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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 is mcc of death pre hospital phase of MI? in hospital phase?
Chorda tympani branch
V fib; v. failure
Brief psychotic disorder; schizophreniform; schizophrenia
LT (LTD4 - E4 - C4) - and Ach

2. why does liver dysfunction cause coagulation disorders?
Nocardia
Kallmans
Coagulation factors are made in the liver
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

3. What does Rb protein do? what chrom is it on?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
FGF and VEGF
CMV - HSV 1 - Candida

4. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Decreases both
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Hyperkalemia; potassium sparing diuretics - potassium supplements
women

5. What are the lab findings in poststreptococcal GN?
Adductor
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Valproate

6. What is extraocular muscle weakness a common symptom of?
Sarcoid
Myasthenia gravis
Vancomycin; histamine mediated
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

7. other than mycobacterim wha other bacteria is acid fast?
Hypo or hyper pigmentations; after tanning
Nocardia
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
Purkinje system; AV node

8. Where is aromatase used?
Vagus nerve stimulation
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
RBF= PAH clearance/(1- hematocrit)
Raphe

9. which nerve is at risk when ligating the superior thyroid artery? Which is the only muscle this nerve innervates? what nerve innervates all the other laryngeal muscles?
46 - 4N; 23 2N
Extrinsic def; instrinsic def; platelet def
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Superior larygeal; cricothyroid; recurrent laryngeal

10. what dissolves the lipid bilayer of a viral envelope?
To pump calcium out in cardiac myocytes so that relaxation occurs
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
Ig A deficiency
Ether and other organic solvents

11. What is the mc location for avascular necrosis? What is it associated with?
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
46 - 4N; 23 2N
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

12. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Bile salt accumulation in urine
Chorda tympani branch
Elastance

13. why are pregnant predisposed to cholelithiasis?
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
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Echinococcus granulosus; anaphylaxis
TSh (in testicular tumors can cause hyperthyroidism)

14. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Skin flushing and warmth; prostaglandins; give with aspirin

15. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Increase; decreased
Sarcoid

16. how does neisseria cause a petechial rash?
Prevent phagocytosis
Neisseria induced small cell vasculitis (including hands and soles)
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
No (unlike adenomyosis); yes

17. other than increasing HDL levels - what else does niacin do?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
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
8 (myc protein) with 2 - 14 - 22 (iG chains)
Prevents hepatic VLDL production

18. carnitine deficiency impairs production of What and how?
Protamine sulfate
Ketone body production by preventing fatty acids into the mitochondria
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
C3 decreased after 5-10 days; sulfonamides

19. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Bile soluble which means they are bile sensitive
Close but purkinje system to ensure contraction in a bottom up fashion
Increase; decreased
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

20. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
Amiloride - spironolactone - triamterene
Atrial
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

21. What does C1 esterase do other than inhibiting complement pathway?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
HSV and VZV
In the extracellular space for collagen cross linking; zinc
Inactivates kallikrein which activates kininogen into bradykinin

22. What is omalizumab and What is it used for?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Serum FFA and serum triglyceride levels
Ig A deficiency
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)

23. which are the only glycosylated proteins in HIV virus?
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)
Env genes (for getting into target cells)
T test; chi squared
Normally close to systolic

24. after a thrombus extraction - what serum enzyme shoots up and why?
Initiation - pointing; pincer grasp; walking; mama/dada
Serum creatine kinase; reperfusion injury causes necrosis
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Radial nerve damage

25. What is the mutation type in thalassemias? what process is defective because of this?
Nonsense; mRNA processing
Cluster
HSV and VZV
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

26. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
E. coli; staphylococcus saprophyticus
Amiloride - spironolactone - triamterene
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Bile salt accumulation in urine

27. What is cataplexy and When is it seen?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
RR-1/RR

28. What causes the blurry vision side effects in first generation anti histamines?
Drug induced interstitial nephritis
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)
Duration and extent of disease
Anti cholinergic effects of pupil dilation and lack of accomodation

29. Which nerve lies in close proximity to the inferior thyroid artery?
Superior larygeal; cricothyroid; recurrent laryngeal
Chlorpheniramine and diphenhydramine
Amiadarone
Recurrent larygneal

30. What is the mainstay treatment for acute mania?
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
Syncope - angina - dyspnea (SAD)
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Highly negative resting potential

31. What does TGF beta do? What produces it?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Fibrosis; macrophages
Vagus nerve stimulation
Right heart failure

32. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Gluteus maximus; difficulty getting up from seated position and climbing chair
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Appetite suppressants

33. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
GI malignancies and Insulin resistance (acromegal for ex)
Skin flushing and warmth; prostaglandins; give with aspirin
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
Faulty positioning of the genital tubercle

34. How is dobutamine better than dopamine?
Decreases both
Adductor
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Anterior nares

35. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Circular - outside nucleus; transport proteins - rRNA - tRNA
Hexokinase
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Gluteus medius and minimus; positive trendelenberg

36. What pulmonary structural change can kartageners syndrome cause?
glycerol kinase
Bronchial dilation (bronchiectasis)
Drug induced interstitial nephritis
No

37. why does hypothyroidism cause increased CPK levels?
Increased reticulocytes
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Ig A deficiency
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

38. What is a clara cell?
Ceftriaxone; azithromycin
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

39. What are the skin presentation in sarcoid?
Acute interstitial nephritis
High potassium conductance and some sodium conductance
Varying; erythema nodosum is common
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

40. What can long term leg cast wearing cause?
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
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
Highly negative resting potential
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

41. What is an abortive viral infection?
Little effect on cell and no change
Boiling - bleach - formalin - UV irradiation
Prostate tumor and increased osteoclast activity
Standing suddenly from supine position; valsalva maneuver

42. Where is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
200-500
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Decreases both

43. what makes bruits?
Skin flushing and warmth; prostaglandins; give with aspirin
Turbulence
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

44. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Reiter syndrome; B27
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
FGF and VEGF
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

45. What is the Na/Ca exchange used for?
Fat - fertile - forty - female
To pump calcium out in cardiac myocytes so that relaxation occurs
The LES is supposed to relax when food comes its way (from above) and in achalasia - a motor dysfunction - LES doesnt relax and seen as elevated pressure on the esophageal mannometry
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

46. What is medullary sponge kidney disease and how does it present? What does it lead to?
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)
Trochlear nerve (IV); abducens nerve (VI)
Classical conditioning
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

47. who bleed more DIC or TTP- HUS patients?
In ER of bile canaliculi
Anti - apoptotic (prevents going into apoptosis)- 18; 14
DIC; TTP- HUS dont bleed that much
Pulmonic and systemic!

48. how does eos release MBP to kill protozoa etc?
No; MRI
11 aa polypeptide; pain NT in CNS and PNS
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
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

49. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
When it invades the bm; carcinoma in situ
Hexokinase
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Insulin like growth factor 1 (just another name)

50. What are the first generation anti histamines?
Env genes (for getting into target cells)
Chlorpheniramine and diphenhydramine
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)