular necrosis

25. which nucleus releases serotonin?
Vancomycin
No and yes
Raphe
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

26. what diseases can vit A be used to treat?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Measles and M3 AML`
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
indomethacin

27. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
Joints d/t increased purine production and thus uric acid production
ANCA because of lack of Ig and C3 deposits on IF
Syringomelia
RBC mass; epo levels (secondary has high)

28. What does nitroprusside do to afterload? preload?
Bronchial dilation (bronchiectasis)
No; yes
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Decreases both

29. what would be a sign of absence of cardiogenic pulm edem?
GI malignancies and Insulin resistance (acromegal for ex)
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
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
indomethacin

30. a patient fearing all white coats is a phenomenon of what?
(urine PAH x urine flow rate)/plasma PAH
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
SVC and IVC; right below the aortic knob
Classical conditioning

31. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
LT (LTD4 - E4 - C4) - and Ach
INTRApartum Abs (ampicillin/penicillin)
Purkinje system; AV node
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

32. What are the two coagulase negative staphylococci? How do you distinguish them?
S. saprophyticus - and s. epidermidis; novobiocin
Underestimation of gestational age
As a CO2 carrier with the carboxylase enzyme
Right before diastole (filling begins)

33. What is epleronone?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Reticulocytes
Prevent phagocytosis
Another type of aldosterone antagonist (like spironolactone)

34. hypertonicity and hyperreflexity are ________________ of hydrocephalus
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
ANCA because of lack of Ig and C3 deposits on IF
C3 decreased after 5-10 days; sulfonamides

35. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
OCPs - multiparity - breast feeding
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Hypothyroidism

36. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Measles and M3 AML`
Turbulence
Integration of viral DNA into genome of host hepatocytes
Reiter syndrome; B27

37. Metronidizaole does not cover...
Chrom 8
gram positive organisms
Faulty positioning of the genital tubercle
Bile soluble which means they are bile sensitive

38. What is the preferred treatment for DKA?
Regular insulin (Not fast acting - regular better)
Barium enema
Tibial
Elastance

39. What is difference between Arnold Chiari type I and II?
SS +rNA
indomethacin
I is more benign and can present later in adulthood
HSV ( also in utero: chlymadia - neisseria - group B strep)

40. If a patient has higher levels of HbF - What does this mean?
chronic urticaria and allergic symptoms
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Localized dermatologic pain that persists for more than one month after zoster eruption
Think Hb deformation diseases

41. What is the precursor protein to beta amyloid and On what chromosome is it found?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
S. aureus
APP on chrom 21 (this is why downs more susceptible)
No and yes

42. What is diphenoxylate and What is it used for? what drug is it structurally similar to? What allows for potent anti diarrheal effect without signigicant opiate effects?
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
Intussusception
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)
Vagus (auricular branch); vasovagal syncope!

43. What does the tuberoinfundibular pathway connect? What is it responsible for?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
RBF= PAH clearance/(1- hematocrit)
RR-1/RR

44. which RPGN is also called pauci immune GN? why?
Initiation - pointing; pincer grasp; walking; mama/dada
Increases bronchial and vascular smooth muscle reactivity to catecholamines
ANCA because of lack of Ig and C3 deposits on IF
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

45. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
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)
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
Around 70 (normal measured diastolic pressures); 9--
Hypo or hyper pigmentations; after tanning

46. are there signs of inflammation in avascular necrosis? then How do you diagnose?
No; MRI
Terminal bronchioles; small bronchi
frameshift mutations (missense is substitution)
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

47. What three pathogens cause infectious esophagitis in HIV positive patients?
CMV - HSV 1 - Candida
RR-1/RR
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
FGF and VEGF

48. What is the diagnosis in delayed puberty plus anosmia?
Fat - fertile - forty - female
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Kallmans

49. How can renal blood flow be calculated from RPF?
RBF= PAH clearance/(1- hematocrit)
Phencyclidine (PCP)
Faulty positioning of the genital tubercle
Clindamycin; covers anaerobic oral flora and aerobic bacteria

50. What are the two mcc of focal brain lesions in HIV positive patients?
Abnormal closing of the urethral folds
Single adenomatous ones
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Thymic tumor