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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 is capacitance inversely proportional to?
Elastance
Reticulocytes
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
RR-1/RR

2. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
Brief psychotic disorder; schizophreniform; schizophrenia
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
No (unlike adenomyosis); yes
Measure of depth invasion (vertical!)

3. what murmur is enhanced by decreased blood flow to the heart?
11 aa polypeptide; pain NT in CNS and PNS
Kallmans
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics

4. what bursa is affected when on knees like a maid/gardner?
Curlings ulcers
Prepatellar
No
Increases bronchial and vascular smooth muscle reactivity to catecholamines

5. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
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
Sarcoid
Faulty positioning of the genital tubercle
Gluteus medius and minimus; positive trendelenberg

6. on which chromosome is wilms tumor found?
11
Bronchial dilation (bronchiectasis)
Secretin stimulates the exocrine pancrease; S enteroendocrine cells in duodenal mucosa in response to acid secrete secretin (HCL is most potent stimulus for secretin release)
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

7. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
OCPs - multiparity - breast feeding
Squatting - sitting - lying supine - passive leg raising
Hereditary angioedema; ACE inhibitors
Regular insulin (Not fast acting - regular better)

8. What is the most common location of colonization of all s. aureus types?
II; I (I more abundant)
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Anterior nares
Prevent phagocytosis

9. What does the tuberoinfundibular pathway connect? What is it responsible for?
High potassium conductance and some sodium conductance
Decreases both
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
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

10. What three factors effect total oxygen content of blood?
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
Elevated GGT and macrocytosis
C3 decreased after 5-10 days; sulfonamides
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

11. What is diagnostic (and possible therapeutic for intussusception)?
Barium enema
ATP binding (resets the myosin head to contract again for next binding)
Well
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

12. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Large stroke volumes with ventricular contraction; aortic regurg
Hyperkalemia; potassium sparing diuretics - potassium supplements
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Octreotide

13. How do bradykinin - C3a and C5a cause edema?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Leukotriene precursor and does neutrophil chemotaxis
By vascular permeability and vasodilation
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

14. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Sickle cell; G6PD
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Nonsense; mRNA processing

15. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
Minimal change disease
Valproate
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
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)

16. other than parvo B19 - what else is associated with red cell aplasia?
Thymic tumor
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Relfex tachycardia; giving beta blockers

17. h1 receptor anatagonists are not effective in treatment of asthma only for...
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
S. saprophyticus - and s. epidermidis; novobiocin
Anti cholinergic effects of pupil dilation and lack of accomodation
chronic urticaria and allergic symptoms

18. What are two common side effects of both acute and long acting nitrates? What causes them?
Headaches and facial flushing; vasodilation in meninges and skin
MAC complex (C5b - C9 complement deficiency)
Common peroneal; bony fractures and compression; sciatic
Anti centromere; anti DNA topoisomerase

19. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
No (unlike adenomyosis); yes
Demargination of neutrophils from the vessel walls
INTRApartum Abs (ampicillin/penicillin)
Classical conditioning

20. ___________ is liver specific
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
glycerol kinase
Valproate

21. What translocations can cause c - myc overexpression?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
SVC and IVC; right below the aortic knob
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
8 (myc protein) with 2 - 14 - 22 (iG chains)

22. name three pathological states that present with large tongues.
Appetite suppressants
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Leukotriene precursor and does neutrophil chemotaxis
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

23. which two drug types can cause orthostatic hypotension (think depression and BPH)?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Vascular endothelium; protease
TCAs and prazosin

24. why are pregnant predisposed to cholelithiasis?
SVC and IVC; right below the aortic knob
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
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

25. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
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
Class I
Bronchial dilation (bronchiectasis)
Prostate tumor and increased osteoclast activity

26. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
P450 mitochondrial monooxygenase
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
SVT; increases vagal tone; rectus abdominis
APP on chrom 21 (this is why downs more susceptible)

27. What are the three causes of acute MI in context of normal coronary arteries ?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Acute gastric mucosal defects (superficial or full thickness)
Nocardia
Inhibits it

28. after a thrombus extraction - what serum enzyme shoots up and why?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Serum creatine kinase; reperfusion injury causes necrosis
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Close but purkinje system to ensure contraction in a bottom up fashion

29. What is acanthosis nigricans associated with?
GI malignancies and Insulin resistance (acromegal for ex)
Ig A deficiency
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
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

30. other than in pyelonephritis - where else are WBC casts seen?
Kallmans
Susceptible; soluble (unable to be cultured in bile)
Drug induced interstitial nephritis
Acute interstitial nephritis

31. what marker should be followed in a patient with cirrhosis?
Single adenomatous ones
Skin flushing and warmth; prostaglandins; give with aspirin
TCAs and prazosin
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

32. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
Syringomelia
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Class I
Gluteus maximus; difficulty getting up from seated position and climbing chair

33. What is the most common initital symptom of ADPKD? what else?
Recurrent larygneal
Mean greater than median greater than mode
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Brief psychotic disorder; schizophreniform; schizophrenia

34. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
RER; RER
Become beta pleated and then form neurofibrillary tangle!

35. what happens to capacitance with age?
C3 decreased after 5-10 days; sulfonamides
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Prevents hepatic VLDL production
...

36. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
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
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Env genes (for getting into target cells)
No

37. What is best to prevent GBS infection in a baby?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
ATP binding (resets the myosin head to contract again for next binding)
INTRApartum Abs (ampicillin/penicillin)
Hereditary angioedema; ACE inhibitors

38. What is Bortezomib and What is it used for?
Standing suddenly from supine position; valsalva maneuver
No and yes
Proteasome inhibitor; treatment for MM and waldenstroms
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

39. What is extraocular muscle weakness a common symptom of?
Myasthenia gravis
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Increase lymphatic drainage!
Amiloride - spironolactone - triamterene

40. What is hyaline arteriosclerosis usually a sign of ?
Diabetic microangiopathy
Echinococcus granulosus; anaphylaxis
Thymic tumor
frameshift mutations (missense is substitution)

41. What is tachyphylaxis?
Prostate tumor and increased osteoclast activity
Fibrosis; macrophages
Sydenham chorea
The term used to describe decreased drug responsiveness with repeated administration

42. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
Superior larygeal; cricothyroid; recurrent laryngeal
E. coli; staphylococcus saprophyticus
Minimal change disease
25; 25

43. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Increased reticulocytes
chronic urticaria and allergic symptoms
Boiling - bleach - formalin - UV irradiation
Prevent phagocytosis

44. What are some of the permissive effects of cortisol?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Trochlear nerve (IV); abducens nerve (VI)
Elastance

45. What is the stabilizing force for the secondary structure of proteins?
Pan colitis and right sided colitis (more than left sided and proctitis)
Vancomycin
Purkinje system; AV node
Hydrogen bonds dictate alpha or beta structure

46. sporadic colon cancer tend to arise From what type of polyps?
Single adenomatous ones
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
IgE

47. What are the potassium sparing diuretics?
SVC and IVC; right below the aortic knob
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Secretin stimulates the exocrine pancrease; S enteroendocrine cells in duodenal mucosa in response to acid secrete secretin (HCL is most potent stimulus for secretin release)
Amiloride - spironolactone - triamterene

48. at three years of age What are social - fine motor - gross motor and language developments?
In the extracellular space for collagen cross linking; zinc
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Downs; regurgitant AV valves - ASDs
SaO2 <92%

49. What type of disease has selective proteinuria? What is found in urine? What is not?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Env genes (for getting into target cells)
The term used to describe decreased drug responsiveness with repeated administration
P53 mutation; AD

50. In What type of nephritis would you see high serum eos count?
...
V fib; v. failure
TCAs and prazosin
Drug induced interstitial nephritis