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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 pickwickian syndrome? What are the lab findings?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Env genes (for getting into target cells)
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

2. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
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)
Hexokinase
8; 12
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

3. What are the skin presentation in sarcoid?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
4 - 4 - 9
Varying; erythema nodosum is common
Proteasome inhibitor; treatment for MM and waldenstroms

4. why is crohns disease associated with oxaloacetate kidney stones?
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
Normal; low
Apocrine; eccrine
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

5. What are two common side effects of both acute and long acting nitrates? What causes them?
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Headaches and facial flushing; vasodilation in meninges and skin
RBC mass; epo levels (secondary has high)
Think Hb deformation diseases

6. carnitine deficiency impairs production of What and how?
When it invades the bm; carcinoma in situ
<1% - 55% - concentration dependent
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)
Ketone body production by preventing fatty acids into the mitochondria

7. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
Pain reliever - reduces pain by locking substance P in the PNS
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Sickle cell; G6PD
Superior larygeal; cricothyroid; recurrent laryngeal

8. What is the Na/Ca exchange used for?
To pump calcium out in cardiac myocytes so that relaxation occurs
SVC and IVC; right below the aortic knob
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
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

9. which antiarrythmic is associated with blue gray discoloration ?
Amiadarone
Prevents hepatic VLDL production
Syncope - angina - dyspnea (SAD)
hyponatremia (aldosterone activation equilibrates body volume)

10. What is the difference between paranoid personality disorder and delusional disorder?
Duration and extent of disease
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
S. saprophyticus - and s. epidermidis; novobiocin
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

11. What is capsaicin? Where does it work?
Pain reliever - reduces pain by locking substance P in the PNS
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
RBF= PAH clearance/(1- hematocrit)
Right heart failure

12. which has better side effect profile - SSRI or TCA?
Syncope - angina - dyspnea (SAD)
Gluteus medius and minimus; positive trendelenberg
...
SSRI

13. What does hypocapnia cause in teh brain? What is hypocapnia?
Well trained athletes and children
Think Hb deformation diseases
Primary
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

14. what murmur is enhanced by decreased blood flow to the heart?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

15. Acyl coA synthetase is not...
Drink plenty of fluids
Amiloride - spironolactone - triamterene
liver specific
To pump calcium out in cardiac myocytes so that relaxation occurs

16. What type of drug is alendronate?
Biphosphonate
Hypothyroidism
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

17. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
Turbulence
Curlings ulcers
Env genes (for getting into target cells)
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

18. which cells produce surfactant? which ones mediate gas exchange?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
II; I (I more abundant)
Adductor
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

19. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Valproate
Enterococci (e. faecalis)- found on genitalia area
INTRApartum Abs (ampicillin/penicillin)

20. What is used to compare means? categorical outcomes?
Pulmonic and systemic!
T test; chi squared
On cardiac tissue and renal juxtaglomerular cells
IgE

21. What is the diagnosis in delayed puberty plus anosmia?
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
Kallmans
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)
Hexokinase

22. Where does complement bind on the Fc region of Ig chains?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
By vascular permeability and vasodilation

23. What does prolonged PT indicated? aPTT? bleeding time?
Protamine sulfate
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Extrinsic def; instrinsic def; platelet def

24. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Hyperkalemia; potassium sparing diuretics - potassium supplements
Anterior circumflex (and axillary nerve)
Increase in permeability of two ions with equal and opposite equilibrium potentials
Become beta pleated and then form neurofibrillary tangle!

25. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Terminal bronchioles; small bronchi
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Hypo or hyper pigmentations; after tanning

26. What is the presentation of sever aortic stenosis?
Terminal bronchioles; small bronchi
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Syncope - angina - dyspnea (SAD)

27. What is achalasia and how would this correlate on the esophageal mannometry?
IgE
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
Drink plenty of fluids
Superior larygeal; cricothyroid; recurrent laryngeal

28. What is a cell surface marker seen in liver angiosarcoma?
Not lined by epithelium
Drug induced interstitial nephritis
only up to bronchi
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

29. what happens to sperm count and semineferous tubules in patient with cryptoorchidism? hormonal function? why do they need to be surgically descended?
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
Leukotriene precursor and does neutrophil chemotaxis
Rare complication of measles (years later)- thought to be d/t certain type that doesnt have surface M protein antigen so goes unseen into CNS
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

30. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
Increase; decreased
Folic acid treatment!
No and yes
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

31. What does C1 esterase do other than inhibiting complement pathway?
Folic acid treatment!
Protamine sulfate
Inactivates kallikrein which activates kininogen into bradykinin
Fibrosis; macrophages

32. what induces bronchial squamous metaplasia?
Valproate
Aromatase deficiency in child
Anterior nares
Smoking

33. What is a common complication of acute pancreatitis? What is it?
Multiple miscarriages d/t hypercoaguability
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Hyperkalemia; potassium sparing diuretics - potassium supplements

34. What is the cause of fixed splitting of S2? why?
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
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Hypothyroidism

35. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Rabies encephalitis from cave bats; rabies killed vaccines
Become beta pleated and then form neurofibrillary tangle!
Large stroke volumes with ventricular contraction; aortic regurg

36. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Integration of viral DNA into genome of host hepatocytes
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

37. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Because of vasodiation to skeletal muscles
Not lined by epithelium
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

38. what enzyme converts procarcinogens into carcinogens?
GI tract; mood!
Lateral; RV; RA; LV
P450 mitochondrial monooxygenase
Insulin like growth factor 1 (just another name)

39. What would a deflection of the membrane potential to near zero indicate?
Become beta pleated and then form neurofibrillary tangle!
Increase in permeability of two ions with equal and opposite equilibrium potentials
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
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

40. What is the mainstay treatment for acute mania?
Vagus (auricular branch); vasovagal syncope!
Amiadarone
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Vagus nerve stimulation

41. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
MAC complex (C5b - C9 complement deficiency)
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
SVT; increases vagal tone; rectus abdominis
Fibronectin - laminin - collagen

42. What is an abortive viral infection?
Little effect on cell and no change
Well trained athletes and children
Anti cholinergic effects of pupil dilation and lack of accomodation
II; I (I more abundant)

43. What is the mc manifestation of CMV in HIV patient? immunocompetent?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Retinitis; mononucleosis
Pain reliever - reduces pain by locking substance P in the PNS
Adductor

44. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
Single adenomatous ones
Smoking
Coagulation factors are made in the liver
OCPs - multiparity - breast feeding

45. What is mcc of death pre hospital phase of MI? in hospital phase?
V fib; v. failure
Fibronectin - laminin - collagen
Ig A deficiency
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac

46. who bleed more DIC or TTP- HUS patients?
GI tract; mood!
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Curlings ulcers
DIC; TTP- HUS dont bleed that much

47. What are fenfluramine - phentermine?
Classical conditioning
APP on chrom 21 (this is why downs more susceptible)
Appetite suppressants
ZDV or AZT

48. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
Primary
LT (LTD4 - E4 - C4) - and Ach
Because of vasodiation to skeletal muscles
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

49. which are the only glycosylated proteins in HIV virus?
Hyperkalemia; potassium sparing diuretics - potassium supplements
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Env genes (for getting into target cells)

50. What is Bortezomib and What is it used for?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Demargination of neutrophils from the vessel walls
Common peroneal; bony fractures and compression; sciatic
Proteasome inhibitor; treatment for MM and waldenstroms