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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?
Curlings ulcers
I is more benign and can present later in adulthood
Prevents hepatic VLDL production
differentiate

2. What does L/S stand for in fetal lung maturity? When does maturity occur?
glycerol kinase
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

3. what murmur is enhanced by decreased blood flow to the heart?
Leukotriene precursor and does neutrophil chemotaxis
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Myasthenia gravis
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

4. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Myasthenia gravis
Medullary
25; 25
In the extracellular space

5. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Hexokinase
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
TSh (in testicular tumors can cause hyperthyroidism)

6. What is the mc malignancy in asbestosis?
Bronchogenic carcinoma
Extrinsic def; instrinsic def; platelet def
Elevated GGT and macrocytosis
Common peroneal; bony fractures and compression; sciatic

7. Which is faster atrial muscle or ventricular muscle?
Rabies encephalitis from cave bats; rabies killed vaccines
Turners`
Atrial
Duration and extent of disease

8. what happens with LDL receptor density in statin therapy?
Primary
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Increases

9. What is a primary HSV 1 infection like?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
women
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

10. why is glucagon used in beta blocker toxicitiy?
Classical conditioning
Hypo or hyper pigmentations; after tanning
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

11. What are the potassium sparing diuretics?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Amiloride - spironolactone - triamterene
Strength of cell mediated immune response
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

12. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Adeno
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
200-500
Highly negative resting potential

13. What is congestive hepatomegaly specific for?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Right heart failure
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
Gluteus maximus; difficulty getting up from seated position and climbing chair

14. What is hyaline arteriosclerosis usually a sign of ?
Think Hb deformation diseases
Bile salt accumulation in urine
Diabetic microangiopathy
RR-1/RR

15. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
Well
SVC and IVC; right below the aortic knob
Inhibits it
Serum FFA and serum triglyceride levels

16. What agonists reduce the gradient across the LV outflow tract?
Selective alpha 1 (increases SVR)
Bile soluble which means they are bile sensitive
High potassium conductance and some sodium conductance
No; yes

17. What is the triad seen in pre eclampsia?
G to T in p53; HCC
Hypertension - edema - and proteinuria
Bile soluble which means they are bile sensitive
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

18. What does VIP do to gastric acid secretion?
Inhibits it
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Chrom 8
Appetite suppressants

19. What is pickwickian syndrome? What are the lab findings?
Echinococcus granulosus; anaphylaxis
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Increases
In ER of bile canaliculi

20. What is easiest way to treat nephrolithiasis?
Joints d/t increased purine production and thus uric acid production
Drink plenty of fluids
hyponatremia (aldosterone activation equilibrates body volume)
SVC and IVC; right below the aortic knob

21. What is the mcc of elevated AFP leves in pregnancy>
Vascular endothelium; protease
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
E. coli; staphylococcus saprophyticus
Underestimation of gestational age

22. Where does complement bind on the Fc region of Ig chains?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Bile soluble which means they are bile sensitive
Drug induced interstitial nephritis
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

23. other than proteinuria - What can cause foamy froathy urine?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Hypo or hyper pigmentations; after tanning
Vascular endothelium; protease
Bile salt accumulation in urine

24. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
Bile soluble which means they are bile sensitive
Valproate
Vagus (auricular branch); vasovagal syncope!
Gluteus maximus; difficulty getting up from seated position and climbing chair

25. is Rifampin ever used as monotherapY? why either way?
Acute gastric mucosal defects (superficial or full thickness)
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
GI tract; mood!
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

26. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
TCAs and prazosin
Think Hb deformation diseases
Highly negative resting potential
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

27. What is the Na/Ca exchange used for?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Bronchogenic carcinoma
To pump calcium out in cardiac myocytes so that relaxation occurs
Well trained athletes and children

28. what indicates the severity of a mitral regurg ? mitral stenosis?
Initiation - pointing; pincer grasp; walking; mama/dada
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
S3 gallop; S2 to opening snap interval
Radial nerve damage

29. on which chromosome is wilms tumor found?
Little effect on cell and no change
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Anti cholinergic effects of pupil dilation and lack of accomodation
11

30. when do ghon complexes form - primary or secondary TB?
Normal; low
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Primary
Retinitis; mononucleosis

31. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
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
C3 decreased after 5-10 days; sulfonamides
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Become beta pleated and then form neurofibrillary tangle!

32. What does glycosylase do to DNA? endonuclease? lyase? What does the order here of enzymes represent? what other enzymes are needed?

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33. how does eos release MBP to kill protozoa etc?
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Chorda tympani branch
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
LT (LTD4 - E4 - C4) - and Ach

34. which two virus families have hemagluttinin on their surface?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Paramyxo and influenza
Syncope - angina - dyspnea (SAD)
Superior larygeal; cricothyroid; recurrent laryngeal

35. where are Beta 1 receptors found?
On cardiac tissue and renal juxtaglomerular cells
Syringomelia
Bile soluble which means they are bile sensitive
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

36. Where does lysyl oxidase act? What is the cofactor for that?
In the extracellular space for collagen cross linking; zinc
Regular insulin (Not fast acting - regular better)
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Inhaled animal dander allergens

37. 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?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Apocrine; eccrine
Normal; low
Hypertension - edema - and proteinuria

38. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
P450 mitochondrial monooxygenase
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Diabetic microangiopathy
Hyperkalemia; potassium sparing diuretics - potassium supplements

39. if there are keratin swirls does that mean well or poorly differentiated?
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
Increase by 50% in urine osmolality
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Well

40. What is the most important prognostic indicator in patients with malignant melanoma?
Pulmonary hypertension
Measure of depth invasion (vertical!)
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
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

41. What does nitroprusside do to afterload? preload?
differentiate
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Decreases both

42. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Become beta pleated and then form neurofibrillary tangle!
Prostate tumor and increased osteoclast activity
Coagulation factors are made in the liver
The time interval between S2 and OS- the shorter the interval - the more intense

43. What is intussusception? how does ischemia and necrosis occur?
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
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Purkinje system; AV node
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

44. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
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
CMV - HSV 1 - Candida

45. What can worse neurologic dysfunction in cobalamic def?
Terminal bronchioles; small bronchi
Folic acid treatment!
G to T in p53; HCC
Increase by 50% in urine osmolality

46. What is a clara cell?
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
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
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

47. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Intussusception
Raphe
indomethacin

48. What is the neurologic manifestation of ADPKD?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Large stroke volumes with ventricular contraction; aortic regurg

49. which has better side effect profile - SSRI or TCA?
Cluster
Closer to head; closer to diaphragm
SSRI
Radial nerve damage

50. What is the cause of rapid plasma decay of thiopental?
Well
Demargination of neutrophils from the vessel walls
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Tissue redistribution (out of plasma) rather than metabolism