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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. In What type of nephritis would you see high serum eos count?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Fibronectin - laminin - collagen
Folic acid treatment!
Drug induced interstitial nephritis

2. Where does complement bind on the Fc region of Ig chains?
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
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)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
women

3. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
OCPs - multiparity - breast feeding
Insulin like growth factor 1 (just another name)
LT (LTD4 - E4 - C4) - and Ach
Right heart failure

4. what happens to sperm count and semineferous tubules in patient with cryptoorchidism? hormonal function? why do they need to be surgically descended?
Vagus nerve stimulation
Fibronectin - laminin - collagen
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
Valproate

5. what kind of drug is sertraline? What is a common side effect?
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)
TCAs and prazosin
SSRI; erectile dysfunction
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

6. which has better side effect profile - SSRI or TCA?
SSRI
Circular - outside nucleus; transport proteins - rRNA - tRNA
Downs; regurgitant AV valves - ASDs
Highly negative resting potential

7. What are the three dopaminergic systems and What are they responsible for? disease?
Because of the low output from heart failure - they will have increased aldosterone levels
No and yes
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
hyponatremia (aldosterone activation equilibrates body volume)

8. What is hyaline arteriosclerosis usually a sign of ?
T test; chi squared
Hyperkalemia; potassium sparing diuretics - potassium supplements
Trochlear nerve (IV); abducens nerve (VI)
Diabetic microangiopathy

9. What is the mc location for avascular necrosis? What is it associated with?
Measure of depth invasion (vertical!)
Classical conditioning
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Increase in permeability of two ions with equal and opposite equilibrium potentials

10. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
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
Ketone body production by preventing fatty acids into the mitochondria
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Fat - fertile - forty - female

11. Where does terminal peptide cleavage of collagen fibrils take place?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Increases
Medial circumflex artery; avascular necrosis
In the extracellular space

12. What is the best indicator for the severity of mitral stenosis?
The time interval between S2 and OS- the shorter the interval - the more intense
Kallmans
Primary
Apocrine; eccrine

13. What does protein M do in Group A strep<
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
RER; RER
Prevent phagocytosis
(urine PAH x urine flow rate)/plasma PAH

14. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
HSV ( also in utero: chlymadia - neisseria - group B strep)
CGD; t cell dysfxn (diGeorge)

15. In what form are mitochondrial DNA? What do they transcribe?
Pulmonary hypertension
Circular - outside nucleus; transport proteins - rRNA - tRNA
OCPs - multiparity - breast feeding
In the extracellular space

16. What are some side effects seen in TCAs?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Vancomycin; histamine mediated
Headaches and facial flushing; vasodilation in meninges and skin

17. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Medial part
Not lined by epithelium
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

18. What antibodies are present in CREST? What is the most specific?
Anti centromere; anti DNA topoisomerase
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
S3 gallop; S2 to opening snap interval
Dissolved in plasma and attached to Hgb

19. what dissolves the lipid bilayer of a viral envelope?
Ether and other organic solvents
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
SaO2 <92%

20. What is damaged in early syringomelia? later?
Think Hb deformation diseases
Chorda tympani branch
Susceptible; soluble (unable to be cultured in bile)
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

21. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Anterior nares
Increase lymphatic drainage!
Prevent phagocytosis
SaO2 <92%

22. what color pigmentations are caused by malassezia furfur? when do they become more visible?
I is more benign and can present later in adulthood
SSRI
Leukotriene precursor and does neutrophil chemotaxis
Hypo or hyper pigmentations; after tanning

23. prostaglandin synthesis keeps...
PDA open
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Paramyxo and influenza

24. which opponens muscle does ulnar innervate?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
TCAs and prazosin
Adductor
Single adenomatous ones

25. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Squatting - sitting - lying supine - passive leg raising
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Drug induced interstitial nephritis
RBC mass; epo levels (secondary has high)

26. What is the cause of rapid plasma decay of thiopental?
Ceftriaxone; azithromycin
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Sickle cell; G6PD
Tissue redistribution (out of plasma) rather than metabolism

27. why should you not use ACE inhibitors with someone who had hereditary angioedema?
11
Appetite suppressants
Env genes (for getting into target 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

28. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
P450 mitochondrial monooxygenase
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

29. what indicates the severity of a mitral regurg ? mitral stenosis?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
manifestations - congenital (stretching of periventricular pyrimadal fibers)
IgE
S3 gallop; S2 to opening snap interval

30. Which nerve lies in close proximity to the inferior thyroid artery?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Recurrent larygneal
Fibrosis; macrophages

31. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Reiter syndrome; B27
Normally close to systolic
Decreases both
Insulin like growth factor 1 (just another name)

32. How is dobutamine better than dopamine?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Chorda tympani branch
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

33. erythema nodosum - elevated ACE - scattered granulomas - arthralgias - hilar lymphadenoapthy are indicative of what?
gram positive organisms
Retinitis; mononucleosis
Hexokinase
Sarcoid

34. which cells produce surfactant? which ones mediate gas exchange?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
II; I (I more abundant)
OCPs - multiparity - breast feeding
only up to bronchi

35. What can chronic vit A toxicity cause?
Large stroke volumes with ventricular contraction; aortic regurg
Lateral; RV; RA; LV
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
RER; copper

36. Is there edema in primary Conns? secondary hyperaldosteronism? why?
Bronchial dilation (bronchiectasis)
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Cluster
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

37. What is pickwickian syndrome? What are the lab findings?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Purkinje system; AV node
Env genes (for getting into target cells)
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

38. after a thrombus extraction - what serum enzyme shoots up and why?
Become beta pleated and then form neurofibrillary tangle!
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Medial part
Serum creatine kinase; reperfusion injury causes necrosis

39. who bleed more DIC or TTP- HUS patients?
Biphosphonate
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
DIC; TTP- HUS dont bleed that much

40. what murmur is enhanced by decreased blood flow to the heart?
Insulin like growth factor 1 (just another name)
Kallmans
HSV and VZV
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

41. What is used to prevent vertical transmission of HIV?
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
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
ZDV or AZT
Regular insulin (Not fast acting - regular better)

42. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
P53 mutation; AD
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Minimal change disease
Atrial

43. there are mucus secreting cells in the bronchioles...
only up to bronchi
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
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)
Medullary

44. which two drug types can cause orthostatic hypotension (think depression and BPH)?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
4 - 4 - 9
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
TCAs and prazosin

45. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Duration and extent of disease
Because gamma chains replace beta chains and then gamma chain formation wanes
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

46. neisseria are...
facultative intracellular
Syringomelia
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Adductor

47. h1 receptor anatagonists are not effective in treatment of asthma only for...
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Relfex tachycardia; giving beta blockers
chronic urticaria and allergic symptoms
Downs; regurgitant AV valves - ASDs

48. which are the only glycosylated proteins in HIV virus?
Adductor
Env genes (for getting into target cells)
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

49. Which is faster purkinje system or atrial muscle?
Medial circumflex artery; avascular necrosis
Close but purkinje system to ensure contraction in a bottom up fashion
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
The term used to describe decreased drug responsiveness with repeated administration

50. What are the two growth factors associated with angiogenesis?
Radial nerve damage
Regular insulin (Not fast acting - regular better)
FGF and VEGF
Purkinje system; AV node

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USMLE Prep 2

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