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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 the cause of rapid plasma decay of thiopental?
Tissue redistribution (out of plasma) rather than metabolism
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Thymic tumor
Increase lymphatic drainage!

2. What is the best indicator for the severity of mitral stenosis?
TSh (in testicular tumors can cause hyperthyroidism)
Ketone body production by preventing fatty acids into the mitochondria
Pulmonic and systemic!
The time interval between S2 and OS- the shorter the interval - the more intense

3. within the right atrium - What is the maximum pressure? left atrium?
Increases cytokine production
8; 12
MAC complex (C5b - C9 complement deficiency)
Inactivates kallikrein which activates kininogen into bradykinin

4. What is best to prevent GBS infection in a baby?
Hypertension - edema - and proteinuria
CGD; t cell dysfxn (diGeorge)
INTRApartum Abs (ampicillin/penicillin)
Ceftriaxone; azithromycin

5. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
2 -3 BPG; glycolysis - instead of ATP; erythrocytes because want to right shift the oxygen dissociation curve so that oxygen is released from RBCs into tissue
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Common peroneal; bony fractures and compression; sciatic

6. at one year of age - What are the social - fine motor - gross motor and language developments?
SSRI
Primary
Initiation - pointing; pincer grasp; walking; mama/dada
Strength of cell mediated immune response

7. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
differentiate
Common peroneal; bony fractures and compression; sciatic
Primary
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

8. What is subacute sclerosisng encephalitis caused by?
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
RR-1/RR
GI malignancies and Insulin resistance (acromegal for ex)
Dissolved in plasma and attached to Hgb

9. What causes the blurry vision side effects in first generation anti histamines?
Reticulocytes
46 - 4N; 23 2N
Anti cholinergic effects of pupil dilation and lack of accomodation
Decreases both

10. What is the cause of fixed splitting of S2? why?
Underestimation of gestational age
Close but purkinje system to ensure contraction in a bottom up fashion
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Drug induced interstitial nephritis

11. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Southern - western
Increase; decreased
Increases

12. What are the two growth factors associated with angiogenesis?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
FGF and VEGF
Primary
Joints d/t increased purine production and thus uric acid production

13. What does 'oxygen' content in blood refer to?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Measure of depth invasion (vertical!)
Dissolved in plasma and attached to Hgb
Demargination of neutrophils from the vessel walls

14. which type of glands produce an initially odorless secretion but can become malodorous secondary to bacterial decompisition on the skin surface? which glands are present throughout the skin except on lips and glans penis?
Apocrine; eccrine
When it invades the bm; carcinoma in situ
8 (myc protein) with 2 - 14 - 22 (iG chains)
Pulmonary hypertension

15. What is the most important prognostic indicator in patients with malignant melanoma?
Brief psychotic disorder; schizophreniform; schizophrenia
Nonsense; mRNA processing
Measure of depth invasion (vertical!)
Retinitis; mononucleosis

16. a patient fearing all white coats is a phenomenon of what?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
GI malignancies and Insulin resistance (acromegal for ex)
Classical conditioning
Common peroneal; bony fractures and compression; sciatic

17. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
Insulin like growth factor 1 (just another name)
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Apocrine; eccrine

18. which has better side effect profile - SSRI or TCA?
46 - 4N; 23 2N
SSRI
...
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

19. which nerve in the lower leg is easily injured and causes foot drop ? What are common causes? From what nerve does it branch off or?
11 aa polypeptide; pain NT in CNS and PNS
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Common peroneal; bony fractures and compression; sciatic
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

20. non ceruloplasmin deposition - ceruloplasmin is...
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
low in serum
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

21. Where is conduction in heart fastest? slowest?
Pan colitis and right sided colitis (more than left sided and proctitis)
Purkinje system; AV node
Covalent (between two cysteines)- allows protein to withstand denaturation
women

22. What is used to prevent vertical transmission of HIV?
ZDV or AZT
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
Gluteus maximus; difficulty getting up from seated position and climbing chair
differentiate

23. why does hypothyroidism cause increased CPK levels?
SaO2 <92%
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

24. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Sickle cell; G6PD
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)

25. What is the precursor protein to beta amyloid and On what chromosome is it found?
APP on chrom 21 (this is why downs more susceptible)
Syncope - angina - dyspnea (SAD)
Acute gastric mucosal defects (superficial or full thickness)
Another type of aldosterone antagonist (like spironolactone)

26. What is the primary histologic finding in patients with eczematous dermatitis?
SSRI; erectile dysfunction
Bronchial dilation (bronchiectasis)
Spongiosis
No

27. What is the presentation of angioedema? Where is most commonly affected?
Primary
glycerol kinase
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Right heart failure

28. How do you calculate excretion rate of a substance? How do you calculate the filtration rate of a substance? clearance of what substance estimates the GFR?
Fibrosis; macrophages
IgE
Increased reticulocytes
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

29. How is dobutamine better than dopamine?
Relfex tachycardia; giving beta blockers
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
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

30. which two drug types can cause orthostatic hypotension (think depression and BPH)?
Chorda tympani branch
TCAs and prazosin
HSV and VZV
INTRApartum Abs (ampicillin/penicillin)

31. What does C1 esterase do other than inhibiting complement pathway?
Inactivates kallikrein which activates kininogen into bradykinin
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Fat - fertile - forty - female

32. What is the mc location for avascular necrosis? What is it associated with?
Increase in permeability of two ions with equal and opposite equilibrium potentials
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Skin flushing and warmth; prostaglandins; give with aspirin
No and yes

33. on What part of the clavicle does the SCM attach?
Faulty positioning of the genital tubercle
Vascular endothelium; protease
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Medial part

34. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Increase; decreased
liver specific
Joints d/t increased purine production and thus uric acid production

35. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
P53 mutation; DCC is also required for adenoma to carcinoma
4 - 4 - 9
NF- KB; responsible for cytokine production
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics

36. What are the first generation anti histamines?
Aromatase deficiency in child
Chlorpheniramine and diphenhydramine
Vagus nerve stimulation
2 -3 BPG; glycolysis - instead of ATP; erythrocytes because want to right shift the oxygen dissociation curve so that oxygen is released from RBCs into tissue

37. What is the diagnosis in delayed puberty plus anosmia?
Kallmans
Enterococci (e. faecalis)- found on genitalia area
Adeno
SS +rNA

38. What are the skin presentation in sarcoid?
MAC complex (C5b - C9 complement deficiency)
Acute gastric mucosal defects (superficial or full thickness)
Insulin like growth factor 1 (just another name)
Varying; erythema nodosum is common

39. Which is faster atrial muscle or ventricular muscle?
C3 decreased after 5-10 days; sulfonamides
No; MRI
Atrial
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

40. Metronidizaole does not cover...
Paramyxo and influenza
SVC and IVC; right below the aortic knob
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
gram positive organisms

41. How do left sided colon adenocarcinomas present? right sided?
(urine PAH x urine flow rate)/plasma PAH
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
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

42. What is the mc malignancy in asbestosis?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Reiter syndrome; B27
The term used to describe decreased drug responsiveness with repeated administration
Bronchogenic carcinoma

43. What is congestive hepatomegaly specific for?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Right heart failure
IgE

44. Where does conjugation of bilirubin take place?
In ER of bile canaliculi
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
TCAs and prazosin
SaO2 <92%

45. What is tachyphylaxis?
Medullary
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
The term used to describe decreased drug responsiveness with repeated administration

46. what has the greatest effect on prognosis when treating c. diptheriae?
Bronchogenic carcinoma
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
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
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

47. In what form are mitochondrial DNA? What do they transcribe?
Circular - outside nucleus; transport proteins - rRNA - tRNA
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Phencyclidine (PCP)
Anterior nares

48. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
<1% - 55% - concentration dependent
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Initiation - pointing; pincer grasp; walking; mama/dada
Minimal change disease

49. What three pathogens cause infectious esophagitis in HIV positive patients?
CMV - HSV 1 - Candida
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Skin flushing and warmth; prostaglandins; give with aspirin

50. What are pancreatic pseudocysts called pseudo rather than true cysts?
Inhaled animal dander allergens
Inhibits it
Not lined by epithelium
Reticulocytes