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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 antibiotic is best to treat alcoholic pulm infections? why?
women
Biphosphonate
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Hyperkalemia; potassium sparing diuretics - potassium supplements

2. who bleed more DIC or TTP- HUS patients?
APP on chrom 21 (this is why downs more susceptible)
Excessive collagen formation during tissue repair in susceptible individuals
DIC; TTP- HUS dont bleed that much
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

3. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
frameshift mutations (missense is substitution)
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
MAO inhibitors; wine and cheese
Prevent phagocytosis

4. other than proteinuria - What can cause foamy froathy urine?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Bile salt accumulation in urine
Atrial
Bile soluble which means they are bile sensitive

5. What causes curlings ulcers?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Increase in permeability of two ions with equal and opposite equilibrium potentials
Spongiosis

6. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Sickle cell; G6PD
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

7. other than mycobacterim wha other bacteria is acid fast?
Nocardia
E. coli
Ig A deficiency
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

8. why does neutrophila occur with corticosteroids?
Demargination of neutrophils from the vessel walls
Single adenomatous ones
Mean greater than median greater than mode
Measure of depth invasion (vertical!)

9. What is normal fibrinogen levels?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
200-500
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
glycerol kinase

10. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
LT (LTD4 - E4 - C4) - and Ach
Class I
women
Enterococci (e. faecalis)- found on genitalia area

11. what induces bronchial squamous metaplasia?
Another type of aldosterone antagonist (like spironolactone)
Smoking
AV node slowest - to allow time for diastole
No (unlike adenomyosis); yes

12. what should you think of in 'smear of an oral ulcer base'?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Tzanck smear

13. What is hyaline arteriosclerosis usually a sign of ?
200-500
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Diabetic microangiopathy
Pulmonic and systemic!

14. What three factors effect total oxygen content of blood?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Anti centromere; anti DNA topoisomerase

15. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
APP on chrom 21 (this is why downs more susceptible)
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

16. what kind of drug is sertraline? What is a common side effect?
Increase lymphatic drainage!
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
SVT; increases vagal tone; rectus abdominis
SSRI; erectile dysfunction

17. what would be a sign of absence of cardiogenic pulm edem?
11 aa polypeptide; pain NT in CNS and PNS
High potassium conductance and some sodium conductance
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Superior larygeal; cricothyroid; recurrent laryngeal

18. What are the first generation anti histamines?
TSh (in testicular tumors can cause hyperthyroidism)
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Chlorpheniramine and diphenhydramine

19. What are some of the permissive effects of cortisol?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
facultative intracellular
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Increases bronchial and vascular smooth muscle reactivity to catecholamines

20. How do you explain the selective proteinuria of loss to albumin only in MCD?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Strength of cell mediated immune response
Congenital hypothyroidism - downs - amyloidosis - acromegaly
SaO2 <92%

21. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Headaches and facial flushing; vasodilation in meninges and skin

22. What does extended consumption of appetite suppressants lead to?
Smoking
No
Biphosphonate
Pulmonary hypertension

23. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
Mean greater than median greater than mode
Become beta pleated and then form neurofibrillary tangle!
Hypothyroidism
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

24. What is the cause of rapid plasma decay of thiopental?
RR-1/RR
Large stroke volumes with ventricular contraction; aortic regurg
Tissue redistribution (out of plasma) rather than metabolism
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

25. What is damaged in early syringomelia? later?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Squatting - sitting - lying supine - passive leg raising
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

26. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Headaches and facial flushing; vasodilation in meninges and skin
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Cluster

27. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Class I
Raphe
S3 gallop; S2 to opening snap interval

28. which headaches are seen mostly in men - are severe - unilateral - periorbital - episodic (around same time every day) - temporal pain - with lacrimation - nasal congestion and ptosis?
only up to bronchi
Cluster
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)
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

29. What are examples of action that decrease venous return to the heart?
Standing suddenly from supine position; valsalva maneuver
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
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)
Underestimation of gestational age

30. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Medial circumflex artery; avascular necrosis
Tissue redistribution (out of plasma) rather than metabolism

31. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
ANCA because of lack of Ig and C3 deposits on IF
Phencyclidine (PCP)
E. coli

32. What is the triad seen in pre eclampsia?
SVC and IVC; right below the aortic knob
women
Hypertension - edema - and proteinuria
Drink plenty of fluids

33. What is cataplexy and When is it seen?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Sydenham chorea
Sudden loss of muscle tone without loss of consciousness; narcolepsy
8 (myc protein) with 2 - 14 - 22 (iG chains)

34. What is it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
Vertical diplopia
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Common peroneal; bony fractures and compression; sciatic
RBC mass; epo levels (secondary has high)

35. where are the vegetations on the valves of a libman sacks endocarditis?
Both sides
IgE
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)
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

36. what immune deficiency causes recurrent neisseria infections?
Purkinje system; AV node
MAC complex (C5b - C9 complement deficiency)
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Right before diastole (filling begins)

37. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
gram positive organisms
Amiadarone
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Rabies encephalitis from cave bats; rabies killed vaccines

38. other than parvo B19 - what else is associated with red cell aplasia?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
No
Thymic tumor
Coagulation factors are made in the liver

39. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
Criggler Najjar (UGT enzyme in bilirubin glucoronidation) ; Dubin Johnson (transport protein lacking - Black liver) and Rotor syndrome - defects in hepatic uptake and excretion of bile (numerous defect)
Minimal change disease
Think Hb deformation diseases
I is more benign and can present later in adulthood

40. Which is slower AV node or ventricular muscle?
Adductor
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
AV node slowest - to allow time for diastole
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

41. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
Hyperkalemia; potassium sparing diuretics - potassium supplements
46 - 4N; 23 2N
SVT; increases vagal tone; rectus abdominis
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

42. What can chronic vit A toxicity cause?
G to T in p53; HCC
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Boiling - bleach - formalin - UV irradiation
Acute interstitial nephritis

43. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Bile soluble which means they are bile sensitive
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
V fib; v. failure

44. Acyl coA synthetase is not...
Biphosphonate
liver specific
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Anti - apoptotic (prevents going into apoptosis)- 18; 14

45. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Medullary
Common peroneal; bony fractures and compression; sciatic
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

46. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
Measles and M3 AML`
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

47. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
Fat - fertile - forty - female
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
SVC and IVC; right below the aortic knob
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

48. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
Tissue redistribution (out of plasma) rather than metabolism
Inhibits it
Serum FFA and serum triglyceride levels
CGD; t cell dysfxn (diGeorge)

49. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Criggler Najjar (UGT enzyme in bilirubin glucoronidation) ; Dubin Johnson (transport protein lacking - Black liver) and Rotor syndrome - defects in hepatic uptake and excretion of bile (numerous defect)
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Biphosphonate

50. how does increased ICP result in curlings ulcers?
Barium enema
Vagus nerve stimulation
Coagulation factors are made in the liver
FGF and VEGF