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USMLE Prep 2

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
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?
Acute interstitial nephritis
Prevents hepatic VLDL production
G to T in p53; HCC
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

2. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
SVT; increases vagal tone; rectus abdominis
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Apocrine; eccrine
Boiling - bleach - formalin - UV irradiation

3. What are examples of action that decrease venous return to the heart?
P53 mutation; AD
Standing suddenly from supine position; valsalva maneuver
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
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)

4. What are some side effects seen in TCAs?
Become beta pleated and then form neurofibrillary tangle!
No and yes
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Terminal bronchioles; small bronchi

5. where are the two classical places that the ulnar nerve can be injured?

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6. When is an S4 sound normal?
Vascular endothelium; protease
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Headaches and facial flushing; vasodilation in meninges and skin
Well trained athletes and children

7. What does C1 esterase do other than inhibiting complement pathway?
Increase in permeability of two ions with equal and opposite equilibrium potentials
Inactivates kallikrein which activates kininogen into bradykinin
Protamine sulfate
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

8. What is the most common initital symptom of ADPKD? what else?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
liver specific
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)
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

9. hypertonicity and hyperreflexity are ________________ of hydrocephalus
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Minimal change disease
II; I (I more abundant)

10. What are two common side effects of both acute and long acting nitrates? What causes them?
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
Headaches and facial flushing; vasodilation in meninges and skin
SSRI
Sudden loss of muscle tone without loss of consciousness; narcolepsy

11. neisseria are...
Insulin like growth factor 1 (just another name)
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Medullary
facultative intracellular

12. what vessel would a fracture to the neck of the of the humerus damage?
...
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)
Abnormal closing of the urethral folds
Anterior circumflex (and axillary nerve)

13. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Raphe
Standing suddenly from supine position; valsalva maneuver
Hyperkalemia; potassium sparing diuretics - potassium supplements
The time interval between S2 and OS- the shorter the interval - the more intense

14. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Because of vasodiation to skeletal muscles
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Bile soluble which means they are bile sensitive
Squatting - sitting - lying supine - passive leg raising

15. What are fenfluramine - phentermine?
Aromatase deficiency in child
Vascular endothelium; protease
Appetite suppressants
Vagus nerve stimulation

16. What is epleronone?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Another type of aldosterone antagonist (like spironolactone)
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase

17. ___________ is liver specific
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
glycerol kinase
When it invades the bm; carcinoma in situ
GI tract; mood!

18. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Amiloride - spironolactone - triamterene
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Chrom 8

19. What is a cell surface marker seen in liver angiosarcoma?
Underestimation of gestational age
Anti - apoptotic (prevents going into apoptosis)- 18; 14
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
MAO inhibitors; wine and cheese

20. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
Fat - fertile - forty - female
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Hypothyroidism
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac

21. Which nerve lies in close proximity to the inferior thyroid artery?
Hereditary angioedema; ACE inhibitors
II; I (I more abundant)
Recurrent larygneal
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

22. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Primary
Medullary
Paramyxo and influenza
4 - 4 - 9

23. which nerve provides innervation for plantar flexion and inversion?
Radial nerve damage
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
As a CO2 carrier with the carboxylase enzyme
Tibial

24. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
Tzanck smear
OCPs - multiparity - breast feeding
Brief psychotic disorder; schizophreniform; schizophrenia
Pulmonary hypertension

25. 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)
Varying; erythema nodosum is common
Vertical diplopia
Right heart failure

26. What is the presentation of sever aortic stenosis?
Inactivates kallikrein which activates kininogen into bradykinin
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Brief psychotic disorder; schizophreniform; schizophrenia
Syncope - angina - dyspnea (SAD)

27. What can worse neurologic dysfunction in cobalamic def?
Biphosphonate
Folic acid treatment!
Anterior circumflex (and axillary nerve)
Normal; low

28. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
Susceptible; soluble (unable to be cultured in bile)
Another type of aldosterone antagonist (like spironolactone)
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)
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

29. What are the three causes of acute MI in context of normal coronary arteries ?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Both sides
SaO2 <92%
Inactivates kallikrein which activates kininogen into bradykinin

30. which RPGN is also called pauci immune GN? why?
Vagus nerve stimulation
HSV and VZV
ANCA because of lack of Ig and C3 deposits on IF
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

31. How do you calculate RPF from urine PAH?
(urine PAH x urine flow rate)/plasma PAH
Radial nerve damage
Standing suddenly from supine position; valsalva maneuver
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin

32. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Leukotriene precursor and does neutrophil chemotaxis
Extrinsic def; instrinsic def; platelet def

33. What is Tzanck smear used to detect?
NF- KB; responsible for cytokine production
HSV and VZV
Raphe
RER; copper

34. What can cause virilization of a mother during pregnancy?
Regular insulin (Not fast acting - regular better)
In the extracellular space
Aromatase deficiency in child
46 - 4N; 23 2N

35. Where is aromatase used?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Insulin like growth factor 1 (just another name)
G to T in p53; HCC

36. What are two indicators of chronic alcohol consumption?
Biphosphonate
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
TCAs and prazosin
Elevated GGT and macrocytosis

37. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Large stroke volumes with ventricular contraction; aortic regurg
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Prevent phagocytosis

38. What does the severity of leprosy depend on?
hyponatremia (aldosterone activation equilibrates body volume)
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
No
Strength of cell mediated immune response

39. what phase do adenosine and acetylcholine act on? doing what?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Apocrine; eccrine
FGF and VEGF
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

40. What is cataplexy and When is it seen?
RBF= PAH clearance/(1- hematocrit)
SVT; increases vagal tone; rectus abdominis
Sudden loss of muscle tone without loss of consciousness; narcolepsy
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)

41. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
RBC mass; epo levels (secondary has high)
HSV ( also in utero: chlymadia - neisseria - group B strep)
Chorda tympani branch

42. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
Vancomycin
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
MAO inhibitors; wine and cheese
The term used to describe decreased drug responsiveness with repeated administration

43. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
facultative intracellular
Bronchial dilation (bronchiectasis)
Susceptible; soluble (unable to be cultured in bile)
Proteasome inhibitor; treatment for MM and waldenstroms

44. other than proteinuria - What can cause foamy froathy urine?
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Circular - outside nucleus; transport proteins - rRNA - tRNA
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Bile salt accumulation in urine

45. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Boiling - bleach - formalin - UV irradiation
Think Hb deformation diseases
Increase lymphatic drainage!
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

46. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
Chlorpheniramine and diphenhydramine
Tzanck smear
differentiate
Hyperkalemia; potassium sparing diuretics - potassium supplements

47. What does sustained hand grip do to the C/V system?
RER; copper
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Bronchial dilation (bronchiectasis)
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

48. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
transcription activation/suppression
gram positive organisms
Gluteus medius and minimus; positive trendelenberg
Env genes (for getting into target cells)

49. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
Enterococci (e. faecalis)- found on genitalia area
G to T in p53; HCC
RER; RER
S. saprophyticus - and s. epidermidis; novobiocin

50. what drugs causes the red man syndrome? how does it occur?
Medullary
Vancomycin; histamine mediated
GI malignancies and Insulin resistance (acromegal for ex)
Barium studies and colonoscopy can cause perforation just use plain abdominal xray