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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 type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Medullary
Recurrent larygneal
Class I

2. Where is aromatase used?
8 (myc protein) with 2 - 14 - 22 (iG chains)
<1% - 55% - concentration dependent
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

3. when arrested in prophase of meiosis I - What are primary oocytes chrom number? What about the secondary oocytes that are stuck in metaphase of Meiosis II?
Around 70 (normal measured diastolic pressures); 9--
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
46 - 4N; 23 2N
Biphosphonate

4. what defines hypoxemia?
Sarcoid
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
ZDV or AZT
SaO2 <92%

5. What effects does cortisol have on catecholamines?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Proteasome inhibitor; treatment for MM and waldenstroms
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

6. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
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
P53 mutation; DCC is also required for adenoma to carcinoma
Ceftriaxone; azithromycin
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase

7. How do left sided colon adenocarcinomas present? right sided?
Echinococcus granulosus; anaphylaxis
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
Around 70 (normal measured diastolic pressures); 9--
Smoking

8. what marker should be followed in a patient with cirrhosis?
25; 25
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Fibronectin - laminin - collagen
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

9. Where does terminal peptide cleavage of collagen fibrils take place?
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
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
In the extracellular space
Large stroke volumes with ventricular contraction; aortic regurg

10. What is congestive hepatomegaly specific for?
Right heart failure
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Drink plenty of fluids

11. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Bronchogenic carcinoma
Retinitis; mononucleosis
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

12. other than mycobacterim wha other bacteria is acid fast?
Abnormal closing of the urethral folds
Aromatase deficiency in child
T test; chi squared
Nocardia

13. what protects the resting heart from arrhythmias?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Vagus (auricular branch); vasovagal syncope!
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Highly negative resting potential

14. What type of vision is myopia? In What type of patients does it improve?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Chrom 8
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
SS +rNA

15. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
Medullary
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
When it invades the bm; carcinoma in situ
Become beta pleated and then form neurofibrillary tangle!

16. What causes curlings ulcers?
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Intussusception
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Sickle cell; G6PD

17. What is the best indicator for the severity of mitral stenosis?
Vancomycin
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)
The time interval between S2 and OS- the shorter the interval - the more intense
Nocardia

18. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
HSV ( also in utero: chlymadia - neisseria - group B strep)
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

19. Which is slower AV node or ventricular muscle?
AV node slowest - to allow time for diastole
RER; copper
Elastance
Diabetic microangiopathy

20. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Sydenham chorea
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
OCPs - multiparity - breast feeding
Reiter syndrome; B27

21. What is an abortive viral infection?
Little effect on cell and no change
Pulmonic and systemic!
Sydenham chorea
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

22. why does hypothyroidism cause increased CPK levels?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Adeno
Normally close to systolic

23. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
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
Proteasome inhibitor; treatment for MM and waldenstroms
Mean greater than median greater than mode
Recurrent larygneal

24. What is easiest way to treat nephrolithiasis?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Drink plenty of fluids
S. saprophyticus - and s. epidermidis; novobiocin
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

25. What is gardeners mydriasis? How is it treated?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Single adenomatous ones
only up to bronchi
Acute gastric mucosal defects (superficial or full thickness)

26. What does nitroprusside do to afterload? preload?
E. coli
Amiloride - spironolactone - triamterene
Decreases both
Medial part

27. What can cause virilization of a mother during pregnancy?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Minimal change disease
Aromatase deficiency in child
IgE

28. What do you treat s. epidermidis with?
Purkinje system; AV node
Myasthenia gravis
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Vancomycin

29. why does neutrophila occur with corticosteroids?
Prostate tumor and increased osteoclast activity
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)
Prevents hepatic VLDL production
Demargination of neutrophils from the vessel walls

30. What does C1 esterase do other than inhibiting complement pathway?
Apocrine; eccrine
Inactivates kallikrein which activates kininogen into bradykinin
RBF= PAH clearance/(1- hematocrit)
Common peroneal; bony fractures and compression; sciatic

31. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Anti cholinergic effects of pupil dilation and lack of accomodation
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Increase; decreased
Measles and M3 AML`

32. What is the difference between additive and synergistic?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
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

33. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Gluteus maximus; difficulty getting up from seated position and climbing chair
Amiadarone
Anterior circumflex (and axillary nerve)
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

34. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
4 - 4 - 9
Thymic tumor

35. how can HAV be inactivated?
Boiling - bleach - formalin - UV irradiation
NF- KB; responsible for cytokine production
RBC mass; epo levels (secondary has high)
Hyperkalemia; potassium sparing diuretics - potassium supplements

36. what should you think of in 'smear of an oral ulcer base'?
Close but purkinje system to ensure contraction in a bottom up fashion
Tzanck smear
MAO inhibitors; wine and cheese
Insulin like growth factor 1 (just another name)

37. neisseria are...
Medullary
Hereditary angioedema; ACE inhibitors
Sickle cell; G6PD
facultative intracellular

38. What three factors effect total oxygen content of blood?
Increase lymphatic drainage!
CGD; t cell dysfxn (diGeorge)
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
8 (myc protein) with 2 - 14 - 22 (iG chains)

39. after a thrombus extraction - what serum enzyme shoots up and why?
Joints d/t increased purine production and thus uric acid production
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Serum creatine kinase; reperfusion injury causes necrosis
Vagus nerve stimulation

40. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
E. coli; staphylococcus saprophyticus
Env genes (for getting into target cells)
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
S3 gallop; S2 to opening snap interval

41. what would be a sign of absence of cardiogenic pulm edem?
Become beta pleated and then form neurofibrillary tangle!
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
differentiate
Not lined by epithelium

42. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Myasthenia gravis

43. on which chromosome is wilms tumor found?
Coagulation factors are made in the liver
11
Chrom 8
Nocardia

44. What is the triad seen in pre eclampsia?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Hypertension - edema - and proteinuria

45. What can chronic vit A toxicity cause?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Large stroke volumes with ventricular contraction; aortic regurg
No (unlike adenomyosis); yes

46. what hormone is structurally similar to hCG?
TSh (in testicular tumors can cause hyperthyroidism)
Tibial
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Diabetic microangiopathy

47. What is Bortezomib and What is it used for?
Proteasome inhibitor; treatment for MM and waldenstroms
Localized dermatologic pain that persists for more than one month after zoster eruption
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
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

48. What antibodies are present in CREST? What is the most specific?
The term used to describe decreased drug responsiveness with repeated administration
FGF and VEGF
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
Anti centromere; anti DNA topoisomerase

49. What is the immune deficinecy seen in ataxia telangactasia?
Ig A deficiency
Lateral; RV; RA; LV
Fat - fertile - forty - female
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

50. ___________ is liver specific
glycerol kinase
Amiloride - spironolactone - triamterene
TCAs and prazosin
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)