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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 type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Class I
The term used to describe decreased drug responsiveness with repeated administration
Increases
Excessive collagen formation during tissue repair in susceptible individuals

2. Where is conduction in heart fastest? slowest?
Pulmonary hypertension
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Purkinje system; AV node
Close but purkinje system to ensure contraction in a bottom up fashion

3. What is epleronone?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Another type of aldosterone antagonist (like spironolactone)
By vascular permeability and vasodilation
Prevent phagocytosis

4. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Downs; regurgitant AV valves - ASDs
Southern - western
Primary
Varying; erythema nodosum is common

5. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Susceptible; soluble (unable to be cultured in bile)
11 aa polypeptide; pain NT in CNS and PNS
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

6. in overweight individuals What is thought to contribute to insulin resistance?
Appetite suppressants
Serum FFA and serum triglyceride levels
Regular insulin (Not fast acting - regular better)
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

7. Metronidizaole does not cover...
8 (myc protein) with 2 - 14 - 22 (iG chains)
Hypo or hyper pigmentations; after tanning
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
gram positive organisms

8. sporadic colon cancer tend to arise From what type of polyps?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Single adenomatous ones
AV node slowest - to allow time for diastole
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

9. What is it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
Vertical diplopia
Folic acid treatment!
SVC and IVC; right below the aortic knob
Increases

10. In what population does cholelithiasis occur?
S3 gallop; S2 to opening snap interval
Chorda tympani branch
TSh (in testicular tumors can cause hyperthyroidism)
Fat - fertile - forty - female

11. which nucleus releases serotonin?
Fat - fertile - forty - female
Reticulocytes
Raphe
Anterior nares

12. What agonists reduce the gradient across the LV outflow tract?
Anterior nares
Selective alpha 1 (increases SVR)
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

13. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
<1% - 55% - concentration dependent
E. coli; staphylococcus saprophyticus
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
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)

14. What does protein M do in Group A strep<
Prevent phagocytosis
Increase; decreased
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
OCPs - multiparity - breast feeding

15. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

16. What type of drug is alendronate?
Biphosphonate
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Because ACE blocks breakdown of bradykinin and hereditary angioedema patients have high levels of bradykinin; high levels of bradykinin - C3a - and C5a mediate edema by increasing vascular permeability and vasodilation
Integration of viral DNA into genome of host hepatocytes

17. 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
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
PDA open

18. What are diastolic (lowest) pressures in aorta? LV?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Because ACE blocks breakdown of bradykinin and hereditary angioedema patients have high levels of bradykinin; high levels of bradykinin - C3a - and C5a mediate edema by increasing vascular permeability and vasodilation
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)
Around 70 (normal measured diastolic pressures); 9--

19. What is medullary sponge kidney disease and how does it present? What does it lead to?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
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)
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)
Around 70 (normal measured diastolic pressures); 9--

20. What is extraocular muscle weakness a common symptom of?
Anterior nares
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Myasthenia gravis
Anti cholinergic effects of pupil dilation and lack of accomodation

21. what phase do adenosine and acetylcholine act on? doing what?
APP on chrom 21 (this is why downs more susceptible)
Increase in permeability of two ions with equal and opposite equilibrium potentials
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Medial circumflex artery; avascular necrosis

22. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
Trauma to stereociliated hair cells of the organ of corti
Normally close to systolic
Mean greater than median greater than mode
RER; RER

23. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Relfex tachycardia; giving beta blockers
Standing suddenly from supine position; valsalva maneuver
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

24. What type of vision is myopia? In What type of patients does it improve?
INTRApartum Abs (ampicillin/penicillin)
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Bile salt accumulation in urine
11 aa polypeptide; pain NT in CNS and PNS

25. 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?
No; MRI
Apocrine; eccrine
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
GI tract; mood!

26. What is acanthosis nigricans associated with?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
GI malignancies and Insulin resistance (acromegal for ex)
GI tract; mood!
Both sides

27. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Inhibits it
Increases
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

28. What is the most common neurologic complication of VZV reactivation?
hyponatremia (aldosterone activation equilibrates body volume)
SaO2 <92%
Localized dermatologic pain that persists for more than one month after zoster eruption
Right before diastole (filling begins)

29. Where is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
PDA open
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
No; MRI
Reiter syndrome; B27

30. Is there edema in primary Conns? secondary hyperaldosteronism? why?
SS +rNA
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Minimal change disease

31. ___________ is liver specific
Skin flushing and warmth; prostaglandins; give with aspirin
4 - 4 - 9
Vagus nerve stimulation
glycerol kinase

32. what induces bronchial squamous metaplasia?
Smoking
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Bronchogenic carcinoma
Rabies encephalitis from cave bats; rabies killed vaccines

33. how does noise induced hearing loss occur?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Varying; erythema nodosum is common
Trauma to stereociliated hair cells of the organ of corti

34. nucleotide deletions do not cause missense mutations - they cause...
Ig A deficiency
frameshift mutations (missense is substitution)
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Increase in permeability of two ions with equal and opposite equilibrium potentials

35. What is a clara cell?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Retinitis; mononucleosis

36. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
TSh (in testicular tumors can cause hyperthyroidism)

37. What does extended consumption of appetite suppressants lead to?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
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)
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Pulmonary hypertension

38. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
Adductor
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Radial nerve and deep brachial artery
DIC; TTP- HUS dont bleed that much

39. 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
In the extracellular space
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
46 - 4N; 23 2N

40. 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?
RBF= PAH clearance/(1- hematocrit)
IgE
Cluster
Class I

41. what defines hypoxemia?
200-500
SaO2 <92%
C3 decreased after 5-10 days; sulfonamides
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

42. How do you explain the selective proteinuria of loss to albumin only in MCD?
II; I (I more abundant)
Pulmonary hypertension
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

43. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Joints d/t increased purine production and thus uric acid production
Leukotriene precursor and does neutrophil chemotaxis
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Southern - western

44. What are the skin presentation in sarcoid?
HSV ( also in utero: chlymadia - neisseria - group B strep)
I is more benign and can present later in adulthood
Varying; erythema nodosum is common
indomethacin

45. what immune deficiency causes recurrent neisseria infections?
The term used to describe decreased drug responsiveness with repeated administration
Terminal bronchioles; small bronchi
Anti centromere; anti DNA topoisomerase
MAC complex (C5b - C9 complement deficiency)

46. SIADH patients have normal blood volume but...
Ether and other organic solvents
Inhaled animal dander allergens
hyponatremia (aldosterone activation equilibrates body volume)
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

47. What effects does cortisol have on 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
Boiling - bleach - formalin - UV irradiation
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
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

48. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
Curlings ulcers
Sydenham chorea
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

49. other than parvo B19 - what else is associated with red cell aplasia?
hyponatremia (aldosterone activation equilibrates body volume)
Thymic tumor
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
P53 mutation; DCC is also required for adenoma to carcinoma

50. biotin is used By what in tissues responsible for gluconeogenesis
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Proteasome inhibitor; treatment for MM and waldenstroms
As a CO2 carrier with the carboxylase enzyme
Common peroneal; bony fractures and compression; sciatic