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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. why should you not use ACE inhibitors with someone who had hereditary angioedema?
E. coli; staphylococcus saprophyticus
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
Protamine sulfate
The term used to describe decreased drug responsiveness with repeated administration

2. What are diastolic (lowest) pressures in aorta? LV?
RER; RER
Around 70 (normal measured diastolic pressures); 9--
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

3. What can too much IgA in serum produces?
Folic acid treatment!
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Downs; regurgitant AV valves - ASDs

4. 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?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Apocrine; eccrine
25; 25
AV node slowest - to allow time for diastole

5. 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?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
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)
Acute interstitial nephritis
Cluster

6. How is dobutamine better than dopamine?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
frameshift mutations (missense is substitution)
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)
No

7. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Demargination of neutrophils from the vessel walls
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
facultative intracellular

8. What is intussusception? how does ischemia and necrosis occur?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Insulin like growth factor 1 (just another name)
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
Turners`

9. other than parvo B19 - what else is associated with red cell aplasia?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
200-500
Right before diastole (filling begins)
Thymic tumor

10. What can nitrates lead to that is bad for angina therapy? How do you counter this?
LT (LTD4 - E4 - C4) - and Ach
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
Faulty positioning of the genital tubercle
Relfex tachycardia; giving beta blockers

11. What effects does cortisol have on catecholamines?
Tissue redistribution (out of plasma) rather than metabolism
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Permissive - sensitizes vasoconstrictive response from catecholamines - doesnt actually act on them but increases transcription of some genes that creates permissive effect (not additive or synergistic becuase cortisol alone doesnt have any effect on
Normally close to systolic

12. metabolism of 1 gram of protein produces How many calories? carb? fat?
8; 12
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
Drink plenty of fluids
4 - 4 - 9

13. why is glucagon used in beta blocker toxicitiy?
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
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)
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

14. is Rifampin ever used as monotherapY? why either way?
Ether and other organic solvents
women
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
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

15. 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)
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
NF- KB; responsible for cytokine production
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)

16. What is capsaicin? Where does it work?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Measles and M3 AML`
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Pain reliever - reduces pain by locking substance P in the PNS

17. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
LT (LTD4 - E4 - C4) - and Ach
Vagus (auricular branch); vasovagal syncope!
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
The term used to describe decreased drug responsiveness with repeated administration

18. at 2 years of age - What are the social - fine motor - gross motor and language developments?
Covalent (between two cysteines)- allows protein to withstand denaturation
Curlings ulcers
Pulmonary hypertension
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

19. What is the sole neurologic manifestation of acute rheumatic fever?
Increase in permeability of two ions with equal and opposite equilibrium potentials
Sydenham chorea
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

20. which has better side effect profile - SSRI or TCA?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Duration and extent of disease
SSRI

21. in the LV and aorta - What are the pressures?
Increase lymphatic drainage!
Radial nerve damage
Normally close to systolic
Boiling - bleach - formalin - UV irradiation

22. what drug is useful for secretory diarrhea?
Octreotide
On cardiac tissue and renal juxtaglomerular cells
Because of the low output from heart failure - they will have increased aldosterone levels
Valproate

23. what murmur is enhanced by decreased blood flow to the heart?
Reticulocytes
Think Hb deformation diseases
Bronchogenic carcinoma
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

24. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Susceptible; soluble (unable to be cultured in bile)
Skin flushing and warmth; prostaglandins; give with aspirin
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

25. What is the preferred treatment for DKA?
Anti centromere; anti DNA topoisomerase
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Hypo or hyper pigmentations; after tanning
Regular insulin (Not fast acting - regular better)

26. What is the neurologic manifestation of ADPKD?
Multiple miscarriages d/t hypercoaguability
Abnormal closing of the urethral folds
SVT; increases vagal tone; rectus abdominis
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

27. why does liver dysfunction cause coagulation disorders?
Reiter syndrome; B27
Hyperkalemia; potassium sparing diuretics - potassium supplements
Decreases both
Coagulation factors are made in the liver

28. 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
Bile soluble which means they are bile sensitive
When it invades the bm; carcinoma in situ
Nonsense; mRNA processing

29. in overweight individuals What is thought to contribute to insulin resistance?
Classical conditioning
S. saprophyticus - and s. epidermidis; novobiocin
Serum FFA and serum triglyceride levels
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

30. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
Little effect on cell and no change
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Vancomycin; histamine mediated
MAC complex (C5b - C9 complement deficiency)

31. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Primary
Pulmonary hypertension
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

32. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
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)
Mean greater than median greater than mode
AV node slowest - to allow time for diastole
P450 mitochondrial monooxygenase

33. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Permissive - sensitizes vasoconstrictive response from catecholamines - doesnt actually act on them but increases transcription of some genes that creates permissive effect (not additive or synergistic becuase cortisol alone doesnt have any effect on
Sickle cell; G6PD
Terminal bronchioles; small bronchi
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

34. why does variocele occur more in left side?
Normally close to systolic
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
8; 12
Tissue redistribution (out of plasma) rather than metabolism

35. how does increased ICP result in curlings ulcers?
Vagus nerve stimulation
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
<1% - 55% - concentration dependent

36. which staphylococci can do mannitol fermaentation?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
S. aureus
Vancomycin; histamine mediated

37. What is the mc location for avascular necrosis? What is it associated with?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Intussusception
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

38. What does TGF beta do? What produces it?
Fibrosis; macrophages
Squatting - sitting - lying supine - passive leg raising
Increased reticulocytes
In the extracellular space for collagen cross linking; zinc

39. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
Raphe
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

40. What does L/S stand for in fetal lung maturity? When does maturity occur?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Barium enema
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Vertical diplopia

41. what defines hypoxemia?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Brief psychotic disorder; schizophreniform; schizophrenia
SaO2 <92%

42. What are the three causes of acute MI in context of normal coronary arteries ?
OCPs - multiparity - breast feeding
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Varying; erythema nodosum is common

43. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Circular - outside nucleus; transport proteins - rRNA - tRNA
Gluteus maximus; difficulty getting up from seated position and climbing chair
Valproate

44. after a thrombus extraction - what serum enzyme shoots up and why?
C3 decreased after 5-10 days; sulfonamides
Serum creatine kinase; reperfusion injury causes necrosis
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Ketone body production by preventing fatty acids into the mitochondria

45. What antibiotic is best to treat alcoholic pulm infections? why?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Vascular endothelium; protease
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

46. 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?
Chlorpheniramine and diphenhydramine
Enterococci (e. faecalis)- found on genitalia area
Purkinje system; AV node
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

47. What is somatomedin C?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Insulin like growth factor 1 (just another name)
CGD; t cell dysfxn (diGeorge)
Medullary

48. other than mycobacterim wha other bacteria is acid fast?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Ether and other organic solvents
(urine PAH x urine flow rate)/plasma PAH
Nocardia

49. What does VIP do to gastric acid secretion?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Inhibits it
Bile salt accumulation in urine
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

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

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