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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 are the two growth factors associated with angiogenesis?
Lateral; RV; RA; LV
To pump calcium out in cardiac myocytes so that relaxation occurs
Radial nerve and deep brachial artery
FGF and VEGF

2. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Hypertension - edema - and proteinuria
Skin flushing and warmth; prostaglandins; give with aspirin
Intussusception
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

3. Where does conjugation of bilirubin take place?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
I is more benign and can present later in adulthood
In ER of bile canaliculi
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

4. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Brief psychotic disorder; schizophreniform; schizophrenia
glycerol kinase
Amiloride - spironolactone - triamterene

5. what should you think of in 'smear of an oral ulcer base'?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
facultative intracellular
Tzanck smear
Chorda tympani branch

6. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Elastance
...
Class I
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

7. What is acanthosis nigricans associated with?
Classical conditioning
G to T in p53; HCC
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
GI malignancies and Insulin resistance (acromegal for ex)

8. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Ketone body production by preventing fatty acids into the mitochondria
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Adductor
RR-1/RR

9. What is the preferred treatment for DKA?
Regular insulin (Not fast acting - regular better)
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
Downs; regurgitant AV valves - ASDs
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

10. what dissolves the lipid bilayer of a viral envelope?
Chorda tympani branch
Ether and other organic solvents
Adductor
In the extracellular space for collagen cross linking; zinc

11. How do you calculate atributable risk percent?
Phencyclidine (PCP)
ATP binding (resets the myosin head to contract again for next binding)
RR-1/RR
Serum FFA and serum triglyceride levels

12. How do you calculate RPF from urine PAH?
differentiate
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
(urine PAH x urine flow rate)/plasma PAH
No (unlike adenomyosis); yes

13. what indicates the severity of a mitral regurg ? mitral stenosis?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
S3 gallop; S2 to opening snap interval
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Anti cholinergic effects of pupil dilation and lack of accomodation

14. What does VIP do to gastric acid secretion?
S. aureus
Inhibits it
Another type of aldosterone antagonist (like spironolactone)
Hypertension - edema - and proteinuria

15. SIADH patients have normal blood volume but...
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)
Downs; regurgitant AV valves - ASDs
hyponatremia (aldosterone activation equilibrates body volume)
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

16. how does achalasia present? What does barium swallow show on dilated esophagus?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
NF- KB; responsible for cytokine production
Increase in permeability of two ions with equal and opposite equilibrium potentials
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

17. in overweight individuals What is thought to contribute to insulin resistance?
DIC; TTP- HUS dont bleed that much
Thymic tumor
Vancomycin; histamine mediated
Serum FFA and serum triglyceride levels

18. What causes the blurry vision side effects in first generation anti histamines?
Anti cholinergic effects of pupil dilation and lack of accomodation
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

19. 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?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Both sides
Medial circumflex artery; avascular necrosis
Apocrine; eccrine

20. 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)
Turbulence
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics

21. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
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
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Circular - outside nucleus; transport proteins - rRNA - tRNA
Increases bronchial and vascular smooth muscle reactivity to catecholamines

22. What are two common side effects of both acute and long acting nitrates? What causes them?
Increase; decreased
Headaches and facial flushing; vasodilation in meninges and skin
Recurrent larygneal
Acute interstitial nephritis

23. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Gluteus medius and minimus; positive trendelenberg
Classical conditioning
Hydrogen bonds dictate alpha or beta structure
FGF and VEGF

24. What is used to prevent vertical transmission of HIV?
Prostate tumor and increased osteoclast activity
ZDV or AZT
By vascular permeability and vasodilation
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

25. What do you treat s. epidermidis with?
Because gamma chains replace beta chains and then gamma chain formation wanes
Vancomycin
Turners`
To pump calcium out in cardiac myocytes so that relaxation occurs

26. what phase do adenosine and acetylcholine act on? doing what?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
liver specific
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

27. Which is faster purkinje system or atrial muscle?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
ANCA because of lack of Ig and C3 deposits on IF
Close but purkinje system to ensure contraction in a bottom up fashion

28. prostaglandin synthesis keeps...
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
G to T in p53; HCC
Integration of viral DNA into genome of host hepatocytes
PDA open

29. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
<1% - 55% - concentration dependent
Intussusception
...

30. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Increase in permeability of two ions with equal and opposite equilibrium potentials
Echinococcus granulosus; anaphylaxis
Insulin like growth factor 1 (just another name)
Turners`

31. What is mcc of death pre hospital phase of MI? in hospital phase?
Close but purkinje system to ensure contraction in a bottom up fashion
V fib; v. failure
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
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

32. Metronidizaole does not cover...
Turbulence
Anterior circumflex (and axillary nerve)
gram positive organisms
Retinitis; mononucleosis

33. What can cause aortic regurg? What is the heart sound you hear?
Because of the low output from heart failure - they will have increased aldosterone levels
Leukotriene precursor and does neutrophil chemotaxis
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
GI malignancies and Insulin resistance (acromegal for ex)

34. what receptors do first generation anti histamines block?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

35. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
RER; RER
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Another type of aldosterone antagonist (like spironolactone)

36. What is the most common location of colonization of all s. aureus types?
Anterior nares
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Tibial
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

37. In what view of CXR is anterior part of heart best seen? anterior part of heart is formed by?right border of heart is formed by? left border?
Not lined by epithelium
4 - 4 - 9
Covalent (between two cysteines)- allows protein to withstand denaturation
Lateral; RV; RA; LV

38. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Hypertension - edema - and proteinuria
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Radial nerve damage
Susceptible; soluble (unable to be cultured in bile)

39. What is the mc malignancy in asbestosis?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Bronchogenic carcinoma
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
No and yes

40. 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?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Cluster
Amiadarone
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

41. What is the best indicator for the severity of mitral stenosis?
Vancomycin
The time interval between S2 and OS- the shorter the interval - the more intense
Prostate tumor and increased osteoclast activity
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)

42. What effects does cortisol have on catecholamines?
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
In the extracellular space for collagen cross linking; zinc
Increase lymphatic drainage!
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

43. Where is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
Acute interstitial nephritis
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

44. what commonly happens in GI in response to acute physiologic stress?
Acute gastric mucosal defects (superficial or full thickness)
Enterococci (e. faecalis)- found on genitalia area
S3 gallop; S2 to opening snap interval
Amiadarone

45. What is epleronone?
Another type of aldosterone antagonist (like spironolactone)
women
LT (LTD4 - E4 - C4) - and Ach
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin

46. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
Aromatase deficiency in child
Because of the low output from heart failure - they will have increased aldosterone levels
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Regular insulin (Not fast acting - regular better)

47. what marker should be followed in a patient with cirrhosis?
Drink plenty of fluids
Amiloride - spironolactone - triamterene
Serum creatine kinase; reperfusion injury causes necrosis
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

48. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
Hypothyroidism
Aromatase deficiency in child
Mean greater than median greater than mode
Inactivates kallikrein which activates kininogen into bradykinin

49. which viruses require a protease?
No; yes
APP on chrom 21 (this is why downs more susceptible)
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
SS +rNA

50. How do you explain the selective proteinuria of loss to albumin only in MCD?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Ether and other organic solvents