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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. how does noise induced hearing loss occur?
Pulmonic and systemic!
Strength of cell mediated immune response
Integration of viral DNA into genome of host hepatocytes
Trauma to stereociliated hair cells of the organ of corti

2. Where does 90% of serotonin lie? What is this NT responsible?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
GI tract; mood!
Regular insulin (Not fast acting - regular better)
Leukotriene precursor and does neutrophil chemotaxis

3. why are pregnant predisposed to cholelithiasis?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Right before diastole (filling begins)
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
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

4. What are some side effects seen in TCAs?
GI malignancies and Insulin resistance (acromegal for ex)
Measles and M3 AML`
RBF= PAH clearance/(1- hematocrit)
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

5. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Anterior nares
HSV ( also in utero: chlymadia - neisseria - group B strep)
Amiloride - spironolactone - triamterene
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

6. What can cause virilization of a mother during pregnancy?
SaO2 <92%
Bile salt accumulation in urine
Aromatase deficiency in child
Boiling - bleach - formalin - UV irradiation

7. What is 5- HETE and What does it do?
Regular insulin (Not fast acting - regular better)
Leukotriene precursor and does neutrophil chemotaxis
Turners`
CMV - HSV 1 - Candida

8. 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?
Normal; low
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

9. What is the best indicator for the severity of mitral stenosis?
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
RER; copper
Extrinsic def; instrinsic def; platelet def
The time interval between S2 and OS- the shorter the interval - the more intense

10. What are fenfluramine - phentermine?
SaO2 <92%
Appetite suppressants
Primary
Joints d/t increased purine production and thus uric acid production

11. What are the long term consequences of hydrocephalus?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Adeno

12. what diseases can vit A be used to treat?
Hypertension - edema - and proteinuria
Measles and M3 AML`
Nocardia
CGD; t cell dysfxn (diGeorge)

13. In what population does cholelithiasis occur?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Vagus nerve stimulation
Fat - fertile - forty - female
SaO2 <92%

14. What is best to prevent GBS infection in a baby?
Vertical diplopia
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
INTRApartum Abs (ampicillin/penicillin)
frameshift mutations (missense is substitution)

15. on which chromosome is wilms tumor found?
MAC complex (C5b - C9 complement deficiency)
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Adductor
11

16. Metronidizaole does not cover...
Ether and other organic solvents
gram positive organisms
46 - 4N; 23 2N
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

17. What is a primary HSV 1 infection like?
Fat - fertile - forty - female
Clindamycin; covers anaerobic oral flora and aerobic bacteria
In the extracellular space for collagen cross linking; zinc
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

18. which virus inactivates both Rb and p53?
Thymic tumor
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Standing suddenly from supine position; valsalva maneuver
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

19. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
E. coli; staphylococcus saprophyticus
ANCA because of lack of Ig and C3 deposits on IF
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
chronic urticaria and allergic symptoms

20. SIADH patients have normal blood volume but...
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
hyponatremia (aldosterone activation equilibrates body volume)
Medial part
DIC; TTP- HUS dont bleed that much

21. how long is substance P? What does it do?
11 aa polypeptide; pain NT in CNS and PNS
Hypothyroidism
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Fibronectin - laminin - collagen

22. prostaglandin synthesis keeps...
Because gamma chains replace beta chains and then gamma chain formation wanes
Cluster
PDA open
Demargination of neutrophils from the vessel walls

23. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
SVT; increases vagal tone; rectus abdominis
Vancomycin; histamine mediated
11 aa polypeptide; pain NT in CNS and PNS
Both sides

24. Where is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Increases bronchial and vascular smooth muscle reactivity to catecholamines
8; 12

25. nucleotide deletions do not cause missense mutations - they cause...
frameshift mutations (missense is substitution)
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
NF- KB; responsible for cytokine production
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

26. What almost exclusively causes Epliglottitis?What type of capsule does it have? What are the symptoms?

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27. What is a cell surface marker seen in liver angiosarcoma?
T test; chi squared
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
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
chronic urticaria and allergic symptoms

28. how does achalasia present? What does barium swallow show on dilated esophagus?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Intussusception
Initiation - pointing; pincer grasp; walking; mama/dada

29. What are the first generation anti histamines?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Chlorpheniramine and diphenhydramine
Drink plenty of fluids

30. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Vascular endothelium; protease
Chrom 8
Obstruction because they infiltrate the intestinal wall and encircle causing decrease in size of lumen - constipation - abdominal distension - abdominal pain - changes in stool caliber; right sided are often exophytic masses iron def anemia and syste

31. When is an S4 sound normal?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Well trained athletes and children
Gluteus medius and minimus; positive trendelenberg

32. which nucleus releases serotonin?
Underestimation of gestational age
liver specific
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Raphe

33. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Chorda tympani branch
Varying; erythema nodosum is common
Gluteus medius and minimus; positive trendelenberg
Turbulence

34. how much percent of sodium is excreted? urea? glucose?
On cardiac tissue and renal juxtaglomerular cells
facultative intracellular
<1% - 55% - concentration dependent
Syringomelia

35. what organ would an activating mutation in PRPP synthetase effect?
Joints d/t increased purine production and thus uric acid production
Tzanck smear
Intussusception
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

36. What effects does cortisol have on catecholamines?
Superior larygeal; cricothyroid; recurrent laryngeal
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
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

37. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
Joints d/t increased purine production and thus uric acid production
(urine PAH x urine flow rate)/plasma PAH
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

38. What does the tuberoinfundibular pathway connect? What is it responsible for?
Thymic tumor
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Susceptible; soluble (unable to be cultured in bile)
No (unlike adenomyosis); yes

39. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Hyperkalemia; potassium sparing diuretics - potassium supplements
Obstruction because they infiltrate the intestinal wall and encircle causing decrease in size of lumen - constipation - abdominal distension - abdominal pain - changes in stool caliber; right sided are often exophytic masses iron def anemia and syste
11 aa polypeptide; pain NT in CNS and PNS

40. what dictates the resting membrane potential of most cells?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
High potassium conductance and some sodium conductance
Hypothyroidism

41. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
(urine PAH x urine flow rate)/plasma PAH
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Mean greater than median greater than mode

42. What are the three dopaminergic systems and What are they responsible for? disease?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Strength of cell mediated immune response
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Tissue redistribution (out of plasma) rather than metabolism

43. which two drug types can cause orthostatic hypotension (think depression and BPH)?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
TCAs and prazosin
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
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

44. What is the Na/Ca exchange used for?
To pump calcium out in cardiac myocytes so that relaxation occurs
The time interval between S2 and OS- the shorter the interval - the more intense
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Syringomelia

45. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
SSRI
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Hypothyroidism

46. What does extended consumption of appetite suppressants lead to?
Because gamma chains replace beta chains and then gamma chain formation wanes
T test; chi squared
Pulmonary hypertension
SVC and IVC; right below the aortic knob

47. What does prolonged PT indicated? aPTT? bleeding time?
SVT; increases vagal tone; rectus abdominis
Elevated GGT and macrocytosis
Syringomelia
Extrinsic def; instrinsic def; platelet def

48. What is congestive hepatomegaly specific for?
Right heart failure
Echinococcus granulosus; anaphylaxis
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Medial circumflex artery; avascular necrosis

49. What is the neurologic manifestation of ADPKD?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
The time interval between S2 and OS- the shorter the interval - the more intense
SSRI; erectile dysfunction

50. What are some of the permissive effects of cortisol?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Increases bronchial and vascular smooth muscle reactivity to catecholamines
By vascular permeability and vasodilation