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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 'oxygen' content in blood refer to?
Ig A deficiency
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Dissolved in plasma and attached to Hgb
Anti centromere; anti DNA topoisomerase

2. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
facultative intracellular
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

3. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
Vagus (auricular branch); vasovagal syncope!
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
V fib; v. failure

4. What is somatomedin C?
No
Insulin like growth factor 1 (just another name)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Anterior nares

5. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
SVT; increases vagal tone; rectus abdominis
Anti centromere; anti DNA topoisomerase
HSV ( also in utero: chlymadia - neisseria - group B strep)
Increase; decreased

6. Acyl coA synthetase is not...
Gluteus maximus; difficulty getting up from seated position and climbing chair
liver specific
Nocardia
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

7. What are the primary determinants of colon cancer risk in UC patients
Duration and extent of disease
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Amiadarone
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

8. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
glycerol kinase
MAO inhibitors; wine and cheese
Serum FFA and serum triglyceride levels
Large stroke volumes with ventricular contraction; aortic regurg

9. what murmur is enhanced by decreased blood flow to the heart?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Apocrine; eccrine
APP on chrom 21 (this is why downs more susceptible)
RER; copper

10. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Headaches and facial flushing; vasodilation in meninges and skin
Raphe
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Smoking

11. What are the three dopaminergic systems and What are they responsible for? disease?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Syncope - angina - dyspnea (SAD)
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

12. 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?
RER; copper
Demargination of neutrophils from the vessel walls
Superior larygeal; cricothyroid; recurrent laryngeal
Dihydropyridine sensitive Ca channels (L type)

13. What is epleronone?
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Another type of aldosterone antagonist (like spironolactone)
Drug induced interstitial nephritis

14. What is the immune deficinecy seen in ataxia telangactasia?
II; I (I more abundant)
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Ig A deficiency

15. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Turbulence
women
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

16. SIADH patients have normal blood volume but...
Medial part
hyponatremia (aldosterone activation equilibrates body volume)
Highly negative resting potential
8 (myc protein) with 2 - 14 - 22 (iG chains)

17. within the right ventricle - What are maximum pressures? the pulm arter?
25; 25
Paramyxo and influenza
Atrial
In ER of bile canaliculi

18. What does extended consumption of appetite suppressants lead to?
Tzanck smear
Serum FFA and serum triglyceride levels
Pulmonary hypertension
indomethacin

19. What can cause aortic regurg? What is the heart sound you hear?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Anterior circumflex (and axillary nerve)

20. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
The time interval between S2 and OS- the shorter the interval - the more intense
RER; copper
Think Hb deformation diseases

21. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Env genes (for getting into target cells)
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Syringomelia
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

22. What causes wrist drop?
Ig A deficiency
women
Radial nerve damage
Increased reticulocytes

23. within the right atrium - What is the maximum pressure? left atrium?
Single adenomatous ones
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
8; 12
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

24. which opponens muscle does ulnar innervate?
46 - 4N; 23 2N
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)
Adductor
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

25. what indicates the severity of a mitral regurg ? mitral stenosis?
Amiloride - spironolactone - triamterene
Serum creatine kinase; reperfusion injury causes necrosis
S3 gallop; S2 to opening snap interval
To pump calcium out in cardiac myocytes so that relaxation occurs

26. do patients with cor pulmonale have increased or decreased levels of aldosterone?
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
Fibronectin - laminin - collagen
Minimal change disease
Because of the low output from heart failure - they will have increased aldosterone levels

27. What is a clara cell?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
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
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Gluteus medius and minimus; positive trendelenberg

28. at 2 years of age - What are the social - fine motor - gross motor and language developments?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
No; MRI
Drug induced interstitial nephritis
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

29. which two drug types can cause orthostatic hypotension (think depression and BPH)?
TCAs and prazosin
Minimal change disease
Joints d/t increased purine production and thus uric acid production
Syncope - angina - dyspnea (SAD)

30. h1 receptor anatagonists are not effective in treatment of asthma only for...
INTRApartum Abs (ampicillin/penicillin)
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Intussusception
chronic urticaria and allergic symptoms

31. where exactly is ACE expressed in the lungs? What type of enzyme is it?
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Vascular endothelium; protease
P53 mutation; AD
Regular insulin (Not fast acting - regular better)

32. sporadic colon cancer tend to arise From what type of polyps?
Hypertension - edema - and proteinuria
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
FGF and VEGF
Single adenomatous ones

33. What is a primary HSV 1 infection like?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Little effect on cell and no change
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

34. What is the mainstay treatment for acute mania?
Retinitis; mononucleosis
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Primary
Fibrosis; macrophages

35. where are Beta 1 receptors found?
On cardiac tissue and renal juxtaglomerular cells
Because gamma chains replace beta chains and then gamma chain formation wanes
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
Hypo or hyper pigmentations; after tanning

36. What does anti phospholipid syndrome in SLE patients predispose them to?
Multiple miscarriages d/t hypercoaguability
Selective alpha 1 (increases SVR)
SS +rNA
RBF= PAH clearance/(1- hematocrit)

37. Which nerve lies in close proximity to the inferior thyroid artery?
Recurrent larygneal
gram positive organisms
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Little effect on cell and no change

38. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Rabies encephalitis from cave bats; rabies killed vaccines
Adeno
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Increased reticulocytes

39. What is tachyphylaxis?
Not lined by epithelium
Ketone body production by preventing fatty acids into the mitochondria
The term used to describe decreased drug responsiveness with repeated administration
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 does p53 do? what chrom is it on?
Class I
E. coli
gram positive organisms
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

41. which RPGN is also called pauci immune GN? why?
ANCA because of lack of Ig and C3 deposits on IF
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
V fib; v. failure
Tzanck smear

42. How do you treat gonococcal infection? chlymadia?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Gluteus medius and minimus; positive trendelenberg
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
Ceftriaxone; azithromycin

43. there are mucus secreting cells in the bronchioles...
The term used to describe decreased drug responsiveness with repeated administration
only up to bronchi
NF- KB; responsible for cytokine production
G to T in p53; HCC

44. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Hyperkalemia; potassium sparing diuretics - potassium supplements
Localized dermatologic pain that persists for more than one month after zoster eruption
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
DIC; TTP- HUS dont bleed that much

45. in essential fructosuria - what enzyme do patients use to metabolize fructose?
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)
Dihydropyridine sensitive Ca channels (L type)
Hexokinase
Prevent phagocytosis

46. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Selective alpha 1 (increases SVR)
Well
Class I
FGF and VEGF

47. What is subacute sclerosisng encephalitis caused by?
Circular - outside nucleus; transport proteins - rRNA - tRNA
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
Valproate
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

48. What is the mc location of brain germinomas?What are the classic symptoms?
NF- KB; responsible for cytokine production
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Inhaled animal dander allergens
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

49. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Sarcoid
Enterococci (e. faecalis)- found on genitalia area

50. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Medial circumflex artery; avascular necrosis
Strength of cell mediated immune response
S3 gallop; S2 to opening snap interval