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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. which two drug types can cause orthostatic hypotension (think depression and BPH)?
SSRI
TCAs and prazosin
Retinitis; mononucleosis
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)

2. which trisomy is associated with endocardial cushion defects? What does thsi mean>
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
Syncope - angina - dyspnea (SAD)
Myasthenia gravis
Downs; regurgitant AV valves - ASDs

3. what kind of drug is sertraline? What is a common side effect?
Serum creatine kinase; reperfusion injury causes necrosis
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
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
SSRI; erectile dysfunction

4. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
Anti centromere; anti DNA topoisomerase
Retinitis; mononucleosis
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Prostate tumor and increased osteoclast activity

5. What is acanthosis nigricans associated with?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
GI malignancies and Insulin resistance (acromegal for ex)
Echinococcus granulosus; anaphylaxis
Well

6. What causes curlings ulcers?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Increase; decreased
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
4 - 4 - 9

7. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Pulmonary hypertension
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Sydenham chorea
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

8. which antiarrythmic is associated with blue gray discoloration ?
Inhaled animal dander allergens
Paramyxo and influenza
Amiadarone
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

9. What can long term leg cast wearing cause?
Injury to common peroneal nerve (d/t trauma or sustained pressure to neck of fibula) causing pain and numbness on dorsum of foot and inability to dorsiflex
P53 mutation; AD
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
As a CO2 carrier with the carboxylase enzyme

10. Where does the aorta lie in relation to the pulmonary artery in transposition of the great arteries (is this right to left or left to right shunt?)?
women
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Southern - western
11 aa polypeptide; pain NT in CNS and PNS

11. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
CMV - HSV 1 - Candida
low in serum
ATP binding (resets the myosin head to contract again for next binding)
Turners`

12. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
T test; chi squared
Increase; decreased
When it invades the bm; carcinoma in situ
Abnormal closing of the urethral folds

13. how can HAV be inactivated?
Amiloride - spironolactone - triamterene
Boiling - bleach - formalin - UV irradiation
CGD; t cell dysfxn (diGeorge)
Prevent phagocytosis

14. in B12 deficiency - what levels in blood rise very quickly and then drop?
No
Reticulocytes
Initiation - pointing; pincer grasp; walking; mama/dada
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

15. What is extraocular muscle weakness a common symptom of?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Prevent phagocytosis
Myasthenia gravis
Coagulation factors are made in the liver

16. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
As a CO2 carrier with the carboxylase enzyme
Vagus (auricular branch); vasovagal syncope!
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Trochlear nerve (IV); abducens nerve (VI)

17. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Reiter syndrome; B27
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
TCAs and prazosin
Congenital hypothyroidism - downs - amyloidosis - acromegaly

18. what murmur is enhanced by decreased blood flow to the heart?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Prostate tumor and increased osteoclast activity
Increases
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

19. What can too much IgA in serum produces?
Because of vasodiation to skeletal muscles
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
I is more benign and can present later in adulthood
Anterior nares

20. How is dobutamine better than dopamine?
By vascular permeability and vasodilation
Integration of viral DNA into genome of host hepatocytes
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
RBF= PAH clearance/(1- hematocrit)

21. What are the two growth factors associated with angiogenesis?
As a CO2 carrier with the carboxylase enzyme
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
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)
FGF and VEGF

22. What type of calcium channels dictate the plateau in cardiac myocyte?
P53 mutation; AD
Trochlear nerve (IV); abducens nerve (VI)
Dihydropyridine sensitive Ca channels (L type)
Right heart failure

23. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
8; 12
Syringomelia
Brief psychotic disorder; schizophreniform; schizophrenia
Folic acid treatment!

24. What is epispadias caused by?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Ether and other organic solvents
Protamine sulfate
Faulty positioning of the genital tubercle

25. why is crohns disease associated with oxaloacetate kidney stones?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
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

26. what dissolves the lipid bilayer of a viral envelope?
Ether and other organic solvents
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
T test; chi squared

27. What is the triad seen in pre eclampsia?
Hypertension - edema - and proteinuria
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
liver specific
Raphe

28. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Highly negative resting potential
FGF and VEGF
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

29. What is the most important prognostic indicator in patients with malignant melanoma?
Vagus nerve stimulation
APP on chrom 21 (this is why downs more susceptible)
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
Measure of depth invasion (vertical!)

30. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
No (unlike adenomyosis); yes
Prepatellar
Increase in permeability of two ions with equal and opposite equilibrium potentials
only up to bronchi

31. What causes release of myosin head from the actin filament?
Purkinje system; AV node
Class I
ATP binding (resets the myosin head to contract again for next binding)
Radial nerve and deep brachial artery

32. What three factors effect total oxygen content of blood?
Classical conditioning
TSh (in testicular tumors can cause hyperthyroidism)
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

33. How do bradykinin - C3a and C5a cause edema?
Underestimation of gestational age
By vascular permeability and vasodilation
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
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

34. What is an abortive viral infection?
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)
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
Strength of cell mediated immune response
Little effect on cell and no change

35. What are two common side effects of both acute and long acting nitrates? What causes them?
Integration of viral DNA into genome of host hepatocytes
Headaches and facial flushing; vasodilation in meninges and skin
Smoking
INTRApartum Abs (ampicillin/penicillin)

36. what enzyme converts procarcinogens into carcinogens?
Octreotide
P450 mitochondrial monooxygenase
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Hyperkalemia; potassium sparing diuretics - potassium supplements

37. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
CMV - HSV 1 - Candida
women
Octreotide
...

38. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
hyponatremia (aldosterone activation equilibrates body volume)
Anti - apoptotic (prevents going into apoptosis)- 18; 14
GI tract; mood!
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

39. how does neisseria cause a petechial rash?
Neisseria induced small cell vasculitis (including hands and soles)
Anti cholinergic effects of pupil dilation and lack of accomodation
Circular - outside nucleus; transport proteins - rRNA - tRNA
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

40. within the right atrium - What is the maximum pressure? left atrium?
No
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
8; 12
Highly negative resting potential

41. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Phencyclidine (PCP)
Right before diastole (filling begins)
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Spongiosis

42. what diseases can vit A be used to treat?
Classical conditioning
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
Measles and M3 AML`
Increase by 50% in urine osmolality

43. What are the skin presentation in sarcoid?
Varying; erythema nodosum is common
S. saprophyticus - and s. epidermidis; novobiocin
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Close but purkinje system to ensure contraction in a bottom up fashion

44. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
Leukotriene precursor and does neutrophil chemotaxis
Class I
Fibrosis; macrophages
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

45. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
Hexokinase
Southern - western
Folic acid treatment!
Brief psychotic disorder; schizophreniform; schizophrenia

46. What are the first generation anti histamines?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
No (unlike adenomyosis); yes
Chlorpheniramine and diphenhydramine
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

47. the rate of blood flow of which two circulations must equal each other at all times?
indomethacin
Gluteus medius and minimus; positive trendelenberg
Pulmonic and systemic!
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

48. What is the most common cause of pyelonephritis in both adults and childre?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Tibial
E. coli
Valproate

49. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
HSV ( also in utero: chlymadia - neisseria - group B strep)
Circular - outside nucleus; transport proteins - rRNA - tRNA
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
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

50. What is capacitance inversely proportional to?
Chorda tympani branch
Elastance
Aromatase deficiency in child
Acute gastric mucosal defects (superficial or full thickness)