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USMLE Prep 2

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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 has better side effect profile - SSRI or TCA?
RER; RER
SSRI
The time interval between S2 and OS- the shorter the interval - the more intense
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

2. non ceruloplasmin deposition - ceruloplasmin is...
low in serum
E6 and E7 of HPV knock off p53 and Rb suppressor genes
ANCA because of lack of Ig and C3 deposits on IF
Chrom 8

3. PDAs are often asymptomatic. How do you treat?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
indomethacin

4. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Increase in permeability of two ions with equal and opposite equilibrium potentials
Increase; decreased
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

5. What is the most common cause of pyelonephritis in both adults and childre?
Echinococcus granulosus; anaphylaxis
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
E. coli
Turbulence

6. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Phencyclidine (PCP)
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
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Squatting - sitting - lying supine - passive leg raising

7. What does L/S stand for in fetal lung maturity? When does maturity occur?
HSV and VZV
Retinitis; mononucleosis
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

8. What is the fibrinogen level in patient with TTP- HUS? DIC?
Normal; low
Fibrosis; macrophages
On cardiac tissue and renal juxtaglomerular cells
GI malignancies and Insulin resistance (acromegal for ex)

9. What type of disease has selective proteinuria? What is found in urine? What is not?
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
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Cluster
Vertical diplopia

10. What almost exclusively causes Epliglottitis?What type of capsule does it have? What are the symptoms?

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11. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Gluteus maximus; difficulty getting up from seated position and climbing chair
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

12. What type of endocarditis is cytoscopy induced?
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
The time interval between S2 and OS- the shorter the interval - the more intense
Enterococci (e. faecalis)- found on genitalia area
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

13. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Multiple miscarriages d/t hypercoaguability
Turners`
Right before diastole (filling begins)
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

14. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
facultative intracellular
APP on chrom 21 (this is why downs more susceptible)
Susceptible; soluble (unable to be cultured in bile)
Tzanck smear

15. where are Beta 1 receptors found?
On cardiac tissue and renal juxtaglomerular cells
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Anti - apoptotic (prevents going into apoptosis)- 18; 14

16. What are some of the permissive effects of cortisol?
Close but purkinje system to ensure contraction in a bottom up fashion
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Inactivates kallikrein which activates kininogen into bradykinin
gram positive organisms

17. What is the precursor protein to beta amyloid and On what chromosome is it found?
Prostate tumor and increased osteoclast activity
APP on chrom 21 (this is why downs more susceptible)
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Covalent (between two cysteines)- allows protein to withstand denaturation

18. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
Hexokinase
Trochlear nerve (IV); abducens nerve (VI)
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

19. 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?
Hypothyroidism
Apocrine; eccrine
Anti - apoptotic (prevents going into apoptosis)- 18; 14
In the extracellular space for collagen cross linking; zinc

20. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Transported to liver - glycerol kinase converts it to glycerol 3 phosphate Which is then converted to DHAP which can either join glycolysis for ATP or be used to make glucose
Extrinsic def; instrinsic def; platelet def

21. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
RBF= PAH clearance/(1- hematocrit)
Well trained athletes and children
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Squatting - sitting - lying supine - passive leg raising

22. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Hereditary angioedema; ACE inhibitors
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Hypo or hyper pigmentations; after tanning
P53 mutation; DCC is also required for adenoma to carcinoma

23. what would be a sign of absence of cardiogenic pulm edem?
RER; RER
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

24. What is the stabilizing force for the secondary structure of proteins?
Drink plenty of fluids
Because of the low output from heart failure - they will have increased aldosterone levels
Hydrogen bonds dictate alpha or beta structure
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

25. What is medullary sponge kidney disease and how does it present? What does it lead to?
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)
Elevated GGT and macrocytosis
Because of the low output from heart failure - they will have increased aldosterone levels
No and yes

26. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Relfex tachycardia; giving beta blockers
High potassium conductance and some sodium conductance
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Protamine sulfate

27. what nerve and artery course along the posterior aspect of the humerus?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Measles and M3 AML`
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)
Radial nerve and deep brachial artery

28. what diseases can vit A be used to treat?
Measles and M3 AML`
Circular - outside nucleus; transport proteins - rRNA - tRNA
Highly negative resting potential
RER; RER

29. When is acid phosphatase elevated (Name two times)?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Bronchial dilation (bronchiectasis)
Prostate tumor and increased osteoclast activity
Syncope - angina - dyspnea (SAD)

30. what enzyme converts procarcinogens into carcinogens?
Recurrent larygneal
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
P450 mitochondrial monooxygenase
Ceftriaxone; azithromycin

31. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
Anterior nares
glycerol kinase
Right heart failure
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

32. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
INTRApartum Abs (ampicillin/penicillin)
Chorda tympani branch
8; 12
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

33. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
Class I
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Tissue redistribution (out of plasma) rather than metabolism
RBC mass; epo levels (secondary has high)

34. What is a common complication of acute pancreatitis? What is it?
Raphe
Increases
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

35. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
P53 mutation; DCC is also required for adenoma to carcinoma
When it invades the bm; carcinoma in situ
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Coagulation factors are made in the liver

36. What is pickwickian syndrome? What are the lab findings?
Octreotide
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
RER; copper
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

37. What can too much IgA in serum produces?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Bile salt accumulation in urine

38. do Class IC agents prolong the QT interval?
No
Underestimation of gestational age
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Purkinje system; AV node

39. 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?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Prostate tumor and increased osteoclast activity

40. Where does the aorta lie in relation to the pulmonary artery in transposition of the great arteries (is this right to left or left to right shunt?)?
46 - 4N; 23 2N
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Paramyxo and influenza
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

41. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Bile soluble which means they are bile sensitive
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
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

42. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Turners`
Tzanck smear
Aromatase deficiency in child
Medial circumflex artery; avascular necrosis

43. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Acute interstitial nephritis
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

44. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
frameshift mutations (missense is substitution)
Lateral; RV; RA; LV
Selective alpha 1 (increases SVR)
Terminal bronchioles; small bronchi

45. When does opening snap begin?
Sickle cell; G6PD
Initiation - pointing; pincer grasp; walking; mama/dada
Not lined by epithelium
Right before diastole (filling begins)

46. How do you treat gonococcal infection? chlymadia?
Ceftriaxone; azithromycin
Minimal change disease
E. coli
Susceptible; soluble (unable to be cultured in bile)

47. How do bradykinin - C3a and C5a cause edema?
By vascular permeability and vasodilation
Retinitis; mononucleosis
Relfex tachycardia; giving beta blockers
G to T in p53; HCC

48. What would a deflection of the membrane potential to near zero indicate?
Increases
Syringomelia
Increase in permeability of two ions with equal and opposite equilibrium potentials
AV node slowest - to allow time for diastole

49. What are the potassium sparing diuretics?
Vertical diplopia
facultative intracellular
Intussusception
Amiloride - spironolactone - triamterene

50. What is the Na/Ca exchange used for?
To pump calcium out in cardiac myocytes so that relaxation occurs
Coagulation factors are made in the liver
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Protamine sulfate

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USMLE Prep 2

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