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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 agonists reduce the gradient across the LV outflow tract?
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
Selective alpha 1 (increases SVR)
SVC and IVC; right below the aortic knob
RER; RER

2. if there are keratin swirls does that mean well or poorly differentiated?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Well
Drug induced interstitial nephritis
Measles and M3 AML`

3. Which is faster purkinje system or atrial muscle?
200-500
Close but purkinje system to ensure contraction in a bottom up fashion
C3 decreased after 5-10 days; sulfonamides
Normally close to systolic

4. What is the diagnosis in delayed puberty plus anosmia?
Kallmans
Increases cytokine production
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Regular insulin (Not fast acting - regular better)

5. What would a deflection of the membrane potential to near zero indicate?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Thymic tumor
Increase in permeability of two ions with equal and opposite equilibrium potentials
Syncope - angina - dyspnea (SAD)

6. metabolism of 1 gram of protein produces How many calories? carb? fat?
APP on chrom 21 (this is why downs more susceptible)
4 - 4 - 9
Kallmans
Sarcoid

7. 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?
Decreases both
In ER of bile canaliculi
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)
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

8. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
differentiate
Anterior circumflex (and axillary nerve)
Adeno
Turners`

9. If a patient has higher levels of HbF - What does this mean?
Because gamma chains replace beta chains and then gamma chain formation wanes
25; 25
Protamine sulfate
Think Hb deformation diseases

10. what makes bruits?
Reticulocytes
MAC complex (C5b - C9 complement deficiency)
Turbulence
women

11. What is the most common initital symptom of ADPKD? what else?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Drink plenty of fluids

12. how does achalasia present? What does barium swallow show on dilated esophagus?
Adeno
In the extracellular space for collagen cross linking; zinc
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
GI malignancies and Insulin resistance (acromegal for ex)

13. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Increases cytokine production
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Rabies encephalitis from cave bats; rabies killed vaccines
Gluteus maximus; difficulty getting up from seated position and climbing chair

14. why does liver dysfunction cause coagulation disorders?
HSV and VZV
S. aureus
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Coagulation factors are made in the liver

15. at three years of age What are social - fine motor - gross motor and language developments?
HSV ( also in utero: chlymadia - neisseria - group B strep)
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Measure of depth invasion (vertical!)

16. what locations of UC increase the risk of Colon cancer?
Pan colitis and right sided colitis (more than left sided and proctitis)
SS +rNA
Varying; erythema nodosum is common
RR-1/RR

17. what phase do adenosine and acetylcholine act on? doing what?
Purkinje system; AV node
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Myasthenia gravis
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

18. What is easiest way to treat nephrolithiasis?
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
Drink plenty of fluids
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

19. What type of disease has selective proteinuria? What is found in urine? What is not?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
4 - 4 - 9
Little effect on cell and no change
Normally close to systolic

20. What is a cord factor and Which bugs have it? How do they appear on culture?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
gram positive organisms
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

21. what drug is useful for secretory diarrhea?
RER; RER
Octreotide
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
ATP binding (resets the myosin head to contract again for next binding)

22. Where does lysyl oxidase act? What is the cofactor for that?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Right heart failure
In the extracellular space for collagen cross linking; zinc
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

23. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
Neisseria induced small cell vasculitis (including hands and soles)
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

24. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
High potassium conductance and some sodium conductance
Susceptible; soluble (unable to be cultured in bile)
differentiate
Vertical diplopia

25. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
Vagus (auricular branch); vasovagal syncope!
SVT; increases vagal tone; rectus abdominis
(urine PAH x urine flow rate)/plasma PAH
Valproate

26. Where is the base of the heart? apex?
differentiate
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
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
Closer to head; closer to diaphragm

27. What is the presentation of sever aortic stenosis?
Syncope - angina - dyspnea (SAD)
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Raphe
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

28. SIADH patients have normal blood volume but...
hyponatremia (aldosterone activation equilibrates body volume)
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Relatively selective B1 adrenergic agonist; acute heart failure with decreased myocardial contractility (cardiogenic shock); increases myocardial contractility; can induce arrhythmias because increases cardiac conduction velocity
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

29. What does 'oxygen' content in blood refer to?
Primary
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Recurrent larygneal
Dissolved in plasma and attached to Hgb

30. 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?
Because of the low output from heart failure - they will have increased aldosterone levels
Multiple miscarriages d/t hypercoaguability
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
46 - 4N; 23 2N

31. 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
Prevent phagocytosis
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
V fib; v. failure

32. other than in pyelonephritis - where else are WBC casts seen?
Dissolved in plasma and attached to Hgb
4 - 4 - 9
Relfex tachycardia; giving beta blockers
Acute interstitial nephritis

33. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
S. saprophyticus - and s. epidermidis; novobiocin
hyponatremia (aldosterone activation equilibrates body volume)
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

34. In what form are mitochondrial DNA? What do they transcribe?
Susceptible; soluble (unable to be cultured in bile)
Circular - outside nucleus; transport proteins - rRNA - tRNA
Increase lymphatic drainage!
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

35. other than mycobacterim wha other bacteria is acid fast?
Leukotriene precursor and does neutrophil chemotaxis
Dissolved in plasma and attached to Hgb
Nocardia
S. saprophyticus - and s. epidermidis; novobiocin

36. are there signs of inflammation in avascular necrosis? then How do you diagnose?
Dihydropyridine sensitive Ca channels (L type)
No; MRI
ANCA because of lack of Ig and C3 deposits on IF
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

37. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
When it invades the bm; carcinoma in situ
Terminal bronchioles; small bronchi
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
differentiate

38. What is the preferred treatment for DKA?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Regular insulin (Not fast acting - regular better)
Hypertension - edema - and proteinuria

39. what protects the resting heart from arrhythmias?
Faulty positioning of the genital tubercle
Highly negative resting potential
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

40. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Not lined by epithelium
Duration and extent of disease
Susceptible; soluble (unable to be cultured in bile)
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

41. IL4 is used for isotypye switching to what?
indomethacin
Syncope - angina - dyspnea (SAD)
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
IgE

42. nucleotide deletions do not cause missense mutations - they cause...
Because of vasodiation to skeletal muscles
liver specific
Increase lymphatic drainage!
frameshift mutations (missense is substitution)

43. prostaglandin synthesis keeps...
(urine PAH x urine flow rate)/plasma PAH
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)
Because of vasodiation to skeletal muscles
PDA open

44. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Integration of viral DNA into genome of host hepatocytes
Sydenham chorea
Mean greater than median greater than mode

45. other than increasing HDL levels - what else does niacin do?
Prevents hepatic VLDL production
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Excessive collagen formation during tissue repair in susceptible individuals
Because gamma chains replace beta chains and then gamma chain formation wanes

46. what color pigmentations are caused by malassezia furfur? when do they become more visible?
low in serum
Skin flushing and warmth; prostaglandins; give with aspirin
Boiling - bleach - formalin - UV irradiation
Hypo or hyper pigmentations; after tanning

47. What is 5- HETE and What does it do?
Leukotriene precursor and does neutrophil chemotaxis
Common peroneal; bony fractures and compression; sciatic
Reiter syndrome; B27
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

48. What does TGF beta do? What produces it?
RER; copper
Bronchial dilation (bronchiectasis)
Pulmonic and systemic!
Fibrosis; macrophages

49. a patient fearing all white coats is a phenomenon of what?
Inactivates kallikrein which activates kininogen into bradykinin
Class I
Classical conditioning
Vancomycin; histamine mediated

50. What is the immune deficinecy seen in ataxia telangactasia?
Ig A deficiency
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Spongiosis
C3 decreased after 5-10 days; sulfonamides