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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. Which is faster purkinje system or atrial muscle?
Prevent phagocytosis
HSV and VZV
Close but purkinje system to ensure contraction in a bottom up fashion
S. saprophyticus - and s. epidermidis; novobiocin

2. What type of calcium channels dictate the plateau in cardiac myocyte?
Right before diastole (filling begins)
By vascular permeability and vasodilation
Dihydropyridine sensitive Ca channels (L type)
(urine PAH x urine flow rate)/plasma PAH

3. What type of bond is a disulfide bond?
Covalent (between two cysteines)- allows protein to withstand denaturation
11 aa polypeptide; pain NT in CNS and PNS
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
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)

4. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Measles and M3 AML`
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
SSRI; erectile dysfunction
Not lined by epithelium

5. 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
Medullary
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Fibrosis; macrophages

6. What is the mc location of brain germinomas?What are the classic symptoms?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Anti centromere; anti DNA topoisomerase
ZDV or AZT
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

7. What is the stabilizing force for the secondary structure of proteins?
Hydrogen bonds dictate alpha or beta structure
Initiation - pointing; pincer grasp; walking; mama/dada
As a CO2 carrier with the carboxylase enzyme
Normally close to systolic

8. what protein is increased in Crohns disease? What does it do?
In the extracellular space
Think Hb deformation diseases
Sickle cell; G6PD
NF- KB; responsible for cytokine production

9. at one year of age - What are the social - fine motor - gross motor and language developments?
Nonsense; mRNA processing
Prostate tumor and increased osteoclast activity
Underestimation of gestational age
Initiation - pointing; pincer grasp; walking; mama/dada

10. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Ceftriaxone; azithromycin
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Increases

11. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Trauma to stereociliated hair cells of the organ of corti
ATP binding (resets the myosin head to contract again for next binding)
P53 mutation; DCC is also required for adenoma to carcinoma

12. why does hypothyroidism cause increased CPK levels?
In the extracellular space for collagen cross linking; zinc
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
ANCA because of lack of Ig and C3 deposits on IF
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

13. What is the preferred treatment for DKA?
Folic acid treatment!
Regular insulin (Not fast acting - regular better)
Appetite suppressants
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

14. What type of endocarditis is cytoscopy induced?
C3 decreased after 5-10 days; sulfonamides
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Enterococci (e. faecalis)- found on genitalia area
Ketone body production by preventing fatty acids into the mitochondria

15. which cells produce surfactant? which ones mediate gas exchange?
II; I (I more abundant)
Vertical diplopia
Intussusception
Normal; low

16. prostaglandin synthesis keeps...
PDA open
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Bile soluble which means they are bile sensitive
Raphe

17. What type of vision is myopia? In What type of patients does it improve?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
SaO2 <92%
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

18. What causes curlings ulcers?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Prevent phagocytosis
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Localized dermatologic pain that persists for more than one month after zoster eruption

19. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Valproate
Hexokinase

20. What is a common complication of acute pancreatitis? What is it?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Circular - outside nucleus; transport proteins - rRNA - tRNA
transcription activation/suppression

21. are there signs of inflammation in avascular necrosis? then How do you diagnose?
No; MRI
Southern - western
Folic acid treatment!
Octreotide

22. Which nerve lies in close proximity to the inferior thyroid artery?
Elevated GGT and macrocytosis
ANCA because of lack of Ig and C3 deposits on IF
In ER of bile canaliculi
Recurrent larygneal

23. What does prolonged PT indicated? aPTT? bleeding time?
200-500
Dissolved in plasma and attached to Hgb
Extrinsic def; instrinsic def; platelet def
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

24. at four years of age - What are the social - fine motor - gross motor - and language developments?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
High potassium conductance and some sodium conductance
Because gamma chains replace beta chains and then gamma chain formation wanes
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

25. what locations of UC increase the risk of Colon cancer?
Chlorpheniramine and diphenhydramine
Ether and other organic solvents
Pan colitis and right sided colitis (more than left sided and proctitis)
Insulin like growth factor 1 (just another name)

26. How do you explain the selective proteinuria of loss to albumin only in MCD?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Nonsense; mRNA processing
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

27. what virus causes pharyngoconjuctival fever?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Adeno
Chlorpheniramine and diphenhydramine
S. saprophyticus - and s. epidermidis; novobiocin

28. What are some of the permissive effects of cortisol?
Raphe
Increases bronchial and vascular smooth muscle reactivity to catecholamines
4 - 4 - 9
Ig A deficiency

29. What is epispadias caused by?
Faulty positioning of the genital tubercle
Enterococci (e. faecalis)- found on genitalia area
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Selective alpha 1 (increases SVR)

30. do patients with cor pulmonale have increased or decreased levels of aldosterone?
Because of the low output from heart failure - they will have increased aldosterone levels
SSRI; erectile dysfunction
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
SVC and IVC; right below the aortic knob

31. What pulmonary structural change can kartageners syndrome cause?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Folic acid treatment!
Bronchial dilation (bronchiectasis)
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

32. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Phencyclidine (PCP)
No
Acute gastric mucosal defects (superficial or full thickness)
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

33. when arrested in prophase of meiosis I - What are primary oocytes chrom number? What about the secondary oocytes that are stuck in metaphase of Meiosis II?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
To pump calcium out in cardiac myocytes so that relaxation occurs
manifestations - congenital (stretching of periventricular pyrimadal fibers)
46 - 4N; 23 2N

34. What do you treat s. epidermidis with?
C3 decreased after 5-10 days; sulfonamides
Vancomycin
Anterior nares
Rabies encephalitis from cave bats; rabies killed vaccines

35. how long is substance P? What does it do?
Radial nerve and deep brachial artery
11 aa polypeptide; pain NT in CNS and PNS
Barium enema
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

36. why does neutrophila occur with corticosteroids?
Demargination of neutrophils from the vessel walls
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
low in serum
Barium enema

37. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
Minimal change disease
Large stroke volumes with ventricular contraction; aortic regurg
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Integration of viral DNA into genome of host hepatocytes

38. Is there edema in primary Conns? secondary hyperaldosteronism? why?
Valproate
Skin flushing and warmth; prostaglandins; give with aspirin
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Standing suddenly from supine position; valsalva maneuver

39. What is congestive hepatomegaly specific for?
Inactivates kallikrein which activates kininogen into bradykinin
Right heart failure
women
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

40. Where does terminal peptide cleavage of collagen fibrils take place?
In the extracellular space
Prevent phagocytosis
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Dihydropyridine sensitive Ca channels (L type)

41. What is extraocular muscle weakness a common symptom of?
Appetite suppressants
Bile soluble which means they are bile sensitive
Myasthenia gravis
SSRI

42. What is Bortezomib and What is it used for?
Proteasome inhibitor; treatment for MM and waldenstroms
Duration and extent of disease
Chlorpheniramine and diphenhydramine
Purkinje system; AV node

43. What actions increase venous return?
Prevents hepatic VLDL production
No; MRI
Squatting - sitting - lying supine - passive leg raising
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

44. What are three symptoms in s.typhi?
Appetite suppressants
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
When it invades the bm; carcinoma in situ

45. metabolism of 1 gram of protein produces How many calories? carb? fat?
MAC complex (C5b - C9 complement deficiency)
4 - 4 - 9
Sarcoid
Syncope - angina - dyspnea (SAD)

46. in overweight individuals What is thought to contribute to insulin resistance?
Apocrine; eccrine
Pulmonary hypertension
Serum FFA and serum triglyceride levels
Headaches and facial flushing; vasodilation in meninges and skin

47. What are the two mcc of focal brain lesions in HIV positive patients?
Both sides
gram positive organisms
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

48. do Class IC agents prolong the QT interval?
only up to bronchi
OCPs - multiparity - breast feeding
Radial nerve damage
No

49. there are mucus secreting cells in the bronchioles...
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
only up to bronchi
Reticulocytes
Trochlear nerve (IV); abducens nerve (VI)

50. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Class I
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Measles and M3 AML`