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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 is used to compare means? categorical outcomes?
S. aureus
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
Gluteus maximus; difficulty getting up from seated position and climbing chair
T test; chi squared

2. What does L/S stand for in fetal lung maturity? When does maturity occur?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Both sides
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Proteasome inhibitor; treatment for MM and waldenstroms

3. What are fenfluramine - phentermine?
Atrial
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Appetite suppressants
Hypo or hyper pigmentations; after tanning

4. What is diagnostic (and possible therapeutic for intussusception)?
Barium enema
Ceftriaxone; azithromycin
S3 gallop; S2 to opening snap interval
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

5. What are the two coagulase negative staphylococci? How do you distinguish them?
Serum FFA and serum triglyceride levels
S. saprophyticus - and s. epidermidis; novobiocin
GI tract; mood!
Echinococcus granulosus; anaphylaxis

6. What is a cord factor and Which bugs have it? How do they appear on culture?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Appetite suppressants
P53 mutation; AD
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

7. What does C1 esterase do other than inhibiting complement pathway?
hyponatremia (aldosterone activation equilibrates body volume)
Inactivates kallikrein which activates kininogen into bradykinin
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics

8. a patient fearing all white coats is a phenomenon of what?
Classical conditioning
Class I
Both sides
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

9. What is the mc manifestation of CMV in HIV patient? immunocompetent?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Retinitis; mononucleosis
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Amiadarone

10. What is the mutation type in thalassemias? what process is defective because of this?
PDA open
11 aa polypeptide; pain NT in CNS and PNS
DIC; TTP- HUS dont bleed that much
Nonsense; mRNA processing

11. What is the neurologic manifestation of ADPKD?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Close but purkinje system to ensure contraction in a bottom up fashion
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

12. What is omalizumab and What is it used for?
Serum creatine kinase; reperfusion injury causes necrosis
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
200-500
Dihydropyridine sensitive Ca channels (L type)

13. why are beta thal major patients asymptomatic at birth?
Tzanck smear
differentiate
Because gamma chains replace beta chains and then gamma chain formation wanes
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

14. do Class IC agents prolong the QT interval?
Selective alpha 1 (increases SVR)
DIC; TTP- HUS dont bleed that much
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
No

15. where are Beta 1 receptors found?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
TSh (in testicular tumors can cause hyperthyroidism)
Trauma to stereociliated hair cells of the organ of corti
On cardiac tissue and renal juxtaglomerular cells

16. What is Tzanck smear used to detect?
HSV and VZV
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Increase lymphatic drainage!
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

17. What are diastolic (lowest) pressures in aorta? LV?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
chronic urticaria and allergic symptoms
Inhaled animal dander allergens
Around 70 (normal measured diastolic pressures); 9--

18. what vessel would a fracture to the neck of the of the humerus damage?
(urine PAH x urine flow rate)/plasma PAH
Inhibits it
Terminal bronchioles; small bronchi
Anterior circumflex (and axillary nerve)

19. How do bradykinin - C3a and C5a cause edema?
Increases
Appetite suppressants
chronic urticaria and allergic symptoms
By vascular permeability and vasodilation

20. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
MAO inhibitors; wine and cheese
chronic urticaria and allergic symptoms
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Sickle cell; G6PD

21. What agonists reduce the gradient across the LV outflow tract?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Retinitis; mononucleosis
Selective alpha 1 (increases SVR)
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

22. how can HAV be inactivated?
Drink plenty of fluids
Well
Boiling - bleach - formalin - UV irradiation
RER; RER

23. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
Reiter syndrome; B27
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Sarcoid
Valproate

24. Which is slower AV node or ventricular muscle?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Increases cytokine production
AV node slowest - to allow time for diastole
Dissolved in plasma and attached to Hgb

25. hypertonicity and hyperreflexity are ________________ of hydrocephalus
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
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)
manifestations - congenital (stretching of periventricular pyrimadal fibers)

26. which cells produce surfactant? which ones mediate gas exchange?
II; I (I more abundant)
Increase lymphatic drainage!
In the extracellular space
<1% - 55% - concentration dependent

27. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Decreases both
Skin flushing and warmth; prostaglandins; give with aspirin
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

28. What are the common causes of metabolic alkalosis? How do you differentiate between them?
S3 gallop; S2 to opening snap interval
S. aureus
11
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

29. In what population does cholelithiasis occur?
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Fat - fertile - forty - female
Drug induced interstitial nephritis

30. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Tibial
Increase by 50% in urine osmolality
Increase lymphatic drainage!
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

31. which staphylococci can do mannitol fermaentation?
Purkinje system; AV node
S. aureus
Classical conditioning
Drug induced interstitial nephritis

32. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Large stroke volumes with ventricular contraction; aortic regurg
V fib; v. failure
Increase by 50% in urine osmolality
Medullary

33. other than in pyelonephritis - where else are WBC casts seen?
Acute interstitial nephritis
Susceptible; soluble (unable to be cultured in bile)
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
E6 and E7 of HPV knock off p53 and Rb suppressor genes

34. What are examples of action that decrease venous return to the heart?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Drink plenty of fluids
Cluster
Standing suddenly from supine position; valsalva maneuver

35. What is difference between Arnold Chiari type I and II?
Coagulation factors are made in the liver
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
I is more benign and can present later in adulthood

36. what drug is useful for secretory diarrhea?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
25; 25
Octreotide
Lateral; RV; RA; LV

37. which RPGN is also called pauci immune GN? why?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Paramyxo and influenza
ANCA because of lack of Ig and C3 deposits on IF
4 - 4 - 9

38. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
200-500
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)
Valproate
Brief psychotic disorder; schizophreniform; schizophrenia

39. which nerve is at risk when ligating the superior thyroid artery? Which is the only muscle this nerve innervates? what nerve innervates all the other laryngeal muscles?
...
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Superior larygeal; cricothyroid; recurrent laryngeal
Selective alpha 1 (increases SVR)

40. What would a deflection of the membrane potential to near zero indicate?
Sickle cell; G6PD
AV node slowest - to allow time for diastole
Amiadarone
Increase in permeability of two ions with equal and opposite equilibrium potentials

41. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
200-500
Underestimation of gestational age
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
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

42. What pulmonary structural change can kartageners syndrome cause?
RBF= PAH clearance/(1- hematocrit)
Paramyxo and influenza
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Bronchial dilation (bronchiectasis)

43. What is used to prevent vertical transmission of HIV?
RER; RER
46 - 4N; 23 2N
No and yes
ZDV or AZT

44. What is the most common location of colonization of all s. aureus types?
Env genes (for getting into target cells)
Serum creatine kinase; reperfusion injury causes necrosis
T test; chi squared
Anterior nares

45. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
IgE
Turners`
Smoking
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

46. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Increases cytokine production
Fibronectin - laminin - collagen
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

47. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
Because ACE blocks breakdown of bradykinin and hereditary angioedema patients have high levels of bradykinin; high levels of bradykinin - C3a - and C5a mediate edema by increasing vascular permeability and vasodilation
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Paramyxo and influenza
Chrom 8

48. What can cause virilization of a mother during pregnancy?
Aromatase deficiency in child
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
hyponatremia (aldosterone activation equilibrates body volume)
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

49. What almost exclusively causes Epliglottitis?What type of capsule does it have? What are the symptoms?

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50. non ceruloplasmin deposition - ceruloplasmin is...
Well trained athletes and children
low in serum
Congenital hypothyroidism - downs - amyloidosis - acromegaly
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