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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 dictates the resting membrane potential of most cells?
High potassium conductance and some sodium conductance
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Normally close to systolic
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

2. in essential fructosuria - what enzyme do patients use to metabolize fructose?
When it invades the bm; carcinoma in situ
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Hexokinase
Pain reliever - reduces pain by locking substance P in the PNS

3. What is hyaline arteriosclerosis usually a sign of ?
Atrial
GI malignancies and Insulin resistance (acromegal for ex)
Diabetic microangiopathy
Multiple miscarriages d/t hypercoaguability

4. Metronidizaole does not cover...
gram positive organisms
Close but purkinje system to ensure contraction in a bottom up fashion
glycerol kinase
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

5. What antibiotic is best to treat alcoholic pulm infections? why?
transcription activation/suppression
G to T in p53; HCC
II; I (I more abundant)
Clindamycin; covers anaerobic oral flora and aerobic bacteria

6. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
As a CO2 carrier with the carboxylase enzyme
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
SSRI; erectile dysfunction

7. What is medullary sponge kidney disease and how does it present? What does it lead to?
Inactivates kallikrein which activates kininogen into bradykinin
Bronchogenic carcinoma
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)
Another type of aldosterone antagonist (like spironolactone)

8. What is easiest way to treat nephrolithiasis?
E. coli
Tissue redistribution (out of plasma) rather than metabolism
Drink plenty of fluids
SVT; increases vagal tone; rectus abdominis

9. What is the difference between additive and synergistic?
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
S. saprophyticus - and s. epidermidis; novobiocin
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
Acute gastric mucosal defects (superficial or full thickness)

10. 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?
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
Raphe
Reticulocytes
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

11. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Skin flushing and warmth; prostaglandins; give with aspirin
Drink plenty of fluids

12. Where is conduction in heart fastest? slowest?
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
Purkinje system; AV node
Inhibits it
HSV ( also in utero: chlymadia - neisseria - group B strep)

13. what drug is useful for secretory diarrhea?
I is more benign and can present later in adulthood
Sydenham chorea
Kallmans
Octreotide

14. what has the greatest effect on prognosis when treating c. diptheriae?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Boiling - bleach - formalin - UV irradiation
RER; copper
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

15. What is the primary histologic finding in patients with eczematous dermatitis?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Spongiosis
SVC and IVC; right below the aortic knob
8; 12

16. other than mycobacterim wha other bacteria is acid fast?
Nocardia
Single adenomatous ones
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
TCAs and prazosin

17. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
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
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Turners`

18. what defines hypoxemia?
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
SaO2 <92%
Adeno
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

19. What does the tuberoinfundibular pathway connect? What is it responsible for?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
SS +rNA
CGD; t cell dysfxn (diGeorge)
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin

20. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
Right heart failure
Brief psychotic disorder; schizophreniform; schizophrenia
Inactivates kallikrein which activates kininogen into bradykinin
Amiloride - spironolactone - triamterene

21. 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?
Class I
Chrom 8
Lateral; RV; RA; LV
I is more benign and can present later in adulthood

22. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Elastance
women
Sydenham chorea
HSV ( also in utero: chlymadia - neisseria - group B strep)

23. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
women
Tzanck smear
Rabies encephalitis from cave bats; rabies killed vaccines
(urine PAH x urine flow rate)/plasma PAH

24. What is the diagnosis in delayed puberty plus anosmia?
Ketone body production by preventing fatty acids into the mitochondria
Right before diastole (filling begins)
Kallmans
Close but purkinje system to ensure contraction in a bottom up fashion

25. What is the mcc of extrinsic allergic asthma?
Inhaled animal dander allergens
Vertical diplopia
HSV and VZV
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

26. What is extraocular muscle weakness a common symptom of?
Dihydropyridine sensitive Ca channels (L type)
P450 mitochondrial monooxygenase
Myasthenia gravis
Because of vasodiation to skeletal muscles

27. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
<1% - 55% - concentration dependent
Medial circumflex artery; avascular necrosis
Diabetic microangiopathy
INTRApartum Abs (ampicillin/penicillin)

28. in the LV and aorta - What are the pressures?
25; 25
Normally close to systolic
Well
Circular - outside nucleus; transport proteins - rRNA - tRNA

29. What is the mc location for avascular necrosis? What is it associated with?
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
Think Hb deformation diseases
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

30. What is it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
On cardiac tissue and renal juxtaglomerular cells
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Chorda tympani branch
Vertical diplopia

31. What is the most common neurologic complication of VZV reactivation?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Localized dermatologic pain that persists for more than one month after zoster eruption
Covalent (between two cysteines)- allows protein to withstand denaturation

32. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
INTRApartum Abs (ampicillin/penicillin)
MAO inhibitors; wine and cheese
Sarcoid
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)

33. What is the mainstay treatment for acute mania?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Adductor
Increases cytokine production
Nocardia

34. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Normally close to systolic
Syringomelia

35. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Phencyclidine (PCP)
Hydrogen bonds dictate alpha or beta structure
No (unlike adenomyosis); yes

36. why is crohns disease associated with oxaloacetate kidney stones?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
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
High potassium conductance and some sodium conductance
SSRI

37. What can worse neurologic dysfunction in cobalamic def?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Folic acid treatment!
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

38. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
Coagulation factors are made in the liver
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
MAC complex (C5b - C9 complement deficiency)
Closer to head; closer to diaphragm

39. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
The term used to describe decreased drug responsiveness with repeated administration
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Bile soluble which means they are bile sensitive
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

40. How do you treat gonococcal infection? chlymadia?
Ceftriaxone; azithromycin
No; MRI
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

41. how long is substance P? What does it do?
11 aa polypeptide; pain NT in CNS and PNS
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Demargination of neutrophils from the vessel walls
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

42. why does hypothyroidism cause increased CPK levels?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
P53 mutation; DCC is also required for adenoma to carcinoma
Covalent (between two cysteines)- allows protein to withstand denaturation
PDA open

43. what enzyme converts procarcinogens into carcinogens?
Vancomycin
P450 mitochondrial monooxygenase
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Anti cholinergic effects of pupil dilation and lack of accomodation

44. What is the mcc of elevated AFP leves in pregnancy>
Demargination of neutrophils from the vessel walls
Underestimation of gestational age
Vascular endothelium; protease
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

45. on which chromosome is wilms tumor found?
Recurrent larygneal
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
11
Gluteus maximus; difficulty getting up from seated position and climbing chair

46. why does neutrophila occur with corticosteroids?
Demargination of neutrophils from the vessel walls
RBF= PAH clearance/(1- hematocrit)
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Fibrosis; macrophages

47. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
In the extracellular space for collagen cross linking; zinc
P53 mutation; DCC is also required for adenoma to carcinoma
11
Because of vasodiation to skeletal muscles

48. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
(urine PAH x urine flow rate)/plasma PAH
Proteasome inhibitor; treatment for MM and waldenstroms
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)
Atrial

49. When does opening snap begin?
Abnormal closing of the urethral folds
Southern - western
Right before diastole (filling begins)
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

50. which nerve in the lower leg is easily injured and causes foot drop ? What are common causes? From what nerve does it branch off or?
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
Common peroneal; bony fractures and compression; sciatic
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
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