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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 is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
In ER of bile canaliculi
Large stroke volumes with ventricular contraction; aortic regurg
APP on chrom 21 (this is why downs more susceptible)
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

2. What is a keloid?
Sickle cell; G6PD
Excessive collagen formation during tissue repair in susceptible individuals
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
11

3. what enzyme converts procarcinogens into carcinogens?
Elastance
E. coli; staphylococcus saprophyticus
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
P450 mitochondrial monooxygenase

4. which antiarrythmic is associated with blue gray discoloration ?
Reticulocytes
Coagulation factors are made in the liver
Amiadarone
Little effect on cell and no change

5. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
Increase in permeability of two ions with equal and opposite equilibrium potentials
SVT; increases vagal tone; rectus abdominis
Strength of cell mediated immune response
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

6. What are pancreatic pseudocysts called pseudo rather than true cysts?
Terminal bronchioles; small bronchi
Not lined by epithelium
Anti centromere; anti DNA topoisomerase
Large stroke volumes with ventricular contraction; aortic regurg

7. which type of glands produce an initially odorless secretion but can become malodorous secondary to bacterial decompisition on the skin surface? which glands are present throughout the skin except on lips and glans penis?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Apocrine; eccrine
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Hypothyroidism

8. What are three symptoms in s.typhi?
200-500
AV node slowest - to allow time for diastole
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Hypothyroidism

9. What is the most common location of colonization of all s. aureus types?
Gluteus maximus; difficulty getting up from seated position and climbing chair
Anterior nares
When it invades the bm; carcinoma in situ
Prostate tumor and increased osteoclast activity

10. are there signs of inflammation in avascular necrosis? then How do you diagnose?
C3 decreased after 5-10 days; sulfonamides
No; MRI
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

11. What is normal fibrinogen levels?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
200-500
Gluteus maximus; difficulty getting up from seated position and climbing chair
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)

12. What is epispadias caused by?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Decreases both
Faulty positioning of the genital tubercle
Chlorpheniramine and diphenhydramine

13. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
Bronchogenic carcinoma
In ER of bile canaliculi
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

14. what dictates the resting membrane potential of most cells?
High potassium conductance and some sodium conductance
Excessive collagen formation during tissue repair in susceptible individuals
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
RBC mass; epo levels (secondary has high)

15. What causes release of myosin head from the actin filament?
Reticulocytes
low in serum
Phencyclidine (PCP)
ATP binding (resets the myosin head to contract again for next binding)

16. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Classical conditioning
Hypo or hyper pigmentations; after tanning
By vascular permeability and vasodilation
Reticulocytes

17. how much percent of sodium is excreted? urea? glucose?
On cardiac tissue and renal juxtaglomerular cells
Coagulation factors are made in the liver
<1% - 55% - concentration dependent
Radial nerve and deep brachial artery

18. do Class IC agents prolong the QT interval?
Radial nerve damage
GI tract; mood!
differentiate
No

19. at one year of age - What are the social - fine motor - gross motor and language developments?
Become beta pleated and then form neurofibrillary tangle!
Initiation - pointing; pincer grasp; walking; mama/dada
Sarcoid
Close but purkinje system to ensure contraction in a bottom up fashion

20. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Chlorpheniramine and diphenhydramine

21. How do left sided colon adenocarcinomas present? right sided?
women
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
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

22. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
DIC; TTP- HUS dont bleed that much
Increase; decreased
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin

23. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
25; 25
Increases
women
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

24. What is Bortezomib and What is it used for?
Curlings ulcers
HSV and VZV
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Proteasome inhibitor; treatment for MM and waldenstroms

25. What is the mc location for avascular necrosis? What is it associated with?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Hyperkalemia; potassium sparing diuretics - potassium supplements
Hypo or hyper pigmentations; after tanning
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

26. 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
Increase in permeability of two ions with equal and opposite equilibrium potentials
Increased reticulocytes
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

27. IL4 is used for isotypye switching to what?
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
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
IgE
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

28. Would alpha 1 agonists cause flushing? muscarinic antagonist?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
No; yes
Around 70 (normal measured diastolic pressures); 9--
No; MRI

29. What is diphenoxylate and What is it used for? what drug is it structurally similar to? What allows for potent anti diarrheal effect without signigicant opiate effects?
Proteasome inhibitor; treatment for MM and waldenstroms
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)
The term used to describe decreased drug responsiveness with repeated administration
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

30. Where does complement bind on the Fc region of Ig chains?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Mean greater than median greater than mode
Turners`

31. What is medullary sponge kidney disease and how does it present? What does it lead to?
Covalent (between two cysteines)- allows protein to withstand denaturation
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)
Hypertension - edema - and proteinuria
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

32. What are the two mcc of focal brain lesions in HIV positive patients?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Decreases both
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase

33. Which is slower AV node or ventricular muscle?
Elastance
AV node slowest - to allow time for diastole
Ether and other organic solvents
Decreases both

34. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Vertical diplopia
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

35. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
Normally close to systolic
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Prostate tumor and increased osteoclast activity
Leukotriene precursor and does neutrophil chemotaxis

36. What does nitroprusside do to afterload? preload?
Anterior circumflex (and axillary nerve)
Decreases both
Appetite suppressants
ANCA because of lack of Ig and C3 deposits on IF

37. What is the mc manifestation of CMV in HIV patient? immunocompetent?
Bronchial dilation (bronchiectasis)
Large stroke volumes with ventricular contraction; aortic regurg
Bile salt accumulation in urine
Retinitis; mononucleosis

38. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
Ceftriaxone; azithromycin
Hypothyroidism
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

39. when arrested in prophase of meiosis I - What are primary oocytes chrom number? What about the secondary oocytes that are stuck in metaphase of Meiosis II?
Env genes (for getting into target cells)
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
SSRI; erectile dysfunction
46 - 4N; 23 2N

40. what drugs causes the red man syndrome? how does it occur?
Radial nerve and deep brachial artery
Vancomycin; histamine mediated
GI tract; mood!
Smoking

41. What is a cell surface marker seen in liver angiosarcoma?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Anti cholinergic effects of pupil dilation and lack of accomodation
ZDV or AZT

42. what protein is increased in Crohns disease? What does it do?
NF- KB; responsible for cytokine production
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
ATP binding (resets the myosin head to contract again for next binding)
women

43. What type of bond is a disulfide bond?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Covalent (between two cysteines)- allows protein to withstand denaturation
II; I (I more abundant)
Syringomelia

44. what kind of drug is sertraline? What is a common side effect?
Classical conditioning
C3 decreased after 5-10 days; sulfonamides
Radial nerve damage
SSRI; erectile dysfunction

45. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
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
Excessive collagen formation during tissue repair in susceptible individuals
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
When it invades the bm; carcinoma in situ

46. why does variocele occur more in left side?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
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
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Around 70 (normal measured diastolic pressures); 9--

47. What is the difference between additive and synergistic?
The LES is supposed to relax when food comes its way (from above) and in achalasia - a motor dysfunction - LES doesnt relax and seen as elevated pressure on the esophageal mannometry
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Insulin like growth factor 1 (just another name)
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

48. what organ would an activating mutation in PRPP synthetase effect?
differentiate
Serum creatine kinase; reperfusion injury causes necrosis
Joints d/t increased purine production and thus uric acid production
Protamine sulfate

49. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Hyperkalemia; potassium sparing diuretics - potassium supplements
Localized dermatologic pain that persists for more than one month after zoster eruption
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

50. where are Beta 1 receptors found?
glycerol kinase
On cardiac tissue and renal juxtaglomerular cells
E. coli
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus