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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. How can renal blood flow be calculated from RPF?
Purkinje system; AV node
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
S. saprophyticus - and s. epidermidis; novobiocin
RBF= PAH clearance/(1- hematocrit)

2. What is the mc location for avascular necrosis? What is it associated with?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Hypertension - edema - and proteinuria
ATP binding (resets the myosin head to contract again for next binding)

3. when do ghon complexes form - primary or secondary TB?
Echinococcus granulosus; anaphylaxis
Hypo or hyper pigmentations; after tanning
Primary
No (unlike adenomyosis); yes

4. What can cause virilization of a mother during pregnancy?
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
Inhibits it
Aromatase deficiency in child
Strength of cell mediated immune response

5. What does prolonged PT indicated? aPTT? bleeding time?
P450 mitochondrial monooxygenase
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Extrinsic def; instrinsic def; platelet def
Tibial

6. 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?
AV node slowest - to allow time for diastole
Lateral; RV; RA; LV
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Recurrent larygneal

7. do patients with cor pulmonale have increased or decreased levels of aldosterone?
Excessive collagen formation during tissue repair in susceptible individuals
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Because of the low output from heart failure - they will have increased aldosterone levels
Curlings ulcers

8. What is the presentation of sever aortic stenosis?
Susceptible; soluble (unable to be cultured in bile)
Syncope - angina - dyspnea (SAD)
When it invades the bm; carcinoma in situ
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

9. What does p53 do? what chrom is it on?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
By vascular permeability and vasodilation
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Spongiosis

10. what would be a sign of absence of cardiogenic pulm edem?
MAC complex (C5b - C9 complement deficiency)
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Hypothyroidism
Boiling - bleach - formalin - UV irradiation

11. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
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
gram positive organisms
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

12. Is there edema in primary Conns? secondary hyperaldosteronism? why?
RR-1/RR
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
PDA open
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

13. which two virus families have hemagluttinin on their surface?
Myasthenia gravis
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)
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Paramyxo and influenza

14. What does extended consumption of appetite suppressants lead to?
Pulmonary hypertension
Bronchial dilation (bronchiectasis)
Excessive collagen formation during tissue repair in susceptible individuals
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

15. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Vascular endothelium; protease
Neisseria induced small cell vasculitis (including hands and soles)
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

16. what protein is increased in Crohns disease? What does it do?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
NF- KB; responsible for cytokine production
AV node slowest - to allow time for diastole
Ig A deficiency

17. Where is the base of the heart? apex?
ZDV or AZT
Anti cholinergic effects of pupil dilation and lack of accomodation
I is more benign and can present later in adulthood
Closer to head; closer to diaphragm

18. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
Think Hb deformation diseases
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
The term used to describe decreased drug responsiveness with repeated administration
Measure of depth invasion (vertical!)

19. What does glycosylase do to DNA? endonuclease? lyase? What does the order here of enzymes represent? what other enzymes are needed?

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20. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
Strength of cell mediated immune response
By vascular permeability and vasodilation
Syncope - angina - dyspnea (SAD)
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)

21. In what form are mitochondrial DNA? What do they transcribe?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Increase in permeability of two ions with equal and opposite equilibrium potentials
Circular - outside nucleus; transport proteins - rRNA - tRNA
facultative intracellular

22. What is used to prevent vertical transmission of HIV?
liver specific
ZDV or AZT
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin

23. Would alpha 1 agonists cause flushing? muscarinic antagonist?
Increase by 50% in urine osmolality
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
No; yes
women

24. What is acanthosis nigricans associated with?
Aromatase deficiency in child
46 - 4N; 23 2N
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
GI malignancies and Insulin resistance (acromegal for ex)

25. What antibodies are present in CREST? What is the most specific?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Anti centromere; anti DNA topoisomerase
RR-1/RR
Regular insulin (Not fast acting - regular better)

26. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Rabies encephalitis from cave bats; rabies killed vaccines
AV node slowest - to allow time for diastole
Increased reticulocytes
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

27. What is omalizumab and What is it used for?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Bronchial dilation (bronchiectasis)

28. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
Amiloride - spironolactone - triamterene
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
HSV ( also in utero: chlymadia - neisseria - group B strep)
frameshift mutations (missense is substitution)

29. What is a clara cell?
Underestimation of gestational age
Raphe
C3 decreased after 5-10 days; sulfonamides
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

30. other than proteinuria - What can cause foamy froathy urine?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Gluteus medius and minimus; positive trendelenberg
No; MRI
Bile salt accumulation in urine

31. which staphylococci can do mannitol fermaentation?
Bile salt accumulation in urine
Normally close to systolic
S. aureus
RBC mass; epo levels (secondary has high)

32. What is the best indicator for the severity of mitral stenosis?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
The time interval between S2 and OS- the shorter the interval - the more intense

33. where are the vegetations on the valves of a libman sacks endocarditis?
GI malignancies and Insulin resistance (acromegal for ex)
Both sides
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Anti centromere; anti DNA topoisomerase

34. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
Hypertension - edema - and proteinuria
OCPs - multiparity - breast feeding
GI tract; mood!
To pump calcium out in cardiac myocytes so that relaxation occurs

35. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
Mean greater than median greater than mode
200-500
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
Duration and extent of disease

36. What is a keloid?
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)
SSRI; erectile dysfunction
Excessive collagen formation during tissue repair in susceptible individuals
Diabetic microangiopathy

37. What are the skin presentation in sarcoid?
(urine PAH x urine flow rate)/plasma PAH
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Sickle cell; G6PD
Varying; erythema nodosum is common

38. What is the most important prognostic indicator in patients with malignant melanoma?
Recurrent larygneal
Amiadarone
TCAs and prazosin
Measure of depth invasion (vertical!)

39. In what population does cholelithiasis occur?
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)
Fat - fertile - forty - female
glycerol kinase
Bile salt accumulation in urine

40. What is medullary sponge kidney disease and how does it present? What does it lead to?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Barium enema
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)
E. coli; staphylococcus saprophyticus

41. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
Inhaled animal dander allergens
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
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

42. When does opening snap begin?
Right before diastole (filling begins)
T test; chi squared
The term used to describe decreased drug responsiveness with repeated administration
Pain reliever - reduces pain by locking substance P in the PNS

43. What is 5- HETE and What does it do?
Leukotriene precursor and does neutrophil chemotaxis
Localized dermatologic pain that persists for more than one month after zoster eruption
Anti centromere; anti DNA topoisomerase
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

44. What is suggestive of complete central DI?
Increase by 50% in urine osmolality
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Insulin like growth factor 1 (just another name)
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

45. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Gluteus medius and minimus; positive trendelenberg
hyponatremia (aldosterone activation equilibrates body volume)
Inhibits it
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

46. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Turners`
P53 mutation; DCC is also required for adenoma to carcinoma
Sydenham chorea

47. What can worse neurologic dysfunction in cobalamic def?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Folic acid treatment!
II; I (I more abundant)
GI malignancies and Insulin resistance (acromegal for ex)

48. a patient fearing all white coats is a phenomenon of what?
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
By vascular permeability and vasodilation
Classical conditioning
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

49. neisseria are...
Prostate tumor and increased osteoclast activity
facultative intracellular
Inhaled animal dander allergens
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

50. the rate of blood flow of which two circulations must equal each other at all times?
Dissolved in plasma and attached to Hgb
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
Little effect on cell and no change
Pulmonic and systemic!