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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 does sustained hand grip do to the C/V system?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Intussusception
Pain reliever - reduces pain by locking substance P in the PNS

2. When is acid phosphatase elevated (Name two times)?
Prostate tumor and increased osteoclast activity
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
differentiate
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

3. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
Gluteus medius and minimus; positive trendelenberg
differentiate
Turbulence
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

4. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
GI tract; mood!
Reiter syndrome; B27
Turbulence
Pulmonary hypertension

5. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
Southern - western
P450 mitochondrial monooxygenase
SVT; increases vagal tone; rectus abdominis
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

6. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
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
Paramyxo and influenza
AV node slowest - to allow time for diastole
Chorda tympani branch

7. non ceruloplasmin deposition - ceruloplasmin is...
Syncope - angina - dyspnea (SAD)
Extrinsic def; instrinsic def; platelet def
low in serum
Leukotriene precursor and does neutrophil chemotaxis

8. What is it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
On cardiac tissue and renal juxtaglomerular cells
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Vertical diplopia
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

9. What are the long term consequences of hydrocephalus?
Bile salt accumulation in urine
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Neisseria induced small cell vasculitis (including hands and soles)
Spongiosis

10. What are pancreatic pseudocysts called pseudo rather than true cysts?
Think Hb deformation diseases
Raphe
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Not lined by epithelium

11. What are the first generation anti histamines?
Chlorpheniramine and diphenhydramine
ANCA because of lack of Ig and C3 deposits on IF
Vascular endothelium; protease
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

12. What is used to compare means? categorical outcomes?
Curlings ulcers
Leukotriene precursor and does neutrophil chemotaxis
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
T test; chi squared

13. which RPGN is also called pauci immune GN? why?
ANCA because of lack of Ig and C3 deposits on IF
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
ST become atrophic and hyalinized (temp induced damage) and depressed sperm count becuase of that; hormonal function not impaired (test and LH levels normal) because Leydig cells not as temp sensitive so secondary sexual characteristics and sexual pe
Vertical diplopia

14. What do you treat s. epidermidis with?
Vancomycin
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Hereditary angioedema; ACE inhibitors
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

15. when do ghon complexes form - primary or secondary TB?
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Primary
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

16. what makes bruits?
Anti cholinergic effects of pupil dilation and lack of accomodation
Extrinsic def; instrinsic def; platelet def
Cluster
Turbulence

17. How do you calculate RPF from urine PAH?
Neisseria induced small cell vasculitis (including hands and soles)
Fibronectin - laminin - collagen
Initiation - pointing; pincer grasp; walking; mama/dada
(urine PAH x urine flow rate)/plasma PAH

18. What is contraindicated in toxic mega colon?
Prevents hepatic VLDL production
Covalent (between two cysteines)- allows protein to withstand denaturation
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
HSV and VZV

19. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Syncope - angina - dyspnea (SAD)
Skin flushing and warmth; prostaglandins; give with aspirin
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Another type of aldosterone antagonist (like spironolactone)

20. who bleed more DIC or TTP- HUS patients?
Chorda tympani branch
DIC; TTP- HUS dont bleed that much
Around 70 (normal measured diastolic pressures); 9--
PDA open

21. what kind of drug is sertraline? What is a common side effect?
SSRI; erectile dysfunction
Well trained athletes and children
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Drug induced interstitial nephritis

22. what hernia has a similar mechanism to hydrocele?
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
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Serum creatine kinase; reperfusion injury causes necrosis
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

23. what virus causes pharyngoconjuctival fever?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Env genes (for getting into target cells)
Turbulence
Adeno

24. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Gluteus medius and minimus; positive trendelenberg
Vancomycin
SVC and IVC; right below the aortic knob
Underestimation of gestational age

25. What does glycosylase do to DNA? endonuclease? lyase? What does the order here of enzymes represent? what other enzymes are needed?

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26. what defines hypoxemia?
SaO2 <92%
Inhibits it
P53 mutation; AD
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

27. why does hypothyroidism cause increased CPK levels?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
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)
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Hypo or hyper pigmentations; after tanning

28. What does Rb protein do? what chrom is it on?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
ZDV or AZT
8; 12
Apocrine; eccrine

29. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
Serum creatine kinase; reperfusion injury causes necrosis
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
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)
Minimal change disease

30. What can worse neurologic dysfunction in cobalamic def?
On cardiac tissue and renal juxtaglomerular cells
Folic acid treatment!
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

31. What is a keloid?
Increases
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
chronic urticaria and allergic symptoms
Excessive collagen formation during tissue repair in susceptible individuals

32. What is pickwickian syndrome? What are the lab findings?
Normally close to systolic
Covalent (between two cysteines)- allows protein to withstand denaturation
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Increase in permeability of two ions with equal and opposite equilibrium potentials

33. what receptors do first generation anti histamines block?
Think Hb deformation diseases
In the extracellular space
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

34. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Rabies encephalitis from cave bats; rabies killed vaccines
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
To pump calcium out in cardiac myocytes so that relaxation occurs
Echinococcus granulosus; anaphylaxis

35. What is difference between Arnold Chiari type I and II?
Fat - fertile - forty - female
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)
I is more benign and can present later in adulthood
manifestations - congenital (stretching of periventricular pyrimadal fibers)

36. What are some side effects seen in TCAs?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Ether and other organic solvents
Anterior nares

37. What does anti phospholipid syndrome in SLE patients predispose them to?
Prevent phagocytosis
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Multiple miscarriages d/t hypercoaguability

38. What is the cause of fixed splitting of S2? why?
Atrial
Thymic tumor
Clindamycin; covers anaerobic oral flora and aerobic bacteria
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

39. Where is conduction in heart fastest? slowest?
Purkinje system; AV node
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

40. What is used to prevent vertical transmission of HIV?
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
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
ZDV or AZT

41. other than in pyelonephritis - where else are WBC casts seen?
Turbulence
Acute interstitial nephritis
Drink plenty of fluids
Become beta pleated and then form neurofibrillary tangle!

42. What is tachyphylaxis?
Duration and extent of disease
II; I (I more abundant)
Because of vasodiation to skeletal muscles
The term used to describe decreased drug responsiveness with repeated administration

43. What are two indicators of chronic alcohol consumption?
Elevated GGT and macrocytosis
Normally close to systolic
Ketone body production by preventing fatty acids into the mitochondria
Increased reticulocytes

44. What is Bortezomib and What is it used for?
Proteasome inhibitor; treatment for MM and waldenstroms
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
Fat - fertile - forty - female
Sarcoid

45. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
P450 mitochondrial monooxygenase
Gluteus maximus; difficulty getting up from seated position and climbing chair
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Extrinsic def; instrinsic def; platelet def

46. What would a deflection of the membrane potential to near zero indicate?
Myasthenia gravis
Sarcoid
Increase in permeability of two ions with equal and opposite equilibrium potentials
Turners`

47. 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?
Common peroneal; bony fractures and compression; sciatic
Hypothyroidism
Superior larygeal; cricothyroid; recurrent laryngeal
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

48. What test would be best to determine if a gene is being transcribed? translated?
Increase; decreased
Serum creatine kinase; reperfusion injury causes necrosis
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Southern - western

49. What is a clara cell?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

50. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
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
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Bile salt accumulation in urine
Terminal bronchioles; small bronchi