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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 are the first generation anti histamines?
Chlorpheniramine and diphenhydramine
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)
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
II; I (I more abundant)

2. 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?
11 aa polypeptide; pain NT in CNS and PNS
Serum creatine kinase; reperfusion injury causes necrosis
Lateral; RV; RA; LV
Extrinsic def; instrinsic def; platelet def

3. what dissolves the lipid bilayer of a viral envelope?
Ether and other organic solvents
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
ZDV or AZT
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

4. h1 receptor anatagonists are not effective in treatment of asthma only for...
Hexokinase
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
chronic urticaria and allergic symptoms

5. why does variocele occur more in left side?
Drug induced interstitial nephritis
E. coli; staphylococcus saprophyticus
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
ZDV or AZT

6. What is the most common neurologic complication of VZV reactivation?
Localized dermatologic pain that persists for more than one month after zoster eruption
Nocardia
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Southern - western

7. where exactly is ACE expressed in the lungs? What type of enzyme is it?
Octreotide
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Vascular endothelium; protease
Adductor

8. What does hypocapnia cause in teh brain? What is hypocapnia?
Enterococci (e. faecalis)- found on genitalia area
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
25; 25
Both sides

9. do Class IC agents prolong the QT interval?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Fat - fertile - forty - female
Fibrosis; macrophages
No

10. What are the three causes of acute MI in context of normal coronary arteries ?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
No; yes
Both sides
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

11. What type of endocarditis is cytoscopy induced?
Enterococci (e. faecalis)- found on genitalia area
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Coagulation factors are made in the liver

12. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Increase by 50% in urine osmolality
Syncope - angina - dyspnea (SAD)
Medullary
Pan colitis and right sided colitis (more than left sided and proctitis)

13. What pulmonary structural change can kartageners syndrome cause?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Valproate
Bronchial dilation (bronchiectasis)
Because gamma chains replace beta chains and then gamma chain formation wanes

14. What can chronic vit A toxicity cause?
Gluteus maximus; difficulty getting up from seated position and climbing chair
Myasthenia gravis
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

15. what dictates the resting membrane potential of most cells?
Prostate tumor and increased osteoclast activity
Chorda tympani branch
Chlorpheniramine and diphenhydramine
High potassium conductance and some sodium conductance

16. What causes release of myosin head from the actin filament?
ATP binding (resets the myosin head to contract again for next binding)
Increased reticulocytes
Prevent phagocytosis
Large stroke volumes with ventricular contraction; aortic regurg

17. Is there edema in primary Conns? secondary hyperaldosteronism? why?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Reticulocytes
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

18. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Echinococcus granulosus; anaphylaxis
Nocardia
Localized dermatologic pain that persists for more than one month after zoster eruption

19. What is contraindicated in toxic mega colon?
INTRApartum Abs (ampicillin/penicillin)
Vancomycin; histamine mediated
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

20. What is the neurologic manifestation of ADPKD?
Tzanck smear
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Highly negative resting potential
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

21. Acyl coA synthetase is not...
liver specific
Common peroneal; bony fractures and compression; sciatic
...
SaO2 <92%

22. What does 'oxygen' content in blood refer to?
Dissolved in plasma and attached to Hgb
Right heart failure
Pain reliever - reduces pain by locking substance P in the PNS
High potassium conductance and some sodium conductance

23. What can cause virilization of a mother during pregnancy?
Aromatase deficiency in child
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
As a CO2 carrier with the carboxylase enzyme

24. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Turners`
Diabetic microangiopathy
Vagus (auricular branch); vasovagal syncope!

25. what happens to capacitance with age?
...
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
HSV and VZV

26. what enzyme converts procarcinogens into carcinogens?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Smoking
P450 mitochondrial monooxygenase
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

27. What type of calcium channels dictate the plateau in cardiac myocyte?
Dihydropyridine sensitive Ca channels (L type)
Class I
Vertical diplopia
Hydrogen bonds dictate alpha or beta structure

28. what has the greatest effect on prognosis when treating c. diptheriae?
Vancomycin; histamine mediated
An invagination of portion of intestine into the lumen of the adjacent intestinal segment; can lead to impaired venous return from the invaginated segment of the bowel which can cause ischemia and subsequent necrosis
Excessive collagen formation during tissue repair in susceptible individuals
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

29. what protein is increased in Crohns disease? What does it do?
Classical conditioning
As a CO2 carrier with the carboxylase enzyme
NF- KB; responsible for cytokine production
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

30. What does nitroprusside do to afterload? preload?
TCAs and prazosin
SSRI
Decreases both
TSh (in testicular tumors can cause hyperthyroidism)

31. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
Medial part
Reiter syndrome; B27
P53 mutation; AD
hyponatremia (aldosterone activation equilibrates body volume)

32. What is pickwickian syndrome? What are the lab findings?
Integration of viral DNA into genome of host hepatocytes
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Bronchogenic carcinoma
Increase lymphatic drainage!

33. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
facultative intracellular
Headaches and facial flushing; vasodilation in meninges and skin
Large stroke volumes with ventricular contraction; aortic regurg
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

34. PDAs are often asymptomatic. How do you treat?
Lateral; RV; RA; LV
Hydrogen bonds dictate alpha or beta structure
indomethacin
Protamine sulfate

35. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
No (unlike adenomyosis); yes
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Downs; regurgitant AV valves - ASDs

36. what drug is useful for secretory diarrhea?
Well
(urine PAH x urine flow rate)/plasma PAH
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Octreotide

37. What are the lab findings in poststreptococcal GN?
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

38. sporadic colon cancer tend to arise From what type of polyps?
Single adenomatous ones
RBF= PAH clearance/(1- hematocrit)
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

39. What are some of the permissive effects of cortisol?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
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
Serum FFA and serum triglyceride levels
Increases bronchial and vascular smooth muscle reactivity to catecholamines

40. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
TSh (in testicular tumors can cause hyperthyroidism)
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
CGD; t cell dysfxn (diGeorge)
Recurrent larygneal

41. What causes the blurry vision side effects in first generation anti histamines?
OCPs - multiparity - breast feeding
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Duration and extent of disease
Anti cholinergic effects of pupil dilation and lack of accomodation

42. What are the acute effects of corticosteroids on the CBC?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Bile soluble which means they are bile sensitive
Reticulocytes
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

43. When does opening snap begin?
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
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Right before diastole (filling begins)
Standing suddenly from supine position; valsalva maneuver

44. What is a cord factor and Which bugs have it? How do they appear on culture?
Acute interstitial nephritis
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Strength of cell mediated immune response
Gluteus maximus; difficulty getting up from seated position and climbing chair

45. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Drug induced interstitial nephritis
Terminal bronchioles; small bronchi
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Vancomycin

46. What is acanthosis nigricans associated with?
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
Think Hb deformation diseases
GI malignancies and Insulin resistance (acromegal for ex)
Cluster

47. What is Tzanck smear used to detect?
ANCA because of lack of Ig and C3 deposits on IF
HSV and VZV
To pump calcium out in cardiac myocytes so that relaxation occurs
Acute gastric mucosal defects (superficial or full thickness)

48. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Medullary
Echinococcus granulosus; anaphylaxis
Prepatellar

49. What is the mc location for avascular necrosis? What is it associated with?
Folic acid treatment!
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
only up to bronchi
Headaches and facial flushing; vasodilation in meninges and skin

50. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
No; yes
Hypothyroidism
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Headaches and facial flushing; vasodilation in meninges and skin

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USMLE Prep 2

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