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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 kind of drug is sertraline? What is a common side effect?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
SSRI; erectile dysfunction
Adeno
TSh (in testicular tumors can cause hyperthyroidism)

2. What actions increase venous return?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Ceftriaxone; azithromycin
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Squatting - sitting - lying supine - passive leg raising

3. What is it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Vertical diplopia
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

4. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Varying; erythema nodosum is common
Pulmonic and systemic!
Hydrogen bonds dictate alpha or beta structure
Phencyclidine (PCP)

5. why are beta thal major patients asymptomatic at birth?
In the extracellular space
Because gamma chains replace beta chains and then gamma chain formation wanes
C3 decreased after 5-10 days; sulfonamides
OCPs - multiparity - breast feeding

6. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
Valproate
RER; copper
Because of the low output from heart failure - they will have increased aldosterone levels
P53 mutation; AD

7. 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?)?
Syncope - angina - dyspnea (SAD)
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

8. are there signs of inflammation in avascular necrosis? then How do you diagnose?
No; MRI
Raphe
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

9. at four years of age - What are the social - fine motor - gross motor - and language developments?
25; 25
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Strength of cell mediated immune response

10. Where is the base of the heart? apex?
Myasthenia gravis
Closer to head; closer to diaphragm
11
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

11. What is the mcc of extrinsic allergic asthma?
Inhaled animal dander allergens
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
The term used to describe decreased drug responsiveness with repeated administration
Right before diastole (filling begins)

12. What can nitrates lead to that is bad for angina therapy? How do you counter this?
SSRI; erectile dysfunction
Medullary
Relfex tachycardia; giving beta blockers
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

13. What does hypocapnia cause in teh brain? What is hypocapnia?
Diabetic microangiopathy
Sydenham chorea
Recurrent larygneal
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

14. How do you calculate RPF from urine PAH?
In the extracellular space for collagen cross linking; zinc
(urine PAH x urine flow rate)/plasma PAH
Radial nerve and deep brachial artery
Covalent (between two cysteines)- allows protein to withstand denaturation

15. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
Brief psychotic disorder; schizophreniform; schizophrenia
Gluteus maximus; difficulty getting up from seated position and climbing chair
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
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)

16. What is the difference between paranoid personality disorder and delusional disorder?
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
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
manifestations - congenital (stretching of periventricular pyrimadal fibers)

17. What are some of the permissive effects of cortisol?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Increases bronchial and vascular smooth muscle reactivity to catecholamines
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Serum FFA and serum triglyceride levels

18. what drugs causes the red man syndrome? how does it occur?
Thymic tumor
Env genes (for getting into target cells)
Vancomycin; histamine mediated
only up to bronchi

19. What is congestive hepatomegaly specific for?
Right heart failure
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
E. coli
Smoking

20. What is subacute sclerosisng encephalitis caused by?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Varying; erythema nodosum is common
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
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

21. which trisomy is associated with endocardial cushion defects? What does thsi mean>
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Paramyxo and influenza
Downs; regurgitant AV valves - ASDs
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

22. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
P53 mutation; DCC is also required for adenoma to carcinoma
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Demargination of neutrophils from the vessel walls

23. where are the vegetations on the valves of a libman sacks endocarditis?
Syringomelia
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Susceptible; soluble (unable to be cultured in bile)
Both sides

24. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
NF- KB; responsible for cytokine production
Sarcoid
S. aureus
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

25. what protects the resting heart from arrhythmias?
Highly negative resting potential
Turbulence
Anti cholinergic effects of pupil dilation and lack of accomodation
IgE

26. which nucleus releases serotonin?
only up to bronchi
G to T in p53; HCC
Increases cytokine production
Raphe

27. sporadic colon cancer tend to arise From what type of polyps?
Single adenomatous ones
Class I
Anti centromere; anti DNA topoisomerase
Integration of viral DNA into genome of host hepatocytes

28. what organ would an activating mutation in PRPP synthetase effect?
Joints d/t increased purine production and thus uric acid production
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

29. What is gardeners mydriasis? How is it treated?
Vancomycin
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Not lined by epithelium
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

30. What are the primary determinants of colon cancer risk in UC patients
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Duration and extent of disease
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
Increase; decreased

31. What causes wrist drop?
IgE
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
Radial nerve damage
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

32. What triggers the neoplastic changes that are associated with HBV infecton?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Medial circumflex artery; avascular necrosis
Integration of viral DNA into genome of host hepatocytes

33. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
Retinitis; mononucleosis
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Superior larygeal; cricothyroid; recurrent laryngeal

34. What type of bond is a disulfide bond?
Elastance
Covalent (between two cysteines)- allows protein to withstand denaturation
Prepatellar
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

35. which virus inactivates both Rb and p53?
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Recurrent larygneal
C3 decreased after 5-10 days; sulfonamides
E6 and E7 of HPV knock off p53 and Rb suppressor genes

36. what diseases can vit A be used to treat?
Reiter syndrome; B27
Measles and M3 AML`
Fibrosis; macrophages
Diabetic microangiopathy

37. What is somatomedin C?
Become beta pleated and then form neurofibrillary tangle!
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Insulin like growth factor 1 (just another name)
Valproate

38. which antiarrythmic is associated with blue gray discoloration ?
When it invades the bm; carcinoma in situ
Amiadarone
Classical conditioning
Myasthenia gravis

39. What does extended consumption of appetite suppressants lead to?
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Chlorpheniramine and diphenhydramine
Pulmonary hypertension
Brief psychotic disorder; schizophreniform; schizophrenia

40. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Ig A deficiency
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
ATP binding (resets the myosin head to contract again for next binding)
Hyperkalemia; potassium sparing diuretics - potassium supplements

41. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
P53 mutation; DCC is also required for adenoma to carcinoma
hyponatremia (aldosterone activation equilibrates body volume)
Retinitis; mononucleosis

42. What is normal fibrinogen levels?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
200-500
The time interval between S2 and OS- the shorter the interval - the more intense

43. how does eos release MBP to kill protozoa etc?
8 (myc protein) with 2 - 14 - 22 (iG chains)
Downs; regurgitant AV valves - ASDs
Amiadarone
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

44. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
Radial nerve and deep brachial artery
Syncope - angina - dyspnea (SAD)
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Valproate

45. what receptors do first generation anti histamines block?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
RER; copper
Terminal bronchioles; small bronchi
Inactivates kallikrein which activates kininogen into bradykinin

46. What is a clara cell?
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
Coagulation factors are made in the liver
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Tissue redistribution (out of plasma) rather than metabolism

47. What would a deflection of the membrane potential to near zero indicate?
Because gamma chains replace beta chains and then gamma chain formation wanes
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Increase in permeability of two ions with equal and opposite equilibrium potentials
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

48. 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?
Retinitis; mononucleosis
GI tract; mood!
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Cluster

49. what happens to capacitance with age?
Standing suddenly from supine position; valsalva maneuver
Vertical diplopia
...
Classical conditioning

50. What does nitroprusside do to afterload? preload?
No; MRI
Decreases both
Standing suddenly from supine position; valsalva maneuver
Curlings ulcers