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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. How do you calculate RPF from urine PAH?
(urine PAH x urine flow rate)/plasma PAH
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Folic acid treatment!

2. What can cause virilization of a mother during pregnancy?
Regular insulin (Not fast acting - regular better)
Aromatase deficiency in child
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Vancomycin

3. which RPGN is also called pauci immune GN? why?
ANCA because of lack of Ig and C3 deposits on IF
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
S. aureus

4. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Fat - fertile - forty - female
P53 mutation; AD
Drug induced interstitial nephritis
Because of vasodiation to skeletal muscles

5. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
In the extracellular space for collagen cross linking; zinc
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Class I
Vancomycin

6. carnitine deficiency impairs production of What and how?
Ketone body production by preventing fatty acids into the mitochondria
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Primary
Intussusception

7. When does neovascularization granulation tissue begin to form after severe ischemia and MI? what happens in 12-24 hours? 2 weeks to 2 months? 1-5 days? 0-4 hours? when do you see edema - hemorrhage - wavy fibers?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
CMV - HSV 1 - Candida
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

8. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
The term used to describe decreased drug responsiveness with repeated administration
Sydenham chorea
SS +rNA
Rabies encephalitis from cave bats; rabies killed vaccines

9. which virus inactivates both Rb and p53?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Closer to head; closer to diaphragm
Sydenham chorea
As a CO2 carrier with the carboxylase enzyme

10. what clinical findings help distinguish small cell carcinoma?
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
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Turners`
Congenital hypothyroidism - downs - amyloidosis - acromegaly

11. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
Vancomycin
low in serum
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

12. metabolism of 1 gram of protein produces How many calories? carb? fat?
4 - 4 - 9
Headaches and facial flushing; vasodilation in meninges and skin
Neisseria induced small cell vasculitis (including hands and soles)
Normal; low

13. What is the fibrinogen level in patient with TTP- HUS? DIC?
Normal; low
Ceftriaxone; azithromycin
liver specific
GI tract; mood!

14. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Cluster
Terminal bronchioles; small bronchi
Echinococcus granulosus; anaphylaxis
Because of the low output from heart failure - they will have increased aldosterone levels

15. at three years of age What are social - fine motor - gross motor and language developments?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Susceptible; soluble (unable to be cultured in bile)
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
SSRI; erectile dysfunction

16. What is the difference between paranoid personality disorder and delusional disorder?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
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)

17. Where is the base of the heart? apex?
Mean greater than median greater than mode
Closer to head; closer to diaphragm
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
Vancomycin; histamine mediated

18. is Rifampin ever used as monotherapY? why either way?
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
On cardiac tissue and renal juxtaglomerular cells
Terminal bronchioles; small bronchi
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

19. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Decreases both
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Vagus (auricular branch); vasovagal syncope!
Increased reticulocytes

20. What is damaged in early syringomelia? later?
Superior larygeal; cricothyroid; recurrent laryngeal
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
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Acute interstitial nephritis

21. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
When it invades the bm; carcinoma in situ
Recurrent larygneal
Barium enema

22. What are fenfluramine - phentermine?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Appetite suppressants
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

23. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Anti centromere; anti DNA topoisomerase
Gluteus medius and minimus; positive trendelenberg
Increases cytokine production
In the extracellular space

24. What does sustained hand grip do to the C/V system?
SVT; increases vagal tone; rectus abdominis
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
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
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

25. Which is faster purkinje system or atrial muscle?
High potassium conductance and some sodium conductance
SSRI; erectile dysfunction
glycerol kinase
Close but purkinje system to ensure contraction in a bottom up fashion

26. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Bile soluble which means they are bile sensitive
Become beta pleated and then form neurofibrillary tangle!
G to T in p53; HCC
Superior larygeal; cricothyroid; recurrent laryngeal

27. What antibodies are present in CREST? What is the most specific?
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Anti centromere; anti DNA topoisomerase
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Turbulence

28. the rate of blood flow of which two circulations must equal each other at all times?
To pump calcium out in cardiac myocytes so that relaxation occurs
Pulmonic and systemic!
Measles and M3 AML`
Paramyxo and influenza

29. What is a clara cell?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Common peroneal; bony fractures and compression; sciatic
Dihydropyridine sensitive Ca channels (L type)

30. which are the only glycosylated proteins in HIV virus?
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Class I
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Env genes (for getting into target cells)

31. What are three symptoms in s.typhi?
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Relfex tachycardia; giving beta blockers
PDA open
Closer to head; closer to diaphragm

32. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
Valproate
Gluteus maximus; difficulty getting up from seated position and climbing chair
chronic urticaria and allergic symptoms
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

33. What can too much IgA in serum produces?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Right heart failure
Both sides

34. sporadic colon cancer tend to arise From what type of polyps?
Anterior nares
SSRI; erectile dysfunction
Single adenomatous ones
Env genes (for getting into target cells)

35. What is Tzanck smear used to detect?
HSV and VZV
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
RR-1/RR

36. why does neutrophila occur with corticosteroids?
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
DIC; TTP- HUS dont bleed that much
Demargination of neutrophils from the vessel walls
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

37. which headaches are seen mostly in men - are severe - unilateral - periorbital - episodic (around same time every day) - temporal pain - with lacrimation - nasal congestion and ptosis?
Octreotide
Cluster
low in serum
Skin flushing and warmth; prostaglandins; give with aspirin

38. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Close but purkinje system to ensure contraction in a bottom up fashion
Decreases both
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Susceptible; soluble (unable to be cultured in bile)

39. where are the two classical places that the ulnar nerve can be injured?

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40. hypertonicity and hyperreflexity are ________________ of hydrocephalus
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Bile salt accumulation in urine
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Well trained athletes and children

41. What can worse neurologic dysfunction in cobalamic def?
TCAs and prazosin
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Folic acid treatment!
The term used to describe decreased drug responsiveness with repeated administration

42. How can renal blood flow be calculated from RPF?
On cardiac tissue and renal juxtaglomerular cells
Paramyxo and influenza
RBF= PAH clearance/(1- hematocrit)
Close but purkinje system to ensure contraction in a bottom up fashion

43. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
APP on chrom 21 (this is why downs more susceptible)
Mean greater than median greater than mode
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

44. What is the cause of rapid plasma decay of thiopental?
Localized dermatologic pain that persists for more than one month after zoster eruption
Tissue redistribution (out of plasma) rather than metabolism
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Extrinsic def; instrinsic def; platelet def

45. What is the mc manifestation of CMV in HIV patient? immunocompetent?
Retinitis; mononucleosis
S. saprophyticus - and s. epidermidis; novobiocin
Nocardia
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

46. What are the common causes of metabolic alkalosis? How do you differentiate between them?
The term used to describe decreased drug responsiveness with repeated administration
IgE
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
P450 mitochondrial monooxygenase

47. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Octreotide
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

48. what diseases can vit A be used to treat?
Measles and M3 AML`
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
RER; RER
Congenital hypothyroidism - downs - amyloidosis - acromegaly

49. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Syncope - angina - dyspnea (SAD)
Turbulence
Medullary

50. What is difference between Arnold Chiari type I and II?
Regular insulin (Not fast acting - regular better)
I is more benign and can present later in adulthood
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Increase in permeability of two ions with equal and opposite equilibrium potentials