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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 can renal blood flow be calculated from RPF?
Env genes (for getting into target cells)
Initiation - pointing; pincer grasp; walking; mama/dada
Both sides
RBF= PAH clearance/(1- hematocrit)

2. What would a deflection of the membrane potential to near zero indicate?
<1% - 55% - concentration dependent
Increase in permeability of two ions with equal and opposite equilibrium potentials
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
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

3. why is crohns disease associated with oxaloacetate kidney stones?
Myasthenia gravis
Hyperkalemia; potassium sparing diuretics - potassium supplements
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
differentiate

4. on What part of the clavicle does the SCM attach?
MAC complex (C5b - C9 complement deficiency)
Medial part
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
P53 mutation; DCC is also required for adenoma to carcinoma

5. What are three symptoms in s.typhi?
Vertical diplopia
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
P53 mutation; DCC is also required for adenoma to carcinoma
Hypo or hyper pigmentations; after tanning

6. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
Prevent phagocytosis
Anterior circumflex (and axillary nerve)
SaO2 <92%
CGD; t cell dysfxn (diGeorge)

7. How do bradykinin - C3a and C5a cause edema?
By vascular permeability and vasodilation
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
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
Medial part

8. In what form are mitochondrial DNA? What do they transcribe?
Circular - outside nucleus; transport proteins - rRNA - tRNA
Insulin like growth factor 1 (just another name)
(urine PAH x urine flow rate)/plasma PAH
Pain reliever - reduces pain by locking substance P in the PNS

9. what induces bronchial squamous metaplasia?
Ketone body production by preventing fatty acids into the mitochondria
Apocrine; eccrine
Smoking
Curlings ulcers

10. What is damaged in early syringomelia? later?
As a CO2 carrier with the carboxylase enzyme
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
only up to bronchi
HSV ( also in utero: chlymadia - neisseria - group B strep)

11. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
Gluteus medius and minimus; positive trendelenberg
No (unlike adenomyosis); yes
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

12. do Class IC agents prolong the QT interval?
No
Env genes (for getting into target cells)
Drug induced interstitial nephritis
Reiter syndrome; B27

13. What is the best indicator for the severity of mitral stenosis?
Extrinsic def; instrinsic def; platelet def
The time interval between S2 and OS- the shorter the interval - the more intense
Rabies encephalitis from cave bats; rabies killed vaccines
Octreotide

14. what drug is useful for secretory diarrhea?
Octreotide
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
low in serum
8; 12

15. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Excessive collagen formation during tissue repair in susceptible individuals
Fibrosis; macrophages
Gluteus medius and minimus; positive trendelenberg

16. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
Joints d/t increased purine production and thus uric acid production
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Covalent (between two cysteines)- allows protein to withstand denaturation
Vagus nerve stimulation

17. What are the acute effects of corticosteroids on the CBC?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Pulmonic and systemic!
Covalent (between two cysteines)- allows protein to withstand denaturation
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

18. do patients with cor pulmonale have increased or decreased levels of aldosterone?
facultative intracellular
RER; copper
Because of the low output from heart failure - they will have increased aldosterone levels
8; 12

19. What are the two growth factors associated with angiogenesis?
Superior larygeal; cricothyroid; recurrent laryngeal
FGF and VEGF
Chrom 8
GI malignancies and Insulin resistance (acromegal for ex)

20. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Recurrent larygneal
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)
Turners`

21. SIADH patients have normal blood volume but...
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Pulmonary hypertension
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
hyponatremia (aldosterone activation equilibrates body volume)

22. What is the diagnosis in delayed puberty plus anosmia?
Kallmans
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Not lined by epithelium

23. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
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
Inhaled animal dander allergens
Vancomycin; histamine mediated

24. Where does terminal peptide cleavage of collagen fibrils take place?
Neisseria induced small cell vasculitis (including hands and soles)
NF- KB; responsible for cytokine production
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
In the extracellular space

25. What is the most common neurologic complication of VZV reactivation?
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Localized dermatologic pain that persists for more than one month after zoster eruption
SVT; increases vagal tone; rectus abdominis

26. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Pulmonic and systemic!
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
OCPs - multiparity - breast feeding

27. What three pathogens cause infectious esophagitis in HIV positive patients?
CMV - HSV 1 - Candida
In the extracellular space
Initiation - pointing; pincer grasp; walking; mama/dada
frameshift mutations (missense is substitution)

28. What are two common side effects of both acute and long acting nitrates? What causes them?
ANCA because of lack of Ig and C3 deposits on IF
glycerol kinase
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Headaches and facial flushing; vasodilation in meninges and skin

29. What are pancreatic pseudocysts called pseudo rather than true cysts?
Not lined by epithelium
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
No (unlike adenomyosis); yes
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

30. What is pickwickian syndrome? What are the lab findings?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
T test; chi squared
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase

31. What can chronic vit A toxicity cause?
Rabies encephalitis from cave bats; rabies killed vaccines
MAO inhibitors; wine and cheese
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Skin flushing and warmth; prostaglandins; give with aspirin

32. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
II; I (I more abundant)
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
E. coli

33. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Increased reticulocytes
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)
Fibronectin - laminin - collagen
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

34. which are the only glycosylated proteins in HIV virus?
Env genes (for getting into target cells)
Amiadarone
Proteasome inhibitor; treatment for MM and waldenstroms
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

35. IL4 is used for isotypye switching to what?
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
Paramyxo and influenza
IgE
Inhibits it

36. What translocations can cause c - myc overexpression?
C3 decreased after 5-10 days; sulfonamides
8 (myc protein) with 2 - 14 - 22 (iG chains)
Abnormal closing of the urethral folds
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

37. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Minimal change disease
GI tract; mood!
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

38. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Gluteus maximus; difficulty getting up from seated position and climbing chair
Bile soluble which means they are bile sensitive
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

39. What is easiest way to treat nephrolithiasis?
Chlorpheniramine and diphenhydramine
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Drink plenty of fluids
Headaches and facial flushing; vasodilation in meninges and skin

40. What is it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
Downs; regurgitant AV valves - ASDs
Vertical diplopia
Neisseria induced small cell vasculitis (including hands and soles)
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

41. what vessel would a fracture to the neck of the of the humerus damage?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
OCPs - multiparity - breast feeding
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Anterior circumflex (and axillary nerve)

42. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Downs; regurgitant AV valves - ASDs
Class I
Trochlear nerve (IV); abducens nerve (VI)
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

43. why does liver dysfunction cause coagulation disorders?
Little effect on cell and no change
Classical conditioning
Mean greater than median greater than mode
Coagulation factors are made in the liver

44. 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?
PDA open
GI malignancies and Insulin resistance (acromegal for ex)
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Common peroneal; bony fractures and compression; sciatic

45. What is tachyphylaxis?
Env genes (for getting into target cells)
Mean greater than median greater than mode
The term used to describe decreased drug responsiveness with repeated administration
SSRI

46. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Hexokinase
Turbulence
S. saprophyticus - and s. epidermidis; novobiocin
...

47. Where does complement bind on the Fc region of Ig chains?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
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

48. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
Spongiosis
Vagus (auricular branch); vasovagal syncope!
PDA open
Clindamycin; covers anaerobic oral flora and aerobic bacteria

49. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Large stroke volumes with ventricular contraction; aortic regurg
Common peroneal; bony fractures and compression; sciatic
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
Curlings ulcers

50. what protects the resting heart from arrhythmias?
Highly negative resting potential
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Brief psychotic disorder; schizophreniform; schizophrenia