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USMLE Prep 2

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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 drug is useful for secretory diarrhea?
Little effect on cell and no change
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Octreotide
AV node slowest - to allow time for diastole

2. where are Beta 1 receptors found?
On cardiac tissue and renal juxtaglomerular cells
Both sides
Trauma to stereociliated hair cells of the organ of corti
Prevents hepatic VLDL production

3. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Rabies encephalitis from cave bats; rabies killed vaccines
Increases
Squatting - sitting - lying supine - passive leg raising

4. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
Inhaled animal dander allergens
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
hyponatremia (aldosterone activation equilibrates body volume)
In the extracellular space for collagen cross linking; zinc

5. In What type of nephritis would you see high serum eos count?
Drug induced interstitial nephritis
Enterococci (e. faecalis)- found on genitalia area
Hypo or hyper pigmentations; after tanning
HSV and VZV

6. What is damaged in early syringomelia? later?
Anti cholinergic effects of pupil dilation and lack of accomodation
Highly negative resting potential
E. coli
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

7. what diseases can vit A be used to treat?
gram positive organisms
Hereditary angioedema; ACE inhibitors
Measles and M3 AML`
GI malignancies and Insulin resistance (acromegal for ex)

8. when do ghon complexes form - primary or secondary TB?
Increased reticulocytes
Folic acid treatment!
Common peroneal; bony fractures and compression; sciatic
Primary

9. What is the preferred treatment for DKA?
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)
Regular insulin (Not fast acting - regular better)
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
SVT; increases vagal tone; rectus abdominis

10. what induces bronchial squamous metaplasia?
Raphe
Decreases both
Smoking
...

11. What are the acute effects of corticosteroids on the CBC?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
manifestations - congenital (stretching of periventricular pyrimadal fibers)
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Around 70 (normal measured diastolic pressures); 9--

12. What is the difference between additive and synergistic?
Atrial
Tibial
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
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

13. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Paramyxo and influenza
ZDV or AZT
liver specific
Terminal bronchioles; small bronchi

14. What are some side effects seen in TCAs?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
RR-1/RR
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
SS +rNA

15. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Bronchogenic carcinoma
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Valproate
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

16. sporadic colon cancer tend to arise From what type of polyps?
RBF= PAH clearance/(1- hematocrit)
Single adenomatous ones
Increase in permeability of two ions with equal and opposite equilibrium potentials
IgE

17. what protein is increased in Crohns disease? What does it do?
Purkinje system; AV node
Joints d/t increased purine production and thus uric acid production
Normally close to systolic
NF- KB; responsible for cytokine production

18. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
Syncope - angina - dyspnea (SAD)
C3 decreased after 5-10 days; sulfonamides
Hydrogen bonds dictate alpha or beta structure
Normal; low

19. what nerve and artery course along the posterior aspect of the humerus?
RR-1/RR
Radial nerve and deep brachial artery
HSV and VZV
SVC and IVC; right below the aortic knob

20. What is the most common initital symptom of ADPKD? what else?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
P53 mutation; DCC is also required for adenoma to carcinoma
Selective alpha 1 (increases SVR)
AV node slowest - to allow time for diastole

21. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
Vancomycin; histamine mediated
women
Squatting - sitting - lying supine - passive leg raising
T test; chi squared

22. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
To pump calcium out in cardiac myocytes so that relaxation occurs
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
C3 decreased after 5-10 days; sulfonamides
women

23. What does sustained hand grip do to the C/V system?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Large stroke volumes with ventricular contraction; aortic regurg
liver specific
Southern - western

24. How is dobutamine better than dopamine?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Selective alpha 1 (increases SVR)

25. on What part of the clavicle does the SCM attach?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Inhibits it
Medial part
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

26. What are the three causes of acute MI in context of normal coronary arteries ?
Both sides
Increase by 50% in urine osmolality
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
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

27. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Susceptible; soluble (unable to be cultured in bile)
Around 70 (normal measured diastolic pressures); 9--
Appetite suppressants
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

28. Where does conjugation of bilirubin take place?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Abnormal closing of the urethral folds
In ER of bile canaliculi
Fibronectin - laminin - collagen

29. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
OCPs - multiparity - breast feeding
Not lined by epithelium
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Regular insulin (Not fast acting - regular better)

30. What are the skin presentation in sarcoid?
Hypo or hyper pigmentations; after tanning
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Varying; erythema nodosum is common
The LES is supposed to relax when food comes its way (from above) and in achalasia - a motor dysfunction - LES doesnt relax and seen as elevated pressure on the esophageal mannometry

31. What is capacitance inversely proportional to?
Fibronectin - laminin - collagen
Elastance
Recurrent larygneal
Anterior circumflex (and axillary nerve)

32. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Folic acid treatment!
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

33. why does variocele occur more in left side?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
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
Inactivates kallikrein which activates kininogen into bradykinin

34. What is the mainstay treatment for acute mania?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

35. what happens to sperm count and semineferous tubules in patient with cryptoorchidism? hormonal function? why do they need to be surgically descended?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
RR-1/RR
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
CMV - HSV 1 - Candida

36. What are the primary determinants of colon cancer risk in UC patients
Duration and extent of disease
Drug induced interstitial nephritis
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
I is more benign and can present later in adulthood

37. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
Class I
Tissue redistribution (out of plasma) rather than metabolism
Brief psychotic disorder; schizophreniform; schizophrenia
By vascular permeability and vasodilation

38. What is the cause of fixed splitting of S2? 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
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Dissolved in plasma and attached to Hgb
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

39. In what form are mitochondrial DNA? What do they transcribe?
Circular - outside nucleus; transport proteins - rRNA - tRNA
RER; copper
Trochlear nerve (IV); abducens nerve (VI)
MAC complex (C5b - C9 complement deficiency)

40. non ceruloplasmin deposition - ceruloplasmin is...
Anti centromere; anti DNA topoisomerase
No (unlike adenomyosis); yes
P450 mitochondrial monooxygenase
low in serum

41. name three pathological states that present with large tongues.
CGD; t cell dysfxn (diGeorge)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

42. What is the precursor protein to beta amyloid and On what chromosome is it found?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
APP on chrom 21 (this is why downs more susceptible)
Bronchogenic carcinoma
Serum FFA and serum triglyceride levels

43. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
No; yes
Increased reticulocytes
Multiple miscarriages d/t hypercoaguability
Become beta pleated and then form neurofibrillary tangle!

44. metabolism of 1 gram of protein produces How many calories? carb? fat?
Bronchial dilation (bronchiectasis)
AV node slowest - to allow time for diastole
4 - 4 - 9
Class I

45. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
ATP binding (resets the myosin head to contract again for next binding)
FGF and VEGF
No (unlike adenomyosis); yes
Turners`

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

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47. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
Elevated GGT and macrocytosis
Curlings ulcers
P53 mutation; DCC is also required for adenoma to carcinoma
200-500

48. What is the presentation of sever aortic stenosis?
On cardiac tissue and renal juxtaglomerular cells
Syncope - angina - dyspnea (SAD)
Pain reliever - reduces pain by locking substance P in the PNS
<1% - 55% - concentration dependent

49. what dissolves the lipid bilayer of a viral envelope?
Ether and other organic solvents
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Single adenomatous ones

50. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
P450 mitochondrial monooxygenase
Medial circumflex artery; avascular necrosis
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Reticulocytes

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USMLE Prep 2

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