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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. other than proteinuria - What can cause foamy froathy urine?
Medial part
Mean greater than median greater than mode
Boiling - bleach - formalin - UV irradiation
Bile salt accumulation in urine

2. how much percent of sodium is excreted? urea? glucose?
<1% - 55% - concentration dependent
SSRI
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Extrinsic def; instrinsic def; platelet def

3. Which is slower AV node or ventricular muscle?
200-500
Downs; regurgitant AV valves - ASDs
Medial part
AV node slowest - to allow time for diastole

4. which staphylococci can do mannitol fermaentation?
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
In ER of bile canaliculi
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
S. aureus

5. What causes curlings ulcers?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Reticulocytes
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics

6. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Diabetic microangiopathy
Increase; decreased
Extrinsic def; instrinsic def; platelet def
Classical conditioning

7. where are Beta 1 receptors found?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
On cardiac tissue and renal juxtaglomerular cells
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

8. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Hypothyroidism
Increase lymphatic drainage!

9. other than parvo B19 - what else is associated with red cell aplasia?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Sarcoid
Terminal bronchioles; small bronchi
Thymic tumor

10. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Ether and other organic solvents
Hypo or hyper pigmentations; after tanning
As a CO2 carrier with the carboxylase enzyme
RER; copper

11. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Vancomycin
High potassium conductance and some sodium conductance
Cluster
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

12. What are some side effects seen in TCAs?
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
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

13. how long is substance P? What does it do?
Recurrent larygneal
Pain reliever - reduces pain by locking substance P in the PNS
11 aa polypeptide; pain NT in CNS and PNS
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

14. What is Tzanck smear used to detect?
Ether and other organic solvents
No; yes
HSV and VZV
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

15. 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
HSV and VZV
Measure of depth invasion (vertical!)
Vancomycin

16. What is subacute sclerosisng encephalitis caused by?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Because of vasodiation to skeletal muscles
Appetite suppressants
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

17. What does prolonged PT indicated? aPTT? bleeding time?
Extrinsic def; instrinsic def; platelet def
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Gluteus maximus; difficulty getting up from seated position and climbing chair
Amiloride - spironolactone - triamterene

18. How do you explain the selective proteinuria of loss to albumin only in MCD?
Measles and M3 AML`
Anterior circumflex (and axillary nerve)
AV node slowest - to allow time for diastole
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

19. What actions increase venous return?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Squatting - sitting - lying supine - passive leg raising
Initiation - pointing; pincer grasp; walking; mama/dada
Hypothyroidism

20. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
gram positive organisms
Become beta pleated and then form neurofibrillary tangle!
...
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

21. in B12 deficiency - what levels in blood rise very quickly and then drop?
Reticulocytes
SaO2 <92%
Faulty positioning of the genital tubercle
Initiation - pointing; pincer grasp; walking; mama/dada

22. within the right ventricle - What are maximum pressures? the pulm arter?
Circular - outside nucleus; transport proteins - rRNA - tRNA
25; 25
only up to bronchi
Gluteus maximus; difficulty getting up from seated position and climbing chair

23. What can cause virilization of a mother during pregnancy?
ANCA because of lack of Ig and C3 deposits on IF
Reiter syndrome; B27
Aromatase deficiency in child
Fat - fertile - forty - female

24. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
FGF and VEGF
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Southern - western
ATP binding (resets the myosin head to contract again for next binding)

25. what bursa is affected when on knees like a maid/gardner?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
As a CO2 carrier with the carboxylase enzyme
Smoking
Prepatellar

26. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Elastance
Ether and other organic solvents
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

27. What is damaged in early syringomelia? later?
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
To pump calcium out in cardiac myocytes so that relaxation occurs
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

28. Where is the base of the heart? apex?
Relfex tachycardia; giving beta blockers
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)
Closer to head; closer to diaphragm
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

29. what kind of drug is sertraline? What is a common side effect?
Increases
SSRI; erectile dysfunction
SaO2 <92%
Think Hb deformation diseases

30. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
ATP binding (resets the myosin head to contract again for next binding)
Brief psychotic disorder; schizophreniform; schizophrenia
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

31. prostaglandin synthesis keeps...
In ER of bile canaliculi
V fib; v. failure
200-500
PDA open

32. What is the immune deficinecy seen in ataxia telangactasia?
Atrial
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Ig A deficiency
only up to bronchi

33. What causes wrist drop?
Smoking
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Radial nerve damage
Inhibits it

34. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
FGF and VEGF
SSRI; erectile dysfunction
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

35. what dictates the resting membrane potential of most cells?
High potassium conductance and some sodium conductance
Another type of aldosterone antagonist (like spironolactone)
Skin flushing and warmth; prostaglandins; give with aspirin
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

36. do Class IC agents prolong the QT interval?
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
No
Myasthenia gravis
25; 25

37. What does p53 do? what chrom is it on?
Octreotide
Decreases both
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Biphosphonate

38. What test would be best to determine if a gene is being transcribed? translated?
In the extracellular space
Southern - western
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
No; MRI

39. What is used to prevent vertical transmission of HIV?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Squatting - sitting - lying supine - passive leg raising
ZDV or AZT
Elastance

40. What is used to treat heparin toxicity?
Protamine sulfate
Skin flushing and warmth; prostaglandins; give with aspirin
Class I
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

41. What is the mcc of elevated AFP leves in pregnancy>
Underestimation of gestational age
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
HSV ( also in utero: chlymadia - neisseria - group B strep)
CGD; t cell dysfxn (diGeorge)

42. What is the mc malignancy in asbestosis?
Sydenham chorea
Bronchogenic carcinoma
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

43. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
women
Increase by 50% in urine osmolality
Class I
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

44. What are the acute effects of corticosteroids on the CBC?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Increase; decreased
Radial nerve damage

45. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Prepatellar
Skin flushing and warmth; prostaglandins; give with aspirin

46. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Hexokinase
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
On cardiac tissue and renal juxtaglomerular cells
No; MRI

47. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
Increase in permeability of two ions with equal and opposite equilibrium potentials
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Drink plenty of fluids
Relfex tachycardia; giving beta blockers

48. why are pregnant predisposed to cholelithiasis?
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
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Elastance
Class I

49. What is the preferred treatment for DKA?
Regular insulin (Not fast acting - regular better)
Large stroke volumes with ventricular contraction; aortic regurg
Measure of depth invasion (vertical!)
Boiling - bleach - formalin - UV irradiation

50. which trisomy is associated with endocardial cushion defects? What does thsi mean>
When it invades the bm; carcinoma in situ
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Downs; regurgitant AV valves - ASDs
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