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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 are the potassium sparing diuretics?
Amiloride - spironolactone - triamterene
11
Bronchogenic carcinoma
Downs; regurgitant AV valves - ASDs

2. what hormone is structurally similar to hCG?
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Prevent phagocytosis
TSh (in testicular tumors can cause hyperthyroidism)
Boiling - bleach - formalin - UV irradiation

3. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Hereditary angioedema; ACE inhibitors
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
Fibrosis; macrophages
Single adenomatous ones

4. how does noise induced hearing loss occur?
Trauma to stereociliated hair cells of the organ of corti
HSV ( also in utero: chlymadia - neisseria - group B strep)
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Faulty positioning of the genital tubercle

5. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Myasthenia gravis
25; 25
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

6. Where is conduction in heart fastest? slowest?
Rabies encephalitis from cave bats; rabies killed vaccines
Purkinje system; AV node
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Ether and other organic solvents

7. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
transcription activation/suppression
Abnormal closing of the urethral folds
Turbulence
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

8. at four years of age - What are the social - fine motor - gross motor - and language developments?
When it invades the bm; carcinoma in situ
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
SSRI

9. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
Vagus (auricular branch); vasovagal syncope!
Biphosphonate
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Ig A deficiency

10. What is used to prevent vertical transmission of HIV?
ZDV or AZT
Measles and M3 AML`
Lateral; RV; RA; LV
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

11. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
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
IgE
Paramyxo and influenza

12. What is an abortive viral infection?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Ig A deficiency
Little effect on cell and no change
The time interval between S2 and OS- the shorter the interval - the more intense

13. other than mycobacterim wha other bacteria is acid fast?
Neisseria induced small cell vasculitis (including hands and soles)
Env genes (for getting into target cells)
Nocardia
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

14. what vessel would a fracture to the neck of the of the humerus damage?
Anterior circumflex (and axillary nerve)
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
HSV and VZV
Standing suddenly from supine position; valsalva maneuver

15. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Biphosphonate
Multiple miscarriages d/t hypercoaguability
Valproate
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

16. What does protein M do in Group A strep<
Elevated GGT and macrocytosis
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Prevent phagocytosis
Drink plenty of fluids

17. What are two common side effects of both acute and long acting nitrates? What causes them?
To pump calcium out in cardiac myocytes so that relaxation occurs
Headaches and facial flushing; vasodilation in meninges and skin
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Phencyclidine (PCP)

18. What is epleronone?
Another type of aldosterone antagonist (like spironolactone)
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Excessive collagen formation during tissue repair in susceptible individuals
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

19. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
46 - 4N; 23 2N
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
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)
Selective alpha 1 (increases SVR)

20. IL4 is used for isotypye switching to what?
Hereditary angioedema; ACE inhibitors
Susceptible; soluble (unable to be cultured in bile)
Well trained athletes and children
IgE

21. what drugs causes the red man syndrome? how does it occur?
RR-1/RR
Inactivates kallikrein which activates kininogen into bradykinin
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Vancomycin; histamine mediated

22. What type of vision is myopia? In What type of patients does it improve?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
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
Elastance
8; 12

23. What is pickwickian syndrome? What are the lab findings?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Localized dermatologic pain that persists for more than one month after zoster eruption
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

24. what happens with LDL receptor density in statin therapy?
Increases
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

25. How can renal blood flow be calculated from RPF?
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
RBF= PAH clearance/(1- hematocrit)
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Biphosphonate

26. What would a deflection of the membrane potential to near zero indicate?
Increase in permeability of two ions with equal and opposite equilibrium potentials
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Bronchial dilation (bronchiectasis)
The time interval between S2 and OS- the shorter the interval - the more intense

27. What can worse neurologic dysfunction in cobalamic def?
Folic acid treatment!
Nocardia
T test; chi squared
Bile soluble which means they are bile sensitive

28. What is the best indicator for the severity of mitral stenosis?
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
Rabies encephalitis from cave bats; rabies killed vaccines
The time interval between S2 and OS- the shorter the interval - the more intense
The term used to describe decreased drug responsiveness with repeated administration

29. what diseases can vit A be used to treat?
Nocardia
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
transcription activation/suppression
Measles and M3 AML`

30. 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?
Inactivates kallikrein which activates kininogen into bradykinin
Tzanck smear
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Injury to common peroneal nerve (d/t trauma or sustained pressure to neck of fibula) causing pain and numbness on dorsum of foot and inability to dorsiflex

31. do patients with cor pulmonale have increased or decreased levels of aldosterone?
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
Recurrent larygneal
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Because of the low output from heart failure - they will have increased aldosterone levels

32. What can chronic vit A toxicity cause?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Turners`
RER; copper
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

33. which RPGN is also called pauci immune GN? why?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Prostate tumor and increased osteoclast activity
ANCA because of lack of Ig and C3 deposits on IF

34. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Medial circumflex artery; avascular necrosis
Tzanck smear
Purkinje system; AV node
Amiadarone

35. What does NF- KB do?
Increases cytokine production
low in serum
Prepatellar
Inhibits it

36. what defines hypoxemia?
Gluteus medius and minimus; positive trendelenberg
46 - 4N; 23 2N
SaO2 <92%
Susceptible; soluble (unable to be cultured in bile)

37. Which is faster purkinje system or atrial muscle?
In the extracellular space for collagen cross linking; zinc
Close but purkinje system to ensure contraction in a bottom up fashion
T test; chi squared
On cardiac tissue and renal juxtaglomerular cells

38. What can cause aortic regurg? What is the heart sound you hear?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Measure of depth invasion (vertical!)
Joints d/t increased purine production and thus uric acid production
Vascular endothelium; protease

39. In What type of nephritis would you see high serum eos count?
Another type of aldosterone antagonist (like spironolactone)
Brief psychotic disorder; schizophreniform; schizophrenia
Drug induced interstitial nephritis
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

40. what induces bronchial squamous metaplasia?
Smoking
Large stroke volumes with ventricular contraction; aortic regurg
...
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

41. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
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
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Classical conditioning

42. Where does lysyl oxidase act? What is the cofactor for that?
In the extracellular space for collagen cross linking; zinc
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Skin flushing and warmth; prostaglandins; give with aspirin
Integration of viral DNA into genome of host hepatocytes

43. why does liver dysfunction cause coagulation disorders?
Syringomelia
Multiple miscarriages d/t hypercoaguability
Coagulation factors are made in the liver
Covalent (between two cysteines)- allows protein to withstand denaturation

44. who bleed more DIC or TTP- HUS patients?
DIC; TTP- HUS dont bleed that much
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Because of the low output from heart failure - they will have increased aldosterone levels
Increases bronchial and vascular smooth muscle reactivity to catecholamines

45. What does C1 esterase do other than inhibiting complement pathway?
Inactivates kallikrein which activates kininogen into bradykinin
T test; chi squared
RER; RER
Hypo or hyper pigmentations; after tanning

46. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
11 aa polypeptide; pain NT in CNS and PNS
Pan colitis and right sided colitis (more than left sided and proctitis)
Echinococcus granulosus; anaphylaxis
Bronchogenic carcinoma

47. What is the mc manifestation of CMV in HIV patient? immunocompetent?
Retinitis; mononucleosis
Chrom 8
Acute interstitial nephritis
Increases

48. hypertonicity and hyperreflexity are ________________ of hydrocephalus
Hypothyroidism
Appetite suppressants
Intussusception
manifestations - congenital (stretching of periventricular pyrimadal fibers)

49. What is diphenoxylate and What is it used for? what drug is it structurally similar to? What allows for potent anti diarrheal effect without signigicant opiate effects?
AV node slowest - to allow time for diastole
low in serum
RBF= PAH clearance/(1- hematocrit)
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)

50. which nerve is at risk when ligating the superior thyroid artery? Which is the only muscle this nerve innervates? what nerve innervates all the other laryngeal muscles?
Prostate tumor and increased osteoclast activity
Superior larygeal; cricothyroid; recurrent laryngeal
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
only up to bronchi