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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 dissolves the lipid bilayer of a viral envelope?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Ether and other organic solvents
E6 and E7 of HPV knock off p53 and Rb suppressor genes

2. what kind of drug is sertraline? What is a common side effect?
Mean greater than median greater than mode
T test; chi squared
Vagus nerve stimulation
SSRI; erectile dysfunction

3. which nucleus releases serotonin?
Not lined by epithelium
Raphe
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Headaches and facial flushing; vasodilation in meninges and skin

4. What is congestive hepatomegaly specific for?
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Pulmonic and systemic!
Right heart failure

5. what bursa is affected when on knees like a maid/gardner?
Prepatellar
E. coli; staphylococcus saprophyticus
Abnormal closing of the urethral folds
Fat - fertile - forty - female

6. hypertonicity and hyperreflexity are ________________ of hydrocephalus
OCPs - multiparity - breast feeding
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Ether and other organic solvents
Paramyxo and influenza

7. Where does conjugation of bilirubin take place?
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
In ER of bile canaliculi
Radial nerve damage
Kallmans

8. What are the two coagulase negative staphylococci? How do you distinguish them?
Adeno
APP on chrom 21 (this is why downs more susceptible)
Prepatellar
S. saprophyticus - and s. epidermidis; novobiocin

9. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
Highly negative resting potential
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
CMV - HSV 1 - Candida

10. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
AV node slowest - to allow time for diastole
MAC complex (C5b - C9 complement deficiency)
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Echinococcus granulosus; anaphylaxis

11. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Hexokinase
Faulty positioning of the genital tubercle
Right heart failure
Selective alpha 1 (increases SVR)

12. what hernia has a similar mechanism to hydrocele?
OCPs - multiparity - breast feeding
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

13. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Primary
Single adenomatous ones
RBC mass; epo levels (secondary has high)

14. there are mucus secreting cells in the bronchioles...
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Gluteus maximus; difficulty getting up from seated position and climbing chair
only up to bronchi
Hypo or hyper pigmentations; after tanning

15. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
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

16. which viruses require a protease?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Clindamycin; covers anaerobic oral flora and aerobic bacteria
SS +rNA
Ig A deficiency

17. Which nerve lies in close proximity to the inferior thyroid artery?
SVC and IVC; right below the aortic knob
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
AV node slowest - to allow time for diastole
Recurrent larygneal

18. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
Because gamma chains replace beta chains and then gamma chain formation wanes
low in serum
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
SS +rNA

19. What are the two growth factors associated with angiogenesis?
FGF and VEGF
frameshift mutations (missense is substitution)
Env genes (for getting into target cells)
Southern - western

20. 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
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Kallmans
P53 mutation; AD

21. is Rifampin ever used as monotherapY? why either way?
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
MAO inhibitors; wine and cheese
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Underestimation of gestational age

22. How do you calculate atributable risk percent?
Vagus nerve stimulation
P53 mutation; DCC is also required for adenoma to carcinoma
RR-1/RR
Drug induced interstitial nephritis

23. prostaglandin synthesis keeps...
MAC complex (C5b - C9 complement deficiency)
PDA open
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
Think Hb deformation diseases

24. do patients with cor pulmonale have increased or decreased levels of aldosterone?
Elevated GGT and macrocytosis
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Because gamma chains replace beta chains and then gamma chain formation wanes
Because of the low output from heart failure - they will have increased aldosterone levels

25. What is used to prevent vertical transmission of HIV?
Circular - outside nucleus; transport proteins - rRNA - tRNA
Serum FFA and serum triglyceride levels
Hereditary angioedema; ACE inhibitors
ZDV or AZT

26. How do you calculate RPF from urine PAH?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Intussusception
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
(urine PAH x urine flow rate)/plasma PAH

27. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
gram positive organisms
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
Because of vasodiation to skeletal muscles

28. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Downs; regurgitant AV valves - ASDs
manifestations - congenital (stretching of periventricular pyrimadal fibers)
S. aureus
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

29. What is the difference between additive and synergistic?
Decreases both
Biphosphonate
Smoking
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

30. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
Spongiosis
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Hereditary angioedema; ACE inhibitors
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

31. in the LV and aorta - What are the pressures?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
T test; chi squared
Normally close to systolic

32. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Hypertension - edema - and proteinuria
Serum creatine kinase; reperfusion injury causes necrosis
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Because of vasodiation to skeletal muscles

33. What is easiest way to treat nephrolithiasis?
Retinitis; mononucleosis
Right before diastole (filling begins)
Drink plenty of fluids
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

34. What three pathogens cause infectious esophagitis in HIV positive patients?
RR-1/RR
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Radial nerve damage
CMV - HSV 1 - Candida

35. how long is substance P? What does it do?
Fibronectin - laminin - collagen
11 aa polypeptide; pain NT in CNS and PNS
Single adenomatous ones
RBF= PAH clearance/(1- hematocrit)

36. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
Reiter syndrome; B27
(urine PAH x urine flow rate)/plasma PAH
LT (LTD4 - E4 - C4) - and Ach
GI tract; mood!

37. what happens to sperm count and semineferous tubules in patient with cryptoorchidism? hormonal function? why do they need to be surgically descended?
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
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
Acute gastric mucosal defects (superficial or full thickness)
Purkinje system; AV node

38. Where does complement bind on the Fc region of Ig chains?
Folic acid treatment!
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Obstruction because they infiltrate the intestinal wall and encircle causing decrease in size of lumen - constipation - abdominal distension - abdominal pain - changes in stool caliber; right sided are often exophytic masses iron def anemia and syste
SaO2 <92%

39. What causes wrist drop?
Gluteus maximus; difficulty getting up from seated position and climbing chair
PDA open
TSh (in testicular tumors can cause hyperthyroidism)
Radial nerve damage

40. Where does terminal peptide cleavage of collagen fibrils take place?
In the extracellular space
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Well
Brief psychotic disorder; schizophreniform; schizophrenia

41. other than mycobacterim wha other bacteria is acid fast?
Nocardia
Standing suddenly from supine position; valsalva maneuver
Bile salt accumulation in urine
frameshift mutations (missense is substitution)

42. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
Pulmonic and systemic!
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Kallmans
GI tract; mood!

43. sporadic colon cancer tend to arise From what type of polyps?
Single adenomatous ones
V fib; v. failure
Increase; decreased
AV node slowest - to allow time for diastole

44. What is 5- HETE and What does it do?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Leukotriene precursor and does neutrophil chemotaxis
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

45. What are the lab findings in poststreptococcal GN?
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Bronchial dilation (bronchiectasis)
Reiter syndrome; B27
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

46. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
When it invades the bm; carcinoma in situ
Susceptible; soluble (unable to be cultured in bile)
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

47. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Medullary
S. aureus
Pain reliever - reduces pain by locking substance P in the PNS
Hypertension - edema - and proteinuria

48. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
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
ANCA because of lack of Ig and C3 deposits on IF
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Boiling - bleach - formalin - UV irradiation

49. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Acute gastric mucosal defects (superficial or full thickness)
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Close but purkinje system to ensure contraction in a bottom up fashion
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

50. what dictates the resting membrane potential of most cells?
High potassium conductance and some sodium conductance
E. coli; staphylococcus saprophyticus
Excessive collagen formation during tissue repair in susceptible individuals
Barium studies and colonoscopy can cause perforation just use plain abdominal xray