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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 type of antiarrythmics can protect against both atrial and ventricular arrythmias?
E. coli; staphylococcus saprophyticus
Class I
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Drug induced interstitial nephritis

2. How do left sided colon adenocarcinomas present? right sided?
Increase by 50% in urine osmolality
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
Tibial

3. What is capacitance inversely proportional to?
Elastance
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
ZDV or AZT
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

4. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
No and yes
Intussusception
Ketone body production by preventing fatty acids into the mitochondria
Increases bronchial and vascular smooth muscle reactivity to catecholamines

5. in the LV and aorta - What are the pressures?
In the extracellular space for collagen cross linking; zinc
Varying; erythema nodosum is common
Normally close to systolic
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

6. Where is aromatase used?
CGD; t cell dysfxn (diGeorge)
Medullary
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
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

7. What do you treat s. epidermidis with?
Localized dermatologic pain that persists for more than one month after zoster eruption
Vancomycin
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
High potassium conductance and some sodium conductance

8. What agonists reduce the gradient across the LV outflow tract?
S. saprophyticus - and s. epidermidis; novobiocin
Syringomelia
Become beta pleated and then form neurofibrillary tangle!
Selective alpha 1 (increases SVR)

9. When is an S4 sound normal?
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Reiter syndrome; B27
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Well trained athletes and children

10. What is the most common location of colonization of all s. aureus types?
Dissolved in plasma and attached to Hgb
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
Anterior nares
Excessive collagen formation during tissue repair in susceptible individuals

11. What does extended consumption of appetite suppressants lead to?
I is more benign and can present later in adulthood
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Serum FFA and serum triglyceride levels
Pulmonary hypertension

12. Would alpha 1 agonists cause flushing? muscarinic antagonist?
No; yes
Amiadarone
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Elastance

13. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Terminal bronchioles; small bronchi
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Headaches and facial flushing; vasodilation in meninges and skin

14. after a thrombus extraction - what serum enzyme shoots up and why?
Medial circumflex artery; avascular necrosis
Amiloride - spironolactone - triamterene
Vancomycin; histamine mediated
Serum creatine kinase; reperfusion injury causes necrosis

15. what dictates the resting membrane potential of most cells?
2 -3 BPG; glycolysis - instead of ATP; erythrocytes because want to right shift the oxygen dissociation curve so that oxygen is released from RBCs into tissue
High potassium conductance and some sodium conductance
Bronchial dilation (bronchiectasis)
Fat - fertile - forty - female

16. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Env genes (for getting into target cells)
T test; chi squared
Turners`

17. What is the difference between additive and synergistic?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
MAO inhibitors; wine and cheese
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
Medullary

18. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Increase lymphatic drainage!
Medial part
As a CO2 carrier with the carboxylase enzyme
Hereditary angioedema; ACE inhibitors

19. on which chromosome is wilms tumor found?
Retinitis; mononucleosis
Pain reliever - reduces pain by locking substance P in the PNS
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
11

20. What is a primary HSV 1 infection like?
Measure of depth invasion (vertical!)
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Curlings ulcers
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

21. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Relfex tachycardia; giving beta blockers
Myasthenia gravis
Tissue redistribution (out of plasma) rather than metabolism

22. within the right atrium - What is the maximum pressure? left atrium?
8; 12
Paramyxo and influenza
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
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

23. why are beta thal major patients asymptomatic at birth?
Downs; regurgitant AV valves - ASDs
Headaches and facial flushing; vasodilation in meninges and skin
Because gamma chains replace beta chains and then gamma chain formation wanes
Squatting - sitting - lying supine - passive leg raising

24. What is the cause of fixed splitting of S2? why?
8 (myc protein) with 2 - 14 - 22 (iG chains)
Increases cytokine production
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
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

25. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
CGD; t cell dysfxn (diGeorge)
Medullary
Hypo or hyper pigmentations; after tanning
Relatively selective B1 adrenergic agonist; acute heart failure with decreased myocardial contractility (cardiogenic shock); increases myocardial contractility; can induce arrhythmias because increases cardiac conduction velocity

26. at one year of age - What are the social - fine motor - gross motor and language developments?
Sarcoid
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Initiation - pointing; pincer grasp; walking; mama/dada
Because gamma chains replace beta chains and then gamma chain formation wanes

27. What is achalasia and how would this correlate on the esophageal mannometry?
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
Superior larygeal; cricothyroid; recurrent laryngeal
Well trained athletes and children
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

28. what marker should be followed in a patient with cirrhosis?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Spongiosis
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Biphosphonate

29. is Rifampin ever used as monotherapY? why either way?
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
Retinitis; mononucleosis
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
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)

30. what locations of UC increase the risk of Colon cancer?
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
Pan colitis and right sided colitis (more than left sided and proctitis)
Boiling - bleach - formalin - UV irradiation
SSRI; erectile dysfunction

31. What is a clara cell?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
G to T in p53; HCC
11
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

32. What are the three causes of acute MI in context of normal coronary arteries ?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Underestimation of gestational age
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Apocrine; eccrine

33. What almost exclusively causes Epliglottitis?What type of capsule does it have? What are the symptoms?

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34. Acyl coA synthetase is not...
liver specific
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Thymic tumor

35. prostaglandin synthesis keeps...
PDA open
Aromatase deficiency in child
Hexokinase
Prepatellar

36. why does variocele occur more in left side?
RER; copper
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Minimal change disease

37. IL4 is used for isotypye switching to what?
Underestimation of gestational age
IgE
Well
Curlings ulcers

38. How do you calculate atributable risk percent?
S3 gallop; S2 to opening snap interval
Hereditary angioedema; ACE inhibitors
RR-1/RR
Octreotide

39. What are the skin presentation in sarcoid?
No and yes
Varying; erythema nodosum is common
Medial part
Because of the low output from heart failure - they will have increased aldosterone levels

40. What is a common complication of acute pancreatitis? What is it?
SSRI
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
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)
Anti centromere; anti DNA topoisomerase

41. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Increased reticulocytes
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Turners`
Relatively selective B1 adrenergic agonist; acute heart failure with decreased myocardial contractility (cardiogenic shock); increases myocardial contractility; can induce arrhythmias because increases cardiac conduction velocity

42. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
Fat - fertile - forty - female
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Normal; low
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)

43. other than increasing HDL levels - what else does niacin do?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Prevents hepatic VLDL production
Right before diastole (filling begins)
Retinitis; mononucleosis

44. What is epispadias caused by?
In the extracellular space
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Faulty positioning of the genital tubercle
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

45. What is a keloid?
Excessive collagen formation during tissue repair in susceptible individuals
Ether and other organic solvents
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
E6 and E7 of HPV knock off p53 and Rb suppressor genes

46. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Trauma to stereociliated hair cells of the organ of corti
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
11 aa polypeptide; pain NT in CNS and PNS
Another type of aldosterone antagonist (like spironolactone)

47. What is pickwickian syndrome? What are the lab findings?
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

48. Where is conduction in heart fastest? slowest?
transcription activation/suppression
Anterior nares
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Purkinje system; AV node

49. What is the sole neurologic manifestation of acute rheumatic fever?
Sydenham chorea
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
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
8; 12

50. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
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
PDA open
Tissue redistribution (out of plasma) rather than metabolism
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac