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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. other than increasing HDL levels - what else does niacin do?
Underestimation of gestational age
Radial nerve damage
Integration of viral DNA into genome of host hepatocytes
Prevents hepatic VLDL production

2. How do you explain the selective proteinuria of loss to albumin only in MCD?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Because gamma chains replace beta chains and then gamma chain formation wanes
Appetite suppressants

3. In what view of CXR is anterior part of heart best seen? anterior part of heart is formed by?right border of heart is formed by? left border?
Lateral; RV; RA; LV
Prostate tumor and increased osteoclast activity
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
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

4. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
Superior larygeal; cricothyroid; recurrent laryngeal
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Both sides
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

5. What is epleronone?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Another type of aldosterone antagonist (like spironolactone)
Around 70 (normal measured diastolic pressures); 9--
indomethacin

6. What does VIP do to gastric acid secretion?
Common peroneal; bony fractures and compression; sciatic
Intussusception
Inhibits it
...

7. which cells produce surfactant? which ones mediate gas exchange?
Neisseria induced small cell vasculitis (including hands and soles)
II; I (I more abundant)
Dihydropyridine sensitive Ca channels (L type)
Selective alpha 1 (increases SVR)

8. What is used to compare means? categorical outcomes?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
11 aa polypeptide; pain NT in CNS and PNS
46 - 4N; 23 2N
T test; chi squared

9. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
only up to bronchi
Purkinje system; AV node
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

10. What is a common complication of acute pancreatitis? What is it?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
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. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
Protamine sulfate
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

12. What does hypocapnia cause in teh brain? What is hypocapnia?
Skin flushing and warmth; prostaglandins; give with aspirin
Measles and M3 AML`
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

13. metabolism of 1 gram of protein produces How many calories? carb? fat?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Joints d/t increased purine production and thus uric acid production
4 - 4 - 9
LT (LTD4 - E4 - C4) - and Ach

14. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
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
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Because of the low output from heart failure - they will have increased aldosterone levels
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)

15. What is best to prevent GBS infection in a baby?
INTRApartum Abs (ampicillin/penicillin)
Vagus (auricular branch); vasovagal syncope!
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Rabies encephalitis from cave bats; rabies killed vaccines

16. When is an S4 sound normal?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Increase; decreased
Well trained athletes and children
On cardiac tissue and renal juxtaglomerular cells

17. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Fibronectin - laminin - collagen
Hyperkalemia; potassium sparing diuretics - potassium supplements
Boiling - bleach - formalin - UV irradiation
Minimal change disease

18. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Normally close to systolic
Susceptible; soluble (unable to be cultured in bile)
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

19. why are pregnant predisposed to cholelithiasis?
FGF and VEGF
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
200-500
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

20. 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?
Circular - outside nucleus; transport proteins - rRNA - tRNA
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Right before diastole (filling begins)
Relfex tachycardia; giving beta blockers

21. What is the Na/Ca exchange used for?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
To pump calcium out in cardiac myocytes so that relaxation occurs
Serum FFA and serum triglyceride levels
Radial nerve damage

22. what clinical findings help distinguish small cell carcinoma?
Recurrent larygneal
APP on chrom 21 (this is why downs more susceptible)
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

23. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
MAO inhibitors; wine and cheese
SSRI
Not lined by epithelium
chronic urticaria and allergic symptoms

24. What is 5- HETE and What does it do?
RR-1/RR
Leukotriene precursor and does neutrophil chemotaxis
Think Hb deformation diseases
II; I (I more abundant)

25. What three factors effect total oxygen content of blood?
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
Chorda tympani branch
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Measure of depth invasion (vertical!)

26. What is gardeners mydriasis? How is it treated?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
ATP binding (resets the myosin head to contract again for next binding)
Terminal bronchioles; small bronchi
Ether and other organic solvents

27. What is the presentation of sever aortic stenosis?
Elevated GGT and macrocytosis
P450 mitochondrial monooxygenase
Syncope - angina - dyspnea (SAD)
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

28. What does p53 do? what chrom is it on?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Abnormal closing of the urethral folds
gram positive organisms
Retinitis; mononucleosis

29. in B12 deficiency - what levels in blood rise very quickly and then drop?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Covalent (between two cysteines)- allows protein to withstand denaturation
Reticulocytes
Biphosphonate

30. what bursa is affected when on knees like a maid/gardner?
Because of vasodiation to skeletal muscles
Prepatellar
4 - 4 - 9
Inhaled animal dander allergens

31. What is normal fibrinogen levels?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
In the extracellular space for collagen cross linking; zinc
200-500
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

32. What is a keloid?
Primary
Increased reticulocytes
Excessive collagen formation during tissue repair in susceptible individuals
AV node slowest - to allow time for diastole

33. how much percent of sodium is excreted? urea? glucose?
An invagination of portion of intestine into the lumen of the adjacent intestinal segment; can lead to impaired venous return from the invaginated segment of the bowel which can cause ischemia and subsequent necrosis
Valproate
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
<1% - 55% - concentration dependent

34. What does 'oxygen' content in blood refer to?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Chorda tympani branch
Dissolved in plasma and attached to Hgb
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

35. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Fat - fertile - forty - female
Anti cholinergic effects of pupil dilation and lack of accomodation
Increase; decreased
8 (myc protein) with 2 - 14 - 22 (iG chains)

36. What is the cause of rapid plasma decay of thiopental?
TSh (in testicular tumors can cause hyperthyroidism)
Terminal bronchioles; small bronchi
Tissue redistribution (out of plasma) rather than metabolism
46 - 4N; 23 2N

37. what has the greatest effect on prognosis when treating c. diptheriae?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Syringomelia
(urine PAH x urine flow rate)/plasma PAH
Chorda tympani branch

38. What agonists reduce the gradient across the LV outflow tract?
Selective alpha 1 (increases SVR)
...
Strength of cell mediated immune response
DIC; TTP- HUS dont bleed that much

39. What three pathogens cause infectious esophagitis in HIV positive patients?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
INTRApartum Abs (ampicillin/penicillin)
Anti centromere; anti DNA topoisomerase
CMV - HSV 1 - Candida

40. within the right atrium - What is the maximum pressure? left atrium?
SSRI; erectile dysfunction
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
8; 12
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

41. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Coagulation factors are made in the liver
Syncope - angina - dyspnea (SAD)
gram positive organisms
Anti - apoptotic (prevents going into apoptosis)- 18; 14

42. which staphylococci can do mannitol fermaentation?
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
S. aureus
25; 25
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

43. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
Bronchial dilation (bronchiectasis)
Acute gastric mucosal defects (superficial or full thickness)
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
Sydenham chorea

44. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
Tissue redistribution (out of plasma) rather than metabolism
(urine PAH x urine flow rate)/plasma PAH
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
CGD; t cell dysfxn (diGeorge)

45. what indicates the severity of a mitral regurg ? mitral stenosis?
No only for prophylaxis (even for treating staphylococcal endocarditis its as multi drug); this is to prevent drug resistance from spontaneous mutations by DNA dependent RNA polymerase
S3 gallop; S2 to opening snap interval
Protamine sulfate
Tibial

46. What is mcc of death pre hospital phase of MI? in hospital phase?
V fib; v. failure
Inhibits it
Increases cytokine production
The time interval between S2 and OS- the shorter the interval - the more intense

47. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
P53 mutation; DCC is also required for adenoma to carcinoma
CGD; t cell dysfxn (diGeorge)
Strength of cell mediated immune response
Hypo or hyper pigmentations; after tanning

48. What are some side effects seen in TCAs?
As a CO2 carrier with the carboxylase enzyme
Vascular endothelium; protease
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

49. What actions increase venous return?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Squatting - sitting - lying supine - passive leg raising
Recurrent larygneal

50. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Mean greater than median greater than mode
Inactivates kallikrein which activates kininogen into bradykinin
Underestimation of gestational age
Hexokinase