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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. Which is faster purkinje system or atrial muscle?
To pump calcium out in cardiac myocytes so that relaxation occurs
Vagus (auricular branch); vasovagal syncope!
Lateral; RV; RA; LV
Close but purkinje system to ensure contraction in a bottom up fashion

2. What is the preferred treatment for DKA?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Intussusception
Acute gastric mucosal defects (superficial or full thickness)
Regular insulin (Not fast acting - regular better)

3. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
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
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Barium enema
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

4. What is the immune deficinecy seen in ataxia telangactasia?
Ig A deficiency
Vancomycin; histamine mediated
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)
8; 12

5. what dictates the resting membrane potential of most cells?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
P53 mutation; DCC is also required for adenoma to carcinoma
Well trained athletes and children
High potassium conductance and some sodium conductance

6. What is pickwickian syndrome? What are the lab findings?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
SSRI

7. biotin is used By what in tissues responsible for gluconeogenesis
indomethacin
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
As a CO2 carrier with the carboxylase enzyme

8. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
Trochlear nerve (IV); abducens nerve (VI)
INTRApartum Abs (ampicillin/penicillin)
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

9. How do you explain the selective proteinuria of loss to albumin only in MCD?
Tibial
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

10. What are three symptoms in s.typhi?
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Abnormal closing of the urethral folds
Neisseria induced small cell vasculitis (including hands and soles)
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

11. other than proteinuria - What can cause foamy froathy urine?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Coagulation factors are made in the liver
ATP binding (resets the myosin head to contract again for next binding)
Bile salt accumulation in urine

12. What is the mc malignancy in asbestosis?
Because of the low output from heart failure - they will have increased aldosterone levels
Lateral; RV; RA; LV
Bronchogenic carcinoma
The term used to describe decreased drug responsiveness with repeated administration

13. what immune deficiency causes recurrent neisseria infections?
II; I (I more abundant)
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
MAC complex (C5b - C9 complement deficiency)
Abnormal closing of the urethral folds

14. What are the two coagulase negative staphylococci? How do you distinguish them?
S. saprophyticus - and s. epidermidis; novobiocin
Susceptible; soluble (unable to be cultured in bile)
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
46 - 4N; 23 2N

15. other than parvo B19 - what else is associated with red cell aplasia?
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Thymic tumor
Myasthenia gravis
G to T in p53; HCC

16. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
Hypothyroidism
Dihydropyridine sensitive Ca channels (L type)
ANCA because of lack of Ig and C3 deposits on IF
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

17. What is the mc location for avascular necrosis? What is it associated with?
ANCA because of lack of Ig and C3 deposits on IF
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Superior larygeal; cricothyroid; recurrent laryngeal
Adeno

18. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Think Hb deformation diseases
E. coli; staphylococcus saprophyticus
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

19. What is cataplexy and When is it seen?
II; I (I more abundant)
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Amiloride - spironolactone - triamterene
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

20. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
RBC mass; epo levels (secondary has high)
On cardiac tissue and renal juxtaglomerular cells
SVC and IVC; right below the aortic knob
frameshift mutations (missense is substitution)

21. why does liver dysfunction cause coagulation disorders?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Coagulation factors are made in the liver
FGF and VEGF

22. What are diastolic (lowest) pressures in aorta? LV?
GI tract; mood!
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Around 70 (normal measured diastolic pressures); 9--
Hyperkalemia; potassium sparing diuretics - potassium supplements

23. what organ would an activating mutation in PRPP synthetase effect?
Joints d/t increased purine production and thus uric acid production
Acute gastric mucosal defects (superficial or full thickness)
200-500
Drink plenty of fluids

24. What causes curlings ulcers?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Appetite suppressants
When it invades the bm; carcinoma in situ

25. which opponens muscle does ulnar innervate?
facultative intracellular
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Adductor
Superior larygeal; cricothyroid; recurrent laryngeal

26. What is subacute sclerosisng encephalitis caused by?
Not lined by epithelium
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
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

27. 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?
Ig A deficiency
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
4 - 4 - 9

28. How is dobutamine better than dopamine?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Serum FFA and serum triglyceride levels
Kallmans
Duration and extent of disease

29. In What type of nephritis would you see high serum eos count?
Serum FFA and serum triglyceride levels
Rabies encephalitis from cave bats; rabies killed vaccines
Drug induced interstitial nephritis
Because gamma chains replace beta chains and then gamma chain formation wanes

30. What is the cause of rapid plasma decay of thiopental?
Well trained athletes and children
Tissue redistribution (out of plasma) rather than metabolism
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Nonsense; mRNA processing

31. What is diagnostic (and possible therapeutic for intussusception)?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Barium enema
Superior larygeal; cricothyroid; recurrent laryngeal
Chrom 8

32. carnitine deficiency impairs production of What and how?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Ketone body production by preventing fatty acids into the mitochondria
Downs; regurgitant AV valves - ASDs
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

33. What is the mc manifestation of CMV in HIV patient? immunocompetent?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Retinitis; mononucleosis
Purkinje system; AV node
As a CO2 carrier with the carboxylase enzyme

34. What type of drug is alendronate?
Measure of depth invasion (vertical!)
Increased reticulocytes
Anti cholinergic effects of pupil dilation and lack of accomodation
Biphosphonate

35. What is used to treat heparin toxicity?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Ceftriaxone; azithromycin
Protamine sulfate
...

36. at one year of age - What are the social - fine motor - gross motor and language developments?
RBC mass; epo levels (secondary has high)
Initiation - pointing; pincer grasp; walking; mama/dada
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Radial nerve damage

37. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Biphosphonate
Diabetic microangiopathy
Multiple miscarriages d/t hypercoaguability

38. there are mucus secreting cells in the bronchioles...
only up to bronchi
RR-1/RR
25; 25
Sydenham chorea

39. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
frameshift mutations (missense is substitution)
Paramyxo and influenza
Terminal bronchioles; small bronchi
Because gamma chains replace beta chains and then gamma chain formation wanes

40. what should you think of in 'smear of an oral ulcer base'?
Squatting - sitting - lying supine - passive leg raising
4 - 4 - 9
Tzanck smear
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

41. 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?
TSh (in testicular tumors can cause hyperthyroidism)
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
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)

42. What is a cord factor and Which bugs have it? How do they appear on culture?
11 aa polypeptide; pain NT in CNS and PNS
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Lateral; RV; RA; LV

43. other than increasing HDL levels - what else does niacin do?
G to T in p53; HCC
Prevents hepatic VLDL production
In the extracellular space
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

44. What type of bond is a disulfide bond?
Apocrine; eccrine
(urine PAH x urine flow rate)/plasma PAH
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Covalent (between two cysteines)- allows protein to withstand denaturation

45. What are two common side effects of both acute and long acting nitrates? What causes them?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Amiadarone
Headaches and facial flushing; vasodilation in meninges and skin

46. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
RER; copper
Highly negative resting potential
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

47. which staphylococci can do mannitol fermaentation?
Folic acid treatment!
S. aureus
Boiling - bleach - formalin - UV irradiation
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

48. What antibodies are present in CREST? What is the most specific?
CMV - HSV 1 - Candida
Anti centromere; anti DNA topoisomerase
Barium enema
P53 mutation; AD

49. SIADH patients have normal blood volume but...
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
hyponatremia (aldosterone activation equilibrates body volume)
ATP binding (resets the myosin head to contract again for next binding)
ANCA because of lack of Ig and C3 deposits on IF

50. What are pancreatic pseudocysts called pseudo rather than true cysts?
SaO2 <92%
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
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Not lined by epithelium